Diastolic function assessment with left atrial strain in long-term survivors of childhood acute lymphoblastic leukemia.

INTRODUCTION AND OBJECTIVES: Survivors of childhood cancer might be at increased risk of diastolic dysfunction at follow-up due to exposure to cardiotoxic treatment. Although assessment of diastolic function is challenging in this relatively young population, left atrial strain might provide a novel insight in this evaluation. Our aim was to examine diastolic function in a cohort of long-term survivors of childhood acute lymphoblastic leukemia by using left atrial strain and conventional echocardiographic parameters. METHODS: Long-term survivors who were diagnosed at a single center between 1985 and 2015 and a control group of healthy siblings were recruited. Conventional diastolic function parameters and atrial strain were compared, and the latter was measured during the 3 atrial phases: reservoir (PALS), conduit (LACS) and contraction (PACS). Inverse probability of treatment weighting was used to account for differences between the groups. RESULTS: We analyzed 90 survivors (age, 24.6±9.7 years, time since diagnosis 18 [11-26] years) and 58 controls. PALS and LACS were significantly reduced compared with the control group: 46.4±11.2 vs 52.1±11.7; P=.003 and 32.5±8.8 vs 38.2±9.3; P=.003, respectively. Conventional diastolic parameters and PACS were similar between the groups. The reductions in PALS and LACS were associated with exposure to cardiotoxic treatment in age- and sex-adjusted analysis (≥ moderate risk, low risk, controls): 45.4±10.5, 49.5±12.9, 52.1±11.7; Padj=.003, and 31.7±9.0, 35.2±7.5, 38.2±9.3; Padj=.001, respectively. CONCLUSIONS: Long-term childhood leukemia survivors showed a subtle impairment of diastolic function that was detected with atrial strain but not with conventional measurements. This impairment was more pronounced in those with higher exposure to cardiotoxic treatment.

Right Ventricular Function in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia: From the CTOXALL Study.

There are limited data regarding right ventricle (RV) impairment in long-term survivors of childhood acute lymphoblastic leukemia (CLS). The aim of this study was to assess RV function in these patients using echocardiographic conventional measurements and automated RV strain. Echocardiographic recordings of 90 CLS and 58 healthy siblings from the CTOXALL cohort were analyzed. For group comparisons, inverse probability weighting was used to reduce confounding. The CLS group (24.6 ± 9.7 years, 37.8% women) underwent an echocardiographic evaluation 18 (11-26) years after the diagnosis. RV systolic dysfunction was found in 16.7% of CLS individuals using RV free-wall strain (RVFWS) compared to 2.2 to 4.4% with conventional measurements. RV systolic function measurements were lower in the CLS than in the control group: TAPSE (23.3 ± 4.0 vs. 25.2 ± 3.4, p = 0.004) and RVFWS (24.9 ± 4.6 vs. 26.8 ± 4.7, p = 0.032). Modifiable cardiovascular risk factors such as obesity (p = 0.022) and smoking (p = 0.028) were independently associated with reduced RVFWS. In conclusion, RV systolic function impairment was frequent in long-term survivors of childhood leukemia, underscoring the importance of RV assessment, including RVFWS, in the cardiac surveillance of these patients.

Automated Global Longitudinal Strain Assessment in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia.

There is limited evidence that supports the use of the global longitudinal strain (GLS) in long-term cardiac monitoring of childhood acute lymphoblastic leukemia survivors (CLSs). Our aim was to assess the utility of automated GLS to detect left ventricular systolic dysfunction (LVSD) in long-term CLSs. Asymptomatic and subclinical LVSD were defined as LVEF < 50% and GLS < 18.5%, respectively. Echocardiographic measurements and biomarkers were compared with a control group. Inverse probability weighting was used to reduce confounding. Regression models were used to identify factors associated with LVEF and GLS in the survivors. Ninety survivors with a median follow-up of 18 (11−26) years were included. The prevalence of LVSD was higher using GLS than with LVEF (26.6% vs. 12.2%). The measurements were both reduced as compared with the controls (p < 0.001). There were no differences in diastolic parameters and NT-ProBNP. Survivors were more likely to have Hs-cTnI levels above the detection limit (40% vs. 17.2%, p = 0.006). The dose of anthracycline was associated with LVEF but not with GLS in the survivors. Biomarkers were not associated with GLS or LVEF. In conclusion, LVSD detection using automated GLS was higher than with LVEF in long-term CLSs. Its incorporation into clinical routine practice may improve the surveillance of these patients.

Characterisation of induced abortion and consequences to women's health at Hospital Central do Huambo - Angola.

To characterise patients with abortion in Huambo, Angola, we have undertaken a descriptive, longitudinal, prospective survey. A structured questionnaire was applied to 715 patients. The study variables were grouped in socio-demographic and clinical-epidemiological variables. There were 29.8% women were aged 20-24, 45.6% had primary education, 41.1% were single and 26.9% worked as a non-formal salesperson. Menarche occurred at 16-18 years (55.5%), first sexual intercourse at 13-15 years (40.3%) and 74.8% did not use contraceptive methods. Abortion was of indeterminate type in 84.3% and 79.3% had had a previous abortion. Serious complications occurred in 8.0% with six maternal deaths (0.8%). Age of menarche and age at onset of sexual activity are interdependent variables (p ≤ .001), the earlier menarche appears, the earlier sexual activity begins. When there was a history of abortion, new abortions occurred earlier (p ≤ .001) and were of indeterminate type (89%). Indeterminate induced abortion is influenced by socioeconomic, educational and political conditions and continues to be a frequent cause of morbidity and mortality.Impact statementWhat is already known on this subject? Unsafe abortion contributes greatly to maternal morbidity and mortality, principally in countries with restrictive abortion laws. The relationship between socio-educational level and unwanted pregnancies is consensual.What the results of this study add? Early initiation of sexual activity combined with non-contraception contributes to unwanted pregnancy and consequent unsafe abortion. Most of the women had previously had an abortion.What the implications are of these findings for clinical practice and/or further research? It is necessary to develop access to adequate information and family planning to combat unwanted pregnancies. It is also important to evaluate long-term consequences of unsafe abortion.

Outcome of Antifungal Combination Therapy for Invasive Mold Infections in Hematological Patients is Independent of the Chosen Combination.

Invasive mold infection (IMI) remains a major cause of mortality in high-risk hematological patients. The aim of this multicenter retrospective, observational study was to evaluate antifungal combination therapy (ACT) for proven and probable IMI in hematological patients. We analyzed 61 consecutive cases of proven (n=25) and probable (n=36) IMI treated with ACT collected from eight Spanish hospitals from January 2005 to December 2009. Causal pathogens were: Aspergillus spp (n=49), Zygomycetes (n=6), Fusarium spp (n=3), and Scedosporium spp (n=3). Patients were classified in three groups according to the antifungal combination employed: Group A, liposomal amphotericin B (L-AmB) plus caspofungin (n=20); Group B, LAmB plus a triazole (n=20), and Group C, voriconazole plus a candin (n=21). ACT was well tolerated with minimal adverse effects. Thirty-eight patients (62%) achieved a favorable response (35 complete). End of treatment and 12-week survival rates were 62% and 57% respectively, without statistical differences among groups. Granulocyte recovery was significantly related to favorable response and survival (p<0.001) in multivariate analysis. Our results suggest that comparable outcomes can be achieved with ACT in high risk hematological patients with proven or probable IMI, whatever the combination of antifungal agents used.

Prolactin secretion after hypothalamic deafferentation in beef calves: response to haloperidol, alpha-methyl-rho-tyrosine, thyrotropin-releasing hormone and ovariectomy.

In ruminant species photoperiod regulates prolactin (PRL) secretion. It is hypothesized that the inhibition of PRL secretion resides in dopaminergic neurons of the medial basal hypothalamus (MBH). To test this hypothesis, anterior (AHD), posterior (PHD) and complete (CHD) hypothalamic deafferentation and sham operation control (SOC) surgeries were carried out during May (long-day photoperiod) in beef heifer calves (6-8 mo old) to measure basal PRL secretion and PRL secretion as affected by intravenous secretagogues. On the day of surgery (day 0), PRL secretion reflected stress of anesthesia and surgery in all groups. Thyrotropin-releasing hormone (TRH), alpha-methyl-rho-tyrosine (alphaMrhoT), and haloperidol (HAL) was iv injected on days 11, 13 and 15, respectively. AHD, PHD, CHD, and SOC calves responded to TRH (100 microg) with an acute increase in PRL that peaked within 20 min. All heifers responded to alphaMrhoT (10 mg/kg BW) with an acute elevation in PRL within 10 min and remaining elevated for 3 h. HAL (0.1 mg/kg BW) induced an acute increase in PRL secretion in all groups, peaking within 15-30 min. Seven months later (December, short-day photoperiod) these heifers were ovariectomized. Basal plasma PRL levels were seasonally low, PRL secretion in AHD, PHD and CHD animals abruptly increased within 15 min to iv injection of 100 microg TRH to a greater amount than seen in SOC heifers. Although a biphasic effect on PRL secretion entrains under long-day and short-day photoperiods, hypothalamic deafferentation in cattle did not affect the pituitary gland's responsiveness to secretagogues.

Impacto del hábito de fumar de los padres, sobre algunas características antropométricas del neonato / Impact of parenteral smoking on some of the anthropometric features of the newborn

Se estudió el efecto del hábito de fumar de los padres, sobre algunas características antropométricas del recién nacido en una muestra de 175 nacimientos simples a término. La posible asociación del hábito de fumar de los padres con las variables antropométricas estudiadas fue explorada mediante los modelos lineales generales, y se halló que el peso, el pliegue tricipital, la circunferencia cefálica y torácica son las únicas variables que se encuentran influidas por el hábito de fumar. El análisis de correlaciones canónicas mostró que no existía asociación en el patrón de distribución de la grasa. Con vista a conocer la influencia de estos factores sobre la armonía de la grasa corporal en el neonato, se realizó un análisis de alometría multidimensional y se concluye que el hábito de fumar de los padres no es capaz de modificar las relaciones armónicas de dicho patrón graso

Estudio morfométrico de placentas humanas normales y de CIUR / Morphometric study of normal human placentas and with intrauterine growth retardation (IUGR)

Se realiza el estudio de 82 placentas humanas, separadas en 2 grupos: normales (52) y CIUR (30). Se estudiaron el peso placentario, el peso del recién nacido, así como las siguientes variables morfométricas: superficie vellositaria, proporción volumétrica lagunar y vellositaria. Encontramos diferencias regionales en ambos grupos en las 3 variables morfométricas. Se encontraron diferencias morfométricas significativas entre las placentas normales y de CIUR, lo cual parece indicar una alteración de la organización estructural de la placenta

Evaluación antropométrica de la talla cefálica en el recién nacido / Clinical evaluation of the newborn's head diameters

Se estudiaron 844 nacimientos simples a término en los cuales se midió el peso, la longitud supina y la circunferencia torácica (CT) del neonato, así como la circunferencia cefálica (C.C.) de éste y sus padres. Se ajustó la edad gestacional y se registraron el sexo y la raza del recién nacido. Con objeto de evaluar la talla cefálica se construyeron dos grupos de ecuaciones de regresión lineal múltiple: uno, a partir de posibles predictores de la talla cefálica y otro, a partir del resto de las dimensiones físicas del propio niño. Se sugiere que el sexo, la edad gestacional y la C.C. de los padres son buenos predictores de la C.C. del recién nacido y permiten obtener ecuaciones de buen ajuste. Igualmente, se obtuvieron ecuaciones de magnífico ajuste para la C.C. del niño a partir de las otras dimensiones físicas estudiadas. Se pone de relieve la posible utilidad práctica de las ecuaciones obtenidas para evaluar si la cabeza ha crecido adecuadamente y en armonía con otros segmentos corporales

Estudio de la discrepancia entre la edad gestacional referida (EGR) y la edad gestacional ajustada (EGA) en nuestro medio / Discrepancy between referred gestacional age (RGA) and fitted gestacional age (FGA) in our environment

El bajo peso al nacer constituye un importante problema de la salud perinatal en nuestro país. Se señala que aproximadamente la mitad de los recién nacidos de bajo peso, tiene una edad gestacional inferior a 37 semanas. Se estima que constituye una necesidad de primer orden, el cálculo con la mayor precisión posible de la edad gestacional de un neonato, pues la conducta médica dependerá en gran medida de la edad gestacional y del estudio de los principales factores que contribuyen a que se produzca el parto antes del término. Se estudia la confiabilidad de la edad gestacional, calculada a partir de la fecha del último período menstrual referido por la madre (EGR) y algunos factores que pueden modificarla. Se utiliza una muestra de 621 nacimientos, en los cuales fue valorada la edad gestacional mediante el examen físico y neurológico del recién nacido (EGA). Se registra la edad materna y la escolaridad. Se estudia la discrepancia EGR-EGA y la influencia de la escolaridad y la edad materna sobre la misma. Se encuentra que el 13% de las gestantes no fue capaz de precisar la fecha de la última mentruación y en el 25% de las que la refirieron, hubo una discrepancia mayor de + ou - 2 semanas. Se comprueba que la corta edad y la baja escolaridad de la madre, se asocian con una mayor frecuencia de discrepancia EGR-EGA, aunque los análisis estadísticos indican que estas variables no se relacionan con la edad gestacional