Syncope due to non-sustained episodes of Torsade de Pointes associated to androgen-deprivation therapy use: a case presentation.

BACKGROUND: Abiraterone is a medication frequently used for metastatic castrate-resistant prostate cancer. We report a case of non-sustained episodes of TdP associated with severe hypokalemia due to androgen-deprivation therapy. Few case presentations describe this association; the novelty lies in the potentially lethal cardiovascular events among cancer patients receiving hormonal therapy. CASE PRESENTATION: A 70-year-old male presented with recurrent syncope without prodrome. ECG revealed frequent ventricular ectopy, non-sustained episodes of TdP, and severe hypomagnesemia and hypokalemia. During potassium and magnesium infusion for repletion, the patient underwent temporary transvenous atrial pacing. As part of the work-up, coronary angiography revealed a mild coronary artery disease, and transthoracic echocardiogram showed a moderately depressed ejection fraction. After electrolyte disturbances were corrected, the QT interval normalized, and transvenous pacing was no longer necessary. Abiraterone was discontinued during the admission, and the patient returned to baseline. CONCLUSIONS: Cancer treatment is complex and requires a multidisciplinary approach. We presented a case of non-sustained TdP associated with androgen-deprivation therapy in an elderly patient with mild coronary artery disease and moderately reduced ejection fraction. Close follow-up and increased awareness are required in patients with hormonal treatment, especially in the setting of other cardiovascular risk factors.

A prospective non-fatal injuries assessment: A multivariate analysis in medical-legal examinations.

OBJECTIVE: To prospectively determine injury recovery time in the medical-legal examinations of non-fatal injuries and their associated factors, carried out by the National Institute of Legal Medicine and Forensic Sciences of Colombia to create a multivariate analysis. METHODS: A prospective medical-legal assessment of non-fatal injuries was carried out on 281 individuals with complete follow-up, in which the observational unit of analysis was the most serious injury. Variables, such as sex, circumstances of the injury, the mechanism that caused the injury, medical certificate of incapacity to work, among others were related to the injury recovery time, measured in days. The Kruskal Wallis (K-W) ANOVA and a multivariate analysis using the ordinal regression model were applied. RESULTS: In the multivariate analysis, the factors most associated with longer recovery time were the extent of joint damage (CR95%:1.47-5.94,p = 0.0001) and bone damage (CR95%:2.92-7.42,p < 0.001). In terms of circumstances of the injury, traffic accidents (CR95%:1.03-2.96,p < 0.001), medical-legal impairments (CR95%:0.34-2.19,p = 0.007), and complications of the primary injury (CR95%: 1.18-2.57,p < 0.001) had the greatest impact on recovery time. Others factors that significantly impacted injury recovery time are surgical treatments (IC95%: 0.33-3.26,p = 0.0164) and delayed treatment (CR95%:1.41-4.72,p < 0.001). A direct correlation (significant and moderately strong) was found between the recovery time of the injury and the days of incapacity for work (r = 0.802, p < 0.001). CONCLUSION: This prospective analysis determined which variables were most strongly related to the medical-legal assessment of non-fatal injuries and the recovery time of said injuries. Further studies aimed at improving the strategies to help individuals complete the legal process are required.

[Second-line treatment in recurrent urinary incontinence after the use of mid-urethral tapes. Systematic review and metaanalysis of proportions.] / Tratamiento de segunda línea en incontinencia urinaria recurrente posterior al uso de cintas de uretra media. Revisión sistemática y metaanálisis de proporciones.

OBJECTIVE: Female urinary incontinence has a prevalence of up to 40%. Stress urinary incontinence is the most frequent type, about 50%. When primary management fails, it is unclear what the behavior should be. This study aims to show the cure rate of the second-line management options described in the literature. MATERIAL AND METHOD: Systematic review of the literature with meta-analysis of proportions. Observational and interventional studies were included in which the different types of management of recurrent/persistent urinary incontinence were evaluated in women who had a mid-urethral tape as primary management. RESULTS: 161 studies were identified and screened, including 29 in the qualitative synthesis and 27 in the quantitative synthesis. Given the high clinical and methodological heterogeneity, an estimation of the cure rate for each type of management was performed, with the following results regarding the total combined cure rate: in the implantation of adjustable tapes of 86% ( IC95%: 76.4% -92.1%), the implantation of a second mid urethral tape was 75.1% (95% CI: 68% -81.1%), in the shortening of the previous mid urethral tape was 62.3% (95% CI: 49.1% -73.9%) and finally the implantation of bulking agents was 55.4% (95% CI: 43.2% -67%). We did not find enough studies to perform a quantitative synthesis with respect to: pubovaginal sling, colposuspension and pelvic floor therapy, as well as secondary outcomes. CONCLUSION: The evidence found shows that there may be superiority of the adjustable tapes versus the mid urethral tapes and other included treatments. However, a comparison to statistically corroborate this difference could not be made. These results should be confirmed with multicenter collaborative randomized clinical trials.

OBJETIVO: La incontinencia urinaria femenina tiene una prevalencia hasta del 40%, su tipo más frecuente, con cerca del 50%, es la incontinencia urinaria con esfuerzo. Cuando el manejo primario falla, no se tiene claridad sobre cuál debe ser la conducta. Este estudio pretende mostrar la proporción de curación de las opciones de manejo de segunda línea descritos en la literatura. MATERIAL Y MÉTODO: Revisión sistemática de la literatura con meta-análisis de proporciones. Se incluyeron estudios observacionales y de intervención, en los que se evaluaron los diferentes tipos de manejos de la incontinencia urinaria recurrente/persistente en mujeres que tuvieran una cinta de uretra media como manejo primario. RESULTADOS: Se identificaron y tamizaron 161 estudios, incluyendo 29 en la síntesis cualitativa y 27 en la síntesis cuantitativa. Dada la alta heterogeneidad clínica y metodológica, se realizó una estimación de la proporción de curación para cada uno de los tipos de manejo, con los siguientes resultados con respecto a la proporción de curación total combinada: en la implantación de cintas ajustables de 86% (IC95%: 76,4%-92,1%), en la implantación de una segunda cinta de uretra media fue de 75,1% (IC95%: 68%-81,1%), en el acortamiento de la cinta de uretra media previa fue de 62,3% (IC95%: 49,1%-73,9%) y por último en la implantación de agentes abultantes fue de 55,4% (IC95%: 43,2%-67%). No se encontraron estudios suficientes para poder realizar una síntesis cuantitativa con respecto a: sling pubovaginal, colposuspensión y terapia de piso pélvico, al igual que para los desenlaces secundarios.CONCLUSIÓN: La evidencia encontrada muestra que podría haber superioridad de las cintas ajustables frente a las cintas de uretra media y los otros tratamientos incluidos. Sin embargo, no se pudo realizar una comparación para corroborar estadísticamente dicha diferencia. Estos resultados deben ser corroborados con ensayos clínicos aleatorizados colaborativos multicéntricos.

Sleep quality perception and romantic relationships in university students: cross-sectional study / Percepción de calidad de sueño en jóvenes universitarios y relaciones románticas: estudio de corte transversal

Abstract Introduction: Sleep in adolescence is influenced by emotional states triggered by romantic relationships, which can be determinant in sleep quality perception. Objective: This study was designed to assess the association between sleep quality perception and romantic relationships, as well as its characteristics in late adolescent/young adult university students. Materials and methods: A cross sectional study was conducted in 443 subjects. Sleep quality perception was quantified using a validated diary for young persons. Individual attachment style, romantic relationship status and its characteristics were determined using specific validated measures. Results: Sleep quality perception was determined using five multivariate models that included statistically significant characteristics of romantic relationships. Higher sleep quality perception was associated with the level of satisfaction of a subject with the relationship and liking for the partner (p=0.035). The prevalence of romantic relationships in students was 64% (95%CI: 59.4-68.9). The individuals that were not in a romantic relationship experienced significantly prolonged sleep latency (p<0.05). Conclusion: Higher sleep quality perception in university students is associated with being in a romantic relationship and the attachment style. These aspects can be identified and intervened, if support systems of educational institutions recognize their potential importance for health, wellbeing and academic performance.

Resumen Introducción. El sueño en adolescentes está influenciado de manera especial por los estados emocionales presentes en las relaciones románticas. Esto puede ser determinante en la percepción de calidad del sueño. Objetivo. Evaluar la asociación entre la percepción de la calidad del sueño y las características de las relaciones románticas en estudiantes universitarios adolescentes y adultos jóvenes. Materiales y métodos. Estudio de corte transversal realizado en 443 sujetos. La percepción de calidad del sueño, los estilos de apego, estar en una relación romántica y sus características se determinaron utilizando medidas validadas. Resultados. La percepción de calidad del sueño se determinó utilizando cinco modelos multivariados que incluyeron características estadísticamente significativas de las relaciones románticas. El nivel de satisfacción del individuo con su relación de pareja y la atracción hacia esta se asoció con su nivel de percepción de calidad del sueño (p=0.035). La prevalencia de las relaciones románticas fue del 64% (IC95%: 59.4-68.9). Los que no estaban en una relación experimentaron latencia del sueño significativamente más prolongada (p<0.05). Conclusión. Las relaciones sentimentales románticas y sus características se asocian con la calidad de sueño percibida por los individuos. Estos aspectos pueden ser identificados e intervenidos y ser útiles para los sistemas de apoyo de las instituciones educativas.