Urine Protein/Creatinine Ratios during Labor: A Prospective Observational Study.

PURPOSE: To evaluate the utility of urine protein/creatinine ratio (uPCR) measurements among healthy parturients at term we performed a prospective cohort study at a community teaching hospital. METHODS: Serial urine samples were collected. Ninety-three women contributed 284 urine samples. uPCRs were determined. Multiple imputation and paired sampled analysis was performed when appropriate. RESULTS: Two-thirds (63/93) of women had at least one measured uPCR ≥ 0.3. One-third (31/93) had a uPCR ≥ 0.3 at admission, including 39.1% (9/23) of women not in labor. Median (IQR) uPCRs increased during labor and after delivery: latent phase/no labor, 0.15 (0.06-0.32); active phase, 0.29 (0.10-0.58); early postpartum, 0.45 (0.18-1.36) (all p < 0.04). Median uPCRs were significantly < 0.3 in the latent phase and significantly > 0.3 in the immediate postpartum period (p < 0.01). Women who labored before cesarean delivery had the highest early postpartum uPCRs: median (IQR) 1.16 (0.39-1.80). A negative urine dipstick protein result did not exclude uPCR ≥ 0.3. uPCRs were similar when compared by method of urine collection. CONCLUSION: uPCR ≥ 0.3 is common among healthy women with uncomplicated pregnancies at term. uPCR increases during labor and is not a reliable measure of pathologic proteinuria at term or during the peripartum period.

A Four-Year Trend in Serum 25-Hydroxyvitamin D Levels in Western Connecticut.

OBJECTIVE: This study describes the trends in blood vitamin D levels in a regional population from 2009-2012 through a cross-sectional study design. METHODS: Over a four-year period (2009-2012), serum levels of 25-hydroxyvitamin D [25(OH)D] have been measured using an automated enzyme immunoassay with a steadily increasing number of tests performed each year. A total of 54700 tests were performed during this period, with a 90% increase in annual tests ordered. RESULTS: Mean and median serum levels of 25(OH) D showed statistically significant increases during this period. Those with 25(OH)D levels below 10 ng/mL represented 1.45% of the subjects in 2009 and 0.3% in 2012. The decrease in the proportion of subjects with 25(OH)D levels below 20 ng/mL and below 30 ng/mL was greatest out of all the proportioned subjects. Mean and median 25(OH)D levels increased with age in males and females. CONCLUSION: These results likely reflect increased health awareness in Western Connecticut compared with national surveys showing a temporal decrease in 25(OH)D levels.

Prevalence and consequences of vitamin D insufficiency in women with takotsubo cardiomyopathy.

OBJECTIVE: The purpose of this study was to identify the prevalence and clinical consequences of vitamin D insufficiency in patients with takotsubo cardiomyopathy. BACKGROUND: Takotsubo cardiomyopathy is a syndrome of acute, transient left ventricular dysfunction seen predominantly in postmenopausal women after acute emotional or physical stress. Postmenopausal women have a high prevalence of bone and musculoskeletal consequences related to hypovitaminosis D. Although rickets is known to cause a reversible dilated cardiomyopathy in children, the importance of vitamin D for adult cardiovascular health is less understood. METHODS: We prospectively identified patients diagnosed with takotsubo cardiomyopathy at Danbury Hospital from April 2009 through January 2011, collected demographic, clinical, laboratory, and angiographic data, and performed serum 25 hydroxyvitamin D levels during the index hospitalization. Vitamin D insufficiency was defined as serum 25-hydroxy-vitamin D less than 30 ng/mL. We compared parameters of myocardial damage and heart failure between patients with and without vitamin D insufficiency. A χ² test and a Student's t test were used for categorical and continuous variables, respectively. Statistical significance was set at P < .05 (2 tailed). RESULTS: Twenty-seven women were diagnosed with takotsubo cardiomyopathy during the study period. The mean age was 67.4 years (SD 10.4). The serum 25-hydroxyvitamin D levels were performed on 25 patients, and 17 of these had hypovitaminosis D (68%). A comparison of laboratory and imaging parameters between the 2 groups revealed that patients with hypovitaminosis D had a slightly higher mean left ventricular end-diastolic pressure and lower mean left ventricular ejection fraction (P < .05), suggestive of slightly worse heart failure. CONCLUSIONS: Women diagnosed with takotsubo cardiomyopathy have a high prevalence of vitamin D insufficiency. In our prospective study of 25 women with takotsubo cardiomyopathy, this was associated with worse hemodynamic parameters.

Hemorragia digestiva alta por úlcera gastroduodenal y lesión aguda mucosa: diagrama de flujo / Upper gastrointestinal hemorrhage by gastroduodenal ulcer and acute mucosa lesion: flow diagram

Se presenta un diagrama de flujo aplicable al diagnóstico y tratamiento de la hemorragia digestiva aguda por úlcera gastroduodenal y lesión aguda de mucosa, para ser usado en los Servicios de Emergencia y UTI, como así también en la función docente. En una posterior comunicación se presentará su codificación en lenguaje Basic

Hemorragia digestiva alta por úlcera gastroduodenal y lesión aguda mucosa: codificación en lenguaje Basic (no estructurado) / Upper gastrointestinal hemorrhage by gastroduodenal ulcer and mucous acute lesion codification in BASIC language (non structured)

Se presenta la codificación en lenguaje Basic (no estructurado) de un diagrama de flujo referido al diagnóstico y tratamiento de la hemorragia digestiva alta, diagrama publicado en un número precedente de ésta misma publicación

Hemorragia digestiva alta por úlcera gastroduodenal y lesión aguda mucosa: diagrama de flujo / Upper gastrointestinal hemorrhage by gastroduodenal ulcer and acute mucosa lesion: flow diagram

Se presenta un diagrama de flujo aplicable al diagnóstico y tratamiento de la hemorragia digestiva aguda por úlcera gastroduodenal y lesión aguda de mucosa, para ser usado en los Servicios de Emergencia y UTI, como así también en la función docente. En una posterior comunicación se presentará su codificación en lenguaje Basic (AU)

Hemorragia digestiva alta por úlcera gastroduodenal y lesión aguda mucosa: codificación en lenguaje Basic (no estructurado) / Upper gastrointestinal hemorrhage by gastroduodenal ulcer and mucous acute lesion codification in BASIC language (non structured)

Se presenta la codificación en lenguaje Basic (no estructurado) de un diagrama de flujo referido al diagnóstico y tratamiento de la hemorragia digestiva alta, diagrama publicado en un número precedente de ésta misma publicación (AU)