RESUMEN
BACKGROUND: Cardiac magnetic resonance (CMR) has gained a central role in the diagnosis of cardiac amyloidosis (CA). While the diagnostic role of a typical late gadolinium enhancement (LGE) pattern (global subendocardial enhancement coupled with accelerated contrast washout) has been identified, evidence is still conflicting regarding the prognostic role of such examination. METHODS AND RESULTS: We retrospectively analysed all patients referring for CMR at Niguarda Hospital (Milan, Italy) from January 2006 to January 2015 for suspected CA. Primary outcome was all-cause mortality. We identified 42 patients and divided them into 2 groups, according to the presence (Group A) or absence (Group B) of a typical amyloidosis LGE pattern. At the end of the follow-up (median 37 months, interquartile range 10-50 months), 31 patients (74%) had died. The hazard ratio for all-cause death was 3.2 (95% confidence interval [CI] 1.5-6.4, p < 0.01) for Group A versus Group B. Median survival time was 17 months (95% CI 7-42 months) for Group A and 70 months (95% CI 49-94 months) for Group B (p < 0.01). Multivariate analysis did not find any adjunctive predictive role for biventricular volumes and ejection fraction, indexed left ventricular mass, transmitral E/e' at echocardiography, age at diagnosis or serum creatinine. CONCLUSION: In our population, a typical LGE pattern was significantly associated with higher mortality. Moreover, patients with a typical LGE pattern showed a globally worse prognosis. Our data suggest that the LGE pattern may play a central role in prognostic stratification of patients with suspected CA, thus prompting further diagnostic and therapeutic measures.
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Campylobacter spp. is a commonly reported food-borne disease with major consequences for morbidity. In conjunction with predicted increases in temperature, proliferation in the survival of microorganisms in hotter environments is expected. This is likely to lead, in turn, to an increase in contamination of food and water and a rise in numbers of cases of infectious gastroenteritis. This study assessed the relationship of Campylobacter spp. with temperature and heatwaves, in Adelaide, South Australia. We estimated the effect of (i) maximum temperature and (ii) heatwaves on daily Campylobacter cases during the warm seasons (1 October to 31 March) from 1990 to 2012 using Poisson regression models. There was no evidence of a substantive effect of maximum temperature per 1 °C rise (incidence rate ratio (IRR) 0·995, 95% confidence interval (95% CI) 0·993-0·997) nor heatwaves (IRR 0·906, 95% CI 0·800-1·026) on Campylobacter cases. In relation to heatwave intensity, which is the daily maximum temperature during a heatwave, notifications decreased by 19% within a temperature range of 39-40·9 °C (IRR 0·811, 95% CI 0·692-0·952). We found little evidence of an increase in risk and lack of association between Campylobacter cases and temperature or heatwaves in the warm seasons. Heatwave intensity may play a role in that notifications decreased with higher temperatures. Further examination of the role of behavioural and environmental factors in an effort to reduce the risk of increased Campylobacter cases is warranted.
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Infecciones por Campylobacter/epidemiología , Campylobacter/fisiología , Calor/efectos adversos , Infecciones por Campylobacter/microbiología , Humanos , Estaciones del Año , Australia del Sur/epidemiología , TemperaturaRESUMEN
INTRODUCTION: The aim of this study is to evaluate the periodontal status of palatally and buccally impacted canines exposed with closed technique, and to compare them with the controlateral canines that served as control teeth as well as to compare them each other. METHODS: 28 patients, 14 with unilateral palatally impacted canines and 14 with unilateral buccally impacted canines comprised the subjects of the study. Mean recall observational period was 2 years 4 months ± 1 year 1 month. Closed eruption technique without the tunnel was performed to expose both the palatally and the buccally impacted canines. Six periodontal variables were considered: probing pocket depth (PPD); width of keratinized tissue (KT); gingival thickness (GT); plaque index (PI); gingival bleeding index (GBI); gingival recession (REC). RESULTS: Palatally impacted canines exhibited significant greater PPD on the mesiolingual site compared to their controlaterals (P<0.05). Buccally impacted canines had significant increased KT compared to their contralaterals (P<0.05). Palatally impacted canines had significant greater PPD on the midbuccal site and on all the palatal sites when compared to the buccally impacted canines (P<0.05). CONCLUSION: The changes observed in the periodontal status of impacted canines, although statistically significant, did not reach clinical significance.
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Changing trends in foodborne disease are influenced by many factors, including temperature. Globally and in Australia, warmer ambient temperatures are projected to rise if climate change continues. Salmonella spp. are a temperature-sensitive pathogen and rising temperature can have a substantial effect on disease burden affecting human health. We examined the relationship between temperature and Salmonella spp. and serotype notifications in Adelaide, Australia. Time-series Poisson regression models were fit to estimate the effect of temperature during warmer months on Salmonella spp. and serotype cases notified from 1990 to 2012. Long-term trends, seasonality, autocorrelation and lagged effects were included in the statistical models. Daily Salmonella spp. counts increased by 1·3% [incidence rate ratio (IRR) 1·013, 95% confidence interval (CI) 1·008-1·019] per 1 °C rise in temperature in the warm season with greater increases observed in specific serotype and phage-type cases ranging from 3·4% (IRR 1·034, 95% CI 1·008-1·061) to 4·4% (IRR 1·044, 95% CI 1·024-1·064). We observed increased cases of S. Typhimurium PT9 and S. Typhimurium PT108 notifications above a threshold of 39 °C. This study has identified the impact of warm season temperature on different Salmonella spp. strains and confirms higher temperature has a greater effect on phage-type notifications. The findings will contribute targeted information for public health policy interventions, including food safety programmes during warmer weather.
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Enfermedades Transmitidas por los Alimentos/microbiología , Calor , Infecciones por Salmonella/microbiología , Salmonella/fisiología , Estaciones del Año , Cambio Climático , Notificación de Enfermedades , Enfermedades Transmitidas por los Alimentos/epidemiología , Salmonella/genética , Infecciones por Salmonella/epidemiología , Serogrupo , Australia del Sur/epidemiología , Especificidad de la EspecieRESUMEN
A sustained increase in Salmonella enterica serovar Virchow notifications in South Eastern Australia between September 1997 and May 1998 instigated a case-control study and environmental investigations. Cases were defined as having locally acquired culture-confirmed S. Virchow phage-type 8 infection and diarrhoeal disease. Matched controls were selected by progressive digit dialling based on cases' telephone numbers. An exposure and food history questionnaire was administered by telephone. Phage typing and pulse field gel electrophoresis were performed on case and environmental isolates. Thirty-two notifications of S. Virchow infection met the case definition, 37% reported bloody diarrhoea and S. Virchow was isolated from blood in 13% of cases. Twelve patients were admitted to hospital and one died. Fresh garlic (OR 4.1, 95% CI 1.3-12.8) and semi-dried tomatoes (OR 12.6, 95% CI 1.5-103.1) were associated with these cases. The associations remained significant after adjusting for sex and age. S. Virchow (PT 8) was cultured from two brands of semi-dried tomatoes associated with cases in two different states. We provide sufficient evidence for semi-dried tomatoes and fresh garlic to be considered as potential risk foods in future Salmonella outbreak investigations.
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Diarrea/virología , Contaminación de Alimentos , Ajo/microbiología , Infecciones por Salmonella/transmisión , Salmonella enterica/patogenicidad , Adolescente , Adulto , Factores de Edad , Anciano , Australia/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Lactante , Solanum lycopersicum/microbiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Infecciones por Salmonella/epidemiología , Factores SexualesRESUMEN
An infant with subvalvar and valvar pulmonary stenosis, subvalvar, and valvar aortic stenosis and hypertrophic cardiomyopathy, who presented with pulmonary hemorrhage, is reported. He had right ventricular hypertrophy, thickened pulmonary valve leaflets, severe asymmetric left ventricular hypertrophy with outflow tract obstruction, and a thickened and dysplastic aortic valve.
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Estenosis de la Válvula Aórtica/cirugía , Cardiopatías Congénitas/cirugía , Trasplante de Corazón/métodos , Hipertrofia Ventricular Izquierda/cirugía , Estenosis de la Válvula Pulmonar/cirugía , Obstrucción del Flujo Ventricular Externo/cirugía , Anomalías Múltiples/diagnóstico , Anomalías Múltiples/cirugía , Angiografía , Estenosis de la Válvula Aórtica/congénito , Estenosis de la Válvula Aórtica/diagnóstico , Progresión de la Enfermedad , Ecocardiografía Doppler , Resultado Fatal , Cardiopatías Congénitas/diagnóstico , Hemorragia/diagnóstico , Humanos , Hipertrofia Ventricular Izquierda/congénito , Hipertrofia Ventricular Izquierda/diagnóstico , Recién Nacido , Enfermedades Pulmonares/diagnóstico , Masculino , Estenosis de la Válvula Pulmonar/congénito , Estenosis de la Válvula Pulmonar/diagnóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Obstrucción del Flujo Ventricular Externo/congénito , Obstrucción del Flujo Ventricular Externo/diagnósticoAsunto(s)
Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/microbiología , Recien Nacido Prematuro , Niño , Preescolar , Diagnóstico Diferencial , Ecocardiografía , Humanos , Lactante , Recién Nacido , Factores de RiesgoRESUMEN
We report the sexual transmission of Coxiella burnetii from a man with occupationally acquired Q fever to his wife. Fifteen days after coitus, his wife also developed serologically proven acute Q fever. C. burnetii DNA sequences were detected by polymerase chain reaction (PCR) performed on semen samples obtained from the husband at 4 and 15 months after the onset of acute Q fever, but PCR results were variable at 23 months, indicating the presence of few organisms.
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Coxiella burnetii/aislamiento & purificación , Fiebre Q/transmisión , Semen/microbiología , Enfermedades Bacterianas de Transmisión Sexual/transmisión , Anticuerpos Antibacterianos/sangre , ADN Bacteriano/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Fiebre Q/diagnóstico , Enfermedades Bacterianas de Transmisión Sexual/diagnósticoAsunto(s)
Brotes de Enfermedades , Restaurantes , Intoxicación Alimentaria por Salmonella/epidemiología , Infecciones por Salmonella/epidemiología , Fagos de Salmonella/aislamiento & purificación , Adolescente , Adulto , Anciano , Niño , Preescolar , China , Humanos , Lactante , Persona de Mediana Edad , Estudios Retrospectivos , Intoxicación Alimentaria por Salmonella/microbiología , Infecciones por Salmonella/microbiología , Salmonella typhimurium , Australia del Sur/epidemiologíaRESUMEN
Color Doppler echocardiography of the left mammary artery was combined with dipyridamole testing in order to assess the presence of significant (>70%) graft stenosis in 87 patients with a mammary artery graft to the left anterior descending coronary artery presenting with chest pain. Occluded grafts are detected by absent diastolic flow velocities at baseline, whereas the response of the diastolic flow velocity to dipyridamole distinguishes patients with critical versus noncritical stenosis of a patent graft.
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Ecocardiografía Doppler en Color , Revascularización Miocárdica , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Circulación Coronaria , Diástole , Dipiridamol/farmacología , Femenino , Oclusión de Injerto Vascular/diagnóstico por imagen , Humanos , Masculino , Arterias Mamarias/diagnóstico por imagen , Persona de Mediana Edad , Grado de Desobstrucción Vascular , Vasodilatadores/farmacologíaRESUMEN
For noninvasive evaluation of anatomy and flow characteristics of internal mammary artery graft (IMA-graft), 2D echo-Color-Doppler (CDE) was performed in 60 patients (54 M, 6 F, mean age 54.1 +/- 6.9 y), who underwent coronary angiography 20.1 +/- 13 months after a coronary artery bypass graft (CABG). CDE was performed, using an echocardiographic unit equipped with a 5 MHz linear transducer. In all patients, measurements of IMA-graft diameter (mm), and peak systolic and diastolic flow velocity (cm/sec) were obtained at baseline and also in 16 patients after dipyridamole infusion (0.54 mg/Kg/min) and in 10 patients after sublingual nitroglycerin (NTG) (0.4 mg). Angiography showed the IMA-graft patency in 58/60 patients (96.8%). A typical biphasic flow was displayed by CDE in 49/58 patients (84.4%) with angiographic patency. Dipyridamole infusion increased both IMA-graft diameter and peak diastolic flow velocity (PDFV) from 2.28 +/- 0.51mm to 2.9 +/- 0.42mm and from 19.4 +/- 6.2 cm/sec to 93.9 +/- 29 cm/sec, respectively (p < 0.0001). No significant modifications of peak systolic flow velocity (PSFV) were observed. NTG increased PDFV from 29.11 +/- 8 cm/sec to 41.88 +/- 7.20 cm/sec (p < 0.005), while diameter and PSFV showed no statistically significant modifications. CDE is a useful diagnostic tool for noninvasive evaluation of IMA-graft patency both early after surgery and during long-term follow-up. CDE pharmacological stress improves the sensibility of the technique and it can provide indirect information about pathophysiology of recipient coronary vessel.
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Ecocardiografía Doppler en Color , Revascularización Miocárdica , Velocidad del Flujo Sanguíneo , Angiografía Coronaria , Dipiridamol , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Grado de Desobstrucción VascularRESUMEN
BACKGROUND AND OBJECTIVES: Multiplane transesophageal echocardiography provides countless tomographic planes through an angle of 180 degrees, thus overcoming the restriction encountered even with biplane transesophageal echocardiography. However, the incremental diagnostic value and clinical usefulness of this technique over biplane transesophageal echocardiography has not been extensively studied. STUDY POPULATION AND METHODS: In order to evaluate its advantages over biplane imaging, 250 patients (129 male, 121 females) aged 14-86 years, underwent multiplane transesophageal echocardiography. Indications for the study were the following: source of embolism in 83 patients, suspected prosthetic dysfunction in 58 patients, valvular disease in 46 patients, congenital heart disease in 30 patients, aortic disease in 17 patients, intra- or paracardiac masses in 11 patients, and other reasons in 5. All the patients underwent an initial comprehensive diagnostic assessment using only the transverse (0 degree) and longitudinal (90 degrees) plane as the biplane imaging technique. "Off-axis" tomographic sections through the full 0 degree to 180 degrees angle were subsequently obtained by means of the gradual electrical rotation of the transducer. The echocardiographic information obtained by rotating the transducer was then compared to that obtained by biplane imaging to determine whether the additional information provided by "off-axis" sections a) carried diagnostic data; b) were to be considered useful but not diagnostic; or c) irrelevant. RESULTS: Additional diagnostic information was obtained in 24 out of the 250 patients (9.6%), including the source of embolism in 9 patients, mitral insufficiency in 6 patients, bicuspid aorta in 2 patients, aortic endocarditis in 2 patients, mitral prosthetic dysfunction in 4 patients and complex congenital heart disease in 1 patient. Additional useful but non-diagnostic information was obtained in 162 patients (64.8%). These data mainly allowed a more comprehensive assessment of the cardiac abnormality, enhancing confidence in the transesophageal diagnosis. Finally, data considered to be irrelevant were found in 64 patients (25.6%). CONCLUSIONS: The present study indicates that the wide range of tomographic planes provided by multiplane transesophageal echocardiography allows a more comprehensive evaluation of cardiac diseases and makes an accurate diagnosis possible in a significant number of cases.
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Ecocardiografía Transesofágica/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de la Aorta/diagnóstico por imagen , Ecocardiografía Transesofágica/instrumentación , Embolia/diagnóstico por imagen , Femenino , Cardiopatías/diagnóstico por imagen , Humanos , Italia , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: The aim of the present study was to evaluate the relation between the number of CD4 lymphocytes, the CD4/CD8 ratio and the plasma levels of neopterin and beta-2 microglobulin, and the clinical status, risk of progression without of active opportunistic infections, among HIV-infected patients. METHODS: Seventy-two patients infected by HIV in different clinical groups were evaluated upon entering the study and following a mean follow up of 6 months for the parameters studied. RESULTS: The values of CD4 lymphocytes and neopterin were related with the clinical status according to the CDC's classification, with no significant differences existing in the beta-2 microglobulin level. The CD4 count as well as the neopterin and the beta-2 microglobulin levels differed significantly when classified to the patients with regard to the risk of progression to AIDS throughout the study. The presence of active opportunistic infections was related with significantly higher concentrations of neopterin without differences recorded for the remaining parameters. CONCLUSIONS: The parameters studied are good markers or both clinical status and/or the risk of short-term progression to AIDS. Neopterin levels are high during acute infections. Therefore, its prognostic value should be cautiously evaluated in this situation.
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Síndrome de Inmunodeficiencia Adquirida/sangre , Biopterinas/análogos & derivados , Relación CD4-CD8 , Linfocitos T CD4-Positivos , Seropositividad para VIH/sangre , Subgrupos Linfocitarios , Microglobulina beta-2/análisis , Síndrome de Inmunodeficiencia Adquirida/inmunología , Adulto , Biomarcadores , Biopterinas/sangre , Femenino , Estudios de Seguimiento , Seropositividad para VIH/inmunología , Humanos , Masculino , Neopterin , Pronóstico , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND: The aim of the present study was to evaluate botulinic poisoning requiring hospital admission in La Rioja (Spain) during one decade from a clinical-epidemiologic point of view. METHODS: Chart records from patients admitted to the departments of Internal Medicine, Neurology, the ICU, and the Neurophysiology and Preventive Medicine files of the reference hospital between 1979 and 1990 were retrospectively reviewed. RESULTS: Fifteen cases were identified. Home preserves of vegetables were most frequently the foods responsible for the poisoning. The presentation as a sole case constituted half of this series. The most frequent symptomatology was neuro-ophthalmologic and digestive. All the cases were type B. Neurophysiologic studies were compatible with the diagnosis in all the cases in which they were performed. Two cases (13.3%) required intensive care and death occurred in one (6.6%). CONCLUSIONS: a) The habit of home preserves was responsible for the presentation of botulism in this environment. b) Early diagnosis was based on complementary clinical tests together with the neurophysiologic study. c) The mild forms were most frequent. Death in this series was 6.6%.
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Botulismo/epidemiología , Contaminación de Alimentos , Adolescente , Adulto , Anciano , Botulismo/diagnóstico , Botulismo/terapia , Niño , Femenino , Conservación de Alimentos , Humanos , Masculino , Productos de la Carne , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , VerdurasRESUMEN
BACKGROUND: The epidemiologic characteristics of HIV infection in La Rioja (Spain) were studied and the future tendencies of the same analyzed. METHODS: The data from official Health sources were collected and analyzed. RESULTS: In La Rioja, the 5th region in Spain regarding to AIDS incidence, the duplication time of the number of cases continues to shorten. The number in December 1991 was 81. The heterosexual route of infection was 5% of the cases of AIDS up to December 1990 and in 1991 it was 15%, while, with regards to the total number of seropositive subjects, the number rose from 0.3% in December 1990 to 10% in 1991. One thousand one hundred fifty-one seropositive patients were detected in December 1991 representing seroprevalence of 0.34% which reaches 1.14% in the age range between 18-32 years. Mean hospital stay was 23.6 days with 3,032 hospital stays calculated for 1991 representing 8.3 occupied beds/day. There are presently 92 patients undergoing antiviral treatment. Between 43-69 new cases of AIDS have been calculated for 1992. CONCLUSIONS: 1) Medical care should be provided to a greater number of seropositive people to avoid early deterioration. 2) The increase in heterosexual infection is alarming. 3) The need for rehabilitation centers for drug abusers and social alternatives to prostitution is clear. 4) Organized campaigns pointing out and returning the dignity and value of life and therewith the role of human sexuality are needed. 5) Alternative means to conventional hospitalization is required.
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Seroprevalencia de VIH , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Adolescente , Adulto , Antivirales/uso terapéutico , Niño , Preescolar , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Seropositividad para VIH/epidemiología , Humanos , Incidencia , Lactante , Recién Nacido , Factores de Riesgo , España/epidemiología , Población UrbanaRESUMEN
Following a brief review of the various types of local anesthesia, including a recent method using EMLA cream, the paper focuses on the different complications which arise in relation to the technique used. Treatment protocols are also analysed in relation to the toxic stage.
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Procedimientos Quirúrgicos Ambulatorios , Anestesia de Conducción/métodos , Anestesia de Conducción/efectos adversos , Anestesia Local , HumanosRESUMEN
The influence of prostaglandins on renal function changes induced by furosemide was analyzed in 21 non-azotemic cirrhotic patients with ascites. Patients were studied in two periods of 120 min immediately before and after furosemide infusion (20 mg, ev). Furosemide caused an increase in creatinine clearance in 15 patients (group A: 99 +/- 7 vs. 129 +/- 5 ml/min; mean +/- S.E.) and a reduction in the remaining six (group B: 102 +/- 13 vs. 71 +/- 9 ml/min). Parallel changes were observed in the urinary excretion of 6-Keto-prostaglandin-F1 alpha (metabolite of renal prostacyclin) which augmented after furosemide in 14 of the 15 patients from group A (478 +/- 107 vs. 1034 +/- 159 pg/min, p less than 0.001) and decreased in all patients from group B (1032 +/- 240 vs. 548 +/- 136 pg/min, p less than 0.05). In contrast, the urinary excretion of prostaglandin E2 was stimulated by furosemide in all patients (group A, 92 +/- 19 vs. 448 +/- 60 pg/min, p less than 0.001; and group B, 209 +/- 63 vs. 361 +/- 25 pg/min, p less than 0.05). In all of the patients furosemide-induced changes (post- minus pre-furosemide values) in creatinine clearance were closely correlated in a direct and linear fashion with those in 6-Keto-prostaglandin-F1 alpha (r = 0.74; p less than 0.001). These changes were associated with a higher furosemide-induced natriuresis in group A than in group B (641 +/- 68 vs. 302 +/- 46 mumol/min, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Epoprostenol/fisiología , Furosemida/uso terapéutico , Riñón/fisiopatología , Cirrosis Hepática/tratamiento farmacológico , 6-Cetoprostaglandina F1 alfa/orina , Dinoprostona/orina , Femenino , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/fisiopatología , Masculino , Uremia/etiologíaRESUMEN
We present 7 personal cases of Boerhaave syndrome, 6 treated surgically and one managed with conservative measures. Boerhaave's syndrome is one of the most serious gastro-intestinal perforation pictures. Although its frequency is scant, because of its seriousness it is important to be aware of it for early diagnosis. While a prompt diagnosis is important in any pathology, it is even more so in this syndrome since there is a clear relationship between the time lapse from perforation to the onset of treatment and the rate of survival. Although we present one case cured medically, this is exceptional and treatment is eminently surgical and should be as early as possible. The technique that provides the best results and an excellent morbimortality rate in relation to efficacy is primary suture followed by a fundal patch. In delayed cases with patients in deteriorated condition, other techniques can be considered. Due to its initial severity and a tendency to postoperative complications, the patient should be closely controlled, and correct antibiotic therapy and complete parenteral support nutrition are very important in treatment.