Comparison of hypertrophic cardiomyopathy in Afro-Caribbean versus white patients in the UK.

BACKGROUND: This study investigated the influence of African/Afro-Caribbean (black) ethnicity on the clinical profile and outcomes in hypertrophic cardiomyopathy (HCM). METHODS: 425 consecutive patients with HCM (163 black and 262 Caucasians (white); mean age 52.5±16.6 years) were assessed at three cardiomyopathy centres. Repeat assessments were performed every 6-12 months and mean follow-up was 4.3±3.0 years. The primary outcome was a composite of cardiovascular death, cardiac arrest or appropriate device therapy. RESULTS: A fortuitous diagnosis of HCM was more commonly made in black compared with white patients (31.3% vs 19.1%, p=0.004). An abnormal ECG at presentation was more frequent in black patients (98.2% vs 90.5%, p=0.002), with T-wave inversion being a common feature (91.4% vs 73.0%, p<0.001). Asymmetric septal hypertrophy was the predominant pattern in both ethnic groups; however, apical (22.2% vs 10.7%, p<0.001) and concentric (9.3% vs 1.5%, p<0.001) patterns were more prevalent in black patients. Hypertension was more frequent in black patients (58.3% vs 31.7%, p<0.001). There were no ethnic differences in risk factor profile or primary outcome. Independent predictors of the primary outcome were non-sustained ventricular tachycardia (HR 6.03, 95% CI 3.06 to 11.91, p≤0.001) and hypertension at presentation (HR 2.02, 95% CI 1.05 to 3.88, p=0.036), with an additive effect. CONCLUSION: Black ethnicity is an important determinant of the phenotypic expression of HCM but does not adversely affect outcomes. Apical and concentric hypertrophy are common in black patients and may hinder the identification of HCM in this cohort. Hypertension has an adverse effect on outcome, irrespective of ethnicity.

Invasive fungal infection in neonatal intensive care units: a multicenter survey.

This study assesses the epidemiology of invasive fungal infection (IFI) in Portuguese Neonatal Intensive Care Units (NICUs) and compares the effectiveness and safety of antifungal therapies. A survey concerning the period 2005-2010 was carried out in NICUs of Greater Lisbon. Among 10 473 admitted neonates, 44 cases were identified, 29 among extreme low birth weight neonates (65.9%). Cumulative incidence rate was 0.42% (95%CI 0.309-0.559). A central vascular catheter was present before IFI in all cases. Candida albicans and Candida parapsilosis were the most frequent isolates. The initial antifungic was fluconazole in 22 cases and liposomal amphotericin B (L-AmB) in 18. Therapy was switched in 10 patients on fluconazole and 3 on L-AmB. Case fatality rate was 11.4% (95%CI 4.39-23.91). No serious adverse drugs reactions (SADRs) or clinical side effects were observed. The knowledge of the local epidemiology helps to identify adequate prophylactic and treatment strategies.

[Cytology role in healthy sexual life promotion of adolescent users of Centro de Atendimento a Jovens de Coimbra]. / As citologias na promoção da saúde sexual das adolescentes utentes do Centro de Atendimento a Jovens de Coimbra.

BACKGROUND: Adolescents usually have risky sexual behaviors which can result in an unwanted pregnancy and/or in transmission of sexually transmitted infections (STIs). Medical consultation can provide adequate and early sexual information. Medical surveillance and pelvic examination are essential for a healthy sexual life. Despite the availability of two vaccines against the major oncogenic types of human papilloma virus, the main agent of cervical cancer, performance of cytology is still needed. The purpose of this study was to characterize the group of adolescents/young adults who made their first cytology during 2005 and 2006 and determine the results of gynecological observation and first cytology. METHODS: This is a retrospective study of users of Centro de Atendimento a Jovens (CAJ) of Centro de Saúde de Celas de Coimbra, who made their first cytology in 2005 and 2006. Clinical data were analyzed to determine the following parameters: demographic data, habits, sexual parameters, gynecological observation, symptoms, first and subsequent cytology results and consultations dropout rate until January 2009. RESULTS: During these two years, 172 first cytologies were performed. At first consultation in CAJ, the average age was 19 years old (15-24). At first intercourse, which occurred on average at 17,5 years old (13-21), 75,6% of girls used condom, 4,6% only pill and 16,3% did not use any contraceptive method. The mean number of sexual partners at first consultation was 1,6. The majority needed to take emergency pill (43/54). Gynecological observation was abnormal in 50,6% of cases, but only 10% reported symptoms. First cytology was performed, on average, three years after first intercourse, and was normal in 149 cases, unsatisfactory for evaluation in one case and abnormal in 22 (eight bacterial vaginosis, six with signs of inflammation, six candidiasis and two low grade intraepithelial lesions). Fifty nine per cent of adolescents made, at least, once more cytology. Three more cases of low grade intraepithelial lesions were detected. Dropout rate of consultations was 17%. CONCLUSIONS: In adolescence, isolated pill use increases the risk of transmission of STIs. Not using any contraceptive method may be related to the increasing use of emergency contraceptive pills. Abnormal gynecological examination may be present in asymptomatic girls. Dysplastic lesions (which are increasing in adolescence) have the same course of adulthood, supporting the need for screening and continuity of follow-up in young people.