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1.
J Investig Med ; 68(6): 1196-1198, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32665395

RESUMO

Women with an abnormal Pap smear are often referred to colposcopy, a procedure during which endocervical curettage (ECC) may be performed. ECC is a scraping of the endocervical canal lining. Our goal was to compare the performance of a naïve Poisson (NP) regression model with that of a zero-inflated Poisson (ZIP) model when identifying predictors of the number of distress/pain vocalizations made by women undergoing ECC. Data on women seen in the colposcopy clinic at a medical school in El Paso, Texas, were analyzed. The outcome was the number of pain vocalizations made by the patient during ECC. Six dichotomous predictors were evaluated. Initially, NP regression was used to model the data. A high proportion of patients did not make any vocalizations, and hence a ZIP model was also fit and relative rates (RRs) and 95% CIs were calculated. AIC was used to identify the best model (NP or ZIP). Of the 210 women, 154 (73.3%) had a value of 0 for the number of ECC vocalizations. NP identified three statistically significant predictors (language preference of the subject, sexual abuse history and length of the colposcopy), while ZIP identified one: history of sexual abuse (yes vs no; adjusted RR=2.70, 95% CI 1.47 to 4.97). ZIP was preferred over NP. ZIP performed better than NP regression. Clinicians and epidemiologists should consider using the ZIP model (or the zero-inflated negative binomial model) for zero-inflated count data.

2.
J Perinat Med ; 48(5): 446-449, 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: covidwho-260592

RESUMO

The novel coronavirus disease 2019 (COVID-19) has caused a rapid and massive transition to online education. We describe the response of our Office of Faculty Development at Texas Tech University Health Sciences Center El Paso (TTUHSC EP) to this unprecedented challenge during and after this post-pandemic crisis. The initiatives for emergency transition to eLearning and faculty development described in this paper may serve as a model for other academic health centers, schools, colleges and universities.

3.
Ophthalmic Epidemiol ; 27(5): 409-416, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32431222

RESUMO

PURPOSE: Healthcare costs are a continual concern. To improve our cost-efficiency we must identify the direct costs of ocular injuries requiring hospitalization. The purpose of this study was to evaluate the direct costs of hospitalized ocular injuries in Texas. METHODS: Retrospective cohort study using the Texas Hospital Inpatient Discharge Public Use Data File, 2013-2014. Persons hospitalized for ocular trauma were identified using ICD-9-CM codes. Injuries were subcategorized as ocular adnexal, open globe, or closed globe based on diagnosis and procedure codes and analyzed across three age groups: 18-44, 45-64, and >65 years. RESULTS: From 2013 to 2014, 1498 patients were hospitalized with ocular adnexal injuries, 644 with open globe injuries, and 2877 with closed globe injuries. Length of stay ranged from 2 to 4 days. The median total charges ranged between $34,576 and $55,409 across all injuries and groups. The largest portion of medical costs were due to radiology in the ocular adnexal and closed globe groups, and operating room charges in the open globe group. CONCLUSIONS: Median hospitalization costs for ocular injuries were between $34,576 and $55,409 for a 2-4 day length of stay. Open globe injuries had the shortest median lengths of stay, 2-3 days, and lower median total costs. Only in the open globe group were operative costs higher than radiology costs. Operative charges were lowest in the oldest age group, who also had longer lengths of stay. Our reported costs were lower than other nationally reported ocular injury costs for similar lengths of hospital stay.

4.
J Perinat Med ; 48(5): 446-449, 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32401229

RESUMO

The novel coronavirus disease 2019 (COVID-19) has caused a rapid and massive transition to online education. We describe the response of our Office of Faculty Development at Texas Tech University Health Sciences Center El Paso (TTUHSC EP) to this unprecedented challenge during and after this post-pandemic crisis. The initiatives for emergency transition to eLearning and faculty development described in this paper may serve as a model for other academic health centers, schools, colleges and universities.


Assuntos
Betacoronavirus , Instrução por Computador/métodos , Infecções por Coronavirus , Educação Profissionalizante/métodos , Docentes/organização & administração , Internet , Pandemias , Pneumonia Viral , Desenvolvimento de Pessoal/organização & administração , Educação Profissionalizante/organização & administração , Humanos , Desenvolvimento de Pessoal/métodos , Texas
6.
BMC Womens Health ; 20(1): 60, 2020 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-32213171

RESUMO

BACKGROUND: Cervical cancer remains a global health problem especially in remote areas of developing countries which have limited resources for cervical cancer screening. In this study, we evaluated the performance of a low-cost, smartphone attachable paper-based microscope when used for classifying images of cervical cytology. METHODS: Cervical cytology samples included: 10 Normal, 10 Low-grade squamous intraepithelial lesion (LSIL), 10 High-grade squamous intraepithelial lesion (HSIL), and 10 Malignant Pap Smears. The agreement between conventional microscopy vs. Foldscope imaging was calculated using a weighted kappa coefficient. A confusion matrix was created with three classes: Normal, LSIL, and HSIL/malignant, to evaluate the performance of the Foldscope by calculating the accuracy, sensitivity, and specificity. RESULTS: We observed a kappa statistic of 0.68 for the agreement. This translates into a substantial agreement between the cytological classifications by the Foldscope vs. conventional microscopy. The accuracy of the Foldscope was 80%, with a sensitivity and specificity of 85 and 90% for the HSIL/Mal category, 80 and 83.3%, for LSIL, and 70 and 96.7% for Normal. CONCLUSIONS: This study highlights the usefulness of the Foldscope in cervical cytology, demonstrating it has substantial agreement with conventional microscopy. Its use could improve cytologic interpretations in underserved areas and, thus, improve the quality of cervical cancer screening. Improvements in existing limitations of the device, such as ability to focus, could potentially increase its accuracy.

8.
J Grad Med Educ ; 11(1): 66-71, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30805100

RESUMO

Background: The Accreditation Council for Graduate Medical Education expects residents to attain competency in systems-based practice by advocating for quality patient care, working in interprofessional teams, and implementing system solutions to prevent errors. Diabetes in pregnancy was identified as an area for improvement through comprehensive interdisciplinary and interprofessional care. Objective: An interdisciplinary and interprofessional workshop was created by 3 regional academic institutions to improve collaborative practice, clinical knowledge, and clinical judgment of residents. Methods: A workshop consisting of 4 clinical simulation stations for ultrasound assessment, glycemic control, hyperglycemic emergencies, and macrosomia complications was designed to address gaps in quality of care. Workshop participants were residents from 6 programs and students in nursing, pharmacy, and sonography. Attitude and clinical knowledge were measured preworkshop and postworkshop, and at 3-month and 6- to 7-month follow-up. Results: There were increases in average clinical knowledge scores across time points from residents: 56.4% preworkshop, 64.8% postworkshop, 66.0% at 3-month follow-up, and 68.1% at 6- to 7-month follow-up. Additionally, participants reported positive attitudes toward interprofessional education and indicated high overall satisfaction. Conclusions: Residents demonstrated improved knowledge and attitudes toward interprofessional training after participating in a large-scale simulation workshop focused on the care of patients with diabetes in pregnancy.


Assuntos
Competência Clínica/normas , Conhecimentos, Atitudes e Prática em Saúde , Comunicação Interdisciplinar , Internato e Residência , Relações Interprofissionais , Obstetrícia/educação , Treinamento por Simulação/métodos , Diabetes Gestacional , Educação de Pós-Graduação em Medicina/métodos , Feminino , Índice Glicêmico , Humanos , Gravidez , Complicações na Gravidez , Ultrassonografia
9.
Female Pelvic Med Reconstr Surg ; 25(1): 72-75, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29095247

RESUMO

OBJECTIVE: This study aimed to determine the readability of commonly available patient information materials for pelvic floor disorders written in Spanish and compare their readability based on type of content and source. METHODS: Spanish patient information handouts, including pamphlets from the National Institutes of Health, International Urogynecology Association, American Congress of Obstetricians and Gynecologists, online printable handouts, and industry-sponsored brochures were assessed for readability. Online materials for patients were obtained from Google searches using key words (pelvic floor disorders, urogynecology, patient information handouts, Spanish). Reading difficulty was assessed using INFLESZ v1.0, (Barrio-Cantalejo IM, Spain) a free software developed to calculate the readability of Spanish written texts. Three index scales were used: Flesch-Szigriszt Index, Word correlation Index, and the Fernandez-Huerta Index. RESULTS: Forty patient information handouts were analyzed. All pamphlets analyzed had readability scores within the "average" to "very difficult" reading difficulty levels as per the index scales used. None of the analyzed pamphlets met the sixth grade reading level criteria suggested by the National Institutes of Health and American Medical Association, including government-developed materials. There were no differences in readability scores between type of leaflet content or source. CONCLUSIONS: Current available free, industry-, organization-, and government-provided reading materials in Spanish do not serve the Spanish-speaking only or low English-speaking literacy population. Future work should aim to simplify the language in such documents to the suggested sixth grade reading level.


Assuntos
Compreensão , Idioma , Educação de Pacientes como Assunto/normas , Distúrbios do Assoalho Pélvico , Feminino , Ginecologia/educação , Letramento em Saúde , Hispano-Americanos , Humanos , Folhetos
10.
South Med J ; 111(9): 544-548, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30180252

RESUMO

OBJECTIVES: To determine the effect of maternal age (MA) and paternal age (PA) on the risk of gestational hypertension, preeclampsia, and eclampsia in women who delivered on the Texas-Mexico border. METHODS: A cohort study using birth certificate data (singleton pregnancies, years 2005-2010) from El Paso County, Texas, was conducted. Six parental age-exposure categories were created with MA 20 to 34 years and PA younger than 35 years serving as the referent. A directed acyclic graph was created. Adjusted risk ratios for the composite outcome of gestational hypertension, preeclampsia, or eclampsia were calculated using Poisson regression. RESULTS: A total of 85,114 records were identified, with a majority of the mothers being of Hispanic ethnicity (89.2%). The incidence of the composite outcome ranged from 2.8% in the MA 20 to 34 years old and PA 35 years and older group to 4.4% in the MA younger than 20 years old and PA 35 years and older group. Compared to the MA 20 to 34 years old and PA younger than 35 years group, women in the MA 35 years and older and PA 35 years and older groups were more likely to experience the outcome (adjusted risk ratio 1.57, 95% confidence interval 1.39-1.77, P < 0.0001). CONCLUSIONS: Couples in which both parents are 35 years old and older should be counseled on the increased risk of gestational hypertension or preeclampsia/eclampsia.


Assuntos
Hipertensão Induzida pela Gravidez/etiologia , Idade Materna , Idade Paterna , Pré-Eclâmpsia/etiologia , Adulto , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Incidência , Masculino , Pré-Eclâmpsia/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Texas/epidemiologia , Adulto Jovem
11.
J Womens Health (Larchmt) ; 27(11): 1378-1384, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30016194

RESUMO

BACKGROUND: The purpose of this study was to evaluate the maternal outcome in women with very advanced maternal age (VAMA) at childbirth (>45 years) compared to advanced maternal age (35-39 and 40-44 years). METHODS: Retrospective cohort study using the Texas Public Use Data File, years 2013-2014. Maternal age was a three-level variable: 35-39 (referent), 40-44, and 45-59 years (VAMA). Adjusted risk ratios (aRRs) for the two older age groups for various obstetrical and nonobstetrical complications were calculated from log-binomial regression models. RESULTS: The sample consisted of 96,879 deliveries. In univariate analyses, a higher frequency (p < 0.05) of gestational diabetes, pregestational diabetes, chronic hypertension, pregnancy related hypertensive disorders, multiple gestation, oligohydramnios, polyhydramnios, placenta previa, postpartum hemorrhage, small for gestational age, intrauterine fetal death, and length of stay were noted in the two older maternal age groups compared to the youngest maternal age group. Multiple gestations were noted to be more frequent in the two older groups: the VAMA group had a 336% increase in their risk (aRR = 4.36, 95% CI: 3.68-5.17), while women 40-44 years of age experienced a 17% increase in their risk (aRR = 1.17, 95% CI: 1.07-1.29) compared to women in the 35-39 year group. The risk of the following outcomes was approximately doubled in VAMA women compared to the referent (all statistically significant): small for gestational age (aRR = 1.92), stillbirth (aRR = 2.12), and intrauterine fetal death (aRR = 1.96). CONCLUSIONS: This population-based study detected a dose-response association between maternal age and the risk of multiple maternal and fetal complications.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Idade Materna , Complicações na Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Parto Obstétrico/métodos , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/classificação , Complicações na Gravidez/epidemiologia , Gravidez Múltipla/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Natimorto/epidemiologia , Texas/epidemiologia
12.
Ann Epidemiol ; 28(7): 447-451, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29622468

RESUMO

PURPOSE: To identify correlates associated with choosing long-acting reversible contraception (LARC) over female sterilization (FS) from a subsample of women aged 35 to 44 years in a nationally representative survey. METHODS: We analyzed data from women aged 35 to 44 years from the 2011-2013 National Survey of Family Growth Female Respondent File (n = 1532). Data were analyzed using SAS 9.3 software. All analyses accounted for the complex survey sample design. Multinomial logistic regression was used to identify factors associated with choosing LARC versus FS. A domain analysis was performed focusing on women aged 35 to 44 years. RESULTS: Approximately 90% of the surveyed women had not received counseling or information about birth control in the past 12 months. Factors associated with using an LARC method versus FS were higher level of education, birth outside of the United States, and higher number of lifetime male sexual partners. Factors associated with using FS versus an LARC method were non-Hispanic black race and women who had not had a checkup related to using a birth control method in the last 12 months. CONCLUSIONS: The results of our study suggest that a large proportion of women of advanced maternal age in the United States have not received contraceptive counseling in the past 12 months. Providers should focus on providing comprehensive contraceptive and sterilization counseling to women aged 35 to 44 years, especially those using unreliable, reversible contraception.


Assuntos
Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Esterilização Reprodutiva/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Contracepção Reversível de Longo Prazo/psicologia , Idade Materna , Esterilização Reprodutiva/psicologia , Inquéritos e Questionários , Estados Unidos/epidemiologia , Serviços de Saúde da Mulher/tendências
13.
Hosp Pediatr ; 8(5): 274-279, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29636365

RESUMO

OBJECTIVES: Inconsistent results have been reported by authors of studies of the management of pediatric patients with ovarian torsion (OT). Our objective was to identify predictors of oophorectomy in girls hospitalized throughout Texas with OT. METHODS: The Texas Public Use Data File (years 2013-2014) was queried for the records of girls under the age of 18 years who had a principal or secondary discharge diagnosis of OT (International Classification of Diseases, Ninth Revision, Clinical Modification code 620.5). Adjusted odds ratios were estimated from a logistic regression model by using Firth's bias-reducing penalized likelihood. Variables for inclusion in the final model were identified by using a directed acyclic graph. RESULTS: A sample of 158 girls was identified with an overall risk of oophorectomy during the hospital stay of 41.1% (65 out of 158). After adjusting for the patient's age, health insurance status, and the presence of an ovarian cyst, girls who were treated at a nonteaching hospital were more than twice as likely to undergo oophorectomy than girls who were treated at a teaching hospital (odds ratio = 2.22; 95% confidence interval: 1.05-4.69). CONCLUSIONS: Our analysis of a statewide database revealed that girls with OT who presented at nonteaching hospitals were significantly more likely to undergo oophorectomy compared with girls who presented at teaching hospitals.


Assuntos
Hospitais de Ensino/estatística & dados numéricos , Doenças Ovarianas/cirurgia , Ovariectomia , Anormalidade Torcional/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Razão de Chances , Doenças Ovarianas/diagnóstico , Doenças Ovarianas/epidemiologia , Ovariectomia/estatística & dados numéricos , Valor Preditivo dos Testes , Estudos Retrospectivos , Texas/epidemiologia , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/epidemiologia
14.
Int Urogynecol J ; 29(2): 235-241, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28770297

RESUMO

INTRODUCTION AND HYPOTHESIS: The majority of epidemiologic studies of urinary incontinence (UI) have been conducted in non-Hispanic populations. We conducted a case-control study to identify factors associated with delayed care-seeking behavior in adult Mexican American women with UI. METHODS: Cases were women with UI who sought care >2 years after the onset of symptoms (delayed care group). Controls were women with UI who sought care ≤2 years after the onset of symptoms. Participants were women who self-identified as Mexican American, Hispanic, Chicana or Latina, and were 18 years of age or older. RESULTS: A total of 209 records (107 cases and 102 controls) were available for analysis. Of the women in the delayed care and control groups, 32% and 23%, respectively, were ≥66 years of age (P = 0.12). Women in the delayed care group were less likely than those in the control group to report that the following item was a barrier (adjusted OR = 0.54, P = 0.06): "The wait is too long to the appointment". Women in the delayed care group were twice as likely as those in the control group (adjusted OR = 2.17, P = 0.03) to agree that lack of interest on the part of the health-care practitioner and staff was a barrier. In addition to standardized responses, open-ended responses were solicited and the most frequent barrier was lack of knowledge. CONCLUSIONS: Among Mexican American women with UI, those who delayed seeking care for their UI were more likely than those who sought care promptly to cite lack of interest on the part of a health-care provider as a barrier to seeking care in a timely fashion.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Americanos Mexicanos/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Incontinência Urinária/psicologia , Idoso , Estudos de Casos e Controles , Feminino , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Tempo
15.
Clin Teach ; 15(6): 457-461, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-28994515

RESUMO

BACKGROUND: Pelvic ultrasound is a critical diagnostic imaging tool in obstetrics and gynaecology. Training opportunities in transvaginal ultrasound have not kept pace with the demand among learners because of the increased complexity of modern ultrasound technology and duty-hour restrictions. Ultrasound simulation training has the potential to overcome this gap. Training opportunities in transvaginal ultrasound have not kept pace with the demand OBJECTIVE: Our study aimed to determine the usefulness, applicability and attitudes toward pelvic ultrasound simulation training among residents, sonographers and practising doctors. METHODS: Pelvic ultrasound simulation activity using high-fidelity virtual reality ultrasound simulators lasted 4 hours and consisted of three modules: abnormal uterine bleeding, adnexal masses and bleeding in pregnancy. All learners completed a pre- and post-encounter quiz, and an anonymous post-simulation survey on the relevance of ultrasound simulation to clinical learning, and its usefulness to improve scanning performance and interpretation skills. RESULTS: Thirty-one participants attended the workshop, and 28 (90.3%) of them responded to the survey. Five respondents agreed and 23 strongly agreed that pelvic ultrasound simulation applies to their clinical ultrasound practice, and seven of them agreed and 21 strongly agreed that their performance of ultrasound and interpretation skills will be improved following their simulation training. The average post-activity knowledge score for all three topics significantly increased (paired Student's t-test, p < 0.0001). CONCLUSIONS: All 28 respondents believe that ultrasound simulation is a useful complement to learning with real patients, with the potential to improve their pelvic ultrasound performance, interpretation skills and clinical reasoning.


Assuntos
Exame Ginecológico/métodos , Ginecologia/educação , Pessoal de Saúde/educação , Obstetrícia/educação , Treinamento por Simulação/métodos , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez
16.
Med Sci Educ ; 27(3): 497-502, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29104814

RESUMO

Objectives: To assess the inter-rater reliability of standardized patients (SPs) as they assess the clinical skills of medical students and to detect possible rating bias in SPs. Methods: The ratings received by 6 students examined in 4 clinical stations by 13 SPs were examined. Each SP contributed at least 3 and at most 10 pairwise ratings, with an average of approximately 5 ratings per SP. The standard Cohen' kappa statistic was calculated and the distribution of scores among SPs was compared via both ANOVA the Kruskal-Wallis H test (one-way ANOVA by ranks). Furthermore, the number of discrepancies between pairwise raters (showing either "positive" or "negative" bias in the rating) were analyzed using ANOVA and a χ2 goodness-of-fit test. Results: The conventional method, which compared the statistics of kappa scores of the raters (including the prevalence-adjusted-bias adjusted kappa scores) did not reject the null hypothesis, that the raters (SPs) are similar. However, the analysis of the distribution of the discrepancies among the raters revealed that the differences between raters cannot be attributed to chance, particularly when a distinction was made between their overall "positive" and "negative" bias. A strong (p<0.001) "negative" bias was detected, and the SPs responsible for this bias have been identified. Conclusions: The statistical method suggested here, which takes into account explicitly the "positive" and the "negative" bias of the raters, is more sensitive than the conventional method (Cohens' kappa). Since the outliers (the biased SPs) affect the fairness of the grading of the medical students, it is important to detect any statistically-significant bias in the rating and to adjust correspondingly the SP's assessment.

17.
Eur J Obstet Gynecol Reprod Biol ; 218: 123-128, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28985546

RESUMO

OBJECTIVE: To assess the effect of letrozole in combination with low dose gonadotropins for ovulation induction in anovulatory infertility from polycystic ovary syndrome (PCOS) and controlled ovarian stimulation for endometriosis, and unexplained infertility patients. STUDY DESIGN: Retrospective cohort study in a setting of private Reproductive Endocrinology and Infertility Clinic affiliated with the University. Three hundred couples (650 cycles) requiring OI/COS for PCOS (92 patients, 195 cycles), endometriosis (89 patients, 217 cycles), and unexplained infertility (119 patients, 238 cycles). Patients received 2.5mg or 5mg letrozole for 5days (D3-D7) and recombinant follicle-stimulating hormone on alternating D3-D7 and human menopausal gonadotropin-highly purified alternating D5-D10 until growth of ideally 2 mature follicles. Ovulation was triggered with 10,000 IU of HCG. Maximum number of cycles per patient was four. RESULTS: Main outcome measures were clinical pregnancy rates, multiple order pregnancy rates, miscarriage rates, number of follicles and endometrial thickness on the day of HCG administration. The cumulative incidence of pregnancy was estimated as 35% (95%CI: 29%-41%) overall and was highest in patients with PCOS (36.6%), followed by unexplained infertility (34.6%) and endometriosis (32.5%). The pregnancy rates per cycle in PCOS, endometriosis and unexplained infertility patients were 17%, 13.2% and 17.2% respectively, no statistically significant difference between the groups. There were three twin pregnancies in PCOS, and one in unexplained infertility group. Monofolliculogenesis was noted in 48% of patients. CONCLUSION(S): Letrozole-low dose gonadotropins combination appears to be effective across different causes of infertility for superovulation. The letrozole-low dose gonadotropin combination resulted in high rate of monofolliculogenesis, low occurrence of multiple gestations and no case of OHSS or cycle cancellation.


Assuntos
Fármacos para a Fertilidade Feminina/farmacologia , Hormônio Foliculoestimulante/farmacologia , Gonadotropinas/farmacologia , Nitrilos/farmacologia , Folículo Ovariano/efeitos dos fármacos , Indução da Ovulação/métodos , Triazóis/farmacologia , Adulto , Quimioterapia Combinada , Endometriose/complicações , Feminino , Fármacos para a Fertilidade Feminina/administração & dosagem , Hormônio Foliculoestimulante/administração & dosagem , Gonadotropinas/administração & dosagem , Humanos , Infertilidade Feminina/etiologia , Letrozol , Masculino , Nitrilos/administração & dosagem , Ovulação/efeitos dos fármacos , Síndrome do Ovário Policístico/complicações , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Triazóis/administração & dosagem
18.
Gynecol Oncol Rep ; 22: 69-71, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29062882

RESUMO

•We report on the medical treatment and outcomes of choriocarcinoma in Hispanic postmenopausal women.•A diagnosis of choriocarcinoma should be considered in older women with elevated serum ß-hCG levels.•The unadjusted incidence of choriocarcinoma was calculated using data from the Texas Cancer Registry.

19.
South Med J ; 109(4): 230-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27043805

RESUMO

OBJECTIVES: Little is known about the factors that affect the length of stay (LOS) of children hospitalized for perforated appendicitis. The objective of this study was to identify clinical and demographic factors associated with a prolonged LOS (PLOS) in children with perforated appendicitis. METHODS: A retrospective cohort study was conducted using the records of 197 children 0 to 17 years old with perforated appendicitis. The children were hospitalized at one of two teaching hospitals located in El Paso, Texas, and were discharged between January 2008 and January 2014. PLOS was defined as an LOS greater than the 75th percentile value in our patient cohort, which was 7 days. An initial log-binomial regression model failed to converge, and hence logistic regression was used to calculate adjusted incidence odds ratios (OR) for PLOS, 95% confidence intervals, P values, and a receiver operating characteristic curve. The best subset method was used to identify predictors for inclusion in the final model. RESULTS: The overall risk of PLOS was 23.4% (46/197). Approximately 76% of the children who experienced PLOS and 94% of those who did not have PLOS were Hispanic. After adjusting for insurance status, presence of an abscess, asthma, consulting interventional radiology, and various antibiotics, Hispanics were less likely than non-Hispanics to experience PLOS (adjusted OR 0.20; P = 0.003). Children whose providers consulted the interventional radiologist had an increased odds of PLOS (adjusted OR 3.64; P = 0.01). CONCLUSIONS: Hispanic ethnicity was associated with a lower odds of PLOS, whereas children who required the services of an interventional radiologist were more likely to experience PLOS.


Assuntos
Apendicite/terapia , Tempo de Internação/estatística & dados numéricos , Adolescente , Apendicite/etnologia , Criança , Pré-Escolar , Feminino , Hispano-Americanos , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Texas/epidemiologia
20.
Iran J Kidney Dis ; 10(2): 68-74, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26921747

RESUMO

INTRODUCTION: Magnetic resonance imaging (MRI) sequence acquisition techniques for iron assessment have revolutionized the study of iron overload in different organs. We hypothesized that MRI can accurately and reliably assess possible iron deposition in the myocardium and liver by measurement of T2* value. MATERIALS AND METHODS: Seventeen patients with end-stage renal disease on hemodialysis were enrolled. An electrocardiography-gated single breath hold fast multiecho T2* sequence was acquired in the short axis at basal and mid-ventricular levels. The same technique was utilized to estimate liver parenchyma iron content. RESULTS: Iron deposition in the liver was present in 50% of the hemodialysis patients. No iron deposition was found in the myocardium. A strong univariable inverse linear association was detected between serum albumin and T2* in the liver (r = -0.84, P < .001). Patients who had been on dialysis for 10 years and longer had a 91% reduction in their odds of developing iron overload in the liver compared to the referent group (exact odds ratio, 0.09; P = .048). CONCLUSIONS: Even though using intravenous iron infusion is a common practice in chronic dialysis patients, it seems the myocardium as opposed to the liver is resistant to or protected against iron deposition. There were no meaningful differences in the relationship between iron overload in the liver and the dialysis time vintage. A more aggressive trend of iron therapy and different formulations of iron infusion could be an explanation of iron deposition in the liver.


Assuntos
Sobrecarga de Ferro/diagnóstico por imagem , Ferro/análise , Falência Renal Crônica/terapia , Fígado/química , Diálise Renal/efeitos adversos , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Miocárdio/química , Razão de Chances , Estudos Prospectivos , Texas
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