Group-based Trajectory Models to Assess Quality of INR Control and Its Association With Clinical Outcomes.

BACKGROUND: The Time in Therapeutic Range (TTR) is the gold-standard measure used to assess the quality of oral anticoagulation with vitamin K antagonists. However, TTR is a static measure, and International Normalized Ratio (INR) control is a dynamic process. Group-based Trajectory Models (GBTM) can address this dynamic nature by classifying patients into different trajectories of INR control over time. OBJECTIVES: The objective of this study was to assess the quality of INR control in a population-based cohort of new users of vitamin K antagonist with a diagnosis of atrial fibrillation using GBTM. METHODS: We classified patients into different trajectories according to their propensity for being adequately anticoagulated over their first year of treatment using GBTM, and we evaluated the association between trajectories and relevant clinical outcomes over the following year. RESULTS: We included 8024 patients in the cohort who fulfilled the inclusion criteria; the mean number of INR determinations over the first year of treatment was 13.9. We identified 4 differential trajectories of INR control: Optimal (9.7% of patients, TTR: 83.8%), Improving (27.4% of patients, TTR: 61.2%), Worsening (28%; TTR: 69.1%), and Poor control (34.9%; TTR: 41.5%). In adjusted analysis, Poor and Worsening control patients had a higher risk of death than Optimal control patients (hazard ratio: 1.79; IC 95%, 1.36-2.36 and hazard ratio: 1.36; IC 95%, 1.02-1.81, respectively). Differences in other outcomes did not achieve statistical significance, except for a reduced risk of transient ischemic attack in the Improving Control group. CONCLUSIONS: GBTM may contribute to a better understanding and assessment of the quality of oral anticoagulation and may be used in addition to traditional, well-established measures such as TTR.

Cribado radiológico de cáncer de mama en mujeres con alto riesgo / Radiological screening of breast cancer in women at high risk

Se han identificado numerosos factores de riesgo relacionados con el desarrollo del cáncer de mama. Las mujeres con alto riesgo deben someterse a un estudio intensificado para la detección precoz de lesiones sospechosas. Sin embargo, la definición de población de alto riesgo ha sufrido modificaciones durante las últimas décadas, apuntando actualmente a los antecedentes personales y familiares, basados en modelos predictivos, y a la herencia, valorada a través de un estudio genético, como los principales factores a tener en cuenta a la hora de seleccionar a las mujeres con mayor riesgo para efectuar el cribado. Así mismo, los protocolos en cuanto al tipo de estudios de imagen y la periodicidad de estos a la hora de realizar el cribado se están homogenizando, implementando el examen de resonancia magnética anual a partir de los 30 años en la mayoría de las recomendaciones. Esta actualización intenta resumir las recomendaciones de las principales sociedades científicas a nivel internacional, en cuanto a la selección de las mujeres con alto riesgo y las exploraciones radiológicas que deben realizarse para efectuar un seguimiento individualizado. (AU)

Numerous risk factors have been identified for the development of breast cancer. High-risk women should participate in an intensified study for the early detection of suspicious lesions. However, the definition of the high-risk population has changed in recent decades. Currently, the main factors to consider in the selection of women at highest risk of developing breast cancer are personal and family history, based on predictive models, and inheritance, evaluated through genetic study. Similarly, protocols for the imaging technique and their timing are being standardised, with the most widely made recommendation being the use of annual magnetic resonance imaging from the age of 30 years. This update attempts to summarise the recommendations of the main international scientific societies for the selection of high-risk women and the radiological examinations that should be performed to establish an individualised follow-up. (AU)

Socio demographic Characteristics of Pregnant Abortion-minded Clients versus Pregnant Non-abortion-minded Clients at a Pregnancy Crisis Center

Purpose: The purpose of this study is to compare the socio-demographic characteristics of pregnant abortion-minded women to those of pregnant non-abortion-minded women who had consulted a pregnancy crisis center in Montgomery County, Ohio. The findings will be used to help develop public health prevention programs for unintended pregnancies to decrease the number of abortions. Methods: A database sample of 581 records collected by a pregnancy crisis center in Montgomery County was used for this study. Criteria for inclusion were women who tested positive for pregnancy and whose pregnancy intentions were assessed as being either abortion-minded or non-abortion-minded. Socio-demographic characteristics such as age, marital status, household income, education, religious preference, race, number of previous pregnancies, number of previous live births, number of previous abortions, number of sexual partners, and age at their first sexual experience were compared to pregnancy intentions. Results: In this study, women who were more abortion-minded were single (p value = < 0.0001), Black (p value = < 0.020), women with an income level under $10,000 (p value = < 0.0001), younger women (mean age 22.6 years, p value = 0.0008), women who had their first sexual encounter at a younger age (mean age 15.6 years, p value= 0.0009), and women who had a higher number of previous abortions (mean number of abortions =0.3, p value...

Improved quality of anorectal endoluminal ultrasonography using emulsion of dimethicone.

PURPOSE: This study was designed to show the benefits of filling echography probes with water mixed with dimethicone to preclude artifacts caused by bubbles. METHODS: One hundred consecutive healthy volunteers (42 males; mean age, 46 years; range, 17-72 years) were blindly randomized to undergo rectal ultrasonography using conventional degassed water or degassed aqueous solution made of 40 ml of water and 10 ml of dimethicone emulsion (1 ml/100 mg). All examinations performed by the same surgeon-unaware of nature of filler liquid-for ten minutes, and number of rectal ultrasonographies with artifacts attributable to air bubbles was recorded. RESULTS: Endoluminal ultrasonography performed with conventional degassed water presented artifacts attributed to presence of air bubbles in 30 of 50 examinations (60 percent). When degassed aqueous solution was used, only 5 of 50 examinations showed artifacts caused by presence of air bubbles (10 percent). This difference was statistically significant (P < 0.0005). The use of conventional fluid was associated with artifacts secondary to the presence of air bubbles, adjusted odds ratio 13.5 (95 percent confidence interval, 4.56-39.88). During this experience, the solution did not damage ultrasound scanner. CONCLUSIONS: We found that use of a dimethicone-degassed water mixture is simple, not expensive, safe, effective, and may reduce frequency of sonographic distortion in presence of air bubbles.

Prevention of peritoneal adhesions by intraperitoneal administration of vitamin E: an experimental study in rats.

PURPOSE: Previous studies have shown dietary supplements of vitamin E to reduce the incidence of postoperative peritoneal adhesions. The objective of this study was to show the effect of intramuscular or intraperitoneal administration of vitamin E on peritoneal adhesions. METHODS: Eighty rats were divided into four groups: Group A (control), Group B (intramuscular vitamin E), Group C (intraperitoneal olive oil, the vehicle/diluent of vitamin E), and Group D (intraperitoneal vitamin E diluted in olive oil). The same experimental method was used in all rats to produce adhesions, consisting of cecal abrasion and ligature of the adjacent parietal peritoneum. The rats were killed at 14 days to assess the adhesions occurring. The results were analyzed using a chi-squared test. RESULTS: All animals in Groups A, B, and C had substantial adhesions. In Group D, 11 rats had insubstantial adhesions and only 4 had substantial adhesions. There were no significant differences between Groups A, B, and C in terms of percent formation of adhesions. A significant difference was found between Group D (vitamin E plus olive oil by the intraperitoneal route) and each of the experimental groups, A, B, and C (P < 0.0005). CONCLUSIONS: Our results show that intraperitoneal administration of vitamin E just before closing the laparotomy was effective for reducing adhesion formation. By contrast, the same effect was not achieved after intramuscular administration.

Eventroplastia laparoscópica: abordaje bilateral / Laparoscopic ventral hernioplasty: bilateral approach

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