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Ventres WB, Stone LA, Abou-Arab ER, Meza J, Buck DS, Crowder JW, Edgoose JYC, Brown A, Plumb EJ, Norris AK, Allen JJ, Giammar LE, Wood JE, Dickson SM, Brown GA. Storylines of family medicine IX: people and places-diverse populations and locations of care. Fam Med Community Health 2024; 12:e002826. [PMID: 38609086 PMCID: PMC11029404 DOI: 10.1136/fmch-2024-002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IX: people and places-diverse populations and locations of care', authors address the following themes: 'LGBTQIA+health in family medicine', 'A family medicine approach to substance use disorders', 'Shameless medicine for people experiencing homelessness', '''Difficult" encounters-finding the person behind the patient', 'Attending to patients with medically unexplained symptoms', 'Making house calls and home visits', 'Family physicians in the procedure room', 'Robust rural family medicine' and 'Full-spectrum family medicine'. May readers appreciate the breadth of family medicine in these essays.
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Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Emad R Abou-Arab
- Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Julio Meza
- Family Medicine, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - David S Buck
- Community Medicine, University of Houston, Tilman J Fertitta Family College of Medicine, Houston, Texas, USA
| | - Jerome W Crowder
- Social and Behavioral Sciences, University of Houston, Tilman J Fertitta Family College of Medicine, Houston, Texas, USA
| | - Jennifer Y C Edgoose
- Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alexander Brown
- NH Dartmouth Family Medicine Residency, Concord, New Hampshire, USA
| | - Ellen J Plumb
- San Francisco VA Medical Center, San Francisco, California, USA
| | - Amber K Norris
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Jay J Allen
- Duluth Family Medicine Residency Program, University of Minnesota Medical School Duluth Campus, Duluth, Minnesota, USA
| | - Lauren E Giammar
- Duluth Family Medicine Residency Program, University of Minnesota Medical School Duluth Campus, Duluth, Minnesota, USA
| | - John E Wood
- Duluth Family Medicine Residency Program, University of Minnesota Medical School Duluth Campus, Duluth, Minnesota, USA
| | - Scott M Dickson
- UAMS Northeast Regional Campus Family Medicine Residency Program, Jonesboro, Arkansas, USA
| | - G Austin Brown
- Cascades East Family Medicine Residency Program, Oregon Health & Science University School of Medicine, Klamath Falls, Oregon, USA
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Shetty A, De La Torre S, Ibrahim B, Hong A, Meza J, Saab S. Role of Biomarkers to Assess the Use of Alcohol. J Clin Gastroenterol 2023; 57:537-545. [PMID: 37039472 DOI: 10.1097/mcg.0000000000001852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Alcohol-associated liver disease has seen a significant rise in the last 2 decades, with an associated rise in the need for accurate alcohol use assessment. Alcohol use has been associated with poor outcomes in both the pre-liver transplant and post-liver transplant patients. Patients with alcohol use disorder often under-report their alcohol consumption because of varying factors, highlighting the need for objective assessment of alcohol use. Aside from the available self-report questionnaires, multiple serologic biomarkers are currently available to assist clinicians to assess recent alcohol consumption among patients with chronic liver disease, liver transplant candidates, and recipients. In this review, we will assess some of these alcohol biomarkers, discuss their strengths and weakness, and review-available data to discuss their role in pre-liver transplant and post-liver transplant population.
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Affiliation(s)
| | | | | | | | - Julio Meza
- Family Medicine, University of California at Los Angeles, Los Angeles, CA
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Meza J, Lai J, Chu DI. Methods for Evaluating Renal Function in Patients with Neurogenic Bladder. Curr Bladder Dysfunct Rep 2022. [DOI: 10.1007/s11884-022-00680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Terán S, Ahumada F, Vergara F, Meza J, Zoroquiain P. OVOL1 immunohistochemical expression is a useful tool to diagnose invasion in ocular surface squamous neoplasms. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:504-509. [PMID: 35787378 DOI: 10.1016/j.oftale.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES OVOL1 is a gene that negatively regulates mesenchymal transformation, which allows epithelial cells to invade the stroma. On the other hand, it negatively regulates c-Myc, which has a positive effect on cell proliferation. The aim of this study is to evaluate the expression of OVOL1 and c-Myc in ocular surface squamous neoplasia (OSSN). PATIENTS AND METHODS Cross-sectional cohort study of 36 samples including 6 squamous papillomas, 19 conjunctival intraepithelial neoplasms, 6 squamous carcinomas and 7 normal conjunctivae were evaluated using immunohistochemistry against OVOL1 and c-Myc. The expression of both markers was analysed using the H-score (intensity 1-3 multiplied by the percentage of positive cells). RESULTS Percentages of 98 and 100 of the OSSN, and 57 and 71% of the normal conjunctivae expressed OVOL1 and c-Myc respectively, however, the mean H-score of OVOL1 and c-Myc was higher in the OSSN than in normal conjunctivae group (P=0.0001 in both). Within the OSSN, OVOL1 demonstrated a higher H-score in the conjunctival intraepithelial neoplasms and papilloma, compared to the squamous carcinoma (P<0.01) group. c-Myc did not show differences between the OSSN groups. An H-score lower than 35 differentiates a squamous cell carcinoma from other OSSN lesions with a sensitivity of 83.3% and a specificity of 100%. CONCLUSIONS The expression of OVOL1 is a useful tool to differentiate between a squamous carcinoma of conjunctival intraepithelial neoplasms and papilloma. OVOL1 could play a role in the invasiveness of squamous neoplasms and places it as a potential therapeutic target.
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Affiliation(s)
- S Terán
- Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Ahumada
- Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Vergara
- Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Meza
- Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Zoroquiain
- Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Meza J, Babajide R, Saoud R, Sweis J, Abelleira J, Helenowski I, Jovanovic B, Eggener S, Miller FH, Horowitz JM, Casalino DD, Murphy AB. Assessing the accuracy of multiparametric MRI to predict clinically significant prostate cancer in biopsy naïve men across racial/ethnic groups. BMC Urol 2022; 22:107. [PMID: 35850677 PMCID: PMC9295380 DOI: 10.1186/s12894-022-01066-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction The Prostate Imaging Reporting and Data System (PIRADS) has shown promise in improving the detection of Gleason grade group (GG) 2–5 prostate cancer (PCa) and reducing the detection of indolent GG1 PCa. However, data on the performance of PIRADS in Black and Hispanic men is sparse. We evaluated the accuracy of PIRADS scores in detecting GG2-5 PCa in White, Black, and Hispanic men. Methods We performed a multicenter retrospective review of biopsy-naïve Black (n = 108), White (n = 108), and Hispanic (n = 64) men who underwent prostate biopsy (PB) following multiparametric MRI. Sensitivity and specificity of PIRADS for GG2-5 PCa were calculated. Race-stratified binary logistic regression models for GG2-5 PCa using standard clinical variables and PIRADS were used to calculate area under the receiver operating characteristics curves (AUC). Results Rates of GG2-5 PCa were statistically similar between Blacks, Whites, and Hispanics (52.8% vs 42.6% vs 37.5% respectively, p = 0.12). Sensitivity was lower in Hispanic men compared to White men (87.5% vs 97.8% respectively, p = 0.01). Specificity was similar in Black versus White men (21.6% vs 27.4%, p = 0.32) and White versus Hispanic men (27.4% vs 17.5%, p = 0.14). The AUCs of the PIRADS added to standard clinical data (age, PSA and suspicious prostate exam) were similar when comparing Black versus White men (0.75 vs 0.73, p = 0.79) and White versus Hispanic men (0.73 vs 0.59, p = 0.11). The AUCs for the Base model and PIRADS model alone were statistically similar when comparing Black versus White men and White versus Hispanic men. Conclusions The accuracy of the PIRADS and clinical data for detecting GG2-5 PCa seems statistically similar across race. However, there is concern that PIRADS 2.0 has lower sensitivity in Hispanic men compared to White men. Prospective validation studies are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01066-9.
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Affiliation(s)
- Julio Meza
- Department of Urology, Northwestern University, 710 N. Fairbanks Court Olson Pavilion 8-250, Chicago, IL, 60611, USA.
| | | | - Ragheed Saoud
- Arthur Smith Institute of Urology at Riverhead, Northwell Health, Riverhead, NY, USA
| | - Jamila Sweis
- Department of Urology, Northwestern University, 710 N. Fairbanks Court Olson Pavilion 8-250, Chicago, IL, 60611, USA
| | - Josephine Abelleira
- Department of Urology, Northwestern University, 710 N. Fairbanks Court Olson Pavilion 8-250, Chicago, IL, 60611, USA
| | - Irene Helenowski
- Department of Urology, Northwestern University, 710 N. Fairbanks Court Olson Pavilion 8-250, Chicago, IL, 60611, USA
| | - Borko Jovanovic
- Department of Urology, Northwestern University, 710 N. Fairbanks Court Olson Pavilion 8-250, Chicago, IL, 60611, USA
| | - Scott Eggener
- University of Chicago Division of Urology, Chicago, IL, USA
| | - Frank H Miller
- Northwestern University Department of Radiology, Chicago, IL, USA
| | | | - David D Casalino
- Northwestern University Department of Radiology, Chicago, IL, USA
| | - Adam B Murphy
- Department of Urology, Northwestern University, 710 N. Fairbanks Court Olson Pavilion 8-250, Chicago, IL, 60611, USA
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Villanueva Zúñiga P, Noriega-Hoces L, Llerena G, Meza J, Huayhua J, Noriega J, Guzman L. P-556 Younger maternal age as a factor associated with embryonic mosaicism. Analysis of 3222 blastocyst by Next Generation Sequencing. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is there an association between healthy younger women under 30 years old and blastocyst mosaicism rate evaluated by NGS analysis?
Summary answer
Embryo mosaicism is independent to younger maternal age. However, morphological embryo quality is associated with embryo mosaicism.
What is known already
Embryo aneuploidy rate is strongly associated with maternal age, increasing in women older than 36y. On the contrary, the aneuploidy rate remains lower in women between 22 to 35y. However, the mosaicism rate in younger women seems to be slightly higher compared to older women. Although, there is still controversy on the relationship with maternal age and others factors.
Study design, size, duration
This retrospective study include 786 oocytes donation cycles were performed from 2016 to 2020. These IVF cycles generated 3222 blastocyst that were analyzed with PGT-A(NGS. Veryseq-Illumina). Mosaic embryos were call when variation was between 20-80%. Mosaic embryos were also sub-classify as a whole or segmental chromosome mosaicism. Mosaic embryos were according to the impact level as a: high Mosaic level (>50%) and low mosaic level (≤50%). Data was classified by donor age: group-1(18-22y)(n = 288) and group-2(23-30y)(n = 498).
Participants/materials, setting, methods
All donors had a normal ovarian reserve and without any pathological or chromosome translocation. Donors had conventional oocyte stimulation with antagonist protocol trigger with agonist GnRH. Embryos were cultured with Lifeglobal media family under 7% CO2 and 5%O2.
A multilevel model was made and associations between variables by logistic regression were adjusted according to paternal age, morphological blastocyst quality, fertilization method, biopsy operator, day of embryo biopsy, number of chromosomes impacted per embryo and sperm quality.
Main results and the role of chance
Oocyte donation cycles generated 3222 blastocyst that were analyzed by NGS. The euploidy rate was 60.4% (n = 723) and 58.6% (n = 1186). Aneuploidy rate was 22.6% (n = 271) and 26.2% (n = 531) (p = 0.04). Mosaicism rate was 17% (n = 204) and 15.1% (n = 309) in group 1 and 2 respectively (p = 0.4)
Mosaic embryos were also further studied and classified according to the impact level. Interestingly, a vast majority of mosaic embryos have low mosaicism level (86.1%) compared to high mosaic level (13.9%) (p < 0.001).
The multilevel model shows that embryo quality correlated with embryo mosaicism where good quality embryos have a lower mosaicism rate compared to fair and poor quality blastocyst.
Finally, the chromosomes 21, 22 and 14 were the most frequent chromosome affect in whole chromosome mosaicism while the chromosomes 1, 2 and 5 were affected by segmental chromosome mosaicism and it was independent of maternal age.
Limitations, reasons for caution
The analysis was limited only for healthy women under 30 year old and it should not be extrapolate to patients with other pathologies.
Wider implications of the findings
The present study revealed that embryo mosaicism remains at similar percentage in younger healthy women. The mosaic embryos generated from young women have a lower chromosome impact, which according to other studies has a good implantation potential.
Trial registration number
N.A
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Affiliation(s)
| | | | | | - J Meza
- PRANOR, Embryology , Lima, Peru
| | - J Huayhua
- ADN Diagnostico , Genetics, Lima, Peru
| | - J Noriega
- Clinica Concebir, Reproductive Medicine , Lima, Peru
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Lai J, Meza J, Oot A, Guo J, Wan V, Bowen D, Kielb S. Management of Pelvic Organ Prolapse in the Adult Congenital Genitourinary Patient. Urology 2022; 161:142-145. [PMID: 34929241 DOI: 10.1016/j.urology.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess and present our experience with the management and outcomes of female pelvic organ prolapse in the adult congenital genitourinary patient population. METHODS Retrospective review of our adult congenital GU patients with spina bifida with a documented Pelvic Organ Prolapse Quantification exam (POP-Q) from 2006 - 2021 was undertaken. Spina bifida lesion level, bladder management method, prolapse stage and component, and obstetric history were reviewed. Outcomes of treated patients are from most recent follow up. RESULTS 37 congenital GU patients were identified. 26 (70%) were nulliparous with many showing advanced prolapse, defined as stage 2 or greater. By POP-Q, only 22% were stage 0, indicating no prolapse. 68% had advanced prolapse, with one case of complete procidentia despite no pregnancy history. The dominant prolapse compartment in advanced prolapse patients regardless of parity was apical, or cervical (47%). 16 had symptomatic prolapse, most with vaginal bulge or noticing bulge with catheterization. 6 patients underwent surgery with 2 vaginal hysterectomy and uterosacral suspensions and 1 sacrocolpopexy with mesh. Due to elongated cervix with protrusion, 3 patients underwent cervical shortening as their primary prolapse intervention. 4 of the patients saw a decrease in POP-Q score post-operatively with 2 patients still pending follow-up. CONCLUSIONS Congenital GU patients may have more advanced prolapse at younger ages and nulliparity and are frequently apical dominant. A variety of surgical options can provide meaningful improvement in the symptomatic patient.
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Affiliation(s)
- Jeremy Lai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Julio Meza
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Antoinette Oot
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jenny Guo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Vivian Wan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Diana Bowen
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Stephanie Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Saber A, Baine M, Meza J, Lin C. Impact Of Immunotherapy On The Survival Of Cancer Patients With Brain Metastases Who Received Definitive Surgery On The Primary. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Buttenheim AM, Levy MZ, Castillo-Neyra R, McGuire M, Toledo Vizcarra AM, Mollesaca Riveros LM, Meza J, Borrini-Mayori K, Naquira C, Behrman J, Paz-Soldan VA. A behavioral design approach to improving a Chagas disease vector control campaign in Peru. BMC Public Health 2019; 19:1272. [PMID: 31533762 PMCID: PMC6751594 DOI: 10.1186/s12889-019-7525-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/21/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Individual behavior change is a critical ingredient in efforts to improve global health. Central to the focus on behavior has been a growing understanding of how the human brain makes decisions, from motivations and mindsets to unconscious biases and cognitive shortcuts. Recent work in the field of behavioral economics and related fields has contributed to a rich menu of insights and principles that can be engineered into global health programs to increase impact and reach. However, there is little research on the process of designing and testing interventions informed by behavioral insights. METHODS In a study focused on increasing household participation in a Chagas disease vector control campaign in Arequipa, Peru, we applied Datta and Mullainathan's "behavioral design" approach to formulate and test specific interventions. In this Technical Advance article we describe the behavioral design approach in detail, including the Define, Diagnosis, Design, and Test phases. We also show how the interventions designed through the behavioral design process were adapted for a pragmatic randomized controlled field trial. RESULTS The behavioral design framework provided a systematic methodology for defining the behavior of interest, diagnosing reasons for household reluctance or refusal to participate, designing interventions to address actionable bottlenecks, and then testing those interventions in a rigorous counterfactual context. Behavioral design offered us a broader range of strategies and approaches than are typically used in vector control campaigns. CONCLUSIONS Careful attention to how behavioral design may affect internal and external validity of evaluations and the scalability of interventions is needed going forward. We recommend behavioral design as a useful complement to other intervention design and evaluation approaches in global health programs.
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Affiliation(s)
- Alison M. Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Curie Boulevard, 416 Fagin Hall, Philadelphia, PA 19104 USA
| | - Michael Z. Levy
- Department of Biostatistics, Epidemiology, and Informatics, Perleman School of Medicine of the University of Pennsylvana, Philadelphia, PA USA
| | - Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology, and Informatics, Perleman School of Medicine of the University of Pennsylvana, Philadelphia, PA USA
| | - Molly McGuire
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
- Chagas Disease Working Group, Arequipa, Peru
| | | | | | - Julio Meza
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Katty Borrini-Mayori
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar Naquira
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jere Behrman
- Department of Economics, University of Pennsylvania, Philadelphia, PA USA
| | - Valerie A. Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
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Neemann K, Olateju EK, Izevbigie N, Akaba G, Olanipekun GM, Richard JC, Duru CI, Kocmich NJ, Samson KK, Rezac-Elgohary A, Anigilaje EA, Yunusa T, Megafu CON, Ajose TO, Medugu N, Meza J, Obaro S. Neonatal outcomes associated with maternal recto-vaginal colonization with extended-spectrum β-lactamase producing Enterobacteriaceae in Nigeria: a prospective, cross-sectional study. Clin Microbiol Infect 2019; 26:463-469. [PMID: 31336200 DOI: 10.1016/j.cmi.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to assess the prevalence of maternal recto-vaginal extended-spectrum β-lactamase producing Enterobacteriacea (ESBL-E) colonization, identify risk factors for maternal and neonatal ESBL-E colonization, and subsequent impact on neonatal mortality. METHODS A prospective, cross-sectional study was conducted at the University of Abuja Teaching Hospital from April 2016 to May 2017. Maternal-neonatal pairs were screened for ESBL-E exposure at time of delivery. Neonatal mortality was assessed at 28 days. RESULTS A total of 1161 singleton deliveries were evaluated. In total, 9.7% (113/1161) of mothers and 4.3% (50/1161) of infants had ESBL-E-positive cultures at delivery. Maternal antibiotic exposure was associated with ESBL-E recto-vaginal colonization (18.6% (21/113) vs. 8.4% (88/1048), p < 0.001)). Maternal ESBL-E colonization (adjusted odds ratio (AOR) 14.85; 95% CI 7.83-28.15) and vaginal delivery (AOR 6.35; 95% CI 2.63-17.1) were identified as a risk factor for positive ESBL-E neonatal surface cultures. Neonatal positive ESBL-E surface cultures were a risk factor for neonatal mortality (stillbirths included, AOR 4.84; 95% CI 1.44-16.31). The finding that maternal ESBL-E recto-vaginal colonization appeared protective in regards to neonatal mortality (AOR 0.22; 95% CI .06-0.75) requires further evaluation. CONCLUSIONS Maternal ESBL-E recto-vaginal colonization is an independent risk factor for neonatal ESBL-E colonization and neonates with positive ESBL-E surface cultures were identified as having increased risk of neonatal mortality.
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Affiliation(s)
- K Neemann
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
| | - E K Olateju
- Department of Pediatrics, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - N Izevbigie
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - G Akaba
- Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - G M Olanipekun
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - J C Richard
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - C I Duru
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - N J Kocmich
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - K K Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - A Rezac-Elgohary
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - E A Anigilaje
- Department of Pediatrics, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - T Yunusa
- Department of Medical Microbiology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - C O N Megafu
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - T O Ajose
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - N Medugu
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - J Meza
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
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Lin C, Verma V, Ly Q, Schwarz J, Meza J, Sasson A, Are C, Kos B, Grem J. Phase I Trial of Concurrent Stereotactic Body Radiation Therapy and Nelfinavir for Locally Advanced Borderline or Unresectable Pancreatic Cancer-Final Results. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kesherwani V, Guzman Vinasco L, Awaji M, Bociek R, Meza J, Shostrom V, Freifeld A, Gebhart C. BK Viremia as a Predictor of Hemorrhagic Cystitis in Adults During the First 100 Days After Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Proc 2018; 50:1504-1509. [DOI: 10.1016/j.transproceed.2018.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
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Ramírez R, Castro J, Meza J, Carballo E, Hernández E, Victoria C, López M. Effectiveness of oxycodone/naloxone in control of pain caused by bone metastases. Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Boyes C, Wozniak M, Boggs N, Shah H, Verma A, Meza J. A Nutrition Tutorial: Activity-Based Learning for Medical Trainees. J Acad Nutr Diet 2012. [DOI: 10.1016/j.jand.2012.06.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Freifeld A, Meza J, Schweitzer B, Shafer L, Kalil A, Sambol A. Seroprevalence of West Nile virus infection in solid organ transplant recipients. Transpl Infect Dis 2010; 12:120-6. [DOI: 10.1111/j.1399-3062.2009.00464.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Adhikari S, Zeger W, Lomneth C, Meza J. 344: Focused Training of Emergency Medicine Residents in Bedside Thoracic Ultrasound: Assessment for Pneumothorax. Ann Emerg Med 2007. [DOI: 10.1016/j.annemergmed.2007.06.405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Donaldson SS, Meza J, Breneman JC, Crist WM, Laurie F, Qualman SJ, Wharam M. Results from the IRS-IV randomized trial of hyperfractionated radiotherapy in children with rhabdomyosarcoma--a report from the IRSG. Int J Radiat Oncol Biol Phys 2001; 51:718-28. [PMID: 11597814 DOI: 10.1016/s0360-3016(01)01709-6] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the outcome and toxicity of hyperfractionated radiotherapy (HFRT) vs. conventionally fractionated radiotherapy (CFRT) in children with Group III rhabdomyosarcoma (RMS). METHODS AND MATERIALS Five hundred fifty-nine children were enrolled into the Intergroup Rhabdomyosarcoma Study IV with Group III RMS. Sixty-nine were ineligible for the analysis because of incorrect group or pathologic findings. Of the 490 remaining, 239 were randomized to HFRT (59.4 Gy in 54 1.1-Gy twice daily fractions) and 251 to CFRT (50.4 Gy in 28 1.8-Gy daily fractions). The age range was <1-21 years. All patients received chemotherapy. RT began at Week 9 after induction chemotherapy for all but those with high-risk parameningeal tumors who received RT during induction chemotherapy. The patient groups were equally balanced. The median follow-up was 3.9 years. RESULTS Analysis by randomized treatment assignment (intent to treat) revealed an estimated 5-year failure-free survival (FFS) rate of 70% and overall survival (OS) of 75%. In the univariate analysis, the factors associated with the best outcome were age 1-9 years at diagnosis; noninvasive tumors; tumor size <5 cm; uninvolved lymph nodes; Stage 1 or 2 disease; primary site in the orbit or head and neck; and embryonal histologic features (p = 0.001 for all factors). No differences in the FFS or OS between the two RT treatment methods and no differences in the FFS or OS between HFRT and CFRT were found when analyzed by age, gender, tumor size, tumor invasiveness, nodal status, histologic features, stage, or primary site. Treatment compliance differed by age. Of the children <5 years, 57% assigned to HFRT received HFRT and 77% assigned to CFRT received CFRT. Of the children >or=5 years, 88% assigned to both HFRT and CFRT received their assigned treatment. The reasons for not receiving the appropriate randomized treatment were progressive disease, early death, parent or physician refusal, young age, or surgery. The toxicity assessment revealed more mucositis with HFRT (66%) than with CFRT (46%) (p = 0.03) for the parameningeal patients, and more skin reactions (16%) and nausea/vomiting (13%) with HFRT than with CFRT (7% and 5%, respectively) for patients with nonparameningeal primary tumors (p = 0.03 and p = 0.02, respectively). The analysis by treatment actually received revealed a 5-year FFS rate of 73% and OS rate of 77%, with no difference between CFRT and HFRT. As well, there was no difference in FFS or OS between CFRT and HFRT when analyzed by age, gender, tumor size, tumor invasiveness, modal status, histology, stage or site of primary. The 5-year estimated cumulative incidence of failure for the irradiated patients was local, 13%; regional, 3%; and distant, 13%; with no differences between HFRT and CFRT. The 5-year local failure rate by site was orbit, 5%; head and neck, 12%; parameningeal, 16%; bladder/prostate, 19%; extremity, 7%; and all others, 14%. The 5-year regional failure rate was parameningeal,1%; extremity, 20%; and all others, 5%. The 5-year distant failure rate was orbit, 2%; head and neck, 6%; parameningeal, 11%; bladder/prostate, 15%; extremity, 28%; and all others, 17%. CONCLUSIONS HFRT, as given in this study, did not improve local/regional control, FFS, or OS compared with CFRT. The risk of local/regional failure was comparable to that of distant failure in children with Group III RMS. The standard of care for Group III RMS continues to be CFRT with chemotherapy.
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Affiliation(s)
- S S Donaldson
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA 94305-5302, USA.
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Pappo AS, Lyden E, Breneman J, Wiener E, Teot L, Meza J, Crist W, Vietti T. Up-front window trial of topotecan in previously untreated children and adolescents with metastatic rhabdomyosarcoma: an intergroup rhabdomyosarcoma study. J Clin Oncol 2001; 19:213-9. [PMID: 11134215 DOI: 10.1200/jco.2001.19.1.213] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the antitumor activity and toxicity of topotecan, used alone and in combination with conventional therapy, in patients with metastatic rhabdomyosarcoma (RMS). PATIENTS AND METHODS Forty-eight patients younger than 21 years of age with newly diagnosed metastatic RMS received 2.0 to 2.4 mg/m(2) of topotecan intravenously daily for 5 days every 21 days before standard therapy. Two courses were given in the absence of progressive disease or excessive toxicity and response was assessed. Patients with at least a partial response (PR) to topotecan proceeded to therapy with alternating courses of vincristine 1.5 mg/m(2), dactinomycin 1.5 mg/m(2), and cyclophosphamide 2.2 g/m(2) (VAC) and vincristine 1.5 mg/m(2), topotecan 0.75 mg/m(2) daily x 5, and cyclophosphamide 250 mg/m(2) daily x 5. Patients who did not respond to topotecan received continuation therapy with VAC alone. RESULTS The overall response rate to topotecan was 46% (complete response, 4%; partial response 42%). Unexpectedly, patients with alveolar RMS had a higher rate of response (65%) than those with embryonal RMS (28%; P: = .08). The most common grade 3 or 4 toxicities were neutropenia (67%), anemia (33%), thrombocytopenia (25%), and infection (21%). Two-year failure-free survival and survival estimates were 24% and 46%, respectively. Response to window therapy did not correlate with survival. CONCLUSION The high response rate and acceptable toxicity profile of topotecan in children with advanced RMS support further evaluation of this agent in phase III trials. The superior responses in alveolar RMS are of interest.
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Affiliation(s)
- A S Pappo
- Intergroup Rhabdomyosarcoma Study Group representing the Children's Cancer Group, Arcadia, CA 91066-6012, USA
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Brzovic PS, Meza J, King MC, Klevit RE. The cancer-predisposing mutation C61G disrupts homodimer formation in the NH2-terminal BRCA1 RING finger domain. J Biol Chem 1998; 273:7795-9. [PMID: 9525870 DOI: 10.1074/jbc.273.14.7795] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The breast and ovarian cancer tumor suppressor gene, BRCA1, encodes for a Zn2+-binding RING finger motif located near the protein NH2 terminus. The RING finger motif is characterized by eight conserved Cys and His residues which form two Zn2+-binding sites termed Site I and Site II. We used limited proteolysis in conjunction with matrix-assisted laser desorption ionization time-of-flight mass spectroscopy to investigate the metal binding properties and to probe the solution structures of wild-type and mutant BRCA1 constructs that include the RING finger. Our results show that the RING finger motif is part of a larger proteolysis-resistant structural domain which encompasses the first 110 residues of BRCA1. Analytical gel-filtration chromatography and chemical cross-linking experiments demonstrate that the BRCA1 NH2-terminal domain readily homodimerizes in solution. The cancer-predisposing C61G mutation, which alters a conserved Zn2+-binding residue, abolishes metal binding to Site II of the RING finger motif, while Site I remains intact and functional. The C61G mutation also results in increased proteolytic susceptibility of the COOH-terminal portion of the NH2-terminal domain and perturbs the oligomerization properties of BRCA1.
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Affiliation(s)
- P S Brzovic
- Department of Biochemistry and Biomolecular Structure Center, University of Washington, Seattle, Washington 98195-7742, USA
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Mercado A, Meza J, Lamerato L. Geriatric functional assessment. J Fam Pract 1998; 46:11-12. [PMID: 9451355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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22
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Rael E, Meza J, Maddux J, Maddux N. Differences in complement inactivation by venom from different rattlesnake (Crotalus) species. Toxicon 1996. [DOI: 10.1016/0041-0101(96)83738-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
We report the results of a prospective study that evaluated the efficacy, predictability, and safety of excimer laser photorefractive keratectomy (PRK) to correct residual myopia after radial keratotomy (RK). Using a 193 nm excimer laser, we performed PRK on ten undercorrected myopic eyes that had previous RK surgery. The mean interval between the RK and PRK was 1.5 years. Mean follow-up was seven months. Mean preoperative refraction was -4.08 +/- 1.35 diopters (D) and after PRK was +1.61 +/- 1.18 D at three months, +1.05 +/- 0.75 D at six months, and +0.79 +/- 0.83 D at 12 months. An uncorrected visual acuity of 20/40 or better was achieved in eight eyes at three months, seven eyes at six months, and three eyes at 12 months. One eye had a transient loss of two Snellen lines of best spectacle corrected visual acuity because of increased haze. No other significant complication was noted. Our study shows that PRK is a predictable, effective, stable, and safe technique to correct residual myopia after RK. The results were similar to those of PRK without prior surgery, although we noted a slightly greater hyperopic deviation. We believe that eyes undercorrected by RK may benefit from subsequent PRK.
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Affiliation(s)
- J Meza
- Department of Ophthalmology, Jiménez-Díaz Foundation, Autonomous University of Madrid School of Medicine, Spain
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Perez-Santonja JJ, Meza J, Moreno E, Garcia-Hernandez MR, Zato MA. Short-term corneal endothelial changes after photorefractive keratectomy. J Refract Corneal Surg 1994; 10:S194-8. [PMID: 7517300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Clinical results show that photorefractive keratectomy (PRK) offers good predictability, efficacy, and safety. However, its potential risks on the human corneal endothelium are poorly known. We report the results of a prospective study conducted to evaluate the corneal endothelium changes after photorefractive keratectomy. Preoperative and serial postoperative specular microscopy was performed in 14 eyes undergoing excimer laser photorefractive keratectomy. The endothelium was analyzed for a variety of parameters, including cell density, coefficient of variation in cell size, and hexagonality. The follow-up was 6 months. The mean cell density was unchanged from 2463 cells/mm2 to 2498 cells/mm2 at 6 months after photorefractive keratectomy. The coefficient of variation of cell size (polymegathism) changed from 0.303 to 0.280 at 1 month, to 0.293 at 3 months, and to 0.290 at 6 months after surgery. The changes in this parameter were statistically significant when comparing pre- versus 1 month postoperative values. The hexagonality was unchanged from 72.08% at baseline to 73.35% at 6 months. No endothelial abnormalities were found after photorefractive keratectomy. Our results suggest a cell migration from the peripheral to central cornea after photorefractive keratectomy in contact lens wearing patients prior to photorefractive keratectomy.
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Affiliation(s)
- J J Perez-Santonja
- Department of Ophthalmology, Jimenez-Diaz Foundation, Autonomous University of Madrid School of Medicine, Spain
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Pérez-Santonja JJ, Bueno JL, Meza J, García-Sandoval B, Serrano JM, Zato MA. Ischemic optic neuropathy after intraocular lens implantation to correct high myopia in a phakic patient. J Cataract Refract Surg 1993; 19:651-4. [PMID: 8229726 DOI: 10.1016/s0886-3350(13)80019-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 33-year-old patient had uncomplicated anterior chamber intraocular lens implantation (Worst-Fechner biconcave myopia lens) to correct high myopia. Immediately after surgery, she developed anterior ischemic optic neuropathy likely associated with increased intraocular pressure and systemic hypotension. To our knowledge, this is the first documented case of anterior ischemic optic neuropathy after anterior chamber intraocular lens implantation to correct high myopia in a phakic eye.
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Affiliation(s)
- J J Pérez-Santonja
- Department of Ophthalmology, Jiménez-D'iaz Foundation, Autonomous University of Madrid School of Medicine, Spain
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Zavaleta D, Attié F, Meza J, Múñóz-Castellanos L, Buendía A, Ovseyevitz J, Vargas J. [Double outlet right ventricle with discordant atrioventricular connection. Clinical study]. Arch Inst Cardiol Mex 1987; 57:199-206. [PMID: 2959219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The clinical and anatomic findings were reviewed in 17 patients with double-outlet right ventricle and atrioventricular discordance. Ten cases had atrial situs solitus, seven with right-sided heart three with left-sided heart. Seven cases had atrial situs inversus, five with left-sided heart and two with right-sided heart. All cases presented ventricular septal defect, 13 subvalvar pulmonary stenosis, two tricuspid regurgitation and two complete atrioventricular block. The spatial relationship between the arterial valves are variable. Most cases in atrial situs solitus had a left-sided and anterior aorta and all patients in atrial situs inversus had a right-sided and anterior aorta. In this study we compared the anomalies found in our cases with double outlet right ventricle with those in 58 patients with corrected transposition. Absolute, relative and attributable risks were calculated for the presence of subvalvular pulmonary stenosis, ventricular septal defect, tricuspid regurgitation and atrioventricular block for each the two groups. We concluded that patients with double-outlet right ventricle are more prone to present ventricular septal defect and subvalvar pulmonary stenosis, while those with corrected transposition have a greater likelihood of presenting with tricuspid regurgitation and atrioventricular block. There is no typical clinical picture for the malformations. Symptoms depend upon the associated anomalies. The final diagnosis is best achieved by the echocardiographic and angiocardiographic studies, but electrocardiogram and chest radiograph may suggest the presence of a discordant atrioventricular connection.
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Affiliation(s)
- D Zavaleta
- Departamento de Cardiología Pediátrica, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F
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Herrero Sagastume V, Berlinches P, Ortega J, Conesa J, Pérez Ortíz E, Meza J, Belón J. [Hypothyroideal coma and pulmonary atelectasia]. Rev Clin Esp 1977; 147:641-4. [PMID: 609820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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