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Mexico City, Mexico

San Luis-Miranda R.,Centro Medico Nacional la Raza
Revista médica del Instituto Mexicano del Seguro Social | Year: 2012

Patent ductus arteriosus (PDA) is the most common congenital heart disease in Mexico. The clinical manifestations of the PCA are from asymptomatic patients to the presence of heart failure. Its management should be individualized based on clinical, hemodynamic data and presence of pulmonary hypertension. Our objective was to provide current medical recommendations based on the best, available scientific evidence for the diagnosis, study and therapeutic decisions of the PCA. Established a standardized sequence to search for Practice Guidelines, based on the clinical questions about PCA diagnosis and treatment. Most of the recommendations were taken from selected guidelines and supplemented with the remaining material. The information is expressed in levels of evidence (E) and grade of recommendation (R) according to the characteristics of the study design and type of publications. Currently produces large amounts of medical information in a relatively short period of time which is necessary to have evidence-based CPG to facilitate and standardize the diagnostic decision-treatment to provide better care for children and adults with PCA.

The population pyramid shows a shift towards groups increasingly elderly and the coronary artery disease continues to occupy one of the top causes of death worldwide, we expect an increasing number of elderly patients with ischemic heart disease in our daily practice. The senile patient is commonly excluded from clinical research, so the evidence for its management is small or supposed from the results of the general population. Older adults have specific physiological characteristics and pathophysiology, they are «complex» cases for diagnostic and therapeutic approach, but they also show a high co-morbid conditions which enhances the challenge that we have, because we must not only focus on the heart, but also in the hepatic, renal, neurological, and other functions; without losing sight of the quality of life, drug interactions and emotional state of elderly patients. It is therefore of great interest to know and share the specifics (based on current evidence) of elderly patients with coronary artery disease to improve their attention and perhaps stimulate the development of new research.

The role of insulin resistance (IR) of infertile patients with chronic anovulation in their therapeutic failure to clomiphene citrate (CC) is not quite clear. Determine the sensitivity to insulin in patients with chronic anovulation and failure to the treatment with clomiphene citrate. A cross-sectional clinical study in infertile patients with clomiphene citrate resistance and in patients with adequate response to clomiphene citrate was carried out. In all patients insulin resistance was determined by the rate of glucose/insulin, HOMA (Homestatic Model Assessment) and the insulin sensitivity test. For the inferential statistical analysis, a Student's t test for independent samples was used. The average total basal insulin was 19.6 +/- 8.1 microU/mL. We observed higher concentrations in the clomiphene citrate resistance group (22.1 +/- 8.9 vs. 15.8 +/- 5.1 mU/mL p = 0.07). The glucose/insulin rate was statistically minor in patients with resistance to clomiphene citrate (4.2 +/- 1.9 versus 6.9 +/- 2.1 p = 0.02), but HOMA was not significantly different in both groups (4.3 +/- 1.4 vs. 3.9 +/- 1.3 p = 0.6). The total rate of glucose disappearance (KIIT) was 4.1 +/- 1.2. However, the statistical analysis did not show significant statistical differences between the two groups. Our preliminary results suggest that insulin resistance can be a mechanism involved in the pharmacologic response to ovulation induction in infertile patients, but coexisting pathophysiological mechanisms such as hyperandrogenism might also account for the lack of response to clomiphene citrate.

Vazquez-Rodriguez J.G.,Centro Medico Nacional la Raza
Cirugia y Cirujanos | Year: 2010

Hemodialysis is the gold standard for substitution of renal function in women with chronic or acute renal insufficiency during pregnancy or the postpartum period. Perinatal complications are frequent. Recognition of appropriate techniques in medical treatment of patients will contribute to decrease its incidence and allow better perinatal results. We undertook this study to review the techniques and medical indications of hemodialysis in pregnant and postpartum patients. This condition requires care in a high-specialty medical center. We recommend incremental increases in intensity and frequency and duration of treatments, use of equipment to manage fluctuations in blood and dialysis fluids, new filters, microdose of heparin and limiting ultrafiltration to avoid hemodynamic, electrolytic, and metabolic alterations, obstetrical hemorrhage or premature delivery. The objective is to maintain a satisfactory clinical status and maternal blood, urea, nitrogen (BUN) levels ≤80 mg/dl and creatinine 5-7 mg/dl for opportune fetal development and birth. Routine pharmacological treatment should continually be individually adjusted as to number of medications and dosage. Recognition of hemodialysis techniques and indications will contribute to obtaining improved perinatal results.

Background: Capillary leak in preeclampsia-eclampsia (P-E) can be evaluated by calculating the plasma colloid osmotic pressure (COP) and the Briones index (BI). We undertook this study to report the values of plasma COP and BI in patients with P-E. We compared their correlation with ascites. methods: We studied 225 pregnant patients with P-E. We calculated plasma COP and BI as a total group and in three categories: 1) severe preeclampsia (SP) patients without HELLP syndrome (hemolytic anemia, elevated liver enzymes and low platelet count), 2) SP patients with HELLP syndrome and 3) patients with eclampsia. We compared the correlation of both parameters as well as the correlation of each with ascites. Student t test and Pearson correlation coefficient (r) were used for statistical analysis. results: Total COP was 20.14 ± 2.52 mmHg. In 148 cases (65.78%) the results were normal (21.54 ± 1.60 mmHg) and in 77 cases (34.22%) results were low (17.55 ± 1.71 mmHg) (p = 0.058). There was no difference among the three categories (p >0.05). Total BI was 0.18 ± 0.03, in 87 cases (38.67 %) it was normal (0.22 ± 0.01) and in 138 cases (61.33 %) it was low (0.16 ± 0.01) (p = 0.07). There were no differences among the three categories (p >0.05). We documented ascites of 627.27 ± 85.21 ml in 11 patients (4.89%). The r of the COP vs. BI was 0.55, COP vs. ascites was -0.03 and BI vs. ascites was -0.43. Conclusions: We found low levels of COP in 34.22% and BI in 61.33% of patients. Both parameters had negative correlation with ascites.

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