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San Cosme, Argentina

Cura F.,Instituto Cardiovascular Of Buenos Aires | Albertal M.,Instituto Cardiovascular Of Buenos Aires | Thierer J.,Instituto Cardiovascular Of Buenos Aires | Escudero A.G.,Hospital Cosme Argerich | And 6 more authors.
Coronary Artery Disease

Background: The relationship of the ischemic time to primary angioplasty and the quality of myocardial reperfusion according to infarcted territory among patients with ST-segment elevation myocardial infarction (STEMI) is unclear. Methods: This study consisted of 140 patients with STEMI within 12h from the symptom onset and undergoing a primary angioplasty from the Protection of Distal Embolization in High-Risk Patients with Acute ST-Segment Elevation Myocardial Infarction Trial. ST-segment resolution (STR) at 60min was analyzed by an independent corelab using continuous ST monitoring. Patients were divided according to anterior (n=74) and nonanterior (n=64) locations and according to ischemic time in quartiles (<90, 90-148, 148-241, and 241-635min). Results: Although there was no significant decrement in the extent of STR with the ischemic time in the entire population (74, 51, 72, and 51%, respectively, P=not significant), patients with anterior location have a significant reduction in the extent of STR after 90min compared with those coming after 90 min (70.6 vs. 29.2% of complete STR, P=0.003, respectively). Conclusion: Patients with anterior STEM I seem to have a stronger impact of ischemic time on the quality of myocardial reperfusion compared with patients with nonanterior location. Coron Artery Dis 22:92-95 © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Herraez D.L.,University of Granada | Martinez-Bueno M.,University of Granada | Riba L.,National Autonomous University of Mexico | De La Torre I.G.,University of Guadalajara | And 29 more authors.
Arthritis and Rheumatism

Objective To identify susceptibility loci for rheumatoid arthritis (RA) in Latin American individuals with admixed European and Amerindian genetic ancestry. Methods Genotyping was performed in 1,475 patients with RA and 1,213 control subjects, using a customized BeadArray containing 196,524 markers covering loci previously associated with various autoimmune diseases. Principal components analysis (EigenSoft package) and Structure software were used to identify outliers and define the population substructure. REAP software was used to define cryptic relatedness and duplicates, and genetic association analyses were conducted using Plink statistical software. Results A strong genetic association between RA and the major histocompatibility complex region was observed, localized within BTNL2/DRA-DQB1- DQA2 (P = 7.6 × 10 -10), with 3 independent effects. We identified an association in the PLCH2-HES5-TNFRSF14-MMEL1 region of chromosome 1 (P = 9.77 × 10 -6), which was previously reported in Europeans, Asians, and Native Canadians. We identified one novel putative association in ENOX1 on chromosome 13 (P = 3.24 × 10-7). Previously reported associations were observed in the current study, including PTPN22, SPRED2, STAT4, IRF5, CCL21, and IL2RA, although the significance was relatively moderate. Adjustment for Amerindian ancestry improved the association of a novel locus in chromosome 12 at C12orf30 (NAA25) (P = 3.9 × 10-6). Associations with the HLA region, SPRED2, and PTPN22 improved in individuals positive for anti-cyclic citrullinated peptide antibodies. Conclusion Our data define, for the first time, the contribution of Amerindian ancestry to the genetic architecture of RA in an admixed Latin American population by confirming the role of the HLA region and supporting the association with a locus in chromosome 1. In addition, we provide data for novel putative loci in chromosomes 12 and 13. Copyright © 2013 by the American College of Rheumatology. Source

Murage K.P.,Indiana University | Ball C.G.,Indiana University | Zyromski N.J.,Indiana University | Nakeeb A.,Indiana University | And 3 more authors.

Background: Disconnected left pancreatic remnant (DLPR) presents clinically as a pancreatic fistula, pseudocyst, or obstructive pancreatitis. Optimal operative treatment, either distal pancreatectomy (DP) or internal drainage (ID), remains unknown. This paper critically evaluates our operative experience in patients with DLPR. Methods: A retrospective analysis of a consecutive case series from a single, high-volume institution was carried out. A total of 76 patients with radiographic-confirmed DLPR (computed tomography + endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography) who had operations between November 1995 and September 2008 were included. Pancreas preservation (the use of ID) was our default unless anatomic, physiologic, or technical factors precluded it. Follow-up to July 2009 was done (median follow-up, 22 months). Standard statistical methodology was used (P < .05 = statistical significance). Results: The mean age of this cohort was 52 years (range, 18-85); 57% of the patients were male. A total of 59 (73%) had acute pancreatitis, whereas 17 (22%) had chronic pancreatitis. Presentation was pseudocyst in 53%, pancreatic fistula in 34%, and obstructive pancreatitis in 13%. Resection (DP) and drainage (ID) options were utilized equally for each clinical presentation as follows: pseudocyst, 60/40; pancreatic fistula, 50/50; or obstructive pancreatitis, 50/50. The strongest driver for DP (92%) was a small pancreatic remnant and splenic vein thrombosis. In contrast, large pancreatic remnants had ID 70% of the time. No differences in short- or long-term outcomes between DP or ID options were identified. Conclusion: Using anatomic, physiologic, and technical factors to guide operative choice in DLPR, we report a 74% success rate with DP and an 82% success rate with ID at a median follow-up of 22 months. A pancreatic remnant size >6 cm favored ID options over resection. © 2010 Mosby, Inc. All rights reserved. Source

Albertal M.,Instituto Cardiovascular Of Buenos Aires | Cura F.,Instituto Cardiovascular Of Buenos Aires | Thierer J.,Instituto Cardiovascular Of Buenos Aires | Trivi M.,Instituto Cardiovascular Of Buenos Aires | And 3 more authors.

We report the time to stable ST-segment reperfusion (TSTR) after primary angioplasty and its relationship with the clinical results; 137 patients who underwent primary angioplasty were included as part of the analysis. All patients had 24 hours ST-segment monitoring. Time to stable STR was defined as the beginning of ST-segment reperfusion (STR) lasting >4 hours without ST-segment reelevation. Six-month mortality was associated with slower TSTR (median 166.5 vs 6 minute, P =.001). Time to stable STR cutoff value of 136.5 minutes was identified as the best mortality predictor (area under the curve: 0.86, P =.001). Multivariate analysis identified Killip class ≥2 (P =.042), TSTR cutoff value (P =.002), and final thrombolysis myocardial infarction (TIMI) flow grade III (P =.067) as predictors of 6-month mortality. Time to stable STR may be a novel continuous electrocardiogram (ECG) parameter following primary angioplasty, which can identify high-risk patients that need to be considered for additional treatments. © 2010 The Author(s). Source

Bessone F.,National University of Rosario | Lucena M.,University of Malaga | Lucena M.,Research Center Biomedica En Red Of Enfermedades Hepaticas gestivas | Roma M.G.,National University of Rosario | And 20 more authors.
Liver International

Background & Aims: Cyproterone acetate (CPA), an anti-androgenic drug for prostate cancer, has been associated with drug-induced liver injury (DILI). We aim to expand the knowledge on the spectrum of phenotypes and outcomes of CPA-induced DILI. Methods: Twenty-two males (70±8 years; range 54-83) developing liver damage as a result of CPA therapy (dose: 150±50mg/day; range 50-200) were included. Severity index and causality by RUCAM were assessed. Results: From 1993 to 2013, 22 patients were retrieved. Latency was 163±97days. Most patients were symptomatic, showing hepatocellular injury (91%) and jaundice. Liver tests at onset were: ALT 18±13×ULN, ALP 0.7±0.7×ULN and total serum bilirubin 14±10mg/dl. International normalized ratio values higher than 1.5 were observed in 14 (66%) patients. Severity was mild in 1 case (4%), moderate in 7 (32%), severe in 11 (50%) and fatal in 3 (14%). Five patients developed ascitis, and four encephalopathy. One patient had a liver injury that resembled autoimmune hepatitis. Eleven (50%) were hospitalized. Nineteen patients recovered after CPA withdrawal, although three required steroid therapy (two of them had high ANA titres). Liver biopsy was performed in seven patients (two hepatocellular collapse, one submassive necrosis, two cholestatic hepatitis, one cirrhosis with iron overload and one autoimmune hepatitis). RUCAM category was 'highly probable' in 19 (86%), 'probable' in 1 (4%), and 'possible' in 2 (9%). Conclusions: CPA-induced liver injury is severe and can be fatal, and may occasionally resemble autoimmune DILI. The benefit/risk ratio of this drug should be thoroughly assessed in each patient. © 2016 John Wiley & Sons A/S. Source

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