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Ex-Hacienda el Hospital, Mexico

Bucio Reta E.R.,Surgical Intensive Care Unit | Berrios Barcenas E.A.,Hospital Espanol | Choreno Machain T.,Surgical Intensive Care Unit
Archivos de Cardiologia de Mexico | Year: 2016

Objective: Identify risk factors that determine pneumonia development in patients who have undergone cardiac surgery. Methods: Prospective study of a single cohort in a postoperative intensive care unit at a tertiary care center, encompassing all patients undergoing cardiac surgery from January to July 2014. Results: 31 postoperative pneumonia cases were enrolled out of 211 patients (14.6%). The following independent risk factors were identified: hypertension (OR: 3.94, p = 0.01), chronic renal failure (OR: 13.67, p = 0.02), reintubation (OR: 22.29, p = 0.001) and extubation after 6 h (OR: 15.81, p = 0.005). Conclusions: Main determinants for pneumonia after surgery were hypertension, chronic renal failure, extubation after 6 h and reintubation. © 2016 Published by Masson Doyma México S.A. Source

Baranchuk A.,Queens University | Nguyen T.,Queens University | Ryu M.H.,Queens University | Femenia F.,Hospital Espanol | And 5 more authors.
Annals of Noninvasive Electrocardiology | Year: 2012

Brugada syndrome is a channelopathy characterized on ECG by coved ST-segment elevation (≥2 mm) in the right precordial leads and is associated with an increased risk of malignant ventricular arrhythmias. The term Brugada phenocopy is proposed to describe conditions that induce Brugada-like ECG manifestations in patients without true Brugada syndrome. An extensive review of the literature identified case reports that were classified according to their suspected etiological mechanism. Future directions to learn more about these intriguing cases is discussed. © 2012, Wiley Periodicals, Inc. Source

Ramirez F.D.,Queens University | Femena F.,Hospital Espanol | Simpson C.S.,Queens University | Redfearn D.P.,Queens University | And 2 more authors.
Expert Review of Cardiovascular Therapy | Year: 2012

Cocaine remains highly prevalent and accessible in the general population, continues to represent one of the most commonly reported substances in drug-related presentations to emergency departments, and is frequently implicated in drug-related deaths. Fatal cardiac arrhythmias are often suspected in the latter cases. In spite of this, its complex effects on the human cardiac conduction system remain poorly elucidated. In this article we sought to systematically review the medical literature to identify the electrocardiographic findings that have been linked to cocaine use in humans in an effort to highlight what physicians can expect to encounter when managing patients using the drug. The evidence is discussed, common findings are emphasized and clinical recommendations are proposed. Source

Cheung A.C.,University of Toronto | Lapointe-Shaw L.,University of Toronto | Kowgier M.,University of Toronto | Meza-Cardona J.,Hospital Espanol | And 3 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2016

Background Fibrates appear to improve biochemistry in patients with primary biliary cholangitis (PBC), but it is unclear which factors predict response and whether treatment improves transplant-free survival. Aim To evaluate biochemical profiles, liver-related outcomes and adverse events following fenofibrate therapy in PBC patients with incomplete response to ursodeoxycholic acid (UDCA). Methods A retrospective cohort study was performed at a tertiary centre. Cox regression was used to compare outcomes between patients treated with fibrates and UDCA (FF) or UDCA alone, adjusted for a propensity score to account for treatment selection bias. Results A total of 120 patients were included (FF group n = 46, UDCA group n = 74, median fenofibrate treatment 11 months); 41% vs. 7% met the Toronto criteria for biochemical response [alkaline phosphatase ≤1.67 times the upper limit of normal] in the FF and UDCA groups, respectively (P = 0.0001). Fenofibrate was also associated with improved decompensation-free and transplant-free survival [hazard ratio (HR) 0.09, 95% CI 0.03-0.32, P = 0.0002]. However, only fenofibrate use, not biochemical response, was independently associated with improved outcomes on multivariable analysis (HR 0.40, 95% CI 0.17-0.93, P = 0.03). Twenty-two percent discontinued fenofibrate due to adverse events (most common: abdominal pain and myalgias). In cirrhotic patients, bilirubin increased more rapidly in the FF group (P = 0.005). Conclusions Fenofibrate therapy is associated with significant improvement in alkaline phosphatase, decompensation-free and transplant-free survival in PBC patients with incomplete UDCA response. However, fenofibrate should be used cautiously in cirrhosis, with close monitoring for clinical/biochemical decompensation. Additional studies are required to assess the validity of alkaline phosphatase as an appropriate response criteria for fibrate therapy. © 2015 John Wiley & Sons Ltd. Source

Ambiguous genitalia is a term used to describe a patient in whose general inspection and complete physical evaluation, gender assignment as male or female is not possible. It can be classified according to its etiology as genetic or embrionary defects with phenotypical effect. Ambiguous genitalia is generally seen in newborns and its considered a medical, psychological and social emergency, leading to the importance of an early diagnosis. In the period of 15 months, between 2010 and 2011 were born in the hospital for three children with ambiguous genitalia, but doing a review on this topic, we thought it was desirable to have a protocol to be followed in the management of these children; This was the way in which we believe, that this would be multidisciplinary, for joining the experiences between the specialists in the diagnosis of this malformation; to decide the steps to be followed in these children. Source

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