Miocardiopatia hipocalcémica

The association between hypocalcemia and heart failure is rare. There are few reported cases in the literature of this association, which is termed hypocalcemic cardiomyopathy.We report the case of a 61-year-old woman with no relevant medical history, admitted for progressively worsening exertional dyspnea, orthopnea and edema of the lower limbs for a previous month. Physical examination showed diffuse muscle spasms, with no signs of latent tetany.Further investigation revealed ionized calcium 0.54 mmol/l (normal 1.12-1.30), phosphorus 9.8 mg/dl, parathyroid hormone <2.5 pg/ml and CK >3000 U/l, with normal thyroid function. The electrocardiogram showed long QT interval and a pattern of left ventricular overload, and myocardial biomarkers were negative. The echocardiogram revealed regional wall motion abnormalities, coronary angiography was normal and a cranial CT scan detected calcification of basal ganglia and white matter.She started diuretic and calcium replacement therapy which resulted in complete clinical recovery, with no need for heart failure therapy after normalization of serum calcium.     

Preparation,Characterization and Release of Urea from Wheat Gluten Electrospun Membranes

Homogeneous and thin porous membranes composed of oriented fibers were obtained from wheat gluten (WG) using the electrospinning technique. SEM micrographs showed an asymmetric structure and some porosity, which, in addition to a small thickness of 40 μm, are desirable characteristics for the membranes’ potential application in release systems. The membranes were loaded with urea to obtain pastilles. FT-IR and DSC studies confirmed the existence of interactions via hydrogen bonding between urea and WG proteins. The pastilles were studied as prolonged-released systems of urea in water. The release of urea during the first 10 min was very fast; then, the rate of release decreased as it reached equilibrium at 300 min, with a total of ≈98% urea released. TGA analysis showed that the release system obtained is thermally stable up to a temperature of 117 °C. It was concluded that a prolonged-release system of urea could be satisfactorily produced using WG fibers obtained by electrospinning for potential application in agricultural crops.     

Development of the Post Cardiac Surgery (POCAS) prognostic score

IntroductionThe risk of mortality in cardiac surgery is generally evaluated using preoperative risk-scale models. However, intraoperative factors may change the risk factors of patients, and the organism functionality parameters determined upon ICU admittance could therefore be more relevant in deciding operative mortality. The goals of this study were to find associations between the general parameters of organism functionality upon ICU admission and the operative mortality following cardiac operations, to develop a Post Cardiac Surgery (POCAS) Scale to define operative risk categories and to validate an operative mortality risk score.MethodsWe conducted a prospective study, including 920 patients who had undergone cardiac surgery with cardiopulmonary bypass. Several parameters recorded on their ICU admission were explored, looking for a univariate and multivariate association with in-hospital mortality (90 days). In-hospital mortality was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate, lactate and the International Normalized Ratio (INR). The POCAS scale was compared with four other risk scores in the validation series.ResultsIn-hospital mortality (90 days) was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate ratio, lactate ratio and the INR. The POCAS scale was compared with four other risk scores in the validation series. Discriminatory power (accuracy) was defined with a receiver-operating characteristics (ROC) analysis. The best accuracy in predicting in-hospital mortality (90 days) was achieved by POCAS. The areas under the ROC curves of the different systems analyzed were 0.890 (POCAS), followed by 0.847 (Simplified Acute Physiology Score (SAP II)), 0.825 (Sepsis-related Organ Failure Assessment (SOFA)), 0.768 (Acute Physiology and Chronic Health Evaluation (APACHE II)), 0.754 (logistic EuroSCORE), 0.714 (standard EuroSCORE) and 0.699 (Age, Creatinine, Ejection Fraction (ACEF) score).ConclusionsOur new system to predict the operative mortality risk of patients undergoing cardiac surgery is better than others used for this purpose (SAP II, SOFA, APACHE II, logistic EuroSCORE, standard EuroSCORE, and ACEF score). Moreover, it is an easy-to-use tool since it only requires four risk factors for its calculation.     

Distribution and hydrolytic enzyme characteristics of Candida albicans strains isolated from diabetic patients and their non-diabetic consorts

Introduction:  The aim of this study was to investigate the oral colonization profile of Candida albicans strains isolated from diabetic patients and their non-diabetic consorts. In addition hydrolytic enzyme activity of these isolates was analysed.
Methods:  The genetic diversity of C. albicans oral isolates from 52 couples was established using isoenzyme marker and cluster analysis. Hydrolytic enzyme characteristics, namely secreted aspartyl proteinases (SAPs) and phospholipases (PLs) were also analysed.
Results:  Simultaneous colonization by C. albicans was observed in the consorts of 12 couples (23.1%). Patterns of monoclonal and polyclonal oral colonization by C. albicans strains were identified and the coexistence of identical or highly related strains was observed in both members of eight couples. The genetic diversity observed in the total yeast population revealed four large, genetically distinct groups (A to D) and the coexistence of strains in couples or consorts conjugally unrelated. SAP and PL activity was observed in the majority of C. albicans isolates without any association to particular strain, strain clusters (highly related isolates), or clinical characteristics of the consorts (diabetic, non-diabetic, and gender).
Conclusion:  Possible sources of transmission and oral propagation of groups (clusters) of strains of C. albicans can occur between diabetic and non-diabetic consorts. A conjugal genotypic identity exists in most C. albicans -positive couples, that is, both consorts share identical or highly related strains; however, this identity is not couple-specific as seen by the coexistence of clusters in couples and unrelated consorts.     

Longitudinal associations of visit satisfaction and treatment alliance with outcomes in pediatric obesity clinic visits

Relationships between health care providers and families may be critical to effective weight management for youth with obesity. In this study, 50 youth with obesity (ages 5–16) and their caregivers completed questionnaires at three successive obesity clinic visits. Results suggest that visit satisfaction and treatment alliance contribute positively to parent/youth self-efficacy and self-reported treatment adherence. However, more weight loss was associated with less favorable treatment alliance and visit satisfaction. Findings suggest that an optimal approach to weight management may require a balance between maintaining a positive rapport and challenging families to make and sustain meaningful lifestyle changes.