Biomedical subjects
D Flores
Publications and source records attributed to D Flores.
The advantages of demand over fixed-rate pacing. Report of clinical experience.
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New triple screen test for Down syndrome: combined urine analytes and serum AFP.
In this study we report a new triple test that combines serum AFP, urine beta-core fragment of hCG, total urine estriol, and maternal age for calculating individual Down syndrome odds in the second trimester. The urine beta-core fragment/estriol ratio was used as a single screening variable. Analyte levels were measured prospectively in 10 Down syndrome cases and 346 normals. Individual Down syndrome odds were calculated by multiplying the product of the Down syndrome likelihood ratios of serum AFP and urine beta-core/estriol levels by the age-related midtrimester risk. The screening efficiency of an algorithm that combines urine beta-core/estriol with maternal age was compared to one that included serum AFP data. A 90% detection rate for Down syndrome was obtained at a 4.65% false positive rate. This was superior to the 75% sensitivity at 5% false positive rate observed when beta-core/estriol and age alone were used. This new triple test has a higher screening efficiency than that generally reported for the traditional serum triple screen and other urine tests, and it also provides information on the risk of neural tube defects. If confirmed in larger trials, the new algorithm could be used as an alternative to the traditional serum triple screen.
Left ventricular diastolic dysfunction secondary to hyperglycemia in patients with type II diabetes.
Diabetes mellitus type II, a cause of preclinical left ventricular dysfunction that can progress to cardiac insufficiency ventricular dysfunction in diabetic patients, is attributed to systemic arterial hypertension, or ischemic cardiopathy. Diastolic ventricular dysfunction takes place during the course of diabetes mellitus. The purpose of the present article is to report on the influence of hyperglycemia on the left ventricular diastolic dysfunction independently of dyslipidemia, obesity, and systemic arterial hypertension, usually present in diabetic patients. Left ventricular diastolic function was studied by Doppler echocardiography in asymptomatic type II diabetic patients without ischemic or valvular cardiopathies, cardiomegaly, or systemic arterial hypertension. Two groups of patients were integrated: patients with and without left ventricular diastolic dysfunction, i.e., groups A and B, respectively. Glycemia, cholesterol, triglycerides, and body mass index (BMI) were determined in each subject. Bivariate statistical tests (Student t, chi-square, or Mann-Whitney U tests) were applied to study the influence of the previously mentioned variables on the ventricular diastolic function. To evaluate the influence of hyperglycemia on ventricular diastolic function separately from dyslipidemia, systemic arterial hypertension, and the influence of obesity, logistic regression, and multivariate statistical analysis were applied. Independently of dyslipidemia and obesity, a relationship was found between hyperglycemia and diastolic dysfunction of the left ventricle in patients belonging to group A (p <0.05, odds ratio [OR] 12.1). No statistical significance was found between glycemia and the diastolic function of the left ventricle in group B patients. Even in type II diabetic patients without cardiopathy, uncontrolled hyperglycemia provokes diastolic left ventricular dysfunction.
[Calculation of the mitral valve area with the proximal convergent flow method with Doppler-color in patients with mitral stenosis].
In this study we evaluate prospectively a new color Doppler method for calculating the mitral valve area based on identifying a blue-red aliasing interfase proximal to the orifice, corresponding to the flow convergence region (FCR). This method can be used to calculate areas using the continuity equation. We studied 61 patients with stenosis. The mitral valve area was calculated using pressure half-time (PHT) Doppler method which were compared with values that obtained by the FCR method, according to the following formula. AVM (cm2) = 2 pi r2 x VN/Vmax; where "r" is the FCR radius measured from the orifice to the first color aliasing (blue-red interface); VN is Nyquist velocity and Vmax is the peak flow velocity by continuous wave Doppler. Twenty three patients had pure mitral stenosis and 38 double mitral lesion. Twenty patients were on sinus rhythm while 41 in atrial fibrillation. Calculated mitral valve area using the FCR method correlated well with mitral valve area determined by PHT method at a correlation coefficient of r = 0.96 (y = 0.097 x + 54.9, SEE = 0.10 cm2, p < 0.001). MVA by FCR ranged from 0.4 to 2.5 cm2 (mean = 1.19 cm2). MVA by PHT ranged from 0.42 to 2.48 cm2 (mean = 1.15 cm2). Color Doppler FCR method provides an accurate estimate of effective mitral valve area and may be useful as an alternative to the pressure half-time method. The calculated mitral valve area by the FCR method is not influenced by the presence of mitral regurgitation nor atrial fibrillation.