Biomedical subjects

Jorge Oseguera

Publications and source records attributed to Jorge Oseguera.

8 recordsLinked to original sources

PubMed2005

[Cardiac involvement in Kearns-Sayre syndrome].

The mitochondrial cytopathies or oxidative-phosphorylation diseases are a diverse group of disorders that result from the structural, biochemical, or genetic derangement of mitochondria. Because mitochondrial dysfunction can affect the most highly energy-dependent organs, cardiac involvement is frequent in these diseases. To identify the clinical features of Kearns-Sayre syndrome, an entity associated with this group of diseases, we evaluated cardiac structure and function in 5 patients with Kearns-Sayre syndrome and followed the clinical course of these patients for 5 years.

Adult↗

PubMedDate not supplied

Clinical findings as predictors of positivity of head-up tilt table test in neurocardiogenic syncope.

BACKGROUND: Neurocardiogenic (vasovagal) syncope occurs frequently and can be diagnosed with the head-up tilt table (HUTT) test. Our objective in this study was to identify clinical predictors of the positivity of HUTT test in neurocardiogenic syncope. METHODS: We conducted a prospective study of 117 cases (81 women and 36 men, 13-85 years of age) referred to our Institution for HUTT testing. The ability of 10 symptoms and signs of clinical history to predict HUTT positivity were evaluated using logistic regression analysis. RESULTS: We observed a low rate of test-negative cases (24%) and 89 positives. Nearly all positives (87/89) were neurocardiogenic, principally of vasodepressor and mixed types (43 and 34 cases, respectively) and a few were cardioinhibitory (10, mostly young males). Regression analysis established that dizziness, nausea, and diaphoresis in past history were associated with HUTT positivity nearly 25 times more frequently than when absent. CONCLUSIONS: Our three conclusions are that syncope in absence of heart disease accompanied by dizziness, nausea, and diaphoresis may be treated as neurocardiogenic in settings where no HUTT is available. In addition, our low rate of negative tests may have been the result of our reexamining referrals prior to deciding test performance, and high frequency of young males in cardioinhibitory syncope needs further research.

Adolescent↗

PubMedDate not supplied

Effect of bariatric surgery on obstructive sleep apnea and hypopnea syndrome, electrocardiogram, and pulmonary arterial pressure.

BACKGROUND: We evaluated the impact of surgically-induced weight loss on Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS), electrocardiographic changes, pulmonary arterial pressure and daytime sleepiness in morbidly obese patients. METHODS: 16 women and 13 men (n=29) underwent bariatric surgery in a 3-year period. The following tests were performed before and 1 year after surgery: nocturnal polysomnography, daytime Multiple Sleep Latency Test (MSLT), and echocardiogram. RESULTS: Mean age was 37.9+/-11 years (range 20-56). Preoperative body mass index was 56.5+/-12.3 kg/m(2) and it was 39.2+/-8.5 kg/m(2) at 13.7+/-6.6 months follow-up. Performed surgical procedures included: vertical banded gastroplasty in 6, Roux-en-Y gastric bypass in 12, and Distal Roux-en-Y gastric bypass in 11. Weight loss induced by surgery eliminated OSAHS in 46% of obese patients with an important improvement in oxygen saturation. Neck, thorax, waist and hip circumferences decreased significantly after surgical intervention but only neck circumference correlated significantly with the apnea/hypopnea index (Spearman rho=0.63, P <0.0001). Electrocardiographic abnormalities were present in 9 patients (31%) before surgery (sinus arrhythmia, ventricular arrhythmias, and sinus arrest). The number of electrocardiographic abnormalities decreased after surgery but new abnormalities appeared in some patients. Systolic pulmonary arterial pressure significantly decreased in the group of patients in whom OSAHS disappeared after surgery. Daytime sleepiness persisted after surgery in most patients. CONCLUSION: Bariatric surgery effectively reduces respiratory disturbances during sleep and improves pulmonary hypertension. Electro cardiographic abnormalities change after surgery. Daytime sleepiness appeared not to be related to respiratory disturbances during sleep.

Adult↗

PubMedDate not supplied

[Description of the resting electrocardiogram in a series of patients with myasthenia gravis].

UNLABELLED: Myasthenia gravis (MG) is a disease characterized by the presence of acetylcholine receptor-directed autoantibodies. Functional cardiac disorders are the most common since there is no neuro-muscular plate in the heart. Autonomic nervous system is involved in MG, but the cardiac manifestations of such an involvement remain unclear. Previous EKG studies in patients with MG show heterogeneous results. MATERIAL AND METHODS: A retrospective, descriptive and observational study was performed to know the main electrocardiographic characteristics and some autonomic nervous function in a series of patients with MG. RESULTS: One-hundred seventeen patients with EKG were analyzed. Twenty-eight were 47.9 +/- 20 years-old males, and 89 were women of 35.2 +/- 7.7 years (p = 0.001). 49 (41.9%) EKG had no changes, while 68 (58.1%) did. The main QT dispersion was 35.5 +/- 18.4 ms among those with some anomaly (p = 0.27). In 54 (78.3%) patients with an abnormal EKG there was T wave alternans, which was also present in 35 (71.4%) (p = 0.32) patients with normal EKG. CONCLUSIONS: MG is frequently associated to unspecific EKG changes. Dynamic electrocardiography allows a precise evaluation of the kind of cardiac involvement derived from MG, specifically the one related to the autonomic function, that is apparently affected in both the sympathetic and parasympathetic arms.

Adult↗

PubMedDate not supplied

Detection of myocardial viability could be improved by rest GIK (glucose-insulin-potassium solution)-Tc 99m sestamibi compared with TL-201 reinjection, in post myocardial infarction patients.

UNLABELLED: GIK solutions improve detection of myocardium viability after acute infarction because they could change the metabolic conditions, improving myocardial perfusion defects. METHODS AND RESULTS: Seventy four patients (52 men, 22 women, mean age 53.3.08 +/- 12.14 years) with previous myocardial infarction (evolution time, 4.2 +/- 3.1 months) underwent pharmacological stress (dipyridamole), rest redistribution and reinjection Tl-201 image as well rest/stress Tc-99m Sestamibi, after the intravenous administration of GIK (200 g glucose +/- 30 UI regular insuline +/- 40 mEq potassiumchloride/500 mL in continuous infusion during 3 hours), Group A (N = 22) or oral administration of 70 g of glucose+/- 40 mEq of potassium chloride taking in advantage the endogenous insulin secretion, to non-diabetic patients (group B = GB, N = 26) and group C (GC, diabetic patients N = 26). All of the 74 patients received 10 mg of sublingual Isorbide previous to 25 mCi of Tc99m Sestamibi administration in a different 2 days protocol. A total of 1,480 myocardial segments were assessed and numbered, and the severity of perfusion defects in the segments involved, were compared between Thallium 201 rest reinjection and GIK-MIBI as the main objective of the study. Involved territories number: 4.02 +/- 2.50 vs. 6.88 +/- 2.12, p = 0.005 for AD; 5.2 +/- 1.44 vs. 6.35 +/- 1.11, p = 0.05 for RC and 1.58 +/- 1.01 vs. 2.05 +/- 1.05, p = 0.05 Cx. For GIK-MIBI vs. Tl-201 reinjection respectively, and defect severity: 8.2 +/- 6.04 vs. 13.22 +/- 5.38, p = 0.01 for LAD; 11.72 +/- 5.08 vs. 15.13 +/- 4.42, p = 0.005 for RC and 2.66 +/- 2.09 vs. 4.69 +/- 3.58, p = 0.003 Cx . For GIK-MIBI vs. Tl-201 reinjection respectively, were found. CONCLUSION: Our data suggest that GIK-MIBI protocol is a safe and easy procedure which improves the detection of perfusion reversible defects compared with Tl-201 reinjection, obtaining better information regarding myocardial viability, with lower acquisition time and less cost.

Female↗

PubMedDate not supplied

[Impact of optimal medical therapy on the arrhythmias and heart rate variability detected with 24 hour Holter in a series of patients from a heart failure clinic].

UNLABELLED: Pharmacological treatment of heart failure (HF) patients usually induces improvements in their functional class (FC). Heart rate variability and Holter-detected arrhythmias are sudden cardiac death predictors and should be evaluated in the presence of optimal medical treatment. METHODS: We conducted a prospective, observational and linear study to evaluate ventricular arrhythmia presence and heart rate variability through 24-hr Holter. A first recording was made upon admission to the HF clinic and the second was obtained when a stable FC was reached or optimal medication doses where attained. RESULTS: We have controls among 47 patients 11.6 +/- 8.1 months after the enrollment Holter. We have 26 (55.3%) men, with an average age of 60.2 +/- 13.9 years. The main ejection fraction (EF) went from 31.9 to 37.4% during follow-up (p = 0.01). At enrollment, 44.7% of our patients were in a FC I, 27.7% in FC II and 27.7% in FC III. At the end of follow-up, 67.4% were in FC I, 27.9% in FC II and 4.7% in FC III. Time-domain variability did not show significant changes and remained in normal average values. Premature atrial contractions diminished (324.1 +/- 811.1 vs. 316 +/- 809.2) but the ventricular ones went from 1,493.6 +/- 3,530.9 in 24 hours, to 1,582.4 +/- 4,394.5 (p = ns) during control, among those with an EF < 40% and SDNN < 100 ms, we found an increase from 7,026.6 +/- 12,168.8 to 9,336 +/- 16,137.8 PVC's in 24-hours (p = 0.008). CONCLUSION: Optimal medical therapy for heart failure can positively change certain aspects of these patients, but it does not improve the arrhythmic sudden death risk profile.

Arrhythmias, Cardiac↗

PubMedDate not supplied

[Current concepts on sudden death].

Sudden death is defined as the death occurring less than one hour before the onset of the patient's symptoms. It is a severe condition considered a public health issue in several countries and in ours, it accounts for 33 000 to 53 000 annual deaths mainly related to ischemic heart disease. The main cause of sudden death are severe ventricular arrhythmias, but determining what patients are at risk for such an episode is complex, that is why risk stratification is usually a low cost-effective intervention. In the present study, we describe different sudden death risk-stratification strategies. Different sudden death treatment strategies regarding general population have different success rates in different countries, nevertheless, among select high risk populations; the best therapy currently available is the automatic implantable cardioverter-defibrillator. We also discuss other treatment options. In Mexico it is deemed necessary to do an important effort for the early detection, prevention and treatment of sudden death in order to limit the consequences of this problem.

Clinical Trials as Topic↗

PubMedDate not supplied

[Familial hypertriglyceridemia and diabetes mellitus type 2].

Hypertriglyceridemia is a cardiovascular risk factor in type-2 diabetes. However, this abnormality may be caused by several mechanisms. In familial hypertriglyceridemia, a hyperlipidemia associated with type-2 diabetes, plasma accumulation of non atherogenic particles explains the presence of hypertriglyceridemia. Our objective was to compare the prevalence of coronary insufficiency and carotid artery stenosis in patients with type-2 diabetes with or without familial hypertriglyceridemia. Controls were paired against cases based on age, gender, diabetes duration, treatment and other cardiovascular risk factors. Controls had either a normal lipid profile (n=48) or hyperlipidemia (n=15). The intima-media thickness of the carotid arteries was significantly lower in cases compared to controls (0.55 +/- 0.12 vs 0.63 +/- 0.22 in normolipidemic controls and 0.66 +/- 0.18 mm in hyperlipidemic subjects (p=0.02)). Exercise treadmill testing was abnormal in a similar proportion of cases and controls (4.8 vs 6.2%). Incidence of cardiovascular complications was not different between groups. We therefore conclude that severe hypertriglyceridemia due to familial hypertriglyceridemia is not associated with an increased prevalence of symptomatic atherosclerosis in patients with type-2 diabetes.

Carotid Stenosis↗