Impact of a specialized outpatient heart failure follow-up program on hospitalization frequency and functional status of patients with advanced heart failure.

BACKGROUND: High rates of morbidity and mortality are observed in patients with advanced heart failure (AHF). AHF is now considered the most costly syndrome in cardiology owing to the substantial economic burden associated with hospitalizations for acute decompensation. A management program that involves specialized follow-up by a multidisciplinary team has been suggested as a desirable strategy for improving outcomes for these patients. ObjectivE: To evaluate the impact of a specialized outpatient heart failure (HF) follow-up program for patients with AHF on frequency and duration of hospitalization for HF and functional status. METHODS: We retrospectively studied 167 consecutive patients with AHF who were referred to the outpatient HF follow-up program in our institution between January and November 2002, of whom 147 followed for > or =30 days were included in the analysis. In addition to demographic and baseline clinical characteristics, HF medication and NYHA functional class, the number and duration of hospitalizations for HF during the previous 12 months were recorded and compared at the time of referral and after a follow-up period of 6.5+/-3 months. RESULTS: Of the 147 patients analyzed (aged 60.8+/-13 years; 79% male; left ventricular ejection fraction 27+/-11%), 67% were in NYHA functional class III, 20% in class II and 13% in class IV at the time of referral. There was a significant improvement in functional class during the mean follow-up period: 55% of the patients were in class III, 37% in class II, 5% in class I and 3% in class IV (p<0.0001). The proportion of patients on beta-blockers or spironolactone increased from 33% and 51% at the time of referral to 69% and 71% respectively after referral (p<0.0001). In the 12 months before referral, 39% of the patients had been hospitalized for acute decompensation of HF (87 hospitalizations - mean 7.2/month) versus 13% of the patients during the mean follow-up period (25 hospitalizations - 3.8/month, p<0.0001). No significant differences were found in the proportion of patients on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, digoxin or diuretics, or in the mean duration of hospitalization before and after referral. ConclusioN: The specialized follow-up of patients with AHF by a team with expertise in HF resulted in significant therapeutic optimization. Increased use of beta-blockers and spironolactone was associated with significant improvement in functional capacity and significant reduction in hospitalizations.     

Clinico-microbiological study of dermatophytoses.

In the present series, 80 cases of dermatophytoses were subjected to mycological examination including microscopy and culture the mycological findings were correlated with clinical presentation of the patients. The isolation rate was 62.5 percent. Fungal culture was successful in 36.25 percent of cases, Trichophyton rubrum being the commonest etiological agent accounting for 55.18 percent of cases.     

Histoenzymology and morphometry of the masticatory muscles of tufted capuchin monkey (Cebus apella Linnaeus, 1758)

Samples of the anterior and posterior regions of the masseter and temporal muscles and of the anterior belly of the digastric muscle of 4 adult male tufted capuchin monkeys (Cebus apella) were removed and stained with HE and submitted to the m-ATPase reaction (with alkaline and acid preincubation) and to the NADH-TR and SDH reactions. The results of the histoenzymologic reactions were similar, except for acid reversal which did not occur in fibers of the fast glycolytic (FG) type in the mandibular locomotor muscles. FG fibers had a larger area and were more frequent in all regions studied. No significant differences in frequency or area of each fiber type were detected, considering the anterior and posterior regions of the masseter and temporal muscles. The frequency of fibers of the fast oxidative glycolytic (FOG) and slow oxidative (SO) types and of FOG area differed significantly between the anterior belly of the digastric muscle and the mandibular locomotor muscle. The predominance of fast twitch (FG and FOG) fibers and the multipenniform and bipenniform internal architecture of the masseter and temporal muscles, respectively, are characteristics that permit the powerful bite typical of tufted capuchin monkeys.     

Télomérisation radicalarie de monomères N-acryloyl-N-alkylamino esters d'intXérêt biologique

Three methyl 11-(N-acryloyl-N-alkylamino)undecanoates were synthesized from acryloyl chloride and amino-or alkylaminoundecanoic acid esters. These compounds were telomerized in the presence of 1-dodecanethiol as telogen to yield telomers with molecular weight lower than 5000. These telomers are likely to generate HIV inhibitor polyanions with good biocompatibility. The K/K_t value was assessed from a kinetic study of the telomerization reaction. NMR spectroscopy analysis indicates that the polymerization degree DP _n are in good agreement with expectation for methyl 11-(N-acryloylamino)undecanoate. However, they were lower than expected for methyl 11-(N-acryloyl-N-alkylamino)undecanoate.     

The accompanying male parent in the intensive care unit

A study is made in the Intensive Care Unit of "José L. Miranda" Provincial Pediatric Teaching Hospital in Santa Clara in order to know the sequence with which the father occupies the place of the mother in the care of hospitalized children. With this objective, 54 male companions are surveyed in the first trimester of 1987. The prevailing occupational profile was that of worker. A higher number of the respondents were between 17 and 25 years of age. The school level of secondary school prevailed among patient companions. Most of them reported no economic inconveniences during the child's disease. The desire to remain at the bedside and the inability of the mother to do so were the major reasons for their stay. The advantages recognized by the nursing personnel in male companions are made known.     

Acute urologic symptoms associated with uterine myoma

While prevalence of uterine leiomyoma is high, its presentation affecting the urinary tract is uncommon. We contribute the cases of two adult women with symptoms of nephritic colic and urinary retention. Etiology was acute obstruction of the urinary tract due to previously asymptomatic urine myomas. Management in both patients was surgery, using hysterectomy to resolve the urinary obstruction. A brief review of the literature is included.     

alpha-dystroglycan isoforms are differentially distributed in adult rat retina

alpha-Dystroglycan (alpha -DG) is a laminin/agrin receptor expressed in skeletal muscle as well as in nervous system and other tissues. Glycosylation of the core protein of alpha-DG is extensive, variable from tissue to tissue, and functionally relevant. To address differential glycosylation of alpha-DG in the retina, we have investigated the distribution of this protein using two different antibodies: 1B7 directed against the core protein of alpha-dystroglycan, and IIH6 directed against a carbohydrate moiety (Ervasti and Campbell [1993] J Cell Biol 122:809-823). Monoclonal antibody 1B7 recognizes a broader band than IIH6, which seems to recognize only a subset of alpha-DG forms in retina. These data reflect the existence of differentially glycosylated isoforms of alpha-DG. Monoclonal antibody 1B7 shows an extensive staining for alpha-DG in the inner limiting membrane as well as in the ganglion cell and inner plexiform layers labeling Müller cell processes, whereas monoclonal antibody IIH6 staining is restricted to the inner limiting membrane and blood vessels. Our data indicate that there are distinct isoforms of alpha-DG that are localized in apposition to basal lamina in the inner limiting membrane and blood vessels or within the parenchyma of the retina along Müller glia. Both isoforms are expressed in a Müller cell line in culture and coimmunoprecipitate with beta-dystroglycan. These data suggest that DGs may participate in organizing synapses and basement membrane assembly in the retina.