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Mortality and morbidity in patients with atrial fibrillation and liver cirrhosis

World Journal of Cardiology 2020年第7期12卷 342-350页

作者： Yousef H Darrat Aiman Smer Claude-Samy Elayi gustavo X morales Fahad Alqahtani Mohamad Alkhouli John Catanzaro Jignesh Shah Mohsin Salih Department of Internal Medicine Veterans Affairs Medical CenterLexingtonKY 40515United States Department of Internal Medicine Creighton UniversityOmahaNE 68178United States Department of Internal Medicine University of FloridaJacksonvilleFL 32211United States Cardiac Electrophysiology Grandview Medical CenterBirminghamAL 35243United States Department of Internal Medicine University of KentuckyLexingtonKY 40536United States Department of Internal Medicine West Virginia UniversityMorgantownWV 26506United States Cardiac Electrophysiology Boulder HeartBoulderCO 80303United States Department of Internal Medicine University of Southern IllinoisSpringfieldIL 62702United States

BACKGROUND Atrial fibrillation(AF)is the most common cardiac arrhythmia encountered in clinical ***,the outcomes associated with AF in hospitalized patients with liver cirrhosis are *** To determine the outcomes of hospitalized patients with liver cirrhosis and *** In this study,we examined morbidity and mortality of patients with concomitant AF and liver cirrhosis from the National Inpatient Sample database,the largest publicly available inpatient healthcare database in the United *** A total of 696937 patients with liver cirrhosis were included,45745 of whom had concomitant AF(6.6%).Liver cirrhosis patients with AF had higher rates of inhospital mortality(12.6%vs 10.3%,P<0.001),clinical stroke(1.6%vs 1.1%,P<0.001),and acute kidney injury(28.2%vs 25.1%,P<0.001),and less gastrointestinal bleeding(4.4%vs 5.1%,P<0.001)and blood transfusion(22.5%vs 23.8%,P<0.001)compared with those who did not have the *** addition,they had a longer length of stay(8±10 d vs 7±8 d,P<0.001)and higher hospitalization costs(20720±33210$vs 16272±24166$,P<0.001).CONCLUSION In subjects with liver cirrhosis,AF is associated with higher rates of inpatient mortality,stroke,and acute kidney injury compared to those who do not have the cardiac arrhythmia.

关键词： Atrial fibrillation Liver cirrhosis Mortality Stroke Acute kidney injury Prolonged hospitalization

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Hemoconcentration is a poor predictor of severity in acute pancreatitis

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World Journal of Gastroenterology 2005年第44期11卷 7018-7023页

作者： José M.Remes-Troche Andrés Duarte-Rojo gustavo morales Guillermo Robles-Díaz Department of Gastroenterology

AIM: To determine whether the hematocrit (Hct) at admission or at 24 h after admission was associated with severe acute pancreatitis (AP), organ failure (OF), and pancreatic ***: A total of 336 consecutive patients with a first AP episode were studied. Etiology, Hct values at admission and at 24 h, development of severe AP according to Atlanta's criteria, pancreatic necrosis, OF and mortality were recorded. Hemoconcentration was defined as Hct level ＞44% for males and ＞40% for females. The t-test and χ2 test were used to assess the association of hemoconcentration to the severity, necrosis and *** accuracy was also ***: Biliary disease was the most frequent etiology(n = 148). Mean Hct levels at admission were 41±6%for females and 46±7% for males (P＜0.01). Seventyeight (23%) patients had severe AP, and OF developed in 45 (13%) patients. According to contrast-enhanced computed tomography scan, 36% (54/150) patients showed pancreatic necrosis. Hct levels were elevated in58% (55/96) and 61% (33/54) patients with interstitial and necrotizing pancreatitis, respectively. Neither Hct levels at admission nor hemoconcentration at 24 h were associated with the severity, necrosis or OF. Sensitivity,specificity and positive predictive values for both determinations were very low; and negative predictive values were between 61% and 86%, being the highest value for ***: Hct is not a useful marker to predict a worse outcome in acute pancreatitis. In spite of the high negative predictive value of hemoconcentration, the prognosis gain is limited due to an already high incidence of mild disease.

关键词：血液浓缩急性胰腺炎治疗并发症

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Geochemical elements in suspended particulate matter of Ensenada de La Paz Lagoon,Baja California Peninsula,Mexico:Sources,distribution,mass balance and ecotoxicological risks

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Journal of Environmental Sciences 2024年第2期136卷 422-436页

作者： Sandra Soledad morales-García Pilar de Acacia Pérez-Escamilla Suresh Babu Sujitha Pichaimani Godwyn-Paulson Andrés Felipe Zuniga-Cabezas Muthuswamy Ponniah Jonathan Instituto Politécnico Nacional(IPN) Centro Mexicano para la Producción más Limpia(CMPL)Av.Acueducto s/nCol.Barrio la Laguna TicománDel Gustavo A.MaderoC.P.07340Ciudad de MéxicoMexico Instituto Politécnico Nacional(IPN) Escuela Superior de Ingeniería y Arquitectura(ESIA)Unidad Ticomán***án 600Delg.Gustavo A.MaderoC.P.07340Ciudad de México(CDMX)Mexico Instituto Politécnico Nacional(IPN) Centro Interdisciplinario de Investigaciones y Estudios sobre Medio Ambiente y Desarrollo(CIIEMAD)Calle 30 de Junio de 1520Barrio la Laguna TicománDel.Gustavo A.MaderoC.P.07340Ciudad de MéxicoMéxico

The present study aimed to evaluate multi-element concentrations(Al,As,Ca,Cd,Co,Cr,Cu,Fe,Mg,Mn,Mo,Ni,Pb,Sr)in suspended particulate material(SPM)collected from Ensenada de La Paz(ELP)lagoon,Baja California Sur,Mexico in two different periods(September and May)to comprehend their origin,geochemical behavior,mass transfer and associated ecotoxicological *** 24 hr variation coefficient of volumetric SPM levels were found to be 51.7%in September and 40.5%in May,signifying the effects of oceanic *** calculated enrichment factor(EF)values for all the studied elements were of higher magnitude because of the high surface area and oxide nature of SPM,and in this study,Mo had the highest EF of 46.77 probably due to its origin from continental *** the ecotoxicological perspective,the integrated toxic risk index revealed low toxic risk to the benthic ***,the mean-ERM-Quotient calculated using the particulate concentrations of As,Cd,Cr,Cu,Ni,Pb indicated 9%probability of toxicity to *** comprehensive geochemical and ecotoxicological assessment of particulate metal concentrations in the ELP lagoon signify low to moderate contamination.

关键词： Suspended particulate material Heavy metals Risk assessment Mass transfer Ensenada de La Paz

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Fulminant Hepatitis Associated with Chronic Consumption of 3,4-Methylenedioxy-Methamphetamine;Case Report

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Open Journal of Gastroenterology 2024年第5期14卷 161-166页

作者： Ulises Solis Gomez gustavo Adolfo Hernández Valdez Juan Antonio Contreras Escamilla Ivan Alejandro Medina Jimenez Jorge morales Rojas Jocelyn Nataly Quintero Melendez Marco Antonio González Villar Department of Internal Medicine ISSSTE APP General Hospital of Tepic Tepic Nayarit Mexico

The amphetamine derivative 3,4-methylenedioxymethamphetamine (MDMA), also called ecstasy, is a neurotoxin widely consumed among young people that has increased in recent years because it is a recreational drug, of which immediate effects are known such as a greater sensation of well-being, extroversion, increased sensory perception. However, its long-term effects have been described very little in the medical literature, including damage to the heart, central nervous system, kidney, etc. One of its little-known effects is hepatotoxicity, of which few cases are known associated with fulminant hepatitis, which is a rapidly deteriorating condition that is generally associated with a syndrome of multiple organ dysfunction and death. Therefore, it is very important to know this type of damage in the short and long term. The following case is of a 39-year-old man who came to our service due to jaundice syndrome and the only history of MDMA consumption, who as the days went by met the criteria for fulminant liver failure, with damage to multiple organs (organ dysfunction syndrome).

关键词： Fulminant Hepatitis Acute Liver Failure Methamphetamine Severe Acute Liver Failure in a User of Drugs of Abuse Hepatology

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QT prolongation is associated with increased mortality in end stage liver disease

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World Journal of Cardiology 2017年第4期9卷 347-354页

作者： Sun Moon Kim Bennet George Diego Alcivar-Franco Charles L Campbell Richard Charnigo Brian Delisle Jonathan Hundley Yousef Darrat gustavo morales Samy-Claude Elayi Alison L Bailey Division of Cardiovascular Medicine Gill Heart InstituteUniversity of Ken-tucky Department of Cardiology Summa Health System Division of Cardiovascular Medicine Erlanger Health SystemUniversity of Tennessee College of Medicine Chattanooga Departments of Biostatistics and Statistics University of Kentucky Piedmont Transplant Institute

AIM To determine the prevalence of QT prolongation in a large series of end stage liver disease(ESLD) patients and its association to clinical variables and *** The QT interval was measured and corrected for heart rate for each patient,with a prolonged QT cutoff defined as QT > 450 ms for males and QT > 470 ms for *** clinical variables were evaluated including sex,age,serum sodium,international normalized ratio,creatinine,total bilirubin,beta-blocker use,Model for EndStage Liver Disease(MELD),MELD-Na,and etiology of liver disease. RESULTS Among 406 ESLD patients analyzed,207(51.0%) had QT prolongation. The only clinical variable associated with QT prolongation was male gender(OR = 3.04,95%CI:2.01-4.60,P < 0.001). During the study period,187patients(46.1%) died. QT prolongation was a significant independent predictor of mortality(OR = 1.69,95%CI:1.03-2.77,P = 0.039). In addition,mortality was also associated with viral etiology of ESLD,elevated MELD score and its components(P < 0.05 for all). No significant reversibility in the QT interval was seen after liver transplantation. CONCLUSION QT prolongation was commonly encountered in an ESLD population,especially in males,and served as a strong independent marker for increased mortality in ESLD patients.

关键词：肝硬化 Electrophysiology 心律不齐 QT 延伸死亡肝移植

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Meningoencephalitis due to Listeria monocytogenes in a Young Immunocompetent Patient: Case Report with Literature Review

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Advances in Infectious Diseases 2024年第1期14卷 213-219页

作者： Janette Alejandra Gamiño Gutierrez gustavo Adolfo Hernández Valdez Arleth Anahí Montaño Gómez Jorge morales Rojas Graciela Gaddy Robles Martinez Anahi Herrera Ruelas Alin Kaori Ferreyra Gudiño Jocelin Celeste Jurado Cardona Jimena Jexabeth Ibáñez Núñez Anahí Fierros Ramos Departmento de Neurocirugia Hospital Civil de Guadalajara Fray Antonio Alcalde Guadalajara México Departamento de Medicina Interna ISSSTE Tepic General Hospital APP Tepic México

Meningoencephalitis secondary to Listeria monocytogenes (L. monocytogenes) mainly affects newborns, the elderly and immunocompromised people;there are extremely rare cases in which said infection occurs in immunocompetent individuals. We present the case of a young adult patient without immunocompromise, who developed meningoencephalitis due to L. monocytogenes;This case is exceptional, since it occurred in an individual outside the classic age group, in addition to not having risk factors, which is why it should be considered an atypical causal agent.

关键词： Meningitis Encephalitis Rhombencephalitis Listeria monocytogenes Immunocompetent

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Uremic Bleeding in 2 Patients with Dieulafoy’s Lesion: Case Report and Literature Review

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Open Journal of Gastroenterology 2024年第5期14卷 167-173页

作者： gustavo Adolfo Hernández Valdez Diana Estefanía Ibarra García Juan Antonio Contreras Escamilla Janette Alejandra Gamiño Gutierrez Francisco Manuel Tonatiuh Carrillo Beltran Ulises Solis Gomez Jocelyn Nataly Quintero Meléndez Ivan Alejandro Medina Jimenez Marco Antonio González Villar Jorge Rojas morales Department of Internal Medicine ISSSTE APP General Hospital of Tepic Tepic Nayarit Mexico Hospital Civil de Guadalajara Fray Antonio Alcalde Guadalajara Jalisco M&#233xico

Dieulafoy’s lesions are rare vascular malformations of the gastrointestinal tract. A Dieulafoy’s lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage to this artery can cause severe and intermittent arterial bleeding from small vascular stumps that are difficult to visualize. Furthermore, these catastrophic bleeding episodes frequently result in hemodynamic instability and the need for transfusion of multiple blood products. Recently, uremic syndrome has been identified as a risk factor for gastric mucosal lesions. We present two clinical cases of acute digestive bleeding due to Dielafoy lesion with chronic kidney disease as the main cause, where two different therapies were performed endoscopically. We concluded with the results of our patients that the best therapy was the application of the hemostatic hemoclip on the injury vs the injection with adrenaline on the wound site. Uremia is identified as a risk factor for upper gastrointestinal bleeding in patients with pre-existing Dieulafoy’s lesion, as well as a higher incidence of new bleeding.

关键词： Dieulafoy’s Lesion Gastrointestinal Bleeding Endoscopy Endoscopy Hemostatic Clips Kidney Disease Adrenaline Thermal Coagulation Dieulafoy

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Portal Venous Thrombosis and Splenic Hemangioma, Secondary to Acute Pancreatitis: Case Report

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Open Journal of Gastroenterology 2024年第1期14卷 11-17页

作者： gustavo Adolfo Hernández Valdez Harvey Yair Zamora Veliz Estefany Gilberty Mendoza Verdin Quitzia Mayanim Rentería Fonseca Itzel Velázquez Viniegra Janette Alejandra Gamiño Gutierrez Diana Rita Velázquez Jimenez Florencio Favian Andrade Luis Fernando Baez Bustos Jorge morales Rojas María Jacqueline Martínez Tejeda Graciela Gaddy Robles Martínez Juan Antonio Contreras Escamilla Departamento de Medicina Interna ISSSTE Tepic General Hospital APP Tepic Nayarit México General Surgery Department ISSSTE Tepic General Hospital APP Tepic Nayarit México Hospital Civil Fray Antonio Alcalde Guadalajara Jalisco México

We present an unusual case of portal vein thrombosis with a splanchnic hemangioma secondary to acute biliary pancreatitis. We report a 45-year-old patient, who has systemic arterial hypertension in treatment, was admitted for abdominal pain in the epigastrium, with irradiation to the right hypochondrium, accompanied by nausea and vomiting of 10 occasions of bile content, physical examination with pain in the right hypochondrium, Murphy positive. We have laboratory studies with a lipase of 788, so a diagnosis of pancreatitis is made with an etiology to be determined. The laboratories suggestive of acute biliary pancreatitis (lipase 788.71);an imaging study was subsequently performed (ultrasonography) with the result of stone in the common bile duct. A laparoscopy was performed with relative improvement, so he was discharged and returned 20 days after surgery due to abdominal pain of the same intensity in the left hypochondrium. Ending his hospitalization with a splenectomy for splenic hemangioma with portal vein thrombosis.

关键词： Pancreatitis Esplenic Hemangioma Esplenectomy Portal Vein Thrombosis Surgery

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Digoxin:A systematic review in atrial fibrillation,congestive heart failure and post myocardial infarction

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World Journal of Cardiology 2015年第11期7卷 808-816页

作者： Sebastiano Virgadamo Richard Charnigo Yousef Darrat gustavo morales Claude S Elayi Department of Cardiology University of Kentucky Gill Heart Institute and Veterans Affairs Medical Center

AIM: To review digoxin use in systolic congestive heart failure, atrial fibrillation, and after myocardial infarction. METHODS: A comprehensive Pub Med search was performed using the key words "digoxin and congestive heart failure", "digoxin and atrial fibrillation", "digoxin, atrial fibrillation and systolic congestive heart failure", and "digoxin and myocardial infarction". Only articles written in English were included in this study. We retained studies originating from randomized controlled trials, registries and included at least 500 patients. The studies included patients with atrial fibrillation or heart failure or myocardial infarction and had a significant proportion of patients(at least 5%) on digoxin. A table reviewing the different hazard ratios was developed based on the articles selected. Our primary endpoint was the overall mortality in the patients on digoxin vs those without digoxin, among patients with atrial fibrillation and also among patients with atrial fibrillation and systolic heart failure. We reviewed the most recent international guidelines to discuss current ***: A total of 18 studies were found that evaluated digoxin and overall mortality in different clinical settings including systolic congestive heart failure and normal sinus rhythm(n = 5), atrial fibrillation with and without systolic congestive heart failure(n = 9), and myocardial infarction(n = 4). Overall, patients with systolic congestive heart failure with normal sinus rhythm, digoxin appears to have a neutral effect on mortality especially if close digoxin level monitoring is employed. However, most of the observational studies evaluating digoxin use in atrial fibrillation without systolic congestive heart failure showed an increase in overall mortality when taking digoxin. In the studies evaluated in this systematic review, the data among patients with atrial fibrillation and systolic congestive heart failure, as well as post myocardial infarction were more

关键词： Digoxin Atrial fibrillation Heart failure Myocardi

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Properties of Chemical Bath Deposited PbS Thin Films Doped with Cd2＋

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材料科学与工程（中英文A版） 2011年第6期1卷 759-767页

作者： Oscar Portillo Moreno Melissa Chavez Portillo Miriam Moreno Flores Javier Martinez Juarez gustavo Abarca Avila Rosendo Lozada morales Orlando Zelaya Angel Facultad de Ciencias Quimicas BUAP C. U. Puebla Mexico CIDS-ICUAP C. U. Puebla Mexico Facultad de Ciencias Fisicomatematicas BUAP C. U. Puebla Mexico Departamento de Fisiea Centro de Investigacion y de Estudios Avanzados Av. IPN 2508 Col San Pedro Zacatenco Mexico

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