A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURO bservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry

Aims: Given the advances in atrial fibrillation (AF) management and the availability of new European Society of Cardiology (ESC) guidelines, there is a need for the systematic collection of contemporary data regarding the management and treatment of AF in ESC member countries. Methods and results: We conducted a registry of consecutive in- and outpatients with AF presenting to cardiologists in nine participating ESC countries. All patients with an ECG-documented diagnosis of AF confirmed in the year prior to enrolment were eligible. We enroled a total of 3119 patients from February 2012 to March 2013, with full data on clinical subtype available for 3049 patients (40.4% female; mean age 68.8 years). Common comorbidities were hypertension, coronary disease, and heart failure. Lone AF was present in only 3.9% (122 patients). Asymptomatic AF was common, particularly among those with permanent AF. Amiodarone was the most common antiarrhythmic agent used (~20%), while beta-blockers and digoxin were the most used rate control drugs. Oral anticoagulants (OACs) were used in 80% overall, most often vitamin K antagonists (71.6%), with novel OACs being used in 8.4%. Other antithrombotics (mostly antiplatelet therapy, especially aspirin) were still used in one-third of the patients, and no antithrombotic treatment in only 4.8%. Oral anticoagulants were used in 56.4% of CHA 2DS2-VASc = 0, with 26.3% having no antithrombotic therapy. A high HAS-BLED score was not used to exclude OAC use, but there was a trend towards more aspirin use in the presence of a high HAS-BLED score. Conclusion: The EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot Registry has provided systematic collection of contemporary data regarding the management and treatment of AF by cardiologists in ESC member countries. Oral anticoagulant use has increased, but novel OAC use was still low. Compliance with the treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal. © The Author 2013

Soy Isoflavones and Breast Cancer Risk: A Meta-analysis

BACKGROUND/AIM: Soy contains genistein and daidzein isoflavones. Isoflavones are phytoestrogens, with a similarity in structure to human 17-β estradiol hormone. They imitate the action of estrogen on organs by binding and activating estrogen receptors. Numerous studies have examined the relationship between soy consumption and breast cancer but not the amount of consumption itself. We performed a systematic review of the literature in order to determine whether the amount of soy and isoflavones consumed has a positive effect in pre- and post-menopausal women. MATERIALS AND METHODS: Data gathering was performed following PRISMA guidelines. Narrowing down the result set for all relevant data was performed via title, abstract, full-text evaluation and the snowball procedure. The selected articles had all relevant data extracted. Analysis of the data was performed using Cochrane's Review Manager statistical analysis tool in order to draw conclusions regarding the positive effect for the amount of soy and isoflavones consumed. RESULTS: Significant results were found when statistically analyzing data from prospective studies which compared soy isoflavones consumption, breast cancer risk and occurrence. The data were indicative of a clear inverse correlation between the amount of isoflavones consumed and breast cancer occurrence in pre- and post-menopausal women. CONCLUSION: The consumption of soy isoflavones can reduce the risk of breast cancer in pre-menopausal and post-menopausal women. Copyright © 2022, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved

Ulipristal acetate for uterine fibroids: A systematic review and meta-analysis

Ulipristal acetate (UA), a selective progesterone modulator, has been approved for short-term therapy for symptomatic fibroids. We decided to undertake a systematic review of the best available evidence and draw a more definitive conclusion regarding the efficacy of UA for the management of uterine fibroids. The outcomes included symptomatic relief, quality of life-related parameters, reduction in fibroid size, side effects and recurrence rate. We included four randomised controlled trials which consisted of three trials which compared UA with placebo, and one trial compared it with gonadotropin-releasing hormone analogues for symptomatic relief. The three trials comparing UA with placebo reported significant improvement in symptoms related to excessive uterine bleeding as evidenced by the attainment of amenorrhea or reduction in pictorial blood assessment chart. However, due to the heterogeneity of the available data, a meta-analysis was possible only for one the outcomes - attainment of amenorrhea which indicated improvement in symptoms [57.88 (19.81-169.16); p < 0.00001]. The improved quality of life parameters and reduction in fibroid size was noted in the UA group. With regards to adverse events, even though the three included studies reported increased non-physiological endometrial-related changes following UA, these changes reverted back to normal within 6 months. Short-term use of UA seems to be an effective and safe method of treating uterine fibroids. © 2015 Taylor & Francis

Undiagnosed vertebral hemangioma causing a lumbar compression fracture and epidural hematoma in a parturient undergoing vaginal delivery under epidural analgesia: a case report [Un hémangiome vertébral non diagnostiqué provoque une fracture lombaire par compression et un hématome péridural chez une parturiente accouchant par voie vaginale sous analgésie péridurale: une présentation de cas]

Introduction: Vertebral hemangiomas are benign vascular tumours of the bony spine which are usually asymptomatic. Pregnancy-related anatomical and hormonal changes may lead to expansion of hemangiomas and development of neurological symptoms. We present an unusual case of vertebral fracture due to an undiagnosed hemangioma presenting as postpartum back pain following epidural analgesia. Case presentation: A multiparous female with an unremarkable history developed intense lumbar pain after vaginal delivery under epidural analgesia. The pain was attributed to tissue trauma associated with the epidural technique. The patient had no clinical improvement with analgesics, and her symptoms deteriorated over the following days. A magnetic resonance imaging scan revealed an acute fracture of the second lumbar vertebra (L2) with epidural extension and mild compression of the dural sac, suggesting hemangioma as the underlying cause. The patient underwent successful spinal surgery with pedicle screw fixation to stabilize the fracture. Conclusion: Vertebral fractures secondary to acute expansion of a vertebral hemangioma rarely occur during vaginal delivery. In such cases, the labour epidural technique and analgesia may challenge the physician in making the diagnosis. Postpartum severe back pain should be thoroughly investigated even in the absence of neurological deficits, and osseous spinal pathology should be considered in the differential diagnosis. © 2015, Canadian Anesthesiologists' Society

An intelligent web recommendation system for ubiquitous geolocation awareness

Because of the rapid development of World Wide Web in recent years, it has become the basic source of information for millions of people around the world. However, the huge volume of data transferred through the web often causes confusion to users, who are often unable to select the kind of information that is actually suitable to their needs. This is where ubiquitous computing techniques should provide relevant information regarding products and services related to the users' needs. This paper presents such a system, the main goal of which is to select among a set of users, those who are most likely to be interested in specific events. For our approach, we employed a ubiquitous information system along with web 2.0 geospatial API technology and we tested it over simulated and real-life data

GnRH antagonist rescue of a short-protocol IVF/ICSI cycle & GnRH agonist triggering to prevent ovarian hyperstimulation syndrome: Two case reports

Objective: To describe two clinical cases concerning patients at risk of developing severe ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF) stimulation. Design: Description of clinical management and outcomes of patients using an IVF antagonist rescue protocol to prevent OHSS. Setting: Reproductive medicine unit, University Hospital. Materials and Methods: Two infertile patients undergoing controlled ovarian stimulation (COS) for IVF/intracytoplasmic sperm injection (ICSI) presenting with high risk of OHSS. IVF/ICSI patients following COS under short protocol and high risk of OHSS were managed by withdrawing the aganist and replacing it with an antagonist and triggering ovulation with an agonist bolus. Main outcome measures included incidence of OHSS, oocytes retrieved, and pregnancy rates. Results: None of the two patients developed OHSS. None of the patients had metaphase II retrieved oocytes at oocyte retrieval. Conclusions: Use of COS with short protocol in an IVF/ICSI cycle carrics a risk of severe OHSS. Rescuing the cycle by withdrawing the agonist and replacing it with an antagonist and triggering ovulation with an agonist bolus is not always effective and should not be used if short time interval between agonist replacement with antagonist and ovulation triggering is available

Morbus Burneville: A case report and review of the literature

Tuberous sclerosis (TS) or tuberous sclerosis complex (TSC), also known as Bourneville disease or Bourneville-Pringle disease, is an autosomal dominant disorder classically characterized by the presence of hamartomatous growths in multiple organs . A combination of symptoms may include seizures, developmental delay, behavioral problems, skin abnormalities, and lung and kidney diseases. The authors present a case of a 18 year-old female patient with a history of TS, epileptic episodes, mental retardation, and papillary formations in multiple organs located at the abdominal, axillary, cervical, facial, and genital region

Plexiform tumorlet in a woman with postmenopausal endometrioid endometrial carcinoma taking tamoxifen for breast cancer: A case report

Leiomyomas are the most common benign smooth muscle tumors of the female genital tract. Among the recognized histologic variants, one of the least common is plexiform leiomyoma. When they are small, even microscopic findings, they are referred to as plexiform tumorlets. In this report the authors describe a case of plexiform tumorlet found incidentally in the hysterectomy specimen of a 64-year-old woman with concomitant endometrioid endometrial carcinoma and a previous history of invasive lobular breast carcinoma. The endometrioid endometrial carcinoma arising on a polyps was diagnosed in a curettage specimen. In the hysterectomy specimen there was no residual endometrioid endometrial carcinoma. Six uterine leiomyomas were found. A small (3 mm) well circumscribed tumor was located in the uterine wall. Histologically it consisted of small nests, islands, cords, and tubules of relatively uniform, round to oval cells surrounded by loose stroma. The differential diagnosis was challenging, and included plexiform leiomyoma, uterine tumor resembling ovarian sex cord tumor, endometrial stromal tumor, and poorly differentiated endometrial or metastatic invasive lobular breast carcinoma. After careful morphologic evaluation and appropriate use of immunohistochemical stains the diagnosis of plexiform tumorlet was made. © 202