CONTEXT: Spontaneous echo contrast (SEC) is a swirling smoke-like image seen inside the heart chambers or in the great vessels. Left Ventricular (LV) dysfunction is known to predispose patients to SEC. The management of SEC is still not as established. Even in patients with atrial fibrillation, SEC does not improve the prediction of cardio-embolic events beyond that of the clinical scoring.
METHODS: Retrospective cross-sectional study.
RESULTS: The study results included 89 patients with SEC. The mean age was 53.9 ± 14.3, with 67% males. The underlying cardiac condition were ischemic heart disease in 68%, non-ischemic cardiomyopathy in 19.3%, and rheumatic valvular heart disease in 12.5%. The most common comorbities were hypertension (54%), renal insufficiency (34%), and diabetes mellitus (34%). Nineteen percent of the patients were in atrial fibrillation. The location of the SEC was in the left ventricle in 90%. The mean ejection fraction was 34.8 ± 16.3% and the ejection fraction was < 35% in 64%. Eighty eight percent had segmental to global hypokinesia. The prevalence of cardio-embolic events was 10%, of which 9.0% presented as stroke, while only 1.0% presented with acute limb ischemia.
CONCLUSION AND RECOMMENDATIONS: SEC is an imaging phenomenon that is associated with LV dysfunction with 64% of the patients with an EF of ? 35%. The presence of SEC increases the occurrence of cardio- embolic events in this population with a prevalence of 10% compared to the reported incidence of 1.8 - 2.4% incidence among patients with LV systolic dysfunction. Albeit in higher percentages, the most common co-morbid conditions are also the same risk factors that are independently associated with increased cardiovascular events. That is why the association of SEC with cardio-embolic events as well as its management, is still not well established, and recommendations on anticoagulation still depend on established clinical scoring. Further study that would associate the different characteristics and co-morbid conditions of patients with SEC to cardio-embolic event is in order.

Human ; Male ; Female ; Adult ; Atrial Fibrillation ; Heart Ventricles ; Hypokinesia ; Embolism ; Stroke ; Coronary Artery Disease ; Diabetes Mellitus ; Heart Valve Diseases ; Renal Insufficiency ; Hypertension

The efficacy and safety of a single tablet regimen (STR) of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (E/C/F/TDF) were analyzed in Phase 3 clinical trials in antiretroviral therapy (ART)-naïve and ART-experienced Asian subjects infected with human immunodeficiency virus (HIV)-1. Studies GS-US-236-102 and GS-US-236-103 were randomized, double-blind, placebo-controlled, 144-week studies conducted in ART-naïve subjects, comparing E/C/F/TDF versus efavirenz (EFV)/F/TDF or ritonavir-boosted atazanavir (ATV+RTV) plus emtricitabine/tenofovir DF (F/TDF), respectively. Studies GS-US-236-115 and GS-US-236-121 were randomized, open-label, 96-week long conducted in ART-experienced subjects, who switched to E/C/F/TDF from ritonavir-boosted protease inhibitors (PI+RTV)+F/TDF, or non-nucleoside reverse transcriptase inhibitors (NNRTI)+F/TDF regimens. The E/C/F/TDF appeared to have sustained efficacy and safety and was well tolerated in the small number of ART-naïve and ART-experienced Asian subjects.
Asian Continental Ancestry Group* ; Atazanavir Sulfate ; HIV* ; HIV-1* ; Humans ; Humans* ; Protease Inhibitors ; Reverse Transcriptase Inhibitors

Introduction: To date, there are no reference intervals for prothrombin time (PT) and activated partial thromboplastin time (APTT) based on “normal” Filipino adults. The common practice in most laboratories is to adopt manufacturer provided values or foreign literature even if the importance of establishing or at least verifying laboratory reference intervals has been stressed by Clinical Laboratory Standards Institute (CLSI). Objectives: Here we aim to describe our experience in using a simple non-parametric method to generate reference intervals for PT and APTT, from healthy Filipino volunteer blood donors. Methodology: We used a de novo, a priori non-parametric estimation method following the CLSI guidelines on establishing reference intervals. Results: The non-parametric lower reference limit for PT is 12.55 seconds, with 90% confidence interval of 12.3 to 12.75 seconds. While the non-parametric upper reference limit for PT is 16.15 seconds, with 90% confidence interval of 15.55 to 16.55 seconds. The non-parametric lower reference limit for activated partial thromboplastin time is 26.12 seconds, with 90% confidence interval of 22.95 to 27.1 seconds, and the non-parametric upper reference limit for activated partial thromboplastin time is 37.44 seconds, with 90% confidence interval of 36.75 to 38.65 seconds. The PT and APTT reference intervals were different from foreign sources and manufacturer provided values in terms of interval width and values of the reference limits by 2 to 4 seconds. Conclusion and Recommendations Estimation of coagulation reference intervals from volunteer health blood donors is doable, simple, and practical. Collaborative multi-center efforts may be done to expand the pool of reference individuals that are included and increase the representativeness of the reference intervals generated. This simple method can also be used to generate reference intervals for other clinical laboratory assays and may also be extended to at least verify reference intervals in special populations like pregnant women, the elderly, and the pediatric population.
Prothrombin Time ; Partial Thromboplastin Time

A variety of methods for testosterone replacement therapy (TRT) exist, and the major potential risks of TRT have been well established. The risk of developing polycythemia secondary to exogenous testosterone (T) has been reported to range from 0.4% to 40%. Implantable T pellets have been used since 1972, and secondary polycythemia has been reported to be as low as 0.4% with this administration modality. However, our experience has suggested a higher rate. We conducted an institutional review board-approved, single-institution, retrospective chart review (2009-2013) to determine the rate of secondary polycythemia in 228 men treated with subcutaneously implanted testosterone pellets. Kaplan-Meyer failure curves were used to estimate time until the development of polycythemia (hematocrit >50%). The mean number of pellets administered was 12 (range: 6-16). The mean follow-up was 566 days. The median time to development of polycythemia whereby 50% of patients developed polycythemia was 50 months. The estimated rate of polycythemia at 6 months was 10.4%, 12 months was 17.3%, and 24 months was 30.2%. We concluded that the incidence of secondary polycythemia while on T pellet therapy may be higher than previously established.
Adult ; Aged ; Androgens/adverse effects* ; Drug Implants ; Hematocrit ; Hormone Replacement Therapy/methods* ; Humans ; Hypogonadism/drug therapy* ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Polycythemia/epidemiology* ; Retrospective Studies ; Testosterone/adverse effects*