A variety of diagnostic criteria for neuroleptic malignant syndrome (NMS) have been used in clini... more A variety of diagnostic criteria for neuroleptic malignant syndrome (NMS) have been used in clinical studies of this disorder, but it is not known if different criteria consistently identify NMS. This study examines agreement between three frequently used sets of diagnostic criteria in a series of possible NMS episodes. All clinically suspected NMS episodes occurring at a large tertiary psychiatric facility during a 6-year period were evaluated by three different sets of diagnostic criteria. Agreement among these criteria was quantified statistically by means of the kappa and intraclass correlation coefficients. The NMS diagnostic criteria examined generally demonstrated only fair agreement with one another in the diagnosis of NMS. Agreement was best among these criteria when the "probable" category was employed. A complex interaction involving both definition and structure of individual diagnostic criteria and designation of criteria as major or minor appears to contribute to these findings. The published diagnostic criteria used in this study do not consistently identify NMS episodes and demonstrate different thresholds for assigning this diagnosis. These differences are not due solely to different definitions of individual criteria (e.g., fever). Possible implications of these findings for clinical practice and research are discussed.
Journal of Pharmacology and Experimental Therapeutics
3H-l-Alprenolol, a potent competitive beta adrenergic antagonist, binds to sites in rat pineal gl... more 3H-l-Alprenolol, a potent competitive beta adrenergic antagonist, binds to sites in rat pineal gland membranes. The properties of these binding sites were compared to those of the receptors which mediate the beta adrenergic activation of pineal adenylate cyclase. Both sites are highly stereospecific. The l-stereoisomers of alprenolol and propranolol were at least two orders of magnitude more potent than the d-stereoisomers in inhibiting isoproterenol-stimulated adenylate cyclase or 3H-l-alprenolol binding. The dissociation constants (Kd) of the l-stereoisomers of both alprenolol and propranolol were 10 to 22 nM as determined by competition for binding sites or by inhibition of isoproternol-stimulated adenylate cyclase. Beta adrenergic agonists which stimulated adenylate cyclase also competitively inhibited the binding of 3H-l-alprenolol. They showed the same order of potency (isoproterenol greater than norepinephrine greater than or equal to epinephrine) and the same individual affinities in the two systems. Alpha adrenergic blockers were ineffective in inhibiting either adenylate cyclase stimulation or 3H-l-alprenolol binding. Isoproternol stimulation of adenylate cyclase acrivity, and 3H-l-alprenolol binding, were rapid and rapidly reversible. The 3H-l-alprenolol binding sites were saturable and bound 0.6 pmol of ligand per mg of added protein. The data suggest that the binding of 3H-l-alprenolol occurs at sites indistinguishable from the pineal beta adrenergic receptor.
We examined a patient who exhibited Gerstmann's syndrome (left-right disorientati... more We examined a patient who exhibited Gerstmann's syndrome (left-right disorientation, finger agnosia, dyscalculia, and dysgraphia) in association with a perioperative stroke in the right parietal lobe. This is the first description of the Gerstmann tetrad occurring in the setting of discrete right hemisphere pathologic findings. A well-localized vascular lesion was demonstrated by computed tomography, magnetic resonance imaging, and single-photon emission computed tomographic studies. The patient had clinical evidence of reversed functional cerebral dominance and radiologic evidence of reversed anatomic cerebral asymmetries.
Hellenic journal of cardiology: HJC = Hellēnikē kardiologikē epitheōrēsē
Acute aortic syndrome (AAS) is a term that is used to describe a similar clinical profile that ma... more Acute aortic syndrome (AAS) is a term that is used to describe a similar clinical profile that may have different underlying pathophysiological mechanisms. It includes classic aortic dissection, intramural aortic hematoma, and penetrating atherosclerotic ulcer. We describe the case of a 77-year-old female who presented with syncope of unknown duration. The chest X-ray was suggestive of a widened mediastinum. The initial work-up with a computed tomography scan and transesophageal echocardiogram failed to diagnose a penetrating atherosclerotic ulcer. We discuss the importance of a high degree of clinical suspicion for AAS and the utility of different imaging technologies in making the diagnosis.
Journal of cardiovascular electrophysiology, Jan 23, 2015
Atrial fibrillation (AF) related cardioembolic cerebrovascular accidents (CVA) are well-known mas... more Atrial fibrillation (AF) related cardioembolic cerebrovascular accidents (CVA) are well-known massive health care problems worldwide.(1, 2) It has been estimated that 2.2 million individuals in America and 4.5 million in Europe have paroxysmal or persistent AF.(3) AF is associated with an increased long-term risk of embolic CVA.(4) The rate of stroke among patients with non-valvular AF averages 5% per year.(5-7) Additionally, the prevalence of AF and the associated risk of ischemic stroke might be to a large extent underestimated given that AF is frequently asymptomatic and undiagnosed.(8) This was corroborated by a recent study, which revealed that subclinical atrial tachyarrhythmias without clinical AF occurred often in patients with pacemakers and were linked to a greater risk of ischemic stroke or systemic embolism.(9) Moreover, prolonged cardiac monitoring with 30-day event monitor or implantable loop recorders has dramatically increased the connection between AF and the so-cal...
The performance of Polyethylene (PE)/Clay/Silver nanocomposites is dependent to a great extent on... more The performance of Polyethylene (PE)/Clay/Silver nanocomposites is dependent to a great extent on the properties of filler-matrix interface. To improve the interfacial properties in PE/Clay/Silver composites, different types of compatibilizers or adhesion promoters were introduced. The compatibilization provided by maleic anhydride (MA), itaconic acid (IA) and 2-[2-(dimethylamine)-ethoxy] ethanol (DMAE) functionalized PEs for forming PE-based nanocomposites was studied and compared. IA was grafted into PE by melt mixing to obtain PEgIA (compatibilizer 1), thereafter, PEgIA and PEgMA (compatibilizer 2) were reacted with DMAE also by melt mixing to obtain PEgI-DMAE (compatibilizer 3) and PEgM-DMAE (compatibilizer 4). These compatibilizers were reacted using ultrasound with a solution of AgNO3 0.04 M and ethylene glycol. Ammonium hydroxide was added in a ratio of 2:1 M with respect to silver nitrate. These silver coated compatibilizers were mixed with PE and with a quaternary ammonium ...
Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and represents a major... more Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and represents a major burden to health care systems. Atrial fibrillation is associated with a 4- to 5-fold increased risk of thromboembolic stroke. The pulmonary veins have been identified as major sources of atrial triggers for AF. This is particularly true in patients with paroxysmal AF but not always the case for those with long-standing persistent AF (LSPAF), in which other locations for ectopic beats have been well recognized. Structures with foci triggering AF include the coronary sinus, the left atrial appendage (LAA), the superior vena cava, the crista terminalis, and the ligament of Marshall. More than 30 studies reporting results on radiofrequency ablation of LSPAF have been published to date. Most of these are observational studies with very different methodologies using different strategies. As a result, there has been remarkable variation in short- and long-term success, which suggests that the optimal ablation technique for LSPAF is still to be elucidated. In this review we discuss the different approaches to LSPAF catheter ablation, starting with pulmonary vein isolation (PVI) through ablation lines in different left atrial locations, the role of complex fractionated atrial electrograms, focal impulses and rotor modulation, autonomic modulation (ganglionated plexi), alcohol ablation, and the future of epicardial mapping and ablation for this arrhythmia. A stepwise ablation approach requires several key ablation techniques, such as meticulous PVI, linear ablation at the roof and mitral isthmus, electrogram-targeted ablation with particular attention to triggers in the coronary sinus and LAA, and discretionary right atrial ablation (superior vena cava, intercaval, or cavotricuspid isthmus lines).
Atrial fibrillation (AF) is the most common arrhythmia in the elderly population and it is associ... more Atrial fibrillation (AF) is the most common arrhythmia in the elderly population and it is associated with a four-fold to five-fold increased risk of thromboembolic events. It was not until the mid-1950s that the left atrial appendage (LAA) was identified as the main location of thrombus formation, particularly in patients with non-valvular AF. In this review, we explain at some extent its embryology, anatomy and physiology, and as well as the clinical and pre-clinical trials published to date testing the safety and efficacy of most LAA closure devices. Among those devices, the most studied include the PLAATO system (ev3 Endovascular, Plymouth, MN), the Amplatzer cardiac plug (St Jude, Golden Valley, MN; St. Jude Medical, Minneapolis, MN), the WATCHMAN device (Boston Scientific, Plymouth, MN; Atritech Inc., Plymouth, MN), and the LARIAT device (SentreHEART, Palo Alto, CA). Similarly, newer LAA closure devices currently under investigation such as the Transcatheter Patch (Custom Medical Devices, Athens, Greece), AEGIS, and the Coherex WaveCrest (Salt Lake City, UT) will also be discussed. Future perspectives and the need for well-designed prospective studies between devices and new oral anticoagulant drugs are also proposed.
ABSTRACT The aim of this work is to present a numerical simulation of the directional solidificat... more ABSTRACT The aim of this work is to present a numerical simulation of the directional solidification and melting of succinonitrile SCN (SCN: NC(CH 2) 2 CN) in a horizontal Bridgman apparatus. Succinonitrile is a plastic material with low melting point and a thermal response similar to that of many metals. Three kinds of experiments were considered in order to analyze the material phase change behavior inside this furnace: "no growth", "solidification" and "melting" cases. For all cases, the results showed a good qualitative agreement between the experimental and simulated shapes of steady state solid – liquid interfaces. In particular, a remarkable fitting has been achieved for the "no growth" case. For both the "solidification" and "melting" cases, however, some discrepancies, attributed to the major influence of convection on the curvature of the solid – liquid interface produced by the movement of the external jackets, h...
European heart journal cardiovascular Imaging, 2012
Echocardiographic contrast (EC) improves the diagnostic accuracy of suboptimal echocardiograms. I... more Echocardiographic contrast (EC) improves the diagnostic accuracy of suboptimal echocardiograms. In October 2007, the Food and Drug Administration (FDA) placed a black box warning on the label of the perflutren-based agents Definity and Optison, contraindicating their use in patients with pulmonary hypertension (PHT) and unstable cardiopulmonary status, after serious cardiopulmonary reactions occurred in temporal relation to EC administration. In 2008 and 2011, the FDA revised the black box warning allowing their use in this same population. However, limited data exist regarding the safety profile of these agents in patients with PHT. Consecutive hospitalized patients with PHT who were referred for echocardiographic evaluation, but required the use of EC, were included. All our patients received the EC agent Definity. We evaluated these patients for serious adverse events (respiratory decompensation, hypotension, syncope, convulsions, arrhythmias, anaphylactic reactions, or death) oc...
International Oil Conference and Exhibition in Mexico, 2006
Abstract During the last 15 years, polymer gels have become an accepted technology for improving ... more Abstract During the last 15 years, polymer gels have become an accepted technology for improving volumetric sweep efficiency in heterogeneous waterfloods. Water injected subsequent to the gel treatment ideally enters previously unswept zones with significant ...
Various patterns of HIV-1 disease progression are described in clinical practice and in research.... more Various patterns of HIV-1 disease progression are described in clinical practice and in research. There is a need to assess the specificity of commonly used definitions of long term non-progressor (LTNP) elite controllers (LTNP-EC), viremic controllers (LTNP-VC), and viremic non controllers (LTNP-NC), as well as of chronic progressors (P) and rapid progressors (RP). We re-evaluated the HIV-1 clinical definitions, summarized in Table 1, using the information provided by a selected number of host genetic markers and viral factors. There is a continuous decrease of protective factors and an accumulation of risk factors from LTNP-EC to RP. Statistical differences in frequency of protective HLA-B alleles (p-0.01), HLA-C rs9264942 (p-0.06), and protective CCR5/CCR2 haplotypes (p-0.02) across groups, and the presence of viruses with an ancestral genotype in the "viral dating" (i.e., nucleotide sequences with low viral divergence from the most recent common ancestor) support the d...
A variety of diagnostic criteria for neuroleptic malignant syndrome (NMS) have been used in clini... more A variety of diagnostic criteria for neuroleptic malignant syndrome (NMS) have been used in clinical studies of this disorder, but it is not known if different criteria consistently identify NMS. This study examines agreement between three frequently used sets of diagnostic criteria in a series of possible NMS episodes. All clinically suspected NMS episodes occurring at a large tertiary psychiatric facility during a 6-year period were evaluated by three different sets of diagnostic criteria. Agreement among these criteria was quantified statistically by means of the kappa and intraclass correlation coefficients. The NMS diagnostic criteria examined generally demonstrated only fair agreement with one another in the diagnosis of NMS. Agreement was best among these criteria when the "probable" category was employed. A complex interaction involving both definition and structure of individual diagnostic criteria and designation of criteria as major or minor appears to contribute to these findings. The published diagnostic criteria used in this study do not consistently identify NMS episodes and demonstrate different thresholds for assigning this diagnosis. These differences are not due solely to different definitions of individual criteria (e.g., fever). Possible implications of these findings for clinical practice and research are discussed.
Journal of Pharmacology and Experimental Therapeutics
3H-l-Alprenolol, a potent competitive beta adrenergic antagonist, binds to sites in rat pineal gl... more 3H-l-Alprenolol, a potent competitive beta adrenergic antagonist, binds to sites in rat pineal gland membranes. The properties of these binding sites were compared to those of the receptors which mediate the beta adrenergic activation of pineal adenylate cyclase. Both sites are highly stereospecific. The l-stereoisomers of alprenolol and propranolol were at least two orders of magnitude more potent than the d-stereoisomers in inhibiting isoproterenol-stimulated adenylate cyclase or 3H-l-alprenolol binding. The dissociation constants (Kd) of the l-stereoisomers of both alprenolol and propranolol were 10 to 22 nM as determined by competition for binding sites or by inhibition of isoproternol-stimulated adenylate cyclase. Beta adrenergic agonists which stimulated adenylate cyclase also competitively inhibited the binding of 3H-l-alprenolol. They showed the same order of potency (isoproterenol greater than norepinephrine greater than or equal to epinephrine) and the same individual affinities in the two systems. Alpha adrenergic blockers were ineffective in inhibiting either adenylate cyclase stimulation or 3H-l-alprenolol binding. Isoproternol stimulation of adenylate cyclase acrivity, and 3H-l-alprenolol binding, were rapid and rapidly reversible. The 3H-l-alprenolol binding sites were saturable and bound 0.6 pmol of ligand per mg of added protein. The data suggest that the binding of 3H-l-alprenolol occurs at sites indistinguishable from the pineal beta adrenergic receptor.
We examined a patient who exhibited Gerstmann's syndrome (left-right disorientati... more We examined a patient who exhibited Gerstmann's syndrome (left-right disorientation, finger agnosia, dyscalculia, and dysgraphia) in association with a perioperative stroke in the right parietal lobe. This is the first description of the Gerstmann tetrad occurring in the setting of discrete right hemisphere pathologic findings. A well-localized vascular lesion was demonstrated by computed tomography, magnetic resonance imaging, and single-photon emission computed tomographic studies. The patient had clinical evidence of reversed functional cerebral dominance and radiologic evidence of reversed anatomic cerebral asymmetries.
Hellenic journal of cardiology: HJC = Hellēnikē kardiologikē epitheōrēsē
Acute aortic syndrome (AAS) is a term that is used to describe a similar clinical profile that ma... more Acute aortic syndrome (AAS) is a term that is used to describe a similar clinical profile that may have different underlying pathophysiological mechanisms. It includes classic aortic dissection, intramural aortic hematoma, and penetrating atherosclerotic ulcer. We describe the case of a 77-year-old female who presented with syncope of unknown duration. The chest X-ray was suggestive of a widened mediastinum. The initial work-up with a computed tomography scan and transesophageal echocardiogram failed to diagnose a penetrating atherosclerotic ulcer. We discuss the importance of a high degree of clinical suspicion for AAS and the utility of different imaging technologies in making the diagnosis.
Journal of cardiovascular electrophysiology, Jan 23, 2015
Atrial fibrillation (AF) related cardioembolic cerebrovascular accidents (CVA) are well-known mas... more Atrial fibrillation (AF) related cardioembolic cerebrovascular accidents (CVA) are well-known massive health care problems worldwide.(1, 2) It has been estimated that 2.2 million individuals in America and 4.5 million in Europe have paroxysmal or persistent AF.(3) AF is associated with an increased long-term risk of embolic CVA.(4) The rate of stroke among patients with non-valvular AF averages 5% per year.(5-7) Additionally, the prevalence of AF and the associated risk of ischemic stroke might be to a large extent underestimated given that AF is frequently asymptomatic and undiagnosed.(8) This was corroborated by a recent study, which revealed that subclinical atrial tachyarrhythmias without clinical AF occurred often in patients with pacemakers and were linked to a greater risk of ischemic stroke or systemic embolism.(9) Moreover, prolonged cardiac monitoring with 30-day event monitor or implantable loop recorders has dramatically increased the connection between AF and the so-cal...
The performance of Polyethylene (PE)/Clay/Silver nanocomposites is dependent to a great extent on... more The performance of Polyethylene (PE)/Clay/Silver nanocomposites is dependent to a great extent on the properties of filler-matrix interface. To improve the interfacial properties in PE/Clay/Silver composites, different types of compatibilizers or adhesion promoters were introduced. The compatibilization provided by maleic anhydride (MA), itaconic acid (IA) and 2-[2-(dimethylamine)-ethoxy] ethanol (DMAE) functionalized PEs for forming PE-based nanocomposites was studied and compared. IA was grafted into PE by melt mixing to obtain PEgIA (compatibilizer 1), thereafter, PEgIA and PEgMA (compatibilizer 2) were reacted with DMAE also by melt mixing to obtain PEgI-DMAE (compatibilizer 3) and PEgM-DMAE (compatibilizer 4). These compatibilizers were reacted using ultrasound with a solution of AgNO3 0.04 M and ethylene glycol. Ammonium hydroxide was added in a ratio of 2:1 M with respect to silver nitrate. These silver coated compatibilizers were mixed with PE and with a quaternary ammonium ...
Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and represents a major... more Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and represents a major burden to health care systems. Atrial fibrillation is associated with a 4- to 5-fold increased risk of thromboembolic stroke. The pulmonary veins have been identified as major sources of atrial triggers for AF. This is particularly true in patients with paroxysmal AF but not always the case for those with long-standing persistent AF (LSPAF), in which other locations for ectopic beats have been well recognized. Structures with foci triggering AF include the coronary sinus, the left atrial appendage (LAA), the superior vena cava, the crista terminalis, and the ligament of Marshall. More than 30 studies reporting results on radiofrequency ablation of LSPAF have been published to date. Most of these are observational studies with very different methodologies using different strategies. As a result, there has been remarkable variation in short- and long-term success, which suggests that the optimal ablation technique for LSPAF is still to be elucidated. In this review we discuss the different approaches to LSPAF catheter ablation, starting with pulmonary vein isolation (PVI) through ablation lines in different left atrial locations, the role of complex fractionated atrial electrograms, focal impulses and rotor modulation, autonomic modulation (ganglionated plexi), alcohol ablation, and the future of epicardial mapping and ablation for this arrhythmia. A stepwise ablation approach requires several key ablation techniques, such as meticulous PVI, linear ablation at the roof and mitral isthmus, electrogram-targeted ablation with particular attention to triggers in the coronary sinus and LAA, and discretionary right atrial ablation (superior vena cava, intercaval, or cavotricuspid isthmus lines).
Atrial fibrillation (AF) is the most common arrhythmia in the elderly population and it is associ... more Atrial fibrillation (AF) is the most common arrhythmia in the elderly population and it is associated with a four-fold to five-fold increased risk of thromboembolic events. It was not until the mid-1950s that the left atrial appendage (LAA) was identified as the main location of thrombus formation, particularly in patients with non-valvular AF. In this review, we explain at some extent its embryology, anatomy and physiology, and as well as the clinical and pre-clinical trials published to date testing the safety and efficacy of most LAA closure devices. Among those devices, the most studied include the PLAATO system (ev3 Endovascular, Plymouth, MN), the Amplatzer cardiac plug (St Jude, Golden Valley, MN; St. Jude Medical, Minneapolis, MN), the WATCHMAN device (Boston Scientific, Plymouth, MN; Atritech Inc., Plymouth, MN), and the LARIAT device (SentreHEART, Palo Alto, CA). Similarly, newer LAA closure devices currently under investigation such as the Transcatheter Patch (Custom Medical Devices, Athens, Greece), AEGIS, and the Coherex WaveCrest (Salt Lake City, UT) will also be discussed. Future perspectives and the need for well-designed prospective studies between devices and new oral anticoagulant drugs are also proposed.
ABSTRACT The aim of this work is to present a numerical simulation of the directional solidificat... more ABSTRACT The aim of this work is to present a numerical simulation of the directional solidification and melting of succinonitrile SCN (SCN: NC(CH 2) 2 CN) in a horizontal Bridgman apparatus. Succinonitrile is a plastic material with low melting point and a thermal response similar to that of many metals. Three kinds of experiments were considered in order to analyze the material phase change behavior inside this furnace: "no growth", "solidification" and "melting" cases. For all cases, the results showed a good qualitative agreement between the experimental and simulated shapes of steady state solid – liquid interfaces. In particular, a remarkable fitting has been achieved for the "no growth" case. For both the "solidification" and "melting" cases, however, some discrepancies, attributed to the major influence of convection on the curvature of the solid – liquid interface produced by the movement of the external jackets, h...
European heart journal cardiovascular Imaging, 2012
Echocardiographic contrast (EC) improves the diagnostic accuracy of suboptimal echocardiograms. I... more Echocardiographic contrast (EC) improves the diagnostic accuracy of suboptimal echocardiograms. In October 2007, the Food and Drug Administration (FDA) placed a black box warning on the label of the perflutren-based agents Definity and Optison, contraindicating their use in patients with pulmonary hypertension (PHT) and unstable cardiopulmonary status, after serious cardiopulmonary reactions occurred in temporal relation to EC administration. In 2008 and 2011, the FDA revised the black box warning allowing their use in this same population. However, limited data exist regarding the safety profile of these agents in patients with PHT. Consecutive hospitalized patients with PHT who were referred for echocardiographic evaluation, but required the use of EC, were included. All our patients received the EC agent Definity. We evaluated these patients for serious adverse events (respiratory decompensation, hypotension, syncope, convulsions, arrhythmias, anaphylactic reactions, or death) oc...
International Oil Conference and Exhibition in Mexico, 2006
Abstract During the last 15 years, polymer gels have become an accepted technology for improving ... more Abstract During the last 15 years, polymer gels have become an accepted technology for improving volumetric sweep efficiency in heterogeneous waterfloods. Water injected subsequent to the gel treatment ideally enters previously unswept zones with significant ...
Various patterns of HIV-1 disease progression are described in clinical practice and in research.... more Various patterns of HIV-1 disease progression are described in clinical practice and in research. There is a need to assess the specificity of commonly used definitions of long term non-progressor (LTNP) elite controllers (LTNP-EC), viremic controllers (LTNP-VC), and viremic non controllers (LTNP-NC), as well as of chronic progressors (P) and rapid progressors (RP). We re-evaluated the HIV-1 clinical definitions, summarized in Table 1, using the information provided by a selected number of host genetic markers and viral factors. There is a continuous decrease of protective factors and an accumulation of risk factors from LTNP-EC to RP. Statistical differences in frequency of protective HLA-B alleles (p-0.01), HLA-C rs9264942 (p-0.06), and protective CCR5/CCR2 haplotypes (p-0.02) across groups, and the presence of viruses with an ancestral genotype in the "viral dating" (i.e., nucleotide sequences with low viral divergence from the most recent common ancestor) support the d...
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Papers by Jorge Romero