Enalapril-induced angioedema: A forgotten adverse event.

Angioedema is an edema of skin, mucosa, respiratory, and gastrointestinal tract, due to vascular permeability increase, resulting in plasma extravasation, which has been associated with multiple causes. We describe a case of a patient who was prescribed with enalapril and presented with symptoms suggestive of angioedema.

Causative Agents of Ventilator-Associated Pneumonia and Resistance to Antibiotics in COVID-19 Patients: A Systematic Review.

Patients with coronavirus disease 2019 (COVID-19) have an increased risk of ventilator-associated pneumonia (VAP). This systematic review updates information on the causative agents of VAP and resistance to antibiotics in COVID-19 patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, and LILACS databases from December 2019 to December 2021. Studies that described the frequency of causative pathogens associated with VAP and their antibiotic resistance patterns in critically ill COVID-19 adult patients were included. The Newcastle-Ottawa Quality Assessment Scale was used for critical appraisal. The data are presented according to the number or proportions reported in the studies. A total of 25 articles were included, involving 2766 VAP cases in COVID-19 patients (range 5-550 VAP cases). Most of the studies included were carried out in France (32%), Italy (20%), Spain (12%) and the United States (8%). Gram-negative bacteria were the most frequent causative pathogens of VAP (range of incidences in studies: P. aeruginosa 7.5-72.5%, K. pneumoniae 6.9-43.7%, E. cloacae 1.6-20% and A. baumannii 1.2-20%). S. aureus was the most frequent Gram-positive pathogen, with a range of incidence of 3.3-57.9%. The median incidence of Aspergillus spp. was 6.4%. Few studies have recorded susceptibility patterns among Gram-negative causative pathogens and have mainly reported extended-spectrum beta-lactamase (ESBL), AmpC, and carbapenem resistance. The median frequency of methicillin resistance among S. aureus isolates was 44.4%. Our study provides the first comprehensive description of the causative agents and antibiotic resistance in COVID-19 patients with VAP. Gram-negative bacteria were the most common pathogens causing VAP. Data on antibiotic resistance patterns in the published medical literature are limited, as well as information about VAP from low- and middle-income countries.

Late Infective Endocarditis Associated with an Atrial Septal Defect Occluder Device.

The Amplatzer septal occluder is one of several percutaneous devices used for the closure of secundum atrial septal defects. The main complications are related to the procedure, with infection being the least common. We present the case of a 67-year-old woman with a secundum atrial septal defect, who, 3 years after repair with an Amplatzer occluder, was admitted with sepsis and bacteraemia following recent hospitalization in an intensive care unit. Transoesophageal echocardiography showed the presence of a mobile echogenic structure in the left atrium suggestive of a vegetation. Few cases of late endocarditis involving the Amplatzer device have been reported, even though partial endothelization is one of the risk factors. There are no guidelines for the prevention, diagnosis or management of this complication. LEARNING POINTS: The Amplatzer septal occluder is one of several alternatives for the closure of atrial septal defects and has few related complications, with infection being the least common.Device-related endocarditis presents either early (<6 months) or late (>6 months).In our case, transoesophageal echocardiography played a key role in the diagnosis of late endocarditis.

Estado del arte del síndrome cardiorrenal, ventajas y limitaciones de las terapias conocidas / State of the art of cardiorenal syndrome, advantages and limitations of known therapies

Resumen Las interacciones entre las enfermedades cardiacas y las renales se han clasificado como síndromes cardiorrenales. La clasificación actual incluye cinco subtipos: insuficiencia cardiaca aguda que conduce a insuficiencia renal aguda (tipo 1), insuficiencia cardiaca crónica que conduce a insuficiencia renal (tipo 2), lesión renal aguda que conduce a insuficiencia cardiaca (tipo 3), enfermedad renal crónica que conduce a insuficiencia cardiaca (tipo 4) y afecciones sistémicas que conducen a insuficiencia cardiaca y renal (tipo 5) (tabla 1)1,2. En esta revisión discutimos la definición, la clasificación y la fisiopatología del síndrome cardiorrenal, enfocándonos en el manejo en fases agudas y su recuperación, al exponer la evidencia actualmente disponible de los diuréticos y la ultrafiltración, con el objetivo de intervenir de manera oportuna a nuestros pacientes al conocer las ventajas y las limitaciones de cada una de las estrategias de manejo en aras de reducir el riesgo de eventos clínicos, rehospitalización y muerte.

Abstract Interactions between heart and kidney disease have been classified as cardiorenal syndromes. The current classification includes five subtypes, which are: acute heart failure leading to acute kidney failure (type 1), chronic heart failure leading to kidney failure (type 2), acute kidney injury leading to heart failure (type 3), chronic kidney disease leading to heart failure (type 4) and systemic conditions leading to heart and kidney failure (type 5) (table 1)1,2. In this review, we discuss the definition, classification, pathophysiology, focusing on acute phases treatment and its recovery, exposing the actual evidence for diuretics and ultrafiltration in order to intervene in a timely manner, pointing out the main advantages and limitations of each of the available strategies of treatment in order to reduce the risk of clinical events, re-hospitalization and death.

Prognostic Factors in Hospitalized COVID-19 Patients at the Start of the Pandemic in Colombia: A Retrospective Cohort Study.

Introduction Different factors are critical when assessing COVID-19 mortality, and can explain why severity differs so widely among populations. However, there is little information regarding prognostic factors and mortality in COVID-19 from Latin American countries. Objectives To determine prognostic factors in hospitalized COVID-19 patients and to evaluate the impact of tocilizumab use in patients with hyperinflammatory syndrome and severe disease defined by the National Early Warning Score 2 (NEWS2) with a value greater than or equal to seven points. Materials and methods This retrospective cohort study included hospitalized COVID-19 patients from May to July 2020. A multivariate logistic regression analysis was performed to determine independent factors associated with mortality. Results A total of 136 patients required hospital admission. In-hospital mortality was 39.7%. Mortality was observed to be potentiated by older age, LDH serum levels and the presence of type 2 diabetes mellitus. Lymphopenia and lower PaO2/FiO2 ratio were more common in these patients. Similarly, patients who died were classified more frequently with severe disease. The independent factors associated with in-hospital mortality were age greater than 65 years, type 2 diabetes mellitus, NEWS2 greater than or equal to seven points and LDH greater than 400U/L. The use of Tocilizumab alone was not related with decreased in-hospital mortality. Subgroup analysis performed in patients with hyperinflammation and severe disease showed similar results. Conclusions COVID-19 mortality in hospitalized patients was high and mainly related with older age, comorbidities, LDH and the severity of disease at hospital admission.

Chikunguña, manifestaciones en el sistema nervioso / Chikungunya, manifestations in the nervous system

RESUMEN La infección por el virus de chikunguña tiene como vector el mosquito de la familia Aedes, por lo que está clasificada como arbovirus. Los primeros informes de la enfermedad datan de hace varias décadas, en el continente asiático, y aunque solo recientemente se ha extendido al continente americano, su rápida propagación permite conocer de cerca las manifestaciones clínicas, entre las que se cuenta, con menos frecuencia, el compromiso neurológico; sin embargo, su importancia radica en la severidad de las manifestaciones a nivel del sistema nervioso central y periférico, ocasionando gran discapacidad en los pacientes. El diagnóstico confirmatorio se hace con la detección del ARN viral mediante PCR, y en la mayoría de los casos el tratamiento indicado es la inmunoglobulina. Aún no se ha determinado en forma precisa cuáles son los factores por los que el virus compromete el sistema nervioso.

SUMMARY Chikungunya virus infection has as vector the Aedes family of mosquitos by what is classified as arbovirus, the first reports of the disease date back to several decades, in the Asian continent and although only recently it has spread to the continent American, its rapid spread allows us to know closely the clinical manifestations, among which neurological compromise is less frequent, however its importance lies in the severity of the manifestations at the level of the central nervous system and peripheral; causing great disability in patients. Confirmatory diagnosis is made with the detection of viral RNA by PCR and in most cases the treatment indicated is immunoglobulin. Although, it has not yet been precisely determined, which are the factors by which the virus compromises the nervous system.