Prognostic utility of pulse pressure in patients with heart failure with preserved ejection fraction: The RICA Registry.

BACKGROUND AND AIMS: The prognostic role of pulse pressure (PP) in heart failure (HF) patients with preserved left ventricular ejection fraction (LVEF) is not well understood. Our aim was to evaluate it in acute and stable HF. MATERIAL AND METHODS: This work is a retrospective observational study of patients included in the RICA registry between 2008 and 2021. Blood pressure was collected on admission (decompensation) and 3 months later on an outpatient basis (stability). Patients were categorized according to whether the PP was greater or less than 50mmHg. All-cause mortality was assessed at 1year after admission. RESULTS: A total of 2291 patients were included, with mean age 80.1±7.7 years. 62.9% were women and 16.7% had a history of coronary heart disease. In the acute phase, there was no difference in mortality according to PP values, but in the stable phase PP<50mmHg was independently associated with all-cause mortality at 1-year follow-up (HR 1.57, 95% CI 1.21-2.05, p=0.001), after adjusting for age, sex, New York Heart Association functional class, previous HF, chronic kidney disease, valvular heart disease, cerebrovascular disease, score on the Barthel and Pfeiffer scales, hemoglobin and sodium levels. CONCLUSIONS: Low stable-phase PP was associated with increased all-cause mortality in HF patients with preserved LVEF. However, PP was not useful as a prognostic marker of mortality in acute HF. Further studies are needed to assess the relationship of this variable with mortality in HF patients.

[Clinico-pathological study of cerebral death]. / Estudio clinicopatológico de la muerte encefálica.

INTRODUCTION: We present the experience of the Hospital Provincial Clinico Quirúrgico Saturnino Lora, Santiago de Cuba, in the clinical study of brain death. MATERIAL AND METHODS: We studied 27 cases admitted to hospital between 1994 and 1995. In 74.07% of these cases organ extraction was carried out. The most commonly affected age group was between 20 and 29 years old, which made up more than half of the total number of cases, with a predominance (81.5%) of males. RESULTS: Cranio-encephalic injury was the commonest cause, in particular severe cerebral contusion and primary brain stem contusion. The patients had brain death lasting between one and five hours and one for 38 hours. Respiratory sepsis was the most frequent associated pathology. Computerized axial tomography and straight X-rays were the imaging techniques most commonly used in the diagnosis of brain death. Severe cerebral oedema was the most frequent anatomopathological finding and was seen in all cases in which necropsy was done, followed by herniation of the cingulum in 23 cases (88.4%) and cerebral necropsy in 20. CONCLUSIONS: These anatomopathological results show the severe damage suffered by cerebral structures.

Sindrome de Reiter: diagnostico de excepcion en una mujer. / Reiter's syndrome: diagnosis of exception in a woman

Se presenta el caso de una paciente con sindrome uretroconjuntivo-articular con manifestaciones mucosas, en la que se planteo el diagnostico de sindrome de Reiter. Se descartan las entidades que con mayor fuerza tienen que diferenciarse de este, como la artritis gonococica y los estudios complementarios y la respuesta al basandonos en la clinica, la evolucion los estudios complementarios y la respeusta al tratamiento; estos mismos elementos parecen confirmar el diagnostico a pesar de lo raro que resulta la presentacion de esta afectacion en mujeres, ninos y ancianos