Clinical characteristics and outcomes in COVID-19 in kidney transplant recipients: a propensity score matched cohort study.

Patients with chronic kidney disease (CKD), especially those on dialysis or who have received a kidney transplant (KT), are considered more vulnerable to severe COVID-19. This susceptibility is attributed to advanced age, a higher frequency of comorbidities, and the chronic immunosuppressed state, which may exacerbate their susceptibility to severe outcomes. Therefore, our study aimed to compare the clinical characteristics and outcomes of COVID-19 in KT patients with those on chronic dialysis and non-CKD patients in a propensity score-matched cohort study. This multicentric retrospective cohort included adult COVID-19 laboratory-confirmed patients admitted from March/2020 to July/2022, from 43 Brazilian hospitals. The primary outcome was in-hospital mortality. Propensity score analysis matched KT recipients with controls - patients on chronic dialysis and those without CKD (within 0.25 standard deviations of the logit of the propensity score) - according to age, sex, number of comorbidities, and admission year. This study included 555 patients: 163 KT, 146 on chronic dialysis, and 249 non-CKD patients (median age 57 years, 55.2% women). With regards to clinical outcomes, chronic dialysis patients had a higher prevalence of acute heart failure, compared to KT recipients, furthermore, both groups presented high in-hospital mortality, 34.0 and 28.1%, for KT and chronic dialysis patients, respectively. When comparing KT and non-CKD patients, the first group had a higher incidence of in-hospital dialysis (26.4% vs. 8.8%, p < 0.001), septic shock (24.1% vs. 12.0%, p = 0.002), and mortality (32.5% vs. 23.3%, p = 0.039), in addition to longer time spent in the intensive care unit (ICU). In this study, chronic dialysis patients presented a higher prevalence of acute heart failure, compared to KT recipients, whereas KT patients had a higher frequency of complications than those without CKD, including septic shock, dialysis during hospitalization, and in-hospital mortality as well as longer time spent in the ICU.

Chagas Cardiomyopathy: Clinical Presentation and Management in the Americas.

The initial infection of Chagas disease is typically asymptomatic, but approximately 30% of people will progress to a chronic cardiac form, and others develop the gastrointestinal form. Death is often sudden due to arrhythmias or progressive heart failure. Prevention through vector control programs and blood bank screening, along with strengthened surveillance systems and rapid information sharing, are key to decreasing disease burden globally. The epidemiology, diagnostic evaluation, diagnosis, and treatment of acute and chronic Chagas cardiac disease are discussed with focus on educating the primary care professionals and general cardiologists in nonendemic areas who have limited experience treating this disease.

Avaliação perioperatória do paciente hipertenso / Perioperative evaluation of the hypertensive patient

A hipertensão arterial sistêmica (HAS) é uma das doenças mais prevalentes no mundo, com taxas que superam 30%. Está intimamente associada à aterosclerose coronariana, insufi ciência renal e doença cerebrovascular, os quais se correlacionam a complicações cardiovasculares maiores após procedimentos cirúrgicos. O aumento no número de cirurgias em uma população cada vez mais idosa coloca diante de nós o desafi o de lidar com grupos de pacientes com mais fatores de risco, dentre os quais se encontra a HAS. Portanto, conhecer a infl uência dessa doença no período perioperatório se torna essencial para todo cardiologista. Contudo, os estudos são escassos e existem problemas metodológicos que impedem conclusões defi nitivas. Logo, conhecer as recomendações das diretrizes vigentes torna-se fundamental.

Arterial hypertension (AH) is one of the most common diseases, with rates of more than 30%. It is closely related with coronary atherosclerosis, chronic renal failure and cerebrovascular diseases, which are associated with postoperative major cardiovascular complications. To deal with an increasing number of surgeries in an older population is a challenge, especially because of a higher prevalence of cardiovascular risk factors, including AH. Thus, the knowledge of the relations between this disease and perioperative complications is essential for every cardiologist. However, data are scant and there are important methodological problems, what precludes defi nitive conclusions. Therefore, it is important and necessary to follow the guidelines recommendations.