PULSE-HF: A Simple Clinical and Geriatric Score to Predict Systolic Dysfunction in the Elderly Without Heart Failure.

To develop a clinical score to determine preclinical predictors of systolic dysfunction in an outpatient elderly population without a diagnosis of heart failure (HF). PULSE-HF is a cross-sectional study in elderly at-risk (coronary artery disease, diabetes or hypertension) outpatients without a diagnosis of heart failure (HF). The objective in this population was to develop a clinical score to determine preclinical predictors of systolic dysfunction. Clinical and geriatric variables were analyzed; independent predictive factors in the logistic regression analysis were included for the score calculation. Of the 722 subjects enrolled, 47 (6.5%) had a left ventricular ejection fraction (LVEF) < 50%, and 15 (2.1%) a LVEF < 40%. Mean age was 76.5 years (5.18) and 445 (61.6%) were female. Multiple logistic regression analysis identified abnormal Q waves (odds ratio [OR]: 4.36; P = 0.003), cardiomegaly (OR: 3.32; P < 0.001), right bundle branch block (OR: 2.84; P = 0.011), cognitive dysfunction (OR: 2.14; P = 0.027) and NT-proBNP (OR 5.43; P < 0.001) as independent predictors of LVEF < 50%. Two prediction scores were built, without and with NT-proBNP inclusion; the area under ROC curves were 0.70 and 0.76, respectively. As the score increased, the sensitivity decreases but increases specificity, and accuracy (97.17% and 91.64% respectively in ≥6 points). NT-proBNP was associated with an increment in the performance (accuracy of 93.18% for score ≥10). We conclude that a simple score using clinical information might be useful to predicting asymptomatic systolic dysfunction in the elderly.

Un caso de megacolon tóxico por salmonella / Case report of a toxic megacolon due to salmonella infection

Se presenta el caso de un paciente masculino de 59 años de edad, con antecedentes de colitis ulcerosa, que luego de la ingesta de agua no potable se internó por diarrea de una semana de evolución con más de veinte deposiciones acuosas diarias. Al momento de la internación se realizó rectosigmoidoscopía que no reveló actividad de su enfermedad intestinal de base. Se solicitaron estudios para descartar diversas etiologías infecciosas, obteniéndose en coprocultivo desarrollo de Salmonella species por lo que se indicó tratamiento antibiótico con ciprofloxacina.

Un caso de megacolon tóxico por Salmonella / Toxic megacolon by salmonella infection. Case report

Se presenta el caso de un paciente masculino de 59 años de edad, con antecedentes de colitis ulcerosa, que luego de la ingesta de agua no potable se internó por diarrea de una semana de evolución con más de veinte deposiciones acuosas diarias...Presentó como complicación del cuadro infeccioso, deshidratación e insuficiencia renal con requerimiento de hemodiálisis y apoyo hemodinámico con inotrópicos, evolucionando luego con toxicidad sistémica, peritonismo y dilatación de colon transverso evidenciada por radiografía de abdomen