Surgical procedure versus medical treatment for infective endocarditis associated to mortality in Mexican population.

BACKGROUND: Early surgical procedures on patients with infective endocarditis (IE) have shown a clearly benefit to reduce embolization at the central nervous system. We conducted a retrospective cohort in Mexican population to evaluate mortality and clinical outcomes in patients with IE with or without surgical intervention. OBJECTIVES: Our aim was to evaluate factors associated with mortality in patients with IE and compare both groups with and without a surgical intervention. METHODS: We evaluated a retrospective cohort of patients who had been diagnosed with IE according to the Duke's criteria at our Institution in SLP, Mexico, from January 2001 to September 2016. We compared the risk factors associated to mortality of patients with or without surgery. Our primary outcome was mortality within 6 months of follow-up after the diagnosis. RESULTS: We included 105 patients, 51 (48.6%) were men, median age 46 [Q1 30, Q3 59] years, 36 patients (34.3%) received surgical treatment (STG), and 69 (65.7%) only medical treatment (MTG) group; 41 patients (39%) died during the study period; in the surgery group eight patients died (22%); and 33 in the MT group (47%) p = 0.049. Adjusted for APACHE II, surgery, creatinine levels and the size of vegetation, the surgery group had lower mortality than patients on MTG (HR 0.36, p = 0.047). CONCLUSION: As previously described in the literature, patients who underwent surgery had lower mortality than the patients who only received medical treatment; however, the Mexican population is different to other populations group, due to higher risk of diabetes mellitus (28%) versus (10%) in global risk of DM in the world and its complications and other chronic diseases as arterial systemic hypertension. Thus, surgical treatment must be elected as goal standard treatment in patient's whit IE and presence of vegetation.

Antecedentes: Los procedimientos quirúrgicos tempranos en pacientes con endocarditis infecciosa (EI) han mostrado un beneficio claro para reducir la embolización en el sistema nervioso central. Realizamos una cohorte retrospectiva en ­población mexicana para evaluar la mortalidad y los resultados clínicos en pacientes con EI con o sin intervención quirúrgica. Objetivos: Nuestro objetivo fue evaluar los factores asociados a la mortalidad en pacientes con endocarditis infecciosa y comparar ambos grupos con y sin intervención quirúrgica. Métodos: Evaluamos una cohorte retrospectiva de pacientes que habían sido diagnosticados de EI según los criterios de Duke en nuestra Institución en SLP, México, desde enero de 2001 a septiembre de 2016. Comparamos los factores de riesgo asociados a la mortalidad de pacientes con o sin cirugía. Nuestro resultado primario fue la mortalidad dentro de los 6 meses de seguimiento después del diagnóstico. Resultados: Se incluyeron 105 pacientes, 51 (48.6%) eran hombres, mediana de edad46 [Q1 30, Q3 59] años, 36 pacientes (34.3%) recibieron tratamiento quirúrgico (STG) y 69 (65.7%) solo grupo de tratamiento médico (MTG); 41 pacientes (39%) murieron durante el período de estudio; en el grupo de cirugía fallecieron 8 pacientes (22%) y en el grupo de MT (47%) 33 p = 0.049. Ajustado por APACHE II, cirugía, niveles de creatinina y tamaño de la vegetación, el grupo de cirugía tuvo menor mortalidad que los pacientes en MTG (HR 0.36, p = 0.047). Conclusión: Como se ha descrito anteriormente en la literatura, los pacientes que se sometieron a cirugía tuvieron menor mortalidad que los pacientes que solo recibieron tratamiento médico, sin embargo, la población mexicana es diferente a otros grupos poblacionales, debido a un mayor riesgo de diabetes mellitus (28%) vs (10%) en otros países y sus complicaciones y otras enfermedades crónicas como hipertensión arterial sistémica. Por tanto, el tratamiento quirúrgico debe ser elegido como principal método de tratamiento en pacientes con endocarditis infecciosa y presencia de vegetaciones.

A population approach of rifampicin pharmacogenetics and pharmacokinetics in Mexican patients with tuberculosis.

The aim of this study was to develop a population pharmacokinetic model of rifampicin (RMP) in Mexican patients with tuberculosis (TB) to evaluate the influence of anthropometric and clinical covariates, as well as genotypic variants associated with MDR1 and OATP1B1 transporters. A prospective study approved by Research Ethics Committee was performed at Hospital Central in San Luis Potosí, Mexico. TB patients under DOTS scheme and who signed informed consent were consecutively included. Anthropometric and clinical information was retrieved from medical records. Single nucleotide polymorphisms in MDR1 (C3435T) and SLCO1B1 (A388G and T521C) genes were evaluated. RMP plasma concentrations and time data were assessed with NONMEM software. A total of 71 Mexican TB patients from 18 to 72 years old were included for RMP quantification from 0.3 to 12 h after dose; 329 and 97 plasma concentrations were available for model development and validation, respectively. Sequential process includes a typical lag time of 0.25 h prior to absorption start with a Ka of 1.24 h-1 and a zero-order absorption of 0.62 h to characterize the gradual increase in RMP plasma concentrations. Final model includes total body weight in volume of distribution (0.7 L/kg, CV = 26.8%) and a total clearance of 5.96 L/h (CV = 38.5%). Bioavailability was modified according to time under treatment and generic formulation administration. In conclusion, a population pharmacokinetic model was developed to describe the variability in RMP plasma concentrations in Mexican TB patients. Genetic variants evaluated did not showed significant influence on pharmacokinetic parameters. Final model will allow therapeutic drug monitoring at early stages.