Myocarditis Induced by Immune Checkpoint Inhibitors: An Exploratory Review.

Checkpoints are essential proteins in the immune system that regulate the intensity and duration of immune responses, preventing damage to healthy tissues during the fight against pathogens and abnormal cells. While these mechanisms are crucial in cancer defense, this disease can alter the functionality of these proteins. This is why checkpoint inhibitors have emerged as an important class of drugs to potentiate the antitumor immune response. However, it has been observed that these drugs can trigger adverse effects, among which myocarditis is one of the most prevalent. This article explores the signaling pathways associated with checkpoint inhibitors, their adverse effects, and their impact on the development of myocarditis, as well as potential therapeutic strategies.

El papel de la Ivabradina y la titulación de los betabloqueadores en la insuficiencia cardíaca: una serie de casos y revisión de la literatura / The role of Ivabradine and beta-blocker titration in heart failure: a case series and literature review

RESUMEN Introducción y objetivos : La insuficiencia cardíaca (IC) es una preocupación creciente de salud pública. Si bien los betabloqueantes (BB) son la base del tratamiento, lograr reducciones objetivo de frecuencia cardíaca puede ser difícil debido a los efectos secundarios y la tolerancia limitada. La ivabradina, un inhibidor único de la corriente If, ofrece un enfoque complementario para controlar la frecuencia cardíaca sin afectar la contractilidad. El objetivo de este estudio fue evaluar la eficacia de agregar ivabradina a la terapia BB en pacientes con IC. Métodos: Se realizó un estudio observacional retrospectivo en un hospital privado en San José, Costa Rica se analizaron 7 casos de pacientes tratados con BB a los cuales posteriormente se les adicionó ivabradina. Se recopilaron datos demo- gráficos, las características clínicas, la frecuencia cardíaca previa y posterior a la ivabradina, la clase funcional NYHA y los valores de laboratorio seleccionados. Resultados: La ivabradina redujo significativamente la frecuencia cardíaca en reposo en un promedio de 26,87 latidos por minuto. El 42,86% alcanzó la dosis meta de su BB inicial después de agregar ivabradina. La clase funcional NYHA se mantuvo estable o mejoró en todos los casos. Conclusiones: Estos resultados sugieren que agregar ivabradina a la terapia BB puede ser una estrategia eficaz para optimizar el control de la frecuencia cardíaca en pacientes con IC. Este enfoque puede mejorar la tolerabilidad de BB, lo que lleva a un mayor manejo de la dosis meta y posiblemente mejores resultados clínicos.

ABSTRACT Introduction and objectives: Heart failure (HF) is a growing public health concern. While beta-blockers (BBs) are the cornerstone of treatment, achieving target heart rate reductions can be difficult due to side effects and limited tolerance. Ivabradine, a unique inhibitor of the If current, offers a complementary approach to controlling heart rate without affecting contractility. This study aimed to evaluate the effectiveness of adding ivabradine to BB therapy in patients with HF. Methods : A retrospective observational study was conducted at a private hospital in San José, Costa Rica. Seven cases of patients treated with BBs who were subsequently added to ivabradine were analyzed. Demographic data, clinical characteristics, heart rate before and after ivabradine, NYHA functional class, and selected laboratory values were collected. Results : Ivabradine significantly reduced resting heart rate by an average of 26.87 beats per minute. Forty-two-point eight-six percent (42.86%) achieved the target dose of their initial BB after adding ivabradine. NYHA functional class remained stable or improved in all cases. Conclusions: These results suggest that adding ivabradine to BB therapy may be an effective strategy to optimize heart rate control in patients with HF. This approach may improve BB tolerability, leading to greater target dose management and possibly better clinical outcomes.

Impact of the Five-Year Intervention of an Antimicrobial Stewardship Program on the Optimal Selection of Surgical Prophylaxis in a Hospital without Antibiotic Prescription Restrictions in Costa Rica: A Retrospective Study.

This study aims to characterize the impact of the implementation of an antimicrobial stewardship program (AMS) on the optimal selection of surgical antibiotic prophylaxis in adult patients. This is a retrospective quasi-experimental study that compared the selection and duration of antibiotics for all surgical prophylaxis prescriptions over six months, both before (pre-AMS) and after a five-year intervention of AMS (post-AMS). In addition, data related to the consumption of antibiotics, adverse drug reactions, and surgical site infections throughout the years of the intervention were analyzed. The rate of appropriate selection of antibiotic prophylaxis in surgical procedures improved to 80% during the post-AMS period. The percentage of optimal duration increased from 69.1% (N = 1598) in the pre-AMS period to 78.0% (N = 841) in the post-AMS period (p < 0.001). The consumption of ceftriaxone significantly decreased, while the use of cefazolin increased more than nine times. No severe adverse reactions or increases in surgical site infections were detected after the intervention. The implementation of an AMS in the surgical ward demonstrated a trend towards a positive overall impact on the selection and duration of prophylactic antibiotics for surgery, with positive results also observed in other variables associated with the prescription of these antibiotics.