Assessment of Cardiac Sarcoidosis: FDG PET and BMIPP SPECT.

PURPOSE OF REVIEW: Cardiac sarcoidosis (CS) is an inflammatory disease of unknown etiology that can lead to life-threatening arrhythmias, heart failure, and death. Advanced cardiac imaging modalities have improved the clinician's ability to detect this disease. The purpose of this review is to discuss the recent evidence of cardiac metabolic imaging as assessed by [18F]FDG PET and [123I]BMIPP SPECT in the evaluation of CS patients. RECENT FINDINGS: [18F]FDG PET is the gold standard to identify myocardial inflammation. [123I]BMIPP SPECT can uncover early myocardial damage as well as advanced stages of CS when fibrosis prevails. In presence of inflammation, myocardial [18F]FDG uptake is increased, but in contrast, BMIPP myocardial uptake is reduced or even suppressed. Thus, a complementary role of cardiac metabolic imaging by [18F]FDG PET and BMIPP SPECT has been proposed to detect the whole spectrum of CS. [18F]FDG PET is considered an important tool to improve the diagnosis and optimize the management of CS. The role of [123I]BMIPP SPECT in diagnosing CS is still under investigation. Further studies are needed to evaluate the clinical utility of combined cardiac metabolic imaging in the diagnosis, prognosis, and for selecting treatments in CS patients.

Mortality Associated with Bacteremia Due to Colistin-Resistant Klebsiella pneumoniae with High-Level Meropenem Resistance: Importance of Combination Therapy without Colistin and Carbapenems.

Combination therapy including colistin and a carbapenem has been found to be associated with lower mortality in the treatment of bloodstream infections (BSI) due to KPC-producing Klebsiella pneumoniae when the isolates show a meropenem or imipenem MIC of <16 mg/liter. However, the optimal treatment of BSI caused by colistin- and high-level carbapenem-resistant KPC-producing K. pneumoniae is unknown. A prospective cohort study including episodes of bacteremia caused by colistin-resistant and high-level meropenem-resistant (MIC ≥ 64 mg/liter) KPC-producing K. pneumoniae diagnosed from July 2012 to February 2016 was performed. The impact of combination therapy on crude 30-day mortality was analyzed by Cox regression using a propensity score as a covariate to control for indication bias and in an inverse probability of treatment weighting (IPTW) cohort. The study sample comprised 104 patients, of which 32 (30.8%) received targeted monotherapy and 72 (69.2%) received targeted combination therapy; none of them received either colistin or a carbapenem. The 30-day crude mortality rate was 30.8% (43.8% in patients treated with monotherapy and 25% in patients receiving combination therapy). In the Cox regression analysis, 30-day mortality was independently associated with septic shock at BSI onset (hazard ratio [HR], 6.03; 95% confidence interval [CI], 1.65 to 21.9; P = 0.006) and admission to the critical care unit (HR, 2.87; 95% CI, 0.99 to 8.27; P = 0.05). Targeted combination therapy was associated with lower mortality only in patients with septic shock (HR, 0.14; 95% CI, 0.03 to 0.67; P = 0.01). These results were confirmed in the Cox regression analysis of the IPTW cohort. Combination therapy is associated with reduced mortality in patients with bacteremia due to colistin-resistant KPC-producing K. pneumoniae with high-level carbapenem resistance in patients with septic shock.

Ceftazidime-Avibactam as Salvage Therapy for Infections Caused by Carbapenem-Resistant Organisms.

Ceftazidime-avibactam (CAZ-AVI) is a recently approved ß-lactam-ß-lactamase inhibitor combination with the potential to treat serious infections caused by carbapenem-resistant organisms. Few patients with such infections were included in the CAZ-AVI clinical trials, and clinical experience is lacking. We present a case series of patients with infections caused by carbapenem-resistant Enterobacteriaceae (CRE) or Pseudomonas aeruginosa (CRPa) who were treated with CAZ-AVI salvage therapy on a compassionate-use basis. Physicians who had prescribed CAZ-AVI completed a case report form. We used descriptive statistics to summarize patient characteristics and treatment outcomes. We used the Wilcoxon rank sum test and Fisher's exact test to compare patients by treatment outcome. The sample included 36 patients infected with CRE and two with CRPa. The most common infections were intra-abdominal. Physicians categorized 60.5% of patients as having life-threatening infections. All but two patients received other antibiotics before CAZ-AVI, for a median of 13 days. The median duration of CAZ-AVI treatment was 16 days. Twenty-five patients (65.8%) concurrently received other antibiotics to which their pathogen was nonresistant in vitro Twenty-eight patients (73.7%, 95% confidence interval [CI], 56.9 to 86.6%) experienced clinical and/or microbiological cure. Five patients (20.8%) with documented microbiological cure died, whereas 10 patients (71.4%) with no documented microbiological cure died (P = 0.01). In three-quarters of cases, CAZ-AVI (alone or combined with other antibiotics) cured infections caused by carbapenem-resistant organisms, 95% of which had failed previous therapy. Microbiological cure was associated with improved survival. CAZ-AVI shows promising clinical results for infections for which treatment options are limited.

Comportamiento de la depresión en el adulto mayor del policlínico "Cristóbal Labra" / Behaviour of depression in the elderly at \"Cristobal Labra\" Polyclinic

Introducción: la depresión en el anciano constituye un problema de salud. Los cambios biológicos, psicológicos, económicos y sociales que se observan en el proceso de envejecimiento, asociados a las numerosas patologías que aparecen en esta etapa de la vida, conllevan a pensar que irremediablemente los ancianos tengan todas las condiciones creadas para deprimirse.Objetivo: caracterizar la depresión en los adultos mayores y los tratamientos empleados para la misma, en la consulta de psicogeriatría y demencia de un policlínico.Métodos: se realizó un estudio descriptivo, retrospectivo de corte transversal a 112 ancianos, remitidos por los médicos de familia a la consulta de Psicogeriatría y Demencia del Policlínico "Cristóbal Labra", durante el período de julio a diciembre de 2011. Los datos se recogieron de las historias clínicas. Para el diagnóstico de la patología se aplicó el test de Yesavage y el Mini mental de Folstein.Resultados: la depresión se diagnosticó al 25 por ciento de los ancianos remitidos a consulta; la misma se incrementó con la edad, el bajo nivel educacional y la presencia de enfermedades como osteoartritis y alteraciones sensoriales. Los síntomas principales fueron los trastornos del sueño en el hombre y la tristeza y llanto en la mujer. Se usó la Medicina Natural Tradicional con éxito en un 42,9 por ciento de los ancianos.Conclusiones: la depresión es una entidad frecuente y poco diagnosticada, el uso de la Medicina Natural y Tradicional constituye una alternativa de tratamiento para la misma

Background: depression in the elderly is a health problem. The biological, psychological, economic and social changes seen in the aging process, associated to some pathologies appearing in this stage of life, inevitably lead to think that the elderly have created all the conditions to be depressed.Objective: to characterize depression in the elderly and the treatments followed for this condition in the Psychogeriatric and Dementia consultation at a polyclinic.Methods: a retrospective descriptive cross-sectional study was performed in 112 elderly who were referred by their family doctors to the Psychogeriatric and Dementia consultation of "Cristobal Labra" Polyclinic from July to December 2011. The data were collected from medical records. For the diagnosis of the pathology, the Yesavage and the Folstein Mini Mental tests were applied.Results: depression was diagnosed in a 25 per cent of the elderly who were referred to the consultation. This condition increased with age, low educational levels and the presence of diseases such as osteoarthritis and sensory changes. The principal symptoms were sleep disturbances in men and sadness and crying in women. Traditional Herbal Medicine was used which reported good results in a 42.9 per cent of the patients.Conclusions: depression is a frequent entity which is sometimes misdiagnosed. The use of Traditional Herbal Medicine constitutes an alternative treatment for it