Severe pulmonary hypertension and circulatory failure associated with Congenital syphilis. Case report.

BACKGROUND: Congenital syphilis is a vertical infection caused by Treponema pallidum. Despite the implementation of preventive strategies during pregnancy, its incidence is increasing, and it constitutes an important public health problem. Most patients with congenital syphilis are asymptomatic; however, a small group may develop severe disease at birth with the need of advanced resuscitation in the delivery room, acute hypoxemic respiratory failure, and hemodynamic instability. Therefore, awareness is needed. METHODS AND RESULTS: This series describes the clinical course of two late preterm infants with congenital syphilis who developed acute hypoxemic respiratory failure, pulmonary hypertension, and circulatory collapse early after birth. Integrated hemodynamic evaluation with neonatologist-performed echocardiography (NPE) and therapeutic management is provided. CONCLUSIONS: A comprehensive hemodynamic evaluation including early and serial functional echocardiography in these patients is needed to address the underlying complex pathophysiology and to help to establish accurate treatment.

Quality of life, adherence and satisfaction of patients with auricular fibrillation treated with dabigatran or vitamin K antagonists. / Calidad de vida, adherencia y satisfacción en pacientes con fibrilación auricular tratados con dabigatrán o antagonistas de la vitamina K.

OBJECTIVE: To analyse the quality of life, adherence and satisfaction of patients with nonvalvular auricular fibrillation (NVAF) treated with dabigatran versus vitamin K antagonists (VKA) in cardiology consultations in Spain. METHODS: We conducted an observational, comparative, prospective and multicentre study of patients with NVAF treated in cardiology departments, who started treatment with dabigatran or VKA in the month prior to the baseline visit. The follow-up lasted 6 months. We analysed quality of life (using the validated AF-QoL 18 questionnaire [0, minimum; 100, maximum]), adherence (using the Morisky-Green test) and the cardiologist's perception (using a specific questionnaire [0, completely dissatisfied; 10, completely satisfied]). RESULTS: We analysed 1015 patients (mean age, 73.3±9.4 years; 57% men; CHA2DS2VASc, 3.4±1.5; HAS-BLED, 1.5±1.0) who were treated with dabigatran (74.7%) or with VKA (25.3%). The total quality-of-life scores remained constant throughout the follow-up (47.9±23.5 and 48.6±24.4 at baseline and at 6 months, respectively; P=NS) but were higher at 6 months for the dabigatran group (50.6±24.7 vs. 42.8±22.5; P<.001). Treatment adherence was high during the study but greater with dabigatran at 6 months (89.2% vs. 81.1%; P=.001). There was a better perception of the cardiologist regarding the satisfaction of the patients treated with dabigatran at 6 months (9.0±1.2 vs. 6.6±2.2; P<.001). CONCLUSIONS: For patients with NVAF and high thromboembolic risk treated in cardiology consultations, the adherence, satisfaction and quality of life were higher for the patients treated with dabigatran than for those treated with VKA.

[Lateralization as alternative to static prone decubitus in patients with ARDS]. / Lateralización como alternativa al decúbito prono estático en pacientes con SDRA.

UNLABELLED: According to Phillips, Continuous Lateral Rotation (CLR) or Kinetic Therapy (KT) together with the technological advances obtain some important benefits in mechanically ventilated patients. OBJECTIVE: Compare Static Prone Decubitus (PD) with DP in CRL. PATIENTS AND METHODS: We analyzed 2 groups with a total of 41 patients in the period of January 1998 to April 2003. The DP group (25 patients) remained static and the lateral group (16 patients) in CLR every 2 h. The groups had 56 +/- 16 vs 64 +/- 17 years, 77 +/- 20 vs 71 +/- 23 kg and 24% vs 31% of survival, respectively. RESULTS: We maintained the PD 37 +/- 30 vs 27 +/- 36 h for group 1 and 2. The response as Responders is 68% and 69%. pO2/FiO2 of supine pre-DP to supine post-DP is 79 +/- 21 to 146 +/- 68 versus 80 +/- 20 to 138 +/- 57 and pulmonary compliance 22 +/- 10 to 21 +/- 10 vs 31 +/- 10 to 32 +/- 9. Mean blood pressure of S to S was 87 +/- 16 to 85 +/- 15 vs 82 +/- 10 to 80 +/- 9, and mean Heart rate 108 +/- 21 to 95 +/- 24 vs 85 +/- 32 to 75 +/- 28. Complications by groups were: facial edema of 84% vs 63%, gastric retention 36% to 38%, vomiting/regurgitation 12% to 0%, epistaxis 8% to 31%. Pressure Sore (PS) Incidence decreased from 36% to 12%, together with seriousness. CONCLUSION: We consider that lateralization if PD is a technique comparable to static PD on the respiratory and hemodynamics level. CLR in PD may prevent some complications.