Prevalent coinfection and associated factors for Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus in patients submitted to renal replacement therapy: A cross-sectional study of 21 dialysis units in the State of Mexico.

BACKGROUND: Chronic kidney disease (CKD) predispose to viral coinfections in patients submitted to renal replacement therapy (RRT); nevertheless, few reports have been performed to elucidate the current epidemiology within this population in Mexico. AIM: To estimate the prevalence of HBV, HCV, and HIV coinfection and to explore factors associated with prevalent coinfection in patients living with renal failure undergoing to RRT. METHODS: A multicenter cross-sectional recruitment across 21 units at the Mexican Institute of Social Security (IMSS) at the State of Mexico was performed during 2019. A standardized clinical questionnaire was performed to elucidate individual and relatives-related conditions. A treatment facility questionnaire was applied to the chief responsible of each unit to explore treatment facility variables. Serological testing, clinical, biochemical, and anthropometrical parameters were extracted from clinical records. RESULT: In 1,304 patients (57.5% male, mean age 45.5 (SD: 15.6) years, and 95.8% in hemodialysis), the prevalence of any viral coinfection was 3.14% (95% CI: 2.32%-4.23%). The highest viral coinfection prevalence were for HCV, HBV, and HIV, in which men and subjects diagnosed after 2010's had the highest rates. We identify that being submitted to peritoneal dialysis, being treated in a surrogated dialysis center and living with a close relative with prior hepatitis coinfection were associated factors for any viral coinfection. CONCLUSION: In patients submitted to RRT, the prevalence of viral coinfection remains high compared with general population. Screening strategies, medical awareness and targeted public healthcare policies should prioritize better care practices within patients submitted to RRT in Mexico.

Miocardiopatía periparto: afección subvalorada / Peripartum cardiomyopathy: An undervalued disease

Resumen: El embarazo es un estado que impone un verdadero reto para el sistema cardiovascular materno. Existe remodelamiento cardiaco, que, junto con el incremento de la masa miocárdica y del tamaño del ventrículo izquierdo y la contractilidad miocárdica disminuida agravada por los cambios del embarazo, pueden condicionar insuficiencia cardiaca aguda durante el periodo periparto. Se considera miocardiopatía periparto cuando la función sistólica del ventrículo izquierdo y los síntomas de insuficiencia cardiaca ocurren en el último mes del embarazo y en los cinco meses posteriores al parto con incidencia de 1 por cada 1300 a 15,000 embarazos. Se comunica el caso de una paciente de 26 años, con antecedente de catarata congénita, que tuvo embarazo normoevolutivo, con parto eutócico, durante el puerperio tuvo disnea y datos de hipoperfusión, mediante evaluación ultrasonográfica pulmonar y cardiaca mostró datos de miocardiopatía dilatada periparto, fue trasladada a un hospital de tercer nivel, donde a pesar del tratamiento intensivo multidisciplinario, falleció. La miocardiopatía periparto es una enfermedad subvalorada con alta mortalidad materna y perinatal; sin embargo, la detección oportuna puede mejorar el tratamiento y el pronóstico. Con la comunicación de este caso, se pretende demostrar la importancia de la detección temprana de una afección poco diagnosticada, como es la miocardiopatía periparto.

Abstract: Pregnancy is a state that imposes a real challenge for the maternal cardiovascular system. There is a cardiac remodeling, which along with an increase in myocardial mass, in left ventricular size and decreased myocardial contractility aggravated by changes in pregnancy, can condition acute heart failure during the peripartum period. Peripartum cardiomyopathy is when the systolic function of the left ventricle and the symptoms of heart failure occur in the last month of pregnancy and in the five months after delivery with an incidence ranging from 1/1300 to 1/15,000 pregnancies. This paper reports the case of a 26-year-old female patient, who had a history of congenital cataract, with normal pregnancy and eutocic delivery; during the puerperium patient showed dyspnea, hypoperfusion data and pulmonary and cardiac ultrasonographic evaluation of peripartum dilated cardiomyopathy, being transferred at a third level, where despite intensive multidisciplinary treatment, the patient died. Peripartum cardiomyopathy is an undervalued disease that has a high maternal and perinatal mortality; however, a timely detection can improve treatment and prognosis. The purpose of this case report is to demonstrate the importance of early detection of a poorly diagnosed entity, such as peripartum cardiomyopathy.