ABSTRACT
Clostridioides difficile (C. difficile) is the major cause of hospital-acquired gastrointestinal infections in individuals following antibiotics treatment. The pathogenesis of C. difficile infection (CDI) is mediated mainly by the production of toxins that induce tissue damage and host inflammatory responses. While innate immunity is well characterized in human and animal models of CDI, adaptive immune responses remain poorly understood. In this review, the current understanding of adaptive immunity is summarized and its influence on pathogenesis and disease outcome is discussed. The perspectives on what we believe to be the main pending questions and the focus of future research are also provided. There is no doubt that the innate immune response provides a first line of defense to CDI. But, is the adaptive immune response a friend or a foe? Probably it depends on the course of the disease. Adaptive immunity is essential for pathogen eradication, but may also trigger uncontrolled or pathological inflammation. Most of the understanding of the role of T cells is based on findings from experimental models. While they are a very valuable tool for research studies, more studies in human are needed to translate these findings into human disease. Another main challenge is to unravel the role of the different T cell populations on protection or induction of immunopathogenesis.
Subject(s)
Adaptive Immunity/immunology , Clostridioides difficile/immunology , Clostridium Infections/immunology , Animals , HumansABSTRACT
Resumen: El síndrome de bajo gasto cardíaco, como su nombre lo indica, comprende un conjunto de signos y síntomas determinados por la incapacidad del sistema cardiovascular de satisfacer la demanda metabólica tisular debido a un bajo volumen minuto. Es una complicación frecuente en el posoperatorio de cirugía cardíaca, y abarca un gran espectro en su presentación, desde un cuadro de corta duración, controlable con drogas vasoactivas e inotrópicas, hasta el shock cardiogénico refractario de gran mortalidad. Aumenta los tiempos de internación, la morbimortalidad a corto y largo plazo, y la utilización de recursos sanitarios. Pese al avance tecnológico en la cardiología intervencionista y terapia intensiva, no deja de ser una complicación frecuente y en ocasiones de muy difícil manejo, siendo fundamental comprender su fisiopatología, etiología y presentación clínica para un adecuado manejo del paciente durante su etapa de recuperación cardiovascular. En esta revisión repasaremos estos temas, y mencionaremos conceptos clave para el tratamiento de este síndrome.
Summary: Low cardiac output syndrome comprises a set of signs and symptoms determined by the inability of the cardiovascular system to satisfy tissue metabolic demand due to low minute volume. It is a frequent complication in the postoperative period of cardiac surgery, and its presentation covers a wide spectrum, from a short-term condition controllable with vasoactive and inotropic drugs to refractory cardiogenic shock with high mortality. It increases hospitalization times, short and long-term morbidity and mortality, and health resources usage. Despite the technological advance in interventional cardiology and intensive therapy, it is still a frequent complication and sometimes very difficult to manage, being essential to understand its pathophysiology, etiology and clinical presentation for an adequate management of the patient during his cardiovascular recovery stage. In this review we will analyze some key concepts for the treatment of this syndrome.
Resumo: A síndrome de baixo débito cardíaco, como o próprio nome sugere, compreende um conjunto de sinais e sintomas determinados pela incapacidade do sistema cardiovascular em satisfazer a demanda metabólica dos tecidos devido ao baixo volume minuto. É uma complicação frequente no pós-operatório de cirurgia cardíaca e sua apresentação abrange um amplo espectro, desde uma condição de curta duração, controlável com drogas vasoativas e inotrópicas, até choque cardiogênico refratário com alta mortalidade. Aumenta o tempo de hospitalização, a morbimortalidade de curto e longo prazo e a utilização de recursos de saúde. Apesar do avanço tecnológico na cardiologia intervencionista e na terapia intensiva, ainda é uma complicação frequente e algumas vezes de difícil manejo, sendo fundamental o entendimento de sua fisiopatologia, etiologia e apresentação clínica para um manejo adequado do paciente durante sua recuperação cardiovascular. Nesta revisão mencionaremos os conceitos-chave para o tratamento dessa síndrome.
ABSTRACT
Resumen: El Congreso Europeo de Cardiología constituye uno de los eventos más relevantes de la comunidad cardiológica mundial. Fue realizado entre el 31 de agosto y el 4 de setiembre en el corazón de París, siendo el tema central la salud cardiovascular global. Como es habitual, contó con la presencia de más de 30.000 profesionales y destacados invitados. Se presentaron actualizaciones de varias guías de práctica clínica e importantes trabajos científicos que sin duda impactarán en el tratamiento de los pacientes con patología cardiovascular. A continuación realizaremos un breve resumen de algunos de los trabajos presentados: - A trial to evaluate the effect of the sodium-glucose cotransporter 2 inhibitor dapagliflozin in patients with heart failure and reduced left ventricular ejection fraction: DAPA-HF - Complete revascularization with multivessel PCI for myocardial infarction: the COMPLETE Trial - Angiotensin-neprylysin inhibition in heart failure with preserved ejection fraction: the PARAGON-HF - Antithrombotic therapy for atrial fibrillation with stable coronary disease: the AFIRE Investigators - Ticagrelor or prasugrel in patients with acute coronary syndromes: the ISAR-REACT 5 Trial
Summary: The European Congress of Cardiology is one of the most relevant events of the world cardiology community. It was held from August 31 to September 4 in the heart of Paris, France, the central theme being global cardiovascular health. As usual, it was attended by more than 30,000 professionals and prominent guests. Updates of several clinical practice guides and important scientific papers were presented. These undoubtedly will impact in the treatment of patients with cardiovascular pathology. Below we present a brief summary of some of the trials presented: - A trial to evaluate the effect of the sodium-glucose cotransporter 2 inhibitor dapagliflozin in patients with heart failure and reduced left ventricular ejection fraction: DAPA-HF - Complete revascularization with multivessel PCI for myocardial infarction: the COMPLETE Trial - Angiotensin-neprylysin inhibition in heart failure with preserved ejection fraction: the PARAGON-HF - Antithrombotic therapy for atrial fibrillation with stable coronary disease: the AFIRE Investigators - Ticagrelor or prasugrel in patients with acute coronary syndromes: the ISAR-REACT 5 Trial
Sumário: O Congresso Europeu de Cardiologia é um dos eventos mais relevantes da comunidade mundial de cardiologia. Foi realizada de 31 de agosto ao 4 de setembro no coração de Paris, na França, o tema central foi a saúde cardiovascular global. Como sempre, participaram mais de 30.000 profissionais e convidados de destaque. Atualizações de vários guias de prática clínica e importantes artigos científicos foram apresentados que, sem dúvida, impactarão o tratamento de pacientes com patologia cardiovascular. Abaixo, faremos um breve resumo de alguns trials apresentados: - A trial to evaluate the effect of the sodium-glucose cotransporter 2 inhibitor dapagliflozin in patients with heart failure and reduced left ventricular ejection fraction: DAPA-HF - Complete revascularization with multivessel PCI for myocardial infarction: the COMPLETE Trial - Angiotensin-neprylysin inhibition in heart failure with preserved ejection fraction: the PARAGON-HF - Antithrombotic therapy for atrial fibrillation with stable coronary disease: the AFIRE Investigators - Ticagrelor or prasugrel in patients with acute coronary syndromes: the ISAR-REACT 5 Trial
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Resumen: Como todos los años, en esta oportunidad se celebró el 68º Congreso del Colegio Americano de Cardiología (ACC, por su sigla en inglés) entre los días 16 y 18 de marzo en Nueva Orleans, Luisiana. Ambientado en la ciudad del Mardi Gras y el jazz, nuevamente convocó a la cardiología mundial para promover el conocimiento a través de la presentación de múltiples actividades científicas. Contó con la presencia de más de 16.000 asistentes y se recibieron 2.300 artículos, muchos de los cuales, sin duda, modificarán la práctica clínica actual. Cabe destacar, asimismo, la presentación de la Guía de Prevención Primaria de la Enfermedad Cardiovascular, donde resalta el casi total abandono del ácido acetilsalicílico en prevención primaria debido a la falta de beneficio neto. Realizaremos un breve resumen de algunos de los principales trabajos científicos presentados: - Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation - The AUGUSTUS Trial - Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients - The PARTNER 3 trial - The Safety and Efficacy of Femoral Access in STEMI: The SAFARI-STEMI Trial - One-Month Dual Antiplatelet Therapy Followed by Clopidogrel Monotherapy versus Standard 12-Month Dual Antiplatelet Therapy With Clopidogrel After Drug-Eluting Stent Implantation. STOP-DAPT 2 Trial - Results of a Large-scale, App-based Study to Identify Atrial Fibrillation Using a Smartwatch: The Apple Heart Study
Summary: As every year, on this occasion the 68th Congress of the American College of Cardiology was held from March 16 to 18 in New Orleans, Louisiana. Set in the city of Mardi Gras and jazz, it once again called on global cardiology to promote knowledge through the presentation of multiple scientific activities. It counted with the presence of more than 16.000 attendees and 2.300 articles were received, many of which will undoubtedly modify the current clinical practice. It is also worth mentioning the presentation of the Primary Prevention of Cardiovascular Disease Guideline, which highlights the almost total discontinuation of acetylsalicylic acid in primary prevention due to the lack of net benefit. We will make a brief summary of some of the main scientific papers presented: - Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation - The AUGUSTUS Trial - Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients - The PARTNER 3 trial - The Safety and Efficacy of Femoral Access in STEMI: The SAFARI-STEMI Trial - One-Month Dual Antiplatelet Therapy Followed by Clopidogrel Monotherapy versus Standard 12-Month Dual Antiplatelet Therapy With Clopidogrel After Drug-Eluting Stent Implantation. STOP-DAPT 2 Trial - Results of a Large-scale, App-based Study to Identify Atrial Fibrillation Using a Smartwatch: The Apple Heart Study
Resumo: Como todos os anos, nesta ocasião, o 68º Congresso do Colégio Americano de Cardiologia (ACC após sua sigla em inglês) foi realizado de 16 a 18 de março em Nova Orleans, Louisiana. Situado na cidade do Mardi Gras e jazz, mais uma vez convidou a cardiologia do mondo para promover o conhecimento através da apresentação de múltiplas atividades científicas. Contou com a presença de mais de 16.000 participantes e 2.300 artigos recebidos, muitos dos quais sem dúvida modificarão a prática clínica atual. Também vale ressaltar a apresentação da Diretriz para a Prevenção Primária de Doenças Cardiovasculares, que destaca o quase total abandono do ácido acetilsalicílico na prevenção primária devido à falta de benefício líquido. Faremos um breve resumo de alguns dos principais trabalhos científicos apresentados: - Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation - The AUGUSTUS Trial - Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients - The PARTNER 3 trial - The Safety and Efficacy of Femoral Access in STEMI: The SAFARI-STEMI Trial - One-Month Dual Antiplatelet Therapy Followed by Clopidogrel Monotherapy versus Standard 12-Month Dual Antiplatelet Therapy With Clopidogrel After Drug-Eluting Stent Implantation. STOP-DAPT 2 Trial - Results of a Large-scale, App-based Study to Identify Atrial Fibrillation Using a Smartwatch: The Apple Heart Study
ABSTRACT
Resumen: El 34° Congreso Uruguayo de Cardiología, celebrado en Montevideo del 2 al 4 de diciembre del pasado año, nuevamente destacó por las excelentes presentaciones de los temas más relevantes del ámbito cardiológico, así como también por sus invitados de renombre, nacionales e internacionales. Acompañando el gran nivel del Congreso se expusieron 32 temas libres que abarcaron diferentes áreas de la cardiología de los cuales comentaremos cuatro trabajos premiados: - Riesgo de trombosis en bioprótesis aórtica y eventos clínicos según uso de anticoagulación. Metaanálisis de la evidencia actual. - Uso de NT-ProBNP como predictor de evolución en el posoperatorio de cirugía cardíaca. - Prevalencia de septal pouch en una cohorte derivada para ecocardiograma transesofágico. - Incidencia de troponina T ultrasensible en rango anormal y su correlación con la anatomía coronaria en pacientes en valoración por enfermedad coronaria estable.
Summary: The 34th Uruguayan Congress of Cardiology, celebrated last year in Montevideo from December 2nd to 4th, again stood out for the excellent presentations of the most relevant topics in the field of cardiology, as well as for its renowned national and international guests. Accompanying the great level of the Congress, 32 articles that covered different topics in the cardiological area were presented, of which we will comment four awarded: - Risk of thrombosis in aortic bioprosthesis and clinical events according to the use of anticoagulation. Meta-analysis of current evidence. - Use of NT-ProBNP as a predictor of evolution in the postoperative period of cardiac surgery. - Prevalence of septal pouch in a cohort derived for transesophageal echocardiography. - Incidence of ultrasensitive troponin T in abnormal range and its correlation with coronary anatomy in patients in assessment for stable coronary disease.
Resumo: O 34º Congresso Uruguaio de Cardiologia, realizado em Montevidéu entre os dias 2 e 4 de dezembro no ano passado, voltou a destacar-se pelas excelentes apresentações dos temas mais relevantes no campo da cardiologia, bem como por seus renomados convidados, nacionais e internacionais. Acompanhando o grande nível do Congresso, tinham 32 temas livres que cobriam diferentes áreas da cardiologia, dos quais comentaremos quatro artigos premiados: - Risco de trombose na bioprótese aórtica e eventos clínicos de acordo com o uso de anticoagulação. Meta-análise da evidência atual. - Uso de NT-ProBNP como preditor de evolução no pós-operatório de cirurgia cardíaca. - Prevalência de bolsa septal em uma coorte derivada para ecocardiografia transesofágica. - Incidência de troponina T ultrassensível em faixa anormal e sua correlação com a anatomia coronariana em pacientes em avaliação para doença coronariana estável.
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Resumen: El Congreso Europeo de Cardiología se llevó a cabo en la ciudad de Múnich del 25 al 29 de agosto. Sin duda, uno de los eventos más importantes e innovadores de la comunidad cardiológica reunió a más de 32.000 profesionales, con destacados invitados internacionales y múltiples actividades científicas. Además de las tradicionales presentaciones de estudios, se inauguró un área de Salud Digital: Digital Health Area donde se llevaron a cabo sesiones continuas sobre E-Cardiology, con múltiples presentaciones de apps móviles, telemedicina y tecnología digital tanto para los profesionales como para la comunidad. Se presentaron las nuevas guías europeas sobre Hipertensión Arterial, tan esperadas luego del debate planteado en relación con las guías americanas en 2017. Las pautas europeas se mantendrán dentro del umbral de diagnóstico de 140/90 mmHg y se centrarán en mejorar las tasas de control a través de combinaciones iniciales de dos fármacos antihipertensivos para la mayoría de los pacientes. Realizaremos un breve resumen de algunos de los principales trabajos científicos presentados: - Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease: ARRIVE. - Coronary CT Angiography and 5-Year Risk of Myocardial Infarction: The SCOT-HEART Investigators. - Partial Oral Treatment of Endocarditis: POET. - Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: GLOBAL LEADERS. - One-Year Outcomes after PCI Strategies in Cardiogenic Shock: CULPRIT-SHOCK.
Summary: The European Congress of Cardiology was held at Munich from August 25th to 29th. Undoubtedly one of the most important and innovative events of the cardiology community, it brought together more than 32.000 professionals, with prominent international guests and multiple scientific activities. In addition to the traditional presentations of studies, ESC 2018 inaugurated a: Digital Health Area, where continuous sessions on E-Cardiology were held with multiple presentations of mobile apps, telemedicine and digital technology for both, the professionals and the community. The new european guidelines on Arterial Hypertension, awaited after the discussion related with the American guidelines in 2017, were presented. European blood pressure guidelines will stick with the 140/90 mmHg diagnostic threshold and will focus on improving control rates through initial two-drug antihypertensive combinations for most patients. We will make a brief summary of some of the main scientific trials presented: - Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease: ARRIVE. - Coronary CT Angiography and 5-Year Risk of Myocardial Infarction: The SCOT-HEART Investigators. - Partial Oral Treatment of Endocarditis: POET. - Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: GLOBAL LEADERS. - One-Year Outcomes after PCI Strategies in Cardiogenic Shock: CULPRIT-SHOCK
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Resumen: Del 10 al 12 de marzo de este año se celebró la reunión número 67 del congreso anual del American College of Cardiology (ACC), la cual tuvo lugar en el Orange County Convention Center, de la ciudad de Orlando, Florida. Sin duda, uno de los eventos más destacados de la agenda cardiológica, contó con la participación de más de 13.000 profesionales, con destacados invitados internacionales y múltiples actividades científicas. Uno de los puntos más esperados del evento fue la presentación de los ensayos clínicos; entre los 2.719 resúmenes aceptados, fueron 20 los trabajos seleccionados para ser presentados en las sesiones de Late Breaking Clinical Trials y 17 en las sesiones de Investigación Clínica1,2,3. Realizaremos un breve resumen de algunos de los principales trabajos científicos presentados. ( The ODYSSEY Outcomes Trial. Alirocumab in Patients After Acute Coronary Syndrome. ( Vest Prevention of Early Sudden Death Trial (VEST). ( TREAT Trial. Ticagrelor vs. Clopidogrel After Fibrinolytic Therapy in Patients With ST-Elevation Myocardial Infarction. ( NOTION. Five-Year Outcomes From the All-Comers Nordic Aortic Valve Intervention Randomized Clinical Trial in Patients with Severe Aortic Valve Stenosis. ( Clinical Outcomes of His Bundle Pacing Compared to Right Ventricular Pacing.
Summary: From March 10 to 12 of this year, the 67th annual meeting of the American College of Cardiology (ACC) was held at the Orange County Convention Center in Orlando, Florida. Undoubtedly, one of the most outstanding events of the cardiological agenda, was attended by more than 13.000 professionals, with prominent international guests and multiple scientific activities. One of the most awaited points of the event was the presentation of the clinical trials; among the 2.719 accepted abstracts, there were 20 works selected to be presented in the Late Breaking Clinical Trials sessions and 17 in the Clinical Research sessions1,2,3 We will make a brief summary of some of the main scientific trials presented: ( The ODYSSEY Outcomes Trial. Alirocumab in Patients After Acute Coronary Syndrome. ( Vest Prevention of Early Sudden Death Trial (VEST). ( TREAT Trial. Ticagrelor vs. Clopidogrel After Fibrinolytic Therapy in Patients With ST-Elevation Myocardial Infarction. ( NOTION: Five-Year Outcomes From the All-Comers Nordic Aortic Valve Intervention Randomized Clinical Trial in Patients with Severe Aortic Valve Stenosis. ( Clinical Outcomes of His Bundle Pacing Compared to Right Ventricular Pacing.
ABSTRACT
El 33° Congreso Uruguayo de Cardiología, celebrado en Punta del Este del 9 al 11 de noviembre, constituye el evento científico cardiológico más importante del año a nivel nacional. Como es habitual contó con la presencia de destacados invitados locales e internacionales. En este marco se presentaron 23 temas libres que abarcaron diferentes áreas de la cardiología; a saber: cardiología clínica, cirugía cardíaca, electrofisiología, hemodinamia, imagen cardíaca y prevención cardiovascular. Dentro de ellos, comentaremos algunos de los más destacados. - Fenómeno de no reflujo en la angioplastia coronaria. Incidencia, tratamiento y eficacia con vasodilatadores coronarios. - La anticoagulación precoz luego de la colocación de bioprótesis aórtica se asocia a mejor pronóstico funcional. - Cardiotoxicidad por trastuzumab en pacientes con cáncer de mama. Serie de casos. - Strain auricular izquierdo por Speckle Tracking: protocolo para su estudio y creación de modelo para análisis segmentario.
The 33rd Uruguayan congress of cardiology, celebrated at Punta del Este from November 9th to 11th, is the most relevant national cardiologic scientific event of the year. It was attended by local and International guests, as usual. Twenty-three abstracts about different cardiologic topics were presented, namely: clinical cardiology, electrophysiology, cardiac surgery, hemodynamics, cardiac imaging and cardiovascular prevention. We will comment on some of the most relevant of them: - No-reflow phenomenon in percutaneous coronary intervention. Incidence, treatment and coronary vasodilators efficacy - Early anticoagulation after aortic bioprostheses implantation is associated with better functional prognosis - Trastuzumab cardiotoxicity in breast cancer patients. Case series. - Left atrial strain by Speckle tracking. Study protocol and creation of a new model for segmental analysis
