Venous excess ultrasound score and acute kidney injury in patients with acute coronary syndrome.

AIMS: Systemic venous congestion is associated with an increased risk of acute kidney injury (AKI) in critically ill patients. Venous Excess Ultrasound Score (VExUS) has been proposed as a non-invasive score to assess systemic venous congestion. We aimed to evaluate the association between VExUS and AKI in patients with acute coronary syndrome (ACS). METHODS AND RESULTS: This is a prospective study including patients with the diagnosis of ACS (both ST elevation and non-ST elevation ACS). VExUS was performed during the first 24 h of hospital stay. Patients were classified according to the presence of systemic congestion (VExUS 0/≥1). The primary objective of the study was to determine the occurrence of AKI, defined by KDIGO criteria. A total of 77 patients were included. After ultrasound assessment, 31 (40.2%) patients were categorized as VExUS ≥1. VExUS ≥1 was more frequently found in inferior vs. anterior myocardial infarction/non-ST-segment elevation acute myocardial infarction (48.3 vs. 25.8 and 22.5%, P = 0.031). At each increasing degree of VExUS, a higher proportion of patients developed AKI: VExUS = 0 (10.8%), VExUS = 1 (23.8%), VExUS = 2 (75.0%), and VExUS = 3 (100%; P < 0.001). A significant association between VExUS ≥1 and AKI was found [odds ratio (OR): 6.75, 95% confidence interval (CI): 2.21-23.7, P = 0.001]. After multivariable analysis, only VExUS ≥1 (OR: 6.15; 95% CI: 1.26-29.94, P = 0.02) remained significantly associated with AKI. CONCLUSION: In patients hospitalized with ACS, VExUS is associated with the occurrence of AKI. Further studies are needed to clarify the role of VExUS assessment in patients with ACS.

[Accelerated idioventricular rhythm before reperfusion. what does it mean? A Case Report]. / Ritmo idioventricular acelerado antes de la reperfusión ¿Cuál es su significado? Reporte de un Caso.

Accelerated idioventricular rhythm has traditionally been recognized as a benign arrhythmia. During an acute myocardial infarction, it is considered a marker of successful reperfusion, though the evidence is controversial. Usually, this arrhythmia is transitory and does not cause hemodynamic compromise; however, its presence may have prognostic value and not necessarily be a benign marker. The recognition of this arrhythmia is always important as well as its recording on a 12-lead electrocardiogram. We present the case of an adult male patient with inferior ST-segment elevation myocardial infarction, who presented accelerated idioventricular rhythm without reperfusion therapy.

[Relation of red cell distribution width and mean platelet volume with the severity of preeclampsia]. / Severidad de la preeclampsia y su relacion con volumen plaquetario y ancho de distribucion eritrocitaria.

BACKGROUND: It has been established a strong association between the red cell distribution width (RDW) and mean platelet volume (MPV) with hypertension in non-pregnant patients. However, few studies have been performed in patients with preeclampsia, yielding inconsistent results. Our aim is to evaluate the relationship between RDW and MPV with the severity of preeclampsia. METHODS: Analytic cross-sectional study. We include 64 patients with preeclampsia (26 mild, 38 severe) and 70 patients with normotensive pregnancy. Clinical data, sociodemographic characteristics and laboratory measures, including RDW and MPV, were recorded for each patient. RESULTS: Hemoglobin and platelet count measures were similar between groups. Preeclamptic patients had levels of RDW (14.7 ± 1.4 vs. 13.4 ± 0.7, p = 0.0001) and MPV (11.8 ± 2.4 vs. 11.0 ± 1.4, p = 0.03) more elevated than control group. Moreover, severe preeclamptic subgroup had more elevated levels of RDW (15.0 ± 1.6 vs. 14.0 ± 0.6, p = 0.001) and MPV (12.7 ± 2.8 vs. 10.8 ± 1.8, p = 0.01) in comparison with mild preeclamptic patients. CONCLUSIONS: We demonstrate that RDW and MPV are accessible and inexpensive measures associated with the severity of preeclampsia.

Introducción: se ha establecido fuertemente la asociación entre el ancho de distribución eritrocitario (ADE) y el volumen plaquetario medio (VPM) con la hipertensión arterial sistémica. Sin embargo, se han realizado pocos estudios en pacientes con preeclampsia, obteniéndose resultados inconsistentes. Nuestro objetivo es evaluar la relación entre el ADE y el VPM con la severidad de la preeclampsia. Métodos: incluimos 64 pacientes con preeclampsia (26 leve, 38 severa) y 70 pacientes con embarazo normotenso. Los datos clínicos, características sociodemográficas y valores de laboratorio, incluyendo ADE y VPM, fueron registrados en cada paciente. Resultados: las medidas de hemoglobina y conteo plaquetario fueron similares entre ambos grupos. Las pacientes con preeclampsia tuvieron niveles de ADE (14.7 ± 1.4 frente a 13.4 ± 0.7, p = 0.0001) y VPM (11.8 ± 2.4 frente a 11.0 ± 1.4, p = 0.03) más elevados que el grupo control. El subgrupo de preeclampsia severa tuvo niveles más elevados de ADE (15.0 ± 1.6 frente a 14.0 ± 0.6, p = 0.001) y VPM (12.7 ± 2.8 frente a 10.8 ± 1.8, p = 0.01) que las pacientes con preeclampsia leve. Conclusiones: se demuestra que el ADE y el VPM son medidas accesibles asociadas a la severidad de la preeclampsia.

Clinical and Echocardiographic Factors Associated with Right Ventricular Systolic Dysfunction in Hemodialysis Patients.

BACKGROUND: Chronic kidney disease is a disorder of epidemic proportions that impairs cardiac function. Cardiovascular diseases are the leading cause of death in hemodialysis patients, and the understanding of new nontraditional predictors of mortality could improve their outcomes. Right ventricular systolic dysfunction (RVSD) has recently been recognized as a predictor of cardiovascular death in heart failure and hemodialysis patients. However, the factors contributing to RVSD in hemodialysis patients remain unknown. The aim of this study was to evaluate the clinical and echocardiographic factors associated with RVSD in hemodialysis patients. METHODS: A cross-sectional study was conducted in which 100 outpatients with end-stage renal disease on chronic hemodialysis were evaluated. A transthoracic echocardiographic examination was performed at optimal dry weight. Right ventricular systolic function was evaluated using tricuspid annular plane systolic excursion (TAPSE). Clinical and echocardiographic data were recorded for each patient. A multivariate linear logistic regression was created using RVSD (TAPSE <14 mm) as the dependent variable. RESULTS: Fifteen patients with RVSD and 85 patients without RVSD were analyzed. TAPSE had a positive correlation with left ventricular ejection fraction (LVEF) and myocardial relaxation velocity. Independent contributors to RVSD were LVEF (OR 1.14, 95% CI 1.05-1.26), left ventricular mass index (OR 1.02, 95% CI 1.00-1.04), and myocardial relaxation velocity (OR 1.81, 95% CI 1.18-3.19). CONCLUSIONS: Echocardiographic factors were significant contributors to RVSD. These measurements could be included as part of the routine workup in all end-stage renal disease patients on hemodialysis.

Endoscopic transventricular exploration with biopsy of the basal cisterns and the role of endoscopic third ventriculostomy in patients suffering with basal cistern meningitis and consecutive hydrocephalus.

OBJECTIVES: The purpose of this work is to elucidate the efficacy of endoscopic basal cisterns exploration, biopsy, and third ventriculostomy (ETV) in patients with basal cistern meningitis and arachnoiditis. MATERIALS AND METHODS: The cases and videos of all patients in whom flexible neuroendoscopy was performed during the period of January 2005-June 2012 at the University Hospital 'Dr. Ignacio Morones Prieto' in San Luis Potosí, México. A group of 47 patients with radiological diagnosis of basal meningitis, arachnoiditis, and negative cerebrospinal fluid analysis were included. RESULTS: From the 28 (60%) patients with histological diagnosis, 22 (47%) were made from biopsy from the arachnoid membranes of the basal cisterns only, 4 (9%) only from the cerebral cortex, and 2 (4%) from both sites. There were no complications related to the endoscopic procedure. In 23 patients from the 42 with hydrocephalus, ETV was successful. The grade of diagnostic accuracy of both biopsies in detect etiology was 68% (28 of 47 patients), the diagnostic accuracy of arachnoid biopsy was 60%, and diagnostic accuracy of convexity brain biopsy was 21% with 24 and 6 patients, respectively. DISCUSSION: Endoscopic transventricular biopsy of the basal cisterns seems to be a safe and a relatively accurate procedure. As longs as frozen subarachnoid space was not seen, the possibilities of performing ETV in hydrocephalus condition are elevated depending on the causal micro-organism.

[The association between red cell distribution width (RDW) and short-term mortality risk in patients with acute coronary syndrome (ACS)]. / Relación entre el ancho de distribución eritrocitaria (ADE) y la mortalidad a corto plazo en pacientes con síndrome coronario agudo (SCA).

OBJECTIVE: To demonstrate the association between red cell distribution width and short-term mortality risk in patients with acute coronary syndrome. METHODS: We prospectively recruited 78 patients with acute coronary syndrome. The study population was classified according to quartiles of the red cell distribution width at hospital admission. A high red cell distribution width was defined as a value in the upper fourth quartile (>15) and a low red cell distribution width was defined as any value set in the lower three quartiles (≤15). After discharge, all patients were followed for three months. RESULTS: The short-term cardiovascular mortality was 47.2% in the high red cell distribution width group vs. 10.2% in the low red cell distribution width group (p<0.001). In the receiver operating characteristic curve analysis, a red cell distribution width value of more than 15% yielded a sensitivity of 66.7%, a specificity of 83%, and a positive predictive value of 79.7% for cardiac mortality. After multivariate analysis, high levels of red cell distribution width were independent predictors for three-month mortality (p=0.001). CONCLUSION: We demonstrated that red cell distribution width is an accessible parameter associated with short-term cardiovascular mortality in patients with acute coronary syndrome.