Linezolid for infective endocarditis: A structured approach based on a national database experience.

ABSTRACT: Current data on the frequency and efficacy of linezolid (LNZ) in infective endocarditis (IE) are based on small retrospective series. We used a national database to evaluate the effectiveness of LNZ in IE.This is a retrospective study of IE patients in the Spanish GAMES database who received LNZ. We defined 3 levels of therapeutic impact: LNZ < 7 days, LNZ high-impact (≥ 7 days, > 50% of the total treatment, and > 50% of the LNZ doses prescribed in the first weeks of treatment), and LNZ ≥ 7 days not fulfilling the high-impact criteria (LNZ-NHI). Effectiveness of LNZ was assessed using propensity score matching and multivariate analysis of high-impact cases in comparison to patients not treated with LNZ from the GAMES database matched for age-adjusted comorbidity Charlson index, heart failure, renal failure, prosthetic and intracardiac IE device, left-sided IE, and Staphylococcus aureus. Primary outcomes were in-hospital mortality and one-year mortality. Secondary outcomes included IE complications and relapses.From 3467 patients included in the GAMES database, 295 (8.5%) received LNZ. After excluding 3 patients, 292 were grouped as follows for the analyses: 99 (33.9%) patients in LNZ < 7 days, 11 (3.7%) in LNZ high-impact, and 178 (61%) in LNZ-NHI. In-hospital mortality was 51.5%, 54.4%, and 19.1% respectively. In the propensity analysis, LNZ high-impact group presented with respect to matched controls not treated with LNZ higher in-hospital mortality (54.5% vs 18.2%, P = .04). The multivariate analysis showed an independent relationship of LNZ use with in-hospital mortality (odds ratio 9.06, 95% confidence interval 1.15--71.08, P = .03).Treatment with LNZ is relatively frequent, but most cases do not fulfill our high-impact criteria. Our data suggest that the use of LNZ as definitive treatment in IE may be associated with higher in-hospital mortality.

[Hormone replacement therapy in ischemic heart disease prevention in women. Arguments against]. / Tratamiento hormonal sustitutivo en la prevención de la cardiopatía isquémica en la mujer. Argumentos en contra.

Hormone replacement therapy is one of the most difficult issues women and their doctors face. Epidemiological studies have consistently found that women using hormone replacement therapy are at a substantially lower risk of developing coronary heart disease. Observational data are supported by findings demonstrating that hormone replacement therapy improves several risk factors o coronary heart disease, specially the favourable changes in lipid profile. However, no study has clearly established hormones help prevent heart disease. In women without heart disease, the benefits of hormone replacement therapy are unclear. However, recent clinical trials have sown that the use of hormone replacement therapy does not provide cardiovascular benefits in women with established heart disease.

[Acute myocardial infarction in nocturnal paroxysmal hemoglobinuria]. / Infarto agudo de miocardio en el seno de hemoglobinuria paroxística nocturna.

The case of a 62-year-old diabetic and smoker male who was under study in another hospital due to anemia, thrombopenia and hematuria of several months of evolution is presented. The patient was admitted to the coronary unit for an acute extensive transmural myocardial infarction and treated with t-PA. A few hours later the patient presented hematuric urine, a decrease in hemoglobin and platelets and acute renal insufficiency. Hematologic study confirmed the diagnosis of paroxystic nocturnal hemoglobinuria. The evolution of the patient was poor despite intensive medical treatment requiring hemodialysis. The patient presented cardiac tamponade and died. The role of hematologic disease in acute myocardial infarction and the treatment and evolution of the coronary syndrome in the context of the disease are discussed.

[The absence of interference between GSM mobile telephones and implantable defibrillators: an in-vivo study. Groupe Systèmes Mobiles]. / Ausencia de interferencia entre teléfonos móviles GSM y desfibriladores implantables: estudio in vivo.

INTRODUCTION AND OBJECTIVES: The electromagnetic field created by mobile telephones can cause pacemaker dysfunction. Although implantable cardioverter defibrillators are also susceptible to electromagnetic interference, few studies have addressed this issue and compatibility with the GSM mode has not been tested. This study was developed to detect possible "in vivo" interference between GSM mobile telephones and implantable cardioverter defibrillators. MATERIAL AND METHODS: The study group is composed of 30 patients with 8 different models of defibrillators. Twenty six had endocardial leads and 4 epicardial. Three GSM mobile phones were used: Siemens S3 COM and Motorola 6200 in all cases and Ericsson GA 318 in one. The tests were performed under continuous electrocardiographic monitoring. All therapies were deactivated and sensitivities were set to maximal parameters. The telephones were positioned in close contact to the defibrillator can and precordium, in two different angles. Three situations were evaluated: calling, established contact for 15 seconds and ringing. The protocol was repeated during pacing to assess the possibility of pacemaker mode inhibition. RESULTS: No cases of electromagnetic interference were observed. One patient presented non-sustained ventricular tachycardia episodes during the tests that were detected by the defibrillator. CONCLUSIONS: These results suggest that electromagnetic interference by GSM mobile phones are not a probable cause of implantable defibrillators dysfunction.