Endocarditis due to Candida albicans in an immunocompromised patient: A case report.

BACKGROUND: Fungal endocarditis is a low-frequency disease with a challenging diagnosis, as it can be mistaken with bacterial endocarditis. Fungal endocarditis causes higher mortality rates in immunocompromised patients. In the clinical practice, the endocarditis caused by fungi represents up to 10% of all infectious endocarditis cases and has a mortality rate of nearly 50%. CASE REPORT: Here we present the case of a 53-year-old woman under corticosteroid therapy with a history of rheumatic heart disease, aortic valve replacement, and rheumatoid arthritis, who presented with fungal endocarditis caused by Candida albicans. Even though the patient received 3 years of antifungal prophylaxis with fluconazole, had valve replacement surgery, and received intensive care, the patient finally worsened and died. CONCLUSIONS: Comorbidities and corticosteroid therapy predisposed the patient to acquire fungal endocarditis. This case highlights the importance of implementing procedures for the isolation and identification of fungi, and for carrying out antifungal-susceptibility testing, as well as establishing surveillance programs to identify infection-causing species and drug resistance patterns in hospitals. Moreover, designing and upgrading the algorithm for infectious endocarditis is the key to future improvements in diagnosis.

Endocarditis due to Candida albicans in an immunocompromised patient: A case report / Endocarditis por Candida albicans en una paciente inmunocomprometida: presentación de un caso

Case report: Here we present the case of a 53-year-old woman under corticosteroid therapy with a history of rheumatic heart disease, aortic valve replacement, and rheumatoid arthritis, who presented with fungal endocarditis caused by Candida albicans. Even though the patient received 3 years of antifungal prophylaxis with fluconazole, had valve replacement surgery, and received intensive care, the patient finally worsened and died. Conclusions: Comorbidities and corticosteroid therapy predisposed the patient to acquire fungal endocarditis. This case highlights the importance of implementing procedures for the isolation and identification of fungi, and for carrying out antifungal-susceptibility testing, as well as establishing surveillance programs to identify infection-causing species and drug resistance patterns in hospitals. Moreover, designing and upgrading the algorithm for infectious endocarditis is the key to future improvements in diagnosis.(AU)

Antecedentes: La endocarditis fúngica es una enfermedad de baja incidencia cuyo diagnóstico puede ser complicado al confundirse con la endocarditis bacteriana. La endocarditis fúngica se asocia a mayor mortalidad en pacientes inmunocomprometidos. En la práctica clínica, la endocarditis fúngica representa hasta el 10% de las endocarditis infecciosas, con una mortalidad de aproximadamente el 50%. Caso clínico: Mujer de 53 años con endocarditis fúngica por Candida albicans en tratamiento con corticosteroides por antecedentes de fiebre reumática, prótesis de válvula aorta y artritis reumatoide. A pesar de 3 años de profilaxis antifúngica con fluconazol, un nuevo reemplazo valvular y cuidados intensivos, la paciente finalmente empeora y muere. Conclusiones: Las comorbilidades y la toma de corticosteroides predispusieron a la paciente a adquirir una endocarditis fúngica. Esto resalta la importancia de implementar procedimientos de aislamiento, identificación del hongo y pruebas de sensibilidad a los antifúngicos, así como establecer programas de vigilancia para identificar especies causantes de infecciones y patrones de resistencia en hospitales. Además, diseñar y actualizar el algoritmo para un mejor diagnóstico de las endocarditis infecciosas es una cuestión clave.

Glomerular Filtration Rate in Patients with Multiple Sclerosis Undergoing Stem Cell Transplantation and Treated with Cyclophosphamide.

BACKGROUND: Glomerular filtration rate (GFR) is partially impaired in patients with multiple sclerosis (MS). When given chemotherapy before receiving hematopoietic stem-cell transplantation, GFR might be further deteriorated. OBJECTIVE: To measure the effect of cyclophosphamide on GFR in patients with MS who undergo chemotherapy. METHODS: We estimated GFR based on creatinine and cystatin C plasma concentrations in patients undergoing autologous hematopoietic stem-cell transplantation to treat their MS. RESULTS: Baseline GFR values were lower in the 28 patients with MS than in the 20 healthy individuals. Also, according to the Chronic Kidney Disease-Epidemiology Collaborative Group (CKD-EPI) 2012 Creat-CysC equation criteria, 4 of 28 patients were classified as having chronic kidney disease (CKD) before receiving the chemotherapy drugs. After receiving 4 × 50 mg per kg body weight cyclophosphamide, abnormal GFR results were recorded in 12 of 28 patients. CONCLUSIONS: Renal function must be monitored in patients with MS undergoing autologous stem-cell transplantation. Also, chemotherapy should be constrained as much as possible to prevent further deterioration of renal function.

Neighbouring populations, opposite dynamics: influence of body size and environmental variation on the demography of stream-resident brown trout (Salmo trutta).

In organisms such as fish, where body size is considered an important state variable for the study of their population dynamics, size-specific growth and survival rates can be influenced by local variation in both biotic and abiotic factors, but few studies have evaluated the complex relationships between environmental variability and size-dependent processes. We analysed a 6-year capture-recapture dataset of brown trout (Salmo trutta) collected at 3 neighbouring but heterogeneous mountain streams in northern Spain with the aim of investigating the factors shaping the dynamics of local populations. The influence of body size and water temperature on survival and individual growth was assessed under a multi-state modelling framework, an extension of classical capture-recapture models that considers the state (i.e. body size) of the individual in each capture occasion and allows us to obtain state-specific demographic rates and link them to continuous environmental variables. Individual survival and growth patterns varied over space and time, and evidence of size-dependent survival was found in all but the smallest stream. At this stream, the probability of reaching larger sizes was lower compared to the other wider and deeper streams. Water temperature variables performed better in the modelling of the highest-altitude population, explaining over a 99 % of the variability in maturation transitions and survival of large fish. The relationships between body size, temperature and fitness components found in this study highlight the utility of multi-state approaches to investigate small-scale demographic processes in heterogeneous environments, and to provide reliable ecological knowledge for management purposes.

The evolution and adaptive potential of transcriptional variation in sticklebacks--signatures of selection and widespread heritability.

Evidence implicating differential gene expression as a significant driver of evolutionary novelty continues to accumulate, but our understanding of the underlying sources of variation in expression, both environmental and genetic, is wanting. Heritability in particular may be underestimated when inferred from genetic mapping studies, the predominant "genetical genomics" approach to the study of expression variation. Such uncertainty represents a fundamental limitation to testing for adaptive evolution at the transcriptomic level. By studying the inheritance of expression levels in 10,495 genes (10,527 splice variants) in a threespine stickleback pedigree consisting of 563 individuals, half of which were subjected to a thermal treatment, we show that 74-98% of transcripts exhibit significant additive genetic variance. Dominance variance is also prevalent (41-99% of transcripts), and genetic sources of variation seem to play a more significant role in expression variance in the liver than a key environmental variable, temperature. Among-population comparisons suggest that the majority of differential expression in the liver is likely due to neutral divergence; however, we also show that signatures of directional selection may be more prevalent than those of stabilizing selection. This predominantly aligns with the neutral model of evolution for gene expression but also suggests that natural selection may still act on transcriptional variation in the wild. As genetic variation both within- and among-populations ultimately defines adaptive potential, these results indicate that broad adaptive potential may be found within the transcriptome.

Noninvasive diagnosis of hypolactasia with 4-Galactosylxylose (Gaxilose): a multicentre, open-label, phase IIB-III nonrandomized trial.

GOALS AND BACKGROUND: Hypolactasia affects over half of the world population. Diagnosis remains problematic as currently available tests, such as the hydrogen breath test, have low reliability and lactose intolerance symptoms are unspecific. We evaluated the diagnostic performance and safety of a new noninvasive diagnostic test based on urine or serum measurement of D-xylose after lactase cleavage of orally administered 4-galactosylxylose (gaxilose). STUDY: In a multicentre, open-label, nonrandomized, phase IIb-III study, consecutive patients with symptoms suggestive of lactose intolerance sequentially underwent intestinal biopsy for direct measurement of lactase activity (reference standard), hydrogen breath test, and blood glucose test after lactose challenge, 4- and 5-hour urine-based gaxilose test, and blood-based gaxilose test. For the gaxilose tests, 0 to 4 and 4 to 5 hours urine samples were taken after a 0.45 g gaxilose dose, whereas serum samples were taken 90 minutes after a 2.7 g dose for D-xylose determination. Genetic testing of hypolactasia was also assessed. RESULTS: Of the 222 patients enrolled, 203 completed all diagnostic tests; 108 were hypolactasic according to biopsy. The sensitivities and specificities and positive and negative predictive values of the gaxilose tests were all >90% versus 69% to 85% for the hydrogen breath test and the blood glucose test. The area under the ROC curve was significantly higher for the gaxilose tests (>0.9, P≤0.007). These tests also had higher sensitivity than genetic testing for hypolactasia and were well tolerated. CONCLUSIONS: The diagnostic performance of the gaxilose tests is excellent and can substantially improve the diagnosis of hypolactasia.

Chronic obstructive pulmonary disease as a cardiovascular risk factor. Results of a case-control study (CONSISTE study).

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) patients present a high prevalence of cardiovascular disease. This excess of comorbidity could be related to a common pathogenic mechanism, but it could also be explained by the existence of common risk factors. The objective of this study was to determine whether COPD patients present greater cardiovascular comorbidity than control subjects and whether COPD can be considered a risk factor per se. METHODS: 1200 COPD patients and 300 control subjects were recruited for this multicenter, cross-sectional, case-control study. RESULTS: Compared with the control group, the COPD group showed a significantly higher prevalence of ischemic heart disease (12.5% versus 4.7%; P < 0.0001), cerebrovascular disease (10% versus 2%; P < 0.0001), and peripheral vascular disease (16.4% versus 4.1%; P < 0.001). In the univariate risk analysis, COPD, hypertension, diabetes, obesity, and dyslipidemia were risk factors for ischemic heart disease. In the multivariate analysis adjusted for the remaining factors, COPD was still an independent risk factor (odds ratio: 2.23; 95% confidence interval: 1.18-4.24; P = 0.014). CONCLUSION: COPD patients show a high prevalence of cardiovascular disease, higher than expected given their age and the coexistence of classic cardiovascular risk factors.

Fish age at maturation is influenced by temperature independently of growth.

Age and size at maturation are important correlates of fitness in many organisms and understanding how these are influenced by environmental conditions is therefore required to predict populations' responses to environmental changes. In ectotherms, growth and maturation are closely linked to temperature, but nonetheless it is often unclear how temperature-induced variation in growth and temperature per se translate to the process of maturation. Here, we test this explicitly with a common garden experiment using nine-spined sticklebacks (Pungitius pungitius). We reared fish in 14 and 17°C and recorded high resolution growth trajectories and the timing of maturation on an individual basis. To characterize the growth of each individual, we fitted a von Bertalanffy growth curve to each measured growth trajectory, so that the three parameters of the curve provided a summary of an individual's growth. Temperature treatments induced changes in both the growth parameters and the age at maturation. In females, changes in the age of maturation were encompassed by variations in growth, whereas in males there was a temperature-related shift in the age at maturation that was unrelated to growth. Our experiment demonstrates that temperature can affect maturation directly, and not only through temperature-induced changes in growth. Therefore, one cannot predict, on the basis of growth only, how changes in temperature might alter age and size at maturation and the subsequent reproduction.

Factors affecting the STR amplification success in poorly preserved bone samples.

BACKGROUND: Factors affecting the success of short tandem repeat (STR) amplification of poorly preserved samples are generally known, but as of yet, they have seldom been systematically assessed. Using two different maximum likelihood-based methods, the relative importance of DNA quantity, degradation and inhibition in STR genotyping was studied with DNA extracts from a set of old bone samples. First, the effects of different factors related to PCR amplification were estimated with a generalized linear mixed model. Second, error rates of allelic drop-out and drop-in were estimated on the basis of the frequency and nature of mismatches between replicates. RESULTS: In autosomal STR analyses, the most important factor was the DNA quantity, followed by the degradation, whereas in Y-chromosomal STR analysis, the most important factor was the degradation. Inhibition was a minor concern in STR analyses of poorly preserved bones. CONCLUSIONS: The success of PCR amplification depends largely on the template DNA quality (amount and degradation), but these problems can be partly compensated for by different primer design and amplification chemistry. Consequently, the relative roles of the compromising factors differ according to the kit used.

Female-biased expression on the X chromosome as a key step in sex chromosome evolution in threespine sticklebacks.

Given that the genome of males and females are almost identical with the exception of genes on the Y (or W) chromosome or sex-determining alleles (in organisms without sex chromosomes), it is likely that many downstream processes resulting in sexual dimorphism are produced by changes in regulation. In early stages of sex chromosome evolution, as the Y-chromosome degenerates, gene expression should be significantly impacted for genes residing on the sex chromosome pair as regulatory mutations accumulate. However, this has rarely been examined because most model organisms have clearly diverged sex chromosomes. Fish provide a unique opportunity to examine the evolution of sex chromosomes because genetic sex determination has evolved quite recently in some groups of fish. We compared sex-specific transcription in threespine stickleback (Gasterosteus aculeatus) liver tissue using a long-oligo microarray. Of the 1,268 genes that were differentially expressed between sexes, a highly significant proportion (23%) was concentrated on chromosome 19, corresponding to the recently described nascent sex chromosomes. The sex-biased genes are enriched for different functional categories in males and females, although there is no specific functional enrichment on the sex chromosomes. Female-biased genes are concentrated at one end of the sex chromosome, corresponding to a deletion in the Y, suggesting a lack of global dosage compensation. Prior research on threespine sticklebacks has demonstrated various degrees of dissimilarity in upstream regions of genes on the Y providing a potential mechanism for the observed patterns of female-biased expression. We hypothesize that degeneration of the Y chromosome results in regulatory mutations that create a sex-specific expression pattern and that this physical concentration of sex-biased expression on the nascent sex chromosome may be a key feature characterizing intermediate phases of sex chromosome evolution.

Determinants and predictors of the cost of COPD in primary care: a Spanish perspective.

OBJECTIVES: 1) To estimate the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) followed in primary care in Spain; 2) To analyze the possible cost predictor variables. PATIENTS AND METHODS: A multicenter, epidemiological, observational, descriptive study. Sociodemographic data, severity of disease, associated comorbidity, treatment followed by patients, quality of life (SF-12 questionnaire), health care resource utilization in the previous 12 months and duration of working disability due to COPD were collected. RESULTS: A total of 10,711 patients (75.6% men; 24.4% women) with a mean age of 67.1 +/- 9.66 years were evaluated. The mean forced expiratory volume in one second (FEV1) value was 57.4 +/- 13.4%. The total cost per patient per year was Euro1,922.60 +/- 2,306.44. The largest component of this cost was hospitalization (Euro788.72 +/- 1,766.65), followed by cost of drugs (Euro492.87 +/- 412.15) and visits to emergency rooms (Euro134.32 +/- 195.44). Linear regression analysis found associated heart disease, FEV1, physical component of quality of life, number of medical visits (primary care physician, pneumologist and emergency room), hospital admissions (frequency and duration of stay) and duration of working disability to be significant predictors of the total annual cost. CONCLUSIONS: The total annual cost of a COPD patient followed in primary care in Spain was considered high in this study. The presence of associated heart disease, severity of airflow obstruction, physical component of quality of life, health care resource utilization and duration of work disability were found to be predictor of cost.

[Infectious diarrhea study in Castellón, Spain (EDICS): population incidence of sporadic cases in 2004 and comparison with the year 2000]. / Estudio de la diarrea infecciosa en Castellón (EDICS): incidencia poblacional de casos esporádicos en 2004 y comparación con el año 2000.

BACKGROUND AND OBJECTIVE: Infectious intestinal diseases are highly prevalent, and among them sporadic cases are the most common processes. The aim of this study was to estimate the incidence of sporadic cases diagnosed in a healthcare district of Castellón (Spain) in the year 2004, and to compare them with those of the year 2000. MATERIAL AND METHOD: Based on routine coprocultures and individual demographic data of each patient, we calculated the population rates by age for the more frequent microorganisms, especially detailed for children up to 5 years of age. We report the results of the year 2004, and compare these with the previous study of the year 2000. RESULTS: Campylobacter showed the highest rate (1.01 x 103), followed by Salmonella (0.75), each without significant differences regarding the year 2000. The rate of rotavirus cases (0.65) was smaller than in 2000; and for adenovirus 2004 was an atypical seasonal year. In children younger than 3 years, rates were 26.54; 10.23 and 11.75. As in the previous study, the age-distribution in children < 5 years was very particular. An U inverted shape was seen for Campylobacer, and the rates for rotavirus decreased after the peak observed in the youngest group (< 6 months). Among hospitalized patients rotavirus was the most common and Campylobacter the less common. CONCLUSIONS: The epidemiological traits of the rates by age until the age of five are characteristic for each microorganism, as are the proportions of hospitalization. Rates of Campylobacter and Salmonella in the year 2004 were similar to the year 2000, but a decrease in the rotavirus rates was observed.

Estudio de la diarrea infecciosa en Castellón (EDICS): incidencia poblacional de casos esporádicos en 2004 y comparación con el año 2000 / Infectious diarrhea study in Castellón, Spain (EDICS): population incidence of sporadic cases in 2004 and comparison with the year 2000

Fundamento y objetivo: Las infecciones intestinales son procesos muy frecuentes y la mayor parte de ellas son casos esporádicos. Se pretende estimar su incidencia poblacional en un área de Castellón durante el año 2004 y compararla con la del año 2000. Material y método: A partir de los coprocultivos habituales se calcularon las tasas por edades para los microorganismos más frecuentes, prestando especial atención a los niños menores de 5 años de edad. Se presentan los resultados de 2004 y su comparación con el año 2000. Resultados: Campylobacter presentó las tasas globales más altas (1,01 ƒ 103), seguido de Salmonella (0,75), sin diferencias significativas con el año 2000. Rotavirus, con una tasa de 0,65, disminuyó respecto a 2000 y adenovirus presentó un año atípico. En menores de 3 años las tasas fueron, respectivamente, de 26,54, 10,23 y 11,75. La distribución por edades en menores de 5 años fue muy diferente en cada microorganismo, con forma de U invertida para Campylobacter y perfil decreciente continuo desde el máximo en menores de 6 meses de edad para rotavirus. En hospitalizados destacan las elevadas tasas de Rotavirus, ya desde los menores de 6 meses de edad, y los escasos ingresos por campilobacteriosis. Conclusiones: Los rasgos epidemiológicos que reflejan las distribuciones por edad desde los menores de 6 meses hasta los niños de 5 años son peculiares para cada germen, como lo son las proporciones de hospitalización. Las tasas de Campylobacter y Salmonella fueron estables, pero rotavirus experimentó una disminución de incidencia

Background and objective: Infectious intestinal diseases are highly prevalent, and among them sporadic cases are the most common processes. The aim of this study was to estimate the incidence of sporadic cases diagnosed in a healthcare district of Castellón (Spain) in the year 2004, and to compare them with those of the year 2000. Material and method: Based on routine coprocultures and individual demographic data of each patient, we calculated the population rates by age for the more frequent microorganisms, especially detailed for children up to 5 years of age. We report the results of the year 2004, and compare these with the previous study of the year 2000. Results: Campylobacter showed the highest rate (1.01 ƒ 103), followed by Salmonella (0.75), each without significant differences regarding the year 2000. The rate of rotavirus cases (0.65) was smaller than in 2000; and for adenovirus 2004 was an atypical seasonal year. In children younger than 3 years, rates were 26.54; 10.23 and 11.75. As in the previous study, the age-distribution in children < 5 years was very particular. An U inverted shape was seen for Campylobacer, and the rates for rotavirus decreased after the peak observed in the youngest group (< 6 months). Among hospitalized patients rotavirus was the most common and Campylobacter the less common. Conclusions: The epidemiological traits of the rates by age until the age of five are characteristic for each microorganism, as are the proportions of hospitalization. Rates of Campylobacter and Salmonella in the year 2004 were similar to the year 2000, but a decrease in the rotavirus rates was observed

Neuroprotective effects of early antiretrovirals in vertical HIV infection.

We performed a retrospective study of a series of 58 of 189 vertically HIV-1 infected children who went on to develop progressive HIV-1-associated encephalopathy to assess real-life effects of early antiretroviral therapy on neurologic outcome. Our findings clearly indicate that antiretroviral therapy before the onset of neurologic symptoms delayed presentation of progressive HIV-1-associated encephalopathy, with an additional beneficial effect on survival.

[Incidence of sporadic cases of the most frequent intestinal infections in Castellon]. / Incidencia de casos esporádicos de las infecciones intestinales más frecuentes en Castellón.

BACKGROUND: Intestinal infections are highly frequent processes of which solely a part are identified by the epidemiological monitoring systems. This study is aimed at estimating the incidence on the population, by age groups, of the sporadic intestinal infections diagnosed in one healthcare district in Castellón in the year 2000. METHODS: Based on the routine coprocultures, the basic demographic data for each patient was gathered for calculating the diagnosis and hospitalization rates. For children up to five years of age, the per annum rates were calculation for each microorganism. RESULTS: Campylobacter showed the highest rates (114.5 x 10(5)), followed by rotavirus (94.7) and Salmonella (83.0). Rotavirus is predominant among children under one year of age (3,194 x 10(5)), Campylobacter among those 1-4 year-olds, with a maximum of 3,850 x 10(5) among one-year olds, while Salmonella was predominant among all ages starting as of 5 years of age. The rates for cases hospitalized showed a different pattern, rotavirus ranking first (34.9 x 10(5)), Salmonella (21.7 x 10(5)) and Campylobacter (9.9 x 10(5)). With the exception of Salmonella, there were no outbreaks during the period under study. The predominance of Campylobacter was observed at the expense of the cases among children within the 1-4 age range who were not hospitalized. CONCLUSIONS: Up to 4 years of age, the distribution of the germs causing these infections differs every year. A knowledge of the descriptive epidemiology of these infections contributes to the study of the social impact thereof and provides support for delving deeper into some questions that are posed with a view to these diseases and the preventive aspects which can be implemented.

Incidencia de casos esporádicos de las infecciones intestinales más frecuentes en Castellón / Incidence of sporadic cases of the intestinal infections most frequent in Castellón, Spain

Fundamento: Las infecciones intestinales son procesos muy frecuentes de las que solo una parte son identificadas por los sistemas de vigilancia epidemiológica. El objetivo de este estudio es estimar la incidencia poblacional por grupos de edad de las infecciones intestinales esporádicas diagnosticadas en un área sanitaria de Castellón durante el año 2000. Métodos: A partir de los coprocultivos de rutina, se reunieron los datos demográficos básicos de cada enfermo para el cálculo de las tasas de diagnóstico y de hospitalización. En niños de hasta 5 años de edad se calcularon las tasas por año para cada microorganismo. Resultados: Campylobacter presentó las tasas más altas (114,5 por 105), seguido de rotavirus (94,7) y Salmonella (83,0). Rotavirus predomina en menores de 1 año (3.194 x 105), Campylobacter en 14 años, con un máximo de 3.850 por 105 en el segundo año de vida mientras Salmonella predominó en todas las edades a partir de los 5 años. Las tasas de casos hospitalizados tuvieron un patrón diferente, con rotavirus en primer lugar (34,9 por 105), Salmonella (21,7 por 105) y Campylobacter (9,9 por 105). Excepto Salmonella, no hubo brotes en ese periodo El predominio de Campylobacter se observó a expensas de los casos en niños de 1-4 años no hospitalizados. Conclusiones: Hasta los 4 años de edad la distribución de los gérmenes causantes de las infecciones es diferente para cada año. El conocimiento de la epidemiología descriptiva de estas infecciones contribuye al estudio de su impacto social y presta soporte para profundizar en algunas cuestiones que se plantean ante estas enfermedades y los aspectos preventivos que se puedan implementar (AU)

Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation: a prospective and randomized study.

BACKGROUND: Data from studies of angiotensin-converting enzyme inhibitors provide evidence that the renin-angiotensin-aldosterone system plays a role as a mediator of atrial remodeling in atrial fibrillation. The present study has evaluated the effect of treatment with the angiotensin I type 1 receptor blocker irbesartan on maintaining sinus rhythm after conversion from persistent atrial fibrillation. METHODS AND RESULTS: To be included in the present study, patients must have had an episode of persistent atrial fibrillation for >7 days. The patients were then randomized and scheduled for electrical cardioversion. Two groups of patients were compared: Group I was treated with amiodarone, and group II was treated with amiodarone plus irbesartan. The primary end point was the length of time to a first recurrence of atrial fibrillation. From a total of 186 patients assessed in the study, 154 were analyzed with the use of intention-to-treat analysis. Seventy-five patients were randomly allocated to group I and 79 to group II. After 2 months of follow-up in the intention-to-treat analysis, the group treated with irbesartan had fewer patients with recurrent atrial fibrillation (Kaplan-Meier analysis, 84.79% versus 63.16%, P=0.008). The Kaplan-Meier analysis of time to first recurrence during the follow-up period (median time, 254 days [range, 60 to 710]) also showed that patients treated with irbesartan had a greater probability of remaining free of atrial fibrillation (79.52% versus 55.91%, P=0.007). CONCLUSIONS: Patients treated with amiodarone plus irbesartan had a lower rate of recurrence of atrial fibrillation than did patients treated with amiodarone alone.