Infections in the first year after heart transplantation in a Latin American country.

BACKGROUND: Heart transplantation is the therapy of choice in patients with advanced heart failure refractory to other medical or surgical management. However, heart transplants are associated with complications that increase posttransplant morbidity and mortality. Infections are one of the most important complications after this procedure. Therefore, infections in the first year after heart transplantation were evaluated. METHODS: A retrospective cohort study of infections after heart transplants was conducted in a teaching hospital in Colombia between 2011 and 2019. Patients registered in the institutional heart transplant database (RETRAC) were included in the study. Microbiological isolates and infectious serological data were matched with the identities of heart transplant recipients and data from clinical records of individuals registered in the RETRAC were analyzed. The cumulative incidences of events according to the type of microorganism isolated were estimated using Kaplan-Meier survival analyses. RESULTS: Seventy-nine patients were included in the study. Median age was 49 years (37.4-56.3), and 26.58% of patients were women. Eighty-seven infections were documented, of which 55.17% (48) were bacterial, 22.99% (20) were viral, and 12.64% (11) were fungal. Bacterial infections predominated in the first month. In the first year, infections caused 38.96% of hospital admissions and were the second cause of death after heart transplants (25.0%). CONCLUSION: Posttransplant infections in the first year of follow-up were frequent. Bacterial infections predominated in the early posttransplant period. Infections, mainly bacterial, were the second most common cause of death and the most common cause of hospitalization in the first year after heart transplantation.

Transmission of malaria from donors to solid organ transplant recipients: A case report and literature review.

Malaria is a febrile and potentially fatal infection. It is typically transmitted to humans through the bite of Anopheles mosquitoes and less frequently can be contracted through blood transfusions, sharing contaminated needles and syringes, mother-to-child transmission, or after solid organ transplantation. Posttransplant malaria has rarely been reported in the literature, even in endemic areas. We report the cases of three solid organ recipients in which Plasmodium vivax infection was documented during postsurgical evaluation 30 days after transplant surgery. The diagnosis of donor-derived malaria was confirmed in all patients by demonstrating Plasmodium in a peripheral blood smear and by polymerase chain reaction (PCR). All recipients had symptoms. The liver transplant recipient had myalgia, arthralgia, and thrombocytopenia; the kidney transplant recipient developed acute renal failure; and the heart transplant recipient had fever, cephalalgia, and tonic-clonic seizures. Pre-transplant screening of donors and recipients from endemic regions may not be sufficient to safely rule out persistent malaria. In Colombia, according to legislation, no mandatory testing is required for the diagnosis of malaria in organ donors in nonendemic areas. Therefore, donor screening by questionnaire is the only tool for preventing transplant-borne malaria. The migratory trend from Venezuela to Colombia has increased the number of imported cases of malaria, and the infection may be present in endemic and nonendemic regions. Although donor evaluation is not standardized in current guidelines, we suggest that donors be tested for malaria with a peripheral blood smear, detection of specific IgG antibodies against Plasmodium, and techniques such as PCR, if possible.

J-Shaped Upper Mini-Sternotomy Versus Full Sternotomy for Aortic Valve Replacement: A Comparative Study.

BACKGROUND: This study aims to compare the characteristics between patients who underwent aortic valve replacement (AVR) through a J-shaped upper mini-sternotomy (UMS) and patients who underwent full sternotomy (FS) in the basis of clinical care and hospital outcomes. METHODS: A retrospective, cross-sectional study was conducted on adult patients who were subjected to AVR by UMS from 2014 to 2017, compared with a historical control of patients who had undergone UMS by FS from 2011 to 2014. Patients, who received combined valve replacement or aortic surgery, as well as heart valve reinterventions due to endocarditis, were excluded. Sociodemographic characteristics, medical history, hospital and intensive care stay, blood transfusions, complications, and mortality of both procedures were compared. RESULTS: There were 57 patients under UMS and 99 patients under FS included in this study. The median age was 67 years, and 56.77% of the patients were male. No differences were observed in the past medical history and the type of valve implanted between the groups. During surgery, patients under UMS received a lower percentage of red blood cell and platelet transfusions compared with FS. However, UMS had a higher percentage of cryoprecipitate transfusion. Intensive care stay was shorter in UMS compared with FS (three days; interquartile range [IQR], 2-4; and four days; IQR, 2-6, respectively) without differences in overall hospital stay, postoperative complications, in-hospital mortality, and 30-day mortality. CONCLUSIONS: The J-shaped upper mini-sternotomy is a feasible surgical technique that does not increase in-hospital or 30-day mortality, neither hospital stay nor infectious complications.

Association of traditional cardiovascular risk factors in adults younger than 55 years with coronary heart disease. Case-control study.

OBJECTIVES: The traditional cardiovascular risk factors associated with coronary artery disease in individuals younger than 55 years old was determined in this study. METHODS: A retrospective, paired case-control study comprised of patients younger than 55 years old who were admitted to the hospital due to acute coronary syndrome with coronary artery disease from 2011 to 2016. There were two controls per case, paired by age, gender, admission date, and health insurance. Data from patients were collected, such as sociodemographic information, cardiovascular risk factors, and drug therapy information. A conditional logistic regression model was created to evaluate the association between traditional cardiovascular risk factors and coronary artery disease. RESULTS: There were 171 cases and 342 controls included in the study. The median age was 49 years, with a predominance of male gender (80.12%). Nearly 66% of cases had at least one traditional cardiovascular risk factor. The most common risk factors were obesity (57.31%), arterial hypertension (45.62%), and smoking (28.97%). Independent risk factors of coronary artery disease in patients younger than 55 years were arterial hypertension (odds ratio, 2.52; 95% confidence interval, 1.48-4.20; p = 0.001) and smoking (odds ratio, 7.15; 95% confidence interval, 3.19-15.99; p = 0.00). No significant association between diabetes mellitus and coronary heart disease in the global group (odds ratio, 2.04; 95% confidence innterval, 0.91-4.58; p = 0.083) was found. CONCLUSION: For patients younger than 55 years, with a theoretically lower risk of coronary artery disease due to their age, having one or several traditional risk factors (smoking, arterial hypertension, dyslipidemia, or diabetes mellitus) confers an increased risk of coronary artery disease regardless of age.

Coriocarcinoma metastásico posparto: presentación de un caso / Metastatic Postpartum Choriocarcinoma: Case report

Se informa el caso de una paciente de 18 años de edad, quien consultó por disnea súbita, asociado con dolor torácico y hemoptisis después de una cesárea. Se documentaron niveles elevados de BHCG (ß-Human Chorionic Gonadotrophin, por sus siglas del inglés) y se evidenciaron imágenes nodulares pulmonares, con áreas de sangrado sugestivas de lesiones metastásicas, asociado con hemotórax izquierdo en la escanografía de tórax. Así mismo, se observaron lesiones metastásicas similares en hígado, riñón izquierdo y sacro. Teniendo en cuenta la edad reproductiva, niveles de BHCG elevados y hallazgos clínicos, se consideró un coriocarcinoma manifiesto clínicamente en el puerperio. Se inició quimioterapia con mejoría clínica y descenso de niveles de BHCG.

We report a case of an 18 year old female patient, with sudden onset dyspnea, chest pain and hemoptysis after cesarean delivery. High BHCG blood levels (Beta-Human Chorionic Gonadotrophin) were documented, and multiple pulmonary nodal images were evidenced, with bleeding areas which suggest metastatic lesions, associated with the left hemithorax in the chest scan. Similar images were also observed in the liver, left kidney and sacrum. Because of childbearing age, high BHCG levels, and clinical features, it was considered a metastatic choriocarcinoma which was clinically manifested in the puerperium. Chemotherapy began, with clinical improvement and decreased BHCG levels.