Progression of valve heart disease in a cohort of patients undergoing renal replacement therapy / Progressão da doença cardíaca valvar em coorte de doentes em terapia renal substitutiva

Abstract Introduction: Cardiovascular disease is an important cause of death among patients with chronic kidney disease (CKD). Valve calcification is a predictor of cardiovascular mortality and coronary artery disease. Objective: To assess heart valve disease frequency, associated factors, and progression in CKD patients. Methods: We conducted a retrospective study on 291 CKD patients at Hospital das Clínicas de Pernambuco. Inclusion criteria were age ≥ 18 with CKD and valve disease, while those on conservative management or with missing data were excluded. Clinical and laboratory variables were compared, and patients were categorized by dialysis duration (<5 years; 5-10 years; >10 years). Statistical tests, including chi-square, Fisher's exact, ANOVA, and Kruskal-Wallis, were employed as needed. Simple and multivariate binary regression models were used to analyze valve disease associations with dialysis duration. Significance was defined as p < 0.05. Results: Mitral valve disease was present in 82.5% (240) of patients, followed by aortic valve disease (65.6%; 86). Over time, 106 (36.4%) patients developed valve disease. No significant association was found between aortic, pulmonary, mitral, or tricuspid valve disease and dialysis duration. Secondary hyperparathyroidism was the sole statistically significant factor for mitral valve disease in the regression model (OR 2.59 [95% CI: 1.09-6.18]; p = 0.031). Conclusion: CKD patients on renal replacement therapy exhibit a high frequency of valve disease, particularly mitral and aortic valve disease. However, no link was established between dialysis duration and valve disease occurrence or progression.

Resumo Introdução: Doenças cardiovasculares são uma causa significativa de morte em pacientes com Doença Renal Crônica (DRC). A calcificação valvar é preditor de mortalidade cardiovascular e doença arterial coronariana. Objetivo: Avaliar a frequência, fatores associados e progressão de valvopatias em pacientes com DRC. Métodos: Coorte retrospectiva com 291 pacientes ambulatoriais no Hospital das Clínicas de Pernambuco. Inclusão: ≥18 anos com DRC e valvopatia; exclusão: tratamento conservador ou dados incompletos. Variáveis clínicas e laboratoriais foram comparadas e categorizadas por tempo de terapia dialítica (TTD): <5 anos, 5-10 anos, >10 anos. Foram aplicados os testes Qui-quadrado, exato de Fisher, ANOVA, Kruskal-Wallis. Associação entre valvopatia e TTD foi avaliada por regressão binária. Significância foi definida como p < 0,05. Resultados: A valvopatia mitral foi encontrada em 82,5% (240) dos casos, seguida da aórtica (65,6%; 86). Houve progressão da doença valvar em 106 (36,4%) pacientes. Não houve associação entre valvopatias aórtica, pulmonar, mitral ou tricúspide e TTD. Hiperparatireoidismo secundário foi a única variável explicativa significativa na regressão para valvopatia mitral (OR 2,59 [IC95%: 1,09-6,18]; p = 0,031). Conclusão: Encontramos alta frequência de valvopatias, especialmente mitral e aórtica, aem pacientes com DRC. Não houve associação entre TTD e valvopatia.

Biochemical characterization of two trimers of the bacterial cell division protein (FtsZ) from E. coli / CARACTERIZACIÓN BIOQUÍMICA DE DOS TRÍMEROS DE LA PROTEÍNA DE LA DIVISIÓN CELULAR BACTERIANA (FtsZ) DE E. coli.

FtsZ is a bacterial divisome protein responsible for Z-ring formation in cytokinesis. Characterization of Escherichia coli FtsZ protein oligomers (EcFtsZ) in native conditions is defiance because the protein is found as a multi-oligomer in self-association-dissociation equilibrium. We characterize the trimeric state of EcFtsZ through native PAGE, gel filtration chromatography and sucrose gradient techniques combined with chemical cross-linking. The filtration results indicate that the EcFtsZ trimer has a molecular mass of 131 kDa and a filtration friction coefficient (Rs/Rmin) equal to 1.9, while the theoretical filtration friction coefficient (fn/f1) calculated for a linear trimer yielded a value equal to 1.8 very close to the experimental value. On the other side, formaldehyde-crosslinked EcFtsZ showed a band 128 kDa recognized by anti-FtsZ antibodies, and a sedimentation friction coefficient (Smax/S20,w) equal to 1.9, while the theoretical sedimentation friction coefficient (Sn/S1) calculated for a triangular trimer was equal to the experimental value. These results suggest that EcFtsZ has two homotrimeric structures (linear and triangular). Finally, we report the aggregation of EcFtsZ at micromolar concentrations of Capsaicin without GTP and Mg2+.

La FtsZ es una proteína del divisoma bacteriano responsable de la formación del anillo Z en la citocinesis. La caracterización de los oligómeros de la proteína FtsZ de Escherichia coli (EcFtsZ) en su estado nativo es un desafío porque la proteína se encuentra como un multioligómero en equilibrio de autoasociación-disociación. Nosotros caracterizamos el estado trimérico de la EcFtsZ a través de técnicas de PAGE nativo, cromatografía de filtración en gel y gradiente de sacarosa combinada con entrecruzamiento químico. Los resultados por filtración indican que el trímero de EcFtsZ tiene una masa molecular de 131 kDa y un coeficiente de fricción por filtración (Rs/Rmin) igual a 1.9, mientras que el coeficiente de fricción por filtración teórico (fn/f1) calculado para un trímero lineal arrojó un valor igual a 1.8 que está muy cercano al valor experimental. Por otro lado, la EcFtsZ entrecruzada con formaldehído presentó una banda de 128 kDa reconocida por anticuerpos anti-FtsZ y un coeficiente de fricción por sedimentación (Smax/S20,w) igual a 1.9, mientras que el coeficiente de fricción por sedimentación teórico (Sn/S1) calculado para un trímero triangular resultó igual a valor experimental. Estos resultados sugieren que la EcFtsZ tiene dos estructuras homotriméricas (lineal y triangular). Finalmente, reportamos la agregación de la EcFtsZ a concentraciones micromolares de Capsaicina sin GTP y Mg2+.

Progression of valve heart disease in a cohort of patients undergoing renal replacement therapy.

INTRODUCTION: Cardiovascular disease is an important cause of death among patients with chronic kidney disease (CKD). Valve calcification is a predictor of cardiovascular mortality and coronary artery disease. OBJECTIVE: To assess heart valve disease frequency, associated factors, and progression in CKD patients. METHODS: We conducted a retrospective study on 291 CKD patients at Hospital das Clínicas de Pernambuco. Inclusion criteria were age ≥ 18 with CKD and valve disease, while those on conservative management or with missing data were excluded. Clinical and laboratory variables were compared, and patients were categorized by dialysis duration (<5 years; 5-10 years; >10 years). Statistical tests, including chi-square, Fisher's exact, ANOVA, and Kruskal-Wallis, were employed as needed. Simple and multivariate binary regression models were used to analyze valve disease associations with dialysis duration. Significance was defined as p < 0.05. RESULTS: Mitral valve disease was present in 82.5% (240) of patients, followed by aortic valve disease (65.6%; 86). Over time, 106 (36.4%) patients developed valve disease. No significant association was found between aortic, pulmonary, mitral, or tricuspid valve disease and dialysis duration. Secondary hyperparathyroidism was the sole statistically significant factor for mitral valve disease in the regression model (OR 2.59 [95% CI: 1.09-6.18]; p = 0.031). CONCLUSION: CKD patients on renal replacement therapy exhibit a high frequency of valve disease, particularly mitral and aortic valve disease. However, no link was established between dialysis duration and valve disease occurrence or progression.

The Green Tea Polyphenol Epigallocatechin-Gallate (EGCG) Interferes with Microcin E492 Amyloid Formation.

Microcin E492 (MccE492) is an antimicrobial peptide and proposed virulence factor produced by some Klebsiella pneumoniae strains, which, under certain conditions, form amyloid fibers, leading to the loss of its antibacterial activity. Although this protein has been characterized as a model functional amyloid, the secondary structure transitions behind its formation, and the possible effect of molecules that inhibit this process, have not been investigated. In this study, we examined the ability of the green tea flavonoid epigallocatechin gallate (EGCG) to interfere with MccE492 amyloid formation. Aggregation kinetics followed by thioflavin T binding were used to monitor amyloid formation in the presence or absence of EGCG. Additionally, synchrotron radiation circular dichroism (SRCD) and transmission electron microscopy (TEM) were used to study the secondary structure, thermal stability, and morphology of microcin E492 fibers. Our results showed that EGCG significantly inhibited the formation of the MccE492 amyloid, resulting in mainly amorphous aggregates and small oligomers. However, these aggregates retained part of the ß-sheet SRCD signal and a high resistance to heat denaturation, suggesting that the aggregation process is sequestered or deviated at some stage but not completely prevented. Thus, EGCG is an interesting inhibitor of the amyloid formation of MccE492 and other bacterial amyloids.

Diversity, Taxonomic Novelty, and Encoded Functions of Salar de Ascotán Microbiota, as Revealed by Metagenome-Assembled Genomes.

Salar de Ascotán is a high-altitude arsenic-rich salt flat exposed to high ultraviolet radiation in the Atacama Desert, Chile. It hosts unique endemic flora and fauna and is an essential habitat for migratory birds, making it an important site for conservation and protection. However, there is limited information on the resident microbiota's diversity, genomic features, metabolic potential, and molecular mechanisms that enable it to thrive in this extreme environment. We used long- and short-read metagenomics to investigate the microbial communities in Ascotán's water, sediment, and soil. Bacteria predominated, mainly Pseudomonadota, Acidobacteriota, and Bacteroidota, with a remarkable diversity of archaea in the soil. Following hybrid assembly, we recovered high-quality bacterial (101) and archaeal (6) metagenome-assembled genomes (MAGs), including representatives of two putative novel families of Patescibacteria and Pseudomonadota and two novel orders from the archaeal classes Halobacteriota and Thermoplasmata. We found different metabolic capabilities across distinct lineages and a widespread presence of genes related to stress response, DNA repair, and resistance to arsenic and other metals. These results highlight the remarkable diversity and taxonomic novelty of the Salar de Ascotán microbiota and its rich functional repertoire, making it able to resist different harsh conditions. The highly complete MAGs described here could serve future studies and bioprospection efforts focused on salt flat extremophiles, and contribute to enriching databases with microbial genome data from underrepresented regions of our planet.

Ketogenic diet and metastasis: A critical review of the literature and possible mechanisms.

The ketogenic diet (KD) is a low-carb diet that has been indicated as a possible coadjuvant in cancer therapy, mainly due to its capacity to reduce glycolysis production, inflammation, and oxidative stress. However, KD's role in metastasis remains poorly explored. This study aims to provide a critical review of the literature about KD's efficacy in metastasis therapy and the possible molecular mechanisms behind it. Initially, general concepts on KD and metastasis are discussed. Then, it delves deeper into the main cancer mechanisms explored by KD experimental studies, discussing the central results obtained in metastasis research and their main limiting conditions. Following, there is a critical analysis of clinical trials, including those in the grey literature. In the end, there is a summary of the actual studies' limitations and barriers to future research. To date, it is possible to conclude that there is not enough evidence supporting the efficacy of KD in the treatment of metastasis.

Antimicrobial resistance, pathogenic potential, and genomic features of carbapenem-resistant Klebsiella pneumoniae isolated in Chile: high-risk ST25 clones and novel mobile elements.

Multidrug- and carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are critical threats to global health and key traffickers of resistance genes to other pathogens. Despite the sustained increase in CR-Kp infections in Chile, few strains have been described at the genomic level, lacking details of their resistance and virulence determinants and the mobile elements mediating their dissemination. In this work, we studied the antimicrobial susceptibility and performed a comparative genomic analysis of 10 CR-Kp isolates from the Chilean surveillance of carbapenem-resistant Enterobacteriaceae. High resistance was observed among the isolates (five ST25, three ST11, one ST45, and one ST505), which harbored 44 plasmids, most carrying genes for conjugation and resistance to several antibiotics and biocides. Ten plasmids encoding carbapenemases were characterized, including novel plasmids or variants with additional resistance genes, a novel genetic environment for blaKPC-2, and plasmids widely disseminated in South America. ST25 K2 isolates belonging to CG10224, a clone traced back to 2012 in Chile, which recently acquired blaNDM-1, blaNDM-7, or blaKPC-2 plasmids stood out as high-risk clones. Moreover, this corresponds to the first report of ST25 and ST45 Kp producing NDM-7 in South America and ST505 CR-Kp producing both NDM-7 and KPC-2 worldwide. Also, we characterized a variety of genomic islands carrying virulence and fitness factors. These results provide baseline knowledge for a detailed understanding of molecular and genetic determinants behind antibiotic resistance and virulence of CR-Kp in Chile and South America. IMPORTANCE In the ongoing antimicrobial resistance crisis, carbapenem-resistant strains of Klebsiella pneumoniae are critical threats to public health. Besides globally disseminated clones, the burden of local problem clones remains substantial. Although genomic analysis is a powerful tool for improving pathogen and antimicrobial resistance surveillance, it is still restricted in low- to middle-income countries, including Chile, causing them to be underrepresented in genomic databases and epidemiology surveys. This study provided the first 10 complete genomes of the Chilean surveillance for carbapenem-resistant K. pneumoniae in healthcare settings, unveiling their resistance and virulence determinants and the mobile genetic elements mediating their dissemination, placed in the South American and global K. pneumoniae epidemiological context. We found ST25 with K2 capsule as an emerging high-risk clone, along with other lineages producing two carbapenemases and several other resistance and virulence genes encoded in novel plasmids and genomic islands.

Repercussões da pandemia de Covid-19 na saúde mental nos estudantes de Medicina de Pernambuco / Effects of the Covid-19 pandemic on the mental health of medical students in Pernambuco

Resumo: Introdução: As pandemias, como a de Covid-19, resultam em perturbação psicossocial que pode romper os limites da capacidade de enfrentamento, de modo a gerar tensões e angústias que se expressam variavelmente entre os envolvidos. Objetivo: analisar as repercussões da pandemia de Covid-19 na saúde mental de estudantes de Medicina do estado de Pernambuco. Método: estudo transversal e descritivo-analítico realizado entre julho e agosto de 2021 com estudantes de Medicina das 11 faculdades de Pernambuco. Como variáveis dependentes, foram analisados os escores de ansiedade e depressão. Quanto às variáveis independentes, foram estudadas: escore de resiliência, características sociodemográficas e comportamentais, e condições de saúde. A coleta dos dados foi realizada por meio da plataforma Google Forms. Aplicaram-se o Inventário de Beck para ansiedade e depressão e a escala de resiliência de Wagnild e Young. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Centro Universitário Maurício de Nassau, e os participantes concordaram o Termo de Consentimento Livre e Esclarecido. Os dados foram analisados pelo programa SPSS 25, considerando significativo valor p < 0,05. Resultado: participaram da pesquisa 416 estudantes. A amostra foi composta predominantemente por mulheres (60,9%), com idade média de 25 anos, das quais 73,8% tinham residência fixa no município da faculdade. Sintomas de ansiedade moderada e grave foram verificados em 27,2% e 10,3% dos avaliados, respectivamente. Observaram-se sintomas depressivos moderados em 17,8% dos estudantes. Cerca de 25% da amostra apresentou grau de resiliência baixo ou muito baixo. Resiliência alta (razão de chances [RC] = 0,18 [0,08-0,41]; p < 0,001) e suporte psicológico anterior à pandemia (RC = 0,36 [0,14-0,95]; p = 0,04) foram fatores de proteção; e cursar o ciclo clínico (quinto-oitavo períodos) foi fator de risco independente (RC = 1,95 [1,07-3,55]; p = 0,02) para ansiedade de moderada a grave. Resiliência alta (RC = 0,01 [0,02-0,11]; p < 0,001 e retornar à cidade natal durante a suspensão das aulas (RC = 0,41 [0,18-0,91]; p = 0,02) foram fatores protetores; e cursar o ciclo clínico foi fator de risco independente (RC = 2,74 [1,26-5,93]; p = 0,01) para depressão de moderada a grave. Conclusão: verificou-se uma alta prevalência de sintomas de ansiedade de moderada e grave, bem como de sintomas depressivos moderados. Um alta proporção dos estudantes apresentou grau de resiliência baixo ou muito baixo.

Abstract: Introduction: The occurrence of pandemics, such as Covid-19, leads to a psychosocial disturbance that can break the limits of the population's coping capacity, generating tensions and anxieties that are expressed in various degrees among those involved. Objective: To analyze the repercussions of the COVID-19 pandemic on the mental health of medical students in the State of Pernambuco. Methods: Cross-sectional analytical study conducted between July and August 2021 with medical students from 11 universities in Pernambuco. The dependent variables analyzed were the scores of anxiety, depression; the independent variables were resilience score, socio-demographic, behavioral characteristics and health conditions. The data were collected through Google Forms. Beck's Anxiety and Depression Inventories, and Wagnild and Young's Resilience Scale were applied. The study was approved by the local ethics committee and informed consent was sought and given. The data were analyzed using SPSS 25, considering as significant a p-value < 0,05. Result: 416 participants were included, the majority (60.9%) of the students were women, the average age was 25 years, and 73.8% of them lived in the municipality of their university. Moderate and severe anxiety symptoms were found in 27.2% and 10.3% of the sample, respectively. Moderate depressive symptoms were observed in 17.8% of the students. About 25% of the sample reported a low or very low degree of resilience. High resilience (Odds Ratio [OR] 0.18 [0.08-0.41]; p <0.001) and psychological support prior to the pandemic (OR 0.36 [0.14-0.95]; p = 0 .04) were protective factors and attending the clinical cycle (2nd-3rd year) was an independent risk factor (OR 1.95 [1.07-3.55]; p = 0.02) for moderate to severe anxiety. High resilience (OR 0.01 [0.02-0.11]; p < 0.001 and returning to one's hometown during the suspension of classes (OR 0.41 [0.18-0.91]; p = 0.02) were protective factors and attending the clinical cycle was an independent risk factor (OR 2.74 [1.26-5.93]; p = 0.01) for moderate to severe depression. Conclusion: We found a high prevalence of moderate and severe anxiety symptoms, as well as moderate depressive symptoms. A high proportion of students demonstrated a low or very low degree of resilience.

ICD indication in hypertrophic cardiomyopathy: which algorithm to use?

OBJECTIVE: This study aimed to evaluate the agreement in the indication of implantable cardioverter-defibrillators in patients with Hypertrophic cardiomyopathy, as per the 2014 European Society of Cardiology and 2020 American Heart Association recommendations, and evaluate fragmented QRS as a predictor of cardiovascular outcome. METHODS: Retrospective cohort with 81 patients was evaluated between 2019 and 2021. Patients with hypertrophic cardiomyopathy ≥16 years old were included. Exclusion criteria include secondary myocardiopathy and follow-up <1 year. Kappa coefficient was used to determine the agreement. Survival and incidence curves were determined by Kaplan-Meier method. A p<0.05 was considered significant. RESULTS: The fragmented QRS was identified in 44.4% of patients. There were no differences between patients with and without fragmented QRS regarding clinical parameters, echocardiography, fibrosis, and sudden cardiac death risk. During follow-up of 4.8±3.4 years, there was no sudden cardiac death, but 20.6% patients with implantable cardioverter-defibrillator had at least one appropriate shock. Three of the seven appropriate shocks occurred in European Society of Cardiology low- to moderate-risk patients. Three shocks occurred in moderate-risk patients and four in American Heart Association high-risk patients. Overall recommendations agreement was 64% with a kappa of 0.270 (p=0.007). C-statistic showed no differences regarding the incidence of appropriate shock (p=0.644). CONCLUSION: sudden cardiac death risk stratification algorithms present discrepancies in implantable cardioverter-defibrillator indication, both with low accuracy.

ICD indication in hypertrophic cardiomyopathy: which algorithm to use?

SUMMARY OBJECTIVE: This study aimed to evaluate the agreement in the indication of implantable cardioverter-defibrillators in patients with Hypertrophic cardiomyopathy, as per the 2014 European Society of Cardiology and 2020 American Heart Association recommendations, and evaluate fragmented QRS as a predictor of cardiovascular outcome. METHODS: Retrospective cohort with 81 patients was evaluated between 2019 and 2021. Patients with hypertrophic cardiomyopathy ≥16 years old were included. Exclusion criteria include secondary myocardiopathy and follow-up <1 year. Kappa coefficient was used to determine the agreement. Survival and incidence curves were determined by Kaplan-Meier method. A p<0.05 was considered significant. RESULTS: The fragmented QRS was identified in 44.4% of patients. There were no differences between patients with and without fragmented QRS regarding clinical parameters, echocardiography, fibrosis, and sudden cardiac death risk. During follow-up of 4.8±3.4 years, there was no sudden cardiac death, but 20.6% patients with implantable cardioverter-defibrillator had at least one appropriate shock. Three of the seven appropriate shocks occurred in European Society of Cardiology low- to moderate-risk patients. Three shocks occurred in moderate-risk patients and four in American Heart Association high-risk patients. Overall recommendations agreement was 64% with a kappa of 0.270 (p=0.007). C-statistic showed no differences regarding the incidence of appropriate shock (p=0.644). CONCLUSION: sudden cardiac death risk stratification algorithms present discrepancies in implantable cardioverter-defibrillator indication, both with low accuracy.

Assessment of bone dose response using ATR-FTIR spectroscopy: A potential method for biodosimetry.

The health care application of ionizing radiation has expanded worldwide during the last several decades. While the health impacts of ionizing radiation improved patient care, inaccurate handling of radiation technology is more prone to potential health risks. Therefore, the present study characterizes the bone dose response using bovine femurs from a slaughterhouse. The gamma irradiation was designed into low-doses (0.002, 0.004 and 0.007 kGy) and high-doses (1, 10, 15, 25, 35, 50 and 60 kGy), all samples received independent doses. The combination of FTIR spectroscopy and PLS-DA allows the detection of differences in the control group and the ionizing dose, as well as distinguishing between high and low radiation doses. In this way, our findings contribute to future studies of the dose response to track ionizing radiation effects on biological systems.

Association between hyperuricemia and hypertension: a case-control study.

OBJECTIVE: The aim of this study was to evaluate the association between hyperuricemia and systemic arterial hypertension. METHODS: This was a case-control study where individuals aged >18 years were included, who were divided into hypertensive and non-hypertensive groups, excluding those with incomplete information in medical records or with the chronic kidney disease epidemiology collaboration <60 mL/min/1.73 m³. Systemic arterial hypertension was categorized as a dependent variable, while the independent variables were hyperuricemia (i.e., primary variable), sex, education, the practice of physical activity, alcoholism, smoking, diabetes mellitus, chronic kidney disease, a family history of systemic arterial hypertension, age, isolated hyperlipidemia, and mixed hyperlipidemia. Statistical analysis included the univariate and multivariate data analysis, performed by adjusting the logistic regression models using the software R (R Core Team [2018]). RESULTS: Out of 103 patients evaluated, 75 patients were included in this study. In hypertensive patients, hyperuricemia was more frequent (p=0.029), being present in 18.9% individuals. In the univariate analysis, a statistically significant association was found between hyperuricemia and systemic arterial hypertension (OR 10.9; 95%CI 1.29-1420.0; p=0.023); however, in the multivariate analysis, when adjustment was made for age, the only control variable that persisted in the model, this association ceased to be significant (OR 8.5; 95%CI 0.87-1157.0; p=0.070). CONCLUSIONS: There was no independent association between hyperuricemia and systemic arterial hypertension. The latter was associated with diabetes mellitus, chronic kidney disease, and age.

Association between hyperuricemia and hypertension: a case-control study

SUMMARY OBJECTIVE: The aim of this study was to evaluate the association between hyperuricemia and systemic arterial hypertension. METHODS: This was a case-control study where individuals aged >18 years were included, who were divided into hypertensive and non-hypertensive groups, excluding those with incomplete information in medical records or with the chronic kidney disease epidemiology collaboration <60 mL/min/1.73 m³. Systemic arterial hypertension was categorized as a dependent variable, while the independent variables were hyperuricemia (i.e., primary variable), sex, education, the practice of physical activity, alcoholism, smoking, diabetes mellitus, chronic kidney disease, a family history of systemic arterial hypertension, age, isolated hyperlipidemia, and mixed hyperlipidemia. Statistical analysis included the univariate and multivariate data analysis, performed by adjusting the logistic regression models using the software R (R Core Team [2018]). RESULTS: Out of 103 patients evaluated, 75 patients were included in this study. In hypertensive patients, hyperuricemia was more frequent (p=0.029), being present in 18.9% individuals. In the univariate analysis, a statistically significant association was found between hyperuricemia and systemic arterial hypertension (OR 10.9; 95%CI 1.29-1420.0; p=0.023); however, in the multivariate analysis, when adjustment was made for age, the only control variable that persisted in the model, this association ceased to be significant (OR 8.5; 95%CI 0.87-1157.0; p=0.070). CONCLUSIONS: There was no independent association between hyperuricemia and systemic arterial hypertension. The latter was associated with diabetes mellitus, chronic kidney disease, and age.

Aerococcus spp infective endocarditis following a prostate biopsy: a case report.

We report a rare case of an infective endocarditis by Aerococcus spp in a bioprosthetic aortic valve following a prostate biopsy, in an asymptomatic adult with no additional risk factor for prostate cancer, excepting for age. The diagnosis was based on the presence of vegetations on the bioprosthesis seen on the echocardiogram, positive blood cultures and fever, and a favorable clinical outcome following the treatment with ceftriaxone and gentamicin.

Antifungal Efficacy of Amphotericin B in Candida Albicans Endocarditis Therapy: Systematic Review.

INTRODUCTION: Although it is the most common agent among the fungal causes of endocarditis, Candida albicans endocarditis is rare. OBJECTIVE: To evaluate the efficacy of amphotericin B in the treatment of C. albicans endocarditis beyond a systematic review. DATA SEARCH: Articles in English, Spanish and Portuguese, conducted in the following databases: MEDLINE, LILACS, IBECS and SciELO, in humans and published in the last 25 years. STUDY SELECTION: Observational studies, clinical trials, and case series providing data on the amphotericin B use in patients with a C. albicans endocarditis diagnosis without age limitations. DATA SYNTHESIS: From the initial search (n=79), 25 articles were fully evaluated, of which 19 were excluded for meeting one or more exclusion criteria, remaining five articles (two observational studies and three case series). Patients using amphotericin B demonstrated improvement in survival rates, and its main use was in association with the surgical method as well as with caspofungin association. CONCLUSION: Literature lacks evidence to conclude about efficacy and safety of amphotericin B in the treatment of fungal endocarditis. Randomized clinical trials are necessary to provide better evidence on the subject.

Antifungal efficacy of amphotericin b in candida albicans endocarditis therapy: systematic review

Abstract Introduction: Although it is the most common agent among the fungal causes of endocarditis, Candida albicans endocarditis is rare. Objective: To evaluate the efficacy of amphotericin B in the treatment of C. albicans endocarditis beyond a systematic review. Data search: Articles in English, Spanish and Portuguese, conducted in the following databases: MEDLINE, LILACS, IBECS and SciELO, in humans and published in the last 25 years. Study selection: Observational studies, clinical trials, and case series providing data on the amphotericin B use in patients with a C. albicans endocarditis diagnosis without age limitations. Data synthesis: From the initial search (n=79), 25 articles were fully evaluated, of which 19 were excluded for meeting one or more exclusion criteria, remaining five articles (two observational studies and three case series). Patients using amphotericin B demonstrated improvement in survival rates, and its main use was in association with the surgical method as well as with caspofungin association. Conclusion: Literature lacks evidence to conclude about efficacy and safety of amphotericin B in the treatment of fungal endocarditis. Randomized clinical trials are necessary to provide better evidence on the subject.