Factors Related to the Development of Infective Endocarditis in Hemodialysis Patients in a Third-Level Hospital in Panama.

INTRODUCTION: Venous access for hemodialysis (HD) makes patients more susceptible to transient bacteremia, predisposing them to the development of infective endocarditis (IE). Among the risk factors observed in this population are temporary access to HD, hypoalbuminemia, diabetes mellitus, female gender, anemia, and colonization by methicillin-resistant Staphylococcus aureus (MRSA). METHODOLOGY: A retrospective case-control study with a one-to-two ratio was carried out on patients with chronic kidney disease (CKD) undergoing renal replacement therapy with at least one vascular access for HD at Complejo Hospitalario Dr. Arnulfo Arias Madrid (CHDrAAM) from 2010 to 2020. Sociodemographic variables, past medical history, and data on current HD were studied. The odds ratio (OR) and adjusted odds ratio (aOR) were calculated for the collected variables. RESULTS: No statistically significant differences between the groups were observed in sociodemographic variables. In terms of past medical history, the cases showed a predominance of coronary disease (47.6% vs 4.8%; OR: 37.27), valvular disease (23.8% vs 0%), and heart failure (33.3% vs 4.8%; OR: 10). In the cases, the use of a temporary catheter was more prevalent (61.9% vs 33.3%; OR: 3.25), and subclavian access was more frequently recorded (28.6% vs 2.4%; OR: 14.4). A short duration of venous access (<30 days) was found in a greater proportion of cases (23.8% vs 4.8%; OR: 6.25). The main pathogen isolated was S. aureus (33.3%), and the most affected valve was the aortic valve (59.1%). Fever was found in 100% of the reported cases, and up to 47.6% presented with a recent murmur. DISCUSSION: Similar to previous studies conducted in other countries, we identified a history of pre-existing valve disease, the use of a temporary catheter, and recent venous access as risk factors. Contrary to what has been reported in the literature, this study did not find female sex, diabetes mellitus, and hypoalbuminemia as risks. CONCLUSION: Factors such as a history of coronary artery disease, heart failure, preexisting valvular disease, the use of a temporary catheter, subclavian venous access, and short duration of venous access (<30 days) were identified as risk factors for the development of IE in patients with CKD on HD.

Impact of a Nurse-Led Multidisciplinary Heart Failure Clinic in a Low-Resource Setting: Experience in a Latin American Public Healthcare System.

Background: Nurse-led multidisciplinary heart failure clinics (MDHFCs) play an important role in patient care in developed countries, due to their proven benefits relating to mortality, hospitalization, and quality of life. However, evidence is limited regarding the role of MDHFCs in a limited-resource setting. Methods: Patients with heart failure (HF) with reduced ejection fraction (n = 89) were enrolled in a prospective, longitudinal cohort, from January 2018 to January 2019. The following endpoints were collected at baseline and after 6 months of follow-up: (i) quality of life, measured using the Minnesota Living with Heart Failure Questionnaire; (ii) medication adherence using the Morisky Medication Adherence Scale, 8-item; (iii) titration of HF medications; (iv) self-care behavior using the European Heart Failure Self-care Behavior Scale; and (v) mortality and hospitalizations up to 12 months after. Results: The questionnaire score was reduced from 66.5 (interquartile range [IQR], 46-86) at baseline to 26 (IQR, 13-45) at 6 months (P < 0.001). New York Heart Association (NYHA) functional class improved at 6 months (NYHA I: 41.9%; NYHA II: 39.5%; NYHA III: 17.2%), compared to baseline (NYHA I: 20%; NYHA II: 49%; NYHA III: 31%; P < 0.001). Medication adherence using the 8-item Morisky Medication Adherence Scale improved the score from 6 (IQR, 4-7) at baseline to 7 (IQR, 6.25-8; P = 0.001) at 6 months. Uptitration of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (25% vs 18% at target dose) and beta-blockers (25% vs 11% at target dose) was documented. After 6 months of follow-up, the European Heart Failure Self-care Behavior Scale was applied, showing a score of 18.5 (IQR, 15-22). The mortality reported at 12 months of follow-up was 9.7%, and the incidence of hospitalization was 44%. Conclusion: An MDHFC is a feasible strategy to manage an HF clinic in a low-resource setting.

Contexte: Les cliniques multidisciplinaires d'insuffisance cardiaque dirigées par du personnel infirmier jouent un rôle important dans les soins aux patients dans les pays développés en raison de leurs bienfaits démontrés en matière de mortalité, d'hospitalisation, et de qualité de vie. Les preuves quant au rôle de ce type de cliniques dans un contexte de pénurie de ressources sont toutefois limitées. Méthodologie: Des patients atteints d'insuffisance cardiaque (IC) présentant une fraction d'éjection réduite (n = 89) ont été inscrits à une étude de cohortes prospective et longitudinale allant de janvier 2018 à janvier 2019. Les critères d'évaluation suivants ont été mesurés à l'inscription et après six mois de suivi : i) qualité de vie, mesurée par le questionnaire Minnesota Living with Heart Failure Questionnaire; ii) adhésion au traitement médicamenteux, mesuré selon l'échelle en huit points Morisky Medication Adherence Scale; iii) modification de la dose de médicaments contre l'IC; iv) comportements d'autosoins, mesurés selon l'échelle European Heart Failure Self-care Behavior Scale; et v) taux de mortalité et d'hospitalisation jusqu'à 12 mois. Résultats: Le score au questionnaire a diminué pour passer de 66,5 (écart interquartile [EI] : 46 à 86) au départ à 26 (EI : 13 à 45) à six mois (p < 0,001). La catégorie fonctionnelle de la New York Heart Association (NYHA) s'est améliorée à six mois (NYHA I : 41,9 %; NYHA II : 39,5 %; NYHA III : 17,2 %), comparativement au départ (NYHA I : 20 %; NYHA II : 49 %; NYHA III : 31 %; p < 0,001). Le score de l'adhésion au traitement médicamenteux mesuré par l'échelle en huit points Morisky Medication Adherence Scale s'est amélioré, passant de 6 (EI : 4 à 7) au départ à 7 (EI : 6,25 à 8; p = 0,001) à six mois. On a noté une augmentation de la dose d'inhibiteurs de l'enzyme de conversion de l'angiotensine ou de bloqueurs des récepteurs de l'angiotensine (25 % vs 18 % à la dose cible) et de bêtabloquants (25 % vs 11 % à la dose cible). Après six mois de suivi, l'échelle European Heart Failure Self-care Behavior Scale a été appliquée, ce qui a donné un score de 18,5 (EI : 15 à 22). Le taux de mortalité rapporté à 12 mois de suivi était de 9,7 %, et le taux d'hospitalisation était de 44 %. Conclusion: Une clinique multidisciplinaire d'insuffisance cardiaque dirigée par du personnel infirmier est une stratégie réaliste pour gérer une clinique d'IC dans un contexte de pénurie de ressources.

Parotid Myoepithelial Carcinoma in a Pediatric Patient with Multiple Recurrences: Case Report.

Myoepithelial carcinoma of the salivary glands is a rare entity, with scarce amount of case reports in the literature. Due to its infrequency, its diagnosis is usually difficult and uncertain. Although there are reports of locoregional recurrences and distant metastases, its low incidence and varied biological behavior limits the clinical evidence that can be used to predict the prognosis and determine the course of treatment. We present a 23-year-old female patient without past medical history with an initial 1-year history of volume increase in the right parotid region of tumor aspect and painful on palpation. As a malignancy was suspected, a total parotidectomy was performed, reporting in the deep lobe a parotid myoepithelial carcinoma with vascular and neural invasion, negative borders, and 3-9 negative regional nodes. During her 16-year clinical evolution, she presented approximately every 2 years and a total of 9 locoregional recurrences and hepatic metastases, including cervical lymphoid nodules, temporal bone, frontal bone, and temporal fossa. Those recurrences have been treated with coordinated efforts between repeated external radiotherapy, chemotherapy, and multiple surgical resections. Myoepithelial tumors represent only 1.0-1.5% of all salivary gland tumors. The literature reports suggest a high incidence of locoregional recurrences and distant metastases in de novo myoepithelial carcinomas. Due to its rarity, treatment continues to be based on the experience of medical staff.