Complete atrioventricular block secondary to the BBIBP-CorV vaccine The report of a rare adverse event; the first description in Colombia

Introduction: cardiovascular complications due to COVID-19 infection are very frequent. However, these complications are rarely reported as a vaccine reaction. Case presentation: a female patient with no significant cardiovascular history developed functional class deterioration 14 days after her third dose of the BBIBP-CorV vaccine, along with three syncopal episodes. She was seen at a primary care level and an electrocardiogram was ordered which showed Mobitz 2 atrioventricular block which progressed to a complete block. Molecular tests for COVID-19 infection were negative, as were immunological studies for collagen disease, Chagas, and viral myocarditis. A transthoracic echocardiogram showed no regional kinetic disturbances, and the ejection fraction was preserved at 60%. Cardiac magnetic resonance imaging showed edema in the T2-STIR sequences, and subepicardial enhancement in the medial distal lateral region was compatible with acute myocarditis. The patient required a permanent pacemaker. Discussion: electrical or mechanical dysfunction secondary to a COVID-19 vaccine is anecdotal, with few reports in the literature. In a review of both the 2021 European Society of Cardiology and the 2018 American Heart Association Guidelines on cardiac pacing and cardiac resynchronization therapy, no recommendation was found for these types of events associated with COVID-19 or following vaccination. An international network should be created to report these events and thus determine general management guidelines. For now, the recommendations must be individualized for these patients. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2602).

Babesiosis. Reporte de caso clínico en Venezuela. Revisión de literatura

Introducción: La babesiosis es una enfermedad causada por protozoos intraeritrocíticos con características clínicas que son similares a las de la malaria, se transmite a los seres humanos a través de la picadura de una garrapata infectada, ocasionalmente por transfusión. A nivel global la prevalencia de la enfermedad es desestimada; se desconoce esa proporción en Latinoamérica y Venezuela. Caso clínico: Paciente masculino de 29 años con fiebre de 15 días, ictericia, dolor abdominal, en quien se sospechó malaria por epidemiología y síntomas, se descartaron otras entidades como endocarditis, leptospirosis, tuvo serología positiva para ehrlichiosis, sin embargo, persistió clínica a pesar del tratamiento con cloroquina, clindamicina y doxiciclina; por tanto, se realizaron estudios complementarios con hallazgo de inclusiones intraeritrocíticas compatibles con babesiosis e inició terapia con clindamicina y quinina por 7 días con evolución satisfactoria. Discusión: El caso reportado requirió de un ejercicio clínico y apoyo interdisciplinario para un desenlace adecuado. Entre los diagnósticos diferenciales de enfermedades intraeritrocitarias se encuentra la babesiosis cuyos síntomas son inespecíficos, pero orienta su diagnóstico al indagar en el antecedente epidemiológico. El tratamiento incluye Atovacuona con Azitromicina o alternativas como Clindamicina con Quinina. Conclusiones: El presente caso fue bastante complejo dado su forma de presentación y al ser una enfermedad con una baja prevalencia en nuestro país, sin embargo, predominó el juicio clínico logrando el mejor resultado posible.

Introduction: Babesiosis is a disease caused by intraerythrocyte protozoa with clinical characteristics that are similar to those of malaria, it is transmitted to humans through the bite of an infected tick, occasionally by transfusion. Globally, the prevalence of the disease is underestimated; this proportion is unknown in Latin America and Venezuela. Clinical case: A 29-year-old male patient with a 15-day fever, jaundice, abdominal pain, in whom malaria was suspected based on epidemiology and symptoms, other entities such as endocarditis, leptospirosis were ruled out, he had positive serology for ehrlichiosis, however, it clinical symptoms persisted despite treatment with chloroquine, clindamycin and doxycycline; therefore, complementary studies were conducted with findings of intraerythrocyte inclusions compatible with Babesiosis and started treatment with clindamycin and quinine for 7 days and presented satisfactory evolution. Discussion: The reported case required a clinical exercise and interdisciplinary support for an adequate outcome. Among the differential diagnoses of intraerythrocyte diseases is babesiosis whose symptoms are non-specific, but guides its diagnosis by inquiring into the epidemiological history. Treatment includes atovaquone with azithromycin or alternatives such as clindamycin with quinine. Conclusions: The present case was quite complex given its form of presentation and being a disease with a low prevalence in our country, however, clinical judgment predominated, achieving the best possible result.

Frequency of metabolic syndrome and stratification of cardiovascular risk in patients with HIV by using three scoring systems / Frecuencia del síndrome metabólico y estratificación del riesgo cardiovascular en pacientes con VIH mediante tres sistemas de puntuación / Frequência da síndrome metabólica e estratificação do risco cardiovascular em pacientes HIV-positivos usando três sistemas de pontuação

Introduction: The presence of metabolic syndrome and cardiovascular risk in HIV positive patients has been overlooked in patients with HIV infection. Objectives: To evaluate the frequency of metabolic syndrome and compare cardiovascular risk stratification according to the Framingham, PROCAM, and SCORE equations in HIV patients. Methodology: A cross-sectional study of 760 HIV-infected adults from January 2016 to December 2018. The presence of metabolic syndrome was assessed using the ATP-III criteria, and the cardiovascular risk score was examined. Results: The most frequent comorbidities were smoking, hypercholesterolemia, and high blood pressure. Student's T test was carried out, showing differences in the classification of low to moderate risk. The number of HIV-infected male patients identified as having moderate cardiovascular risk according to the Framingham risk equation was two folds compared to those with the PROCAM and SCORE systems. Conclusions: This study showed a high prevalence of patients with low cardiovascular risk. It is appropriate to consider cardiovascular risk factors in patients with HIV, since they are very frequently associated with adverse outcomes of this type.

Introducción: La presencia del síndrome metabólico y el riesgo cardiovascular en pacientes VIH positivos ha sido desestimado en pacientes con infección por VIH. Objetivos: Evaluar la frecuencia del síndrome metabólico y comparar la estratificación del riesgo cardiovascular según las ecuaciones de Framingham, PROCAM y SCORE en pacientes con VIH. Metodología: estudio transversal de 760 adultos infectados por el VIH en el periodo enero de 2016-diciembre de 2018. Se evaluó la presencia de síndrome metabólico a través de los criterios del ATP-III y se examinó la puntuación de riesgo cardiovascular. Resultados: Las comorbilidades más frecuentes fueron el tabaquismo, la hipercolesterolemia y la hipertensión arterial. Se realizó la prueba T de Student, y a partir de ella se lograron apreciar diferencias en categorización de riesgo bajo a moderado. El número de pacientes varones infectados por el VIH identificados como de riesgo cardiovascular moderado según la ecuación de riesgo de Framingham fue mayor del doble en comparación con los sistemas PROCAM y SCORE. Conclusiones: El estudio mostró una alta prevalencia de pacientes con bajo riesgo cardiovascular. Es pertinente considerar los factores de riesgo cardiovascular en pacientes con VIH, ya que estos se encuentran frecuentemente asociados con desenlaces adversos de este tipo.

Introdução: A presença da síndrome metabólica e do risco cardiovascular em pacientes HIV positivos tem sido negligenciada em pacientes com infecção por HIV. Objetivos: Avaliar a frequência da síndrome metabólica e comparar a estratificação do risco cardiovascular de acordo com as equações de Framingham, PROCAM e SCORE em pacientes com HIV. Metodologia: estudo transversal de 760 adultos infectados com HIV no período de Janeiro de 2016-Dezembro de 2018. A presença de síndrome metabólica foi avaliada através de critérios ATP-III e a pontuação de risco cardiovascular foi examinada. Resultados: As comorbilidades mais frequentes foram o tabagismo, a hipercolesterolêmia e a hipertensão. Realizou-se o teste T Student, e a partir dele foram apreciadas as diferenças de categorização de risco baixo a moderado. O número de pacientes masculinos infectados com HIV identificados como de risco cardiovascular moderado de acordo com a equação de risco de Framingham foi mais do dobro em comparação com o PROCAM e SCORE. Conclusões: O estudo mostrou uma elevada prevalência de pacientes com baixo risco cardiovascular. É pertinente considerar fatores de risco cardiovascular em pacientes com HIV, uma vez que estes estão frequentemente associados a resultados cardiovasculares adversos.