Assessment of biomarkers and clinical parameters as predictors of survival in patients with chagasic heart failure.

BACKGROUND: Chagas disease, endemic in Latin America and spreading globally due to emigration, has a significant health burden, particularly in relation to chagasic heart failure (HF). Chagasic cardiomyopathy (CCM) is characterized by chronic inflammatory myocardial disease. This study aimed to identify inflammatory parameters and biomarkers that could aid in the management of patients with chagasic HF. METHODS AND FINDINGS: A cohort study was conducted at a tertiary cardiology single-center over a mean follow-up period of 2.4 years. The study included patients with HF secondary to CCM enrolled between October 2013 and July 2017. Various clinical parameters, echocardiography findings, parasitemia status, brain natriuretic peptide (BNP) and troponin T (TnT) levels, and inflammatory biomarkers (IL-6, IL-10, IL-12p70, IL-17A, adiponectin, and IFN-γ) were assessed. The study encompassed a cohort of 103 patients, with a median age of 53 years and 70% being male. The left ventricular ejection fraction (LVEF) was 28%, with 40% of patients classified as NYHA II functional class. The median BNP level was 291 pg/ml. The observed mortality rate during the study period was 38.8%. Predictors of lower survival were identified as elevated levels of BNP, TnT, reduced LVEF, and increased adiponectin (thresholds: BNP > 309 pg/ml, TnT > 27.5 ng/ml, LVEF < 25.5%, adiponectin > 38 µg/mL). Notably, there was no evidence indicating a relationship between parasitemia and the inflammatory parameters with lower survival in these patients, including INF-γ, IL-6, IL-10, IL12-(p70), and IL17a. CONCLUSION: Despite the presence of a chronic inflammatory process, the evaluated inflammatory biomarkers in this cohort were not predictive of survival in patients with chagasic HF with reduced ejection fraction (HFrEF). However, reduced LVEF, elevated BNP, adiponectin levels, and troponin T were identified as predictors of lower survival in these patients.

Endomyocardial fibrosis of the right ventricle in a patient with schistosomiasis: a case report.

Background: Endomyocardial fibrosis (EMF) is a rare and underdiagnosed cause of restrictive cardiomyopathy. Its aetiology is not yet defined and could be caused by the influence of different clinical factors that seem to combine with genetic aspects of individuals susceptible to an inflammatory process that leads to formation of fibrosis. Case summary: We describe a case of a 50-year-old man from the northeastern region of Brazil, where there is high prevalence of schistosomiasis. He presented to our centre with symptoms of right heart failure. The echocardiogram showed normal left ventricular ejection fraction. Right ventricular had normal systolic function but in the apical region was filled with a homogeneous and hypoechoic image causing obliteration and restriction of the apex. The late gadolinium enhancement with cardiac magnetic resonance showed diffuse and heterogeneous subendocardial fibrosis in the right ventricle apex consistent with EMF, but declined endocardiectomy. Discussion: This report presents an interesting case of EMF and schistosomiasis simultaneously. The hypothesis of parasitosis as a probable cause of EMF was raised by helminth-induced hypereosinophilia. Complementary imaging tests such as magnetic resonance imaging and echocardiography, in addition to clinical and epidemiological suspicion, are essential for its diagnosis. Early surgical resolution becomes crucial for long-term survival.

Perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario en una población de Pichincha-Ecuador / Microbial drug resistance profile in adults with urinary tract infection in a population of Pichincha-Ecuador

INTRODUCCIÓN. Las infecciones del tracto urinario son causa de mayor morbilidad en la población adulta y afectan con frecuencia a la mujer. Al ser un problema prevalente, fue fundamental realizar estudios sobre perfiles de susceptibilidad locales para establecer medidas de vigilancia y control de uso de antibióticos. OBJETIVO. Determinar el perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario. MATERIALES Y MÉTODOS. Estudio descriptivo, transversal. La población fue de 437 urocultivos y una muestra de 176 positivos con su antibiograma, realizados en el laboratorio del Hospital Básico de Sangolquí entre enero de 2017 hasta abril de 2018. Los criterios de inclusión fueron: pacientes mayores de 15 años de edad de ambos sexos, ambulatorios y hospitalizados, que presentaron urocultivos positivos definidos por una cuenta mayor a 100 000 Unidades Formadoras de Colonia. RESULTADOS. Del 40,27% (176; 437) de urocultivos positivos, la bacteria aislada con frecuencia fue Escherichia coli. 69,31% (122; 176), con resistencia a ampicilina 77,97% (92; 118), trimetropim-sulfametoxazole 62,26% (66; 106), norfloxacino 37,50% (42; 112), ciprofloxacino 35,65 % (41; 115), ampicilina/sulbactam 32,20% (38; 118) y con susceptibilidad a: fosfomicina, ceftriaxona, amikacina y nitrofurantoina. CONCLUSIÓN. Se determinó el perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario; donde Escherichia coli. fue aislada con frecuencia, con susceptibilidad favorable para nitrofurantoína y fosfomicina.

INTRODUCTION. Urinary tract infections are the cause of greater morbidity in the adult population and it often affects women. As it is a prevalent problem, it was essential to carry out studies on local susceptibility profiles to establish surveillance measures and control of antibiotic use. OBJECTIVE. To determine the microbial drug resistance profile in adults with urinary tract infection. MATERIALS AND METHODS. Descriptive, cross-sectional study. The population was 437 urine cultures and a sample of 176 positive with their antibiogram, carried out in the laboratory of the Hospital Básico de Sangolquí between january 2017 and april 2018. Inclusion criteria were: patients older than 15 years of age of both sexes, ambulatory and hospitalized, who presented positive urine cultures defined by a count greater than 100 000 Colony Forming Units. RESULTS. Of the 40,27% (176; 437) of positive urine cultures, the bacterium frequently isolated was Escherichia coli. 69,31% (122; 176), with resistance to ampicillin 77,97% (92; 118), trimethoprim-sulfamethoxazole 62,26% (66; 106), norfloxacin 37,50% (42; 112), ciprofloxacin 35,65% (41; 115), ampicillin / sulbactam 32,20% (38; 118) and with susceptibility to: fosfomycin, ceftriaxone, amikacin and nitrofurantoin. CONCLUSION. The microbial drug resistance profile was determined in adults with urinary tract infection; where Escherichia coli. was frequently isolated, with favorable susceptibility to nitrofurantoin and fosfomycin.

Isquemia miocárdica secundaria a fenómeno de robo de flujo por fístulas coronarias: reporte de caso / Myocardial ischemia secondary to flow steal phenomenon by coronary fistulas: case report / Isquemia miocárdica secundária ao fenômeno de roubo de fluxo por fistulas coronárianas: relato de caso

Resumen: Las fístulas coronarias son una comunicación anómala directa entre las arterias coronarias y las cavidades cardíacas o alguno de los vasos sanguíneos próximos al corazón. Son poco comunes, con una incidencia angiográfica entre 0,1%-2%. Dependiendo de la magnitud de robo coronario, pueden ser asintomáticas o causar cuadros clínicos graves con alta repercusión funcional, como isquemia miocárdica, insuficiencia cardíaca congestiva, endocarditis, infecciones recurrentes del aparato respiratorio o en casos raros hipertensión pulmonar. Se presenta el caso de una paciente con fístulas coronarias que ocasionaron isquemia miocárdica por robo de flujo coronario con importante repercusión clínica y hemodinámica. El diagnóstico definitivo se llevó a cabo mediante intervencionismo coronario percutáneo y dadas las características anatómicas de las fístulas, se determinó tratamiento médico.

Summary: Coronary fistulas are an anomalous direct communication between the coronary arteries and one of the four cardiac cavities or one of the blood vessels near the heart, are uncommon with an angiographic incidence between 0.1% - 2%, and, depending of the magnitude of coronary steal, they may be asymptomatic or cause severe clinical symptoms with high functional repercussion, such as myocardial ischemia, congestive heart failure, endocarditis, recurrent respiratory infections or, in rare cases, pulmonary hypertension. We present a case of a female patient with coronary fistulas that caused myocardial ischemia due to coronary flow steal with important clinical and hemodynamic repercussions. The definitive diagnosis was made through percutaneous coronary intervention and given the anatomical characteristics of the fistulas, medical treatment was determined.

Resumo: As fístulas coronarianas são uma comunicação anômala direta entre as artérias coronárias e uma das quatro cavidades cardíacas ou um dos vasos sanguíneos próximos ao coração; são incomuns com uma incidência angiográfica entre 0,1% - 2% e, dependendo da magnitude do roubo coronariano, podem ser assintomáticos ou causar sintomas clínicos graves, com alta repercussão funcional, como isquemia miocárdica, insuficiência cardíaca congestiva, endocardite, infecções respiratórias de repetição ou, em raros casos, hipertensão pulmonar. Apresentamos um caso de uma paciente com fístulas coronarianas que causaram isquemia miocárdica por roubo de fluxo coronariano com importante repercussão clínica e hemodinâmica. O diagnóstico definitivo foi feito por meio de intervenção coronariana percutânea e, dadas as características anatômicas das fístulas, foi determinado tratamento médico.

Prevalencia de síndrome metabólico y factores de riesgo asociados en jóvenes universitarios ecuatorianos / Prevalence of metabolic syndrome and associated risk factors in ecuadorian university students

Antecedentes y Objetivo: En México, el 64% de los pacientes hospitalizados sufren de desnutrición hospitalaria y hasta un 100% en adultos mayores, se han estudiado las causas, entre ellas se destacan: la sub-alimentación, el tiempo de hospitalización, el catabolismo presente en diversas patologías, falta de interés o tiempo del personal que labora en los hospitales entre otras. El objetivo del presente trabajo fue obtener la prevalencia de sub-alimentación en los pacientes hospitalizados con soporte enteral, en el Centro Médico 'Lic. Adolfo López Mateos' (CMLALM) durante el periodo Agosto-Octubre 2014. Metodología: Se diseñó un estudio observacional, transversal, descriptivo; con una población de 52 pacientes con soporte enteral en el que se analizó la prevalencia de pacientes con sub-alimentación a partir de la ministración de la dieta enteral y la prescripción nutricional calórica establecida, durante el periodo de Agosto-Octubre 2014. Resultados: Se realizaron medidas de tendencia central para obtener el porcentaje de pacientes con sub-alimentación calórica. La prevalencia de pacientes con sub-alimentación fue del 71%, con mayor predominio el sexo masculino (70%) y en un rango de edad entre 51 años y 61 años (43%). El servicio médico de hospitalización donde se encontró la mayor prevalencia de pacientes con sub-alimentación fue medicina interna afectando a 14 pacientes (38%), seguido de neurocirugía con 7 pacientes (19%) y unidad de cuidados intensivos (UCI) con 7 pacientes (19%); siendo el turno nocturno donde se presentó en mayor predominio la sub-alimentación. Conclusiones: La sub-alimentación afectó a 37 pacientes con soporte enteral los cuales representan el 71% de la población estudiada, esta cifra coincide con otros estudios similares. La causa principal de la sub-alimentación fue el incumplimiento en la ministración de la dieta enteral (AU)

Introduction: Overweight and obesity in in young people especially in children and adolescents is considered as public health problem in the world. Obesity could be the most important cause of insulin resistance. For this reason obese children and adolescents become in a risky group for developing metabolic syndrome (MS). In Ecuador is shocking the low following that is given to the diagnosis of MS for predicting the risk of cardio and cerebral vascular disease and diabetes mellitus. Objective: To determine the prevalence of metabolic syndrome and its risk factors in a sample of students from the 'Universidad Central del Ecuador' (UCE) in Quito. Methods: Students form first, second and third semester of Medicine College in UCE were included in the study. The age range was between 17 and 25 years old. All students were measured weight, height, body mass index (BMI, blood pressure, waist circumference and serum levels of total cholesterol, HDL, LDL, triglycerides and glucose. Results: The study shows that the prevalence of MS was 7.58% (IDF). It means that 1 of 13 students had MS. 22.24% has pre obesity and 3.14% has obesity. We found that waist circumference was mainly higher in women than men (53.39% vs. 25.85) of low values of HDLc, the 38.84% occurred among women and 19.73% among men, the values of total cholesterol, LDL cholesterol and glucose were normal. Conclusion: In the tested sample was found that 1 out of 13 students had MS and 1 out of 2 had at least one risk factor for MS. According with the pre-obesity and obesity result, 1 out of 4 students shows one of these symptoms. In addition, these results show the direct relationship between risk factors and TA. Finally, Healthy lifestyles promotion (includes non-pharmacological treatments such diet and exercise) could be the first goal to prevent metabolic disease, because the large amount of persons with at least one risk factor for MS (AU)

[Prevalence of metabolic syndrome and associated risk factors in ecuadorian university students]. / Prevalencia de síndrome metabólico y factores de riesgo asociados en jóvenes universitarios ecuatorianos.

INTRODUCTION: Overweight and obesity in in young people especially in children and adolescents is considered as public health problem in the world. Obesity could be the most important cause of insulin resistance. For this reason obese children and adolescents become in a risky group for developing metabolic syndrome (MS). In Ecuador is shocking the low following that is given to the diagnosis of MS for predicting the risk of cardio and cerebral vascular disease and diabetes mellitus. OBJECTIVE: To determine the prevalence of metabolic syndrome and its risk factors in a sample of students from the "Universidad Central del Ecuador" (UCE) in Quito. METHODS: Students form first, second and third semester of Medicine College in UCE were included in the study. The age range was between 17 and 25 years old. All students were measured weight, height, body mass index (BMI, blood pressure, waist circumference and serum levels of total cholesterol, HDL, LDL, triglycerides and glucose. RESULTS: The study shows that the prevalence of MS was 7.58% (IDF). It means that 1 of 13 students had MS. 22.24% has pre obesity and 3.14% has obesity. We found that waist circumference was mainly higher in women than men (33.67% vs. 9.55) of the 31.79% of low values of HDLc, the 24.50% occurred among women and 7.29% among men. , the values of total cholesterol, LDL cholesterol and glucose were normal. CONCLUSION: In the tested sample was found that 1 out of 13 students had MS and 1 out of 2 had at least one risk factor for MS. According with the pre-obesity and obesity result, 1 out of 4 students shows one of these symptoms. In addition, these results show the direct relationship between risk factors and TA. Finally, Healthy lifestyles promotion (includes non-pharmacological treatments such diet and exercise) could be the first goal to prevent metabolic disease, because the large amount of persons with at least one risk factor for MS.

Introducción: El sobrepeso y la obesidad en niños y adolescentes se consideran un problema de salud pública en el mundo. La obesidad parece ser el desencadenante más importante de la resistencia a la insulina, lo que convierte a los niños y adolescentes obesos en un grupo de riesgo para desarrollar Síndrome Metabólico. En el Ecuador, el seguimiento que se le da al diagnóstico de Síndrome Metabólico para la predicción del riesgo de enfermedad cardio y cerebro vascular y Diabetes Mellitus, es limitado. Objetivo: Determinar la prevalencia de Síndrome Metabólico y sus factores riesgo en una muestra de estudiantes de la Universidad Central del Ecuador de la ciudad de Quito. Métodos: Fueron incluidos estudiantes de los tres primeros semestres de la carrera de Medicina de la UCE, comprendidos entre 17 y 25 años. A todos los estudiantes se midió peso, talla, se calculó índice de masa corporalIMC, tensión arterial, perímetro abdominal, y niveles séricos de colesterol total, cHDL, cLDL, triglicéridos y glucosa. Resultados: En el presente estudio se encontró que la prevalencia de Síndrome Metabólico fue de 7.58% (IDF). El 22,24% presentó pre obesidad y 3.14% obesidad. Se encontró que el perímetro abdominal estuvo alterado preferentemente en mujeres en relación con los hombres (33.67% vs 9.55%). En el 31.79% se encontró niveles de cHDL bajo los valores normales, siendo más significativo en mujeres (24.50% mujeres, 7.29% hombres), los valores de colesterol total, colesterol LDL y glucosa estuvieron dentro de parámetros normales. Conclusión: En la muestra estudiada se encontró que 1 de cada 13 estudiantes presentaron Síndrome Metabólico y 1 de cada 2, al menos un factor de riesgo. En relación a pre obesidad y obesidad, 1 de cada 4 estudiantes presento algún grado de sobrepeso u obesidad. Se evidencio una relación directamente proporcional entre la presencia de factores de riesgo y un aumento de TA. Dada la gran cantidad de personas que presentan al menos un factor de riesgo es indispensable promover estilos de vida saludable que incluyan medidas no farmacológicas como dieta y ejercicio.