Study of Candidemia and its Antifungal Susceptibility Profile at the University Hospital of Montevideo, Uruguay.

Systemic candidiasis are high mortality infections caused by yeasts of the genus Candida, affecting patients with numerous risk factors. Nowadays, candidemia produced by "non-albicans" species has increased considerably. Timely diagnosis and subsequent treatment substantially improve patients' survival. Our objectives are to study the frequency, distribution, and antifungal susceptibility profiles of candidemia isolates in our hospital. We conducted a descriptive, cross-sectional study. Positive blood cultures were recorded from January 2018 to December 2021. Positive Candida genus blood cultures were selected, classified, and analyzed on their susceptibility profile for amphotericin B, fluconazole and caspofungin using AST-YS08® card for VITEK 2 Compact® to determine minimum inhibitory concentration (MIC) and CLSI M60 2020 2nd Edition to determine breakpoints. 3862 positive blood cultures were obtained, 113 (2.93%) presented growth of Candida spp., corresponding to 58 patients. 55.2% came from the Hospitalization Ward and Emergency Services and 44.8% from the Intensive Care Unit. The species were distributed as follows: Nakaseomyces glabratus (Candida glabrata) (32.74%), Candida albicans (27.43%), Candida parapsilosis (23.01%), Candida tropicalis (7.08%) and others (9.73%). Most species were found to be susceptible to most antifungals, except for C. parapsilosis, presenting 4 isolates with resistance to fluconazole and N. glabratus (C. glabrata), whose clinical susceptibility data remains insufficient to provide accurate breakpoints. The percentage of recorded positive blood cultures of Candida spp. was 2.93%, these results were consistent with those reported at a regional level. A predominance of "non-albicans" species was observed. It is essential to know the prevalence, epidemiology, and susceptibility profiles of candidemia in our country, as well as being updated on its subsequent changes, maintaining epidemiological surveillance. This allows professionals to map out early and effective therapeutic strategies, staying alert of possible multi-resistant strains.

Evaluación de profilaxis con factor VIII de origen plasmático en pacientes con hemofilia A severa / Evaluation of factor VIII prophylaxis of plasmatic origin in patients with severe hemophilia A / Avaliação da profilaxia do fator VIII de origem plasmática em pacientes com hemofilia A grave

Introducción: la hemofilia A severa (HAS) es una enfermedad hemorrágica hereditaria causada por un déficit de factor VIII (FVIII) menor al 1%. Se presenta principalmente con sangrados articulares, los cuales provocan una artropatía hemofílica que afecta su independencia funcional. El uso de la profilaxis terciaria con FVIII ofrece beneficios en adultos disminuyendo la tasa anual de sangrado (TAS) y mejorando la independencia funcional. Objetivo: determinar el porcentaje de pacientes que logran mantener un nivel de FVIII mayor al 1%, conocer si existe una mejora en la independencia funcional, así como una disminución en la TAS con el régimen profiláctico empleado. Métodos: estudio observacional, analítico. Se incluyó a los pacientes con HAS que se controlaron en el Hospital de Clínicas "Dr. Manuel Quintela" durante 2020 en profilaxis con FVIII durante 12 meses. Se obtuvieron tres muestras separadas en el tiempo para dosificación de FVIII y se evaluó la TAS y la independencia funcional en cada paciente. Resultados: se analizaron ocho pacientes, todos presentaron valores de FVIII superiores al 1% a la hora y 24 horas posterior a la administración de FVIII. Los episodios de sangrado se redujeron 4,76 veces con el uso de la profilaxis (p = 0,019). La independencia funcional mostró que 5/8 pacientes mejoraron al menos 1 punto del score. Conclusiones: la profilaxis terciaria en estos pacientes fue beneficioso en reducir la TAS y mejorar su capacidad funcional.

Summary: Introduction: severe hemophilia A (SAH) is an hereditary hemorrhagic disease, caused by a factor VIII (FVIII) deficiency of less than 1%. It presents with joint bleeding mainly, which causes a hemophilic arthropathy, which affects its functional independence. The use of tertiary prophylaxis with FVIII offers benefits in adults by decreasing the annual bleeding rate (ABR) and improving functional independence. Objective: to determine the percentage of patients who manage to maintain an FVIII level greater than 1%, to know if there is an improvement in functional independence, as well as a decrease in the ABR with the prophylactic regimen used. Methods: observational, analytical study. Patients with SAH who were controlled at the Hospital de Clínicas "Dr. Manuel Quintela", during the year 2020, in prophylaxis with FVIII for 12 months were included. Three samples separated in time for FVIII dosing were obtained and the ABR and functional independence were evaluated in each patient. Results: 8 patients were analyzed, all presented FVIII higher than 1% at one hour and 24 hours after the administration of FVIII. The bleeding episodes were reduced 4.76 times with the use of Prophylaxis (p = 0.019). Functional independence showed that 5/8 patients improved at least 1 point in the Score. Conclusions: tertiary prophylaxis in these patients was beneficial in reducing SAD and improving their functional capacity.

Introdução: a hemofilia A grave (HAS) é uma doença hemorrágica hereditária, causada pela deficiência do fator VIII (FVIII) inferior a 1%. Apresenta-se principalmente com sangramento articular, que causa artropatia hemofílica, que afeta sua independência funcional. O uso de profilaxia terciária com FVIII oferece benefícios em adultos, reduzindo a taxa de sangramento anual (TAS) e melhorando a independência funcional. Objetivos: determinar a porcentagem de pacientes que conseguem manter um nível de FVIII maior que 1%, identificar uma possível melhora da independência funcional, bem como uma diminuição da TAS com o esquema profilático utilizado. Métodos: estudo observacional, analítico de pacientes com HAS controlados no Hospital das Clínicas "Dr. Manuel Quintela", durante o ano de 2020, em profilaxia com FVIII durante 12 meses. Foram obtidas três amostras separadas no tempo para dosagem de FVIII e avaliação da TAS e da independência funcional de cada paciente. Resultados: foram analisados 8 pacientes, todos apresentaram FVIII maior que 1% em uma hora e 24 horas após a administração do FVIII. Os episódios de sangramento foram reduzidos 4,76 vezes com o uso da profilaxia (p = 0,019). A independência funcional mostrou que 5/8 pacientes melhoraram pelo menos 1 ponto do escore FISH. Conclusões: a profilaxia terciária nesses pacientes foi benéfica na redução da TAS e na melhora da capacidade funcional.

Hipoglicemia asociada a hepatocarcinoma / Hypoglycemia associated with hepatocellular carcinoma aVR

Se reporta el caso de un varón 27 años que desarrolló hipoglicemia grave como manifestación de un hepatocarcinoma por infección de hepatitis B.

We report the case of a 27 year-old male who developed severe hypoglycemia as a manifestation of a hepatocellular carcinoma by infection of hepatitis B.