Infections in the first year after heart transplantation in a Latin American country.

BACKGROUND: Heart transplantation is the therapy of choice in patients with advanced heart failure refractory to other medical or surgical management. However, heart transplants are associated with complications that increase posttransplant morbidity and mortality. Infections are one of the most important complications after this procedure. Therefore, infections in the first year after heart transplantation were evaluated. METHODS: A retrospective cohort study of infections after heart transplants was conducted in a teaching hospital in Colombia between 2011 and 2019. Patients registered in the institutional heart transplant database (RETRAC) were included in the study. Microbiological isolates and infectious serological data were matched with the identities of heart transplant recipients and data from clinical records of individuals registered in the RETRAC were analyzed. The cumulative incidences of events according to the type of microorganism isolated were estimated using Kaplan-Meier survival analyses. RESULTS: Seventy-nine patients were included in the study. Median age was 49 years (37.4-56.3), and 26.58% of patients were women. Eighty-seven infections were documented, of which 55.17% (48) were bacterial, 22.99% (20) were viral, and 12.64% (11) were fungal. Bacterial infections predominated in the first month. In the first year, infections caused 38.96% of hospital admissions and were the second cause of death after heart transplants (25.0%). CONCLUSION: Posttransplant infections in the first year of follow-up were frequent. Bacterial infections predominated in the early posttransplant period. Infections, mainly bacterial, were the second most common cause of death and the most common cause of hospitalization in the first year after heart transplantation.

Estimated prevalence of the Duffy null phenotype Fy (a-b-) among black blood-donors in Southwestern Colombia.

INTRODUCTION: Hemolytic reactions are adverse complications associated with red blood cell transfusion. These reactions are associated with clinically important erythrocyte antigens, such as those of Duffy blood Meny (2010). Individuals with the Duffy null phenotype Fy (a-b-) are more likely to develop an alloimmunization reaction, resulting in an incompatibility with all available red blood cell units, thus increasing the risk of complications from their underlying disease Höher et al. (2018). Hence, it is important to determine the prevalence of the Fy (a-b-) phenotype in blood donors in our population and to create a database to ensure safe transfusion in patients with this phenotype. Moreover, we intend to establish whether there is any relationship between individuals with this phenotype and the sickle cell trait. We conducted this study to measure the prevalence of the Fy (a-b-) phenotype in our blood donors. MATERIALS AND METHODS: This prospective, descriptive study included black blood donors visiting the blood bank of a tertiary care university hospital between January 2019 and July 2019. We used Fitzpatrick classification phototype VI and self-identification to select donors in the study. The presence of the Duffy antigens Fya and Fyb was determined by the Coombs test using monoclonal antibodies. To establish the presence of hemoglobin S (HbS) and sickle cell traits, a hemoglobin electrophoresis test was performed. RESULTS: We included 166 patients in the study. Seventy-nine donors were identified as having Fy (a-b-). The prevalence of the Fy (a-b-) phenotype was 48 %. Sickle cell trait hemoglobinopathy was found in 6 blood donors (8%). CONCLUSION: This information is relevant for the implementation of a database of blood donors to guarantee the safety of transfusion in patients with a Fitzpatrick skin type 6at our institution. Moreover, it may provide information of interest to other blood banks in case donors with this phenotype are needed. No significant association was found between the donor Fy (a-b-) phenotype and the sickle cell trait.

J-Shaped Upper Mini-Sternotomy Versus Full Sternotomy for Aortic Valve Replacement: A Comparative Study.

BACKGROUND: This study aims to compare the characteristics between patients who underwent aortic valve replacement (AVR) through a J-shaped upper mini-sternotomy (UMS) and patients who underwent full sternotomy (FS) in the basis of clinical care and hospital outcomes. METHODS: A retrospective, cross-sectional study was conducted on adult patients who were subjected to AVR by UMS from 2014 to 2017, compared with a historical control of patients who had undergone UMS by FS from 2011 to 2014. Patients, who received combined valve replacement or aortic surgery, as well as heart valve reinterventions due to endocarditis, were excluded. Sociodemographic characteristics, medical history, hospital and intensive care stay, blood transfusions, complications, and mortality of both procedures were compared. RESULTS: There were 57 patients under UMS and 99 patients under FS included in this study. The median age was 67 years, and 56.77% of the patients were male. No differences were observed in the past medical history and the type of valve implanted between the groups. During surgery, patients under UMS received a lower percentage of red blood cell and platelet transfusions compared with FS. However, UMS had a higher percentage of cryoprecipitate transfusion. Intensive care stay was shorter in UMS compared with FS (three days; interquartile range [IQR], 2-4; and four days; IQR, 2-6, respectively) without differences in overall hospital stay, postoperative complications, in-hospital mortality, and 30-day mortality. CONCLUSIONS: The J-shaped upper mini-sternotomy is a feasible surgical technique that does not increase in-hospital or 30-day mortality, neither hospital stay nor infectious complications.

Antibacterial Activity of a Cationic Antimicrobial Peptide against Multidrug-Resistant Gram-Negative Clinical Isolates and Their Potential Molecular Targets.

Antimicrobial resistance reduces the efficacy of antibiotics. Infections caused by multidrug-resistant (MDR), Gram-negative bacterial strains, such as Klebsiella pneumoniae (MDRKp) and Pseudomonas aeruginosa (MDRPa), are a serious threat to global health. However, cationic antimicrobial peptides (CAMPs) are promising as an alternative therapeutic strategy against MDR strains. In this study, the inhibitory activity of a cationic peptide, derived from cecropin D-like (ΔM2), against MDRKp and MDRPa clinical isolates, and its interaction with membrane models and bacterial genomic DNA were evaluated. In vitro antibacterial activity was determined using the broth microdilution test, whereas interactions with lipids and DNA were studied by differential scanning calorimetry and electronic absorption, respectively. A strong bactericidal effect of ΔM2 against MDR strains, with minimal inhibitory concentration (MIC) and minimal bactericidal concentrations (MBC) between 4 and 16 µg/mL, was observed. The peptide had a pronounced effect on the thermotropic behavior of the 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC)/1,2-dimyristoyl-sn-glycero-3-phosphorylglycerol (DMPG) membrane models that mimic bacterial membranes. Finally, the interaction between the peptide and genomic DNA (gDNA) showed a hyperchromic effect, which indicates that ΔM2 can denature bacterial DNA strands via the grooves.

Mean platelet volume as a predictor of platelet count recovery in dengue patients.

BACKGROUND: Thrombocytopenia is a marker of severity in dengue, and its resolution predicts clinical improvement. The objective was to evaluate mean platelet volume (MPV) trajectories as a predictor of platelet count (PC) recovery in dengue patients. METHODS: An observational, longitudinal and analytical study was conducted at Fundación Valle del Lili (Cali, Colombia). Patients diagnosed with dengue during 2016-2020 were included. The association between PC and the covariates was evaluated using simple linear, quadratic and non-parametric spline smoothing regression models. A longitudinal linear mixed model was adjusted and then validated for PC measurements. RESULTS: A total of 71 patients were included. The median age was 27 y, 38.5% were women and half had dengue with warning signs. A statistically significant PC decrease was observed when MPV was 13.87 fL and 4.46 d from the onset of symptoms, while PC displayed a significant constant increase with neutrophils count. Then, PC recovery was achieved with an MPV of 13.58 fL, 4.5 d from the onset of symptoms and a minimum neutrophils count of 150 µL. CONCLUSION: MPV may be a predictor of PC recovery in dengue patients. PC recovery is expected when a patient has an MPV of 13.58 fL, an onset time of 4.5 d and a neutrophils count of 150 µL.

A novel filtration system based on ceramic silver-impregnated pot filter combined with adsorption processes to remove waterborne bacteria.

Halving the proportion of the people without sustainable access to safe drinking water and basic sanitation is among the Sustainable Development Goals (SDG). Lack of access to safe drinking water has been associated with the prevalence of waterborne diseases. Due to this reported association, the development of household water treatment devices has been an alternative to improve the quality supply of domestic water. In this study, we aimed to evaluate the performance of a ceramic silver-impregnated pot filter (CSF) system coupled with an adsorption process, composed of silver-impregnated granular activated carbon and zeolite (CSF + GAC-Z), to remove waterborne bacteria Escherichia coli and Salmonella spp. from spiked water. The performance of this system was compared with the conventional CSF system. In this respect, we evaluated six CSF and six CSF + GAC-Z using spiked water with 103 and 102 CFU/mL of E. coli and Salmonella spp. The mean percentage of removals ranged between 98% and 99.98%. The highest bacterial removal efficiency was recorded by the CSF + GAC-Z (99%) and CSF (99.98%) for E. coli and Salmonella spp., respectively, but no significant statistical differences were found between filtration systems. Our findings suggest that the CSF + GAC-Z system was effective in the removal of waterborne bacteria from spiked water.

A Novel Cecropin D-Derived Short Cationic Antimicrobial Peptide Exhibits Antibacterial Activity Against Wild-Type and Multidrug-Resistant Strains of Klebsiella pneumoniae and Pseudomonas aeruginosa.

Infections caused by multidrug-resistant (MDR) Pseudomonas aeruginosa and Klebsiella pneumoniae are a serious worldwide public health concern due to the ineffectiveness of empirical antibiotic therapy. Therefore, research and the development of new antibiotic alternatives are urgently needed to control these bacteria. The use of cationic antimicrobial peptides (CAMPs) is a promising candidate alternative therapeutic strategy to antibiotics because they exhibit antibacterial activity against both antibiotic susceptible and MDR strains. In this study, we aimed to investigate the in vitro antibacterial effect of a short synthetic CAMP derived from the ΔM2 analog of Cec D-like (CAMP-CecD) against clinical isolates of K pneumoniae (n = 30) and P aeruginosa (n = 30), as well as its hemolytic activity. Minimal inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs) of CAMP-CecD against wild-type and MDR strains were determined by the broth microdilution test. In addition, an in silico molecular dynamic simulation was performed to predict the interaction between CAMP-CecD and membrane models of K pneumoniae and P aeruginosa. The results revealed a bactericidal effect of CAMP-CecD against both wild-type and resistant strains, but MDR P aeruginosa showed higher susceptibility to this peptide with MIC values between 32 and >256 µg/mL. CAMP-CecD showed higher stability in the P aeruginosa membrane model compared with the K pneumoniae model due to the greater number of noncovalent interactions with phospholipid 1-Palmitoyl-2-oleyl-sn-glycero-3-(phospho-rac-(1-glycerol)) (POPG). This may be related to the boosted effectiveness of the peptide against P aeruginosa clinical isolates. Given the antibacterial activity of CAMP-CecD against wild-type and MDR clinical isolates of P aeruginosa and K pneumoniae and its nonhemolytic effects on human erythrocytes, CAMP-CecD may be a promising alternative to conventional antibiotics.

Association of traditional cardiovascular risk factors in adults younger than 55 years with coronary heart disease. Case-control study.

OBJECTIVES: The traditional cardiovascular risk factors associated with coronary artery disease in individuals younger than 55 years old was determined in this study. METHODS: A retrospective, paired case-control study comprised of patients younger than 55 years old who were admitted to the hospital due to acute coronary syndrome with coronary artery disease from 2011 to 2016. There were two controls per case, paired by age, gender, admission date, and health insurance. Data from patients were collected, such as sociodemographic information, cardiovascular risk factors, and drug therapy information. A conditional logistic regression model was created to evaluate the association between traditional cardiovascular risk factors and coronary artery disease. RESULTS: There were 171 cases and 342 controls included in the study. The median age was 49 years, with a predominance of male gender (80.12%). Nearly 66% of cases had at least one traditional cardiovascular risk factor. The most common risk factors were obesity (57.31%), arterial hypertension (45.62%), and smoking (28.97%). Independent risk factors of coronary artery disease in patients younger than 55 years were arterial hypertension (odds ratio, 2.52; 95% confidence interval, 1.48-4.20; p = 0.001) and smoking (odds ratio, 7.15; 95% confidence interval, 3.19-15.99; p = 0.00). No significant association between diabetes mellitus and coronary heart disease in the global group (odds ratio, 2.04; 95% confidence innterval, 0.91-4.58; p = 0.083) was found. CONCLUSION: For patients younger than 55 years, with a theoretically lower risk of coronary artery disease due to their age, having one or several traditional risk factors (smoking, arterial hypertension, dyslipidemia, or diabetes mellitus) confers an increased risk of coronary artery disease regardless of age.

Removal of E. coli and Salmonella in pot ceramic filters operating at different filtration rates.

The use of pot ceramic filters PCF to improve the domestic water quality supply has been recognized as an alternative in regions where there is unsecure water treatment or contamination of the treated water during transport and storage and an absence of safe drinking water. The aim of this study was to evaluate a model of PCF impregnated with colloidal silver under three filtration rates (1.0, 2.0 and 3.0 L/h) and three E. coli and Salmonella spp concentrations (104, 103 and 102 CFU/mL). The evaluation was made using spiked water having a turbidity of 29.9 ±â€¯4.4 NTU and conductivity of 176 ±â€¯31.7 µS/cm. The results showed a turbidity removal efficiency of 97% and average effluent of 0.9 NTU. The microbiological efficiency removal was of 2 Log Reduction Value (LRV) for E. coli and 1 LRV for Salmonella spp. There were not found significant statistical differences between the filtration rates and the removal efficiencies for turbidity E. coli and Salmonella spp. It was observed that the microbiological removal efficiency was affected by biofilm formation a phenomenon that was attributed to the presence of Salmonella spp. The combination of chemical and mechanical cleaning methods contributed to the elimination of the biofilm.

Trombosis venosa abdominal en una población adulta seguida en una clínica de anticoagulación / Abdominal venous thrombosis in an adult population followed in an anticoagulation clinic

Resumen Introducción: La trombosis venosa abdominal es inusual y es una de las formas menos estudiada de la enfermedad tromboembólica venosa. Objetivo: Describir las características epidemiológicas, los factores de riesgo, las complicaciones y el manejo anticoagulante en pacientes con diagnóstico de trombosis venosa abdominal, atendidos en una clínica de anticoagulación en Cali, Colombia. Materiales y método: Estudio descriptivo en el que se identificaron 83 pacientes con diagnóstico de trombosis venosa abdominal, manejados en la clínica de anticoagulación de la Fundación Valle del Lili, entre los años 2011 y 2019. La edad promedio fue de 53.3 ± 17.4 años y el 59% eran de sexo femenino. Fue más frecuente en las venas mesentéricas (19%), seguidas de la vena porta (18%). Los antecedentes incluyen cáncer, hipertensión arterial y estado hipercoagulable/trombofilia. Conclusiones: La trombosis venosa abdominal es una patología poco frecuente. El principal compromiso se presenta en la vena mesentérica. La enoxaparina es el manejo más frecuente. Los pacientes requieren en su mayoría anticoagulación extendida.

Abstract Introduction: Abdominal venous thrombosis is rare condition and is one of the least studied forms of venous thromboembolic disease. Objective: To describe the epidemiological characteristics, risk factors, complications and anticoagulant management in patients with a diagnosis of abdominal venous thrombosis, treated at an anticoagulation clinic in Cali, Colombia. Materials and method: Descriptive study, 83 patients with diagnosis of abdominal venous thrombosis were identified, managed in the anticoagulation clinic of Fundación Valle del Lili, between the years 2011 and 2019. The average age was 53.3 ± 17.4, and 59% female. More frequent in mesenteric veins (19%), followed by portal vein (18%). Personal antecedent includes cancer, high blood pressure, and hypercoagulable/thrombophilia status. Conclusions: Abdominal vein thrombosis is a rare disease. The main compromise occurs at the level of the mesenteric vein. Enoxaparin is the most common management. Most patients require extended anticoagulation.