Effects of Serelaxin in Patients with Acute Heart Failure.

BACKGROUND: Serelaxin is a recombinant form of human relaxin-2, a vasodilator hormone that contributes to cardiovascular and renal adaptations during pregnancy. Previous studies have suggested that treatment with serelaxin may result in relief of symptoms and in better outcomes in patients with acute heart failure. METHODS: In this multicenter, double-blind, placebo-controlled, event-driven trial, we enrolled patients who were hospitalized for acute heart failure and had dyspnea, vascular congestion on chest radiography, increased plasma concentrations of natriuretic peptides, mild-to-moderate renal insufficiency, and a systolic blood pressure of at least 125 mm Hg, and we randomly assigned them within 16 hours after presentation to receive either a 48-hour intravenous infusion of serelaxin (30 µg per kilogram of body weight per day) or placebo, in addition to standard care. The two primary end points were death from cardiovascular causes at 180 days and worsening heart failure at 5 days. RESULTS: A total of 6545 patients were included in the intention-to-treat analysis. At day 180, death from cardiovascular causes had occurred in 285 of the 3274 patients (8.7%) in the serelaxin group and in 290 of the 3271 patients (8.9%) in the placebo group (hazard ratio, 0.98; 95% confidence interval [CI], 0.83 to 1.15; P = 0.77). At day 5, worsening heart failure had occurred in 227 patients (6.9%) in the serelaxin group and in 252 (7.7%) in the placebo group (hazard ratio, 0.89; 95% CI, 0.75 to 1.07; P = 0.19). There were no significant differences between the groups in the incidence of death from any cause at 180 days, the incidence of death from cardiovascular causes or rehospitalization for heart failure or renal failure at 180 days, or the length of the index hospital stay. The incidence of adverse events was similar in the two groups. CONCLUSIONS: In this trial involving patients who were hospitalized for acute heart failure, an infusion of serelaxin did not result in a lower incidence of death from cardiovascular causes at 180 days or worsening heart failure at 5 days than placebo. (Funded by Novartis Pharma; RELAX-AHF-2 ClinicalTrials.gov number, NCT01870778.).

[ASCITES AS MAIN PRESENTATION IN SYSTEMIC LUPUS ERYTHEMATOSUS] / Ascitis como presentación de lupus eritematoso sistémico.

A 40 year-old female patient was admitted to the hospital with ascites and abdominal pain developed in the last five days. The ascitic fluid was an exudate with negative results for common diseases. Antinuclear antibodies and anti-DNA were positive and a low activity of serum complement was found. The renal biopsy disclosed a lupus glomerulonephritis grade IV. She received oral prednisone and a pulse of cyclophosphamide with gradual resolution of the ascites.

Rabdomiolisis y miocarditis asociados con infección por el virus dengue / Rhabdomyolysis and myocarditis associated to dengue virus infection

Se presenta el caso de una paciente que reside en el distrito de Mazamari, provincia de Satipo (selva central del Perú), con un cuadro clínico de dengue, confirmado por serología, donde las mialgias fueron una de las manifestaciones importantes y que desarrolló rabdomiolisis, CPK 6931 μ/L (VN 0-190 μ/L) y miocarditis a juzgar por las elevaciones de CPK-MB y troponina I. El tratamiento sintomáticoy una adecuada hidratación permitieron la recuperación de la paciente sin complicaciones mayores.

It is shown a patient from Mazamari, province of Satipo (Peruvian central jungle) with a clinical presentation of dengue, with serological confirmation, where myalgia was one of the most striking symptoms and the patient developed rhabdomyolisis, CK 6931 μ/L (normal values: 0-190 μ/L) and myocarditis, increased CK-MB and troponin I. Appropriate treatment with hydration and analgesics led to thepatient´s recovery without major complications.

Terapia antihipertensiva: aspectos económicos / Economic aspects of antihypertensive therapy

La hipertensión arterial (HTA), constituye un problema de salud pública por la alta prevalencia, la morbilidad asociada y el costo del tratamiento de la enfermedad y de sus complicaciones. Se da a conocer la clasificación de las drogas antihipertensivas de acuerdo a su efecto hemodinámico

Tuberculosis osteocutánea de la región esternoclavicular: presentación de un caso y revisión de la literatura / Sterno clavicular region osteocutaneous tuberculosis: Report of a case and revision of the literature

Una paciente de 61 años de edad presentó una tumoración fluctuante sobre la región esternoclavicular izquierda, pérdida de peso y sensación febril. En los meses previos había desarrollado una adenitis en la región axilar izquierda que se fistulizó. El estudio radiológico demostró lesiones destructivas de la clavícula y secuelas de TBC pulmonar; y, la biopsia de un ganglio suparaclavicular reveló un infiltrado inflamatorio granulomatoso crónico con necrosis caseosa y células de Langhans. Hubo respuesta favorable al tratamiento antituberculoso. Esta forma clínica es muy infrecuente y se revisa la literatura al respecto.

Ascitis como presentación de lupus eritematoso sistémico / Ascites as main presentation in systemic lupus erythematosus

Se presenta el caso de una paciente de 40 años quien ingresó por presentar ascitis de cinco días de evolución más dolor abdominal. El estudio de líquido ascítico fue un exudado con resultados negativos para las enfermedades comunes. Se les halló anticuerpos antinucleares y anti-ADN positivos con baja actividad de complemento. La biopsia renal reveló una glomerulonefritis lúpica de grado IV. Recibió prednisona oral y un pulso de ciclofosfamida, y la ascitis se resolvió gradualmente.

A 40 year-old female patient was admitted to the hospital with ascites and abdominal pain developed in the last five days. The ascitic fluid was an exudate with negative results for common diseases. Antinuclear antibodies and anti-DNA were positive and a low activity of serum complement was found. The renal biopsy disclosed a lupus glomerulonephritis grade IV. She received oral prednisone and a pulse of cyclophosphamide with gradual resolution of the ascites.