Vaccine-carditis study: Spanish multicenter registry of inflammatory heart disease after COVID-19 vaccination.

INTRODUCTION AND OBJECTIVES: Vaccines against SARS-CoV-2 have been a major scientific and medical achievement in the control of the COVID-19 pandemic. However, very infrequent cases of inflammatory heart disease have been described as adverse events, leading to uncertainty in the scientific community and in the general population. METHODS: The Vaccine-Carditis Registry has included all cases of myocarditis and pericarditis diagnosed within 30 days after COVID-19 vaccination since August 1, 2021 in 29 centers throughout the Spanish territory. The definitions of myocarditis (probable or confirmed) and pericarditis followed the consensus of the Centers for Disease Control and the Clinical Practice Guidelines of the European Society of Cardiology. A comprehensive analysis of clinical characteristics and 3-month evolution is presented. RESULTS: From August 1, 2021, to March 10, 2022, 139 cases of myocarditis or pericarditis were recorded (81.3% male, median age 28 years). Most cases were detected in the 1st week after administration of an mRNA vaccine, the majority after the second dose. The most common presentation was mixed inflammatory disease (myocarditis and pericarditis). 11% had left ventricular systolic dysfunction, 4% had right ventricular systolic dysfunction, and 21% had pericardial effusion. In cardiac magnetic resonance studies, left ventricular inferolateral involvement was the most frequent pattern (58%). More than 90% of cases had a benign clinical course. After a 3-month follow-up, the incidence of adverse events was 12.78% (1.44% mortality). CONCLUSIONS: In our setting, inflammatory heart disease after vaccination against SARS-CoV-2 predominantly affects young men in the 1st week after the second dose of RNA-m vaccine and presents a favorable clinical course in most cases.

Usefulness of natriuresis to predict in-hospital diuretic resistance.

BACKGROUND: Urinary sodium excretion predicts long-term adverse events after discharge in patients with acute heart failure (AHF). The role of natriuresis as an early marker of poor diuretic response during an AHF episode has been scarcely investigated. We sought to evaluate whether early natriuresis or its change during heart failure hospitalization is associated with the development of in-hospital diuretic resistance (DR). METHODS: This was a prospective, observational single center study of consecutive patients with AHF. Urine electrolytes were estimated from a spot urine sample within the first 6 hours following the first diuretic dose and 48 hours after admission. In-hospital DR was defined as poor diuretic response based on diuretic efficiency metrics and persistent congestion despite an intensive diuretic protocol. RESULTS: Between January and December 2018, 143 patients were admitted for AHF. Of these, 102 fulfilled the inclusion criteria (60% males, median age 77 years [interquartile range [IQR]: 69-83), and 20 patients (19.6%) met the definition of DR. Early natriuresis was lower in patients with DR than in non-resistant patients (46 mEq/L [IQR: 38.5-80.0] vs 97.5 mEq/L [IQR: 70.5-113.5], P<0.001). Urinary sodium <50 mEq/L increased the risk of developing in-hospital DR (risk ratio: 5.011 [95% confidence interval 2.408-10.429], P<0.001). The area under the receiver operating characteristic curve for early natriuresis to predict DR was 0.791 (95% confidence interval 0.681-0.902, P<0.001). CONCLUSIONS: Initial natriuresis can predict in-hospital DR. Patients with urinary sodium <50 mEq/L have an increased risk of early resistance to diuretic treatment.

Prevalencia de los trastornos mentales en el sur de Quito y su relación con factores socio-economicos

La investigación fue echa entre los meses de julio-diciembre de 1990. El universo escogido correspondió a 1260 personas entre 10 y 60 años de edad, de ambos sexos, habitantes del sector sur de Quito. Se aplicó una encuesta basada en trabajos anteriores tanto del Ecuador como de Chile en la que se evaluaron las siguientes variables: edad, sexo, estado civil, tipo de familia, instrucción, riesgo de trabajo, jornada de trabajo, horario de trabajo, esfuerzo físico, responsabilidad laboral, tipo de trabajo, estado de salud física, hospitalizaciones por patología mental, asistencia a consulta de salud mental, problemas en trabajo o estudio, uso de medicinas por problemas físicos o psíquicos, antecedentes familiares de patología mental, índice de hacinamiento, ingreso familiar, propiedad de vivienda y propiedad de vehículo frente a las siguientes patologías psiquiátricas: trastorno depresivo, trastorno de personalidad, somatoforme, trastorno de adaptación, trastorno psicótico, trastorno neurótico, trastorno por dependencia a substancias psicoactivas y trastorno convulsivo. El instrumento a se demostró como de alta sensibilidad y baja especificidad con una margen de confiabilidad superior al 90 por ciento. HIPOTESIS: 1.- En la ciudad de Quito existe una elevada prevalencia de trastornos mentales. 2.- Existe asociación entre disfunción familiar, deterioro de las condiciones socio-economicas, estrés y patología mental especialmente en grupos sociales de trabajadores asalariados y subasalariados. 3.- No hay mayores diferencias entre grupos y patología mental en relación a la inserción social. 4.- El deterioro de las condiciones de trabajo afecta especialmente a los gupos económicamente activos, y este expone a mayores riesgos de patología mental. 5.- Persisten a pesar de los avances en el campo de la salud mental concepciones y practicas médicas tradicionales que impiden la atención adecuada a los casos considerados iniciales o limítrofes. CONCLUSIONES: 1.- las condiciones de vida deficientes están asociadas a una elevada prevalencia de trastornos mentales en el sector de Quito. 2.- La desestructuración y disfunción familiar, factores socio-económicos y culturales inadecuados, se asocian con patología mental. 3.- Las condiciones inadecuadas en el trabajo y el deterioro del consumo se asocian con patología mental. 4.- Concepciones erradas asociadas a la tradición y una inadecuada cobertura de los servicios de salud mental dificultan la asistencia...