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AimsThe management of patients with asymptomatic significant aortic regurgitation (sAR) is often challenging and appropriate timing of aortic valve surgery remains controversial. Prognostic value of diastolic parameters has been demonstrated in several cardiac diseases. In particular, left atrial (LA) function has been shown to be an important determinant of morbimortality. The purpose of this study was to analyze the prognostic significance of diastolic function in asymptomatic patients with sAR.Methods and resultsA total of 126 patients with asymptomatic sAR were included. Conventional echocardiographic systolic and diastolic function parameters were assessed. LA and left ventricular (LV) auto-strain analysis was performed in a subgroup of 57 patients. During a mean follow up of 33±19 months, 25(19,8%) patients reached the combined end-point. Univariate analysis showed that LV volumes, LV ejection fraction (LVEF), LV-GLS, E wave, E/e’ ratio, LA volume and LA reservoir strain (LASr) were significant predictors of events. Multivariate model-1 that tested all classical echocardiographic variables statistically significant in the univariate model showed that LVEDV [HR=1,02;95% CI:1,01-1,03;(p

RESUMEN Introducción: El confinamiento por COVID-19, repercute en la situación socioeconómica, de salud y de seguridad alimentaria especialmente en población vulnerable, debido a la reducción de empleos, ingreso y acceso a los alimentos. Objetivo: Determinar la inseguridad alimentaria y la priorización de la compra de alimentos en hogares en situación de confinamiento, durante la pandemia por COVID-19 en Chile. Material y métodos: Estudio observacional analítico. Se envió cuestionario online a través de redes sociales, que incluía información sociodemográfica, prioridad de compra de algunos alimentos seleccionados, pérdida de alimentos en el hogar y una escala de seguridad alimentaria doméstica. Resultados: Participaron 1.114 personas, de ellos el 87,8% eran mujeres, el 80,9% de los participantes llevaba 4 o más semanas de confinamiento. A medida que aumentan las semanas de confinamiento, se incrementa la inseguridad alimentaria leve 26,9% a 36,1% y moderada, 1,7% a 7,8% y se disminuye la seguridad alimentaria 70,6% a 55,7%. Entre el 49,2% y 55,5% de los participantes, en la quinta semana de confinamiento priorización lácteos, arroz/pasta, harina, legumbres, aceite, papas y un 27,0% el azúcar/miel. No se priorizaron los alimentos frescos como las frutas y verduras (FV). Conclusión: El confinamiento genera un aumento progresivo de la inseguridad alimentaria leve y moderada. La priorización de compra en confinamiento se caracteriza por, alimentos con más tiempo de conservación, de mayor consumo, fáciles de preparar y que son ingredientes básicos de otras preparaciones. Alimentos frescos, como frutas y verduras no fueron priorizados. La priorización se relacionó con el nivel educativo.

Objectives Cardiac surgery is a life-saving procedure in patients diagnosed with infective endocarditis (IE). There are several validated risk scores developed to predict early-mortality; nevertheless, long-term survival has been less investigated. The aim of the present study is to analyze the impact of IE-specific risk factors for early and long-term mortality. Methods An observational retrospective study was conducted that included all patients who underwent surgery for IE from 2002 to 2016. Median follow-up time after surgery was 53.2 months (IQI 26.2–106.8 months). In-hospital mortality was analyzed using multiple logistic regression. Long-term survival was analyzed after one, two and five years. Cox proportional hazards regression was employed to identify risk factors related to long-term mortality. Results Of the 180 patients underwent cardiac surgery, 133 were discharged alive (in-hospital mortality was 26.11%). 6 variables were identified as independent factors associated with in-hospital mortality, most of them closely related to the severity of IE: age, multivalvular involvement, critical preoperative status, preoperative mechanical ventilation, abscess and thrombocytopenia. Long-term survival in patients discharged alive was 89.1%, 87.4% and 77.6% after one, two and five years. Long-term mortality was independent of specific IE factors and 86.51% of deaths were not related to cardiovascular or infectious diseases. Conclusion Despite the high perioperative mortality rate after surgical treatment for active IE, long-term survival after hospital discharge was acceptable, regardless of the severity of the endocarditis episode. Although in-hospital survival depended mainly on several IE factors, long-term survival was not related to the severity of endocarditis baseline affection.

Resumen: Introducción: La trombocitopenia preoperatoria se ha relacionado con un peor pronóstico en la endocarditis infecciosa. Objetivo: Valorar la influencia de la trombocitopenia en la cirugía de la endocarditis infecciosa en nuestra serie. Métodos: Análisis retrospectivo unicéntrico de los pacientes intervenidos por endocarditis infecciosa entre 2002 y 2016. Análisis de supervivencia a corto y a largo plazo, estratificado en función de la presencia de trombocitopenia (recuento plaquetario

BackgroundLifestyle habits associate with metabolic health in overall populations. Whether such association is similar among subjects with a different nutritional status has been less studied. We aimed to (i) determine the prevalence of metabolic phenotypes in Chile, and (ii) determine the association between lifestyle habits and metabolic health according to the nutritional status.MethodsThe National Health Survey of Chile 2016-2017 was analyzed. A metabolically unhealthy phenotype was defined as manifesting ≥3 of the following risk factors: elevated blood pressure, elevated triglycerides, elevated glucose, elevated waist circumference, or reduced high-density lipoprotein cholesterol. Individuals manifesting ResultsThe prevalence of a metabolically unhealthy phenotype was 36% in the overall sample. Such a prevalence was 7%, 33% and 58% among subjects with normal weight, overweight and obesity, respectively. In subjects with normal weight, the highest quartile of fruits/vegetables consumption was associated with reduced odds of having a metabolically unhealthy phenotype (0.09 [0.01-0.48]). In subjects with obesity, the highest quartile of moderate-vigorous physical activity was associated with reduced odds of having a metabolically unhealthy phenotype (0.29 [0.09-0.91]).ConclusionOne third of the Chilean population manifests an unhealthy phenotype. We identified associations between lifestyle habits and metabolic health that are specific to the nutritional status. Thus, emphasizing fruits/vegetables consumption in subjects with normal weight, and physical activity in subjects with obesity, may maximize the benefits of public health interventions.

OBJECTIVES We assessed the prognostic utility of risk scores in surgery for infective endocarditis (IE) to evaluate their reliability in mortality risk prediction. METHODS An observational retrospective study was developed to include all patients who underwent surgery for active IE from 2002 to 2016. Classical and endocarditis-specific risk scores were calculated. RESULTS A total of 180 patients were included in the study. The 30-day mortality rate was 26.82% [95% confidence interval (CI) 20.26-33.20%]. Classical risk scores were confirmed to have a suboptimal prognostic ability. Therefore, 4 IE-specific risk scores were calculated. Discrimination was evaluated using the area under the receiver operating characteristic curve. It was 0.76 (95% CI 0.68-0.82) for the Society of Thoracic Surgeons-IE (STS-IE) score; 0.68 (95% CI 0.58-0.76) for the De Feo-Cotrufo score; 0.73 (95% CI 0.66-0.79) for the PALSUSE score and 0.65 (95% CI 0.57-0.72) for the Costa score. The STS-IE score had higher discrimination when compared with the De Feo-Cotrufo score (P = 0.055) and the Costa score (P = 0.024); however, there was no significant difference when we compared the STS-IE score with the PALSUSE score (P = 0.58). Calibration was assessed using the Hosmer-Lemeshow test; an adequate calibration was confirmed in all 4 scores. CONCLUSIONS Specific risk scores had better prognostic performance than classical risk scores. The STS-IE score had the highest discrimination and was adequately calibrated. The PALSUSE score also showed optimal discrimination and calibration. The De Feo-Cotrufo score had a lower discrimination in our sample; however, the De Feo-Cotrufo score is recommended in the current guidelines. The Costa score had the lowest discrimination.

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There is a lack of consensus about which endocarditis-specific preoperative characteristics have an actual impact over postoperative mortality. Our objective was the identification and quantification of these factors. We performed a systematic review of all the studies which reported factors related to in-hospital mortality after surgery for acute infective endocarditis, conducted according to PRISMA recommendations. A search string was constructed and applied on three different databases. Two investigators independently reviewed the retrieved references. Quality assessment was performed for identification of potential biases. All the variables that were included in at least two validated risk scores were meta-analyzed independently, and the pooled estimates were expressed as odds ratios (OR) with their confidence intervals (CI). The final sample consisted on 16 studies, comprising a total of 7484 patients. The overall pooled OR were statistically significant (p

Background Native valve endocarditis in drug-user patients had a microbiology, a frequency of involvement of different cardiac valves, and a prognosis that differ from those in non–drug users. A retrospective study of native valve endocarditis cases in intravenous drug users diagnosed from 1985 to 1999 in our institution was performed to analyze the inhospital mortality of drug users with native valve endocarditis and to identify factors predictive of mortality. Methods All patients fulfilled the Duke's criteria for definite or probable endocarditis. Analysis of predictors of inhospital mortality was restricted to right-sided infective endocarditis (IE) with definite diagnosis and echocardiographic data. The following variables were analyzed: sex, HIV serostatus, CD4 cell count 3 , time of IE diagnosis (before 1993 or after 1993), previous valvulopathy, polymicrobial IE, fungal etiology (mixed or alone), neurological complication, arterial emboli, pulmonary emboli, congestive heart failure, vegetation size (VS) >2 cm, and inhospital cardiac surgery. Logistic regression was used in a multivariate model to identify factors independently associated with mortality. Adjusted odds ratios (OR) and 95% CIs were examined. Results Four hundred ninety-three cases of IE were diagnosed in this period. Two hundred twenty cases of native valve endocarditis in intravenous drug users were identified. Fourteen cases in this group died (6%). Mean time from diagnosis to death was 18.5 ± 15 days (range, 3-52). Vegetation size was available in 111 cases. Univariate analysis identified the following variables associated with inhospital mortality in right-sided cases: VS >2 cm and fungal etiology. In multivariate analysis, the variables associated with mortality that achieved statistical significance were size of vegetation >2 cm ( P = .014, OR 10.2, 95% CI 1.6-78.0) and fungal etiology ( P = .009, OR 46.2, 95% CI 2.4-1100.9). Conclusions The main prognostic factors of inhospital mortality in right-sided IE in drug users in our series were VS >2 cm and fungal etiology. The role of early surgery in these patients should be reevaluated.

Introduction Changes in the etiology, epidemiology, and outcome of infective endocarditis (IE) have been observed in recent years. Newer invasive therapeutic interventions have increased the risk of bacteremia and nosocomial endocarditis in the population at risk. A retrospective analysis of hospital-acquired IE cases was performed in a tertiary hospital during 1985 to 1999 Material and methods Cases included were those classified as “probable” or “definite” by the IE diagnostic criteria of Durack. Nosocomial acquisition was considered if diagnosis was made > 72 h after hospital admission and there was no evidence that IE was present at the time of admission. Patients receiving a diagnosis within 60 days of a previous hospital admission were also classified as nosocomial, when a risk procedure for bacteremia was performed, or when any predisposing factor for IE was present during hospitalization. Early prosthetic valve endocarditis (PVE) cases ( Results Of 493 cases of IE diagnosed over 15 years, 38 were considered to be hospital acquired. Twenty-eight cases were native valve endocarditis (NVE) in non-IV drug user patients, and 10 cases were late PVE. Overall, the most frequent microorganisms involved were staphylococci (58%). The main sources of infection were intravascular procedures or catheter-related infections (55%). When nosocomial NVE cases were compared with community-acquired cases, mortality was greater (29% vs 9.7%) in hospital-acquired endocarditis. Analysis of time trends showed an increased rate of nosocomial cases in NVE throughout the years of the study Conclusions In NVE, the number of cases that are hospital acquired has been increasing during the last 15 years. These cases are frequently associated with invasive intravascular procedures or IV catheter-related infections. Most patients have a previous valvulopathy that predisposes to IE. The spectrum of microorganisms involved is different from the community-acquired cases. Also, the outcome of endocarditis is worse in nosocomial NVE patients

Intestinal bacterial overgrowth and translocation, both common in cirrhosis with ascites, may lead to the activation of monocytes and lymphocytes, increased levels of proinflammatory cytokines, and enhanced synthesis of nitric oxide present in cirrhosis. Bacterial endotoxin promotes the synthesis of lipopolysaccharide (LPS)-binding protein (LBP), and forms a LPS-LBP complex that binds to CD14. This study was designed to evaluate LBP levels and their correlation to the immune response and the hemodynamic status in cirrhotic patients. Plasma LBP, endotoxin, soluble CD14 (sCD14), cytokines, renin, nitrites, and systemic vascular resistance were determined before and 4 weeks after norfloxacin or placebo in 102 cirrhotic patients and 30 controls. LBP was elevated in 42% of ascitic cirrhotic patients (15.7 ± 0.7 versus 6.06 ± 0.5 μg/mL, P < .01). In 60% of high LBP patients, endotoxin was within normal range. Among ascitic patients, those with high LBP showed greater (P < .05) levels of sCD14, tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), nitrites + nitrates (NOx)/creatinine, and renin, and lower vascular resistance. In the cirrhotic patients with high LBP, norfloxacin normalized (P < .01) LBP (from 16.6 ± 0.5 to 5.82 ± 0.8 μ g/mL) and sCD14; reduced the level of cytokines, NOx/creatinine, and renin; and increased vascular resistance; but lacked effect in patients with normal LBP. Portal pressure was unchanged after norfloxacin in another group of 18 cirrhotic patients with high and 19 with normal LBP. In conclusion, the subset of ascitic cirrhotic patients with marked immune and hemodynamic derangement is identified by increased LBP levels. Amelioration of these abnormalities by norfloxacin suggests the involvement of enteric bacteria or their products in the triggering of the process. (HEPATOLOGY 2003;37:208-217.)

Changes in the etiology, epidemiology, and outcome of infective endocarditis (IE) have been observed in recent years. Newer invasive therapeutic interventions have increased the risk of bacteremia and nosocomial endocarditis in the population at risk. A retrospective analysis of hospital-acquired IE cases was performed in a tertiary hospital during 1985 to 1999.Cases included were those classified as "probable" or "definite" by the IE diagnostic criteria of Durack. Nosocomial acquisition was considered if diagnosis was made72 h after hospital admission and there was no evidence that IE was present at the time of admission. Patients receiving a diagnosis within 60 days of a previous hospital admission were also classified as nosocomial, when a risk procedure for bacteremia was performed, or when any predisposing factor for IE was present during hospitalization. Early prosthetic valve endocarditis (PVE) cases (1 year) were excluded from the analysis. Clinical characteristics, etiology, predisposing cardiac condition, source of infection, and outcome were analyzed. Results were compared with those obtained in community-acquired cases.Of 493 cases of IE diagnosed over 15 years, 38 were considered to be hospital acquired. Twenty-eight cases were native valve endocarditis (NVE) in non-IV drug user patients, and 10 cases were late PVE. Overall, the most frequent microorganisms involved were staphylococci (58%). The main sources of infection were intravascular procedures or catheter-related infections (55%). When nosocomial NVE cases were compared with community-acquired cases, mortality was greater (29% vs 9.7%) in hospital-acquired endocarditis. Analysis of time trends showed an increased rate of nosocomial cases in NVE throughout the years of the study.In NVE, the number of cases that are hospital acquired has been increasing during the last 15 years. These cases are frequently associated with invasive intravascular procedures or IV catheter-related infections. Most patients have a previous valvulopathy that predisposes to IE. The spectrum of microorganisms involved is different from the community-acquired cases. Also, the outcome of endocarditis is worse in nosocomial NVE patients.

Endomyocardial biopsy is an invasive procedure, often performed on children for the diagnosis of myocarditis, and is not without risk. Therefore, a noninvasive test of adequate diagnostic accuracy is highly desirable. We evaluated the role of antimyosin scintigraphy in infants and children with clinically suspected myocarditis.Forty patients (age range, 2 mo to 14 y) with suspected myocarditis underwent (111)In-antimyosin scintigraphy. All patients were clinically followed for 29 +/- 17 mo; 21 patients underwent serial antimyosin scans (3.8 +/- 1.7 per patient). The antimyosin uptake was assessed by heart-to-lung ratio (HLR). The scan results were compared with endomyocardial biopsy results in 22 patients.Thirty-five of the 40 patients showed abnormal antimyosin findings; 17 patients showed intense myocardial antimyosin uptake (HLR2). The HLR was higher in patients presenting within the first 2 mo of illness (2.09 +/- 0.43 vs. 1.74 +/- 0.34, P = 0.01). Of 22 patients with endomyocardial biopsy, 17 demonstrated myocarditis. All 9 patients who had an HLR2 and underwent endomyocardial biopsy had histologic evidence of myocarditis. Of the remaining 13 patients with HLR2, 8 had biopsy-verified myocarditis (62%). The intensity of antimyosin uptake was the major determinant of survival in children, with a relative risk of 18 (confidence interval, 1.34-242; P = 0.027). High antimyosin uptake (HLR2) seen within 2 mo of the onset of symptoms was associated with a higher mortality rate. The survivors with an HLR2 and those with an HLR2 showed a high likelihood of complete functional recovery. Furthermore, the patients with serial antimyosin scans having persistently positive findings showed a poor clinical outcome.Intense myocardial uptake of antimyosin antibody is a reliable indicator of myocarditis in infants and children. Severe myocardial damage detected in the early phase of disease is associated with a higher mortality rate. The persistence of antimyosin uptake is associated with poor clinical outcomes.

La Endocarditis Infecciosa (EI) es una enfermedad infrecuente, de alta mortalidad. En las últimas décadas ha habido cambios relevantes tanto en las técnicas de diagnóstico por imagen como en la epidemiología de la población a la que afecta, que son el objeto de nuestro trabajo. Como método de trabajo se ha realizado un estudio observacional retrospectivo. Se han revisado las historias clínicas de los pacientes diagnosticados de Endocarditis Infecciosa en el Hospital Ramón y Cajal en los últimos 31 años (1985-2016), a partir de un registro del Servicio de Enfermedades Infecciosas. Se ha obtenido como resultado, que el número de casos de Endocarditis Infecciosa se ha mantenido estable a lo largo de los 31 años del estudio. La mayor frecuencia en varones (67%) se mantuvo constante, mientras que la edad de los pacientes ha ido aumentando progresivamente. Se ha apreciado cambios en los microorganismos causales, entre los cuales los más frecuentemente aislados han sido Staphylococcus aureus (37,3%), seguido de estafilococos coagulasa-negativo (14,3%) y Streptococcus viridans (13,2%). De modo llamativo, disminuyeron significativamente los casos de EI asociada al uso de drogas inyectadas y aumentaron proporcionalmente los de EI sobre válvula natural (39,5%) y sobre válvula protésica (31.5%). También aumentaron el empleo del ecocardiograma transesofágico en el diagnóstico (43,7%) y los casos que se sometieron a cirugía (28,9%). La cifra de endocarditis nosocomial sigue siendo un problema importante (12,4%). La mortalidad se ha mantenido elevada sin cambios (20%). Como conclusión podemos señalar que se han encontrado cambios significativos en la epidemiología de la enfermedad a lo largo de los 31 años del estudio, en parte asociado a la disminución del uso de drogas inyectadas y al aumento de los procedimientos quirúrgicos sobre el corazón. Pese a los avances en el manejo diagnóstico y terapéutico la enfermedad sigue teniendo una mortalidad elevada., Infective endocarditis is an uncommon disease of high mortality. In recent decades there have been significant changes both in image diagnostic techniques and in the epidemiology of the affected population, which are the subject of our work. Observational retrospective study. We have reviewed the medical records of patients diagnosed with infective endocarditis in the Hospital Ramon y Cajal in the past 31 years (1985-2016), included in a registry of the Service of Infectious Diseases. The number of cases of infective endocarditis has remained stable over the 31 years of the study. A higher frequency in males (67%) has remained constant, while the age of patients has progressively increased. Changes have been observed in the causative organisms, among which Staphylococcus aureus was the most frequently isolated (37.3%), followed by coagulase-negative staphylococci (14.3%) and Streptococcus viridans (13.2%). Strikingly, there was a significant reduction in the number of cases of endocarditis associated with injection drug use and an increase in those on natural valve (39.5%) and prosthetic valve (31.5%). We also found an increase in the use of transesophageal ecocardiogram in the diagnosis (43.7%) and cases who underwent surgery (28.9%). The number of nosocomial endocarditis continues to be a major problem (12.4%). Mortality has remained high without changes (20%). We have found significant changes in the epidemiology of the disease over the 31 years of the study, in part associated to the decrease in the use of injected drugs and the increase of the surgical procedures on the heart. Diagnostic and therapeutic handling also has advanced, but despite this disease continues to have a high mortality.

ResumenIntroducción y objetivosLa cirrosis hepática condiciona un empeoramiento del pronóstico en pacientes con endocarditis infecciosa (EI) y la indicación quirúrgica en este tipo de pacientes es controvertida. Nuestro objetivo fue el análisis de la morbimortalidad en este grupo de pacientes.MétodosSe han revisado los casos de EI diagnosticados en nuestro hospital desde el 1 de enero de 1985 hasta el 15 de junio del 2015. Se ha realizado un estudio descriptivo de todos los casos, así como un análisis del subgrupo de pacientes que además presentaba algún grado de cirrosis hepática.ResultadosSe registraron 996 episodios de EI durante el periodo de estudio, de los cuales 54 episodios (5,42%) se diagnosticaron en pacientes con hepatopatía. Veintinueve pacientes (44,4%) se encontraban en estadio A de Child-Pugh, 19 pacientes (35,2%) en estadio B y 11 pacientes (20,37%) en estadio C. La mortalidad global de los pacientes cirróticos fue del 37%. La mortalidad en estos pacientes intervenidos quirúrgicamente aumentó de manera significativa del 20% en estadio A al 83% en estadio C de Child-Pugh, con una incidencia de complicaciones mayores del 77,1%.ConclusionesLa cirrosis hepática empeora claramente el pronóstico de la EI, aumentando la mortalidad global del 19,2% al 37%. Además se asocia a una tasa de complicaciones mayores muy elevada. Aunque los pacientes en estadio A intervenidos quirúrgicamente presentaron una mortalidad inferior a quienes siguieron tratamiento médico exclusivamente, la elevada mortalidad en estadios más avanzados obliga a establecer la indicación quirúrgica de manera individualizada y procurar un cuidadoso manejo perioperatorio en estos pacientes.AbstractIntroduction and objectivesLiver cirrhosis worsens the prognosis of patients with infective endocarditis (IE), and the indication of surgery in this group of patients remains controversial. The aim of this study was to analyse the mortality of patients with liver cirrhosis and IE.MethodsThe study included all the patients diagnosed with IE in our Hospital, from 1 January 1985 to 15 June 2015. A descriptive analysis was performed on the whole cohort of patients, as well as on the subgroup that also had liver cirrhosis.ResultsA total of 996 patients were diagnosed with IE, 54 (5.42%) of whom also had liver cirrhosis. Of these, 29 (44.4%) patients were in stage A on the Child-Pugh scale, 19 (35.2%) patients were in stage B, and (20.37%) 11 patients were in stage C. The incidence of major complications in cirrhotic patients was 77.1%. The overall mortality was 37%. Postoperative mortality significantly increased from 20% in stage A, to 83% in stage C of Child-Pugh scale.ConclusionsHepatic cirrhosis worsens the prognosis of IE, increasing postoperative mortality from 19.2% to 37%. Moreover, it is associated with a very high rate of major complications (77.1%). The mortality of stage A cirrhotic patients assigned to surgery was lower than the mortality of patients assigned to medical treatment. The high mortality rate in advanced stages of cirrhosis suggests that a more individualized surgical indication needs to be established, as well as a more careful post-operative management.