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Background: Measurement of vascular access flow (Qa) is a recommendation in the care of hemodialysis patients. We developed an observational study to answer the following question: Can access blood flow be estimated?Methods: This observational study was carried out in the hemodialysis unit of the José Carrasco Arteaga Hospital in Cuenca-Ecuador. The sample calculation was 41 cases. Patients older than 17 years with stage 5d chronic renal failure and vascular access with arteriovenous fistula were included. The variables were descriptive of the population: Qa and extracorporeal blood flow (Qb). Qa measurement was performed with the Transonic ® monitor. Qb was measured at dynamic arterial line pressures (DALPs) of -60 mmHg, -100 mmHg, -160 mmHg, and -200 mmHg. The correlation coefficient "r" was obtained between Qa and Qb. SPSS 22.0 was used to analyze the information and perform a linear regression equation to estimate access blood flow (eQa).Results: Fifty-seven patients aged 62.9 ± 12.7 years with 29.4 ± 33 months on hemodialysis were included; 23 women (40.3%) and 45.6% had diabetic nephropathy. Fistulas were seen in 40 cases in the left upper limb (70.2%) and 17 (29.8%) in the right upper limb. The prevalence of aneurysms was 10.5%. The 50th percentile of Qb was 415 mL/min with a DALP of -200 mmHg. The mean access flow was 1516 ± 878 ml/min. The correlation between Qb and Qa was statistically more significant between Qb and DALP of -200 mmHg. The association had a coefficient Rs = 0.643 (IC 0.453 to 0.771) P Conclusions: It was possible to estimate access blood flow with parameters for easy intradialysis measurements. The equation obtained, if applied to the same patient with the same DALP, could become a useful parameter for monitoring vascular access.Trial registration: ClinicalTrials.gov Identifier: NCT00522704. Registered 14 March 2008, https://clinicaltrials.gov/ct2/show/NCT00522704

INTRODUCCION: La Endocarditis Bacteriana es una enfermedad grave de dificil diagnostico, debido al cuadro clinico inespecifico. Se caracteriza por la formacion de vegetaciones infectadas por microorganismos en las valvulas y camaras cardiacas o en el endotelio de los grandes vasos. Las valvulopatias congenitas y las enfermedades reumaticas son los principales factores de riesgo asociados con el padecimiento en valvulas nativas. Desde hace un siglo, la cavidad bucal ha sido reconocida como una fuente potencial de bacteriemia. CASO CLINICO: Paciente masculino de 40 anos de edad, presento disnea de inicio subito, debilidad muscular, perdida del estado de conciencia, posteriormente afasia y hemiplejia derecha. Se realizo una tomografia simple de craneo evidenciando una zona isquemica, presento alza termica ≥ 38oC. En el ecocardiograma con presencia de imagen sugestiva de vegetacion adherida a la valvula aortica y protrusion hacia tracto de salida del ventriculo izquierdo. EVOLUCION: Se realizo cirugia de cambio valvular aortico mecanico, con tratamiento antibiotico presentado evolucion favorable y recuperando la fuerza muscular en hemicuerpo derecho. En hospitalizacion se instauro anticoagulacion oral durante el cual luego varios dias presento cuadro convulsivo, se evidencia en la tomografia zona hemorragica y se remplazo medicacion por heparina de bajo peso molecular. CONCLUSION: La endocarditis bacteriana se sospecha en todo paciente que presenta clinica de fiebre y criterios de DUKE positivos. Siendo la piedra angular del diagnostico el ecocardiograma y el hemocultivo positivo, para establecer su etiologia requiriendo un manejo adecuado, precoz para brindar una terapeutica oportuna *DESCRIPTORES DeCS: ENDOCARIDITIS, VALVULA AORTICA, INFECCIONES BACTERIANAS.

INTRODUCCION: La enfermedad isquemica trivascular, llamada asi por afectar las arterias descendente anterior, coronaria derecha y circunfleja, tiene una prevalencia entre 1 % y 3.6 % diagnosticada por angiografia; su tratamiento es la revascularizacion coronaria. CASO CLINICO: Paciente masculino de 63 anos de edad con antecedentes de trasplante hepatico, uso de inmunosupresores, enfermedad renal cronica estadio 5 e infarto agudo de miocardio por 2 ocasiones; es diagnosticado con enfermedad isquemica trivascular. EVOLUCION: Luego del diagnostico se decidio realizar revascularizacion coronaria sin circulacion extracorporea, esta reduce el trauma del musculo cardiaco y organos blandos. La recuperacion es rapida y disminuye la estadia hospitalaria, reduce el riesgo de sangrado, accidente cerebrovascular y fallo renal. CONCLUSION: El pronostico de un paciente con enfermedad trivascular es malo, con una supervivencia del 3 % sin tratamiento, luego de la revascularizacion la tasa de mortalidad es baja con un adecuado seguimiento. *DESCRIPTORES DeCS: ISQUEMIA MIOCARDICA, REVASCULARIZACION MIOCARDICA.

INTRODUCCION: El sindrome de QT largo Congenito (SQTLC) es un trastorno genetico que afecta al sistema de conduccion cardiaco alterando la repolarizacion ventricular. Este sindrome se ha asociado con sincope, arritmias ventriculares como torsade de pointes (TdP) y fibrilacion ventricular (FV), llevan­do inclusive a la muerte subita. En algunos casos, debido al aumento de la repolarizacion ventricular, se puede acompanar de bloqueos Auriculo Ventriculares (BAV) lo cual dificulta notablemente el trata­miento. Debido a la rara presentacion de este tipo de patologia, se da a conocer el siguiente caso. CASO CLINICO: Neonato de 13 dias de vida nacido de cesarea por polihidramnios, quien presento desde el nacimiento ruidos cardiacos hipofoneticos y taquicardia no ritmica. En ecocardiograma se evidencio derrame pericardico y alteraciones en el ritmo cardiaco caracterizadas por periodos frecuentes de TV Polimorfica del tipo TdP, adicionalmente se documento BAV del tipo Mobitz II extremo 2:1. EVOLUCION: Por el riesgo de muerte subita secundario a la inestabilidad electrica del paciente y la presencia de BAV que contraindico el uso de betabloqueantes, se implanto un marcapasos definitivo epicardico de urgencia seguido por altas dosis de betabloqueador con lo que se revirtio la arritmia. La nina al momento tiene 8 meses de edad, presenta un desarrollo pondo estructural normal, los padres niegan episodios de sincope o agitacion psicomotora, durante los controles del marcapaso no se evi dencian nuevos episodios de arritmia ventricular. CONCLUSION: En este caso el uso del marcapasos definitivo evito el fallecimiento del paciente inusual-mente a la edad de 13 dias de nacimiento. Presentamos una asociacion inusual de BAV, Sd de QT largo y TV con TdP.

The aim of this study was to evaluate the factors that prevent dry weight achievement in patients with end-stage renal disease (ESRD) in renal replacement therapy through the change in their body weight after kidney transplant (KT) compared with 1 week before KT. The study included 188 ESRD patients of diverse etiology who received living kidney transplantation with normal immediate graft function, 62.2% were male, age 29 ± 11 years old. All patients were on renal replacement therapy for at least 1 month before KT with either hemodiafiltration (N = 106), hemodialysis (N = 25), or peritoneal dialysis (N = 57). Based on body weight difference (after transplant-before transplant), patients with body weight difference ≤2 kg were considered as being close to their dry weight (Group 1, N = 112), whereas patients with body weight difference >2 kg were considered as being overhydrated (Group 2, N = 76). Clinical and biochemical characteristics were obtained from the medical records at three periods of time: time of ESRD initiation (baseline), 1 week before undergoing KT, and 1 week after KT. The mean time (± standard deviation) from renal replacement therapy initiation to the week before KT was 9.2 ± 5 months. Group 2 had a higher proportion of men, antihypertensive use, peritoneal dialysis, and higher urine output during all periods. Before KT, Group 2 had higher systolic and diastolic blood pressures than Group 1. After KT, both systolic and diastolic blood pressures decreased in Group 2, whereas no change occurred in Group 1. Before KT, Group 2 had higher levels of blood urea nitrogen, creatinine, uric acid, and phosphorous compared with Group 1. Compared with baseline, Group 1 had more optimal blood urea nitrogen, creatinine, and uric acid parameters before KT than Group 2. After KT, all parameters improved with respect to baseline in both groups. Hemoglobin, albumin, and sodium were similar between groups, except for higher hemoglobin in Group 2 than Group 1 after KT. Multivariate regression analysis showed that male sex, peritoneal dialysis, and systolic blood pressure before KT were independent risk factors for overhydration. In conclusion, high systolic blood pressure and peritoneal dialysis were two independent modifiable variables associated with overhydration before KT. Assessment of the body weight change after KT is a useful tool to evaluate dry weight, in addition to identifying variables associated with poor volume control. This could allow adjustment of clinical and dialysis parameters in future patients.

The aim of this study was to evaluate the factors that prevent dry weight achievement in patients with end-stage renal disease (ESRD) in renal replacement therapy through the change in their body weight after kidney transplant (KT) compared with 1 week before KT. The study included 188 ESRD patients of diverse etiology who received living kidney transplantation with normal immediate graft function, 62.2% were male, age 29 ± 11 years old. All patients were on renal replacement therapy for at least 1 month before KT with either hemodiafiltration (N = 106), hemodialysis (N = 25), or peritoneal dialysis (N = 57). Based on body weight difference (after transplant-before transplant), patients with body weight difference ≤2 kg were considered as being close to their dry weight (Group 1, N = 112), whereas patients with body weight difference2 kg were considered as being overhydrated (Group 2, N = 76). Clinical and biochemical characteristics were obtained from the medical records at three periods of time: time of ESRD initiation (baseline), 1 week before undergoing KT, and 1 week after KT. The mean time (± standard deviation) from renal replacement therapy initiation to the week before KT was 9.2 ± 5 months. Group 2 had a higher proportion of men, antihypertensive use, peritoneal dialysis, and higher urine output during all periods. Before KT, Group 2 had higher systolic and diastolic blood pressures than Group 1. After KT, both systolic and diastolic blood pressures decreased in Group 2, whereas no change occurred in Group 1. Before KT, Group 2 had higher levels of blood urea nitrogen, creatinine, uric acid, and phosphorous compared with Group 1. Compared with baseline, Group 1 had more optimal blood urea nitrogen, creatinine, and uric acid parameters before KT than Group 2. After KT, all parameters improved with respect to baseline in both groups. Hemoglobin, albumin, and sodium were similar between groups, except for higher hemoglobin in Group 2 than Group 1 after KT. Multivariate regression analysis showed that male sex, peritoneal dialysis, and systolic blood pressure before KT were independent risk factors for overhydration. In conclusion, high systolic blood pressure and peritoneal dialysis were two independent modifiable variables associated with overhydration before KT. Assessment of the body weight change after KT is a useful tool to evaluate dry weight, in addition to identifying variables associated with poor volume control. This could allow adjustment of clinical and dialysis parameters in future patients.