Resumen Introducción : La enfermedad por arañazo de gato (EAG) es producida por Bartonella henselae y debido a que afecta principalmente niños, es poco reconocida en adultos. El cua dro evolutivo es generalmente benigno y autolimitado, aun que ocasionalmente puede haber compromiso sistémico. Métodos : Estudio observacional, descriptivo y re trospectivo realizado en un hospital de tercer nivel del conurbano bonaerense. Se incluyeron pacientes mayores de 15 años con diagnóstico de EAG en un período de 5 años (2016-2021). Resultados : Se analizaron 30 pacientes adultos, con una mediana de edad de 20.5 años (17-29), el 73% (n = 22) fueron varones. El 96% (n = 27) presentó contacto estre cho con gatos. La presentación clínica más frecuente fue adenopatías periféricas (90%); el porcentaje de compli caciones fue de 33% (n = 10). La indicación de antibio ticoterapia fue de 86.7% (n = 26), con una mediana de duración de 5 días (5-10). La evolución fue favorable en el 83% (n = 25), en el 16% (n = 5) se perdió seguimiento. Discusión : La EAG es poco reconocida en adultos; las características clínicas de este grupo etario se en cuentran poco descriptas en la literatura. Es un desafío diagnóstico debido a que su forma de presentación más frecuente es la adenopatía localizada.

Abstract Introduction : Cat-scratch disease (CSD) is caused by Bartonella henselae and it is under-recognized in adults because it mainly affects children. Clinical course is commonly benign and self-limited; occasionally, there may be systemic involvement. Methods : Case-series study carried out in a tertiary care hospital in Buenos Aires suburbs. Patients older than 15 years diagnosed with CSD over a 5-year period were included (2016-2021). Results : 30 adult patients were analyzed, with a median age of 20.5 years (IQR 17-29), 73% (n = 22) were male; 96% (n = 27) had history of exposure to cats. The most common clinical presentation of CSD was periph eral lymphadenopathy (90%), the average complication rate was 33% (n = 10), 86.7% (n = 26) received antimi crobial therapy, with a median duration of 5 days (IQR 5-10). Outcome was favorable in 83% (n = 25), 16% (n = 5) were lost to follow-up. Discussion : Clinical features of CSD in adults are poorly described in the worldwide literature. Diagnosis can be challenging because the clinical hallmark is re gional lymphadenopathy.

Resumen Introducción : Los retrasos en el tratamiento anti microbiano adecuado de las bacteriemias prolongan la estadía hospitalaria, aumentan la mortalidad e in crementan los costos. Aún hoy en día se requiere un tiempo considerable para obtener la identificación y antibiograma de los microorganismos en los hemocul tivos positivos. El objetivo fue evaluar el impacto de la implementa ción del panel BCID2 de FilmArray® (FA) sobre el tiempo de inicio de tratamientos antimicrobianos adecuados y sobre los costos potenciales de los mismos. Métodos : Estudio observacional retrospectivo de los hemocultivos positivos de pacientes hospitalizados, procesados por FA y por metodología tradicional. Se evaluaron los cambios de antimicrobianos en base a los resultados del FA. Se calcularon los días de reducción de tratamiento antimicrobiano y el ahorro potencial en el uso de los mismos, teniendo en cuenta también los costos del FA. Resultados : Se analizaron 87 episodios de bacte riemia. En 42 (48.3%) de ellos se desescaló el trata miento a antimicrobianos de menor espectro, en 7 (8%) se escaló a antimicrobianos de mayor espectro, en 8 (9.2%) se cambió el antimicrobiano sin variar el espectro y en 30 (34.5%) no se realizaron cambios con los resultados del FA. Los cambios de antimicrobianos se realizaron en promedio 2.3 días más rápido que con los métodos convencionales. Se calculó un ahorro potencial de US$ 7408. Conclusión : La implementación del panel BCID2 de FilmArray ® permitió adecuar los tratamientos antimi crobianos más rápidamente acortando la duración de los tratamientos empíricos de amplio espectro, lo cual resultó costo-efectivo.

Abstract Introduction : Delay in initiating appropriate anti microbial therapy prolongs hospitalization, increases in-hospital mortality, and raises economic costs. Cur rently, the identification and susceptibility testing of bacteria in positive blood cultures require a considerable amount of time. The objective of this study was to assess the impact of the BCID2 FilmArray® (FA) panel on the timing of appropriate antimicrobial therapy and potential anti microbial costs. Methods : This is a retrospective observational study focused on positive blood cultures in hospitalized pa tients. FA processing was conducted concurrently with routine sample processing. Changes in antibiotic treat ments based on FA results were evaluated, and the re duction in antimicrobial therapy duration and associated cost savings were calculated. Results : Eighty-seven bacteremia episodes were ana lysed. In 42 (48%) of them antimicrobial therapy was de-escalated to narrower spectrum agents, while in 7 (8%) therapy was escalated to broader spectrum anti microbials. Additionally, in 8 (9%) antimicrobials were switched without changing spectrum and in 30 (34%) no changes were made based on FA results. Antimicrobial changes were made 2.3 days faster than with routine sample processing resulting in calculated potential sav ings of US$ 7408. Conclusion : The implementation of FA facilitated a faster administration of appropriate antimicrobial therapy, leading to a reduction in the duration of broad-spectrum empirical antimicrobial therapy and subse quent economic savings.

Abstract Background/Aims: Inflammatory bowel disease (IBD)-related knowledge empowers patients, providing the development of adaptative coping strategies. Recently, a more comprehensive questionnaire for evaluating IBD-related knowledge was developed, the IBD-KNOW. The main aim of our study was to translate to Portuguese and validate the IBD-KNOW questionnaire. We also explored the predictors of high scores of disease-related knowledge and the effect of knowledge on health-related quality of life (HRQoL) and therapeutic adherence. Methods: This is an observational, unicentric, and cross-sectional study. We translated and adapted the original English version of the IBD-KNOW questionnaire into Portuguese. Afterwards, IBD patients in the outpatient clinics were invited to fill out a multimodal form including the Portuguese version of IBD-KNOW, a visual analogue scale (VAS) of self-perceived knowledge, the Portuguese version of Short IBD Questionnaire (SIBDQ) and the Portuguese version of Morisky Adherence Scale 8-item (MMAS-8). Demographic and disease characteristics were collected. We assessed validity (through discriminate validity among non-IBD volunteers and correlation between IBD-KNOW and VAS) and reliability (through internal consistency, test-retest, and intraclass correlation). Statistical analysis was performed using SPSS version 25.0. Results: The mean IBD-KNOW score was significantly different among non-IBD validation group (doctors: 23, nurses: 18, and non-medical volunteers: 12, p < 0.001). IBD-KNOW showed a high internal consistency (Cronbach’s α 0.78) and intraclass correlation (0.90). As expected, the IBD-KNOW score was positively correlated with VAS for self-perceived knowledge (r =0.45, p < 0.001). One hundred and one patients with IBD (54 with ulcerative colitis and 47 with Crohn’s disease) completed the questionnaire at baseline. Multivariate analyses showed that a high IBD-KNOW score was associated with longer disease duration (OR: 2.59 [CI 1.11-5.74]; p = 0.04), previous hospitalization (OR: 3.63 [CI 1.301-9.96]; p = 0.01), current biologic treatment (OR: 3.37 [CI 1.31-8.65]; p = 0.02), and higher educational level (OR: 4.66 [CI 1.74-10.21]; p = 0.02). Moreover, there was no significant correlation between overall IBD-KNOW and SIBDQ, nor between IBD treatment adherence (MMAS-8 = 8) and a higher mean IBD-KNOW score (p = 0.552). Conclusion: The Portuguese version of IBD-KNOW is a simple, valid, and reliable tool for assessing IBD-related knowledge. Longer disease duration, hospitalization, use of biologics, and higher educational level are associated with higher levels of knowledge. Higher patient knowledge was not associated with higher HRQoL and adherence to therapy.

Resumo Introdução/objetivos: O conhecimento relacionado com a Doença Inflamatória Intestinal (DII) visa capacitar os doentes, proporcionando o desenvolvimento de estratégias adaptativas de coping. Recentemente, foi desenvolvido um questionário mais abrangente para avaliar os conhecimentos relacionados com a DII, o IBD-KNOW. O principal objetivo do nosso estudo foi traduzir para português e validar o questionário IBD-KNOW. Também explorámos os preditores de um elevado nível de con-hecimento relacionado com a DII e avaliámos o impacto do conhecimento na qualidade de vida associada a cuidados de saúde (QVACS) e na adesão terapêutica. Métodos: Este é um estudo observacional, unicêntrico e transversal. Traduzimos e adaptámos para português a versão original inglesa do questionário IBD-KNOW. Posteriormente, os doentes com DII de ambulatório foram convidados a preencher um questionário multimodal que incluía, a versão portuguesa do IBD-KNOW, uma escala visual analógica (EVA) de autoperceção do conhecimento, a versão portuguesa do Short IBD Questionnaire (SIBDQ) e a versão portuguesa do Morisky Adherence Scale 8-item (MMAS-8). Foram colhidos dados referentes a aspetos demográficos e da doença. Avaliámos a vali-dade (através da validade discriminatória entre voluntár-ios sem DII e da correlação entre IBD-KNOW e a EVA) e a fiabilidade (através da consistência interna, do teste-reteste e da correlação intraclasse). A análise estatística foi realizada utilizando a versão 25.0 do SPSS. Resultados: A pontuação média do IBD-KNOW foi significativamente diferente entre os voluntários não-DII (médicos: 23, enfermeiros: 18 e voluntários não-médicos: 12, p < 0,001). O IBD-KNOW mostrou uma elevada consistência interna (Cronbach’s α 0,78) e uma correlação intraclasse (0,90).

Abstract: Observational studies have described an increase in the duration of oxygen therapy, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) in relation to the use of high-flow nasal cannula (HFNC, 2013-2016). Objective: to analyze changes in the evolution of very preterm newborns with the use of HFNC. Patients and Method: The incidence of neonatal pathologies between 2013 and 2021 was analyzed with a statistical process control. An analysis of cases (with HFNC, 2017-2021) and controls (without HFNC, 2013-2016) was performed, 1:2, matched by weight and gestational age, comparing the main neonatal morbidities and respiratory support. Univariate analysis and logistic regression were performed with the variables associated with BPD and ROP. Results: 59 cases and 116 controls. The statistical process control revealed an increase in BPD and ROP over time, which coincides with the incorporation of the HFNC and with the increase in days of oxygen therapy. The case-control analysis showed an increase in respiratory support and oxygen therapy measures and greater severity at birth, according to the Apgar and Neocosur score, in the group with HFNC. Logistic regression showed a significant association between the use of the HFNC and the risk of BPD and ROP. In addition, a longer duration of mechanical ventilation, lower birth weight, and more late sepsis were associated with BPD, and lower weight and gestational age at birth and longer duration of mechanical ventilation were associated with ROP. Conclusions: These findings require a quality improvement program to reduce BPD and ROP, seeking an adequate use of HFNC.

Resumen: Estudios observacionales han descrito aumento de duración de oxigenoterapia, displasia broncopulmonar (DBP) y retinopatía del prematuro (RDP) en relación al uso de cánula de alto flujo (CNAF). Objetivo: analizar los cambios presentados en la evolución de recién nacidos muy prematuros con el uso de CNAF. Pacientes y Método: Con control estadístico de procesos se analizó la incidencia de patologías neonatales entre el 2013 y 2021. Se realizó un análisis de casos (CNAF, 2017-2021) y controles (sin cánula, 2013-2016), 1:2, pareados por peso y edad gestacional, comparando las principales morbilidades neonatales y el soporte respiratorio. Se realizó análisis univariado y regresión logística con las variables asociadas a DBP y RDP. Resultados: 59 casos y 116 controles. El control estadístico de procesos reveló un aumento de DBP y RDP en el tiempo, que coincide con la incorporación de la CNAF y con el aumento de los días de oxigenoterapia. El análisis de casos y controles describió aumento de medidas de soporte respiratorio y oxigenoterapia y mayor gravedad al nacer, según Apgar y score Neocosur, en el grupo con CNAF. En regresión logística se encontró asociación significativa del uso de la CNAF con el riesgo de DBP y RDP. Además se asoció mayor duración de ventilación mecánica, menor peso de nacimiento y más sepsis tardía para DBP; menor peso y edad gestacional al nacer y mayor duración de ventilación mecánica para RDP. Conclusiones: Estos hallazgos requieren un programa de mejoría de calidad para disminuir la DBP y RDP, procurando un uso adecuado de CNAF.

Abstract Brain abscess is a focal suppurative process pro duced in most cases by bacterial agents. Aggregati bacter aphrophilus is a gram-negative bacteria belong ing to the HACEK group, which causes infective endo carditis, liver abscesses, among others. Brain abscesses secondary to this germ are rare and, in most cases, it is associated with contact with pets, poor dental hygiene or dental procedures. Treatment consists of drainage of the abscess (greater than 2.5 cm) combined with antibiotic therapy, ideally beta-lactams. The case of a 64-year-old male patient with no relevant history is here presented. He was admitted to the emergency service due to headache, hemianopsia of a week’s duration and later tonic-clonic seizures, in whom imaging studies and culture of a brain lesion subse quently revealed a brain abscess due to A. aphrophilus. This case aims to illustrate about the rarity of this infection, because A. aphrophilus is a normal part of the oropharyngeal flora and respiratory tract, in which it rarely causes invasive bacteremia.

Resumen El absceso cerebral es un proceso supurativo focal producido en la mayoría de los casos por agentes bacte rianos. Aggregatibacter aphrophilus es una bacteria gram negativa perteneciente al grupo HACEK, causante de endocarditis infecciosa, abscesos hepáticos, entre otras. Los abscesos cerebrales secundarios a este germen son infrecuentes y en la mayoría de los casos asociados a contactos con animales domésticos, pobre higiene dental o procedimientos odontológicos. El tratamiento consiste en drenaje del absceso (mayores de 2.5 cm) combinado con terapia antibiótica, idealmente betalactámicos. Se presenta el caso de un paciente varón de 64 años sin antecedentes de relevancia quien ingresó al servicio de emergencias por cuadro de cefalea, hemianopsias de una semana de evolución y posteriormente crisis tónico clónicas, en quien posteriormente en estudios imageno lógicos y cultivo de lesión cerebral se arribó al diagnóstico de absceso cerebral por A. aphrophilus. Este informe tiene como objetivo ilustrar al lector sobre la rareza de esta infección, debido a que A. aphrophilus forma parte normal de la flora orofaríngea y del tracto respiratorio, en los que rara vez ocasiona bacteriemias invasivas.

Resumo Introdução: Doenças cardiovasculares são uma causa significativa de morte em pacientes com Doença Renal Crônica (DRC). A calcificação valvar é preditor de mortalidade cardiovascular e doença arterial coronariana. Objetivo: Avaliar a frequência, fatores associados e progressão de valvopatias em pacientes com DRC. Métodos: Coorte retrospectiva com 291 pacientes ambulatoriais no Hospital das Clínicas de Pernambuco. Inclusão: ≥18 anos com DRC e valvopatia; exclusão: tratamento conservador ou dados incompletos. Variáveis clínicas e laboratoriais foram comparadas e categorizadas por tempo de terapia dialítica (TTD): <5 anos, 5–10 anos, >10 anos. Foram aplicados os testes Qui-quadrado, exato de Fisher, ANOVA, Kruskal-Wallis. Associação entre valvopatia e TTD foi avaliada por regressão binária. Significância foi definida como p < 0,05. Resultados: A valvopatia mitral foi encontrada em 82,5% (240) dos casos, seguida da aórtica (65,6%; 86). Houve progressão da doença valvar em 106 (36,4%) pacientes. Não houve associação entre valvopatias aórtica, pulmonar, mitral ou tricúspide e TTD. Hiperparatireoidismo secundário foi a única variável explicativa significativa na regressão para valvopatia mitral (OR 2,59 [IC95%: 1,09–6,18]; p = 0,031). Conclusão: Encontramos alta frequência de valvopatias, especialmente mitral e aórtica, aem pacientes com DRC. Não houve associação entre TTD e valvopatia.

Abstract Introduction: Cardiovascular disease is an important cause of death among patients with chronic kidney disease (CKD). Valve calcification is a predictor of cardiovascular mortality and coronary artery disease. Objective: To assess heart valve disease frequency, associated factors, and progression in CKD patients. Methods: We conducted a retrospective study on 291 CKD patients at Hospital das Clínicas de Pernambuco. Inclusion criteria were age ≥ 18 with CKD and valve disease, while those on conservative management or with missing data were excluded. Clinical and laboratory variables were compared, and patients were categorized by dialysis duration (<5 years; 5–10 years; >10 years). Statistical tests, including chi-square, Fisher’s exact, ANOVA, and Kruskal-Wallis, were employed as needed. Simple and multivariate binary regression models were used to analyze valve disease associations with dialysis duration. Significance was defined as p < 0.05. Results: Mitral valve disease was present in 82.5% (240) of patients, followed by aortic valve disease (65.6%; 86). Over time, 106 (36.4%) patients developed valve disease. No significant association was found between aortic, pulmonary, mitral, or tricuspid valve disease and dialysis duration. Secondary hyperparathyroidism was the sole statistically significant factor for mitral valve disease in the regression model (OR 2.59 [95% CI: 1.09–6.18]; p = 0.031). Conclusion: CKD patients on renal replacement therapy exhibit a high frequency of valve disease, particularly mitral and aortic valve disease. However, no link was established between dialysis duration and valve disease occurrence or progression.

ABSTRACT In the last years, clinicians and researchers have evaluated orthodontic treatment outcomes through intraoral examination or the use of indices. One of the most frequently used indices is the Grading System for Dental Casts and Panoramic Radiographs System (CRE). A literature search was carried out in different databases such as PubMed, Embase, Lilacs, Cochrane, and other sources, through a structured strategy using keywords and Boolean operators. The references that met the search criteria and the researchers' examination were obtained in full text, classified, and analyzed to collect information on the 4 set out topics: 1. CRE (ABO/OGS) in the evaluation of the quality of results, 2. CRE (ABO/OGS) and other indices, 3. CRE (ABO/OGS) digital implementation, 4. CRE (ABO/OGS) regional implementation. 103 articles were found, of which 52 were selected. The use of CRE worldwide was observed, showing that it is a versatile tool in multiple fields, such as analysis of therapeutic management, type of equipment used, measurement stability, performance of university and private services, among other topics aimed at knowing the result of orthodontic treatment. From other part, its use along with other indices seems to be a complement that would allow analysis of dental, skeletal, and facial variables not contemplated. The digital implementation of the CRE (ABO/OGS) shows to be a promising tool that after adjustments can bring advantages in the analysis of results. Likewise, it has been found that the use of CRE (ABO/OGS) within universities has generated improvement in treatment results when compared over time.

Resumen La evaluación de los resultados del tratamiento ortodóntico ha sido estudiada en los últimos años por clínicos e investigadores a través del examen intraoral o el uso de índices, como el Grading System for Dental Casts and Panoramic Radiographs System (CRE). Se realizó una búsqueda de la literatura en diferentes bases de datos como Pubmed (MEDLINE), Embase, Lilacs, Cochrane y otras fuentes, con el uso de palabras claves y operadores booleanos. Las referencias que cumplieron los criterios de búsqueda y el examen de los investigadores fueron obtenidas en texto completo, clasificados y analizados para recopilar información de las 4 temáticas planteadas: 1. CRE (ABO/OGS) en la evaluación de la calidad de resultados, 2. CRE (ABO/OGS) y otros índices en la evaluación, 3. Implementación digital CRE (ABO/OGS), 4. Implementación regional CRE (ABO/OGS). Fueron encontrados 103 artículos, de los cuales 52 fueron seleccionados, a partir de estos se observó el uso del CRE a nivel mundial, mostrando ser una herramienta versátil en múltiples campos, como el análisis del manejo terapéutico, tipo de aparatología utilizada, medición de estabilidad, desempeño de servicios universitarios y privados, entre otras temáticas, orientadas a conocer el resultado del tratamiento ortodóntico; su uso conjunto con otros índices parece ser un complemento que permitiría analizar variables dentales, esqueléticas y faciales no contempladas. La implementación digital del CRE (ABO/OGS), OGS muestra ser una herramienta prometedora que tras ajustes puede traer ventajas en el análisis de resultados. Así mismo, se ha encontrado que el uso del CRE(ABO/OGS) dentro de las universidades ha generado la mejoría de los resultados de los tratamientos al compararse en el tiempo.

Abstract Objective: To evaluate the success rate of high-flow nasal cannula (HFNC) therapy using an adapted obsolete mechanical ventilator (MV), Optiflow™ and Vapotherm™ in newborns (NBs). Method: This was a retrospective observational study conducted in the neonatal intensive care unit (NICU). The sample comprised NBs who underwent HFNC therapy due to ventilatory dysfunction, for weaning from non-invasive ventilation (NIV), or post-extubation. The three groups, stratified according to gestational age (GA) and birth weight, and corrected GA and weight at the beginning of HFNC use, were as follows: Optiflow ™, Vapotherm ™, and obsolete Mechanical Ventilator (MV) adapted for high flow therapy. Subsequently, the NBs were divided into a success group (SG) and a failure group (FG). HFNC success was defined as a therapy duration exceeding 72 h. Results: A total of 209 NBs were evaluated, with 31.1 % using HFNC due to ventilatory dysfunction, 2.4 % after extubation, and 66.5 % after NIV weaning. HFNC success rate was observed in 90.9 % of the NBs, with no difference between equipment types (Vapotherm ™, Optiflow ™, and adapted VM). Conclusion: Different types of HFNC equipment are equally effective when used in neonatology for respiratory dysfunction, as a method of weaning from NIV and post-extubation. Adapted obsolete MV can be an alternative for HFCN therapy in resource-constrained settings.

Resumo A síndrome VEXAS (vacúolos, enzima E1, cromossoma X, autoinflamação, mutação somática) foi identificada em 2020 por Beck et al, ao analisar o genoma de 2560 doentes com diferentes tipos de manifestações autoinflamatórias. Fizemos uma revisão da literatura com o objetivo de divulgar a evidência científica existente e aumentar o grau de suspeição clínica da comunidade médica. Atualmente, estão identificadas várias mutações associadas a esta síndrome, originando defeitos na ubiquitinação e ativação do sistema imune inato. Da análise fenotípica dos portadores da mutação, foram encontradas características comuns: sexo masculino, idade superior a 50 anos, citopenias, febre e sintomas constitucionais, podendo estar envolvidos todos os órgãos e sistemas com manifestações e proporções variáveis. A natureza inflamatória e multissistémica desta doença representa uma dificuldade acrescida no seu diagnóstico e tratamento, cursando com elevada morbimortalidade. Atualmente, os tratamentos com maior eficácia demonstrada são corticoterapia, azacitidina, inibidores da JAK-1/2 e inibidores da interleucina-6, parecendo também existir benefício com o transplante autólogo de células estaminais. Tendo em conta a sua identificação recente e baixo número de doentes diagnosticados, a maioria dos estudos disponíveis apresentam limitações relacionadas com a metodologia e curta duração de seguimento, imperando a necessidade de ensaios clínicos prospetivos de modo a definir as melhores estratégias terapêuticas e melhorar o prognóstico destes doentes.

Abstract VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome was identified in 2020 by Beck et al, when analyzing the genome of 2560 patients with different types of autoinflammatory manifestations. A literature review was carried out with the aim of disseminating existing scientific evidence and increasing the degree of clinical suspicion of the medical community. Currently, many mutations associated with this syndro-me have been identified, causing defects in the ubiquitylation and activation of the innate immune system. From the phenotypic analyses of the mutation carriers, some common features were found: male, over 50 years old, cytopenias, fever and constitutional symptoms, and all organs and systems with variable manifestations and proportions may be involved. The inflammatory and multi-systemic nature of this disease leads to a diagnostic and treatment challenge, adding to the already existing high morbimortality. Presently, the treatments with greater efficiency are corticosteroid therapy, azacytidine, JAK-1/2 inhibitors and interleukin-6 inhibitors. There are also benefits in autologous stem cell transplants. Given its recent identification and low number of diagnosed patients, most available studies have limitations related to the methodology and short duration of follow-up, prevailing the need for prospective clinical trials in order to define the best therapeutic strategies and to improve these patients’ prognosis.

Abstract Background: Cardiac resynchronization therapy (CRT) has been established as an effective therapy for heart failure with reduced ejection fraction. Randomized clinical trials have shown its impact on mortality and HF hospitalizations, as well as improvement of symptoms and quality of life. Objectives: Finding clinical, electrocardiographic, and echocardiographic variables that may predict the response to cardiac resynchronization therapy (CRT). Methods: We performed a single-center, observational, analytic, and retrospective study that included 102 patients with heart failure (HF) diagnosis who underwent CRT according to guideline-directed therapy from January 2010 to April 2020 in a third-level center. CRT response was defined as an improvement of New York Heart Association functional class in at least 1 category associated with a recovery of ≥ 5% in the left ventricular ejection fraction (LVEF). Results: Our study population was 102 patients of which 61 (59.8%) were men. The mean age at HF diagnosis was 54 ± 18.7 years. Ischemic heart disease was the etiology in 37 (36.3%) cases. Fifty-one (50%) patients were classified as responders. Responders had wider QRS, and lower LVEF and right ventricular fractional area change at baseline. After CRT, responders had a greater reduction of QRS duration, and improvement in LVEF, global longitudinal strain, and echocardiographic dyssynchrony parameters. Multivariate regression analysis showed that left bundle branch block (LBBB), left ventricular end-diastolic volume (LVEDV), tricuspid annular plane systolic excursion (TAPSE), and baseline difference of pre-ejection periods were predictors of a positive response to CRT in this population. Conclusions: LBBB, TAPSE, LVEDV, and pre-ejection time difference are independent variables that can predict adequate response to CRT.

Resumen Antecedentes: La terapia de resincronización cardíaca (TRC) se ha establecido como una terapia efectiva para la insuficiencia cardíaca con fracción de eyección reducida. Ensayos clínicos aleatorizados han demostrado su impacto en la mortalidad y hospitalizaciones por insuficiencia cardíaca, así como la mejora de los síntomas y la calidad de vida. Objetivos: Determinar las variables clínicas, electrocardiográficas y ecocardiográficas que puedan predecir la respuesta a la terapia de resincronización cardíaca (TRC). Método: Estudio unicéntrico, observacional, analítico, retrospectivo, que incluyó 102 pacientes con diagnóstico de IC sometidos a TRC y terapia dirigida por guías, de enero de 2010 a abril de 2020, en un centro de tercer nivel. La respuesta a TRC fue definida como mejoría de la clase funcional de la New York Heart Association en al menos 1 categoría, asociado con una recuperación ≥ 5% en la fracción de expulsión del ventrículo izquierdo (FEVI). Resultados: Incluimos a 102 pacientes, 61 (59.8%) fueron hombres. El promedio de edad al diagnóstico de IC fue 54 ± 18.7 años. La cardiopatía isquémica fue la etiología en 37 (36.3%) pacientes. 51 (50%) pacientes, fueron clasificados como respondedores. Los respondedores presentaron QRS amplio, menor FEVI y menor fracción de acortamiento del ventrículo derecho al inicio del estudio. Después de la TRC, los respondedores tuvieron una mayor reducción en la duración del QRS, mejoría en la FEVI, strain longitudinal global y parámetros de disincronía ecocardiográfica. El análisis de regresión multivariado mostró que el bloqueo de rama izquierdo (BRI), el volumen telediastólico del ventrículo izquierdo (VTDVI) la excursión sistólica del plano anular tricuspídeo (TAPSE) y la diferencia basal del período expulsivo fueron predictores de respuesta positiva a TRC. Conclusiones: BRI, TAPSE, VTDVI y la diferencia basal de períodos preexpulsivos son variables independientes que predicen respuesta adecuada a TRC.

RESUMEN Introducción: La fiebre es un marcador de enfermedades infecciosas e inflamatorias que se da por una respuesta inmune innata y por diferentes mediaciones entre marcadores moleculares. En el paciente inmunodeprimido, uno o varios mecanismos inmunológicos pueden estar alterados, debido a que la respuesta inmune puede estar deprimida y la fiebre puede denotar un estado patológico grave subyacente. Se realizó una búsqueda exploratoria en las bases de datos PubMed/Medline, Scopus y Scielo entre septiembre y octubre de 2022. Se incluyeron los términos fiebre, pacientes inmunodeprimidos, tratamiento y sistema inmune. Se seleccionaron 41 artículos científicos con diferentes diseños epidemiológicos. Objetivo: Describir aspectos relacionados con la fisiopatología de la fiebre, el tratamiento de la presencia de fiebre en pacientes con virus de inmunodeficiencia humana y síndrome de inmunodeficiencia adquirida, así como también en pacientes receptores de trasplantes de órgano sólido y de trasplantes hematopoyéticos, pacientes neutropénicos y pacientes tratados con corticosteroides y terapia biológica. Desarrollo: El tratamiento del paciente inmunodeprimido con fiebre incluye aspectos fundamentales como una adecuada anamnesis y examen físico, además de pruebas diagnósticas orientadas para establecer la causa de la fiebre. En estos pacientes, las infecciones juegan un papel protagónico y su intervención temprana es fundamental para impactar en la morbimortalidad. Conclusiones: El paciente inmunodeprimido con presencia de fiebre presenta un panorama desafiante para su manejo médico integral. Entre otros aspectos es relevante considerar el tipo y tiempo de inmunosupresión, así como los factores de riesgo, con el fin de orientar los diagnósticos y tratamientos.

ABSTRACT Introduction: Fever is a marker of infectious and inflammatory diseases that is caused by an innate immune response and by different mediations between molecular markers. In the immunocompromised patient, one or more immunological mechanisms may be altered because the immune response may be compromised, and fever may denote a serious underlying disease state. An exploratory search was conducted in the PubMed/Medline, Scopus, and Scielo databases between September and October 2022. The terms fever immunocompromised patients, treatment, and immune system. A total of 41 scientific articles with different epidemiological designs were selected. Objective: To describe aspects related to the pathophysiology of fever, management of the presence of fever in patients with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome, as well as in patients who have received solid organ transplants and hematopoietic transplants, neutropenic patients and patients treated with corticosteroids and biological therapy. Developing: The approach to the immunocompromised patient with fever includes fundamental aspects such as an adequate history and physical examination, as well as diagnostic tests aimed at establishing the cause of the fever. In these patients, infections play a leading role and early intervention is essential to impact morbidity and mortality. Conclusions: The immunocompromised patient with the presence of fever presents a challenging panorama for his/her comprehensive medical approach. Among other aspects, it is relevant to consider the type and duration of immunosuppression, as well as the risk factors, to guide diagnoses and treatments.

Abstract Background: Mycotic aneurysm is a rare entity with rapid progression, which can be fatal without adequate treatment. The incidence of rupture is greater than that of degenerative aneurysms and is associated with a high mortality rate. Case report: We report the case of a 58-year-old man with a known history of HIV infection with good immunovirological staging, treated squamous cell carcinoma of the anal canal and chronic gastritis, who presented with a six-day history of intense back pain, malaise, fever, and chills. After examination, he was hospitalized with a clinical suspicion of acute pyelonephritis. During hospitalization, he was diagnosed with pneumonia of the right pulmonary base, infectious spondylodiscitis, and mycotic aneurysm of the abdominal aorta, which involved the visceral plaque. The microbiological workup revealed only positive blood cultures for Klebsiella pneumoniae. After a multidisciplinary discussion of the case and six weeks of antibiogram-oriented antibiotic therapy, the patient underwent an aorto-aortic interposition via left thoracophrenolaparotomy without the need to reimplant visceral vessels due to the patch configuration of the proximal anastomosis. The procedure was performed under left heart bypass. The postoperative course was uneventful, and the patient was discharged four weeks later. At 18 months follow-up, she remained asymptomatic and free of recurrence. Conclusion: In this case, it remains to be defined whether the cause of the mycotic aneurysm was hematogenous dissemination from the identified pneumonia or contiguity from the diagnosed spondylodiscitis. Given the morbidity and mortality associated with this entity, early diagnosis and adequate treatment with surgical correction and antibiotic therapy with sufficient duration and dose are important aspects for improving survival in these cases.

Abstract To date, hydroxyurea is the only effective and safe drug that significantly reduces morbidity and mortality of individuals with Sickle cell disease. Twenty years of real-life experience has demonstrated that hydroxyurea reduces pain attacks, vaso-occlusive events, including acute chest syndrome, the number and duration of hospitalizations and the need for transfusion. The therapeutic success of hydroxyurea is directly linked to access to the drug, the dose used and adherence to treatment which, in part, is correlated to the availability of hydroxyurea. This consensus aims to reduce the number of mandatory exams needed to access the drug, prioritizing the requesting physician's report, without affecting patient safety.

ABSTRACT Background: The effect of a specific protein kinase A inhibitor H89 on Aquaporin 5 (AQ5) levels, which has a role in the inflammation of asthma pathogenesis, was investigated in this study. Objective: To prove that H89, which was thought to be a promising agent, may show antiinflammatory activity in the treatment of asthma by causing inhibition of the protein kinase A enzyme that is involved in inflammation. Methods: Thirty-two Wistar-Albino adult male rats, ranging between 250 and 350 g, were divided into four groups: (a) control group; (b) sham group, administration of 1 ml ovalbumin (OVA) solution intraperitonal (IP) and 0.1 ml OVA dissolved in dimethyl sulfoxide intrana- sally; (c) asthma group, IP + intranasally OVA administration; and (d) H89 group, (IP + intranasally OVA) + 0.1 ml H89. The lungs of the rats were evaluated histopathologically and immunohistochemically at the end of the study Results: The histopathological changes and AQ5 levels of the sham and asthma groups were not statistically different (p > 0.05). However, the parameters were found to be increased in the asthma group compared with the control group (p < 0.001). The alveolar degeneration and vascular congestion were statistically significantly decreased in the H89 group (p < 0.05). The AQ5 levels were reduced in the H89 group, but the difference was not statistically significant. Conclusion: Aquaporin 5 levels and histopathological changes were increased in asthmatic patients, and an -mprovement was detected with H89 -reatment. H89 has an effect on -the inflammation of asthma pathogenesis, so it can be thought to be used in asthma treatment. However, more studies are needed to find out the therapy duration and ideal doses of H89 treatment.

BACKGROUND: Two intervention approaches are implemented in South Africa to alleviate the deleterious consequences of congenital or early onset hearing impairment on language acquisition and subsequent poor learning outcomes. AIM: This study investigated the learning outcomes of foundation phase learners with severe to profound hearing impairment who received Listening and Spoken Language - South Africa (LSL-SA) (adapted Auditory Verbal Therapy) therapy compared to those who received Traditional Speech-Language Therapy (TSLT). SETTING: The study was conducted at four early intervention (EI) schools for children with hearing impairment across three provinces in South Africa. METHODS: Data were collected through record reviews of their Speech-Language Therapy Outcomes and South African National Department of Basic Education academic report cards. Data were analysed using quantitative statistics. RESULTS: Findings demonstrated that children with hearing impairment enrolled in LSL-SA outperformed those enrolled in TSLT in achieving age-equivalent language outcomes. A higher percentage of learners enrolled in LSL-SA achieved meritorious to outstanding learning outcomes. While a comparable number of learners progressed to mainstream schooling, children with hearing impairment enrolled in LSL-SA are enrolled for a shorter duration until discharge than those enrolled in TSLT. This is an important finding, particularly in low-middle income countries (LMICs). CONCLUSION: Listening and Spoken Language - South Africa graduates achieved superior learning outcomes dependent on language attainment, providing contextually relevant evidence supporting the effectiveness of the LSL-SA EI approach. CONTRIBUTION: These context-specific outcomes stress the obligation to upscale and fast-track EI services. Implications for investment in LSL-SA are proposed through collaboration between families, educators, and early interventionists.