Therapies for patients with coexisting heart failure with reduced ejection fraction and non-alcoholic fatty liver disease

Heart failure with reduced ejection fraction (HFrEF) and nonalcoholic fatty liver disease (NAFLD) are two common comorbidities that share similar pathophysiological mechanisms. There is a growing interest in the potential of targeted therapies to improve outcomes in patients with coexisting HFrEF and NAFLD. This manuscript reviews current and potential therapies for patients with coexisting HFrEF and NAFLD. Pharmacological therapies, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, mineralocorticoids receptor antagonist, and sodium-glucose cotransporter-2 inhibitors, have been shown to reduce fibrosis and fat deposits in the liver. However, there are currently no data showing the beneficial effects of sacubitril/valsartan, ivabradine, hydralazine, isosorbide nitrates, digoxin, or beta blockers on NAFLD in patients with HFrEF. This study highlights the importance of considering HFrEF and NAFLD when developing treatment plans for patients with these comorbidities. Further research is needed in patients with coexisting HFrEF and NAFLD, with an emphasis on novel therapies and the importance of a multidisciplinary approach for managing these complex comorbidities.Revisión por pare

Therapies for patients with coexisting heart failure with reduced ejection fraction and non-alcoholic fatty liver disease

Heart failure with reduced ejection fraction (HFrEF) and nonalcoholic fatty liver disease (NAFLD) are two common comorbidities that share similar pathophysiological mechanisms. There is a growing interest in the potential of targeted therapies to improve outcomes in patients with coexisting HFrEF and NAFLD. This manuscript reviews current and potential therapies for patients with coexisting HFrEF and NAFLD. Pharmacological therapies, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, mineralocorticoids receptor antagonist, and sodium-glucose cotransporter-2 inhibitors, have been shown to reduce fibrosis and fat deposits in the liver. However, there are currently no data showing the beneficial effects of sacubitril/valsartan, ivabradine, hydralazine, isosorbide nitrates, digoxin, or beta blockers on NAFLD in patients with HFrEF. This study highlights the importance of considering HFrEF and NAFLD when developing treatment plans for patients with these comorbidities. Further research is needed in patients with coexisting HFrEF and NAFLD, with an emphasis on novel therapies and the importance of a multidisciplinary approach for managing these complex comorbidities

Asociación entre la sintomatología climatérica y la adherencia al Tratamiento Antirretroviral de Gran Actividad en mujeres peruanas en edad mediana con infección por el virus de inmunodeficiencia humana

Objetivo: Evaluar si existe asociación entre la sintomatología climatérica (SC) y la adherencia al Tratamiento Antirretroviral de Gran Actividad (A-TARGA) en mujeres de mediana edad (40 a 59 años) con infección por el Virus de Inmunodeficiencia Humana (VIH). Método: Se realizó un estudio transversal analítico en tres hospitales Ministerio de Salud en Lima, Perú. La SC fue medida con el Menopause Rating Scale y categorizada en: sin sintomatología (SS), con sintomatología leve (SCL), con sintomatología moderada (SCM) y con sintomatología severa (SCS). Las pacientes se clasificaron como adherentes y no adherentes al TARGA de acuerdo con la puntuación global del cuestionario de evaluación de adherencia al tratamiento antirretroviral (CEAT-VIH). Asimismo, se evaluó la edad, orientación sexual, esquema de tratamiento, tiempo de enfermedad, estadio menopaúsico, riesgo de depresión y comorbilidades. Se estimaron las razones de prevalencia (RP) con su respectivo IC95% mediante modelos lineales generalizados familia Poisson con bootstrap no paramétrico a nivel crudo y ajustado por criterios epidemiológico y estadístico. Resultados: Se incluyeron 313 mujeres en el análisis. El 70,6% no eran adherentes al TARGA. En cuanto a la SC: 19,9% tuvieron SCL, 32,6% mantuvieron SCM y 15% presentaron SCS. La probabilidad de ser no adherente al TARGA fue superior en las mujeres con SCL, SCM y SCS que, en aquellas SS, tanto en el análisis crudo [RP:1,79 (IC95%: 1,39 a 2,29)], [RP:1,76 (IC95%: 1,38 a 2,23)], [RP:2,07 (IC95%: 1,64 a 2,61)], como en el análisis ajustado por criterio estadístico [RPa:1,80 (IC95%: 1,41 a 2,29)], [RPa:1,72 (IC95%: 1,36 a 2,18)], [RPa: 2,06 (IC95%: 1,64 a 2,60)] y ajustado por criterio epidemiológico [RPa:1,84 (IC95%: 1,45 a 2,34)], [RPa:1,83 (IC95%: 1,44 a 2,32)], [RPa:2,17 (IC95%: 1,73 a 2,73)]; respectivamente. Conclusiones: Los hallazgos sugieren una asociación entre la SC y la A-TARGA independientemente de las variables clínicas y demográficas medidas. La exploración de la sintomatología climatérica en la mujer con VIH podría ser relevante en la práctica clínica.Association between climacteric symptomatology and adherence to Highly Active Antiretroviral Therapy in middle-aged Peruvian women with human immunodeficiency virus infection Objective: To evaluate the association between Climacteric Symptomatology (CS) and adherence to highly active antiretroviral therapy (A-HAART) in middle age women (40 to 59 years old) with HIV infection. Methods: We carried out a cross-sectional study in Lima, Peru. The CS was categorized in: no symptomatology (NS), mild symptomatology (MiS), moderate symptomatology (MoS) and severe symptomatology (SS), using the score of the Menopause Rating Scale (MRS). According to the global score of the Antiretroviral Treatment Adherence Evaluation Questionnaire (CEAT-HIV), the patients were classified as: adherent and non-adherent to HAART. Also, age, sexual orientation, HAART scheme, time with HIV infection, menopausal stage, risk of depression and comorbidities were measured as control variables. We performed Poisson generalized linear models with non-parametric boostrap for calculating prevalence ratios at crude (PR) and adjusted by statistical and epidemiological criteria (aPR). Results: We included 313 in the analysis, 70.6% were non-adherent to HAART. Regarding CS, 19.9% had MiS, 32.6% had MoS and 15% had SS. The probability of non-adherent was superior in women with MiS, MoS and SS that those with NS; at crude model [PR:1.79 (CI95%: 1.39 a 2.29)], [PR:1.76 (CI95%: 1.38 a 2.23)], [PR:2.07 (CI95%: 1.64 a 2.61)], as well as adjusted by statistical criteria [aPR:1.80 (CI95%: 1.41 a 2.29)], [aPR:1.72 (CI 95%: 1.36 a 2.18)], [aPR: 2.06 (CI 95%: 1.64 a 2.60)] and adjusted by epidemiological [aPR:1.84 (CI95%: 1.45 a 2.34)], [aPR:1.83 (CI 95%: 1.44 a 2.32)], [aPR:2.17 (CI 95%: 1.73 a 2.73)]; respectively. Conclusions: Our results suggest that CS is associated with A-HAART independently of the clinical and demographic variables. The exploration of the CS on the women with HIV infection could be relevant in clinical practice arena.Tesi

Submandibular hemangioma with cardiorespiratory arrest in an infant

Hemangiomas are defined as soft tissue lesions in the maxillofacial or oral region. Hemangiomas of salivary glands constitute 30% of the non-epithelial tumors in major salivary glands. Benign tumors in salivary glands are located 85% in parotid gland and 13% in submandibular gland. We present a case of submandibular hemangioma in an infant patient that had some complications and a challenging diagnosis. A 3-month-old female patient presented a giant hemangioma located in the submandibular, preauricular and right malar region with purplish color that during hospitalization had a cardiorespiratory arrest as a severe complication of the disease.Revisión por pare

Performance of Computed Tomographic Angiography–Based Aortic Valve Area for Assessment of Aortic Stenosis

Background A total of 40% of patients with severe aortic stenosis (AS) have low‐gradient AS, raising uncertainty about AS severity. Aortic valve calcification, measured by computed tomography (CT), is guideline‐endorsed to aid in such cases. The performance of different CT‐derived aortic valve areas (AVAs) is less well studied. Methods and Results Consecutive adult patients with presumed moderate and severe AS based on echocardiography (AVA measured by continuity equation on echocardiography <1.5 cm2) who underwent cardiac CT were identified retrospectively. AVAs, measured by direct planimetry on CT (AVACT) and by a hybrid approach (AVA measured in a hybrid manner with echocardiography and CT [AVAHybrid]), were measured. Sex‐specific aortic valve calcification thresholds (≥1200 Agatston units in women and ≥2000 Agatston units in men) were applied to adjudicate severe or nonsevere AS. A total of 215 patients (38.0% women; mean±SD age, 78±8 years) were included: normal flow, 59.5%; and low flow, 40.5%. Among the different thresholds for AVACT and AVAHybrid, diagnostic performance was the best for AVACT <1.2 cm2 (sensitivity, 85%; specificity, 26%; and accuracy, 72%), with no significant difference by flow status. The percentage of patients with correctly classified AS severity (correctly classified severe AS+correctly classified moderate AS) was as follows; AVA measured by continuity equation on echocardiography <1.0 cm2, 77%; AVACT <1.2 cm2, 73%; AVACT <1.0 cm2, 58%; AVAHybrid <1.2 cm2, 59%; and AVAHybrid <1.0 cm2, 45%. AVACT cut points of 1.52 cm2 for normal flow and 1.56 cm2 for low flow, provided 95% specificity for excluding severe AS. Conclusions CT‐derived AVAs have poor discrimination for AS severity. Using an AVACT <1.2‐cm2 threshold to define severe AS can produce significant error. Larger AVACT thresholds improve specificity

Terapéutica Integrada - ME163 - 202102

Curso de especialidad de la carrera de medicina, de carácter teórico-práctico del ciclo 8, en el que los estudiantes al realizar la revisión y análisis de casos clínicos elaboran los planes de tratamiento y prevención de los principales problemas de salud. El curso de terapéutica integrada busca desarrollar las competencias específicas de práctica clínica-promoción, prevención y tratamiento (nivel 2) y profesionalismo-sentido ético y legal y responsabilidad profesional (nivel 2), que les permitirá a los estudiantes plantear los planes de prevención y tratamiento farmacológico y no farmacológico de los principales problemas de salud en el paciente adulto y pediátrico

Clínica Integrada - ME210 - 202101

Curso de especialidad, de la carrera de medicina, de carácter teórico- práctico del ciclo 7, en el que los estudiantes integran conocimientos previos con la anamnesis, el examen físico y establecen el diagnostico por síndromes o problemas y el plan de trabajo. El curso de Clínica integrada busca desarrollar las competencias generales de comunicación escrita y comunicación oral(nivel 2) y las competencias específicas de práctica clínica-diagnóstico (nivel 2) y profesionalismo-sentido ético y legal y responsabilidad profesional(nivel 2). La integración de conocimientos en la historia clínica, permitirá al estudiante, plantear un adecuado diagnóstico, plan de trabajo para la atención de su futuro paciente