Design and baseline characteristics of SALT-HF trial: hypertonic saline therapy in ambulatory heart failure

Aims: Hypertonic saline solution (HSS) plus intravenous (IV) loop diuretic appears to enhance the diuretic response in patients hospitalized for heart failure (HF). The efficacy and safety of this therapy in the ambulatory setting have not been evaluated. We aimed to describe the design and baseline characteristics of the SALT-HF trial participants. Methods and results: ‘Efficacy of Saline Hypertonic Therapy in Ambulatory Patients with HF’ (SALT-HF) trial was a multicenter, double-blinded, and randomized study involving ambulatory patients who experienced worsening heart failure (WHF) without criteria for hospitalization. Enrolled patients had to present at least two signs of volume overload, use ≥ 80 mg of oral furosemide daily, and have elevated natriuretic peptides. Patients were randomized 1:1 to treatment with a 1-h infusion of IV furosemide plus HSS (2.6–3.4% NaCl depending on plasmatic sodium levels) versus a 1-h infusion of IV furosemide at the same dose (125–250 mg, depending on basal loop diuretic dose). Clinical, laboratory, and imaging parameters were collected at baseline and after 7 days, and a telephone visit was planned after 30 days. The primary endpoint was 3-h diuresis after treatment started. Secondary endpoints included (a) 7-day changes in congestion data, (b) 7-day changes in kidney function and electrolytes, (c) 30-day clinical events (need of IV diuretic, HF hospitalization, cardiovascular mortality, all-cause mortality or HF-hospitalization). Results: A total of 167 participants [median age, 81 years; interquartile range (IQR), 73–87, 30.5% females] were randomized across 13 sites between December 2020 and March 2023. Half of the participants (n = 82) had an ejection fraction >50%. Most patients showed a high burden of comorbidities, with a median Charlson index of 3 (IQR: 2–4). Common co-morbidities included diabetes mellitus (41%, n = 69), atrial fibrillation (80%, n = 134), and chronic kidney disease (64%, n = 107). Patients exhibited a poor functional NYHA class (69% presenting NYHA III) and several signs of congestion. The mean composite congestion score was 4.3 (standard deviation: 1.7). Ninety per cent of the patients (n = 151) presented oedema and jugular engorgement, and 71% (n = 118) showed lung B lines assessed by ultrasound. Median inferior vena cava diameter was 23 mm, (IQR: 21–25), and plasmatic levels of N-terminal-pro-B-type natriuretic peptide (NTproBNP) and antigen carbohydrate 125 (CA125) were increased (median NT-proBNP 4969 pg/mL, IQR: 2508–9328; median CA125 46 U/L, IQR: 20–114). Conclusions: SALT-HF trial randomized 167 ambulatory patients with WHF and will determine whether an infusion of hypertonic saline therapy plus furosemide increases diuresis and improves decongestion compared to equivalent furosemide administration alone

Role of age and comorbidities in mortality of patients with infective endocarditis

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:<65 years, 65 to 80 years, and = 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 = 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients =80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, =80 years). In-hospital mortality was lower in the <65-year group (20.3%, <65 years;30.1%, 65-79 years;34.7%, =80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%, =80 years; p = 0.003).Independent predictors of mortality were age = 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI = 3 (HR:1.62; 95% CI:1.39–1.88), and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age = 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted

Carcinoma tricofolicular con capacidad metastásica

El carcinoma folicular es un tumor maligno derivado del folículo piloso. La mayor parte de los tumores foliculares son benignos, pero en los últimos años se han publicado casos aislados de tumores anexiales con características de malignidad y con una gran agresividad local siendo en principio tumores que se consideraban benignos. Creemos que este tumor está siendo infradiagnosticado, y como consecuencia, infratratado al ser confundido con otros tumores malignos originados en la piel, como el carcinoma basocelular y sobre todo con el carcinoma epidermoide, en parte por poca documentación y por la dificultad para su diagnóstico anatomopatológico. Presentamos un caso de carcinoma tricofolicular en cuero cabelludo en una mujer de 51 años de edad que rápidamente invade sistema nervioso central y que en solo 3 meses metastatiza a pulmón

Mites in the neotropical lizard Liolaemus pacha (Iguania: Liolaemidae): relation to body size, sex and season

Parasites can significantly influence the health of the host by inhibiting important physiological and behavioral processes. Some factors like body size, age of host, sex, and season can influence parasite load in nature. Mites are ectoparasites that can occur in lizards, possibly having a negative impact on their host. Our goals were to identify the mite that infested the Neotropical lizard Liolaemus pacha and describe its anatomical distribution, evaluate if mite intensity affected lizard mass, assess the relationship between lizard body size and mite intensity, and calculate the prevalence and intensity of mites in these lizards, comparing males and females and the reproductive and non-reproductive seasons. We analyzed preserved specimens and also studied lizards in their natural environment. We performed linear regression analyses between the intensity of mite infestation and snout-vent length and between lizard mass and intensity of mite infestation. To compare the intensity of mite infestation between sex and season, we used the Mann-Whitney Test. The mite was identified as a species of Pterygosoma Peters, 1849 (Prostigmata: Pterygosomidae). Mite infestation was mainly in the ventral area, particularly in the guiar and lateral regions. Lizard body size did not explain the intensity of mite infestation, nor was lizard mass influenced by the intensity of mite infestation. Males in their natural habitat presented, on average, more mites than females, which might be related to differences in behavior. There were no differences between seasons. This study constitutes the second Argentine record of the presence of the ectoparasite Pterygosoma sp. in a Liolaemus species and the first that explores its relation to ecological parameters.Los parásitos pueden afectar significativamente la salud de su hospedador al impedir procesos fisiológicos y comportamentales importantes. Algunos factores como el tamaño corporal, la edad del hospedador, el sexo y la estación, pueden influir en la carga ectoparasitaria en la naturaleza. Los ácaros son ectoparásitos que pueden estar presentes en lagartijas, teniendo un posible impacto negativo sobre su hospedador. Nuestros objetivos fueron: identificar el ácaro presente en la lagartija neotropical Liolaemus pacha y definir su distribución corporal; evaluar si las intensidades de infestación de ácaros influyen en el peso de las lagartijas y si el tamaño corporal de las mismas afecta la intensidad ectoparasitaria; y calcular la prevalencia e intensidad de ácaros en estas lagartijas, comparando entre machos y hembras, y entre las estaciones reproductiva y no-reproductiva. Se analizaron ejemplares de colección y se realizó un seguimiento de lagartijas en su ambiente natural. Realizamos un análisis de regresión lineal entre la intensidad de infestación del ácaro y la longitud hocico-cloaca y entre el peso y la intensidad de ácaros. Para comparar las intensidades de ácaros entre sexos y estación, aplicamos el Test de Mann-Whitney. Se identificó al ácaro como una especie de Pterygosoma Peters, 1849 (Prostigmata: Pterygosomidae). La mayor infestación fue en la zona ventral, principalmente en las regiones guiar y laterales. El tamaño corporal no explicó las intensidades de infestación del ácaro, así como tampoco el peso de las lagartijas fue influido por las intensidades de ácaros. Los machos en su ambiente natural presentaron en promedio más ácaros que las hembras, lo que podría estar asociado a diferencias comportamentales. No hubo diferencias entre las dos estaciones estudiadas. Este trabajo constituye el segundo registro en Argentina de la presencia del ectoparásito Pterygosoma sp. en una especie de Liolaemus y el primero que explora su relación con variables ecológicas.Fil: Juarez Heredia, Viviana Isabel. Fundación Miguel Lillo. Dirección de Zoología. Instituto de Herpetología; ArgentinaFil: Vicente, Natalin Soledad. Fundación Miguel Lillo. Dirección de Zoología. Instituto de Herpetología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Robles, Cecilia Ines. Fundación Miguel Lillo. Dirección de Zoología. Instituto de Herpetología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Halloy, Monique. Fundación Miguel Lillo. Dirección de Zoología. Instituto de Herpetología; Argentin