Colombian validation of two scales to forecast the risk of infectious endocarditis and to determine the priority of echocardiography in patients with Staphylococcus aureus bacteremia

RESUMEN: Introducción: La endocarditis infecciosa secundaria a bacteriemia por Staphylococcus aureus tiene alta morbimortalidad. El uso sistemático de ecocardiografía en BSA es discutido. El propósito de nuestro estudio fue validar la escala VIRSTA y PREDICT para predicción del riesgo de endocarditis infecciosa en pacientes colombianos con bacteriemia por S. aureus y así determinar la necesidad de ecocardiografía. Metodología: Cohorte retrospectiva en pacientes hospitalizados con diagnóstico de bacteriemia por S. aureus en dos instituciones de alta complejidad de Medellín, Colombia entre 2012-2018. Se estableció el diagnóstico de endocarditis infecciosa con base en los criterios de Duke modificados. Se calculó el puntaje VIRSTA y PREDICT con los datos recolectados y se calculó el rendimiento operativo de ambas escalas. Resultados: En el análisis final se incluyeron 922 pacientes, 62 (6.7%) fueron diagnosticados con endocarditis infecciosa. La frecuencia de endocarditis infecciosa en pacientes con escala VIRSTA negativa fue de 0.44% (2/454). La frecuencia de endocarditis infecciosa en paciente con escala PREDICT negativa al día 5 fue de 4.8% (30/622). La sensibilidad y valor predictivo negativo de la escala VIRSTA fue de 96.7% y 99.5%, respectivamente. Para la escala PREDICT al día 5, la sensibilidad y valor predictivo negativo fueron de 51.6% y 95.1%, respectivamente. La capacidad discriminatoria, dada por el área bajo la curva, fue de 0.86 para la escala VIRSTA, y de 0.64 para la escala PREDICT. Conclusiones: En pacientes con VIRSTA negativo la realización sistemática de ecocardiografía podría ser innecesaria debido a la baja frecuencia de endocarditis infecciosa. En pacientes con PREDICT negativo, a pesar de la baja frecuencia de EI, no es seguro omitir la realización de ecocardiografía

Effects of total table salt restriction on blood pressure

Aims The aim of the study was to evaluate the effect of total omission of dietary salt intake on BP. Materials and methods The effects of total omission on the consumption of dietary salt over the BP, were evaluated for this study in a group of 30 hypertensive patients between 40-60 years old, uncontrolled, with monotherapy with angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists. BP was recorded over three days at the same time, according to the guidelines of the American Heart Association for correct BP measurement in humans. The average of the three registers measurement was taken as baseline for comparison of the data. The only intervention was the total restriction of table salt and sauces with salt. The patients were followed monthly during the first five months recording BP under the same conditions that basal measurement, after this, were indicated to all the patients the consumption of salt 5g/day (provided by the researchers) and were followed for another five months in the same measurement conditions above. Results Total restriction of consumption of dietary salt caused highly significant reduction (P>0.0001) of SBP, which was progressive and was evident from the first week of follow up. In addition, caused a decrease in DBP during the first week of monitoring, but that effect was not continuous, and no significant decrease in DBP was observed during follow-up (P 0.0662) Discussion and сonclusions We recommend that a minimum restriction to 5g/day would be ideal in this population group

Novel formula to measure mean pulmonary artery pressure

Mean Pulmonary Arterial Pressure (MPAP) is an important parameter in evaluation of patients with pulmonary hypertension. The aim of this study is to correlate a new formula using non-invasive blood pressure and Bernoulli’s right ventricle systolic pressure (RVSP) with invasive method. To archive the objectives, we enrolled 143 patients with suspected pulmonary hypertension from January 2015 till January 2016; all patients underwent right heart catheter evaluation and simultaneously RVSP by transthoracic echocardiography and non-invasive blood pressure to calculate MPAP by the formula MPAP = Pulse Pressure / (Mean Arterial Pressure/RVSP); and the results were compared using the Pearson’s simple-linear correlation method. We found a significant association between invasive and equation results with a Pearson’s correlation of 0,872 with a confidence interval from 0,795 to 0,921; sensitivity was 1,538% with a 95% confidence of interval (CI) from 0,038% to 8,276%, and Specificity was 100% with 95% CI from 94,48% to 100%. Our results suggest that the new formula have a good correlation estimating MPAP compared with invasive right heart catheterization method