Miocarditis autoinmune inducida por hipertiroidismo secundario a enfermedad de Graves. Reporte de un caso

La afectación cardiovascular en pacientes con tirotoxicosis es caracterizada por la presentación de arritmias, fenómenos embólicos, eventos coronarios e insuficiencia cardiaca. Esta última, es una presentación inusual, en la mayoría de las ocasiones acompañada de alto gasto cardiaco, relegando a las de bajo gasto cardiaco a una pequeña proporción de etiología aún por esclarecer. Se presenta el caso de una paciente de sexo femenino con diagnóstico de hipertiroidismo durante la gestación, que un mes poscesárea inició con síntomas de insuficiencia cardiaca en el contexto de tirotoxicosis. Se documentó cardiopatía dilatada con fracción de eyección reducida, cuyos hallazgos por resonancia magnética cardiaca sugirieron el diagnóstico de miocarditis. Se determinó el origen autoinmune secundario a enfermedad de Graves, como etiología de la miocarditis, con adecuada respuesta al manejo inmunosupresor y antitiroideo.

Cardiovascular involvement in patients with thyrotoxicosis is characterized by the presentation of arrhythmias, embolic phenomena, coronary events, and heart failure. The latter is an unusual presentation, in most cases characterized as high-output cardiac failure, relegating the low-output cardiac failure to a small proportion of etiology yet to be clarified. We describe the case of a female patient with diagnosis of hyperthyroidism during pregnancy, who one month after caesarean section began with symptoms of heart failure in the context of thyrotoxicosis. Dilated heart disease with reduced ejection fraction is documented, with findings in the cardiac magnetic resonance that suggested the diagnosis of myocarditis. An autoimmune origin secondary to Graves' disease was determined, as the etiology of the myocarditis, with an adequate response to immunosuppressive and antithyroid management.

Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. METHODS: We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. RESULTS: We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95% confidence interval [CI] 0.55-0.72)], showing a 37% rate reduction. CONCLUSIONS: Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.

Impact of a multidimensional infection control strategy on central line-associated bloodstream infection rates in pediatric intensive care units of five developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control strategy including a practice bundle to reduce the rates of central line-associated bloodstream infection (CLAB) in patients hospitalized in pediatric intensive care units (PICUs) of hospitals, which are members of the INICC, from nine cities of five developing countries: Colombia, India, Mexico, Philippines, and Turkey. METHODS: CLAB rates were determined by means of a prospective surveillance study conducted on 1,986 patients hospitalized in nine PICUs, over a period of 12,774 bed-days. The study was divided into two phases. During Phase 1 (baseline period), active surveillance was performed without the implementation of the multi-faceted approach. CLAB rates obtained in Phase 1 were compared with CLAB rates obtained in Phase 2 (intervention period), after implementation of the INICC multidimensional infection control program. RESULTS: During Phase 1, 1,029 central line (CL) days were recorded, and during Phase 2, after implementing the CL care bundle and interventions, we recorded 3,861 CL days. The CLAB rate was 10.7 per 1,000 CL days in Phase 1, and in Phase 2, the CLAB rate decreased to 5.2 per 1,000 CL days (relative risk [RR] 0.48, 95% confidence interval [CI] 0.29-0.94, P = 0.02), showing a reduction of 52% in the CLAB rate. CONCLUSIONS: This study shows that the implementation of a multidimensional infection control strategy was associated with a significant reduction in the CLAB rates in the PICUs of developing countries.