Social determinants of blood pressure control in a middle-income country in Latin America.

Blood pressure (BP) control is a key intervention to decrease cardiovascular diseases (CVD), the main cause of death in low and middle-income countries (MIC). Scarce data on the determinants of BP control in Latin America are available. Our objective is to explore the role of gender, age, education, and income as social determinants of BP control in Argentina, a MIC with a universal health care system. We evaluated 1184 persons in two hospitals. Blood pressure was measured using automatic oscillometric devices. We selected those patients treated for hypertension. The average BP of less than 140/90 mmHg was considered a controlled BP. We found 638 hypertensive individuals, of whom 477 (75%) were receiving antihypertensive drugs, and of those, 248 (52%) had controlled BP. The prevalence of low education was more frequent in uncontrolled patients (25.3% vs. 16.1%; P < .01). We did not find association between household income, gender, and BP control. Older patients had less BP control (44% of those older than 75 years vs. 60.9% of those younger than 40; test for trend P < .05). Multivariate regression indicates low education (OR 1.71 95% CI [1.05, 2.79]; P = .03) and older age (OR 1.01; 95% IC [1.00, 1.03]) as independent predictors of the lack of BP control. We conclude that rates of BP control are low in Argentina. In a MIC with a universal health care system low education and old age but not household income are independent predictors of the lack of BP control.

[Abdominal aortic aneurysm infected with Campylobacter fetus. Case report and medical literature review]. / Aneurisma de la aorta abdominal infectado por Campylobacter fetus. Comunicación de un caso clínico y revisión de la literatura médica.

Infection is a rare complication of abdominal aortic aneurysms. Campylobacter fetus has special tropism for vascular endothelium. It has been reported as a cause of infected abdominal aortic aneurysms. The mortality of these patients is high, so an early recognition with a start of antibiotic therapy is crucial. In addition to medical treatment surgery may be required, which has high mortality in patients with many diseases and unstable. We report the case of an old man with infected abdominal aortic aneurysm with C. fetus, whom was decided to be treated with imipenem, due to his cardiovascular history and his general condition at admission. The patient showed a good clinical response without recurrence of symptoms. We also carry out a review of the reported cases.

Aneurisma de la aorta abdominal infectado por Campylobacter fetus: comunicación de un caso clínico y revisión de la literatura médica / Abdominal aortic aneurysm infected with Campylobacter fetus: case report and medical literature review

Resumen La infección es una complicación infrecuente de los aneurismas de la aorta abdominal. Campylobacter fetus tiene un especial tropismo por el endotelio vascular y ha sido reportado como causa de infección de aneurismas aórticos. Este tipo de infección es de alta mortalidad por lo que el reconocimiento temprano con el inicio precoz de terapia antibacteriana efectiva es clave. Además del tratamiento médico, puede requerirse cirugía, la que tiene una alta letalidad en pacientes inestables y con comorbilidades. Comunicamos el caso clínico de un adulto mayor con un aneurisma de aorta abdominal infectado por C. fetus. Dado su compromiso del estado general y antecedentes cardiovasculares se decidió tratamiento médico con imipenem, con una buena respuesta clínica y microbiológica, sin recurrencia de los síntomas. También se presenta una revisión de los casos publicados.

Abstract Infection is a rare complication of abdominal aortic aneurysms. Campylobacter fetus has special tropism for vascular endothelium. It has been reported as a cause of infected abdominal aortic aneurysms. The mortality of these patients is high, so an early recognition with a start of antibiotic therapy is crucial. In addition to medical treatment surgery may be required, which has high mortality in patients with many diseases and unstable. We report the case of an old man with infected abdominal aortic aneurysm with C. fetus, whom was decided to be treated with imipenem, due to his cardiovascular history and his general condition at admission. The patient showed a good clinical response without recurrence of symptoms. We also carry out a review of the reported cases.

Experiencia prospectiva en el uso perioperatorio de antagonistas de vitamina K en pacientes de bajo riesgo tromboembólico que reciben cirugía electiva / Perioperative management of vitamin K antagonists in patients with low thromboembolic risk undergoing elective surgery: A prospective experience

Fundamento y objetivos: Se cuantificó la ocurrencia de episodios hemorrágicos y tromboembólicos en pacientes anticoagulados con antagonistas de vitamina K con bajo riesgo de tromboembolia, sometidos a un procedimiento invasivo electivo. Material y métodos: Se realizó un estudio descriptivo, prospectivo, unicéntrico entre diciembre de 2010 y julio de 2014. Se incluyeron pacientes mayores de 18 años, anticoagulados crónicamente con cumarínicos que ingresaron para realizar cirugía electiva. Se excluyeron los pacientes con aclaramiento de creatinina<30ml/min, peso>120kg, trombocitopenia inducida por heparina, embarazadas, catéter peridural para analgesia, cirugías no programadas y aquellos con alto riesgo tromboembólico. Se suspendió el antagonista de vitamina K 5 días antes del procedimiento sin administrar enoxaparina anticoagulante. Se midió RIN 24h antes del procedimiento y se administraron 3mg de vitamina K si este era mayor de 1,5. En el postoperatorio se reinició cumarínico según el riesgo de hemorragia asociado al procedimiento quirúrgico. Se evaluaron los episodios embólicos y hemorrágicos ocurridos desde el día 5 anterior al procedimiento hasta 30 días después de este. Resultados: Se registraron 75 procedimientos. En 56 casos (74,7%) los pacientes estaban anticoagulados por fibrilación auricular, 15 por tromboembolismo venoso (20%) y 4 por válvula cardíaca mecánica (5,3%). Veintiséis pacientes (34,5%) se sometieron a cirugías de alto riesgo de hemorragia y 49 (65,5%) de bajo riesgo. No se registró ningún episodio tromboembólico y acontecieron 4 (5,3%) episodios hemorrágicos; 3 (4%) correspondieron a hemorragias mayores (2, mortales). Conclusiones: Suspender la anticoagulación con cumarínicos sin tratamiento puente en pacientes de bajo riesgo de tromboembolia no expondría a estos a la ocurrencia de episodios embólicos (AU)

Background and objectives: To quantify thromboembolic and bleeding events in patients with low thromboembolic risk, who were chronically receiving vitamin K antagonists and undergoing elective surgery. Material and methods: A descriptive, prospective, single-center study was conducted between December 2010 and July 2014. Patients aged over 18 years old, chronically anticoagulated with vitamin K antagonists and admitted for elective surgery were included in the study. We excluded patients with a creatinine clearance<30ml/min, a body weight>120kg, heparin-induced thrombocytopenia, pregnant women, carriers of an epidural catheter for analgesia, patients who underwent unscheduled surgery and high thromboembolic risk-patients. Vitamin K antagonists were discontinued 5 days prior to the procedure without administering anticoagulant enoxaparin. The NIR was measured 24h before the procedure. A single dose of 3mg of vitamin K was administered in cases of a NIR>1.5. Vitamin K antagonists was resumed according to the surgical bleeding risk. Events were registered between 5 days prior to the procedure until 30 days after it. Results: A total of 75 procedures were included in the study. Fifty-six patients (74.7%) received vitamin K antagonists for atrial fibrillation, 15 suffered from venous thromboembolism (20%) and 4 had mechanical heart valves (5.3%). Twenty-six patients (34.5%) underwent high-bleeding risk surgeries and 49 (65.5%) underwent low risk procedures. No thromboembolic event was recorded. Four bleeding events (5.3%) were reported, 3 of which were considered major bleeding events (2 fatal). Conclusions: Suspending vitamin K antagonists with no bridging therapy performed in patients with a low thromboembolic risk does not expose such patients to a significant risk of embolic events (AU)

Perioperative management of vitamin K antagonists in patients with low thromboembolic risk undergoing elective surgery: A prospective experience. / Experiencia prospectiva en el uso perioperatorio de antagonistas de vitamina K en pacientes de bajo riesgo tromboembólico que reciben cirugía electiva.

BACKGROUND AND OBJECTIVES: To quantify thromboembolic and bleeding events in patients with low thromboembolic risk, who were chronically receiving vitamin K antagonists and undergoing elective surgery. MATERIAL AND METHODS: A descriptive, prospective, single-center study was conducted between December 2010 and July 2014. Patients aged over 18 years old, chronically anticoagulated with vitamin K antagonists and admitted for elective surgery were included in the study. We excluded patients with a creatinine clearance<30ml/min, a body weight>120kg, heparin-induced thrombocytopenia, pregnant women, carriers of an epidural catheter for analgesia, patients who underwent unscheduled surgery and high thromboembolic risk-patients. Vitamin K antagonists were discontinued 5 days prior to the procedure without administering anticoagulant enoxaparin. The NIR was measured 24h before the procedure. A single dose of 3mg of vitamin K was administered in cases of a NIR>1.5. Vitamin K antagonists was resumed according to the surgical bleeding risk. Events were registered between 5 days prior to the procedure until 30 days after it. RESULTS: A total of 75 procedures were included in the study. Fifty-six patients (74.7%) received vitamin K antagonists for atrial fibrillation, 15 suffered from venous thromboembolism (20%) and 4 had mechanical heart valves (5.3%). Twenty-six patients (34.5%) underwent high-bleeding risk surgeries and 49 (65.5%) underwent low risk procedures. No thromboembolic event was recorded. Four bleeding events (5.3%) were reported, 3 of which were considered major bleeding events (2 fatal). CONCLUSIONS: Suspending vitamin K antagonists with no bridging therapy performed in patients with a low thromboembolic risk does not expose such patients to a significant risk of embolic events.