Prognostic value of troponin I in atrial fibrillation.

OBJECTIVE: To evaluate whether circulating cardiac troponin I (cTnI) levels are associated with worst outcomes in patients with atrial fibrillation (AF). METHODS: Consecutive patients visiting the emergency room (ER) with a new episode of a previously diagnosed AF or a new diagnosis of AF during ER admission between January 1st, 2010 and December 31st, 2015, were enrolled in the study (n = 2617). After applying exclusion criteria and eliminating repeated episodes, 2013 patients were finally included. Of these, 1080 patients with at least one cTnI measurement in the ER were selected and classified into 4 groups according to cTnI quartiles: Q1 (n = 147) cTnI <10 ng/L (Group 1); Q2 (n = 254): 10-19 ng/L (Group 2); Q3 (n = 409): 20-40 ng/L (Group 3); and Q4 (n = 270): cTnI >40 ng/L (Group 4). The median follow-up period was 47.8 ± 32.8 months. The primary endpoint was all-cause death during the follow-up. RESULTS: A higher mortality was found in group 4 compared with the other groups (58.9% vs. 28.5%, respectively, p < 0.001), along with, hospitalizations (40.4% vs. 30.7%, p = 0.004), and readmissions due to decompensated heart failure (26.7% vs. 2.5%, p = 0.002). The probability of survival without AF recurrences was lower in the Q4 (p = 0.045). Moreover, cTnI levels >40 ng/L (Q4) were an independent risk factor of death (HR, 2.03; 95% CI, 1.64-2.51; p < 0.001). CONCLUSION: The assessment of cTnI at ER admission could be a useful strategy for risk stratification of patients diagnosed with AF by identifying a subgroup with medium-term to long-term increased risk of adverse events and mortality.

Leishmaniasis visceral en paciente inmunocompetente / Visceral leishmaniasis in immunocompetent patient

La leishmaniasis es una enfermedad parasitaria ocasionada por protozoos del género Leishmania, cuya forma de transmisión habitual es vectorial. Actualmente está clasificada como enfermedad tropical desatendida. A pesar de esto, se ha visto un aumento de casos en los últimos años en relación con 3 hechos: falta de medidas de control, movimientos de población y presencia de inmunosupresión. A continuación, exponemos el caso de un varón de 26 años sin antecedentes previos, que presentaba un cuadro de 2 meses de evolución inespecífico con predominio de sensación de distermia, astenia, diaforesis e hiperoxia. En la exploración se evidenció hepatoesplenomegalia y en la analítica inicial se objetivó una marcada neutropenia y anemia. Se procedió al estudio citomorfológico de sangre periférica y aspirado de médula ósea donde se evidenció parasitación por Leishmania, a pesar de no presentar ningún factor de inmunosupresión; característica habitual de esta dolencia (AU)

Leishmaniasis is a parasitic disease caused by protozoa of the genus Leishmania. Its usual transmission form is vectorial. It is currently classified as a neglected tropical disease. Despite this, cases have been increasing in recent years due to three factors: lack of control measures, population movements, and presence of immunosuppression. The case is presented of a 26 year-old male with no previous history, who had a clinical profile of two months non-specific evolution with dysthermic feeling, asthenia, diaphoresis and hyperoxia. On physical examination he had hepatosplenomegaly and the initial laboratory results showed a marked anaemia and neutropenia. A cyto-morphological study of peripheral blood and bone marrow aspirate were performed that reported a Leishmania parasite infestation, but no evidence of any immunosuppressive factor, which is a regular feature of this disease (AU)