Patients with cardiac disease: Changes observed through last decade in out-patient clinics

AIM: To describe current profile of patients with cardio-vascular disease(CVD) and assessing changes through last decade.METHODS: Comparison of patients with established CVD from two similar cross-sectional registries performed in 1999(n = 6194) and 2009(n = 4639).The types of CVD were coronary heart disease(CHD),heart failure(HF) and atrial fibrillation(AF).Patients were collected from outpatient clinics.Investigators were 80% cardiologist and 20% primary care practitioners.Clinical antecedents,major diagnosis,blood test results and medical treatments were collected from all patients.RESULTS: An increase in all risk factors,except for smoking,was observed;a 54.4% relative increase in BP control was noted.CHD was the most prevalent CVD but HF and AF increased significantly,41.5% and 33.7%,respectively.A significant reduction in serum lipid levels was observed.The use of statins increased by 141.1% as did all cardiovascular treatments.Moreover,the use of angiotensin-renin system inhibitors in patients with HF,beta-blockers in CHD patients or oral anticoagulants in AF patients increased by 83.0%,80.3% and 156.0%,respectively(P < 0.01).CONCLUSION: The prevalence of all cardiovascular risk factors has increased in patients with CVD through last decade.HF and AF have experienced the largest increases.

Conservative management of perforated duodenal diverticulum: A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.

Twelve-month efficacy and safety of the conversion to everolimus in maintenance heart transplant recipients

AIM: To determine the clinical reasons for conversion to everolimus(EVL) and long-term outcomes in heart transplant(HT) recipients.METHODS: A retrospective 12-mo study has been carried out in 14 Spanish centres to assess the efficacy and safety of conversion to EVL in maintenance HT recipients.RESULTS: Two hundred and twenty-two patients were included(mean age: 53 ± 10.5 years; mean time from HT: 8.1 ± 4.5 years). The most common reasons for conversion were nephrotoxicity(30%), chronic allograft vasculopathy(20%) and neoplasms(17%). The doses and mean levels of EVL at baseline(conversion to EVL) and after one year were 1.3 ± 0.3 and 1.2 ± 0.6 mg/d and 6.4 ± 3.4 and 5.6 ± 2.5 ng/mL, respectively. The percentage of patients receiving calcineurin inhibitors(CNIs) at baseline and on the final visit was 95% and 65%, respectively. The doses and mean levels of CNIs decreased between baseline and month 12 from 142.2 ± 51.6 to 98.0 ± 39.4 mg/d(P < 0.001) and from 126.1 ± 50.9 to 89.2 ± 47.7 ng/mL(P < 0.001), respectively, for cyclosporine, and from 2.9 ± 1.8 to 2.6 ± 1.9 mg/d and from 8.3 ± 4.0 to 6.5 ± 2.7 ng/mL(P = 0.011) for tacrolimus. In the subgroup of patients converted because of nephrotoxicity, creatinine clearance increased from 34.9 ± 10.1 to 40.4 ± 14.4 mL/min(P < 0.001). There were 37 episodes of acute rejection in 24 patients(11%). The most frequent adverse events were oedemas(12%), infections(9%) and gastrointestinal problems(6%). EVL was suspended in 44 patients(20%). Since the database was closed at the end of the study, no further followup data is available.CONCLUSION: Conversion to EVL in maintenance HT recipients allowed minimisation or suspension of the CNIs, with improved kidney function in the patients with nephrotoxicity, after 12 mo.