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BACKGROUND: In 2015, the Ministry of Health (MINSA) of Peru inaugurated the first national center for electrophysiology studies in a public tertiary referral hospital with the purpose to provide healthcare access to the most underserved population. This study aims to describe the rate of success and complications of catheter ablation in this center since its inception, as well as the demographic characteristics of these patients. METHODS: This study is descriptive and retrospective. We used the medical record of the patients who underwent catheter ablation (first-time and re-do procedure) in the center from July 2015 to February 2018. RESULTS: 55 catheter ablations were performed in 53 patients, who were 35 (±15) years old and 47% male. 63.6% had a full MINSA health coverage, while 16.4% and 20% had partial MINSA coverage and no health coverage, respectively. Atrio-ventricular reentrant tachycardia mediated by accessory pathways was the most common (76.4%) electrophysiology diagnosis. The overall immediate success rate was 96.4%. No complications were reported. CONCLUSIONS: The efficacy and safety of this procedure are comparable to international standards. The main limitations might be the insufficiency of resources and inadequate diffusion of our center activity.

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Takotsubo syndrome (TTS) is characterized by transient, regional systolic dysfunction of the left ventricle, often mimicking acute coronary syndrome. Atypical variants of this syndrome with mid-ventricular, basal, and focal wall motion patterns are increasingly diagnosed and show different clinical features compared to typical TTS. Even though TTS was generally considered a benign condition, continuous and strict monitoring is necessary to diagnose potentially life-threating complications. This is the first case report, to our knowledge, of atypical TTS in a patient with Goodpasture syndrome triggered by acute kidney injury (AKI).

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Endothelial biomarkers are gaining interest in the stratification of cardiovascular risk and early diagnosis of cardiotoxicity secondary to antineoplastic drugs. Interestingly, some drugs, such as anthracyclines, have been recently associated with vascular damage, which reveals the pivotal role of research in identifying biomarkers that could potentially be included into more specific cardiotoxicity risk scores. An extensive report of the incidences of cardiovascular adverse effects of oncologic drugs is presented, with the main purpose of highlighting not only the risk of developing heart failure but also the importance of associated vascular adverse effects (i.e., hypertension, venous, and arterial thrombosis) experienced by patients in the post-chemotherapy phase.

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Pericardial disease is a common complication of solid tumors and occasionally seen in hematologic malignancies. Pericardial effusion, when it occurs, is usually caused by tumor seeding of the pericardium leading to a serous effusion or by mass effect from mediastinal lymphadenopathy blocking drainage of lymphatic ducts. Pericardial disease from non-Hodgkin's lymphoma is uncommon and malignant pericardial effusion is even rarer. Here we present a case of a 31-year-old male with diffuse large B-cell lymphoma who developed cardiac tamponade from a malignant pericardial effusion.

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Las infecciones del tracto urinario (ITU) son un problema común de salud. En Perú se ha encontrado resistencia de Escherichia coli a ciprofloxacino entre 31 por ciento y 69,8 por ciento. Objetivos. Determinar la frecuencia y características asociadas a infección urinaria alta comunitaria (ITUc) por E. coli resistente a ciprofloxacino. Diseño. Estudio transversal. Lugar. Departamento de Emergencia del Hospital Edgardo Rebagliati Martins, Lima, Perú. Participantes. Pacientes con diagnóstico de ITUc en el 2010. Intervenciones.Se revisó la historia clínica de pacientes con urocultivos positivos a E. coli, con diagnóstico de ITUc confirmado. Se realizó análisis descriptivo (media, frecuencia) y análisis bivariado (chi cuadrado, prueba de Fisher), con p significativo <0,05. Principales medidas de resultados. Variables sociodemográficas, presentación clínica, comorbilidades y resistencia a otros antibióticos. Resultados. Se incluyó 81 pacientes, con edad media de 65 años (±17,4); 57 (70,4 por ciento) pacientes presentaron E. coli con resistencia a ciprofloxacino, que estuvo asociada (p<0,05) a resistencia a cotrimoxazol, cefalosporinas, aminoglicósidos y a la producción de beta-lactamasa de espectro extendido. En pacientes con E. coli resistente a ciprofloxacino fue más frecuente (p>0,05) el uso antibiótico previo de cefalosporinas y quinolonas, y comorbilidades neurológicas, gastrointestinales y renales. Conclusiones. La resistencia de E. coli a ciprofloxacino en ITUc fue más frecuente comparada con estudios previos, asociada con resistencias a cotrimoxazol, cefalosporinas, aminoglicósidos y producción de BLEE...

Urinary tract infections (UTI) represent a common health problem. In Peru Escherichia coli resistance rates to ciprofloxacin vary from 31 per cent to 69.8 per cent. Objectives. To determine the frequency and characteristics associated with community-acquired ciprofloxacin-resistant E. coli upper urinary tract infection (cUTI). Design. Cross-sectional study. Setting. Emergency Department, Edgardo Rebagliati Martins Hospital, Lima, Peru. Participants. Patients diagnosed with cUTI in 2010. Interventions. Medical records of patients with cUTI and urine cultures positive for E. coli were reviewed. Descriptive analysis (mean, frequency) and bivariate analysis (chi-square test or Fisher test) were used with p<0.05 significance. Main outcomes measures. Sociodemographic variables, clinical presentation, comorbidities and resistance to other antibiotics. Results. Eighty-one patients with cUTI were included, mean age 65 (± 17.4) years; 57 (70.4 per cent) patients had ciprofloxacin-resistant E. coli infection associated (p<0.05) with resistance to cotrimoxazole, cephalosporins, aminoglycosides and expanded spectrum beta-lactamase (ESBL)-producing organisms. In these patients prior use of cephalosporins and quinolones was more frequent (p>0.05) as well as neurological, gastrointestinal and renal comorbidities. Conclusions. Community-acquired ciprofloxacin-resistant E. coli upper urinary tract infection was more frequent than in previous studies and associated with resistance to cotrimoxazole, cephalosporins, aminoglycosides and ESBL-producing organisms...

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INTRODUCTION: Leishmaniasis is an endemic Andean vector-borne- tropical disease in Peru, whose mucocutaneous clinical presentation is rare. Leishmaniasis can occur in co-infections with HTLV-1 virus and HIV. We describe a case of L. mucocutaneous in a patient infected with HIV, with a history of cutaneous leishmaniasis with inadequate treatment 20 years ago. He was treated with stibogluconate with adequate response to treatment and regression of lesion after 4 weeks. Mucocutaneous leishmaniasis and HIV coinfection is rare and its clinical presentation may be atypically. It is important to consider it in patients coming from endemic areas and with a history of a previous cutaneous clinical presentation.

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Introduction: Leishmaniasis is an endemic Andean vector-borne- tropical disease in Peru, whose mucocutaneous clinical presentation is rare. Leishmaniasis can occur in co-infections with HTLV-1 virus and HIV. We describe a case of L. mucocutaneous in a patient infected with HIV, with a history of cutaneous leishmaniasis with inadequate treatment 20 years ago. He was treated with stibogluconate with adequate response to treatment and regression of lesion after 4 weeks. Mucocutaneous leishmaniasis and HIV coinfection is rare and its clinical presentation may be atypically. It is important to consider it in patients coming from endemic areas and with a history of a previous cutaneous clinical presentation.

La leishmaniasis es una enfermedad metaxénica andino-tropical, considerada endémica en Perú. Su forma mucocutánea es poco frecuente. Puede presentarse en coinfección con los virus HTLV-1 y VIH. Se describe un caso de leishmaniasis mucocutánea en un paciente infectado con VIH, con antecedente de leishmaniasis cutánea con tratamiento incompleto 20 años atrás. Es tratado con estibogluconato sódico por 30 días, con adecuada respuesta y regresión de la lesión a las cuatro semanas. La coinfección de leishmaniasis mucocutánea y VIH no es frecuente. Las manifestaciones de leishmaniasis pueden no presentarse de forma típica en pacientes con VIH. Se debe considerar la procedencia de la zona endémica y/o el antecedente de haber presentado la forma cutánea previamente.

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