Background
The impact of coronavirus disease 2019 (COVID‐19) in haematological patients (HP) has not been comprehensively reported.
Methods
We analysed 39 patients with SARS‐CoV‐2 infection and ...haematological malignancies. Clinical characteristics and outcomes were compared to a matched control group of 53 non‐cancer patients with COVID‐19. Univariate and multivariate analyses were carried out to assess the risk factors associated with poor outcome.
Results
The most frequent haematological diseases were lymphoma (30%) and multiple myeloma (30%). Eighty‐seven % HP developed moderate or severe disease. Patients with haematological malignancies had a significantly higher mortality rate compared to non‐cancer patients (35.9% vs 13.2%; P = .003 (odds ratio 6.652). The worst outcome was observed in chronic lymphocytic leukaemia patients. Only age >70 years and C reactive protein >10 mg/dl at admission were associated with higher risk of death (odds ratio 34.86, P = .003 and 13.56,P = .03). Persistent viral sheddind was detected in 5 HP. Active chemotherapy, viral load at diagnosis and COVID‐19 therapy were not predictors of outcome.
Conclusion
Mortality of COVID‐19 is significantly higher in patients with haematological malignancies compared to non‐cancer patients. The impact of persistent viral shedding must be considered in order to re‐start therapies and maintain infectious control measures.
Purpose
To evaluate the effect of different non-osteoporotic drugs on the increase or decrease in the risk of incident fragility fractures (vertebral, humerus or hip) in a cohort of patients ...diagnosed with osteoporosis on active anti-osteoporotic therapy.
Methods
For this retrospective longitudinal study, baseline and follow-up data on prescribed non-osteoporotic treatments and the occurrence of vertebral, humerus or hip fractures in 993 patients from the OSTEOMED registry were analyzed using logistic regression models. The drugs evaluated with a possible beneficial effect were thiazides and statins, while the drugs evaluated with a possible harmful effect were antiandrogens, aromatase inhibitors, proton pump inhibitors, selective serotonin reuptake inhibitors, benzodiazepines, GnRH agonists, thyroid hormones, and oral and inhaled corticosteroids.
Results
Logistic regression analyses indicated that no treatment significantly improved fracture risk, with the only treatments that significantly worsened fracture risk being letrozole (OR = 0.18,
p
-value = 0.03) and oral corticosteroids at doses ≤ 5 mg/day (OR = 0.16,
p
-value = 0.03) and > 5 mg/day (OR = 0.27,
p
-value = 0.04).
Conclusion
The potential beneficial or detrimental effects of the different drugs evaluated on fracture risk are masked by treatment with anabolic or antiresorptive drugs that have a more potent action on bone metabolism, with two exceptions: letrozole and oral corticosteroids. These findings may have important clinical implications, as patients receiving these treatments are not fully protected by bisphosphonates, which may imply the need for more potent anti-osteoporotic drugs such as denosumab or teriparatide.
Cardiac allograft vasculopathy (CAV) is a major cause of long-term morbidity and mortality after heart transplantation (HTx), whose relationship with CMV infection is uncertain. This study evaluated ...the influence of CMV infection in the development of CAV.
We enrolled 166 consecutive HTx recipients who underwent their first transplant from January 1995 to July 2002. All patients received 14 days of intravenous ganciclovir and were prospectively monitored for CMV infection during the first year after HTx. CAV was diagnosed by coronary angiography performed at 1, 5, and 10 years after HTx, following the new criteria of the International Society for Heart and Lung Transplantation. We collected all variables potentially related with the development of CAV. Risk factors were studied using a complementary log-log model.
After a median follow-up of 11 years (range, 1-17 years), 72 patients (43%) developed CAV (63.8% CAV(1), 15.2% CAV(2), 20.8% CAV(3)). Symptoms secondary to CAV were present in 32% of these patients, and 8% died because of it. In the regression multivariate analysis, independent variables associated with the development of CAV were donor age (hazard ratio HR, 1.028; 95% confidence interval CI, 1.002-1.053; p < 0.028), presence of cellular acute rejection ≥ 2R (HR, 1.764; 95% CI, 1.011-3.078; p < 0.0414), CMV infection (HR, 2.334; 95% CI, 1.043-5.225; p < 0.0354), and not having been treated with a calcium channel blocker (HR, 0.472; 95% CI, 0.275-0.811; p < 0.0055).
Standardized angiographic criteria show CMV infection is associated with the development of CAV.
Whether immunosuppression impairs severe acute respiratory syndrome coronavirus 2‐specific T cell–mediated immunity (SARS‐CoV‐2‐CMI) after liver transplantation (LT) remains unknown. We included 31 ...LT recipients in whom SARS‐CoV‐2‐CMI was assessed by intracellular cytokine staining (ICS) and interferon (IFN)‐γ FluoroSpot assay after a median of 103 days from COVID‐19 diagnosis. Serum SARS‐CoV‐2 IgG antibodies were measured by ELISA. A control group of nontransplant immunocompetent patients were matched (1:1 ratio) by age and time from diagnosis. Post‐transplant SARS‐CoV‐2‐CMI was detected by ICS in 90.3% (28/31) of recipients, with higher proportions for IFN‐γ‐producing CD4+ than CD8+ responses (93.5% versus 83.9%). Positive spike‐specific and nucleoprotein‐specific responses were found by FluoroSpot in 86.7% (26/30) of recipients each, whereas membrane protein‐specific response was present in 83.3% (25/30). An inverse correlation was observed between the number of spike‐specific IFN‐γ‐producing SFUs and time from diagnosis (Spearman's rho: −0.418; p value = .024). Two recipients (6.5%) failed to mount either T cell–mediated or IgG responses. There were no significant differences between LT recipients and nontransplant patients in the magnitude of responses by FluoroSpot to any of the antigens. Most LT recipients mount detectable—but declining over time—SARS‐CoV‐2‐CMI after a median of 3 months from COVID‐19, with no meaningful differences with immunocompetent patients.
This single‐center study shows that, after a median of 103 days from diagnosis, the majority of liver transplant recipients recovered from COVID‐19 exhibit SARS‐CoV‐2‐specific cell‐mediated immunity detectable by two different methods that was comparable to nonimmunocompromised control patients.
Doped polyaniline (PANI) exhibits excellent electrical properties that can be used in composite materials to replace metallic or carbonaceous nanofillers commonly used in composites for sensor ...applications. Polymer blends based on PANI and thermoplastic elastomer styrene-ethylene/butylene-styrene (SEBS) copolymer have been prepared by solvent casting showing large strain yield (>10% for 40 wt% PANI content), high electrical conductivity, 1 S/m, after the percolation threshold at ≈10 wt% PANI. Further, the composites show suitable piezoresistive response with gauge factor (GF) between GF ≈ 1.5 and 2.4 for deformations up to 10%. The overall properties of the solution casted PANI/SEBS blends indicate their suitability for advanced electromechanical sensors applications, with simple integration and processable by solution printing technologies.
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Abstract
Background
Although presurgical nasal decontamination with mupirocin (NDM) has been advocated as a measure for preventing postsurgical mediastinitis (PSM) due to Staphylococcus aureus, this ...strategy is not universally recommended due to lack of robust supporting evidence. We aimed to evaluate the role of preoperative NDM in the annual incidence of S. aureus PSM at our institution.
Methods
An interrupted time-series analysis, with an autoregressive error model, was applied to our single-center cohort by comparing preintervention (1990–2003) and postintervention (2005–2018) periods. Logistic regression was performed to analyze risk factors for S. aureus PSM.
Results
12 236 sternotomy procedures were analyzed (6370 52.1% and 5866 47.9% in the pre- and postintervention periods, respectively). The mean annual percentage adherence to NDM estimated over the postintervention period was 90.2%. Only 4 of 127 total cases of S. aureus PSM occurred during the 14-year postintervention period (0.68/1000 sternotomies vs 19.31/1000 in the preintervention period; P < .0001). Interrupted time-series analysis demonstrated a statistically significant annual reduction in S. aureus PSM of –9.85 cases per 1000 sternotomies (−13.17 to −6.5; P < .0001) in 2005, with a decreasing trend maintained over the following 5 years and an estimated relative reduction of 84.8% (95% confidence interval CI, 89.25–74.09%). Chronic obstructive pulmonary disease was the single independent risk factor for S. aureus PSM (odds ratio, 3.7; 95% CI, 1.72–7.93) and was equally distributed in patients undergoing sternotomy during pre- or postintervention periods.
Conclusions
Our experience suggests the implementation of preoperative NDM significantly reduces the incidence of S. aureus PSM.
Interrupted time-series analysis in a cohort of 12 236 patients undergoing cardiac surgery demonstrated that the implementation of universal presurgical nasal decontamination was followed by a relative reduction of ~85% in the annual incidence of Staphylococcus aureus post–sternotomy mediastinitis.
There has been little investigation of male adolescent violence against women as acknowledged by boys themselves, and even less on such violence in different contexts with comparative studies of ...behavior between those who perpetrate this violence and the population at large. This study used cluster analysis to establish a male adolescent typology based on boys' self-reporting of violence against women in three contexts. The participants were 3,132 Spanish teenage boys aged 14-18 with experience of relationships with girls. Three discrete, identifiable types were obtained: the first group (69.8%), of
boys; the second group (26%), more involved in
outside a relationship but with a low incidence of dating violence offline; the third group (4.2%), with
but less involved in sexual harassment online than the second group. The logistic regression analysis showed that justification of male dominance and violence was the main risk condition for inclusion in the second and third groups, followed by low self-esteem (for the third group) and risky sexual behaviors online (for the second and third groups). The findings based on these results are important for preventing male adolescent dating violence against women in the three male types detected.
Purpose
To examine the response to anti-osteoporotic treatment, considered as incident fragility fractures after a minimum follow-up of 1 year, according to sex, age, and number of comorbidities of ...the patients.
Methods
For this retrospective observational study, data from baseline and follow-up visits on the number of comorbidities, prescribed anti-osteoporotic treatment and vertebral, humerus or hip fractures in 993 patients from the OSTEOMED registry were analyzed using logistic regression and an artificial network model.
Results
Logistic regression showed that the probability of reducing fractures for each anti-osteoporotic treatment considered was independent of sex, age, and the number of comorbidities, increasing significantly only in males taking vitamin D (OR = 7.918), patients without comorbidities taking vitamin D (OR = 4.197) and patients with ≥ 3 comorbidities taking calcium (OR = 9.412). Logistic regression correctly classified 96% of patients (Hosmer–Lemeshow = 0.492) compared with the artificial neural network model, which correctly classified 95% of patients (AUC = 0.6).
Conclusion
In general, sex, age and the number of comorbidities did not influence the likelihood that a given anti-osteoporotic treatment improved the risk of incident fragility fractures after 1 year, but this appeared to increase when patients had been treated with risedronate, strontium or teriparatide. The two models used classified patients similarly, but predicted differently in terms of the probability of improvement, with logistic regression being the better fit.
Background. It is necessary to clarify the incidence of and risk factors for tuberculosis (TB) among solid-organ transplant (SOT) recipients as well as changes in the chronology, clinical ...presentation, and prognosis of the disease. Methods. A total of 4388 SOT recipients were monitored prospectively at 16 transplant centers included in the Spanish Network for Research in Infectious Diseases (REIPI). TB episodes were studied, and the incidence rate was calculated. Certain variables were analyzed, by Cox regression analysis, as potential risk factors for TB. Results. Among the 4388 SOT recipients, 21 cases of TB were reported (0.48%). The median duration of follow-up was 360 days (range, 0–720 days). The global incidence of TB was 512 cases per 105 patients per year (95% confidence interval CI, 317–783), which was higher than that in the general population in Spain (18.9 cases per 105 inhabitants per year; relative risk RR, 26.6). The highest incidence (2072 cases per 105 patients per year; 95% CI, 565–5306) was observed among lung transplant recipients (RR, 73.3). Of the TB cases, 95% occurred within the first year after transplant, and 76% were pulmonary forms. Crude mortality was 19.0%, and attributable mortality was 9.5%. Multivariate analysis identified recipient age (RR, 1.05; 95% CI, 1.0–1.1) and receipt of a lung transplant (RR, 5.6; 95%, 1.9–16.9) as independent risk factors. Conclusions. TB incidence is increased among SOT recipients. The risk factors identified were age and receipt of a lung transplant. TB-attributable mortality (9.5%) is still high.
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