The high cost of fidaxomicin has restricted its use despite the benefit of a lower
Clostridioides difficile
infection (CDI) recurrence rate at 4 weeks of follow-up. This short follow-up represents ...the main limitation of pivotal clinical trials of fidaxomicin, and some recent studies question its benefits over vancomycin. Moreover, the main risk factors of recurrence after treatment with fidaxomicin remain unknown. We designed a multicentre retrospective cohort study among four Spanish hospitals to assess the efficacy of fidaxomicin in real life and to investigate risk factors of fidaxomicin failure at weeks 8 and 12. Two-hundred forty-four patients were included. Fidaxomicin was used in 96 patients (39.3%) for a first episode of CDI, in 95 patients (38.9%) for a second episode, and in 53 patients (21.7%) for a third or subsequent episode. Patients treated with fidaxomicin in a first episode were younger (59.9 years vs 73.5 years), but they had more severe episodes (52.1% vs. 32.4%). The recurrence rates for patients treated in the first episode were 6.5% and 9.7% at weeks 8 and 12, respectively. Recurrence rates increased for patients treated at second or ulterior episodes (16.3% and 26.4% at week 8, respectively). Age greater than or equal to 85 years and having had a previous episode of CDI were identified as recurrence risk factors at weeks 8 and 12. We conclude that the outcomes with fidaxomicin in real life are at least as good as those observed in clinical trials despite a more demanding evaluation. Be it 85 years of age or older, and the use after a first episode appears to be independent factors of CDI recurrence after treatment with fidaxomicin.
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections and a frequent cause for hospitalization in the elderly. The aim of our study was to analyse epidemiological, ...microbiological, therapeutic, and prognostic of elderly hospitalised patients with and to determine independent risk factors for multidrug resistance and its outcome implications. A single-centre observational prospective cohort analysis of 163 adult patients hospitalized for suspected symptomatic UTI in the Departments of Internal Medicine, Infectious Diseases and Short-Stay Medical Unit of a tertiary hospital was conducted. Most patients currently admitted to hospital for UTI are elderly and usually present high comorbidity and severe dependence. More than 55% met sepsis criteria but presented with atypical symptoms. Usual risk factors for multidrug resistant pathogens were frequent. Almost one out of five patients had been hospitalized in the 90 days prior to the current admission and over 40% of patients had been treated with antibiotic in the previous 90 days. Infection by MDR bacteria was independently associated with the previous stay in nursing homes or long-term care facilities (LTCF) (OR 5.8, 95% CI 1.17–29.00), permanent bladder catheter (OR 3.55, 95% CI 1.00–12.50) and urinary incontinence (OR 2.63, 95% CI 1.04–6.68). The degree of dependence and comorbidity, female sex, obesity, and bacteraemia were independent predictors of longer hospital stay. The epidemiology and presentation of UTIs requiring hospitalisation is changing over time. Attention should be paid to improve management of urinary incontinence, judicious catheterisation, and antibiotic therapy.
Diversity patterns of the deep-sea megafauna in the Caribbean Basin and the Guiana ecoregion were analyzed in order to test the hypothesis of species richness variation as a function of depth and the ...hypothesis of non-differences between ecoregions by analyzing spatial patterns of five taxa and a merged assemblage. Collections of five taxa (corals, sea stars, sea urchins, sea lilies and gastropods) were obtained from seven oceanographic expeditions aboard the R/V Pillsbury at 310 stations between 60 and 7500 m depth. Data were sorted according to depth zones and ecoregions and were analyzed in order to estimate species richness, changes in species composition and distinction of β-diversity by species turnover or by nestedness. The observed patterns of diversity were consistent between taxa and their assemblage: Species richness increased from the continental shelf (60-200 m deep) to the slope (200-2000 m deep), followed by a decrease at the continental rise-abyssal zone. We detected marked changes in species composition according to depth ranges. Changes in species composition in relation to ecoregions were also detected. In general, the Caribbean Basin lacks important physical barriers, causing high deep-sea ecosystem connectivity; however, variation in composition could be related to changes in environmental conditions associated with productivity and/or continental influences.
Leishmaniasis, considered by the World Health Organization as one of the most important tropical diseases, is endemic in the Mediterranean Basin. The aim of this study was to evaluate epidemiological ...and clinical characteristics of cutaneous (CL) and mucocutaneous leishmaniasis (MCL) in La Fe University Hospital, Valencia, Spain. The particular focus was on diagnosis techniques and clinical differences according to the immunological status of the patients.
An eleven-year retrospective observational study of CL and MCL episodes at the hospital was performed. Epidemiological, clinical and therapeutic variables of each case, together with the microbiological and anatomopathological diagnosis, were analyzed.
A total of 42 patients were included, 30 of them were male and 28 were immunocompetent. Most of the cases (36/42) were diagnosed in the last 5 years (2013-2017). The incidence of CL and MCL increased from 3.6/100,000 (2006-2012) to 13.58/100,000 (2013-2017). The majority of the patients (37/42) exhibited CL, in 30 cases as single lesions (30/37). Ulcerative lesions were more common in immunosuppressed patients (13/14) than in immunocompetent patients (20/28), (P = 0.2302). The length of lesion presence before diagnosis was 7.36 ± 6.72 months in immunocompetent patients and 8.79 ± 6.9 months in immunosuppressed patients (P = 0.1863). Leishmania DNA detection (92.3%) was the most sensitive diagnostic technique followed by Giemsa stain (65%) and histopathological examination (53.8%). Twelve patients (12/42) had close contact with dogs or were living near to kennels, and 10 of them did not present underlying conditions. Intralesional glucantime (21/42) and liposomal amphotericin B (7/42) were the most common treatments administered in monotherapy. All patients evolved successfully and no relapse was reported.
Some interesting clinical and epidemiological differences were found in our series between immunocompetent and immunosuppressed patients. Future studies can take these results further especially by studying patients with biological therapy. Skin biopsies combining NAAT with histological techniques are the most productive techniques for CL or MCL diagnosis.
The role of oxidative stress in different aortopathies is evaluated. Thirty-two tissue samples from 18 men and 14 women were divided into: 4 control (C) subjects, 11 patients with systemic arterial ...hypertension (SAH), 4 with variants of Marfan’s syndrome (MV), 9 with Marfan’s syndrome (M), 2 with Turner’s syndrome, and 2 with Takayasu’s arteritis (TA). Aorta fragments were homogenized. Lipoperoxidation (LPO), copper-zinc and manganese superoxide dismutase (Mn and Cu-Zn-SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione S-transferase (GST), endothelial nitric oxide synthase (eNOS), nitrates and nitrites ( NO 3 − / NO 2 − ), and type IV collagen, and laminin were evaluated. There was an increase in Mn- and Cu-Zn-SOD activity in SAH, MV, M, and Turner’s syndrome. There was also an increase in CAT activity in M and Turner’ syndrome. GPx and GST activity decreased and LPO increased in all groups. eNOS was decreased in SAH, MV, and M and NO 3 − / NO 2 − were increased in SAH and TA. Type IV collagen was decreased in Turner’s syndrome and TA. Laminin γ -1 was decreased in MV and increased in M. In conclusion, similarities and differences in oxidative stress in the different aortopathies studied including pathologies with aneurysms were found with alterations in SOD, CAT, GPx, GST, and eNOS activity that modify subendothelial basement membrane proteins.
En el mundo, las actividades antrópicas y la pérdida de hábitat tienen efectos negativos sobre la flora y fauna. Se ha comprobado que el estudio del conocimiento popular de grupos faunísticos ...representa un recurso valioso para la toma de decisiones. El objetivo de este estudio fue evaluar el conocimiento popular sobre los mamíferos terrestres en seis poblados circundantes al Parque Nacional Barra Honda (PNBH), Nicoya, Costa Rica. El análisis de las encuestas se realizó tomando en cuenta la frecuencia y los porcentajes obtenidos en relación con el conocimiento popular, la diversidad de especies, las percepciones sobre los mamíferos terrestres y las actividades de cacería. Los entrevistados mencionaron que, en las áreas externas al PNBH, se pueden observar entre 14 y 18 mamíferos, donde se destaca al puma (Puma concolor), tolomuco (Eira barbara), tepezcuintle (Cuniculus paca) y al venado cola blanca (Odocoileus virginianus). Alrededor del 50 % de los entrevistados identificaron el tepezcuintle y al venado cola blanca como especies que son cazadas con mayor frecuencia. Algunos de los mamíferos identificados por los pobladores de las áreas circundantes al PNBH son catalogados como perjudiciales para los cultivos, animales de granja y ganado, por lo que son cazados de manera indiscriminada.
RESUMEN La disfotopsia negativa representa un motivo importante de insatisfacción del paciente tras una cirugía de catarata no complicada. Se manifiesta como una sombra oscura en el campo visual ...temporal, habitualmente en forma de medialuna, que cuando es persistente transforma en frustrante un resultado posquirúrgico que de otra manera sería considerado exitoso. Dada la amplia literatura publicada al respecto, esta revisión pretende resumir lo más actualizado sobre este fenómeno óptico en cuanto a sus causas, factores asociados, diagnóstico y tratamiento. Se realizó una búsqueda en Scholar Google con las palabras clave “Negative dysphotopsia”, la cual se confinó a artículos de la Journal of Cataract Refractive Surgery, y se encontró un total de 822 resultados; de ellos, 54 desde el año 2019 hasta el momento de la revisión.
RESUMEN El ojo humano es un instrumento óptico simple, pero extremadamente robusto. Los sistemas de imágenes para el diagnóstico y evaluación del segmento anterior del ojo constituyen una herramienta ...fundamental para el oftalmólogo. Hasta hace poco, el uso de estas técnicas proporcionaba fundamentalmente información cualitativa sobre ciertas enfermedades; sin embargo, el desarrollo de nuevas técnicas de cuantificación abre una nueva Era de evaluación y tratamiento basado en imagen. La tomografía de coherencia óptica de segmento anterior se ha convertido en una herramienta crucial en la Oftalmología. El MS-39 es un topógrafo que usa el dominio espectral y la topografía con disco de Plácido para obtener mediciones del segmento anterior del ojo. Brinda información sobre paquimetría, elevación, curvatura y poder dióptrico de ambas caras de la córnea. Además, permite realizar mapas epiteliales y biometría del cristalino. La alta repetibilidad de esta tecnología justifica su uso en la práctica clínica. De ahí la motivación para realizar una búsqueda de diversos artículos publicados, con el objetivo de describir las características y la utilidad del MS-39 para el estudio del segmento anterior del ojo. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud, con todos sus buscadores.
Background This study compiles the diversity of sea anemones in different shallow habitats (i.e. rocky shores, coral reefs, mangroves and sandy bottoms) in several locations of Venezuela, including ...the most important marine reserves of Venezuela: Morrocoy National Park, Mochima National Park, Archipiélago de Los Roques National Park, Laguna de La Restinga National Park, Isla de Cubagua, and Chichiriviche de la Costa. Results Twenty-six species of sea anemones sensu lato were documented, from which only two actiniarian species are newly recorded in Venezuela. In addition, specimens of the scientific collection of the Museo Oceanológico Hermano Benigno Román, of Isla de Margarita, Venezuela, were examined and its taxonomic status updated. Conclusions The diversity of sea anemones in Venezuela is updated to 44 species. An illustrated guide of living specimens and short descriptions of the external anatomy of the specimens is included to facilitate sea anemone species identification in the field and to provide a base line for ecological studies that require accurate identification to species level.
Human population is exposed to numerous parasitic ichthyozoonoses. Although Tamaulipas state (northeastern Mexico) is well known for its fishing and aquaculture industry, there are few reports of ...this type of zoonosis. Therefore, it is imperative to investigate whether the parasites that affect these fish may represent a zoonotic risk for the inhabitants of the area.
The objective of this study was to identify molecular and/or morphologically muscle parasites of fish from coastal locations in Tamaulipas, Mexico, and assess the risk of infection for humans. Between 2017 and 2018, 764 individual fish belonging to 28 species were examined for parasites. Collected worms were processed for their identification using morphological characteristics. In addition, partial sequences of the large subunit (28S) ribosomal RNA gene were obtained from some species to corroborate their identity. Prevalence and mean intensity of all registered infections were calculated. A total of seven species of parasites were found: cestodes (Poecilancistrium caryophyllum), trematodes (Clinostomum tataxumui, Clinostomum cichlidorum), nematodes (Eustrongylides sp., Contracaecum sp.) and pentastomids (Sebekia purdieae, Sebekia sp.). Parasites infected 10 species belonging to different fish families (Ariidae, Centrarchidae, Centropomidae, Cichlidae, Eleotridae, Ictaluridae, Mugilidae and Sciaenidae). Congeneric species of parasites or related to those registered in this study have been identified as zoonotic agents in other regions of the world. Despite the low levels of infection (2.6–16.6% prevalence and 1–5.5 parasites per infected host), there is a latent risk of transmission to humans, so it is recommended to avoid eating raw or undercooked fish meat.
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•Fish species for human consumption in Tamaulipas are infected with larval parasites.•Species of platyhelminthes, nematodes and pentastomids were identified taxonomically.•Parasites were related to species known as etiological agents of human parasitosis.•Infection levels were low, but there is a latent risk of human infections.
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