Cancer is an important condition associated with the development of atrial fibrillation (AF). The objectives of the BLITZ-AF Cancer study were to collect real-life information on the clinical profile ...and use of antithrombotic drugs in patients with AF and cancer to improve clinical management, as well as the evaluation of the association between different antithrombotic treatments (or their absence) and the main clinical events.
European multinational, multicenter, prospective, non-interventional study conducted in patients with AF (electrocardiographically confirmed) and cancer occurring within 3 years. The CHA2DS2-VASc and the HAS-BLED scores were calculated in all enrolled patients.
From June 2019 to July 2021, 1514 patients were enrolled, 36.5% women, from 112 cardiology departments in 6 European countries (Italy, Belgium, the Netherlands, Spain, Portugal and Ireland). Italy enrolled 971 patients in 77 centers. Average age of patients was 74 ± 9 years, of which 20.9% affected by heart failure, 18.1% by ischemic heart disease, 9.8% by peripheral arterial disease and 38.5% by valvular diseases; 41.5% of patients had a CHA2DS2-VASc score ≥4. The most represented cancer sites were lung (14.9%), colorectal tract (14.1%), prostate (8.8%), or non-Hodgkin's lymphoma (8.1%). Before enrollment, 16.6% of patients were not taking antithrombotic therapy, while 22.7% were on therapy with antiplatelet agents and/or low molecular weight heparin. After enrollment these percentages decreased to 7.7% and 16.6%, respectively and, at the same time, the percentage of patients on direct oral anticoagulant (DOAC) therapy increased from 48.4% to 68.4%, also to the detriment of those on vitamin K antagonist therapy.
The BLITZ-AF Cancer study, which enrolled patients diagnosed with AF and cancer, highlights that the use of DOACs by cardiologists in this clinical context has increased, even though the guidelines on AF do not give accurate indications about oral anticoagulant therapy in patients with cancer.
To assess the effectiveness of a Hib vaccination program against X-ray defined bacterial pneumonia in children <2 years in Colombia.
389 cases of radiologically confirmed pneumonia were recruited ...from hospitals in Bogotá and Medellin, Colombia. Two controls per case, matched on age, sex, and socio-economic level, were selected from children attending child health services at the hospitals where pneumonia cases were admitted.
The risk of having X-ray confirmed pneumonia decreased with each Hib dose received; the vaccine effectiveness was 47% (2–72%) among those receiving one dose; 52% for two doses received, and 55% for three doses. These effectiveness levels remained after adjusting for other factors associated with risk of pneumonia.
This study indicates that trials may have underestimated the proportion of radiological pneumonia in the under 2s that is due to Hib. This suggests that the impact of the vaccination will be greater than expected if it can be extended to reach the poorest children, who are at the greatest risk.
Studies, repairs and maintenance of heritage architecture are becoming increasingly important in modern society.The rapid growth recently experienced in many regions of the world has added a ...particular urgency to the need to preserve our built cultural heritage. This requires the collaboration of different parties including not only architects, engineers and scientists but also artists, socio-economic professionals and all other stakeholders to ensure the effective integration of the rehabilitated buildings within the community.Comprising specially selected papers, this book addresses a series of topics related to the historical aspects and reuse of heritage architecture, as well as technical issues on the structural integrity of different types of buildings. Restoration processes require the appropriate characterisation of materials, the modes of construction and the structural behaviour of the building. Modern computer simulation can provide accurate results demonstrating the stress state of the building and possible failure mechanisms affecting its stability. Equally important are studies related to their dynamic and earthquake behaviour, aiming to provide an assessment of the seismic vulnerability of heritage buildings.Of particular interest is the need for Heritage Building rehabilitation to conform to energy consumption reduction goals framed within climate change initiatives. It is necessary to encourage actions to improve energy efficiency, harmonised with both appropriate amounts of investment and transnational commitments to reduce greenhouse gas emissions.
Carbapenem-resistant Enterobacterales represent a major health threat and have few approved therapeutic options. Enterobacterales isolates were collected from hospitalized inpatients from 49 sites in ...six European countries (1 January–31 December 2020) and underwent susceptibility testing to cefiderocol and β-lactam/β-lactamase inhibitor combinations. Meropenem-resistant (MIC >8 mg/L) and cefiderocol-susceptible isolates were analyzed by PCR, and cefiderocol-resistant isolates by whole-genome sequencing, to identify resistance mechanisms. Overall, 1,909 isolates (including 970 Klebsiella spp., 382 Escherichia coli, and 244 Enterobacter spp.) were collected, commonly from bloodstream infections (43.6%). Cefiderocol susceptibility was higher than approved β-lactam/β-lactamase inhibitor combinations and largely comparable to cefepime-taniborbactam and aztreonam-avibactam against all Enterobacterales (98.1% vs 78.1%–97.4% and 98.7%–99.1%, respectively) and Enterobacterales resistant to meropenem (n = 148, including 125 Klebsiella spp.; 87.8% vs 0%–71.6% and 93.2%–98.6%, respectively), β-lactam/β-lactamase inhibitor combinations (66.7%–92.1% vs 0%–88.1% and 66.7%–97.9%, respectively), and to both meropenem and β-lactam/β-lactamase inhibitor combinations (61.9%–65.9% vs 0%–20.5% and 76.2%–97.7%, respectively). Susceptibilities to approved and developmental β-lactam/β-lactamase inhibitor combinations against cefiderocol-resistant Enterobacterales (n = 37) were 10.8%–56.8% and 78.4%–94.6%, respectively. Most meropenem-resistant Enterobacterales harbored Klebsiella pneumoniae carbapenemase (110/148) genes, although metallo-β-lactamase (35/148) and oxacillinase (OXA) carbapenemase (6/148) genes were less common; cefiderocol susceptibility was retained in β-lactamase producers, other than NDM, AmpC, and non-carbapenemase OXA producers. Most cefiderocol-resistant Enterobacterales had multiple resistance mechanisms, including ≥1 iron uptake-related mutation (37/37), carbapenemase gene (33/37), and ftsI mutation (24/37). The susceptibility to cefiderocol was higher than approved β-lactam/β-lactamase inhibitor combinations against European Enterobacterales, including meropenem- and β-lactam/β-lactamase inhibitor combination-resistant isolates.IMPORTANCEThis study collected a notably large number of Enterobacterales isolates from Europe, including meropenem- and β-lactam/β-lactamase inhibitor combination-resistant isolates against which the in vitro activities of cefiderocol and developmental β-lactam/β-lactamase inhibitor combinations were directly compared for the first time. The MIC breakpoint for high-dose meropenem was used to define meropenem resistance, so isolates that would remain meropenem resistant with doses clinically available to patients were included in the data. Susceptibility to cefiderocol, as a single active compound, was high against Enterobacterales and was higher than or comparable to available β-lactam/β-lactamase inhibitor combinations. These results provide insights into the treatment options for infections due to Enterobacterales with resistant phenotypes. Early susceptibility testing of cefiderocol in parallel with β-lactam/β-lactamase inhibitor combinations will allow patients to receive the most appropriate treatment option(s) available in a timely manner. This is particularly important when options are more limited, such as against metallo-β-lactamase-producing Enterobacterales.
Carbapenem-resistant
and
spp. represent major threats and have few approved therapeutic options. Non-fermenting Gram-negative isolates were collected from hospitalized inpatients from 49 sites in 6 ...European countries between 01 January 2020 and 31 December 2020 and underwent susceptibility testing against cefiderocol and β-lactam/β-lactamase inhibitor combinations. Meropenem-resistant (MIC >8 mg/L), cefiderocol-susceptible isolates were analyzed by PCR, and cefiderocol-resistant isolates were analyzed by whole-genome sequencing to identify resistance mechanisms. Overall, 1,451 (950
.
; 501
spp.) isolates were collected, commonly from the respiratory tract (42.0% and 39.3%, respectively). Cefiderocol susceptibility was higher than β-lactam/β-lactamase inhibitor combinations against
(98.9% vs 83.3%-91.4%), and
resistant to meropenem (
= 139; 97.8% vs 12.2%-59.7%), β-lactam/β-lactamase inhibitor combinations (93.6%-98.1% vs 10.7%-71.8%), and both meropenem and ceftazidime-avibactam (96.7% vs 5.0%-45.0%) or ceftolozane-tazobactam (98.4% vs 8.1%-54.8%), respectively. Cefiderocol and sulbactam-durlobactam susceptibilities were high against
spp. (92.4% and 97.0%) and meropenem-resistant
spp. (
= 227; 85.0% and 93.8%) but lower against sulbactam-durlobactam- (
= 15; 13.3%) and cefiderocol- (
= 38; 65.8%) resistant isolates, respectively. Among meropenem-resistant
and
spp., the most common β-lactamase genes were metallo-β-lactamases 30/139;
(15/139) and oxacillinases 215/227;
(194/227), respectively. Acquired β-lactamase genes were identified in 1/10 and 32/38 of cefiderocol-resistant
and
spp., and
-like or
mutations in 10/10 and 37/38, respectively.
cefiderocol susceptibility was high against
and
spp., including meropenem-resistant isolates and those resistant to recent β-lactam/β-lactamase inhibitor combinations common in first-line treatment of European non-fermenters.
This was the first study in which the
activity of cefiderocol and non-licensed β-lactam/β-lactamase inhibitor combinations were directly compared against
and
spp., including meropenem- and β-lactam/β-lactamase inhibitor combination-resistant isolates. A notably large number of European isolates were collected. Meropenem resistance was defined according to the MIC breakpoint for high-dose meropenem, ensuring that data reflect antibiotic activity against isolates that would remain meropenem resistant in the clinic. Cefiderocol susceptibility was high against non-fermenters, and there was no apparent cross resistance between cefiderocol and β-lactam/β-lactamase inhibitor combinations, with the exception of sulbactam-durlobactam. These results provide insights into therapeutic options for infections due to resistant
and
spp. and indicate how early susceptibility testing of cefiderocol in parallel with β-lactam/β-lactamase inhibitor combinations will allow clinicians to choose the effective treatment(s) from all available options. This is particularly important as current treatment options against non-fermenters are limited.
Various lung ultrasound (LUS) scanning modalities have been proposed for the detection of B-lines, also referred to as ultrasound lung comets, which are an important indication of extravascular lung ...water at rest and after exercise stress echo (ESE). The aim of our study was to assess the lung water spatial distribution (comet map) at rest and after ESE. We performed LUS at rest and immediately after semi-supine ESE in 135 patients (45 women, 90 men; age 62 ± 12 y, resting left ventricular ejection fraction = 41 ± 13%) with known or suspected heart failure or coronary artery disease. B-lines were measured by scanning 28 intercostal spaces (ISs) on the antero-lateral chest, 2nd-5th IS, along with the midaxillary (MA), anterior axillary (AA), mid-clavicular (MC) and parasternal (PS) lines. Complete 28-region, 16-region (3rd and 4th IS), 8-region (3rd IS), 4-region (3rd IS, only AA and MA) and 1-region (left 3rd IS, MA) scans were analyzed. In each space, the B-lines were counted from 0 = black lung to 10 = white lung. Interpretable images were obtained in all spaces (feasibility = 100 %). B-lines (>0 in at least 1 space) were present at ESE in 93 patients (69%) and absent in 42. More B-lines were found in the 3rd IS and along AA and MA lines. The B-line cumulative distribution was symmetric at rest (right/left = 1.10) and asymmetric with left lung predominance during stress (right/left = 0.67). The correlation of per-patient B-line number between 28-S and 16-S (R
= 0.9478), 8-S (R
= 0.9478) and 4-S scan (R
= 0.9146) was excellent, but only good with 1-S (R
= 0.8101). The average imaging and online analysis time were 5 s per space. In conclusion, during ESE, the comet map of lung water accumulation follows a predictable spatial pattern with wet spots preferentially aligned with the third IS and along the AA and MA lines. The time-saving 4-region scan is especially convenient during stress, simply dismissing dry regions and focusing on wet regions alone.
Objective. The objective of this study is to analyze the legal framework for health and intellectual property in Cuba and its impacton people's access to health resources and on the roles of ...different social actors. Methods. The methods used were those developed by the Pan American Health Organization to implement the project of the Conceptual Map on Public Health and Intellectual Property. Results. Information retrieved specifically on the legal framework for the National Health System, the Intellectual Property System and the strengthening of the country's biopharmaceutical industry--and on the framework's development over time--was processed and analyzed to generate Cuba's Conceptual Map on Public Health and Intellectual Property. Conclusions. Analysis of Cuba's adaptation of its legal framework and assessment of the interaction between the social actors involved show how the political will that has prevailed over several decades has had a positive impact on people's access to health resources. Key words Intellectual property; health legislation; universal access to health care services; right to health; Cuba. Objetivo. El objetivo de este estudio es el analisis del marco legal de salud y propiedad intelectual en Cuba y su incidencia en las condiciones de acceso de la poblacion a los recursos de salud y el papel de los diferentes actores sociales. Metodologia. Se utilizo la metodologia desarrollada por la Organizacion Panamericana de la Salud para la ejecucion del Proyecto Mapa Conceptual sobre Salud Publica y Propiedad Intelectual. Resultados. La informacion recobrada en especifico sobre el marco legal y su evolucion en el tiempo en Cuba relacionado con el Sistema Nacional de Salud, el Sistema de Propiedad Intelectual y el fortalecimiento de la industria biofarmaceutica del pais, fue procesada y analizada generando el Mapa Conceptual sobre Salud Publica y Propiedad Intelectual de Cuba. Conclusiones. El analisis de la experiencia cubana en la adecuacion de su marco legal y la evaluacion de la interrelacion de los actores sociales permite observar como la voluntad politica existente a lo largo de varias decadas ha impactado de manera positiva en el acceso a la salud de la poblacion. Palabras clave Propiedad intelectual; legislacion sanitaria; acceso universal a servicios de salud; derecho a la salud; Cuba.
Los laboratorios públicos productores de vacunas de América Latina y el Caribe han contribuido en diferente grado al control y a la erradicación de las enfermedades prevenibles por vacunación y ...varios están produciendo las vacunas que se aplican rutinariamente en los programas nacionales de inmunización, como la vacuna antituberculosa (a base del bacilo de Calmette-Guérin, BCG), la vacuna contra difteria-tétanos-pertussis (DTP), el toxoide tetánico (TT), la vacuna antisarampionosa y la vacuna antipoliomielítica oral. Gracias a los adelantos científicos recientes, se prevé un aumento importante del número de vacunas seguras y eficaces que estarán disponibles en un futuro cercano para uso en los programas normales de vacunación. Sin embargo, los gastos asociados con el desarrollo de estas vacunas y con los derechos de propiedad intelectual que las protegen son cuantiosos. Además, pocos laboratorios en América Latina poseen la capacidad técnica para investigar y elaborar estas vacunas. Tales factores tendrán un impacto en la celeridad con que se incorporarán en los esquemas de vacunación de los países de la Región. En la actualidad, los laboratorios públicos productores de vacunas de la Región no están capacitados para competir en este nuevo contexto y corren el riesgo de ser desplazados del mercado por completo. De ahí la necesidad de que cambien radicalmente su manejo gerencial y su capacidad cientificotécnica, lo cual exige que los gobiernos se comprometan a mejorar y fortalecer aquellos aspectos políticos y financieros que garanticen la participación de los laboratorios nacionales en el suministro sostenible de vacunas a los programas de vacunación, así como en la investigación, desarrollo y producción de vacunas nuevas
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