We aimed to explore the role of interleukin (IL)‐6, interferon‐gamma (IFNγ), IL‐10, and tumor necrosis factor (TNF) as predictors of systemic lupus erythematosus (SLE) clinical and serological ...activity, and their correlation with the treatment received. We performed a retrospective analysis of 77 patients with SLE according to the 2012 Systemic Lupus International Collaborative Clinics (SLICC) criteria. The outcomes were serological activity (SA), active disease (AD), complete remission (CR), the low‐disease activity state (LDAS), and immunosuppressive treatment. SA was present in 17.1%, AD in 17.3%, CR in 13%, and LDAS in 64.9% of patients. IL‐6 values were higher in patients in SA, in AD, in those receiving steroids alone, and in patients without CR or LDAS (p < 0.05). IFNγ was associated with anti‐double stranded DNA (dsDNA) antibodies positivity and immunosuppression, whereas IL‐10 values were higher in patients with CR (p < 0.05). The IL6‐IFN product was able to predict anti‐double stranded DNA (anti‐dsDNA) antibodies positivity (area under the receiver operating characteristic curve AUC‐ROC = 0.705, 95% confidence interval CI 0.563–0.847), SA (AUC‐ROC = 0.720, 95% CI 0.542–0.899), AD (AUC‐ROC = 0.701, 95% CI 0.520–0.882), steroid treatment (AUC‐ROC = 0.751, 95% CI 0.622–0.879), and the absence of LDAS (AUC‐ROC = 0.700, 95% CI 0.558–0.834). The IL6‐IFN/IL10 ratio predicted AD (AUC‐ROC = 0.742, 955 CI 0.540–0.944), steroid treatment (AUC‐ROC = 0.721, 95% CI 0.572–0.870), and the absence of LDAS (AUC‐ROC = 0.694, 95% CI 0.536–0.853). In conclusion, IL‐6, IL‐10, and IFNγ might help to assess SLE serological and clinical activity. Their combination in the IL‐6‐IFN product and the IL‐6xIFN to IL‐10 ratio results in novel tools to determine and predict SA, AD, and LDAS. Prompt detection of SLE activity might allow a rapid intervention to avoid established or chronic damage.
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.
the admission and death causes of SLE patients might have changed over the last years.
Analysis of the Spanish National Hospital Discharge database. All individuals admitted with SLE, according to ...ICD-9, were selected. The following five admission categories were considered: SLE, cardiovascular disease (CVD), neoplasm, infection, and venous-thromboembolic disease (VTED), along four periods of time (1997-2000, 2001-2005, 2006-2010, and 2011-2015).
The admissions (99,859) from 43.432 patients with SLE were included. The absolute number of admissions increased from 15,807 in 1997-2000 to 31,977 in 2011-2015. SLE decreased as a cause of admission (from 47.1% to 20.8%,
< 0.001), while other categories increased over the time, as follows: 5% to 8.6% for CVD, 8.2% to 13% for infection, and 1.4% to 5.5% for neoplasm (
< 0.001 for all). The admission mortality rate rose from 2.22% to 3.06% (
< 0.001) and the causes of death evolved in parallel with the admission categories. A significant trend to older age was observed over time in the overall population and deceased patients (
< 0.001).
Better control of SLE over the past two decades has led to a decrease in early admissions, and disease chronification. As a counterpart, CVD, infections, and neoplasm have become the main causes of admissions and mortality.
Gastric Outlet Obstruction (GOO) is a clinical syndrome characterized by postprandial vomiting, epigastric pain, and abdominal distension due to mechanical or motility disorders. The suspicion will ...mainly rely on abdominal radiological imaging (computed tomography, barium studies) that might not be widely available or even be contraindicated. We report a 65-year-old male who developed progressive epigastralgia, anorexia, and vomiting. Physical examination revealed mild abdominal distension and epigastric tenderness on deep palpation. With the presumptive diagnosis of gastric outlet obstruction, an abdominal point-of-care ultrasound (POCUS) was performed and showed impaired gastric emptying and a "target sign." A gastroscopic exploration confirmed inflammatory pyloric stenosis due to coexisting antral and duodenal ulcers. POCUS could play an essential role in the easy ultrasonographic diagnosis of gastroparesis, helping to differentiate from other causes of obstruction and even raise suspicion in the diagnosis of pyloric stenosis as a consequence of a GGO. POCUS may serve as a first-line imaging test that can raise suspicion of this difficult to diagnose and probably underreported disease.
Background. Coronavirus disease 2019 (COVID-19) has a high mortality in certain group of patients. We analysed the impact of baseline immunosuppression in COVID-19 mortality and the role of severe ...lymphopenia in immunocompromised subjects. Methods. We analysed all patients admitted with COVID-19 in a tertiary hospital in Madrid between March 1st and April 30th 2020. Epidemiological and clinical data, including severe lymphopenia (<500 lymphocytes/mm3) during admission, were analysed and compared based on their baseline immunosuppression condition. Results. A total of 1594 patients with COVID-19 pneumonia were hospitalised during the study period. 166 (10.4%) were immunosuppressed. Immunocompromised patients were younger (64 vs. 67 years, p = 0.02) but presented higher rates of hypertension, diabetes, heart, neurological, lung, kidney and liver disease (p < 0.05). They showed more severe lymphopenia (53% vs 24.1%, p < 0.001), lower SapO2/FiO2 ratios (251 vs 276, p = 0.02) during admission and higher mortality rates (27.1% vs 13.5%, p < 0.001). After adjustment, immunosuppression remained as an independent factor related to mortality (Odds Ratio (OR): 2.24, p < 0.001). In the immunosuppressed group, age (OR = 1.06, p = 0.01), acute respiratory distress syndrome (ARDS) (OR = 12.27, p = 0.017) and severe lymphopenia (OR = 3.48, p = 0.04) were the factors related to high mortality rate. Conclusion. Immunosuppression is an independent mortality risk factor in COVID-19. Severe lymphopenia should be promptly identified in these patients.
•Liver transplant recipients presented the highest incidence of Clostridioides difficile infection.•Previous hospitalization and the use of quinolones are related with Clostridioides difficile ...infection.•Kidney failure, amoxicillin-clavulanate, and severity may be associated with recurrent Clostridioides difficile infection.
There is limited knowledge about risk factors for Clostridioides difficile infection (CDI) and recurrent CDI in solid organ transplant (SOT) recipients.
A case-control study of CDI in SOT recipients compared with controls (SOT recipients who did not present CDI).
Sixty-seven patients from 1089 SOT recipients (6.2%) suffered at least one episode of CDI. The mean age was 55 ± 12 years and 20 cases (69%) were men. The accumulated incidence was 8% in liver transplantation, 6.2% in lung transplantation, 5.4% in heart transplantation, and 4.7% in kidney transplantation. Twenty-nine cases (43.3%) were diagnosed during the first 3 months after SOT. Forty-one cases (61.2%) were hospital acquired. Thirty-one patients with CDI presented with mild-moderate infection (46.3%), 30 patients with severe infection (44.8%), and 6 patients with severe-complicated disease (9%). Independent variables found to be related with CDI were hospitalization in the previous 3 months (odds ratio: 2.99; 95% confidence interval 1.21-7.37) and the use of quinolones in the previous month (odds ratio: 3.71 95% confidence interval 1.16-11.8). Eleven patients (16.4%) had at least one recurrence of CDI. Previous treatment with amoxicillin-clavulanate, severe-complicated index episode, and high serum creatinine were associated with recurrent CDI in the univariant analysis
Liver transplant recipients presented the highest incidence of CDI among SOT recipients. Risk factors for CDI were hospitalization in the previous 3 months and the use of quinolones in the previous month.
Determination of the humoral response to Clostridioides difficile (CD) toxins could be of great value in the management of patients with CD infection (CDI).
A prospective study was conducted on the ...clinical characteristics and humoral response in patients with CDI. Determination of ELISA IgG CD anti-toxin B (tgcBiomics, Germany) was performed. The following dilutions were planned for each patient, 1:100, 1: 200, 1: 400, 1: 800: 1: 1600. A significant concentration of antibody was considered to be present in each dilution if an optical density 0.2 units higher than the negative control of the technique was evident.
Eighty-five patients were included during the study period, November 2018–February 2020. The median age was 73 years (interquartile range: 62.5–85 years), with female predominance (45 patients, 52.9%). Thirty-nine patients (45.9%) had a severe infection. Seven patients (8.2%) had suffered an episode of CDI in the previous three months. Seventeen patients (20%) had one or more recurrent episodes during the three-month follow-up: No patient died during admission or required surgery for severe-complicated infection. The incidence of recurrence in patients with no antibody detected at 1:400 dilution was 25.4% (16 patients) while it was 4.3% (one patient) in patients with antibody present at that dilution (p = 0.03). Liver cirrhosis was associated with higher humoral response against CD.
Antibodies IgG CD anti-toxin B detection at a dilution of 1:400, using a B ELISA technique, effectively identified patients at increased risk of recurrence. This information could help assist in the management of patients.
ObjectiveInfections are a common complication of SLE. Our objective was to evaluate their causes and impact on the survival of patients with SLE.MethodsAnalysis of the admissions and death causes in ...patients diagnosed with SLE from the Spanish Hospital Discharge Database and the infection-related deaths of the Spanish population from the National Statistical Institute, between 2016 and 2018.Only infections recorded as the main diagnosis were analysed (severe or clinically relevant infection).ResultsAmong 18 430 admissions in patients with SLE, disease activity was the cause of admission in 19% of all patients and infection in 15%. However, infection was the main cause of death (25%) while SLE activity was responsible for only 6% of deaths (p<0.001). Severe infection exceeded SLE as a cause of death for patients dying at ages between 40–59 (23% vs 4%, p<0.001), 60–79 (26% vs 6%, p<0.001) and older than 80 years (25% vs 6%, p<0.001). Infection was the cause of death in 8% of the Spanish population, a significantly lower rate when compared with patients with SLE (p<0.001). Compared with the general population, infections were the highest relative cause of death in patients with SLE, particularly at younger ages: 40% vs 3% for those below 20 years old (p<0.01), 33% vs 4% between 20 and 39 (p<0.001), 23% vs 5% between 40 and 59 (p<0.001), 26% vs 5% between 60 and 79 (p<0.001) and 25% vs 9% for those older than 80 years (p<0.001).ConclusionOur nationwide study confirms that infections are the leading cause of death in SLE in Spain, with the highest proportion occurring in young patients with lupus compared with the general population of the same age range.
RESUMEN Introducción: La infertilidad afecta al 15 % de las parejas en edad fértil, de las que aproximadamente 4-8 % requerirán técnicas de reproducción asistida de alta tecnología. Con la ...incorporación de la mujer a la vida laboral y la consiguiente postergación de la maternidad es posible el aumento de la infertilidad. La hormona antimülleriana en la mujer se produce por las células de la granulosa. Esta regula el reclutamiento de folículos, su crecimiento y previene el agotamiento folicular, por lo que constituye una importante herramienta en los protocolos de inducción de la ovulación. Objetivo: Evaluar los niveles de la hormona antimülleriana como marcador de respuesta ovárica en pacientes tratadas por fertilización in vitro. Método: Se realizó un estudio descriptivo, observacional y de corte transversal en la consulta protocolizada de Reproducción Asistida del Hospital Clínico Quirúrgico Hermanos Ameijeiras, en el periodo comprendido de abril 2017 hasta abril 2019. La muestra quedó conformada por 137 mujeres que participaron en esta consulta. Se empleó estadística descriptiva e inferencial. Resultados: La edad promedio de las pacientes fue de 33,1 ± 7,4 años. Predominó la concentración sérica normal de la hormona antimülleriana en mujeres entre 31-35 años (26,3 %), nivel normal de FSH en (39,4 %), recuento de folículos antrales normal (24,1 %), buena calidad ovocitaria (39,4 %), y buena calidad embrionaria (36,5 %). Conclusiones: El nivel sérico de la hormona antimülleriana se asoció significativamente a la edad, la hormona folículo estimulante, el recuento de los folículos antrales, y la calidad ovocitaria y embrionaria.
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