Summary
The aim of the study was to analyse the epidemiology and prognosis of candidaemia in elderly patients. We performed a comparison of clinical presentation of candidaemia according to age and a ...study of hazard factors within a prospective programme performed in 29 hospitals. One hundred and seventy‐six episodes occurred in elderly patients (>75 years), 227 episodes in middle‐aged patients (61‐75 years) and 232 episodes in younger patients (16‐60 years). Central venous catheter, parenteral nutrition, neutropenia, immunosuppressive therapy and candidaemia caused by Candida parapsilosis were less frequent in elderly patients. These patients received inadequate antifungal therapy (57.3%) more frequently than middle‐aged and younger patients (40.5% P < .001). Mortality during the first week (20%) and 30 days (42%) was higher in elderly patients. The variables independently associated with mortality in elderly patients during the first 7 days were acute renal failure (OR: 2.64), Pitt score (OR: 1.57) and appropriate antifungal therapy (OR: 0.132). Primary candidaemia (OR: 2.93), acute renal failure (OR: 3.68), Pitt score (OR: 1.38), appropriate antifungal therapy (OR: 0.3) and early removal of the central catheter (OR: 0.47) were independently associated with 30‐day mortality.In conclussion, inadequate antifungal treatment is frequently prescribed to elderly patients with candidaemia and is related with early and late mortality.
To assess the prevalence of illegal drug use in college students on any previous occasion, during the previous year and the previous month, and to analyze the relationship between illegal drug use ...and family support and other factors.
A cross-sectional study using data from students participating in the uniHcos project (n = 3767) was conducted. The prevalence and age of onset of consumption of cannabis, non-prescription sedatives, stimulants and depressants was evaluated. Polyconsumption was also assessed. The independent variables were: family support, age, residence, and employment status. To determine the factors related to drug use multivariate logistic regression models stratified by gender were fitted.
Differences between men and women in prevalence of illegal drug use except non-prescription sedatives were observed. In both genders, less family support was associated with higher consumption of all drugs, except depressants, and with polyconsumption. To be studying and looking for work was related to cannabis and stimulant use and to polyconsumption among women, but only to cannabis use among men.
These results support the notion that the start of university studies is a particularly relevant stage in the onset of illegal drug use and its prevention, and that consumption may be especially associated with family support.
Evaluar la prevalencia del consumo de drogas ilegales en estudiantes universitarios y analizar la relación entre dicho consumo, el apoyo familiar y otros factores.
Se realizó un diseño transversal basado en datos de participantes en el proyecto uniHcos (n = 3767). Se evaluaron la prevalencia y la edad de inicio del consumo de cannabis, tranquilizantes sin receta, estimulantes y depresores, y el policonsumo. Como variables independientes se consideraron el apoyo familiar, la edad, la residencia y la situación laboral. Para la determinación de los factores asociados al consumo de drogas se ajustaron modelos de regresión logística estratificados por sexo.
Se observaron diferencias entre hombres y mujeres en la prevalencia del consumo de todas las drogas ilegales, excepto tranquilizantes sin receta. En ambos sexos, cuanto peor apoyo familiar, mayor consumo de todas las drogas, excepto depresores y policonsumo. Encontrarse estudiando y buscando trabajo se relacionó con el consumo de cannabis, estimulantes y policonsumo en las mujeres, y solo con cannabis en los hombres.
Los resultados de este estudio aportan nueva evidencia a favor de que el inicio de la etapa universitaria es un momento de especial relevancia en el inicio del consumo de drogas ilegales y su prevención, pudiendo este consumo estar especialmente relacionado con el apoyo familiar.
Background: Pseudomonas aeruginosa healthcare-associated infections are one of the top antimicrobial resistance threats world-wide. In order to analyze the current trends, we performed a Spanish ...nation-wide high-resolution analysis of the susceptibility profiles, the genomic epidemiology and the resistome of P. aeruginosa over a five-year time lapse. Methods: A total of 3.180 nonduplicated P. aeruginosa clinical isolates from two Spanish nation-wide surveys performed in October 2017 and 2022 were analyzed. MICs of 13 antipseudomonals were determined by ISO-EUCAST. Multidrug resistance (MDR)/extensively drug resistance (XDR)/difficult to treat resistance (DTR)/pandrug resistance (PDR) profiles were defined following established criteria. All XDR/DTR isolates were subjected to whole genome sequencing (WGS). Findings: A decrease in resistance to all tested antibiotics, including older and newer antimicrobials, was observed in 2022 vs 2017. Likewise, a major reduction of XDR (15.2% vs 5.9%) and DTR (4.2 vs 2.1%) profiles was evidenced, and even more patent among ICU isolates XDR (26.0% vs 6.0%) and DTR (8.9% vs 2.6%) (p < 0.001). The prevalence of Extended-spectrum β-lactamase/carbapenemase production was slightly lower in 2022 (2.1%. vs 3.1%, p = 0.064). However, there was a significant increase in the proportion of carbapenemase production among carbapenem-resistant strains (29.4% vs 18.1%, p = 0.0246). While ST175 was still the most frequent clone among XDR, a slight reduction in its prevalence was noted (35.9% vs 45.5%, p = 0.106) as opposed to ST235 which increased significantly (24.3% vs 12.3%, p = 0.0062). Interpretation: While the generalized decrease in P. aeruginosa resistance, linked to a major reduction in the prevalence of XDR strains, is encouraging, the negative counterpart is the increase in the proportion of XDR strains producing carbapenemases, associated to the significant advance of the concerning world-wide disseminated hypervirulent high-risk clone ST235. Continued high-resolution surveillance, integrating phenotypic and genomic data, is necessary for understanding resistance trends and analyzing the impact of national plans on antimicrobial resistance. Funding: MSD and the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea—NextGenerationEU.
Abstract 3247
Ph+ALL is a rare subgroup of pediatric ALL with very high risk of treatment failure and reported long-term overall survival (OS) of only 30–40%. Standard treatment includes allogeneic ...SCT in first complete remission (CR1). Imatinib has been lately incorporated to first-line treatment regimens. In a recent study with pediatric Ph+ALL patients, imatinib given continuously at a dose of 340 mg/m2/day in combination with chemotherapy resulted in a significant improvement in early outcome (Schultz KR et al, J Clin Oncol 2009).
to describe the Spanish Cooperative Group SHOP results in Ph+ALL with imatinib given continuously at an intermediate dose in combination with intensive chemotherapy and compare the toxicities and outcome of patients treated in the imatinib cohort -SHOP 05- with those treated without imatinib -SHOP 94 and SHOP 99- (historical controls).
children with Ph+ALL aged 1–18 years treated in 39 institutions in Spain were enrolled in three consecutive SHOP-ALL trials (SHOP 94/SHOP 99/SHOP 05) from February-1994 to April-2010. Imatinib, at a dose of 260 mg/m2/d was added to an intensive chemotherapy regimen since day-15 of induction treatment in SHOP 05. Allogeneic SCT from matched sibling donor (MSD) or matched unrelated donor (MUD) was scheduled in CR1 in all trials. Toxicities were graded following WHO criteria. Survival analysis was determined by the Kaplan-Meier estimate.
a total of 47 patients out of 1436 pediatric ALL were enrolled during the study period (SHOP 94: 8, SHOP 99: 23, SHOP 05: 16). Four patients enrolled in SHOP 99 trial were excluded from the analysis for protocol violation (imatinib treatment in CR1 in a pre-imatinib protocol). Among 43 evaluable patients, 16 were treated with continuous intermediate-dose imatinib as per SHOP 05 protocol whereas 27 received a similar chemotherapy backbone treatment without imatinib. There were 22 boys (51.2%) and median age was 6.8 years, range 1.2–15. Median WBC (109/L) was 41, range 2.8–481.2. Three patients (7.3%) had CNS involvement at diagnosis. Main clinical characteristics at presentation were comparable among the three trials.
All patients in the imatinib cohort (SHOP 05) and 24 out of 27 patients in the non-imatinib cohort (SHOP 94/99) achieved CR1 after induction treatment, with 3 refractory patients in the non-imatinib cohort. Imatinib in combination with intensive chemotherapy was in general well tolerated. There were no induction deaths in our series. One patient in the imatinib group died in CR1 due to an infection prior to SCT. There were more grade III-IV transaminase (ALT) elevations in consolidation in patients receiving imatinib (7 out of 16) than in those not receiving it (2 out of 19). Hepatic failure or bilirrubin elevation greater than grade I were not observed in these cases and ALT elevations were transient without imatinib discontinuation or dose-adjustment. Hematological toxicities were similar in patients treated with or without imatinib, and no unexpected treatment delay was observed. No pleural effusions were reported. Thirty patients underwent an allogeneic SCT in first CR, 17 out of 27 (63%) patients in trials SHOP 94/99 (non-imatinib cohort) and 13 out of 16 (81%) patients in trial SHOP 05 (imatinib cohort). Median time to SCT was 6.4 months (range 3–14.8). Transplant related mortality was 19.5%. Ten patients relapsed (non imatinib cohort: 9, imatinib cohort: 1), at a median time of 17.6 months (range 8.3–35.2). Median follow-up of the trials SHOP 94/99 (pre-imatinib) and SHOP 05 (imatinib) was 113 and 30 months respectively. Event-free survival (EFS) at 30 months was 33.3% (+/−9.1%) and 75.2 % (+/−12.6) respectively (p = 0.032) and overall survival (OS) at 30 months was 38.46% (+/−9.5%) and 84.6 (+/−10%) respectively (p=0.029).
Intermediate dose of imatinib (260 mg/m2/day) given concomitantly with chemotherapy and followed by allogeneic SCT (MSD or MUD) had an acceptable toxicity profile and markedly improved early EFS and OS in pediatric Ph+ALL. Longer follow-up is needed to assess the effect of imatinib on long-term EFS.
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Off Label Use: Imatinib is a tyrosine-kinase inhibitor approved for the treatment of chronic myeloid leukemia. Its use in acute lymphoblastic leukemia Philadelphia positive has not been approved yet although preliminar results show promising results.
Current concepts on the location and functional significance of nicotinic receptors in the carotid body rest on
α-bungarotoxin binding and autoradiographic studies. Using an in vitro preparation of ...the cat carotid body whose catecholamine deposits have been labeled by prior incubation with the tritiated natural precursor
3Htyrosine, we have found that nicotine induces release of
3Hcatecholamines in a dose-dependent manner (IC
50=9.81
μM). We also found that mecamylamine (50
μM) completely abolished the nicotine-induced release, while
α-bungarotoxin (100 nM; ≈20 times its binding
K
d) only reduced the release by 56%. These findings indicate that chemoreceptor cells, and perhaps other carotid body structures, contain nicotinic receptors that are not sensitive to
α-bungarotoxin and force a revision of the current concepts on cholinergic mechanisms in the carotid body chemoreception.
Fragmenta chorologica occidentalia Alfredo J. Veiga; Javier Cremades; Ignacio Bárbara ...
Anales del Jardín Botánico de Madrid (1979),
06/1998, Letnik:
56, Številka:
1
Journal Article
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