Abstract
Background
Patients who acquire infective endocarditis (IE) following contact with the healthcare system, but outside the hospital, are classified as having non-nosocomial ...healthcare-associated IE (HCIE). Our aim was to characterize HCIE and establish whether its etiology, diagnosis, and therapeutic approach suggest it should be considered a distinct entity.
Methods
This study retrospectively analyzes data from a nationwide, multicenter, prospective cohort including consecutive cases of IE at 45 hospitals across Spain from 2008 to 2021. HCIE was defined as IE detected in patients in close contact with the healthcare system (eg, patients receiving intravenous treatment, hemodialysis, or institutionalized). The prevalence and main characteristics of HCIE were examined and compared with those of community-acquired IE (CIE) and nosocomial IE (NIE) and with literature data.
Results
IE was diagnosed in 4520 cases, of which 2854 (63%) were classified as CIE, 1209 (27%) as NIE, and 457 (10%) as HCIE. Patients with HCIE showed a high burden of comorbidities, a high presence of intravascular catheters, and a predominant staphylococcal etiology, Staphylococcus aureus being identified as the most frequent causative agent (35%). They also experienced more persistent bacteremia, underwent fewer surgeries, and showed a higher mortality rate than those with CIE (32.4% vs 22.6%). However, mortality in this group was similar to that recorded for NIE (32.4% vs 34.9%, respectively, P = .40).
Conclusions
Our data do not support considering HCIE as a distinct entity. HCIE affects a substantial number of patients, is associated with a high mortality, and shares many characteristics with NIE.
Non-nosocomial healthcare-associated infective endocarditis (HCIE) occurs when patients acquire the infection outside the hospital but following contact with the healthcare system. Our data showed that HCIE affects many patients, has high mortality, and shares many similarities with nosocomial infective endocarditis.
To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis ...(SPVE).
From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on β-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin.
Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84–11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03–6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29–3.38) in the multivariable analysis.
The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.
The differentiation of influenza and COVID-19 could constitute a diagnostic challenge during the ongoing winter due to their clinical similitude. Thus, novel biomarkers that enable distinguishing ...both diseases are required. Here, we evaluated whether the surfactant protein D (SP-D), a collectin produced at the alveolar epithelium with known immune properties, was useful to differentiate pandemic influenza A(H1N1) from COVID-19 in critically ill patients. Our results revealed high serum SP-D levels in severe pandemic influenza but not COVID-19 patients. This finding was validated in a separate cohort of mechanically ventilated COVID-19 patients who also showed low plasma SP-D levels. However, plasma SP-D levels did not distinguish seasonal influenza from COVID-19 in mild-to-moderate disease. Finally, we found that high serum SP-D levels were associated with mortality and renal failure among severe pandemic influenza cases. Thus, our studies have identified SP-D as a unique biomarker expressed during severe pandemic influenza but not COVID-19.
Prevalence of metabolic syndrome and progression of nephropathy depend on sex. We examined a protective effect of estradiol against nephropathy in metabolic syndrome through the modulation of the ...arachidonic acid metabolism by activating the 5-lipoxygenase and cytochrome p450 4A pathways. 28 female Wistar rats were divided into four groups of seven animals each: control, intact metabolic syndrome, ovariectomized metabolic syndrome, and metabolic syndrome ovariectomized plus estradiol. Blood pressure, body weight, body fat, triglycerides, insulin, HOMA-index, albuminuria, and TNF-
α
were increased in ovariectomized metabolic syndrome rats (
p
<
0.001
). The perfusion pressure in isolated kidneys of ovariectomized metabolic syndrome rats in presence of 4
μ
g of arachidonic acid was increased. The inhibitors of the arachidonic acid metabolism Baicalein, Miconazole, and Indomethacin in these rats decreased the perfusion pressure by 57.62%, 99.83%, and 108.5%, respectively and they decreased creatinine clearance and the arachidonic acid percentage. Phospholipase A
2
expression in the kidney of ovariectomized metabolic syndrome rats was not modified. 5-lipoxygenase was increased in metabolic syndrome ovariectomized rats while cytochrome p450 4A was decreased. In conclusion, the loss of estradiol increases renal damage while the treatment with estradiol benefits renal function by modulating arachidonic acid metabolism through the 5-lipoxygenase and cytochrome p450 4A pathways.
Summary Objective To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery. Methods ...Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals. Results A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child–Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23–1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery. Conclusions Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.
Quantitative determination of the hydration structure of hexaaquairidium(III), Ir(H2O)63+, in aqueous solution, the most inert aqua ion known, has been achieved for the first time by a combined ...experimental-theoretical approach employing X-ray absorption spectroscopy and molecular dynamics (MD) simulations. The Ir LIII-edge extended X-ray absorption fine structure (EXAFS) spectrum and LI-, LII-, and LIII-edge X-ray absorption near-edge structure (XANES) spectra of three concentrations of Ir(H2O)63+ in perchloric acid media were measured. To carry out classical MD simulations of the aqua ion in water, a new set of first-principles Ir-H2O intermolecular potentials, based on the hydrated ion concept, has been developed. Structural, dynamics, and energetic properties have been obtained from the analysis of the statistical trajectories generated. The Ir-O radial distribution function shows two well-defined peaks at 2.04 +/- 0.01 and 4.05 +/- 0.05 A corresponding to the first and second hydration shell, respectively; the fundamental frequencies for the aqua ion in water are well reproduced by the MD simulation, and its dynamic properties are similar to the experimental values corresponding to other hexahydrated trivalent ions. Particular attention has been devoted to the experimental determination of the second hydration shell. It has been found that contrarily to what expected on the basis of the inertness of the Ir3+ aquaion, the detection of the second hydration shell by EXAFS for this cation is more difficult than for others less inert aqua ions such as Cr3+ or Rh3+. But when combined with MD simulations it is possible to confirm the coordination distance for this shell at 4.1 +/- 0.1 A. In addition, the computation of LI, LII and LIII XANES spectra were carried out using the structural information obtained from MD. These computations allowed the assignment of special features of the spectra to the second hydration shell on a quantitative basis. Therefore, interestingly XANES spectra have given a stronger support to the second hydration shell than EXAFS. The fit of the LIII-edge EXAFS gives an accurate description of the first hydration shell structure in aqueous solution. The value for Ir-O first shell is 2.04 +/- 0.01 A. The statistical information available with the MD results has allowed the analysis of the standard deviation associated with the computation of the XANES spectrum. It is shown that the standard deviation increases with the number of hydration shells and this increase is nonuniform along the average spectrum.
En un momento de grandes cambios, la docencia universitaria no se encuentra ajena a los retos y necesidades planteados por la sociedad en la que desenvuelve su actividad. Juega una especial ...importancia el papel de la mujer como agente dinamizador de la actividad económica. En este sentido la universidad debe de tratar de fomentar el espíritu emprendedor entre el alumnado. Según esto, este proyecto se orienta hacia la elaboración de material docente para la mejora de la visibilización del rol empresarial de la mujer mediante la elaboración de casos de emprendimiento femenino. El material docente se ha materializado en un libro coeditado por el Consejo Social de la universidad de Córdoba, la Fundación Caja Rural del Sur y la editorial Tirant lo Blanc (indexada en el primer cuartil del índice SPI). Dicho material proporciona una variada selección de casos reales que el alumno puede consultar convirtiéndose así en un complemento didáctico esencial en la Asignatura de Creación de Empresas. Además, a medio plazo, este libro, mediante su continua utilización en próximos cursos, podría permitir hacer un seguimiento y medición de las tasas de respuesta en intención emprendedora entre los alumnos.
Seventeen patients with Philadelphia (Ph) chromosome-positive chronic myeloid leukemia (CML) were treated with the ICE regimen plus G-CSF with the aim of mobilizing and collecting Ph-negative ...peripheral stem cells (PSC) in the setting of an autotransplant program. Fifteen patients had CML in first chronic phase (CP), and two in accelerated phase (AP). Three patients had been previously treated with interferon alpha 2a (IFN). Twelve patients underwent leukaphereses and a mean of 4.7 x 10(8)/kg mononuclear cells were obtained. Four CP patients did not show a significant mobilization peak of CD34+ cells and leukapheresis was not performed; finally, one patient died before apheresis could be performed. Six of the 12 who underwent leukaphereses obtained more than 1.0 x 10(6)/kg CD34+ cells. Eight of the 12 mobilized patients (67%) obtained a major cytogenetic response, including two complete and six partial; in the remaining four patients minimal or absent cytogenetic responses were observed. A higher rate of Ph purging was obtained in patients mobilized early or showing residual Ph-negative cells before mobilization, even if they were in AP. Infectious complications were frequent with a 38% rate of bacteremia recorded and one case of pulmonary aspergillosis resulting in a toxicity similar to that occurring in acute myeloid leukemia-induction chemotherapy. The ICE regimen can promote 'in vivo' purging of the Ph+ cells in 67% of CML mobilized patients (8/12). Failure of mobilization occurs in 65% of patients (11/17), mainly because of poor CD34+ cell yield.
La capacidad oxidativa del musculo puede ser valorada mediante el analisis de la actividad de tres enzimas aerobias: CS (citrato sintasa), SDH (succinato deshidrogenasa) y HAD (3-OH-Acil CoA ...deshidrogenasa). El caballo se distingue por su importante capacidad aerobia, confirmada por las elevadas actividades CS y HAD expuestas en estudios comparativos con otras especies animales. Dentro de la musculatura equina, el gluteo medio y, mas concretamente, sus porciones internas muestran actividades CS y HAD altas. La edad y el crecimiento fisico, en general, conducen hacia una potenciacion de la capacidad oxidativa muscular, apreciandose un incremento de mayor magnitud entre los 2 y 3 anos. El entrenamiento produce un efecto similar, especialmente aquel disenado para resistencia, al contrario de lo que ocurre con las enzimas anaerobias, cuya respuesta adaptativa al ejercicio fisico continuado suele ser de escasa magnitud. El desentrenamiento puede conllevar un mantenimiento de la capacidad oxidativa, o un descenso, dependiendo de la mejoria lograda tras el entrenamiento o de la intensidad de la actividad realizada durante el periodo de desentrenamiento.
Les caracteristiques metaboliques d'un muscle peuvent etre analysees a partir des rapports entre les enzymes representant les voies principales de resynthese de l'energie. L'objectif de ce travail a ...donc ete d'effectuer une analyse comparative des muscles locomoteurs bovins sur le plan enzymatique. Des biopsies musculaires ont ete realisees sur 24 taureaux de combat males, d'un age compris entre 4 et 5 ans et appartenant a 4 elevages differents. Quatre echantillons ont ete preleves sur chaque animal: 2 au niveau du muscle semitendineux (ST) et 2 autres echantillons sur le fessier moyen (GM), a des profondeurs absolues de 30 et 50 mm. Les activites des enzymes CS (potentiel oxydant du cycle de Krebs), HAD (beta-oxydation lipidique), HK (phosphorylation du glucose), PHOS (glycogenolyse) et LDH (capacite glycolique) ont ete analyses. Puis, les rapports enzymatiques suivants ont ete consideres: PHOS/LDH; HK/CS; HAD/CS; LDH/CS et PHOS/HK. Certaines differences ont ete observees entre les deux muscles et les differentes profondeurs. Ainsi, le rapport HK/CS ne presentait pas de differences entre le ST et le GM, tandis que le rapport LDH/CS etait le plus eleve dans le ST a 30 mm et dans le GM a 50 mm. Aucune difference metabolique n'a ete mise en evidence dans le muscle GM entre 30 et 50 mm pour le rapport HK/CS et le rapport LDH/CS. En revanche, dans le muscle ST, le rapport LDH/CS et le rapport HK/CS etaient significativement plus eleves a 30 mm qu'a 50 mm. Les differences les plus marquees sont apparues lors de la comparaison d'animaux de differents elevages. En conclusion, les principales differences metaboliques entre les 2 muscles ont ete les rapports entre les capacites d'emploi des sources energetiques extracellulaires, pour oxyder le coenzyme A dans le cycle de Krebs et pour reduire le pyruvate en lactate
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