Varicella pneumonia associated with spontaneous popliteal arterial thrombosis in an adult: a case study and review of the literature

Introduction: Chickenpox is generally a childhood exanthematic benign self-limited disease. In contrast, most complications and fatal cases occur among adults, which is the group that suffers less commonly from this disease. The frequency of chickenpox in adults is increasing worldwide, together with the associated complications, mainly varicella pneumonia, which can lead to death. The incidence of other complications such as peripheral artery thrombosis is much lower but can cause important morbidity. Case presentation: We report the case of a 63-year-old male smoker, who was otherwise previously healthy, who was admitted to the Emergency Department with chickenpox and varicella pneumonia with respiratory insufficiency requiring mechanical ventilation and intensive care unit admission. During hospitalization, the patient developed spontaneous popliteal artery thrombosis that finally led to transfemoral amputation. Conclusions: Varicella pneumonia and peripheral artery thrombosis are two of the known complications of chickenpox. Both complications seem to be much more frequent in men with an active smoking habit. Clinicians should be aware of these complications in order to recognize them promptly and provide adequate treatment

Relación del índice cintura estatura con el riesgo coronario en adultos de la ciudad de Trujillo según edad y género

Objetivo:. Determinar una relación entre el índice cintura estatura (ICE)   con la  categorías de riesgo coronario según Panel de Expertos en Lípidos ATPIII  y valorarlo como factor de riesgo para la categoría de riesgo coronaria alta. Material y métodos: Estudio observacional, prospectivo, transversal, analítico realizado en Trujillo. Se incluyeron en el estudio a 652 adultos, 305 varones y 347 mujeres, entre 20 y 79 años atendidos en campañas desde 2013 a  2015. Las categorías de riesgo coronario fueron determinadas según ATP III y para el ICE se consideraron los rangos de riesgo de desarrollar enfermedad cardiovascular:  bajo <0,50, moderado 0,50-0,54 y alto ≥0,55. Resultados: Se encontró un OR para el ICE >=0.55 para categoría de riesgo coronario alto de  3.14 en varones , 3.15 en mujeres y 3.40 para la población general. El ICE de riesgo alto se acompañó significativamente de mayor frecuencia de categoría de riesgo coronario alto  según ATPIII  que en el ICE bajo  en varones, mujeres y la población general  y viceversa  el ICE bajo se acompañó significativamente de mayor frecuencia de  categoría de riesgo coronario bajo que en el ICE alto. Conclusiones: El índice cintura estatura  alto es un factor de riesgo para categoría de riesgo coronario alto.Palabras claves: índice cintura estatura, riesgo coronario, ATPII

Major bleeding in patients with pulmonary embolism presenting with syncope

[Introduction] Syncope has been shown to be a risk factor of bleeding in patients receiving thrombolytic therapy for acute pulmonary embolism (PE). Whether syncope predicts bleeding in a broader population of patients with PE remains unknown.[Methods] We used the RIETE registry data to assess whether initial presentation with syncope could predict bleeding in PE patients receiving anticoagulant therapy, and to explore the association between presence of syncope and timing and site of major bleeding events.[Results] Among 45,765 patients with acute PE from March 2001 to January 2021, 6760 (14.8%) had syncope. Patients with syncope were older and more likely to have hypotension, tachycardia, hypoxaemia or elevated troponin levels than those without syncope. They also were more likely to receive thrombolytics. During the first 90 days, 1097 patients (2.4%) suffered major bleeding (gastrointestinal 335, hematoma 271 and intracranial 163) and 3611 died (158 had fatal bleeding). Patients with syncope had a higher rate of major bleeding (odds ratio [OR]: 1.63; 95% CI: 1.41–1.89) and a nonsignificantly higher rate of fatal bleeding (OR: 1.47; 95% CI: 0.99–2.17) than those without syncope. Multivariable analysis confirmed that patients with syncope were at increased risk for major bleeding (adjusted hazard ratio [aHR]: 1.34; 95% CI: 1.15–1.55). On sensitivity analysis, the increased risk for major bleeding was confirmed in patients initially receiving anticoagulant therapy without thrombolytics at 7 days (aHR: 1.47; 95% CI: 1.13–1.91) and 90 days (aHR: 1.33; 95%CI: 1.13–1.56).[Discussion] Syncope is a predictor of major bleeding events in patients with PE, even among those receiving anticoagulation monotherapy.We express our gratitude to Sanofi Spain, LEO PHARMA and ROVI for supporting this Registry with an unrestricted educational grant.Peer reviewe

Elevated Neopterin Levels Predict Fatal Outcome in SARS-CoV-2-Infected Patients

International audienceHighlights: Innate immune activation during Covid-19 infection is associated with pernicious clinical outcome.Background: Coronavirus disease 2019 (Covid-19) is a worldwide threat that has already caused more than 3 000 000 deaths. It is characterized by different patterns of disease evolution depending on host factors among which old-age and pre-existing comorbidities play a detrimental role. Previous coronavirus epidemics, notably SARS-CoV, were associated with increased serum neopterin levels, which can be interpreted as a sign of acute innate immunity in response to viral infection. Here we hypothesize that neopterin may serve as a biomarker of SARS-CoV-2 viral infection and Covid-19 disease severity.Methods: We measured neopterin blood levels by ELISA. Seric concentration was quantified from 256 healthy donors and 374 Covid-19 patients at hospital admission. Enrolled Covid-19 patients were all symptomatic and displayed a large spectrum of comorbidities. Patients were followed until disease resolution or death.Results: Severe and critically ill SARS-CoV-2 infected patients were characterized by a profound exacerbation of immune activation characterized by elevated neopterin blood levels. Systemic neopterin levels above 19nM stratified healthy individuals from Covid-19 patients with 87% specificity and 100% sensitivity. Moreover, systemic neopterin levels above 53nM differentiated non-survivors from survivors with 64% specificity and 100% sensitivity.Conclusion: We propose that neopterin concentration measured at arrival to hospital is a hallmark of severe Covid-19 and identifies a high-risk population of pernicious clinical outcome with a need for special medical care

Rezafungin versus caspofungin for treatment of candidaemia and invasive candidiasis (ReSTORE): a multicentre, double-blind, double-dummy, randomised phase 3 trial

10.1016/s0140-6736(22)02324-8The Lancet4011037049-5

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes