Bacteriemia por Actinomyces odontolyticus

History. A 47-year-old male, HIV negative. He reported fever and an injury on his right groin with signs of infection. He had injected himself cocaine on that area. Tests. Blood cultures: A. odontolyticus. Computerized tomography: septic venous thrombosis with endoluminal gas in the common femoral vein, right iliac external and common femoral vein. Evolution. The patient admitted on licking the needle prior to drug injection. Enoxaparin and amoxicilin-clavulanate were initiated. Diagnosis. Bacteriemia and septic thrombophlebitis by A. odontolyticus. Discussion. A. odontolyticus is a common pathogen in the oral cavity and systemic infections in immunocompetent patients are rare.Clínica. Varón de 47 años, VIH negativo, con fiebre y herida infectada en ingle derecha de 11 días de evolución. Se había inyectado cocaína en la zona. Pruebas. Hemocultivos: se aisló A. odontolyticus. Tomografía computarizada: trombosis venosa séptica con gas endoluminal en la vena femoral común, ilíaca externa y común derecha. Evolución. El paciente admitió lamer la aguja antes de inyectarse. Se inició enoxaparina y amoxicilina-ácido clavulánico. Diagnóstico. Bacteriemia y tromboflebitis séptica por A. odontolyticus. Discusión. A. odontolyticus es un patógeno propio de la cavidad oral; las infecciones sistémicas en pacientes inmunocompetentes son muy poco frecuentes

Miocardiopatía por estrés: takotsubo

Clinic. A 83-year-old woman who presented with acute chest pain after an intense emotional stimulus. Diagnostic tests. EKG showed negative T waves in anterior and ultrasensitive troponins were raised. The echocardiogram showed an intensely depressed with akinesia media and distal segments of all sides and apex, with conventional coronary angiography systolic function without significant lesions. The MRI was consistent with stress cardiomyopathy (ECM) takotsubo. Discussion. of uncertain origin, the ECM can mimic myocardial infarction with normal coronary arteries and good prognosis.Clínica. Mujer de 83 años que consultó por dolor torácico agudo tras un estímulo emocional intenso. Pruebas diagnósticas. El electrocardiograma mostró ondas T negativas en cara anterior y las troponinas ultrasensibles estaban elevadas. El ecocardiograma mostró una función sistólica global intensamente deprimida con acinesia de los segmentos medios y distales de todas las caras y el ápex, con coronariografía convencional sin lesiones significativas. La imagen por RM era compatible con miocardiopatía de estrés (MCE-takotsubo). Discusión. De origen incierto, la MCE puede remedar un infarto de miocardio con coronarias normales y buen pronóstico

Predicting the onset and persistence of episodes of depression in primary health care. The predictD-Spain study: Methodology

Background: The effects of putative risk factors on the onset and/or persistence of depression remain unclear. We aim to develop comprehensive models to predict the onset and persistence of episodes of depression in primary care. Here we explain the general methodology of the predictD-Spain study and evaluate the reliability of the questionnaires used. Methods: This is a prospective cohort study. A systematic random sample of general practice attendees aged 18 to 75 has been recruited in seven Spanish provinces. Depression is being measured with the CIDI at baseline, and at 6, 12, 24 and 36 months. A set of individual, environmental, genetic, professional and organizational risk factors are to be assessed at each follow-up point. In a separate reliability study, a proportional random sample of 401 participants completed the test-retest (251 researcher-administered and 150 self-administered) between October 2005 and February 2006. We have also checked 118,398 items for data entry from a random sample of 480 patients stratified by province. Results: All items and questionnaires had good test-retest reliability for both methods of administration, except for the use of recreational drugs over the previous six months. Cronbach's alphas were good and their factorial analyses coherent for the three scales evaluated (social support from family and friends, dissatisfaction with paid work, and dissatisfaction with unpaid work). There were 191 (0.16%) data entry errors. Conclusion: The items and questionnaires were reliable and data quality control was excellent. When we eventually obtain our risk index for the onset and persistence of depression, we will be able to determine the individual risk of each patient evaluated in primary health car

Improvement in detecting cytomegalovirus drug resistance mutations in solid organ transplant recipients with suspected resistance using next generation sequencing

Objetives The aim of this study was to identify CMV drug resistance mutations (DRM) in solid organ transplant (SOT) recipients with suspected resistance comparing next-generation sequencing (NGS) with Sanger sequencing and assessing risk factors and the clinical impact of resistance. Methods Using Sanger sequencing as the reference method, we prospectively assessed the ability of NGS to detect CMV DRM in the UL97 and UL54 genes in a nationwide observational study from September 2013 to August 2016. Results Among 44 patients recruited, 14 DRM were detected by Sanger in 12 patients (27%) and 20 DRM were detected by NGS, in 16 (36%). NGS confirmed all the DRM detected by Sanger. The additional six mutations detected by NGS were present in <20% of the sequenced population, being located in the UL97 gene and conferring high-level resistance to ganciclovir. The presence of DRM by NGS was associated with lung transplantation (p = 0.050), the administration of prophylaxis (p = 0.039), a higher mean time between transplantation and suspicion of resistance (p = 0.038) and longer antiviral treatment duration before suspicion (p = 0.024). However, the latter was the only factor independently associated with the presence of DRM by NGS in the multivariate analysis (OR 2.24, 95% CI 1.03 to 4.87). Conclusions NGS showed a higher yield than Sanger sequencing for detecting CMV resistance mutations in SOT recipients. The presence of DRM detected by NGS was independently associated with longer antiviral treatment.Funding: M.A.M. was supported in part by: Agency for Health Technology Assessment and Research Supported by Ministerio de Economía y Competitividad, Instituto de Salud Carlos III (PS12/02131 and PI17/02150); Agència de Gestió d´Ajuts Universitaris I de Recerca, Generalitat de Catalunya, 2017 SGR 794; and Fundació Marató TV3 project code 201824

Predicting the onset and persistence of episodes of depression in primary health care. The predictD-Spain study: Methodology

Background: The effects of putative risk factors on the onset and/or persistence of depression remain unclear. We aim to develop comprehensive models to predict the onset and persistence of episodes of depression in primary care. Here we explain the general methodology of the predictD-Spain study and evaluate the reliability of the questionnaires used. Methods: This is a prospective cohort study. A systematic random sample of general practice attendees aged 18 to 75 has been recruited in seven Spanish provinces. Depression is being measured with the CIDI at baseline, and at 6, 12, 24 and 36 months. A set of individual, environmental, genetic, professional and organizational risk factors are to be assessed at each follow-up point. In a separate reliability study, a proportional random sample of 401 participants completed the test-retest (251 researcher-administered and 150 self-administered) between October 2005 and February 2006. We have also checked 118,398 items for data entry from a random sample of 480 patients stratified by province. Results: All items and questionnaires had good test-retest reliability for both methods of administration, except for the use of recreational drugs over the previous six months. Cronbach's alphas were good and their factorial analyses coherent for the three scales evaluated (social support from family and friends, dissatisfaction with paid work, and dissatisfaction with unpaid work). There were 191 (0.16%) data entry errors. Conclusion: The items and questionnaires were reliable and data quality control was excellent. When we eventually obtain our risk index for the onset and persistence of depression, we will be able to determine the individual risk of each patient evaluated in primary health care.The research in Spain was funded by grants from the Spanish Ministry of Health (grant FIS references: PI04/1980, PI0/41771, PI04/2450, and PI06/1442), Andalusian Council of Health (grant references: 05/403, 06/278 and 08/0194), and the Spanish Ministry of Education and Science (grant reference SAF 2006/07192). The Malaga sample, as part of the predictD-International study, was also funded by a grant from The European Commission (reference QL4-CT2002-00683)