Recurrencia de endocarditis infecciosa: factores de riesgo de recidiva y reinfección

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de Lectura: 05-07-202

Using machine learning and information visualisation for discovering latent topics in Twitter news

We propose a method to discover latent topics and visualise large collections of tweets for easy identification and interpretation of topics, and exemplify its use with tweets from a Colombian mass media giant in the period 2014--2019. The latent topic analysis is performed in two ways: with the training of a Latent Dirichlet Allocation model, and with the combination of the FastText unsupervised model to represent tweets as vectors and the implementation of K-means clustering to group tweets into topics. Using a classification task, we found that people respond differently according to the various news topics. The classification tasks consists of the following: given a reply to a news tweet, we train a supervised algorithm to predict the topic of the news tweet solely from the reply. Furthermore, we show how the Colombian peace treaty has had a profound impact on the Colombian society, as it is the topic in which most people engage to show their opinions.Comment: 10 pages, 6 figures, to be presented at SmartTech-IC 201

Learning from students' perception on professors through opinion mining

Students' perception of classes measured through their opinions on teaching surveys allows to identify deficiencies and problems, both in the environment and in the learning methodologies. The purpose of this paper is to study, through sentiment analysis using natural language processing (NLP) and machine learning (ML) techniques, those opinions in order to identify topics that are relevant for students, as well as predicting the associated sentiment via polarity analysis. As a result, it is implemented, trained and tested two algorithms to predict the associated sentiment as well as the relevant topics of such opinions. The combination of both approaches then becomes useful to identify specific properties of the students' opinions associated with each sentiment label (positive, negative or neutral opinions) and topic. Furthermore, we explore the possibility that students' perception surveys are carried out without closed questions, relying on the information that students can provide through open questions where they express their opinions about their classes

Bacilos gramnegativos multirresistentes. Cuándo tenerlos en cuenta y cómo tratarlos a día de hoy

Infections due to multiresistant gram-negative bacilli are frequent and associated with elevated morbidity and mortality. It is important to recognize those patients at high risk. Its clinical management is complex, having witnessed important developments in recent years. Among these developments, we have new antibiotics, such as ceftolozane/tazobactam or ceftazidime/avibactam. We present a case of a 50 year-old man, with a recent liver transplant, that is admitted with pneumonia caused by multidrug-resistant Klebsiella pneumoniae, including carbapenemic resistance.Las infecciones por bacilos gramnegativos multirresistentes son frecuentes y con elevada morbimortalidad, siendo importante reconocer a aquellos pacientes con riesgo alto. Su manejo es complejo y ha presenciado en los últimos años novedades importantes. Entre ellas, encontramos el uso de nuevos antibióticos, como ceftolozano/tazobactam o ceftazidima/avibactam. Presentamos un caso de varón de 50 años, con trasplante hepático reciente, que ingresó por una neumonía por Klebsiella pneumoniae multirresistente, incluyendo resistencia a carbapenémicos

Sequential oral antibiotic in uncomplicated Staphylococcus aureus bacteraemia: a propensity-matched cohort analysis

Objectives: We aimed to analyse the efficacy and safety of oral sequential therapy (OST) in uncomplicated Staphylococcus aureus bacteraemia (SAB). Methods: Single-centre observational cohort at a tertiary hospital in Spain, including all patients with the first SAB episode from January 2015 to December 2020. We excluded patients with complicated SAB and those who died during the first week. Patients were classified into the OST group (patients who received oral therapy after initial intravenous antibiotic therapy [IVT]), and IVT group (patients who received exclusively IVT). We performed a propensity-score matching to balance baseline differences. The primary composite endpoint was 90-day mortality or microbiological failure. Secondary endpoints included 90-day SAB relapse. Results: Out of 407 SAB first episodes, 230 (56.5%) were included. Of these, 112 (n = 48.7%) received OST and 118 (51.3%) IVT exclusively. Transition to oral therapy was performed after 7 days (interquartile range, 4–11). The primary endpoint occurred in 10.7% (11/112) in OST vs. 30.5% (36/118) in IVT (p < 0.001). SAB relapses occurred in 3.6% (4/112) vs. 1.7% (2/118) (p 0.436). None of the deaths in OST were related to SAB or its complications. After propensity-score matching, the primary endpoint was not more frequent in the OST group (relative risk, 0.42; 95% CI, 0.22–0.79). Ninety-day relapses occurred similarly in both groups (relative risk, 1.35; 95% CI, 0.75–2.39). Discussion: After an initial intravenous antibiotic, patients with uncomplicated SAB can safely be switched to oral antibiotics without apparent adverse outcomes. This strategy could save costs and complications of prolonged hospital stays. Prospective randomized studies are needed

Use of Monoclonal Antibodies in Immunocompromised Patients Hospitalized with Severe COVID-19: A Retrospective Multicenter Cohort

This work was supported by the Research Institute Puerta de Hierro-Segovia de Aranda (IDIPHSA), funding number 0040200108 (2.400€).Objective: We aim to describe the safety and efficacy of sotrovimab in severe cases of COVID-19 in immunocompromised hosts. Methods: We used a retrospective multicenter cohort including immunocompromised hospitalized patients with severe COVID-19 treated with sotrovimab between October 2021 and December 2021. Results: We included 32 patients. The main immunocompromising conditions were solid organ transplantation (46.9%) and hematological malignancy (37.5%). Seven patients (21.9%) had respiratory progression: 12.5% died and 9.4% required mechanical ventilation. Patients treated within the first 14 days of their symptoms had a lower progression rate: 12.0% vs. 57.1%, p = 0.029. No adverse event was attributed to sotrovimab. Conclusions: Sotrovimab was safe and may be effective in its use for immunocompromised patients with severe COVID-19. More studies are needed to confirm these preliminary data.Depto. de MedicinaFac. de MedicinaTRUEResearch Institute Puerta de Hierro-Segovia de Aranda (IDIPHSA)pu

Vigilancia intensificada sobre el Dengue y los primeros casos de dengue hemorrágico confirmados en Colombia durante el primer semestre de 1990

We show here the results obtained of the Active Surviellance of the National System of Health on Classic Dengue (CD), Classic Dengue with Hemorrhagic Feactures (CDIHF) Hemorrhagic Dengue (HD) and Hemnorrhagic Dengue with Socho Syndrome (HDI SS), during first semester in 1990. From the total 3.098 samples revieved, 568 CD (18%) were confirmed, 121 Showed Hemorrhagic Feactures (21 %) and 35 were considered as HD (6%), accoding to the OMS requirements including the last 35 cases, 9 of them presening shock (26%), on of which was fatal (3%). The reions showing more CD incidence were: Arauca and Casanare. For HD, the regions with high incidence in Colombia were Arauca, Magdalena and Norte de Santander.Se presentan los resultados arrojados por la Vigilancia Activa, ejercida por el Sistema Nacional de Salud, sobre Dengue Clásico (DC), Dengue Clásico con Manifestaciones Hemorrágicas (DC/MH), Dengue Hemorrágico (DH) y Dengue Hemorrágico con Síndrome de Shock (DH/SS), durante el primer semestre de 1990. De las 3.098 muestras recibidas se confirmaron 68 casos de DC (18%), 121 de ellos presentaron manifestaciones hemorrágicas (21%) y 35 llenaron los requisitos de la OMS para ser considerados como DH (6%). De estos últimos, 9 presentaron shock (26%), de los cuales uno fue fatal (3%). Las regiones con mayor incidencia de DC fueron: Arauca y Casanare, y para DH: Arauca, Magdalena y Norte de Santander. Por ser la primera vez que en Colombia se confirma la presencia de DH, se describen las principales características clínico-epidemiológicas observadas en los primeros casos presentados

Clinical Factors Associated with Reinfection versus Relapse in Infective Endocarditis: Prospective Cohort Study

We aimed to identify clinical factors associated with recurrent infective endocarditis (IE) episodes. The clinical characteristics of 2816 consecutive patients with definite IE (January 2008?2018) were compared according to the development of a second episode of IE. A total of 2152 out of 2282 (94.3%) patients, who were discharged alive and followed-up for at least the first year, presented a single episode of IE, whereas 130 patients (5.7%) presented a recurrence; 70 cases (53.8%) were due to other microorganisms (reinfection), and 60 cases (46.2%) were due to the same microorganism causing the first episode. Thirty-eight patients (29.2%), whose recurrence was due to the same microorganism, were diagnosed during the first 6 months of follow-up and were considered relapses. Relapses were associated with nosocomial endocarditis (OR: 2.67 (95% CI: 1.37?5.29)), enterococci (OR: 3.01 (95% CI: 1.51?6.01)), persistent bacteremia (OR: 2.37 (95% CI: 1.05?5.36)), and surgical treatment (OR: 0.23 (0.1?0.53)). On the other hand, episodes of reinfection were more common in patients with chronic liver disease (OR: 3.1 (95% CI: 1.65?5.83)) and prosthetic endocarditis (OR: 1.71 (95% CI: 1.04?2.82)). The clinical factors associated with reinfection and relapse in patients with IE appear to be different. A better understanding of these factors would allow the development of more effective therapeutic strategies

doi.org/10.1371/journal. pone.0250796

The aim was to analyze the characteristics and predictors of unfavorable outcomes in solid organ transplant recipients (SOTRs) with COVID-19. We conducted a prospective observational cohort study of 210 consecutive SOTRs hospitalized with COVID-19 in 12 Spanish centers from 21 February to 6 May 2020. Data pertaining to demographics, chronic underlying diseases, transplantation features, clinical, therapeutics, and complications were collected. The primary endpoint was a composite of intensive care unit (ICU) admission and/or death. Logistic regression analyses were performed to identify the factors associated with these unfavorable outcomes. Males accounted for 148 (70.5%) patients, the median age was 63 years, and 189 (90.0%) patients had pneumonia. Common symptoms were fever, cough, gastrointestinal disturbances, and dyspnea. The most used antiviral or host-targeted therapies included hydroxychloroquine 193/200 (96.5%), lopinavir/ritonavir 91/200 (45.5%), and tocilizumab 49/200 (24.5%). Thirty-seven (17.6%) patients required ICU admission, 12 (5.7%) suffered graft dysfunction, and 45 (21.4%) died. A shorter interval between transplantation and COVID-19 diagnosis had a negative impact on clinical prognosis. Four baseline features were identified as independent predictors of intensive care need or death: advanced age, high respiratory rate, lymphopenia, and elevated level of lactate dehydrogenase. In summary, this study presents comprehensive information on characteristics and complications of COVID-19 in hospitalized SOTRs and provides indicators available upon hospital admission for the identification of SOTRs at risk of critical disease or death, underlining the need for stringent preventative measures in the early post-transplant periodThis study was supported by Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016); co-financed by European Development Regional Fund “A way to achieve Europe”, Operative Program Intelligence Growth 2014-2020. EC and JSC received grants from the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Proyectos de Investigación sobre el SARSCoV-2 y la enfermedad COVID-19 (COV20/ 00370; COV20/00580). JSC is a researcher belonging to the program “Nicola´s Monardes”(C0059–2018), Servicio Andaluz de Salud, Junta de Andalucía, Spain. SS-A is supported by a grant from the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Proyectos de Investigación sobre el SARS-Co