Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Evidence of spatial clustering of childhood acute lymphoblastic leukemia cases in Greater Mexico City: report from the Mexican Inter-Institutional Group for the identification of the causes of childhood leukemia

BackgroundA heterogeneous geographic distribution of childhood acute lymphoblastic leukemia (ALL) cases has been described, possibly, related to the presence of different environmental factors. The aim of the present study was to explore the geographical distribution of childhood ALL cases in Greater Mexico City (GMC).MethodsA population-based case-control study was conducted. Children &lt;18 years old, newly diagnosed with ALL and residents of GMC were included. Controls were patients without leukemia recruited from second-level public hospitals, frequency-matched by sex, age, and health institution with the cases. The residence address where the patients lived during the last year before diagnosis (cases) or the interview (controls) was used for geolocation. Kulldorff’s spatial scan statistic was used to detect spatial clusters (SCs). Relative risks (RR), associated p-value and number of cases included for each cluster were obtained.ResultsA total of 1054 cases with ALL were analyzed. Of these, 408 (38.7%) were distributed across eight SCs detected. A relative risk of 1.61 (p&lt;0.0001) was observed for the main cluster. Similar results were noted for the remaining seven ones. Additionally, a proximity between SCs, electrical installations and petrochemical facilities was observed.ConclusionsThe identification of SCs in certain regions of GMC suggest the possible role of environmental factors in the etiology of childhood ALL

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

[Risk factors associated with cognitive impairment in aged: Cross-sectional study]

&lt;p&gt;&lt;strong&gt;Abstract&nbsp;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; With the increase in life expectancy, conditions related to older age have increased in incidence, one of these pathologies is Cognitive Impairment (CI), which has a prevalence of up to 28%, conditions that increase the presence of CI are known. However, there is controversy about the factors that increase the risk of CI.&nbsp;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; To determine the factors associated with cognitive impairment in older adults.&nbsp;&lt;strong&gt;Material and methods:&lt;/strong&gt; We conducted a cross-sectional, analytical, observational, retroprolective study that included adults ≥65 years of age, with no history of cerebral vascular event, cranioencephalic trauma. Demographic factors were analyzed, CI was assessed with the Mini Mental State Examination test. For statistical analysis we used Odds Ratio (OR) and 95% confidence interval (95% CI) for each factor and multiple logistic regression as multivariate analysis.&nbsp;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; 420 older adults were included, 61% were women, 32.6% with age &gt;75 years, 84.5% with schooling &lt;9 years, in the multiple logistic regression the following were independent factors for the presence of mild CI: dependence on basic activities of daily living (ADLs) with OR 5.88, absence of cognitive stimulation RM 4.50, age &gt;75 years OR 2.92, polypharmacy OR 2.16, uncontrolled blood pressure OR 1.92.&nbsp;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; ADLs dependence, absence of cognitive stimulation, age &gt;75 years, polypharmacy and uncontrolled blood pressure are risk factors associated with CI in older adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introducción: &lt;/strong&gt;con el aumento&lt;strong&gt;&nbsp;&lt;/strong&gt;en la esperanza de vida las condiciones relacionadas con mayor edad incrementaron su incidencia; una de estas patologías es el deterioro cognitivo (DC) que presenta una prevalencia de hasta el 28%, hoy en día se conocen condiciones que aumentan la presencia de DC. Sin embargo, existe controversia sobre los factores que aumentan el riesgo para su presencia.&nbsp;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objetivo:&lt;/strong&gt; determinar los factores asociados al deterioro cognitivo en adultos mayores. &lt;strong&gt;Material y métodos:&nbsp;&lt;/strong&gt;se realizó un estudio transversal, analítico, observacional, retroprolectivo que incluyó a adultos ≥ 65 años, sin antecedente de evento vascular cerebral o traumatismo craneoencefálico. Se analizaron factores demográficos, el DC se evaluó con la prueba Mini-Mental. Para el análisis estadístico se usó razón de momios (RM) e intervalo de confianza al 95% (IC95%) para cada factor y como análisis multivariado, regresión logística múltiple.&nbsp;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Resultados: &lt;/strong&gt;se incluyeron 420 adultos mayores, de los cuales el 61% eran mujeres, el 32.6% tenían edad&nbsp;&gt;&nbsp;75 años, el 84.5% con escolarización&nbsp;&lt;&nbsp;9 años. En la regresión logística múltiple los siguientes fueron factores independientes para la presencia de DC leve: la dependencia de actividades básicas de la vida diaria (ABVD), ausencia de estimulación cognitiva, edad &gt; 75 años, polifarmacia y descontrol de tensión arterial.&nbsp;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusión: &lt;/strong&gt;la dependencia de ABVD, ausencia de estimulación cognitiva, edad &gt; 75 años, polifarmacia y descontrol de la tensión arterial son factores de riesgo asociados al DC en adultos mayores.&lt;/p&gt

Hypervirulence and Multiresistance to Antibiotics in Klebsiella pneumoniae Strains Isolated from Patients with Hospital- and Community-Acquired Infections in a Mexican Medical Center

Klebsiella pneumoniae is a pathogenic bacterium associated with different infectious diseases. This study aimed to establish the different association profiles of virulence genes related to the hypermucoviscous phenotype (HM), capsular serotypes, biofilm formation, and multidrug resistance in K. pneumoniae strains from patients with hospital- and community-acquired infections. K. pneumoniae virulence genes and capsular serotypes were identified by PCR, antibiotic susceptibility by the Kirby&ndash;Bauer method, HM by the string test, and biofilm formation by measurement in polystyrene microtiter plates. Of a total of 150 strains from patients with hospital- (n = 25) and community-acquired infections (n = 125), 53.3% (80/150) were HM-positive and 46.7% (70/150) were HM-negative. HM-positive (68/80) and HM-negative (67/70) strains were biofilm-forming. Moreover, 58.7% (47/80) HM-positive and 57.1% (40/70) HM-negative strains were multidrug-resistant. Among HM-positive, HM-negative, and serotypes K1 (25/150), K2 (48/150), and non-K1/K2 strains, (77/150) the frequently detected adhesion genes were fimH, mrkD, ycfM, and kpn; entB, irp2, irp1, and ybtS, for iron acquisition; and rmpA for protectins. The gene association pattern fimH/kpn/mrkD/ycfM/entB/irp1/irp2/ybtS/fyuA (18/150) was frequent among the strains. K. pneumoniae strains from patients with hospital- and community-acquired infections demonstrated a wide diversity of virulence gene profiles related to phenotype (hypermucoviscosity, multidrug resistance, and biofilm formation) and serotypes