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

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Miradas desde la historia social y la historia intelectual: América Latina en sus culturas: de los procesos independistas a la globalización

Fil: Benito Moya, Silvano G. A. Universidad Católica de Córdoba. Facultad de Filosofía y Humanidades; Argentina.Fil: Universidad Católica de Córdoba. Facultad de Filosofía y Humanidades; Argentina

Herpes zóster diseminado: caso clínico y revisión bibliográfica

Herpes zoster classical clinical presentation is the acute onset of multiple vesicles over an erythematous base, disposed over one or two dermatomes with up to 20 vesicles located outside the main dermatome. Disseminated herpes zoster is an atypical and rare form of presentation of herpes zoster, which manifests with lesions beyond the described territory. It occurs mainly in patients with some type of cellular immunosuppression. The diagnosis is made with the medical history and physical examination, however, it should be confirmed with laboratory tests. Treatment must be initiated early to avoid serious complications, such as bacterial infection of the lesions, post-herpetic neuralgia, or even central nervous system involvement. The drug of choice is intravenous acyclovir that must be maintained until the cessation of the appearance of new lesions, and then switch to its oral presentation for another 5-7 days. Disseminated herpes zoster mortality rounds 5-15%. There are varicella-zoster virus vaccines, that have been shown to reduce the incidence of herpes zoster relapses, however its utility to disseminated herpes zoster is uncertain and further studies are required. We present the case of a male patient with a history of rheumatoid arthritis who consults with multiple vesicles distributed throughout his body

Enfermedad de Grover, una patología ampollar poco frecuente: a propósito de 2 casos

Introduction: Grover’s disease (GD) or transient acantholytic dermatosis, is a papulovesicular pruritic disease of unknown etiology. It´s most important histopathological finding is the presence of focal acantholysis. The incidence has not been firmly established. Case report: We report two cases of papulovesicular rashes, the first one in a 79 year old man with good response to second line treatment and the second one, in a 30 year old woman. Both with different suspected triggering factors. Comment: GD predominates in white men with an average age of presentation of 61. Clinically, it presents as erythematous papules, crusted-papule and is usually pruritic. The etiopathology is still unknown, but it is associated with triggers such as: ultraviolet radiation (UVR), ionizing radiation, heat, sweat, friction and chemotherapy. Acantholysis is the classic histological finding. Management includes general measures, topical corticosteroids, calcineurin inhibitors, tretinoin, calcipotriene and antihistamines. In refractory cases, second-line treatment is used: oral isotretinoin, systemic corticosteroids and phototherapy. Paradoxically, phototherapy can also trigger GD. Conclusions: Due to the low prevalence of GD in Chile, 2 new cases are provided to the literature. In both cases, the diagnostic presumption was based on an exhaustive clinical history, confirmed by histopathological findings

Sarcoidosis subcutánea sin compromiso sistémico

We present the case of a 52 year old woman with a history of bilateral ovarian cancer operated. The patient attended the dermatology unit for a sudden onset of a left plantar nodule of three weeks of evolution, painful on walking, with no other history in particular. At physical examination, the patient presented a surface nodule slightly hyperpigmented, with ill-defined edges, round shape, firm consistency, mobile and painful to compression, one cm of diameter, in the middle third of the left plant. No concomitant scars are seen. Doppler soft tissue ultrasound is requested, showing a granulomatous nodule on the surface of the plantar aponeurosis. The biopsy lesion revealed non-caseating granulomas in cell tissue, PAS and Ziehl-Neelsen staining are negative A left plantar subcutaneous sarcoidosis is diagnosed, systemic involvement is ruled out. Within the first year of follow-up, there are no new lesions or findings compatible with systemic disease

Evaluation of the antimicrobial potential of digested and undigested carob phenolic extracts: Impact on selected gut microbiota

Carob pulp is a natural source of polyphenols, which have been shown to possess health benefits. These compounds play a crucial role in initiating, shaping, and modulating the gut microbiota. The objective of this study was to evaluate the impact of carob pulp phenolic extracts on nine specific groups of human gut microbiota before and after in vitro gastrointestinal digestion. The effects of pure gallic and coumaric acids were also tested. The results showed that the treated phenolic compounds exhibited inhibitory effects on the growth of most pathogenic bacteria. Gallic acid, in particular, demonstrated the most potent antimicrobial effect on Listeria monocytogenes , reducing its growth to below 5%. Staphylococcus aureus and Escherichia coli showed a growth reduction of up to 10%. Furthermore, both phenolic acids, before and after digestion, led to a slight reduction in E. coli O157:H7 numbers. Probiotic bacteria experienced minimal decrease following exposure to phenolic extracts. However, the growth of Lactobacillus casei ssp . rhamnosus was significantly inhibited by almost 50%. Interestingly, the in vitro digestion process exhibited a stronger antibacterial effect against pathogenic bacteria compared to probiotic bacteria. These results highlight the potential of carob phenolic extracts in modulating the intestinal microbiota, thereby offering interesting prospects for the development of diet-based health strategies

Highly responsive UV-photodetectors based on single electrospun TiO2 nanofibres

In this work we study the optoelectronic properties of individual TiO2 fibres produced through coupled sol-gel and electrospinning, by depositing them onto pre-patterned Ti/Au electrodes on SiO2/Si substrates. Transport measurements in the dark give a conductivity above 2 × 10-5 S, which increases up to 8 × 10-5 S in vacuum. Photocurrent measurements under UV-irradiation show high sensitivity (responsivity of 90 A W-1 for 375 nm wavelength) and a response time to illumination of ∼5 s, which is superior to state-of-the-art TiO2-based UV photodetectors. Both responsivity and response speed are higher in air than in vacuum, due to oxygen adsorbed on the TiO2 surface which traps photoexcited free electrons in the conduction band, thus reducing the recombination processes. The photodetectors are sensitive to light polarization, with an anisotropy ratio of 12%. These results highlight the interesting combination of large surface area and low 1D transport resistance in electrospun TiO2 fibres. The simplicity of the sol-gel/electrospinning synthesis method, combined with a fast response and high responsivity makes them attractive candidates for UV-photodetection in ambient conditions. We anticipate their high (photo) conductance is also relevant for photocatalysis and dye-sensitized solar cells

El aborto ante la Corte IDH: a propósito del caso "Beatriz Vs. El Salvador"

Resumen: Por primera vez en su historia, el tribunal regional tiene entre manos la resolución de un caso específico sobre aborto. Se trata del caso “Beatriz vs. El Salvador”, en el que la Comisión Interamericana de Derechos Humanos (CIDH) ha requerido a la Corte Interamericana (Corte IDH) que declare que el Estado salvadoreño es responsable por no proveer el “acceso a una interrupción legal, temprana y oportuna” del embarazo a una mujer, con una enfermedad de base, que gestaba en su vientre a una niña con anencefalia. El caso “Beatriz vs. El Salvador” proyecta al ámbito del Sistema Interamericano de Derechos Humanos (SIDH) una de las discusiones más álgidas de nuestro tiempo. Ciertamente, la regulación del aborto –y su contracara, los alcances de la protección de la vida humana prenatal– es objeto de incesantes debates en todo el globo. En ese contexto de desencuentros, algunos países fueron erosionando la clásica prohibición del aborto, mediante cambios normativos y jurisprudenciales. En El aborto ante la corte IDH: a propósito del Caso Beatriz Vs. El Salvador investigadores y académicos de distintos países se abocaron a la búsqueda de respuestas desde perspectivas diversas. El resultado de sus hallazgos (y otros nuevos interrogantes) está plasmado en los capítulos que son el corazón de este libro colectivo.Contenido: Introducción. Una hoja de ruta del caso “Beatriz vs. El Salvador” / Débora Ranieri de Cechini, Sofía Calderone -- Parte I: Derechos humanos, dignidad y razonabilidad en la encrucijada de la interpretación -- La dignidad humana en el Derecho Internacional de los Derechos Humanos y el caso “Beatriz y otros vs. El Salvador”/ Paolo G. Carozza -- Interpretación convencional y populismo. Una aproximación desde el caso “Beatriz” / Juan Cianciardo -- “Artavia Murillo”, “Beatriz”, y la disolución del Rule of Law / Pilar Zambrano -- Lo que realmente importa no son los tratados, sino el modo en que funciona, en la práctica, el Sistema Interamericano de Derechos Humanos / Max Silva Abbott - Parte II: Protección de la vida humana no nacida y aborto en el Sistema Interamericano de Derechos Humanos -- Claves para la resolución del caso “Beatriz”: el estatus jurídico del aborto y la protección del no nacido / Gabriela García Escobar; José Gilberto Solís Jiménez -- Parte III: Embarazo de riesgo, diagnóstico de anencefalia y regulación del aborto: perspectivas -- Cuidados paliativos y psicología perinatal en familias con diagnóstico de anencefalia: un aporte desde las ciencias de la salud /Graciela Moya; Ivanna Dehollainz -- El caso “Beatriz” y el aborto de personas con discapacidad / Jorge Nicolás Lafferriere -- La noción de tortura, tratos crueles, inhumanos y degradantes en el derecho internacional de los derechos humanos: consideraciones a propósito del caso “Beatriz y otros vs. El Salvador”/ María Carmelina Londoño Lázaro