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

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Se desarrolla un proyecto de innovación educativa que pretende mejorar la comunicación, el trato y el respeto entre iguales, fomentando la convivencia y ayudando a detectar y afrontar problemas básicos en resolución de conflictos desde la práctica educativa diaria. El plan de trabajo se adapta a las necesidades del colegio con la organización de los recursos humanos y materiales. El proyecto se desarrolla en todos los cursos y niveles del centro implicando a toda la comunidad educativa y especialmente a las familias. En una primera fase se han llevado a acabo actividades de toma de contacto, sensibilización y formación de profesores, padres y alumnos. En una segunda fase, se desarrollan las actividades más participativas dirigidas a los alumnos en los diferentes niveles educativos. Y por último en una tercera fase, el inicio de las tutorías y actividades más específicas, con futura continuidad en los conocimientos básicos para la futura mediación entre iguales como estrategia en la resolución de conflictos en educación Primaria y Educación Secundaria. La metodología es fundamentalmente es activa, donde el profesorado y el alumnado son protagonistas del proceso de creación, desarrollo y aprendizaje. Los principios metodológicos utilizados son comunes a todas las actuaciones pedagógicas como trabajar la adquisición de estrategias de exploración y descubrimiento en el proceso de construcción de los conocimientos, partir de los conocimientos previos y aplicación de las nuevas tecnologías a la educación. Tras la aplicación del proyecto se ha dado una respuesta para favorecer el aprendizaje de loa alumnos y alumnas y se ha fomentado el trabajo en equipo. Se han desarrollado actitudes de respeto y valoración positiva adecuados a las necesidades educativas diarias en relación al trato con iguales, respeto sentimientos y empatía.Castilla y LeónConsejería de Educación. Dirección General de Universidades e Investigación; Monasterio de Nuestra Señora de Prado, Autovía Puente Colgante s. n.; 47071 Valladolid; +34983411881; +34983411939ES

Research, Innovation and Extension to the service to society, in the framework of the Sixth Conference on Social Appropriation of Knowledge (SAK)

Annually, the Technological University of Pereira has been carrying out some events in the line of Social Appropriation of Knowledge. This has been done through the research, innovation, and extension Vice Rectory, moreover, these sessions are framed within the institutional objective: “Define and direct the guidelines for the institutional research that strengthen the research groups and the Seedbeds, through the formation of researchers, the development of science, technology, and innovation projects or programs, as well as the generation of networks and strategic partnerships that contribute to the creation and appropriation of knowledge for the society”. Therefore, the 6th Social Appropriation of Knowledge event took place under the title of “The research, Innovation, and Extension at the service of society” which was constituted as an academic and institutional opportunity where the results of the research projects from the last 5 years were published. The results of this event revealed, once again, the high academic level in investigation development at the university. There were 11 articles divided into 6 fields: Health, Engineering, Technology, Education, Industrial Technology, and Art, in which the results obtained by the research projects from the investigation groups were shown, promoting a knowledge exchange from their authors whose intellectual formation is diverse. With this publication, as part of a permanent effort to socialize the knowledge, the university promotes the circulation of its professors, students, and general community voices, having in mind that knowledge must be transferred through different channels, strengthening the academy and society in general, according to the institutional mission that invites us to incentivize a research culture in the university community.Presentation........................................................................................................... 5 Chapter 1. Health Teaching during the pandemic: what changes did professors implement? Results of a survey in a Colombian medical program. ........................................... 9 Germán Alberto Moreno Gómez ,Rodolfo Adrián Cabrales Vega, Jairo Franco Londoño, Samuel Eduardo Trujillo Henao, Víctor Manuel Patiño Suárez Evaluation of the effectiveness of a rat, rabbit and human intestine decellularization protocol...................................................................................... 19 Julio César Sánchez Naranjo, Laura Victoria Muñoz Rincón, Andrés Felipe Quiroz Ma zuera, Andrés Mauricio García Cuevas, Cristhian David Arroyave Durán, Fabián David Giraldo Castaño, Álvaro Guerra Solarte, Juliana Buitrago Jaramillo Exploration of the filtering functions of the intestine through a filtering loop model: an experimental approach towards a feasible renal replacement.............. 31 Julio César Sánchez Naranjo, Laura Victoria Muñoz Rincón, Andrés Mauricio García Cuevas, Álvaro Guerra Solarte y Juliana Buitrago Jaramillo Chapter 2. Engineering Identification of sociodemographic factors using multivariate analysis related to the dropout of Universidad Tecnológica de Pereira undergraduate students.... 47 Nelcy N Atehortua-Sanchez, Paula Marcela Herrera, Julian D Echeverry Correa Design and Construction of an HVDC-MMC Terminal on a Low Scale to Interconnection of Windfarms to the Electrical Grid........................................ 61 Diego Alberto Montoya Acevedo, Andrés Escobar Mejía Chapter 3. Technologies Preliminary study of cytototoxic and bactericidal activities of nonpolar extracts from seeds and peel of Persea americana cv Lorena ............................................ 85 Gloria Edith Guerrero Alvarez, Daniel Steven Fernández, Daniela Londoño Ramirez Cytototoxic and bactericidal activities of nonpolar extracts from seeds and peel of Persea americana cv Hass..................................................................................... 95 Gloria Edith Guerrero Alvarez, Gustavo Alfonso Cifuentes Colorado, Paula Daniela Sandoval Mossos Chapter 4. Education Pedro Henríquez Ureña traveler and Cosmopolitan ........................................... 107 William Marín Osorio Reading and writing in the training of our teachers: a commitment of all ......... 133 María Gladis Agudelo Gil, Gloria Inés Correa Aristizábal Chapter 5. Industrial engineering Tasks design to promote metacognitive regulation in discrete event simulation ......................................................................................................... 151 María Elena Bernal Loaiza, Manuela Gómez Suta, Rosario Iodice CONTENIDO Chapter 6. Arts The media feuilleton, between fiction and reality............................................... 169 Teresita Vásquez Ramíre

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

CatedresBackground: To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods: Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results: Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions: Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women

COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study

CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization

Discovering HIV related information by means of association rules and machine learning

Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS-so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective

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

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. 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: A total of 3120 patients with IE (1327  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 th

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients