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

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

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Migrant Farmworkers’ Exposure to Pesticides in Sonora, Mexico

Expanding agribusiness in Sonora, a state in Northern Mexico, has increased the demand for temporary migrant agricultural workers. Sonora is one of the top states in Mexico for pesticide utilization. We conducted an exploratory study to evaluate exposure to organophosphate (OP) and pyrethroid pesticides among migrant farmworkers. A sample of 20 migrant farmworkers was recruited from a large commercial grape farm during the harvest season. We administered a questionnaire on work activities, exposure characteristics, and socio-demographics. We collected urine samples to quantify pesticide metabolite concentrations. Most participants were originally from the state of Chiapas, Mexico, none had completed high school, and about half spoke an indigenous language as well as Spanish. The majority of participants had detectable concentrations of pyrethroid and organophosphate biomarkers. Geometric mean creatinine-adjusted concentrations for 3-phenoxybenzoic acid (1.83 µg/g), trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (0.88 µg/g), 4-fluoro-3-phenoxybenzoic acid (0.94 µg/g), 3,5,6-trichloro-2-pyridinol (3.56 µg/g), and para-nitrophenol (0.63 µg/g) were significantly higher than in the general United States’ population and Mexican Americans. Our results also suggest that migrant farmworkers in this region are exposed to pesticides at higher levels than other farmworkers’ studies. Farmworkers’ age, language, training on personal protective equipment, time at the farm, and season, were significant exposure determinants

Reducing Salmonella enterica serovar Enteritidis contamination in food: lytic bacteriophages in a homemade mayonnaise-like matrix

Background:Salmonella enterica serovar Enteritidis (SE) is one of the major causes of food-borne disease worldwide, mainly associated with the consumption of poultry products, such as eggs. Several control methods have been implemented in the egg production process, but they have not effectively reduced the outbreaks. Therefore, the use of bacteriophages for the biocontrol of food-borne pathogens is gaining increasing acceptance. Objective: To evaluate a bacteriophage cocktail's effectiveness in reducing SE counts in an experimentally contaminated mayonnaise-like matrix. Methods: Homemade mayonnaise was contaminated with SE (103 CFU/ml) with equal volume to a matrix (1:1) treated with a bacteriophage cocktail (five phages, MOI 105), and stored at 21 °C for 24 and 72 h. Bacterial counts were performed to evaluate the bio-controlling activity of the cocktail and compared with a contaminated but not treated group. Results: Significant reductions (up to 3.75 log10 CFU/ml) were observed in the bacteriophage-treated groups (p<0.0001). Conclusions: These results demonstrate the effectiveness of bacteriophages as biocontrol agents for Salmonella Enteritidis in a raw-egg-derivative foodstuff. Further studies are needed to prove the reduction in an undiluted homemade mayonnaise.Antecedentes:Salmonella enterica serovar Enteritidis (SE) é uma das principais causas de doenças transmitidas por alimentos em todo o mundo, principalmente associada ao consumo de produtos derivados de aves, como ovos. Diferentes métodos de controle foram implementados no processo de produção de ovos, mas não foram capazes de reduzir efetivamente os surtos nas pessoas. Por esse motivo, o uso de bacteriófagos para o controle biológico de patógenos de origem alimentar está ganhando crescente aceitação. Objetivo: Avaliar a eficácia de um coquetel de bacteriófagos na redução da contagem de SE em uma matriz experimentalmente semelhante a maionese contaminada. Método: A maionese caseira foi contaminada com SE (103 UFC/ml) no mesmo volume da matriz (1:1), tratada com uma mistura de bacteriófagos (cinco fagos, MOI 105) e armazenada a 21 °C por 24 e 72 h. As contagens bacterianas foram realizadas para avaliar a atividade de biocontrole da mistura e comparadas com um grupo contaminado, mas não tratado. Resultados: Reduções significativas (até 3,75 log10 UFC/ml) foram observadas nos grupos tratados com bacteriófagos (p<0,0001). Conclusões: Esses resultados demonstram a eficácia do uso de bacteriófagos como agentes de biocontrole de Salmonella Enteritidis em alimentos crus derivados de ovos, mas são necessários mais estudos para verificar a redução da maionese caseira não diluída.Antecedentes: La Salmonella enterica, serovar Enteritidis (SE), es una de las principales causas de enfermedades transmitidas por alimentos en todo el mundo, asociadas principalmente al consumo de productos avícolas tales como los huevos. Diferentes métodos de control se han ensayado en el proceso de producción de huevos, pero no han sido capaces de reducir eficazmente los brotes de salmonelosis en las personas. Por esta razón, el uso de bacteriófagos para el control biológico de patógenos transmitidos por los alimentos está ganando cada vez más aceptación. Objetivo: Evaluar la eficacia de un cóctel de bacteriófagos para reducir los recuentos de SE en una matriz similar a la de mayonesa contaminada experimentalmente. Método: La mayonesa casera fue contaminada con SE (103 UFC/ml) en igual volumen que la matriz (1:1), tratada con una mezcla de bacteriófagos (cinco fagos, MOI 105), y almacenada a 21 °C por 24 y 72 h. Se realizaron recuentos bacterianos para evaluar la actividad biocontroladora de la mezcla y compararlos con un grupo contaminado, pero no tratado. Resultados: Se observaron reducciones significativas (hasta 3,75 log10 CFU/ml) en los grupos tratados con bacteriófagos (p<0,0001). Conclusiones: Estos resultados demuestran la efectividad del uso de bacteriófagos como agentes de biocontrol de Salmonella Enteritidis en un alimento crudo derivado del huevo. Sin embargo, se necesita realizar más estudios para comprobar la reducción en mayonesa casera no diluida

Influencia del color de la placa cromotrópica en la captura accidental de fauna auxiliar en cultivo de pimiento bajo invernadero en el Campo de Cartagena

El uso de placas cromotrópicas para atrapar insectos perjudiciales, basado en su atracción por el color, está muy extendido en cultivos bajo invernadero de pimiento. En estos cultivos la lucha biológica contra las plagas conlleva la suelta de insectos predatores beneficiosos, pudiendo ser atraídos por esas trampas. El color de la placa influye en la especie y en el número de capturas realizadas. Estas trampas pueden ser de distinto material, plástico, papel, etc., siendo las más utilizadas las primeras. En el presente trabajo se ha estudiado el número de capturas no deseadas hechas de un insecto auxiliar, Aphidius colemani, predador de pulgones, en placas cromotrópicas de distinto color, colocadas en invernadero de pimiento entre los meses de febrero y junio. Los resultados preliminares indican cierta atracción por el color amarillo del insecto auxiliar, y una determinada inestabilidad del color amarillo en las trampas de papel.Programa F.E.D.E.R a través del I.M.I.D.A (proyecto P0I 07-004)

Legionella pneumophila as a Health Hazard to Miners: A Pilot Study of Water Quality and QMRA

Legionella pneumophila (L. pneumophila), the causative agent of legionellosis, is an aquatic bacterium that grows in warm water. Humans are only presented with a health risk when aerosolized water containing L. pneumophila is inhaled. In mining operations, aerosolized water is used as dust control and as part of the drilling operations, a currently ignored exposure route. This study characterized L. pneumophila concentrations in the mine's non-potable water and the relationship between L. pneumophila and chlorine concentrations. These concentrations informed a quantitative microbial risk assessment (QMRA) model to estimate the infection risk to miners exposed to aerosolized water containing L. pneumophila. Fourteen water samples were collected from seven locations at a mine and analyzed for temperature, pH, chlorine, and L. pneumophila serogroup. Most samples (93%) tested positive for L. pneumophila cells. The faucet from the sprinkler system on the adit level (entrance to the underground mine levels) showed the highest concentration of L. pneumophila (8.35 x 10(4) MPN/L). Disability adjusted life years (DALYs) were estimated in the QMRA model and showed that the risk for all miners was significantly lower (p < 0.0001) with the ventilation system on than when the system was off. Our study showed that the use of a ventilation system at the adit level of the mine reduced the risk of infection with aerosolized L. pneumophila.Southwest Environmental Health Sciences Center [NIEHS P30 ES006694]Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

CAG repeat polymorphism of androgen receptor gene and X-chromosome inactivation in daughters of women with polycystic ovary syndrome (PCOS): Relationship with endocrine and metabolic parameters

Background: The polycystic ovary syndrome (PCOS) is a hyperandrogenic disorder that arise from a combination of genetic and environmental factors. Aim: To assess the role of the androgen receptor (AR) CAG repeat polymorphism in the metabolic and reproductive features in daughters of women with PCOS (PCOSd). Methods: Sixty-seven PCOSd and 60 daughters of control women (Cd) were studied in early stages of sexual development. Sex steroids, glucose, insulin and lipids were determined. The AR CAG repeat sizes and X-chromosome inactivation (XCI) were analyzed. Results: PCOSd and Cd had similar mean number of CAG repeats and XCI pattern. In PCOSd and Cd, methylation-weighted biallelic means CAGn (mwCAGn) was not associated with androgen levels. In infants and pubertal PCOSd, mwCAGn was associated with a low concentration of HDL-cholesterol. Conclusions: AR CAG repeat polymorphism appears to be unrelated with serum androgen levels. However, the short mwCAGn variant may have a possible impact

Adrenal function during childhood and puberty in daughters of women with polycystic ovary syndrome

Context: In some patients, PCOS may develop as a consequence of an exaggerated adrenarche during pubertal development. Objective: The aim of the study was to assess adrenal function during childhood and pubertal development in daughters of women with PCOS (PCOSd). Design: We included 98 PCOSd [64 during childhood (ages 4-8 yr) and 34 during the peripubertal period (ages 9-13 yr)] and 51 daughters of controlwomen(Cd) [30 during childhood and 21 during the peripubertal period]. In both groups, an acute ACTH-(1-24) stimulation test (0.25 mg) and an oral glucose tolerance test were performed. Bone age and serum concentrations of cortisol, androstenedione, 17-hydroxyprogesterone, dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS), glucose, and insulin were determined. Results: PCOSd and Cd were similar in age and body mass index. During the peripubertal period, basal and poststimulated DHEAS concentrations were higher in PCOSd compared to Cd. Among PCOSd, 12.5% of girls in childhood and 3