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

Festivals : St Patrick' s-Thanksgiving : unidades didácticas de Inglés : primer ciclo de Educación Primaria

Contiene dos unidades didácticas de Inglés, que pretenden proporcionar al profesorado modelos de programación y materiales didácticos de apoyo a su práctica docente. La primera unidad, St Patricks, trata sobre la fiesta y la leyenda de San Patricio, patrón de Irlanda, y consta de cuatro sesiones. La segunda unidad, Thanksgiving, está dedicada a una celebración típica de Estados Unidos, la fiesta de Acción de Gracias, y consta de cinco sesiones. Ambas unidades incluyen una introducción, la explicación detallada de cada sesión y tres anexos con material fotocopiable, fichas de evaluación y juegos.MadridES

Descubriendo nuestro mundo, convivimos mejor

Se desarrolla un proyecto de innovación educativa que pretende investigar sobre las diferentes nacionalidades del alumnado del centro, y recopilar sus cuentos e historias en torno a Cristóbal Colón y el Descubrimiento de América. El proyecto trata de conocer otras culturas y aprender a respetarlas como fruto de la diversidad cultural existente. Se proporciona al alumnado herramientas y facilitadores para conseguir cambios de actitud respecto a la inmigración, entendiéndolo como aspectos enriquecedores de una cultura plural. El proyecto comienza recopilando todo tipo de cuentos y leyendas de los países representados en el centro. Se presenta el personaje de Cristóbal Colón mediante carteles, manualidades y otras actividades reflejadas en cada unidad didáctica. Se realizan dos grandes talleres de forma paralela a las actividades: 'Taller descubriendo el mundo' y 'Taller para la convivencia'. La participación del profesorado es muy positiva, implicándose en la organización de actividades, recogida de materiales y su evaluación, creando en todo momento un buen clima de trabajo. El proyecto ha aumentado el conocimiento, acercamiento y respeto por parte el alumnado nacional hacia otras cultural de la minoría inmigrante. El proyecto demuestra la eficacia de las actividades en el avance producido en el conocimiento de cultural, acercamiento y respeto mutuo.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

Memoria final de los grupos de trabajo Intercere I e Intercere II

No publicadoDurante el año 2000 en el CRA Cerecedo se constituyeron 2 grupos de trabajo (Intercere I e Intercere II) en los que participaron todo el claustro de profesores, para continuar la labor emprendida el año anterior con la implantación de Aldea Digital. Esta memoria recoge el trabajo realizado por los 2 grupos en materia de Nuevas Tecnologías. Los objetivos planteados por el grupo fueron: elaborar una guía de trucos en el manejo de Windows 98, utilizar procesadores de textos en tareas educativas, facilitar al profesorado el acceso a Internet, crear una guía de web educativas, utilizar el escáner en tareas educativas, utilizar un procesador de dibujo para el escaneo de imágenes, mantener contacto con los centros escolares de el entorno vía Internet, intentar nivelar las diferencias entre niños/as del centro posibilitándoles a todos el acceso a las nuevas tecnologías. El primer trimestre del curso se dedicó exclusivamente a tareas formativas, que se complementaban con explicaciones en cada tutoría aprovechando las visitas de los coordinadores a las diferentes localidades para impartir sus clases; en el segundo trimestre se comenzaron a aplicar los conocimientos adquiridos en el trabajo docente del aula y en la última parte del curso se trabajó con los paquetes de actividades bajados de racó del Clic. Los objetivos planteados se han conseguido sin demasiados problemas, debido a que en las sesiones posteriores a su explicación, se resolvían dudas posibles surgidas durante la práctica individual. En general el trabajo fue productivo, mostrando gran interés por las actividades a realizar.Castilla y LeónES

Journée sans culture : Troubler la fête, rallumer notre joie = To Spoil the Party, To Set Our Joy Ablaze

"Composed as an extension of the conversations that took place during the 2015 Journée sans culture, To Spoil the Party, to Set Our Joy Ablaze gathers contributions from those who moderated the discussions of the day as well as those who set up its sites of rest, reflection, and play. These authors work to remain true to the spirit of what they lived, led by the desire to find a source of collective energy that exceeds the pervasive effects of tiredness and resignation. Their texts are joined by others, commissioned by the editorial team, which explore matters of concern not sufficiently addressed during the day." -- Publisher's website

Toxicity of Asciminib in Real Clinical Practice: Analysis of Side Effects and Cross-Toxicity with Tyrosine Kinase Inhibitors

(1) Background: Despite the prognostic improvements achieved with tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML), a minority of patients still fail TKIs. The recent introduction of asciminib may be a promising option in intolerant patients, as it is a first-in-class inhibitor with a more selective mechanism of action different from the ATP-competitive inhibition that occurs with TKIs. Therefore, our goal was to analyze toxicities shown with asciminib as well as to study cross-toxicity with previous TKIs. (2) Methods: An observational, multicenter, retrospective study was performed with data from 77 patients with CML with therapeutic failure to second-generation TKIs who received asciminib through a managed-access program (MAP) (3) Results: With a median follow-up of 13.7 months, 22 patients (28.5%) discontinued treatment: 32% (7/22) due to intolerance and 45% (10/22) due to resistance. Fifty-five percent of the patients reported adverse effects (AEs) with asciminib and eighteen percent grade 3&ndash;4. Most frequent AEs were: fatigue (18%), thrombocytopenia (17%), anemia (12%), and arthralgias (12%). None of the patients experienced cardiovascular events or occlusive arterial disease. Further, 26%, 25%, and 9% of patients required dose adjustment, temporary suspension, or definitive discontinuation of treatment, respectively. Toxicities under asciminib seemed lower than with prior TKIs for anemia, cardiovascular events, pleural/pericardial effusion, diarrhea, and edema. Cross-toxicity risk was statistically significant for thrombocytopenia, anemia, neutropenia, fatigue, vomiting, and pancreatitis. (4) Conclusion: Asciminib is a molecule with a good safety profile and with a low rate of AEs. However, despite its new mechanism of action, asciminib presents a risk of cross-toxicity with classical TKIs for some AEs

Toxicity of Asciminib in Real Clinical Practice: Analysis of Side Effects and Cross-Toxicity with Tyrosine Kinase Inhibitors

Simple Summary After the recent irruption of asciminib into the therapeutic arsenal for chronic myeloid leukemia, real-life data remain scarce to determine which patients may benefit most from this drug. Data on the efficacy of the drug in real-world setting have been reported, but a detailed analysis of the toxicity profile and the influence of prior intolerance to classical tyrosine kinase inhibitors (TKIs) has not been performed. The aim of the present analysis is to study in detail the toxicity profile of asciminib as well as to describe the risk of cross-toxicity with classical TKIs. These results may help to select the patient profile with the best chance of therapeutic success with asciminib monotherapy. (1) Background: Despite the prognostic improvements achieved with tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML), a minority of patients still fail TKIs. The recent introduction of asciminib may be a promising option in intolerant patients, as it is a first-in-class inhibitor with a more selective mechanism of action different from the ATP-competitive inhibition that occurs with TKIs. Therefore, our goal was to analyze toxicities shown with asciminib as well as to study cross-toxicity with previous TKIs. (2) Methods: An observational, multicenter, retrospective study was performed with data from 77 patients with CML with therapeutic failure to second-generation TKIs who received asciminib through a managed-access program (MAP) (3) Results: With a median follow-up of 13.7 months, 22 patients (28.5%) discontinued treatment: 32% (7/22) due to intolerance and 45% (10/22) due to resistance. Fifty-five percent of the patients reported adverse effects (AEs) with asciminib and eighteen percent grade 3-4. Most frequent AEs were: fatigue (18%), thrombocytopenia (17%), anemia (12%), and arthralgias (12%). None of the patients experienced cardiovascular events or occlusive arterial disease. Further, 26%, 25%, and 9% of patients required dose adjustment, temporary suspension, or definitive discontinuation of treatment, respectively. Toxicities under asciminib seemed lower than with prior TKIs for anemia, cardiovascular events, pleural/pericardial effusion, diarrhea, and edema. Cross-toxicity risk was statistically significant for thrombocytopenia, anemia, neutropenia, fatigue, vomiting, and pancreatitis. (4) Conclusion: Asciminib is a molecule with a good safety profile and with a low rate of AEs. However, despite its new mechanism of action, asciminib presents a risk of cross-toxicity with classical TKIs for some AEs

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