Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

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

A new device for deep cervical artificial insemination in gilts reduces the number of sperm per dose without impairing final reproductive performance

Abstract Background The aim of this study was to evaluate the reproductive performance of a new artificial insemination (AI) device specifically designed for gilts (Deep cervical AI, Dp-CAI) by means of which the sperm is deposited deeply in the cervix (8 cm more cranial than in traditional cervical insemination-CAI). New AI techniques have arisen in recent decades in the porcine industry, such as post-cervical artificial insemination (PCAI), which involves depositing the sperm in the body of the uterus [through a catheter (outer tube)-cannula (inner tube)] rather than by CAI. Although the PCAI method has been successfully applied in farm conditions to reduce sperm doses without impairing the reproductive performance, this technique has limitations in gilts mainly because of the difficulty involved in introducing the inner cannula through the cranial part of the cervix. For this reason, the Dp-CAI method described herein may be considered as an alternative to CAI and PCAI methods in gilts. Results Gilts were divided in two experimental groups: 1) Dp-CAI: gilts (n = 1166) inseminated using 1.5 × 109 sperm/45 mL; 2) CAI (as a control group): gilts (n = 130) inseminated using 2.5 × 109 sperm/85 mL. The Dp-CAI method was successfully applied in 88.90% of the gilts, with no differences detected between gilts with 1 or 2 previous oestrus cycles, although the catheter could be introduced more deeply in 2 oestrus gilts (P < 0.05). As the length of the insemination device that could not be introduced increased (at the moment of insemination), so the success rate of the Dp-CAI device fell, as did the total number of piglets born. When the reproductive output in CAI and Dp-CAI was compared, none of the parameters analysed [pregnancy and farrowing rates (%), and number of piglets born (total and live)] showed significant differences. Conclusions The use of the Dp-CAI technique provides a new AI method as an alternative to CAI and PCAI for pigs. The device, especially designed for gilts, was used with a high degree of success reducing conventional sperm doses without impairing reproductive parameters

The Western Mancha aquifer: data mapping to provide transparency to aid stakeholder participation and decision making

The paper presents a series of maps on the Western Mancha aquifer, an aquifer of 5,500 km 2, extending over an area of 41 villages in the region of La Mancha, in the central Spanish plateau. Maps were produced using cartograms, which highlight the differential groundwater use at the local level of the municipality, looking at equity and efficiency issues related to groundwater. The main purpose of the paper is to provide comprehensive, transparent and easily understandable mapping of groundwater use in a region where data is abundant but not necessarily consistent, clear or presented in an easily accessible or understandable format. The paper provides a meta-analysis in the form of maps of available data as a result of a large number of European research projects, national and European policy initiatives, but where a general multi-disciplinary and summative overview is still lacking. This mapping can contribute to decision making in public policy, as support for compliance with the European Union Water Framework Directive on good ecological status, in an area where there are competing, and in many ways incompatible, water demands between irrigation and wetlands. This analysis highlights that a spatially differentiated approach could provide win-win scenarios, i.e. intensive groundwater use and wetland protection

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