25 research outputs found

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

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    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

    Diet and food strategies in a southern al-Andalusian urban environment during Caliphal period, ecija, Sevilla

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    The Iberian medieval period is unique in European history due to the widespread socio-cultural changes that took place after the arrival of Arabs, Berbers and Islam in 711 AD. Recently, isotopic research has been insightful on dietary shifts, status, resource availability and the impact of environment. However, there is no published isotopic research exploring these factors in southern Iberian populations, and as the history of this area differs to the northern regions, this leaves a significant lacuna in our knowledge. This research fills this gap via isotopic analysis of human (n = 66) and faunal (n = 13) samples from the 9th to the 13th century Écija, a town renowned for high temperatures and salinity. Stable carbon (δ13C) and nitrogen (δ15N) isotopes were assessed from rib collagen, while carbon (δ13C) values were derived from enamel apatite. Human diet is consistent with C3 plant consumption with a very minor contribution of C4 plants, an interesting feature considering the suitability of Écija to C4 cereal production. δ15N values vary among adults, which may suggest variable animal protein consumption or isotopic variation within animal species due to differences in foddering. Consideration of δ13C collagen and apatite values together may indicate sugarcane consumption, while moderate δ15N values do not suggest a strong aridity or salinity effect. Comparison with other Iberian groups shows similarities relating to time and location rather than by religion, although more multi-isotopic studies combined with zooarchaeology and botany may reveal subtle differences unobservable in carbon and nitrogen collagen studies alone.OLC is funded by Plan Galego I2C mod.B (ED481D 2017/014). The research was partially funded by the projects “Galician Paleodiet” and by Consiliencia network (ED 431D2017/08) Xunta de GaliciaS

    Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

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    The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

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

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    [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

    Early Medieval ‘places and spaces’. Breaking down boundaries in British Archaeology

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    British medieval archaeology is becoming increasingly integrated as new methodologies, research programmes and data sets encourage researchers to cross the boundaries between the study of settlements, burials, and landscapes. This paper reviews, through a series of case studies, new approaches to 'social landscapes' and in particular assembly sites, including fairs, legal assemblies, cemeteries and places of execution. These studies illustrate how a greater willingness to 'trespass' into other disciplines such as place-name studes and legal history is yielding new insights into the archaelogical record. The paper concludes that it is becoming increasingly difficult to separate the study of early medieval burial, settlement and landscape into distinct sub-disciplines, especially for the period between c600-100, a time when conceptions of 'community' were rapidly changing.</p

    Long-term construction of vineyard landscapes in the Ebro Valley: The deserted village of Torrentejo (Basque Country, Spain)

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    Cultural landscapes are the result of human societies interacting with their environment, which is reflected in the onset and evolution of social practices such as settlement and agricultural production. This paper discusses the results of a transdisciplinary research program carried out on the vineyard landscape of the Rioja Alavesa district, one of the main wine-producing regions of Spain, focusing on the deserted village of Torrentejo (Basque Country, Spain). The study of archival records, combined with extensive archaeological survey and excavation, as well as the intensive analysis of geoarchaeological core samples, permitted the reconstruction of a long sequence of human settlement and agricultural practices extending over ~4000 years. The oldest documented records refer to a Chalcolithic occupation, developed on a buried gypsisol and possibly related to the climatic event at 4.2 ka BP. After a long hiatus, four phases of landscape transformation were documented above this Chalcolithic occupation: (1) the formation of a nucleated village in the Early Middle Ages, represented by the construction of a terraced agricultural landscape, and its passage under the control of different seigneurial powers over the High Middle Ages; (2) the abandonment of the village during the Late Middle Ages and the subsequent concentration of settlement in the charted town of Bastida; (3) a complete reorganisation and expansion of the local terraced systems in the 18th–19th centuries, in a context of specialisation and commercialisation of agricultural production; and (4) present-day mechanisation and capitalisation. These results therefore offer an interesting overview on the complexity and diversity of the historical trends that lie beneath the vineyard landscape of Torrentejo, proving the value of interdisciplinary research approaches for the investigation of the role of human settlement and agriculture in the formation and evolution of agricultural landscapes.This research was supported by the project “Peasant agency and social complexity in north-western Iberia in the medieval period” (Spanish Ministry of Economy, Industry and Competitiveness AEI/FEDER UE HAR2016-76094-C4-2R), the Research Group on Medieval Archaeology, Heritage and Cultural Landscapes (Government of the Basque Country, IT1193-19) and the Group of Rural Studies (Associated Unit UPV/EHU-CSIC)

    First Direct Evidence of Agrarian Practices in the Alava Plateau (Northern Iberia) During the Middle Ages Through Carbon and Nitrogen Stable Isotope Analyses of Charred Seeds

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    This paper presents the results of carbon and nitrogen stable isotope analyses on 50 charred seed samples from the medieval villages of Zornoztegi and Aistra, dated to between fourth and fourteenth centuries CE. The assemblage was mainly formed by Triticum aestivum/durum, although some Hordeum vulgare, Avena and Vicia ervilia samples were also included. Despite the social and political differences between the sites, no big contrasts were found between them. According to Delta C-13 values, watering was predominantly low to moderate. There were statistically significant differences in the distribution of carbon stable isotope ratios of wheats between Zornoztegi and Aistra, as moderately and well watered grains were more common in the former. Barley samples were consistently in the range of poorly watered grains, while bitter vetch were extremely variable. Nitrogen isotope ratios were very homogeneous across taxa and between sites, and they pointed at the predominance of low manuring regimes, with only a few samples within the range of medium manured crops. No significant chronological changes in any of the indicators were found throughout the Middle Ages
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