Full blood count values as a predictor of poor outcome of pneumonia among HIV-infected patients

Background To evaluate the predictive value of analytical markers of full blood count that can be assessed in the emergency department for HIV infected patients, with community-acquired pneumonia (CAP). Methods Prospective 3-year study including all HIV-infected patients that went to our emergency department with respiratory clinical infection, more than 24-h earlier they were diagnosed with CAP and required admission. We assessed the different values of the first blood count performed on the patient as follows; total white blood cells (WBC), neutrophils, lymphocytes (LYM), basophils, eosinophils (EOS), red blood cells (RBC), hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, red blood cell distribution width (RDW), platelets (PLT), mean platelet volume, and platelet distribution width (PDW). The primary outcome measure was 30-day mortality and the secondary, admission to an intensive care unit (ICU). The predictive power of the variables was determined by statistical calculation. Results One hundred sixty HIV-infected patients with pneumonia were identified. The mean age was 42 (11) years, 99 (62%) were male, 79 (49%) had ART. The main route of HIV transmission was through parenteral administration of drugs. Streptococcus pneumonia was the most frequently identified etiologic agent of CAP The univariate analysis showed that the values of PLT (p < 0.009), EOS (p < 0.033), RDW (p < 0.033) and PDW (p < 0.09) were predictor of mortality, but after the logistic regression analysis, no variable was shown as an independent predictor of mortality. On the other hand, higher RDW (OR = 1.2, 95% CI 1.1-1.4, p = 0.013) and a lower number of LYM (OR 2.2, 95% CI 1.1-2.2; p = 0.035) were revealed as independent predictors of admission to ICU. Conclusion Red blood cell distribution and lymphocytes were the most useful predictors of disease severity identifying HIV infected patients with CAP who required ICU admission. Electronic supplementary material The online version of this article (10.1186/s12879-018-3090-0) contains supplementary material, which is available to authorized users

Detección de problemas asociados a la calidad: frutas y hortalizas

El presente documento de la RED TEMÁTICA FRUTURA de CYTED recoge las aportaciones de sus miembros al denominado 1er evento, celebrado en Sao Paulo en septiembre de 2009. El título asignado a dicho primer evento o reunión de los participantes, contiene el tema asignado a la Red Temática, es decir Desarrollo de un sistema integral de la mejora de la calidad y seguridad de las frutas durante la confección, el transporte y la comercialización mediante nuevas tecnologías de inspección y monitorización, y se refiere al análisis de temas actuales respecto de la Detección y caracterización de problemas asociados a la calidad: Los problemas y desafíos asociados con el transporte de fruta fresca para cada país participante, con especial atención a los países tropicales. Bajo este título se organizan unas sesiones técnicas, y visitas y presentaciones técnicas en instituciones de Sao Paulo y el EMBRAPA, que son las siguientes: Visita técnica a la Unidad de Instrumentación Agropecuaria en São Carlos/SP , sita a 300 km de São Paulo), y la visita técnica a la Central de Abastecimiento del Estado de São Paulo - CEAGESP/SP. Las contribuciones aquí recogidas se completaron con los puntos de vista expresados por la industria, en un coloquio de empresas, presidido por el Dr. Fernando Flores, con la participación de industriales, que abordaron sus puntos de vista sobre el tema: Los problemas del transporte de frutas y hortalizas, desde el punto de vista de la industria. De ellas se extrajo algunas conclusiones para tener en cuenta en las siguientes reuniones. La principal de ellas, fue que es fundamental a la hora de aconsejar mejoras en el transporte internacional de frutas contar con dicho punto de vista, lo que se tendrá en cuenta en los eventos siguientes de FRUTURA . Asociando países y contribuciones, se identificaron y describieron varios condicionamientos y problemas que aparecen durante el transporte de productos perecederos, en especial de frutas durante su transporte, y que se asocian a pérdidas de calidad: • Evaluar la problemática del transporte de frutas y hortalizas a mercados ubicados a gran distancia supone entender la fisiología del producto y conocer los cambios que puede sufrir durante la conservación y el transporte. Las pérdidas en el transporte de frutas se basan en condiciones ambientales no apropiadas a las que el producto se ve expuesto, tanto en transporte terrestre como en el aéreo, y se relaciona con instalaciones y equipos de frío\ud insuficientes, e insuficientemente controlados. • La reglamentación de cada uno de los países receptores de fruta y hortalizas frescas afecta enormemente a los intercambios comerciales, y es un aspecto que debe ser estudiado especialmente, y a nivel internacional. Existen por ejemplo regulaciones cuarentenarias frente a plagas que requieren tratamientos específicos con altas exigencias tecnológicas. • Teniendo en cuenta que las condiciones óptimas, en especial de temperatura, son diferentes para cada producto. los amplísimos conocimientos y datos existentes a este respecto han de ser analizados y aplicados apropiadamente en los procesos de transporte. • Se establece el alto potencial de nuevas tecnologías como las RFID (Identificación por Radio Frecuencia) y WSN (Redes inalámbricas de Sensores) que hacen posible la supervisión/monitorización y el control de las condiciones del ambiente y del producto en el interior de contenedores de transporte. • El diseño y uso de envases adecuados al producto, el tipo de transporte, paletización, condiciones de frío y las especies frutícolas debe ser analizado cuidadosamente para grandes distancias. Por otro lado, aumenta de demanda de productos fáciles de preparar, siendo las frutas como manzana, pera y durazno mínimamente procesadas en fresco (MPF) una nueva alternativa para los consumidores. Sin embargo estas frutas MPF presentan una serie de daños durante su procesamiento que reducen su vida útil durante su transporte y comercialización, por lo que presentan exigencias especiales en su envasado, comercialización y almacenaje. • Se añade a la variabilidad y falta de calidad de las frutas en el mercado, las deficiencias en las fechas y condiciones de cosecha, de envasado, de tratamiento y de manejo en origen, y a lo largo de la cadena de distribución. • Debe asumirse en varios países y zonas productivas una falta de conocimientos de los productores, transportistas e intermediarios en la distribución. (Es un objetivo iniciar acciones de formación en este sentido, a través de FRUTURA). • Los problemas en las infraestructuras, se centran en varios aspectos de gran relevancia y en todo caso requieren ser optimizados si se persigue calidad y reducción de pérdidas: situación de las fincas, caminos, distancias, carreteras, puertos, aeropuertos, equipos de transporte (camiones, contenedores). Las capacidades y características de los centros de distribución, tales como los visitados CEAGESP de Sao Paulo y MERCAMADRID que representan un factor de enorme influencia en la comercialización de calidad, procesos y productos. Los artículos, al ser contribuciones de los miembros de los distintos países asociados a FRUTURA aportan datos, de la producción frutícola y de su transporte, específicos para algunos de los países participantes en el proyecto: Uruguay, Argentina, Brasil, Costa Rica y España. Los trabajos aquí recogidos se completan con las presentaciones expuestas en la reunión, y que se encuentran accesibles en la página web de FRUTURA: www.frutura.net. Finalmente, otra contribución relevante de estos trabajos es sus listados de bibliografía, los cuales ofrecen una información de gran valor dentro de los objetivos de FRUTURA

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P &lt;0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Full blood count values as a predictor of poor outcome of pneumonia among HIV-infected patients

Background To evaluate the predictive value of analytical markers of full blood count that can be assessed in the emergency department for HIV infected patients, with community-acquired pneumonia (CAP). Methods Prospective 3-year study including all HIV-infected patients that went to our emergency department with respiratory clinical infection, more than 24-h earlier they were diagnosed with CAP and required admission. We assessed the different values of the first blood count performed on the patient as follows; total white blood cells (WBC), neutrophils, lymphocytes (LYM), basophils, eosinophils (EOS), red blood cells (RBC), hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, red blood cell distribution width (RDW), platelets (PLT), mean platelet volume, and platelet distribution width (PDW). The primary outcome measure was 30-day mortality and the secondary, admission to an intensive care unit (ICU). The predictive power of the variables was determined by statistical calculation. Results One hundred sixty HIV-infected patients with pneumonia were identified. The mean age was 42 (11) years, 99 (62%) were male, 79 (49%) had ART. The main route of HIV transmission was through parenteral administration of drugs. Streptococcus pneumonia was the most frequently identified etiologic agent of CAP The univariate analysis showed that the values of PLT (p < 0.009), EOS (p < 0.033), RDW (p < 0.033) and PDW (p < 0.09) were predictor of mortality, but after the logistic regression analysis, no variable was shown as an independent predictor of mortality. On the other hand, higher RDW (OR = 1.2, 95% CI 1.1-1.4, p = 0.013) and a lower number of LYM (OR 2.2, 95% CI 1.1-2.2; p = 0.035) were revealed as independent predictors of admission to ICU. Conclusion Red blood cell distribution and lymphocytes were the most useful predictors of disease severity identifying HIV infected patients with CAP who required ICU admission. Electronic supplementary material The online version of this article (10.1186/s12879-018-3090-0) contains supplementary material, which is available to authorized users

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd

The risk of COVID-19 death is much greater and age dependent with type I IFN autoantibodies

International audienceSignificance There is growing evidence that preexisting autoantibodies neutralizing type I interferons (IFNs) are strong determinants of life-threatening COVID-19 pneumonia. It is important to estimate their quantitative impact on COVID-19 mortality upon SARS-CoV-2 infection, by age and sex, as both the prevalence of these autoantibodies and the risk of COVID-19 death increase with age and are higher in men. Using an unvaccinated sample of 1,261 deceased patients and 34,159 individuals from the general population, we found that autoantibodies against type I IFNs strongly increased the SARS-CoV-2 infection fatality rate at all ages, in both men and women. Autoantibodies against type I IFNs are strong and common predictors of life-threatening COVID-19. Testing for these autoantibodies should be considered in the general population

The risk of COVID-19 death is much greater and age dependent with type I IFN autoantibodies

International audienceSignificance There is growing evidence that preexisting autoantibodies neutralizing type I interferons (IFNs) are strong determinants of life-threatening COVID-19 pneumonia. It is important to estimate their quantitative impact on COVID-19 mortality upon SARS-CoV-2 infection, by age and sex, as both the prevalence of these autoantibodies and the risk of COVID-19 death increase with age and are higher in men. Using an unvaccinated sample of 1,261 deceased patients and 34,159 individuals from the general population, we found that autoantibodies against type I IFNs strongly increased the SARS-CoV-2 infection fatality rate at all ages, in both men and women. Autoantibodies against type I IFNs are strong and common predictors of life-threatening COVID-19. Testing for these autoantibodies should be considered in the general population