Urinary tract infections in the elderly. The effect of reducing the age criteria in a geriatric service

Introduction: Urinary tract infections (UTIs) are one of the most common community-acquired infections in older adults. Methodology: This was a retrospective and descriptive study carried out in a Mexican Geriatric Service from January 2013 to December 2015. Demographic characteristics of patients were recorded including age, gender, cause of disease, urine culture, microorganism identifi cation and antibiogram. The objective of this study was to describe the situational status of microbial antibiotic resistance in the elderly after reduction of the age criteria to be treated in a geriatric service. Results: One hundred and eighty-two geriatric patients (74 males mean age 81.5±13.5 years and 108 females mean age 81.5±11.5 years) with positive urine culture for one or more microbial identifi cation and antibiograms were included in the analysis. The most common isolations were positive for Escherichia coli BLEE, Escherichia coli, Candida albicans, Enterococcus faecalis, Pseudomonas aeruginosa, Proteus vulgaris and Klebsiella pneumoniae. After widening of the age range to enter the geriatric service (in 2015), there was a reduction in total cases of Escherichia coli BLEE and an increase for Escherichia coli. Conclusion: In our study, a growing increase of E. coli BLEE was recorded, however, at the same time, it was possible to confi rm that the majority of cases of this bacterium showed resistance to β-lactams, cephalosporins of different generations, quinolones and sulfas, demonstrating that it is becoming a public health problem

Poor prognostic factors in patients older than 70 years with acute coronary syndrome

La información sobre escalas pronósticas en el paciente geriátrico con síndrome coronario isquémico agudo (SICA) es escasa; por esto, nos planteamos como objetivo identificar a los factores que condicionen un deterioro en la función cardíaca y que fuesen valorables en este grupo de edad, en la población mexicana. Pacientes y método. Estudio descriptivo, retrospectivo. Se captaron los datos de pacientes mayores de 70 años diagnosticados con SICA, en el Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM), durante el periodo 1 de enero de 2006 al 30 de mayo de 2010; estos fueron analizados estadísticamente. Resultados. Se registraron los datos de 119 pacientes, 26 mujeres y 93 hombres,con media de edad de 75,91 ± 4,68 y rango 70-94. Se encontró que la lesión de la arteria descendente anterior es una predictora, con los modelos de análisis de regresión lineal (método “introducir”), regresión logística multinomial, estimación ponderada (para sexo), ecuación de regresión de Cox y regresión logística binaria (únicamente para el sexo masculino). Conclusiones. Las enfermedades de base no controladas adecuadamente y la lesión de la arteria descendente anterior son las principales variables predictoras de muerte en mayores de 70 años con SICA

Effects of Exogenous Enzymes and Salix babylonica L. Extract on Cellular Immune Response and its Correlation with Average Daily Weight Gain in Growing Lambs

The aim of this study was to determine the effects of exogenous enzyme (EZ) and Salix babylonica L. (SB) extract on cellular immune response, and its correlation with average daily weight gain (ADG). Twenty Suffolk lambs, 6-8 months of age and average live weight of 24±0.3 kg, were used in a trial which lasted 60 days. The lambs were distributed into 4 groups of 5 lambs each and housed in individual 1.5x1.5 m cages in a completely randomized design. The treatments were: (i) Control; lambs consuming basal diet (BD) only; (ii) EZ; lambs consuming BD plus 10g of EZ (ZADO®); (iii) SB; lambs consuming BD plus 30 mL of SB, and (iv) EZSB; lambs consuming BD plus 10g EZ and 30 mL of SB. Blood samples were collected on days 0, 15, 30, 45 and 60 and analysed for helper T lymphocytes, cytotoxic T limphocytes, granulocytes and monocytes by flow cytometry. Treatments had no effect on parameters measured, but day of sampling had linear and cubic effects on helper T lymphocytes, granulocytes and monocytes (P<0.01) and cubic effects on cytotoxic T lymphocytes (P<0.01). The results suggest that EZ and SB have immunosuppressant effects in the first 15 days, after this effect were immunosuppressive on cytotoxic T lymphocytes and granulocytes, for monocytes the effect was immunostimulant. No there were correlation between ADG and cellular immune response in this experiment

Prognostic value of PCT and CRP as markers of severity in community acquired pneumonia in older adults

Introducción: La neumonía adquirida en la comunidad (NAC) es una de las principales causas de mortalidad en el mundo. La proteína C reactiva puede identificar a pacientes críticamente enfermos. La procalcitonina (PCT) ha sido referida como un marcador sensible de gravedad de la infección bacteriana y sepsis. Metodología: Se realizó un estudio cohorte prospectivo en el servicio de geriatría del Centro Médico ISSEMYM, Metepec, Estado de México, con todos los pacientes que ingresaron a hospitalización con diagnóstico de NAC entre mayo 2012 a marzo 2013. Se midieron PCR, PCT y laboratorios de rutina. Para la comparación de variables continuas se utilizó la T de Student ó U de Mann Whitney según su distribución. Para la comparación de variables categóricas se utilizo la prueba de X2. Para el análisis de supervivencia se utilizó el estimador de Kaplan-Meier. Para establecer el riesgo de mortalidad se empleó el modelo de regresión de COX obteniendo el Hazard Ratio. Para la correlación entre los niveles séricos de PCT y PCR se utilizó el coeficiente de correlación de Spearman. Resultados: Se registraron los datos de un total de 82 pacientes. La supervivencia media cuando PCT > de 0.5 ng/dl fue de 17 días (IC 95%, 11 a 23 días) versus 26 días (IC 95%, 17 a 35 días) para PCT < de 0.5 ng/dl (p ≤ 0.01). Conclusiones: El nivel sérico de PCT mayor a 0.5 ng/dl mostró ser un marcador pronóstico en pacientes geriátricos con neumonía

Feed intake, nutrient digestibility, nitrogen utilization, and ruminal fermentation activities in sheep fed Atriplex halimus ensiled with three developed enzyme cocktails

The effects of feeding Atriplex halimus treated with three developed enzyme cocktails to Barki sheep on feed intake, nutrient digestibility, N utilization, and ruminal fermentation were assessed. A. halimus was ensiled with two developed enzyme cocktails of ZAD1® (Z1) and/or ZAD2® (Z2) as liquid enzyme preparations (2 l/t) with 5% molasses and ensiled for 30 days. Three Barki rams (45 ± 3.2 kg) were used per treatment in five consecutive digestibility trials, while three ewes fitted with a permanent rumen fistula were used as source of inoculum for in vitro rumen fermentation trials. Barley grain (300 g/animal/day) was fed as energy supplement during the experimental trial for all diets. Five diets were composed as follows: A. halimus (leaves and stems) (D1); untreated A. halimus plus 4 g/animal/day ZADO® (Z) (enzyme preparation in powder form) (D2); A. halimus ensiled with Z1 and barley plus 4 g/animal/day Z (D3); A. halimus ensiled with Z2 and barley (D3) plus 4 g/animal/day Z (D4); A. halimus ensiled with a combination of Z1 and Z2 (1 :1) and barley plus 4 g/head/day Z (D5). For all trials, ad libitum A. halimus was offered twice a day at 9:00 and 16:00 h while barley grain was given once a day at 10:00 h. Both D1 and D2 diets increased (P <0.001) dry matter intake of A. halimus and total dry matter intake. Addition of 4 g/day of Z to Z1 and/or Z2 ensiled diets improved (P < 0.0001) organic matter, crude protein, crude fibre, and neutral detergent fibre digestibilities. Diets D1 and D2 increased (P < 0.001) N intake, whereas the direct addition of Z to D3, D4, and D5 decreased (P < 0.001) N balance and N balance/N absorption ratio. Sheep fed on Z in addition to Z2 ensiled A. halimus showed higher improvements for total volatile fatty acids (P < 0.001), ammonia N (P = 0.007), and microbial protein production (P = 0.003). It can be concluded that feeding sheep on A. halimus ensiled with Z1 and Z2 with direct feeding of Z enzyme preparation improved intake, digestibility, nitrogen balance and utilization, as well as rumen fermentation

Performance of Screening Strategies for Latent Tuberculosis Infection in Patients with Inflammatory Bowel Disease: Results from the ENEIDA Registry of GETECCU

(1) Aims: Patients receiving antitumor necrosis factor (anti-TNF) therapy are at risk of developing tuberculosis (TB), usually due to the reactivation of a latent TB infection (LTBI). LTBI screening and treatment decreases the risk of TB. This study evaluated the diagnostic performance of different LTBI screening strategies in patients with inflammatory bowel disease (IBD). (2) Methods: Patients in the Spanish ENEIDA registry with IBD screened for LTBI between January 2003 and January 2018 were included. The diagnostic yield of different strategies (dual screening with tuberculin skin test [TST] and interferon-gamma-release assay [IGRA], two-step TST, and early screening performed at least 12 months before starting biological treatment) was analyzed. (3) Results: Out of 7594 screened patients, 1445 (19%; 95% CI 18-20%) had LTBI. Immunomodulator (IMM) treatment at screening decreased the probability of detecting LTBI (20% vs. 17%, p = 0.001). Regarding screening strategies, LTBI was more frequently diagnosed by dual screening than by a single screening strategy (IGRA, OR 0.60; 95% CI 0.50-0.73, p < 0.001; TST, OR 0.76; 95% CI 0.66-0.88, p < 0.001). Two-step TST increased the diagnostic yield of a single TST by 24%. More cases of LTBI were diagnosed by early screening than by routine screening before starting anti-TNF agents (21% [95% CI 20-22%] vs. 14% [95% CI 13-16%], p < 0.001). The highest diagnostic performance for LTBI (29%) was obtained by combining early and TST/IGRA dual screening strategies in patients without IMM. (4): Conclusions: Both early screening and TST/IGRA dual screening strategies significantly increased diagnostic performance for LTBI in patients with IBD, with optimal performance achieved when they are used together in the absence of IMM

Risk Factors for COVID-19 in Inflammatory Bowel Disease: A National, ENEIDA-Based Case–Control Study (COVID-19-EII)

(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case-control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March-July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3-5.9), occupational risk (OR: 2.9; 95%CI: 1.8-4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2-2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09-0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution

Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

The authors wish to make the following corrections to this paper [...]

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

Eficacia de indapamida SR en el tratamiento de hipertensión sistólica aislada en pacientes ancianos

La hipertensión arterial sistólica aislada es un padecimiento frecuente en ancianos, y constituye el principal factor de riesgo cardiovascular para enfermedad vascular cerebral (EVC) e infarto agudo del miocardio (IAM) dentro de este grupo de pacientes. Las actuales guías de tratamiento favorecen el uso de terapia farmacológica con diuréticos de tipo tiazídico, grupo al que pertenece la indapamida, como fármacos de primera línea. Como objetivo primario, se examinó la eficacia de indapamida de liberación prolongada (SR) de 1.5 mg para disminuir la presión sistólica. Material y métodos: Se trató de un estudio experimental, abierto, longitudinal, descriptivo, prospectivo, no comparativo, no controlado, no aleatorizado y de investigación clínica. 35 pacientes mayores de 60 años diagnosticados con hipertensión arterial sistólica aislada fueron incluidos en el estudio, se mantuvo un seguimiento de los pacientes para medir presión arterial y os siguientes parámetros metabólicos: glucosa sérica, microalbuminuria, colesterol total y triglicéridos. Resultados: Indapamida SR mostró ser eficaz al disminuir las cifras de tensión arterial sistólica en más de 10 mmHg o más respecto a la basal. El valor promedio basal de la presión arterial sistólica fue 179.58 ± 13.98 mmHg y después de 12 meses de tratamiento con indapamida SR se logró alcanzar una cifra promedio de 133.80 ± 10.43 mmHg, descenso que fue estadísticamente significativo (p<0.05). Indapamida SR también logró disminuciones en las cifras de presión diastólica con un promedio inicial de 81.66 ± 8.68 mmHg y después de 12 meses de tratamiento descendió a 75.47 ± 8.02 mmHg (p<0.05)