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

¿Cómo aprender a leer?. Estudio comparativo sobre los métodos global y silábico

El tema que ha ocupado esta investigación ha sido recoger información y valorar si existen diferencias en el aprendizaje de la mecanización lectora entre dos de los métodos que se utilizan en la enseñanza de la lectoescritura: el método global y el método silábico. Nos hemos centrada en el primer ciclo de Educación Primaria de un colegio rural cuya población escolar proviene de familias con un nivel socioeconómico cultural medio. Hemos contado con la colaboración de las dos profesoras de dos cursos que aplicaban esos métodos con sus respectivos grupos

ATLAS OTALEX C

Extremadura, in Spain, and Alentejo and Centro, in Portugal, are tree regions belonging to different countries but with several common interests. They are continuous border areas that share similar ecological, socioeconomic and environmental characteristics. The cooperation between these territories which promotes the collaboration and exchange of information between both sides of the Spanish-Portuguese frontier, has important references in several crossborder projects, such as: COORDSIG “Coordination of Geographical Information Systems and Instruments of Territorial Observation in Low Density Rural Areas”, co-financed by EFRD, program Interreg II C, developed between 1997 and 2001; PLANEXAL “Territorial Recognition for the approach of common urban-territorial management and planning strategies in Extremadura and Alentejo”, co-financed by Interreg III A Spain Portugal Program, between 2003 and 2005; GEOALEX “Geographical model for environmental and territorial management of rural low density areas”, co-financed by Interreg III A (Sub-program Alentejo-Extremadura) from 2004 to 2006; OTALEX “Territorial Observatory Alentejo Extremadura”, co-financed by Interreg III A Spain-Portugal Program, developed from 2006 to 2009; and OTALEX II “Territorial and Environmental Observatory Alentejo Extremadura”, co-financed also by Interreg III A Spain-Portugal Program and developed between 2008 and 2011. Starting in 2009 as the ongoing project of OTALEX II, OTALEX C “Territorial and Environmental Observatory Alentejo Extremadura Centro”, co-financed by the Cross Border Cooperation Operational Program of Spain-Portugal 2007-2013 (POCTEP), has as main purpose the creation of a management and environmental monitoring system thought the SDI – IDE OTALEX (Spatial data infrastructure of the Territorial and Environmental Observatory Alentejo-Extremadura-Centro - www.ideotalex.eu) as an information and institutional sharing platform between Alentejo-Extremadura-Centro administrations. The project is integrated by different spanish and portuguese entities that belong to three levels of administration. At national level the spanish Nacional Centro of Geographical Information / Nacional Geographical Institute (CNIG-IGN) and portuguese General Territory Direction (DGT); at the regional level, the General Direction for Transports, Territorial Management and Urbanism (Consejería of Fomento, Vivienda, Territorial Management and Tourism – Government of Extremadura) and Coordination and Regional Development Commission of Alentejo (CCDR-A); at local level, Intermunicipal Community of Central Alentejo (CIMAC), Intermunicipal Community of Alto Alentejo (CIMAA), O. A. Equality and Local Development Area (Diputación of Badajoz) and Diputación of Cáceres; in the high education, the University of Extremadura, the University of Évora and the Polytechnic Institute of Castelo Branco; and as public enterprise, the Enterprise of Development and Infra-structures of Alqueva Dam, S.A. (EDIA). The publication of this crossborder atlas of Alentejo-Extremadura-Centro regions, the ATLAS OTALEX C, integrates the results of an extensive series of crossborder projects overcoming the fruitful cohesion of territories in the defence of their common interests. The present publication collects and synthetizes the harmonization effort made in bringing in common the information of the distinct partners of OTALEX C project, and aims to contribute in an effective way to the sustainable development of these crossborder regions through the definition of common strategies and of the implementation of crossborder of territorial and environmental observation instruments

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

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