A case of COVID-19 immediately after liver transplantation: Not only bad news

COVID-19, the illness caused by the SARS-CoV-2 virus originated in December 2019 in Wuhan, China and has caused more 3,3 million cases and more than 230,000 deaths throughout the world, with 25,000 of them only in Spain, where the first case was diagnosed on January 31st, 2020. As COVID-19 is a "new" disease, we still do not have data on prognosis or treatment in transplant patients or on how to manage immunosuppression in this complex scenario. We present a case of COVID-19 diagnosed during the early postoperative period in a recipient whose liver transplantation was performed on late March during the lockdown in Spain, with donor and recipient previously negative rRT-PCR to SARS-CoV-2. In the first post-operative week the patient suffered COVID-19 pneumonia that was treated with immunosuppression minimization, oral Hydroxycloroquine and Azithromycin with favorable outcome. The patient was discharged on POD 21 without complications. To date, few early post-liver transplantation SARS-CoV-2 infected recipients have been published, but only one was an early postoperative infection. In our case the outcome was favorable, even though it was an early post -liver transplantation COVID-19 in a frail patient

Healthcare-associated pneumonia: a prospective study in Spain

Objective: The aim of the study was to describe the epidemiological characteristics and factors related to outcome in Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated pneumonia (HCAP). Methods: A 3-year prospective observational epidemiological case study of HCAP was conducted in seven Spanish hospitals. Microbiological and patient characteristics and outcomes were collected and classified by causative pathogen into 4 categories: "S. pneumoniae", "MRSA", "Others" and "Unknown". Patients were followed up 30 days after discharge. Results: A total of 258 (84.6%) patients were enrolled (170 were men [65.9%]). Mean age was 72.4 years ± 15 years (95% CI [70.54-74.25]). The etiology of pneumonia was identified in 73 cases (28.3%): S. pneumoniae in 35 patients (13.6%), MRSA in 8 (3.1%), and other microorganisms in 30 patients (11.6%). Significant differences in rates of chronic obstructive pulmonary disease (p < 0.05), previous antibiotic treatment (p<0.05), other chronic respiratory diseases, inhaled corticosteroids (p <0.01), and lymphoma (p < 0.05) were observed among the four groups. Patients with MRSA pneumonia had received more previous antibiotic treatment (87.5%). Thirty-three (12.8%) patients died during hospitalisation; death in 27 (81.2%) was related to pneumonia. Conclusions: The etiology of HCAP was identified in only one quarter of patients, with S. pneumoniae being the most prevalent microorganism. Patients with chronic respiratory diseases more frequently presented HCAP due to MRSA than to S. pneumoniae. Death at hospital discharge was related in most cases to pneumonia.Objetivo: Describir las características epidemiológicas y factores relacionados con la neumonía asociada a cuidados sanitarios (NACS) causada por Streptococcus pneumoniae y Staphylococcus aureus resistente a meticilina (SARM). Pacientes y métodos: Estudio epidemiológico observacional prospectivo de casos a 3 años en siete hospitales españoles. Se recogieron las características microbiológicas y de los pacientes y sus resultados y se clasificaron en función del patógeno causante en 4 categorías: ?S. pneumoniae?, ?SARM?, ?Otros? y ?Desconocido?. Al alta, se realizó un seguimiento de 30 días. Resultados: Se incluyeron 258 (84,6%) pacientes (170 hombres [65.9%]; edad media 72,4 años ± 15 años (95% IC [70,54-74,25]). La etiología de la neumonía se identificó en 73 casos (28,3%):S. pneumoniae en 35 pacientes (13,6%), SARM en 8 (3,1%) y otros microorganismos en 30 pacientes (11,6%). Hubo diferencias significativas en tasas de enfermedad pulmonar obstructiva crónica (p < 0,05), tratamiento antibiótico previo (p < 0,05), otras enfermedades respiratorias crónicas, corticoides inhalados (p < 0,01) y linfoma (p < 0,05) entre los cuatro grupos. Los pacientes con NACS causada por SARM recibieron tratamiento antibiótico previo en mayor medida (87,5%). Treinta y tres (12,8%) pacientes murieron durante la hospitalización; en 27 (81,2%) debido a la neumonía. Conclusiones: Se identificó la etiología de la NACS en solo un cuarto de los pacientes, siendo S. pneumoniae el patógeno más frecuente. En los pacientes con enfermedades respiratorias crónicas fue más frecuente la NACS causada por SARM. La muerte tras el alta hospitalaria se relacionó con la neumonía en la mayoría de los casos

Differential leukocyte expression of IFITM1 and IFITM3 in patients with severe pandemic influenza A(H1N1) and COVID-19

Interferon-induced transmembrane (IFITM) proteins mediate protection against enveloped viruses by blocking membrane fusion at endosomes. IFITM1 and IFITM3 are crucial for protection against influenza, and various single nucleotide polymorphisms altering their function have been linked to disease susceptibility. However, bulk IFITM1 and IFITM3 mRNA expression dynamics and their correlation with clinical outcomes have not been extensively addressed in patients with respiratory infections. In this study, we evaluated the expression of IFITM1 and IFITM3 in peripheral leukocytes from healthy controls and individuals with severe pandemic influenza A(H1N1) or coronavirus disease 2019 (COVID-19). Comparisons between participants grouped according to their clinical characteristics, underlying disease, and outcomes showed that the downregulation of IFITM1 was a distinctive characteristic of severe pandemic influenza A(H1N1) that correlated with outcomes, including mortality. Conversely, increased IFITM3 expression was a common feature of severe pandemic influenza A(H1N1) and COVID-19. Using a high-dose murine model of infection, we confirmed not only the downregulation of IFITM1 but also of IFITM3 in the lungs of mice with severe influenza, as opposed to humans. Analyses in the comparative cohort also indicate the possible participation of IFITM3 in COVID-19. Our results add to the evidence supporting a protective function of IFITM proteins against viral respiratory infections in humans.Introduction Methods - Human samples - IFITM expression in humans - Influenza infection in mice - IFITM expression in mice - Cytokine levels in mouse lungs - Study approval - Statistical analysis Results - Participant characteristics - IFITM1 and IFITM3 in patients with severe pandemic influenza A(H1N1) - High-dose influenza A (H1N1) virus infection downregulates IFITM expression in mice - IFITM1 and IFITM3 in severe COVID-19 Discussio

Revista de Vertebrados de la Estación Biológica de Doñana

Catálogo descriptivo de los anfibios y reptiles de CubaEvolución estacional de la comunidad de aves en un robledal de Sierra NevadaComposición de la comunidad de aves en pinares del Parque Nacional de Doñana (suroeste de España).Alimentación de la pagaza piconegra (Gelochelidon nilotica) en las marismas del GuadalquivirContaminación xenobiótica del Parque Nacional de Doñana. III. Residuos de insecticidas organoclorados, bifenilos policlorados y metales pesados en ciconiformesAlimentación de la lechuza común Tyto alba en la cuenca del Duero, EspañaEstudio de una población rural de (Mus musculus L.) I. La probabilidad de captura y la estima numéricLa reproducción en Gazella dorcasIncidencia del Nemátodo parásito Skrjabingylus Leuckart, 1842 sobre el Mustela en España.Desplazamientos de ungulados silvestres a través de una zona de ecotono en Doñana.Etograma de la cabra montés (Capra pyrenaica) y comparación con otras especies.Sobre comportamiento agresivo de Triturus marmoratus en época de celoEmbarrancamiento masivo de ejemplares de tortuga lad (Dermochelys coriacea L.) en las costas de Ceuta (España, norte de África)Sobre un ejemplar melánico de Podarcis hispanica (Steindachner, 1870)Nuevos datos sobre la distribución de cuatro especies de reptiles en la provincia de Cádiz.Algunos datos sobre la nidificación de Ciconia nigra L. en sierra Morena (S. España)Observación del halcón de Eleonor (Falco eleonorae) en el centro de EspañaNueva localidad de cría del pájaro moscón (Remiz pendulinus) en la Península IbéricaRegistro de aves en el sur de BoliviaNidificación del paiño de Madeira Oceanodroma castro (Harcourt, 1851) en las Islas Canarias.Observación primaveral de Phalaropus fulicarius L. en el SO de EspañaNuevos datos sobre la presencia del nóctulo gigante Nyctalus lasiopterus (Chiroptera, vespertilionidae) en EspañaNote sur l'alimentation de Martes martes a Menorca (Baleares).Peer reviewe

Doñana. Acta vertebrata. vol 17 (2)

Tres ejemplos de aplicación de métodos indirectos para la estimación de parametros poblacionales en cérvidoAlimentación de la garza real (Ardea cinerea) en la cuenca del Duero (España) durante el periodo reproductoDistribución y tamaño de colonias de buitre leonado (Gyps fulvus) en el alto Ebro y zona Cantábrica próximaDistribución y hábitat del visón americano (Mustela vison Schreber) en el sistema CentraRégimen alimentario del erizo (Erinaceus europaeus L.) durante verano y otoño en setos de la provincia de León (NO de España)Señales sociales de la espátula (Platalea leucorodia) durante el periodo reproductivoVariación del peso corporal en Arvicola terrestris (Rodentia, Arvicolidae) del nordeste ibéricoSobre el dimorfismo sexual en el cráneo del gato montés Felix silvestris Schreber, 1777 del sudoeste ibéricoUn nuevo núcleo poblacional de Apodemus flavicollis (Melchior, 1834) en la Península Ibérica.Selección de la lechuza común (Tyto alba) sobre el topillo común (Microtus duodecimcostatus)Importancia de la vegetación emergente en el comportamiento alimenticio de la fochaObservaciones sobre el papel del lagarto ocelado (Lacerta lepida Daudin), el erizo (Erinaceus europaeus L.) y el tejón (Meles meles L.) en la dispersión de semillasComentarios sobre los estimadores empleados en el método de la batida.El uso de la batida como método de censo: una replicaPeer reviewe

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

Prognostic assessment of valvular surgery in active infective endocarditis: multicentric nationwide validation of a new score developed from a meta-analysisis

Spanish Collaboration on Endocarditis—Grupo de Apoyo al Manejo de la Endocarditis infecciosa en ESpaña (GAMES).[Objectives] Several risk prediction models have been developed to estimate the risk of mortality after valve surgery for active infective endocarditis (IE), but few external validations have been conducted to assess their accuracy. We previously developed a systematic review and meta-analysis of the impact of IE-specific factors for the in-hospital mortality rate after IE valve surgery, whose obtained pooled estimations were the basis for the development of a new score (APORTEI). The aim of the present study was to assess its prognostic accuracy in a nationwide cohort.[Methods] We analysed the prognostic utility of the APORTEI score using patient-level data from a multicentric national cohort. Patients who underwent surgery for active IE between 2008 and 2018 were included. Discrimination was evaluated using the area under the receiver operating characteristic curve, and the calibration was assessed using the calibration slope and the Hosmer–Lemeshow test. Agreement between the APORTEI and the EuroSCORE I was also analysed by Lin’s concordance correlation coefficient (CCC), the Bland–Altman agreement analysis and a scatterplot graph.[Results] The 11 variables that comprised the APORTEI score were analysed in the sample. The APORTEI score was calculated in 1338 patients. The overall observed surgical mortality rate was 25.56%. The score demonstrated adequate discrimination (area under the receiver operating characteristic curve = 0.75; 95% confidence interval 0.72–0.77) and calibration (calibration slope = 1.03; Hosmer–Lemeshow test P = 0.389). We found a lack of agreement between the APORTEI and EuroSCORE I (concordance correlation coefficient = 0.55).[Conclusions] The APORTEI score, developed from a systematic review and meta-analysis, showed an adequate estimation of the risk of mortality after IE valve surgery in a nationwide cohort

Detection of spleen, kidney and liver infarcts by abdominal computed tomography does not affect the outcome in patients with left-side infective endocarditis.

Extra-cardiac abdominal complications are common in left-side infective endocarditis (LS-IE). The aim of this work was to study whether patients with LS-IE presenting splenic, renal, or liver (SRL) involvement seen in abdominal computed tomography (CT) had different clinical features, therapeutic plans, and outcome than those without these findings on CT.From January 2008 to April 2010, multidisciplinary teams have prospectively collected all consecutive cases of IE, diagnosed according to the Duke criteria, in which abdominal CT was performed.A total of 147 patients with LS-IE had abdominal CT. Fifty (34%) had SRL lesions: 46 splenic, 15 renal, 1 liver infarct, and 2 liver abscesses. Patients with SRL lesions were mainly men (P = .01), had liver disease (P = .001) with natural valve (P = .050) and mitro-aortic valve involvement (P = .042), splenomegaly (P = .001), nonabdominal emboli (P = .001), and a greater number and larger vegetation (>15 mm, P = .049) in the mitro-aortic valves (P = .051) than patients with normal abdominal CT. The site of acquisition, clinical characteristics, microbiology, surgical treatment, days of hospitalization, hospital death, and 1-year mortality were similar in patients with and without SRL emboli on CT. In the stepwise logistic regression analysis, male gender (odds ratio [OR] = 3.6, 95% confidence interval [CI] = 1.4-9.1), liver disease (OR = 8.3, 95% CI = 2.1-31.8), and nonabdominal emboli (OR = 5.2, 95% CI = 2.3-11.7) were independently associated with SRL lesions.Male patients with native LS-IE who had liver disease and nonabdominal emboli had more frequent abdominal lesions seen on CT. The presence of SRL infarcts on abdominal CT scan performed on patients with LS-IE seems to have poor practical implications, and as a consequence, its realization should only be considered when there are symptoms or signs that suggest them