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

Retinal function assessment in alcohol use disorder patients

Objective. Retinal injury induced by ethanol consumption has been previously reported in animal models, including biochemical, histological and functional alterations. These results need to be clinically tested in alcoholic patients which do not report several systemic or ophthalmic diseases. Methods. Six patients with alcohol use disorder were recruited from an ‘Alcoholism Treatment Unit’. All of them with active alcohol consumption when the study was conducted or that had stopped drinking six months prior to the study, with no ocular disease or visual acuity alterations. All patients underwent fundus photography, optical coherence tomography (OCT) as well as visual field test. Electrophysiological tests were conducted to check retinal function: Ganzfeld Electroretinogram (ERG), Pattern Electroretinogram (PERG), Multifocal Electroretinogram (mfERG), and also Visual Evoked Potential (VEP). Results.Visual acuity was normal in all cases as well as fundus photography and visual field test. The OCT showed a mild decrease in the retinal nerve fiber layer thickness average in three patients. Five patients showed impairments in mfERG response, decreased amplitude in ERG response and no significant alterations in PERG and VEP. Conclusion. Although standard ophthalmic tests did not show signs of an ocular disease, the study of electrical function showed different impairments in almost all patients. The alterations reported in mfERG and ERG recordings could reflect inner retina injury, thus supporting the possible existence of an alcoholic retinopathy. Further studies with larger number of subjects are necessary to assess the specific impact of other factors such as tobacco or nutritional status on patients with alcohol use disorder.Sin financiaciónNo data JCR 20190.497 SJR (2019) Q2, 262/545 Psychiatry and Mental Health, 126/295 Clinical PsychologyNo data IDR 2019UE

Aplicaciones educativas de la psicología positiva

Resumen basado en el de la publicaciónSe realiza un acercamiento a la psicología positiva, desde el estudio de las bases de bienestar psicológico, la felicidad, las fortalezas y virtudes humanas. La psicología positiva promueve el estudio de las características, condiciones y procesos que contribuyen al funcionamiento óptimo de la persona, a su excelencia como individuo y al logro de una vida plena y significativa. Se tratan temas como el trabajo en equipo, la creatividad, el liderazgo, la resolución de problemas, las relaciones interpersonales, el optimismo, etc. Se considera que la aplicación a la escuela de esta corriente dentro de la psicología es necesaria. Por lo tanto, se apuesta por una tarea educativa entendida como recurso cultural de gestión personal de conocimiento para saber y ser feliz en la vida.ValenciaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 planta; 28014 Madrid; Tel. +34917748000; [email protected]

Aplicaciones educativas de la psicología positiva

Resumen basado en el de la publicaciónSe realiza un acercamiento a la psicología positiva, desde el estudio de las bases de bienestar psicológico, la felicidad, las fortalezas y virtudes humanas. La psicología positiva promueve el estudio de las características, condiciones y procesos que contribuyen al funcionamiento óptimo de la persona, a su excelencia como individuo y al logro de una vida plena y significativa. Se tratan temas como el trabajo en equipo, la creatividad, el liderazgo, la resolución de problemas, las relaciones interpersonales, el optimismo, etc. Se considera que la aplicación a la escuela de esta corriente dentro de la psicología es necesaria. Por lo tanto, se apuesta por una tarea educativa entendida como recurso cultural de gestión personal de conocimiento para saber y ser feliz en la vida.ValenciaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 planta; 28014 Madrid; Tel. +34917748000; [email protected]

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

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients

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