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

Fuzzy Logic Based Opportunistic Scheduler Design to Improve Fairness in Cellular Wireless Networks

Volume 4 Issue 9 (September 2016

A case of propylthiouracil-induced antineutrophilic cytoplasmic antibody-positive vasculitis successfully treated with radioactive iodine

Antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis is one of the rare complications of propylthiouracil treatment. Having a variable clinical spectrum, it may be presented with both skin limited vasculitis and life-threatening systemic vasculitis. In this study, we present a case that developed ANCA-positive vasculitis with skin and kidney involvement (hematuria and proteinuria) six months after propylthiouracil treatment was initiated for toxic nodular goiter. Proteinuria recovered dramatically subsequent to radioactive iodine treatment following ceasing the drug

Time-level relationship for nitric oxide and the protective effects of aminoguanidine in experimental spinal cord injury

Background. The secondary injury process following spinal cord trauma has been shown to involve different mechanisms such as excessive release of excitatory amino-acids, and induction of free radical induced lipid peroxidation. In this experimental study, the time-level relationship of the nitric oxide and the neuroprotective effects of aminoguanidine were investigated in a rat spinal cord trauma model

Retrieval of a retained capsule endoscopy through a metallic colonic stent in a patient with a neoplastic obstruction

We present a case of a 77-year-old woman with a history of iron-deficiency anemia. An upper GI endoscopy and colonoscopy were performed in 2019 without significant findings other than colonic diverticula. A year later, a small bowel capsule endoscopy (SBCE) ruled out any pathological lesions in the small bowel, reaching the cecum without complications. However, one month after ingestion of SBCE the patient was admitted to the emergency department due to nausea, abdominal bloating and tenderness. Abdominal CT-Scan revealed a stenosis in the descending colon with an image of a metallic foreign body consistent with a retained capsule and important dilation of the proximal colon (Fig. 1A). A colonoscopy was performed showing a stenotic mucosal lesion that was suspicious for colonic neoplasia located at 50 cm from the anal verge. Multiple biopsies were taken. Afterwards, a self-expandable metal colonic stent of 90 mm × 25 mm was deployed under radiologic and endoscopic control (Fig. 1B, C) resulting in the drainage of fecal material and solving the obstructive syndrome. SBCE was successfully retrieved under radiologic control using a polypectomy snare through the metal stent (Fig. 1D). Finally, the patient was discharged. Pathological reports confirmed a colorectal adenocarcinoma and the patient is currently awaiting for oncologic surgery