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

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

Background and purpose: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P&lt;0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P&lt;0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality.

BACKGROUND AND PURPOSE: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. METHODS: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). RESULTS: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. CONCLUSIONS: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT

Proteínas trasportadoras de fósforo de la familia PHT1 y su uso potencial en la agricultura moderna

La agricultura se ha globalizado por sus modernos avances orientados a producir más y mejores alimentos bajo un modelo de protección ambiental. Esta práctica se realiza en suelos con diferentes cantidades de nutrientes disponibles y se basa en el uso de fuentes minerales externas para satisfacer la demanda del cultivo. El fósforo (P) es un macroelemento que participa en funciones vitales de las plantas como la producción de adenosín trifosfato (ATP), formación de biomembranas y reacciones de señalización, entre otras. Las plantas utilizan estrategias fisio-morfológicas ante una deficiencia de Pque se manifiestan en síntomas característicos comodesarrollo deficiente, elongación de raíz,maduración precoz yreducción de la productividad del cultivocomo consecuencia. Para mantener la homeostasis celular, las plantas inducenla sobreproducción de proteínas de membrana con función transportadoras de fosfatoen los diferentes órganos. Estas proteínaspertenecen a la familia PHT1, presentan un transporte de tipo sin porteque facilita la introducción de fosfato inorgánico (Pi) desde la rizosfera y permiten satisfacer lademanda biológicadurante los procesos de señalización yenergía. Estructuralmenteestas proteínassonaltamente conservadas en plantas (monocotiledóneas y dicotiledóneas) y secaracterizan por poseer 12 dominios transmembranales, undominio conservado 2A0109 y tamaño aproximado de 520 aa. El objetivo de la presente revisión es situar en perspectiva el conocimiento actual delas proteínas transportadoras de fosfato PHT1, tomando de base los avances en modelos biológicospara mejorar los procesos productivos y lastécnicas de manejonutricional en los cultivos.Agriculture has been globalized by its modern advances aimed at producing more and better food under a model of environmental protection. This practice is carried out in soils with different amounts of available nutrients and is based on the use of external mineral sources to satisfy the demand of the crop. Phosphorus (P) is a macroelement that participates in vital functions of plants such as the production of adenosine triphosphate (ATP), biomembrane formation and signaling reactions, among others. The plants use physio-morphological strategies in the face of a deficiency of P that manifest themselves in characteristic symptoms such as deficient development, root elongation, early maturation and reduction of crop productivity as a consequence. To maintain cellular homeostasis, plants induce overproduction of membrane proteins with phosphate transporting function in different organs. These proteins belong to the PHT1family, they present a simport type transport that facilitates the introduction of inorganic phosphate (Pi) from the rhizosphere and allows to satisfy the biological demand during the signaling and energy processes. Structurally these proteins are highly conserved in plants (monocotyledonous and dicotyledonous) and are characterized by having 12 transmembrane domains, a conserved 2A0109 domain and an approximate size of 520 aa. The objective of this review is to put in perspective the current knowledge of PHT1phosphate transport proteins, taking as a basis the advances in biological models to improve the productive processes and the techniques of nutritional management in crop

Respuesta del tomate cultivado en hidroponía con soluciones nutritivas en sustrato humus de lombriz-fibra de coco

The aim of this study was to determine the effect that induces Steiner nutrient solution 100% of nutrient concentration, as well as variations in the concentration of the same (25 and 50%) of the concentration, compared with the control (water only ), applied in mixtures of organic substrates based on vermicompost and coir in proportions v: v 25:75, 50:50 and 75:25. With the Imperial hybrid tomato grafted Multifort® ball type, indeterminate growth during the 2011-2012 crop seasons. A factorial experiment was established 4 x 3 on a completely randomized experimental design with four replications. The study variables were greenness index (determined with SPAD 502), polar and equatorial diameter of fruit, and performance as rated by the official standard NMX-FF-031-1997. Increases were observed in the greenness index of 43.1, 48.7 and 55.8% with the solutions at 25, 50 and 100% of the nutritional 150 DAT (days after transplantation) compared with plants irrigated with water concentration; the equatorial diameter of the fruit had increases of 34.3-39.3% in the first cluster, compared to the fruits in the control, in the second cluster were of 55.8-60.2%, and the third of 360.8-412.7%; the polar diameter of the third cluster of fruits increased 308.6, 334.4 and 324.8% in the respective solutions at 25, 50 and 100%; while solutions with the same total return is expressed in increments of 295.0, 378.2 and 394.7%, but the best responses occurred where solutions were applied at 50 and 100%.El objetivo de este estudio fue conocer el efecto que induce la solución nutritiva Steiner al 100% de concentración nutrimental, así como las variaciones en la concentración de la misma (25 y 50%) de dicha concentración, en comparación con el testigo (sólo agua), aplicadas en mezclas de sustratos orgánicos a base de humus de lombriz y fibra de coco, en proporciones v:v de 25:75, 50:50 y 75:25. Con el tomate hibrido Imperial injertado con Multifort® tipo bola, de crecimiento indeterminado, durante el ciclo agrícola 2011-2012. Se estableció un experimento factorial 4 x 3 en un diseño experimental completamente al azar con cuatro repeticiones. Las variables de estudio fueron índice de verdor (determinada con SPAD 502), diámetro ecuatorial y polar de fruto, y rendimiento según la clasificación de la norma oficial NMX-FF-031-1997. Se observaron incrementos en el índice de verdor de 43.1, 48.7 y 55.8% con las soluciones al 25, 50 y 100% de concentración nutrimental a los 150 ddt (días después del trasplante), en comparación con plantas irrigadas con agua; el diámetro ecuatorial de los frutos tuvo incrementos de 34.3-39.3% en el primer racimo, en comparación al de frutos en el testigo, en el segundo racimo fueron de 55.8-60.2%, y en el tercero de 360.8-412.7%; el diámetro polar de frutos del tercer racimo se incrementó 308.6, 334.4 y 324.8% con las respectivas soluciones al 25, 50 y 100%; mientras que con las mismas soluciones el rendimiento total se expresó con incrementos de 295.0, 378.2 y 394.7%, pero las mejores respuestas se dieron donde se aplicaron las soluciones al 50 y 100%

Educación religiosa en América Latina y el Caribe : reflexiones y voces plurales para caminos pedagógicos interculturales

Compilador: José Mario Méndez Méndez Sección 1. Diversidad de Convicciones: creencias y espiritualidades. Sección 2. Textualidades Sagradas Sección 3. Ciencias de la religión. Sección 4. Expresiones de la diversidad. Sección 5. Religión y Cultura. Sección 6. Aportes pedagógicos. Sección 7. Educación religiosa en América Latina. Sección 8. Educación religiosa y espacios. Sección 9. Aspectos Jurídicos.El presente texto reúne los aportes de muchas personas que-desde diferentes países del continente-desean contribuir a la revisión y transformación intercultural de la educación religiosa en Latinoamérica y el Caribe. Como lo sugiere el título, confluyen aquí reflexiones y voces plurales para caminos pedagógicos interculturales. Cada una de las "voces" que conforman este texto expresa la intención de promover una educación liberadora-intercultural-decolonial, a partir de los desafíos que reconocemos en la realidad latinoamericana-caribeña.This text brings together the contributions of many people who-from different countries of the continent-wish to contribute to the revision and intercultural transformation of religious education in Latin America and the Caribbean. As the title suggests, reflections and plural voices converge here for intercultural pedagogical paths. Each one of the "voices" that make up this text expresses the intention of promoting a liberating-intercultural-decolonial education, based on the challenges that we recognize in the Latin American-Caribbean reality.Universidad Bíblica Latinoamericana, FONAPER, Foro de Educación Religiosa Costarricense, Universidad Regional de Blumenau, UNOCHAOECÓ, Escuela Ecuménica de Ciencias de la ReligiónEscuela Ecuménica de Ciencias de la Religió

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