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

Gestión del conocimiento: perspectiva multidisciplinaria. Volumen 13

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 13 de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada, de acceso abierto a todas las áreas del conocimiento, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico. Con esta colección, se aspira contribuir con el cultivo, la comprensión, la recopilación y la apropiación social del conocimiento en cuanto a patrimonio intangible de la humanidad, con el propósito de hacer aportes con la transformación de las relaciones socioculturales que sustentan la construcción social de los saberes y su reconocimiento como bien público. El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 13, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro cuenta con el apoyo de los grupos de investigación: Universidad Sur del Lago “Jesús María Semprúm” (UNESUR) - Zulia – Venezuela; Universidad Politécnica Territorial de Falcón Alonso Gamero (UPTFAG) - Falcón – Venezuela; Universidad Politécnica Territorial de Mérida Kléber Ramírez (UPTM) - Mérida - Venezuela; Universidad Guanajuato (UG) - Campus Celaya - Salvatierra - Cuerpo Académico de Biodesarrollo y Bioeconomía en las Organizaciones y Políticas Públicas (CABBOPP) - Guanajuato – México; Centro de Altos Estudios de Venezuela (CEALEVE) - Zulia – Venezuela, Centro Integral de Formación Educativa Especializada del Sur (CIFE - SUR) - Zulia – Venezuela; Centro de Investigaciones Internacionales SAS (CEDINTER) - Antioquia – Colombia y diferentes grupos de investigación del ámbito nacional e internacional que hoy se unen para estrechar vínculos investigativos, para que sus aportes científicos formen parte de los libros que se publiquen en formatos digital e impreso

Experience of ten years of neutropenic enterocolitis in intensive care at Instituto Nacional de Pediatría

Neutropenic enterocolitis (NEC) is a disease characterized by an inflam- matory process with damage to the intestinal mucosa and occurs as a complication of cytotoxic chemotherapy in oncological diseases, and severe neutropenia secondary to other diseases.Objective: To describe the population of patients with NEC who are served in the pediatric intensive care unit at Instituto Nacional de Pediatría. Methods: 10-year data of patients registered with a diagnosis of NEC (1 500 cel/µL less neutropenia, acute abdomen, consistent studies cabi- net) on admission to the intensive therapy that consisted of: age, type of cancer, organ failure, stage of sepsis, medical treatment and surgical management. Frequencies and percentages for qualitative; statistical analysis for measures of dispersion and central tendency were used for quantitative variables. Results: Population of 116 patients, 69 (60%) were men. The leukemia is the most common malignancy in 55%. 35% of patients corresponded to stage school. Sepsis was the most common presentation. Abdominal pain symptom most frequently found. 33% died as a result. Conclusions: The present study is exploratory in nature and compares the local epidemiology of the Instituto Nacional de Pediatría with UTIP world

Un Modelo de proceso de cuidado nutricional: Consenso para Latinoamérica

Introduction: Nutritional care models are standardized and systematized processes, whose objective is to provide consistency and linkage of information which generates a positive impact in terms of quality, service and costs.&nbsp; The objective of the expert consensus was to propose a nutrition care model for Latin America taking into account principle #2 of the International Declaration of Cartagena. Method: A questionnaire was developed and submitted to expert opinion following the Delphi methodology.&nbsp;&nbsp; The questionnaire initially consisted of 16 questions that evaluated the following issues: What are the stages and tools of the model? What approach should it have? On what pillars should the model be based? Consensus was considered when the questionnaire items achieved a score of ≥70% on the Likert scale 4 (agree) and 5 (strongly agree). Results: 3 rounds of expert consultation were carried out, where a model consisting of 5 steps was defined (starting with screening for malnutrition risk, ending with home care) which are based on 5 pillars: education, public policies, ethical foundations, economics of clinical nutrition and multidisciplinary/multisectoral approach.&nbsp; Quality indicators for each of the 5 steps were proposed and analyzed. Conclusion: The nutrition care model for Latin America is based on 5 steps and 5 pillars. This model should be considered as a didactic tool and strategy to facilitate the implementation and teaching of nutritional care in the Latin American context in the clinical setting at all levels of care.Introducción: Los modelos de cuidado nutricional son procesos estandarizados y sistematizados, cuyo objetivo es brindar consistencia y vinculación de la información lo cual genera un impacto positivo en términos de calidad, servicio y costos. &nbsp;El objetivo del consenso de expertos fue proponer un modelo de cuidado nutricional para Latinoamérica teniendo en cuenta el principio #2 de la Declaración Internacional de Cartagena. Método: Se desarrolló un cuestionario el cual fue sometido a la opinión de expertos siguiendo la metodología Delphi.&nbsp;&nbsp; El cuestionario, contó inicialmente con 16 preguntas que evaluaban los siguientes temas: ¿Cuáles son las etapas y herramientas del modelo?&nbsp; ¿Qué enfoque debe tener?&nbsp; ¿Sobre qué pilares fundamentar el modelo? Se consideró consenso cuando los ítems del cuestionario lograron un puntaje de ≥70% en la escala de Likert 4 (de acuerdo) y 5 (totalmente de acuerdo). Resultados: Se realizaron 3 rondas de consulta a expertos, donde se definió un modelo consistente en 5 pasos (iniciando con el tamizaje del riesgo de desnutrición, terminando con los cuidados domiciliarios) los cuales se fundamentan en 5 pilares: educación, políticas públicas, fundamentos éticos, economía de la nutrición clínica y enfoque multidisciplinar/multisectorial.&nbsp; Se propusieron y analizaron indicadores de calidad de cada uno de los 5 pasos. Conclusión: &nbsp;El modelo de cuidado nutricional para Latinoamérica se basa en 5 pasos y 5 pilares. Este modelo se debe considerar como una herramienta y estrategia didáctica que facilite la implementación y enseñanza del cuidado nutricional en el contexto latinoamericano en el ámbito clínico en todo nivel de atención. &nbsp

Characteristics and outcomes of multisystem inflammatory syndrome in children: A multicenter, retrospective, observational cohort study in Mexico

IntroductionMultisystem inflammatory syndrome in children associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death.MethodsThis multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis (LCA) to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression.ResultsThe study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysms were found in 5.7% and 13.2% of the patients in whom coronary artery diameter was measured, respectively. Any cause in-hospital mortality was 5.4%. Hospitalization after ten days of symptoms was associated with coronary artery abnormalities (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2.0). Age ≥10 years (OR: 5.6, 95% CI: 1.4–2.04), severe underlying condition (OR: 9.3, 95% CI: 2.8–31.0), platelet count &lt;150,000 /mm3 (OR: 4.2, 95% CI: 1.2–14.7), international normalized ratio &gt;1.2 (OR: 3.8, 95% CI: 1.05–13.9), and serum ferritin concentration &gt;1,500 mg/dl at admission (OR: 52, 95% CI: 5.9–463) were risk factors for death.DiscussionMortality in patients with MIS-C was higher than reported in other series, probably because of a high rate of cases with serious underlying diseases

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