14 research outputs found

    Role of age and comorbidities in mortality of patients with infective endocarditis

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    [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‚ÄĮyears,65 to 80‚ÄĮyears,and‚ÄĮ‚Č•‚ÄĮ80‚ÄĮyears.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‚ÄĮ<‚ÄĮ65‚ÄĮyears;1291 65-80‚ÄĮyears;502‚ÄĮ‚Č•‚ÄĮ80‚ÄĮyears) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ‚Č•80‚ÄĮyears who underwent surgery were significantly lower compared with other age groups (14.3%,65‚ÄĮyears; 20.5%,65-79‚ÄĮyears; 31.3%,‚Č•80‚ÄĮyears). In-hospital mortality was lower in the <65-year group (20.3%,<65‚ÄĮyears;30.1%,65-79‚ÄĮyears;34.7%,‚Č•80‚ÄĮyears;p‚ÄĮ<‚ÄĮ0.001) as well as 1-year mortality (3.2%, <65‚ÄĮyears; 5.5%, 65-80‚ÄĮyears;7.6%,‚Č•80‚ÄĮyears; p‚ÄĮ=‚ÄĮ0.003).Independent predictors of mortality were age‚ÄĮ‚Č•‚ÄĮ80‚ÄĮyears (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32‚Äď3.34), CCI‚ÄĮ‚Č•‚ÄĮ3 (HR:1.62; 95% CI:1.39‚Äď1.88),and non-performed surgery (HR:1.64;95% CI:11.16‚Äď1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65‚ÄĮyears(p‚ÄĮ<‚ÄĮ0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age‚ÄĮ‚Č•‚ÄĮ80‚ÄĮyears, 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

    Young adults perinatally infected with HIV perform more poorly on measures of executive functioning and motor speed than ethnically matched healthy controls

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    Perinatal HIV is associated with significant neurocognitive morbidities, but few studies have examined cognitive impact of early HIV infection on patients surviving to adulthood. The purpose of this study was to evaluate neurocognitive outcomes among a cohort of perinatally infected young adults. Individuals between the ages of 18 and 24 with perinatal infection were recruited for this cross-sectional study along with similarly aged healthy controls. Participants completed an MRI and brief neuropsychological assessment battery. Multivariate analysis of covariance controlling for age, gender, race/ethnicity, and education was completed to detect differences between the HIV+ and control groups. Multivariable linear regression was performed to assess HIV-associated factors potentially impacting neuropsychological findings among the HIV+ group. Twenty-nine HIV+ young adults and 13 healthy controls were included in the study. After adjusting for age and sociodemographic variables, the HIV+ group scored lower on attention/working memory (Digit Span (p‚ÄČ=‚ÄČ.008) and Letter-Number Sequencing (p‚ÄČ=‚ÄČ.038)), set-shifting (DKEFS Trail Making Test Condition 4 (p‚ÄČ=‚ÄČ.026) and motor speed (DKEFS Trail Making Test Condition 5 (p‚ÄČ=‚ÄČ.003)). For the HIV+ group, nadir CD4 was associated with better Letter-Number Sequencing score (p‚ÄČ=‚ÄČ.029) and use of highly active antiretroviral therapy was associated with better performance on Category Fluency (p‚ÄČ=‚ÄČ.040). After controlling for sociodemographic variables, executive dysfunction persists among young adults with perinatal HIV infection in comparison to controls. Future studies to further elucidate the impact of executive dysfunction on independent living and functional outcomes are indicated

    Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy

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