Search

Background: We aim to investigate the effects of the Bruton’s tyrosine kinase (BTK) inhibitor remibrutinib on human in vitro cell activation induced by serum obtained from chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU) patients. Methods: 22 patients with CSU (mean age 52 years, 27% women) and 22 with CIndU (46 years, 27% women) were included. A sex-equivalent control group was enrolled. Total IgE serum levels and the FcεR1a expression on blood basophils were determined before the initiation of omalizumab therapy. Patients were then classified as responders or non-responders to anti-IgE therapy, according to their clinical data and IgE and FcεR1a receptor expression. Mast cell generation and stimulation and basophil stimulation were performed. Flow cytometry was used to analyze samples. Percentage of activation, degranulation and inhibition in basophils and mast cells are studied. Results: Main results show that remibrutinib inhibits mast cells and basophil degranulation induced by IgE cross-linking. Also, serum from patients induced a greater degranulation of mast cells and basophils compared to controls. We found that activation of mast cells and basophils by patient sera was not related to omalizumab responsiveness. Conclusion: Our results show that remibrutinib is able to inhibit the degranulation of human basophils and mast cells in vitro, independently of the patient’s expression of FcεR1 expression and response to omalizumab.

Background: Oncological outcomes of self-expanding metallic stent used as a bridge to surgery in potential curative patients with left-sided colonic cancer obstruction remain unclear. The aim of this study was to investigate perioperative and mid-term oncological outcomes of 2 of the currently most commonly performed treatments in left-sided colonic cancer obstruction.Methods: This is a retrospective multicenter study including patients with left-sided colonic cancer obstruction treated with curative intent between 2013 and 2017. The presence of metastasis at diagnosis was an exclusion criterion. The primary outcome was to evaluate the noninferiority, in terms of overall survival, of bridge to surgery strategy compared with emergency colonic resection. The secondary outcomes were perioperative morbimortality, disease free survival, local recurrence, and distant recurrence.Results: A total of 564 patients were included, 320 in the emergency colonic resection group and 244 in the bridge to surgery group. Twenty-seven patients of the bridge-to-surgery group needed urgent operation. Postoperative morbidity rates were statistically higher in the emergency colonic resection group (odds ratio [95% confidence interval] 0.37 [0.24-0.55], P < .001). There was no difference in 90-day mortality between groups (odds ratio [95% confidence interval] 0.85 [0.36-1.99], P = .702). The median follow-up was 3.80 years (2.29-4.92). The results show the noninferiority of bridge to surgery versus emergency colonic resection in terms of overall survival (hazard ratio [95% confidence interval) 0.78 [0.56-1.07], P = .127). There were no differences in disease free survival, distant recurrence, and local recurrence rates between bridge to surgery and emergency colonic resection groups.Conclusion: Self-expanding metallic stent as bridge to surgery might not lead to a negative impact on the long-term prognosis of the tumor compared with emergency colonic resection in expert hands and selected patients. (c) 2022 Elsevier Inc. All rights reserved.

Background: Colorectal surgery is associated with the highest rate of surgical site infection (SSI). This study analyses the effectiveness of an interventional surveillance program on SSI rates after elective colorectal surgery. Material and methods: Cohort study showing temporal trends of SSI rates and Standardized Infection Ratio (SIR) in elective colorectal surgery over a 12-year period. Prospectively collected data of a national SSI surveillance program was analysed and the effect of specific interventions was evaluated. Patient and procedure characteristics, as well as SIR and SSI rates were stratified by risk categories and type of SSI analysed using stepwise multivariate logistic regression models. Results: In a cohort of 42,330 operations, overall cumulative SSI incidence was 16.31%, and organ-space SSI (O/S–SSI) was 8.59%. There was a 61.63% relative decrease in SSI rates (rho = -0.95804). The intervention which achieved the greatest SSI reduction was a bundle of 6 measures. SSI in pre-bundle period was 19.73% vs. 11.10% in post-bundle period (OR 1.969; IC 95% 1.860–2.085; p < 0.0001). O/S–SSI were 9.08% vs. 6.06%, respectively (OR 1.547; IC 95% 1.433–1.670; p < 0.0001). Median length of stay was 7 days, with a significant decrease over the studied period (rho = -0.98414). Mortality of the series was 1.08%, ranging from 0.35% to 2.0%, but a highly significant decrease was observed (rho = -0.67133). Conclusions: Detailed analysis of risk factors and postoperative infection in colorectal surgery allows strategies for reducing SSI incidence to be designed. An interventional surveillance program has been effective in decreasing SIR and SSI rates. © 2022 The Authors

Melatonin is the main hormone involved in the control of the sleep-wake cycle. It is easily synthesisable and can be administered orally, which has led to interest in its use as a treatment for insomnia. Moreover, as production of the hormone decreases with age, in inverse correlation with the frequency of poor sleep quality, it has been suggested that melatonin deficit is at least partly responsible for sleep disorders. Treating this age-related deficit would therefore appear to be a natural way of restoring sleep quality, which is lost as patients age. However, despite the undeniable theoretical appeal of this approach to insomnia, little scientific evidence is available that supports any benefit of this substitutive therapy. Furthermore, the most suitable dose ranges and pharmaceutical preparations for melatonin administration are yet to be clearly defined. This review addresses the physiology of melatonin, the different pharmaceutical preparations, and data on its clinical usefulness. (C) 2018 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U.

Background: Catheter-related bloodstream infections (CRBSI) are frequent healthcare-associated infections and an important cause of death. Aim: To analyse changes in CRBSI epidemiology observed by the Infection Control Catalan Programme (VINCat). Methods: A cohort study including all hospital-acquired CRBSI episodes diagnosed at 55 hospitals (2007-2019) in Catalonia, Spain, was prospectively conducted. CRBSI incidence rates were adjusted per 1,000 patient days. To assess the CRBSI rate trend per year, negative binomial models were used, with the number of events as the dependent variable, and the year as the main independent variable. From each model, the annual rate of CRBSI diagnosed per 1,000 patient days and the incidence rate ratio (IRR) with its 95% confidence intervals (CI) were reported. Results: During the study, 9,290 CRBSI episodes were diagnosed (mean annual incidence rate: 0.20 episodes/1,000 patient days). Patients' median age was 64.1 years; 36.6% (3,403/9,290) were female. In total, 73.7% (n = 6,845) of CRBSI occurred in non-intensive care unit (ICU) wards, 62.7% (n = 5,822) were related to central venous catheter (CVC), 24.1% (n = 2,236) to peripheral venous catheters (PVC) and 13.3% (n = 1,232) to peripherally-inserted central venous catheters (PICVC). Incidence rate fell over the study period (IRR: 0.94; 95%CI: 0.93-0.96), especially in the ICU (IRR: 0.88; 95%CI: 0.87- 0.89). As a whole, while episodes of CVC CRBSI fell significantly (IRR: 0.88; 95%CI: 0.87-0.91), peripherally-inserted catheter CRBSI (PVC and PICVC) rose, especially in medical wards (IRR PICVC: 1.08; 95%CI: 1.05-1.11; IRR PVC: 1.03; 95% 1.00-1.05). Conclusions: Over the study, CRBSIs associated with CVC and diagnosed in ICUs decreased while episodes in conventional wards involving peripherally-inserted catheters increased. Hospitals should implement preventive measures in conventional wards.

Background: The incidence of catheter-related bloodstream infections (CRBSIs) has fallen over the last decade, especially in intensive care units (ICUs). Aim: To assess the existence of concomitant trends in outcomes and to analyse the current risk factors for mortality. Methods: A multicentre retrospective cohort study was conducted at 24 Catalan hospitals participating in the Surveillance of healthcare-associated infections in Catalonia (VINCat). All hospital-acquired CRBSI episodes diagnosed from January 2010 to December 2019 were included. A common protocol including epidemiological, clinical, and microbiological data was prospectively completed. Mortality at 30 days after bacteraemia onset was analysed using the Cox regression model. Findings: Over the study period, 4795 episodes of CRBSI were diagnosed. Among them, 75% were acquired in conventional wards and central venous catheters were the most frequently involved (61%). The 30-day mortality rate was 13.8%, presenting a significant downward trend over the study period: from 17.9% in 2010 to 10.6% in 2019 (hazard ratio (HR): 0.95; 95% confidence interval (CI): 0.92-0.98). The multivariate analysis identified age (HR: 1.03; 95% CI: 1.02-1.04), femoral catheter (1.78; 1.33-2.38), medical ward acquisition (2.07; 1.62-2.65), ICU acquisition (3.45; 2.7-4.41), S. aureus (1.59; 1.27-1.99) and Candida sp. (2.19; 1.64-2.94) as risk factors for mortality, whereas the mortality rate associated with episodes originating in peripheral catheters was significantly lower (0.69; 0.54-0.88). Conclusion: Mortality associated with CRBSI has fallen in recent years but remains high. Intervention programmes should focus especially on ICUs and medical wards, where incidence and mortality rates are highest. (c) 2022 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Context Lynch syndrome (LS) is the most common inherited colorectal and endometrial cancer syndrome, caused by germline mutations in DNA mismatch repair (MMR) genes. It is also characterized by an increased risk of other tumors with lower prevalence, such as adrenal cortical carcinoma (ACC), an endocrine tumor with an incidence of

Recent years have seen important advances in our understanding of calciphylaxis, especially regarding newly identified risk factors and histologic findings that may aid diagnosis. This retrospective study of cases of calciphylaxis treated in our hospital in the last 13 years focuses on newly revealed aspects of this disease. We describe 16 patients (62.5% women; mean age, 67.9 years). In addition to advanced kidney disease (in 75% of our patients), other factors associated with the presence of calciphylaxis were a history of treatments related to phosphorus and calcium metabolism (75%) and anticoagulation (62.5%), usually with vitamin-K antagonists. Histology showed alterations in elastic fibers in only 25% of the biopsy specimens. Eleven of the patients died: sepsis was most often the cause. (C) 2021 AEDV. Published by Elsevier Espana, S.L.U.

Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and bacterial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. La Sociedad Espanola de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociacion Espanola de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery. (C) 2020 Elsevier Espana, S.L.U. and Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.

Chilblain-like acral lesions have been identified in some coronavirus disease 2019 (COVID-19) patients. It has been suggested that these pseudo-chilblains could be a specific marker of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Most patients with these lesions have had negative polymerase chain reactions (PCRs), but some authors believe serology tests are likely to give positive results. We designed a prospective study including all patients with pseudo-chilblains treated in outpatient department in April and May 2020 and then performed SARS-CoV-2 PCR and serology tests on all available patients. We evaluated 59 patients, of whom 17 had undergone PCR before the study period, all with negative results. For the present study, we performed 20 additional PCRs, serology tests in 25 patients, and a parvovirus B19 antibody test in 15 patients. All results were negative. Our findings counter the hypothesis that serology is likely to reveal SARS-CoV-2 infection in patients with pseudo-chilblains. One hypothesis for our negative results is that the time period between symptom onset and antibody production is longer in these patients; another is that the lesions are caused by behavioral changes during lockdown rather than SARS-CoV-2 infection. We nevertheless maintain that COVID-19 should be ruled out in people presenting with chilblain-like lesions.

Objective To assess the effectiveness and survival of ustekinumab (UST) among patients with psoriatic arthritis (PsA) treated under routine clinical care. Methods Multicenter study. Epidemiological and clinical data was collected through electronic medical records of all patients with PsA who started UST in 15 hospitals of Spain. Results Two hundred and one patients were included, 130 (64.7%) with 45 mg and 71 (35.3%) with 90 mg. One hundred and thirty one patients (65.2%) had previously received another biological therapy. The median baseline DAS 28 ESR was 3.99, and Psoriasis Area and Severity Index (PASI) was 3. Overall, there was a significant decrease in DAS66/68 CRP, swollen joint count (SJC), tender joint count (TJC), and PASI in the first month of treatment, with earlier improvement in skin (PASI) than joints outcomes. Survival was numerically lower in patients with UST 45 mg (58.1%) than 90 mg (76.1%), although significant differences were not found (p = 0.147). When comparing naive and < 1 TNF blocker versus > 2 TNF blocker-experienced patients, a significantly earlier response was seen in the former group regarding SJC (p = 0.029) at 1 month. Fifty-one patients (25.3%) stopped UST due to joint inefficacy and 4 patients due to adverse events (1.9%). Drug survival was significantly better in patients with fewer lines of previous biological agents (p = 0.003 for < 1 TNF blocker versus > 2 TNF blocker users). Conclusions UST was effective in PsA patients in a routine clinical care setting. Patients with UST 90 mg and fewer lines of previous biologics achieved better and faster responses.

Background Little information exists about the role of anemia in patients with acute coronary syndromes (ACS) admitted to Intensive Cardiac Care Units (ICCU). The aim of this study was to assess the prevalence of anemia and its impact on management and outcomes in this clinical setting. Methods All consecutive patients admitted to eight different ICCUs with diagnosis of non-ST segment elevation ACS (NSTEACS) were prospectively included. Anemia was defined as hemoglobin < 130 g/L in men and < 120 g/L in women. The association between anemia and mortality or readmission at six months was assessed by the Cox regression method. Results A total of 629 patients were included. Mean age was 66.6 years. A total of 197 patients (31.3%) had anemia. Coronary angiography was performed in most patients (96.2%). Patients with anemia were significantly older, with a higher prevalence of comorbidities, poorer left ventricle ejection fraction and higher GRACE score values. Patients with anemia underwent less often coronary angiography, but underwent more often intraaortic counterpulsation, non-invasive mechanical ventilation and renal replacement therapies. Both ICCU and hospital stay were significantly longer in patients with anemia. Both the incidence of mortality (HR = 3.36, 95% CI: 1.43-7.85, P = 0.001) and the incidence of mortality/readmission were significantly higher in patients with anemia (HR = 2.80, 95% CI: 2.03-3.86, P = 0.001). After adjusting for confounders, the association between anemia and mortality/readmission remained significant (P = 0.031). Conclusions Almost one of three NSTEACS patients admitted to ICCU had anemia. Most patients underwent coronary angiography. Anemia was independently associated to poorer outcomes at 6 months.

BACKGROUND: Short peripheral venous catheters are one of the most frequently used devices in hospitals. Peripheral venous catheter failure, defined as the unscheduled dysfunction of peripheral venous catheter, is common and frequently entails a new invasive procedure. Flushing the catheter maintains patency and could prolong peripheral venous catheter dwell time. The introduction of pre-filled saline flushing syringes as compared to manually filled saline flushing syringes could facilitate the frequency of catheter flushing, and subsequently it could reduce peripheral venous catheter failure rate. OBJECTIVE: To demonstrate differences in overall peripheral venous catheter failure rates before and after the introduction of pre-filled saline flushing syringes and to assess the risk factors for peripheral venous catheter failure. METHODS: Quasi-experimental design, before-and-after intervention study. Intervention: introduction of pre-filled saline syringes for flushing. Multicenter study conducted in medical and surgical wards of three European hospitals during a 9-month period (4 months pre-intervention, 5 months intervention). A multivariate Cox proportional model was used to identify factors associated with the occurrence of peripheral venous catheter failure. RESULTS: Data from 3853 peripheral venous catheters in 1915 patients were analyzed. Compared to pre-intervention period, a significant decrease in peripheral venous catheter failure rate was observed in the intervention period (57% vs 43.4%, p < 0.001). Independent factors associated with peripheral venous catheter failure were as follows: Charlson score ?4 (hazard ratio: 1.648; 95% confidence interval: 1.069-2.527), days of hospital stay ?10 (hazard ratio: 1.468; 95% confidence interval: 1.172-1.837), and catheter "D" (hazard ratio: 1.758; 95% confidence interval: 1.058-2.919). CONCLUSION: The use of pre-filled saline syringes significantly reduced peripheral venous catheter failure and increased catheter dwell time. Thus, it is important to reinforce the use of the pre-filled syringes for flushing to reduce the incidence of peripheral venous catheters' failure.

Sleep-related movement and behaviour disorders may have an impact on sleep quality and lead to daytime symptoms. These groups of conditions include diseases such as restless legs syndrome, periodic leg movements, and REM and NREM parasomnias. The knowledge of their clinical features and management is of utmost importance for the neurologist and sleep specialist. Frequently, these patients are referred to such specialists and it is relevant to know that certain sleep disorders may be associated with other neurological conditions.Trastornos del movimiento y de la conducta durante el sueño en el adulto.Los trastornos del movimiento y de la conducta durante el sueño pueden tener un impacto en la calidad del sueño del paciente y dar lugar a síntomas diurnos. En estos grupos de enfermedades se incluyen entidades como el síndrome de piernas inquietas, los movimientos periódicos de las piernas y las parasomnias del sueño de movimientos oculares rápidos (REM) y no REM. El conocimiento de sus características clínicas y nociones sobre su manejo es de gran importancia para el neurólogo y especialista en sueño por su frecuencia e impacto en la calidad del sujeto. Con frecuencia, estos pacientes son referidos a dichos especialistas, y es relevante conocer que ciertos trastornos del sueño pueden asociarse a otras enfermedades neurológicas.

Recently, young COVID-19 patients have presented with erythematous and purpuric acral lesions similar to chilblains(1–3). Despite the scarcity of published cases, this topic has attracted significant mass media attention.(4) Dermatologists have noted that more people than would be expected at this time of year are seeking medical attention for these chilblain-like lesions. Some have suggested that people presenting with this manifestation should be tested and isolated(2). Determining the accuracy of this association is therefore crucial. To establish the real prevalence of COVID-19 in patients with acral skin lesions, we firstly evaluated all the cases of acral lesions presented in dermatology and paediatrics departments and family doctors’ offices in an eastern Spanish region over a three-week period. Then we prospectively performed a SARS-CoV-2 PCR on nasopharyngeal aspirates taken from all available patients to determine whether their cutaneous manifestations were predictive of a positive result. To put our findings into context, we reviewed all the articles published before May 2020 concerning COVID-19 patients with cutaneous lesions. We evaluated 58 patients, whose characteristics are summarized in Table 1. In most cases, lesions were chilblain-like. Fifteen patients had already been tested, and only one had a positive result: an 85-year-old man admitted for severe Covid-19 pneumonia. He had an ulcer on a toe that was finally determined to be vascular in nature. We performed prospective PCR testing in 24 patients. All test results were negative. In total, then, PCR was negative in 38 patients and positive in a single patient whose lesion was very unlikely to be due to COVID-19. Our bibliography search returned 97 articles and we found 2 more through cross-references. Nine of these articles dealt with acral lesions specifically. Their results are summarized in Table 2. Data published in the literature are heterogeneous, as are the methods employed to collect them. The first papers looked at cutaneous manifestations in patients with confirmed SARS-CoV-2 infection.(5–8) This approach cannot reveal whether this dermatologic manifestation is a specific marker of SARS-CoV-2 infection, since patients without COVID-19 are not included. The other approach, which we have followed, is to analyse all patients with acral lesions. This can be done retrospectively, reporting on patients in the sample who have already been tested, or prospectively, performing the test on all available patients, regardless of whether they have symptoms. The retrospective method has a significant risk of confounding bias: due to the scarcity of COVID-19 tests(8), they are usually reserved for patients with COVID-19-related symptoms, who are obviously more likely to test positive. All previous studies including only patients with cutaneous acral lesions (summarized in table 2) have been retrospective, and only a minority of patients were tested. In total, 12 out of at least 49 tested patients were positive (24.5%). Combined with our results, they total 13 positives out of 88 tests (14.8%). There are two possible explanations for the high proportion of negative results: I) A high number of false negatives. II) The lesions are not related to SARS-CoV-2 infection. The low prevalence of an infected contact in our sample, after three weeks of strict confinement in Spain, makes the possibility of being infected in our cohort less likely. The diffusion of this entity by the mass media may have caused patients who would not normally consult to do so.(9) . Other possible explanations include a concomitant parvovirus B19 outbreak(10) or trauma-induced lesions. Our study suggests that acral skin lesions are not a specific marker of SARS-CoV-2 infection. Although larger prospective studies are needed, current evidence indicates that acral skin lesions should not be regarded as a sign of COVID-19 in otherwise asymptomatic patients.

A high degree of vigilance and appropriate diagnostic methods are required to detect Clostridioides difficile infection (CDI). We studied the effectiveness of a multimodal training program for improving CDI surveillance and prevention. Between 2011 and 2016, this program was made available to healthcare staff of acute care hospitals in Catalonia. The program included an online course, two face-to-face workshops and dissemination of recommendations on prevention and diagnosis. Adherence to the recommendations was evaluated through surveys administered to the infection control teams at the 38 participating hospitals. The incidence of CDI increased from 2.20 cases/10 000 patient-days in 2011 to 3.41 in 2016 (P < 0.001). The number of hospitals that applied an optimal diagnostic algorithm rose from 32.0% to 71.1% (P = 0.002). Hospitals that applied an optimal diagnostic algorithm reported a higher overall incidence of CDI (3.62 vs. 1.92, P < 0.001), and hospitals that were more active in searching for cases reported higher rates of hospital-acquired CDI (1.76 vs. 0.84, P < 0.001). The results suggest that the application of a multimodal training strategy was associated with a significant rise in the reporting of CDI, as well as with an increase in the application of the optimal diagnostic algorithm.

Objective To determine the incidence and risk factors of first cardiovascular event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD). Methods Analysis of data after 2.5 years of follow-up from the prospective study CARMA project, that includes patients with CIRD [rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA)] and matched individuals without CIRD from 67 hospitals in Spain. CVE cumulative incidence per 1000 patients was calculated after 2.5 years from the start of the project. Weibull proportional hazard model was used to calculate hazard ratio (HR) and 95% confidence interval (95% CI) of the risk factors. Results 2595 (89.1%) patients completed the 2.5 years of follow-up visit. Cumulative incidence of CVE in patients with CIRD was 15.30 cases per 1000 patients (95% CI: 12.93-17.67), being higher in the subgroup with AS; 22.03 (95% CI: 11.01-33.04). Patients with AS (HR: 4.11; 95% CI: 1.07-15.79), those with older age (HR: 1.09; 95% CI: 1.05-1.13), systolic hypertension (HR: 1.02; 95% CI: 1.00-1.04) and long duration of the disease (HR: 1.07; 95% CI: 1.03-1.12) were at higher risk of first CVE during the 2.5 years of follow-up. In contrast, female gender was a protective factor (HR: 0.43; 95% CI: 0.18-1.00). Conclusion Among CIRD patients prospectively followed-up at rheumatology outpatient clinics, those with AS show higher risk of first CVE. Besides cardiovascular risk factors, such as hypertension, being a man and older

Objective Cardiovascular (CV) disease is one of the main causes of morbi-mortality in spondyloarthritis (SpA), partially explained by traditional CV risk factors. Information on lipoprotein(a) [Lp(a)], a non-conventional risk factor, in SpA is scarce. In this study we assessed the prevalence of hyperlipoproteinaemia(a) in SpA patients and analysed the possible related factors. Methods A baseline analysis was made of ankylosing spondylitis (AS) and psoriatic arthritis (PsA) patients and controls included in the CARMA project (CARdiovascular in RheuMAtology), a 10-year prospective study evaluating the risk of CV events in chronic inflammatory rheumatic diseases. A multivariate logistic regression model was performed using hyperlipoproteinaemia( a) (Lp(a) >50 mg/dl) as a dependent variable and adjusting for confounding factors. Results 19.2% (95% CI: 16.80-22.05) of the SpA patients [20.7% (95% CI: 16.91-24.82) of those with AS and 17.7% (95% CI: 14.15-21.75) of those with PsA] and 16.7% (95% CI: 13.23-20.86) of the controls had hyperlipoproteinaemia(a) (p=0.326). Adjusting for age and sex, SpA patients were more likely to have hyperlipoproteinaemia(a) than controls (OR: 1.43, 95% CI: 1.00-2.04; p=0.05), especially those with AS (OR: 1.81, 95% CI: 1.18-2.77; p=0.007). In the adjusted model, apolipoprotein B in all patients, non-steroidal anti-inflammatory drugs in AS, and female sex in PsA, were associated with hyperlipoproteinaemia(a). No disease-specific factors associated with hyperlipoproteinaemia(a) were identified. Conclusion SpA patients show a moderately increased risk of hyperlipoproteinaemia(a) compared to controls, especially those with AS. Lp(a) determination may be of interest to improve the CV risk assessment in SpA patients.

Background Complicated urinary tract infections (cUTIs) are responsible for a major share of all antibiotic consumption in hospitals. We aim to describe risk factors for treatment failure and mortality among patients with cUTIs. Methods A multinational, multicentre retrospective cohort study, conducted in 20 countries in Europe and the Middle East. Data were collected from patients' files on hospitalised patients with a diagnosis of cUTI during 2013-2014. Primary outcome was treatment failure, secondary outcomes included 30 days all-cause mortality,among other outcomes. Multivariable analysis using a logistic model and the hospital as a random variable was performed to identify independent predictors for these outcomes. Results A total of 981 patients with cUTI were included. Treatment failure was observed in 26.6% (261/981), all cause 30-day mortality rate was 8.7% (85/976), most of these in patients with catheter related UTI (CaUTI). Risk factors for treatment failure in multivariable analysis were ICU admission (OR 5.07, 95% CI 3.18-8.07), septic shock (OR 1.92, 95% CI 0.93-3.98), corticosteroid treatment (OR 1.92, 95% CI 1.12-3.54), bedridden (OR 2.11, 95%CI 1.4-3.18), older age (OR 1.02, 95% CI 1.0071.03-), metastatic cancer (OR 2.89, 95% CI 1.46-5.73) and CaUTI (OR 1.48, 95% CI 1.04-2.11). Management variables, such as inappropriate empirical antibiotic treatment or days to starting antibiotics were not associated with treatment failure or 30-day mortality. More patients with pyelonephritis were given appropriate empirical antibiotic therapy than other CaUTI [110/171; 64.3% vs. 116/270; 43%, p

Melatonin is the main hormone involved in the control of the sleep-wake cycle. It is easily synthesisable and can be administered orally, which has led to interest in its use as a treatment for insomnia. Moreover, as production of the hormone decreases with age, in inverse correlation with the frequency of poor sleep quality, it has been suggested that melatonin deficit is at least partly responsible for sleep disorders. Treating this age-related deficit would therefore appear to be a natural way of restoring sleep quality, which is lost as patients age. However, despite the undeniable theoretical appeal of this approach to insomnia, little scientific evidence is available that supports any benefit of this substitutive therapy. Furthermore, the most suitable dose ranges and pharmaceutical preparations for melatonin administration are yet to be clearly defined. This review addresses the physiology of melatonin, the different pharmaceutical preparations, and data on its clinical usefulness.

BACKGROUND: Surgical site infections (SSIs) are the leading cause of healthcare-associated infections in acute care hospitals in Europe. However, the risk factors for the development of early-onset (EO) and late-onset (LO) SSI have not been elucidated. AIM: This study investigated the predictive factors for EO-SSI and LO-SSI in a large cohort of patients undergoing colorectal surgery. METHODS: We prospectively followed-up adult patients undergoing elective colorectal surgery in 10 hospitals (2011-2014). Patients were divided into three groups: EO-SSI, LO-SSI, or no infection (no-SSI). The cut-off defining EO-SSI and LO-SSI was seven days (median time to SSI development). Different predictive factors for EO-SSI and LO-SSI were analysed, comparing each group with the no-SSI patients. FINDINGS: Of 3701 patients, 320 (8.6%) and 349 (9.4%) developed EO-SSI and LO-SSI, respectively. The rest had no-SSI. Patients with EO-SSI were mostly males, had colon surgery and developed organ-space SSI whereas LO-SSI patients frequently received chemotherapy or radiotherapy and had incisional SSI. Male sex (odds ratio (OR): 1.92; P 2 (OR: 1.51; P = 0.01), administration of mechanical bowel preparation (OR: 0.7; P = 0.03) and stoma creation (OR: 1.95; P

© 2018 SPIE. High-resolution thermal sensing and bioimaging at the cellular level and in animal models is interesting for both early diagnosis and controlled treatment via photothermal conversion of several diseases. Despite excellent in vitro results have been obtained with visible emitting luminescent nanothermometers, their application for in vivo studies is very limited due to the reduced penetration depth of visible light in biological tissues. This can be overcome if materials with emitting in the so-called biological windows (650-1350 nm) are used. Despite all this work, the number of studies exploring the possibilities of longer emission wavelengths in luminescence thermometry are scarce. This includes those lying in the so called short-wavelength infrared (SWIR) that extends from 1.35 to 2.3 μm. SWIR light transmits more effectively (up to three times) through specific biological tissues (oxygenated blood and melanin-containing tumors), achieving higher penetrations depths. Due to the reduced tissue absorbance and scattering within this region. Here, we analyze the possibilities for temperature sensing purposes of emissions in the SWIR region generated by Er3+, Tm3+and Ho3+ions in KLu(WO4)2nanoparticles. The thermometric responses of these particles are compared with those shown by other Ln3+-doped nanoparticles of the same family of materials operating in the other biological windows, and demonstrate the potentiality of SWIR emitting nanoparticles for temperature measurements in biological tissues. The results indicate that SWIR emitting nanoparticles are good candidates for luminescent thermometry in biomedical applications.

Background. The purpose of this study was to analyze the secular trends of infective endocarditis in a teaching hospital between January 1996 and December 2015. Methods. We report on a single-center retrospective study of patients with left-side valve infective endocarditis. We performed an analysis of secular trends in the main epidemiological and etiological aspects, as well as clinical outcomes, in 5 successive 4-year periods (P1 to P5). Results. In total, 595 episodes of infective endocarditis were included, of which 76% were community-acquired and 31.3% involved prosthetic valves. Among the cases, 70% occurred in men, and the mean age (SD) was 64.1 (14.3) years. A significant increase in older patients (age >= 70 years) between P1 (15.332%) and P5 (51.9%; P

Background Initial medication non-adherence is highly prevalent in primary care but no previous studies have evaluated its impact on the use of healthcare services and/or days on sick leave. Aim To estimate the impact of initial medication non-adherence on the use of healthcare services, days of sick leave, and costs overall and in specific medication groups. Design and setting A 3-year longitudinal register-based study of all primary care patients (a cohort of 1.7 million) who were prescribed a new medication in Catalonia (Spain) in 2012. Method Thirteen of the most prescribed and/or costly medication subgroups were considered. All medication and medication subgroups (chronic, analgesics, and penicillin) were analysed. The number of healthcare services used and days on sick leave were considered. Multilevel multivariate linear regression was used. Three levels were included: patient, GP, and primary care centre. Results Initially adherent patients made more use of medicines and some healthcare services than non-adherent and partially adherent patients. They had lower productivity losses, producing a net economic return, especially when drugs for acute diseases (such as penicillins) were considered. Initial medication non-adherence resulted in a higher economic burden to the system in the short term. Conclusion Initial medication non-adherence seems to have a short-term impact on productivity losses and costs. The clinical consequences and long-term economic consequences of initial medication non-adherence need to be assessed. Interventions to promote initial medication adherence in primary care may reduce costs and improve health outcomes.

OBJECTIVE: To determine current outcomes and predictors of treatment failure among patients with surgical site infection (SSI) after colorectal surgery. METHODS: A multicentre observational prospective cohort study of adults undergoing elective colorectal surgery in 10 Spanish hospitals (2011-2014). Treatment failure was defined as persistence of signs/symptoms of SSI or death at 30 days post-surgery. RESULTS: Of 3701 patients, 669 (18.1%) developed SSI; 336 (9.1%) were organ-space infections. Among patients with organ-space SSI, 81.2% required source control: 60.4% reoperation and 20.8% percutaneous/transrectal drainage. Overall treatment failure rate was 21.7%: 9% in incisional SSIs and 34.2% in organ-space SSIs (p

BACKGROUND: Organ-space surgical site infections (SSI) are the most serious and costly infections after colorectal surgery. Most previous studies of risk factors for SSI have analysed colon and rectal procedures together. The aim of the study was to determine whether colon and rectal procedures have different risk factors and outcomes for organ-space SSI. METHODS: A multicentre observational prospective cohort study of adults undergoing elective colon and rectal procedures at 10 Spanish hospitals from 2011 to 2014. Patients were followed up until 30 days post-surgery. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Oral antibiotic prophylaxis (OAP) was considered as the administration of oral antibiotics the day before surgery combined with systemic intravenous antibiotic prophylaxis. RESULTS: Of 3,701 patients, 2,518 (68%) underwent colon surgery and 1,183 (32%) rectal surgery. In colon surgery, the overall SSI rate was 16.4% and the organ-space SSI rate was 7.9%, while in rectal surgery the rates were 21.6% and 11.5% respectively (p < 0.001). Independent risk factors for organ-space SSI in colon surgery were male sex (Odds ratio -OR-: 1.57, 95% CI: 1.14-2.15) and ostomy creation (OR: 2.65, 95% CI: 1.8-3.92) while laparoscopy (OR: 0.5, 95% CI: 0.38-0.69) and OAP combined with intravenous antibiotic prophylaxis (OR: 0.7, 95% CI: 0.51-0.97) were protective factors. In rectal surgery, independent risk factors for organ-space SSI were male sex (OR: 2.11, 95% CI: 1.34-3.31) and longer surgery (OR: 1.49, 95% CI: 1.03-2.15), whereas OAP with intravenous antibiotic prophylaxis (OR: 0.49, 95% CI: 0.32-0.73) was a protective factor. Among patients with organ-space SSI, we found a significant difference in the overall 30-day mortality, being higher in colon surgery than in rectal surgery (11.5% vs 5.1%, p = 0.04). CONCLUSIONS: Organ-space SSI in colon and rectal surgery has some differences in terms of incidence, risk factors and outcomes. These differences could be considered for surveillance purposes and for the implementation of preventive strategies. Administration of OAP would be an important measure to reduce the OS-SSI rate in both colon and rectal surgeries.

Objective: To evaluate the long-term impact of a brief pharmacist intervention (PI) compared with usual care (UC) on prevention of depression relapse. Design: randomised controlled clinical trial Setting: Primary Care Participants: Of the 179 depressed patients initiating antidepressants, the 113 whose clinical symptoms had remitted (main definition) at 6 months assessment were selected for this secondary study (PI = 58; UC = 55). Intervention: PI was an interview to promote medication adherence when patients get antidepressants from pharmacy. Main measurements: Baseline, 3 months, and six-months follow-up assessments were made. The severity of depressive symptoms was evaluated with PHQ9. Patients presenting a remission of symptoms were selected. The patient medical records were reviewed to identify a relapse in the following 12 months by using 4 indicators. Results: There was a lower proportion of patients that relapsed in the PI group than in the UC group 18 months after initiation of treatment, but the difference was not statistically significant either in the intent-to-treat analysis (OR = 0.734 [95%CI; 0.273-1.975]) or the per-protocol analysis (OR = 0.615 [95%Cl; 0.183-2.060]). All the sensitivity analyses showed consistent results. The sample size and adherence to the protocol in the intervention group were low. Conclusion: PI group showed a non-statistically significant tendency towards presenting fewer relapses. This could be related to the improvement in adherence among patients that received the intervention. (C) 2015 Elsevier Espana, S.L.U.

Objectives: To compare clinical and microbiological characteristics, treatment and outcomes of MRSA bacteraemia among elderly and younger patients. Material and methods: Prospective study conducted at 21 Spanish hospitals including patients with MRSA bacteraemia diagnosed between June/2008 and December/2009. Episodes diagnosed in patients aged 75 or more years old (>= 75) were compared with the rest of them (= 75. Comorbidity was significantly higher in older patients (Charlson score >= 4: 52.8 vs. 44%; p = .037) as was the severity of the underlying disease (McCabe >= 1: 61.9 vs. 43.4%; p < .001). In this group the acquisition was more frequently health-care related (43.3 vs. 33.9%, p = .023), mostly from long-term care centers (12.1 vs. 3.7%, p < .001). An unknown focus was more frequent among >= 75 (19.9 vs. 13.8%; p = .050) while severity at presentation was similar between groups (Pitt score >= 3: 31.2 vs. 27.6%; p = .352). The prevalence of vancomycin resistant isolates was similar between groups, as was the appropriateness of empirical antibiotic therapy. Early (EM) and overall mortality (OM) were significantly more frequent in the >= 75 group (EM: 12.1 vs. 6%; p = .010 OM: 42.9 vs. 23%; p < .001). In multivariate analysis age >= 75 was an independent risk factor for overall mortality (aOR: 2.47, CI: 1.63-3.74; p < .001). Conclusion: MRSA bacteraemia was frequent in patients aged >= 75 of our cohort. This group had higher comorbidity rates and the source of infection was more likely to be unknown. Although no differences were seen in severity or adequacy of empiric therapy, elderly patients showed a higher overall mortality. (C) 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

There is increasing concern regarding the association between certain methicillin-resistant Staphylococcus aureus (MRSA) genotypes and poor clinical outcome. To assess this issue, a large cohort of 579 subjects with MRSA bacteraemia was prospectively followed from June 2008 to December 2009, in 21 hospitals in Spain. Epidemiology, clinical data, therapy, and outcome were recorded. All MRSA strains were analysed in a central laboratory. Presence of a haematogenous seeding infection was the dependent variable in an adjusted logistic regression model. Of the 579 patients included in the study, 84 (15%) had haematogenous seeding infections. Microdilution vancomycin median MIC (IQR) was 0.73 (0.38-3) mg/L. Most MRSA isolates (n=371; 67%) belonged to Clonal Complex 5 (CC5) and carried an SCCmec element type IV and agr type 2. Isolates belonging to ST8-agr1-SCCmecIV, ST22-agr1-SCCmecIV and ST228-agr2-SCCmecIa single locus variant of ST5accounted for 8%, 9% and 9% of the isolates, respectively. After adjusting by clinical variables, any of the clones was associated with increased risk of haematogenous seeding infections. Higher vancomycin MIC was not identified as an independent risk factor, either. In contrast, persistent bacteraemia (OR 4.2; 2.3-7.8) and non-nosocomial acquisition (3.0; 1.7-5.6) were associated with increased risk.

VI Forum Internacional de Innovación y Creatividad: Escuelas y Aulas Creativas, Escuelas y aulas creativas recoge las aportaciones más significativas del VI Forum sobre Innovación y creatividad centrado en Escuelas y Aulas creativas. Este Encuentro de profesionales de la Educación es continuidad de cinco Encuentros anteriores con los que se intenta compartir, conocer y propiciar el cambio y la mejora a través de la innovación y la creatividad. Pero no como una innovación instrumental y metodológica, sino trasformadora que genere cambios actitudinales y de conciencia que comporten compromiso individual y colectivo. Han sido característicos de este Forum: El diálogo entre los diferentes ámbitos de construcción de conocimiento; la creatividad como eje transversal, valor educativo y social y estrategia de cambio en la educación; el aula como escenario formativo y transformador de la persona y todo ello gracias a la interacción del docente y del discente en el contexto del centro, la familia y la comunidad educadora...

A high proportion of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia die within a few days of the onset of infection. However, predictive factors for early mortality (EM) have barely been examined. The aim of this study was to determine the predictive factors for EM in patients with MRSA bacteraemia. All episodes of MRSA bacteraemia were prospectively followed in 21 Spanish hospitals from June 2008 to December 2009. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed in a central laboratory. Mortality was defined as death from any cause occurring in the 30 days after the onset of MRSA bacteraemia. EM was defined as patients who died within the first 2 days, and late mortality (LM) for patients who died after this period. Multivariate analyses were performed by using logistic regression models. A total of 579 episodes were recorded. Mortality was observed in 179 patients (31): it was early in 49 (8.5) patients and late in 130 (22.5). Independent risk factors for EM were [OR (95 CI)] initial Pitt score 3 [3.99 (1.723.24)], previous rapid fatal disease [3.67 (1.3210.24)], source of infection lower respiratory tract or unknown [3.76 (1.3110.83) and 2.83 (1.117.21)], non-nosocomial acquisition [2.59 (1.165.77)] and inappropriate initial antibiotic therapy [3.59 (1.637.89)]. When predictive factors for EM and LM were compared, inappropriate initial antibiotic therapy was the only distinctive predictor of EM, while endocarditis and lower respiratory tract sources both predicted LM. In our large cohort of patients several factors were related to EM, but the only distinctive predictor of EM was inappropriate initial antibiotic therapy.

Las finanzas municipales en Costa Rica exhiben grandes variaciones temporales y espaciales. En algunos municipios, la serie de tiempo de ingresos tributarios per cápita se comporta como un proceso de caminata aleatoria. Otros municipios presentan series históricas estables. Las series históricas de ingresos tributarios municipales per cápita de todo Costa Rica (1998-2010) y por cantón (2005-2011) fueron clasificadas de acuerdo con el proceso que exhiben como estables en sus niveles o procesos de caminata aleatoria. Se encontró que, para el conjunto del país, los ingresos tributarios de los gobiernos locales han crecido; sin embargo, las series históricas de los distintos cantones no permiten determinar en forma significativa el parámetro de deriva, que describe el nivel de crecimiento, de cantones específicos. Análisis comparativos de las series nacionales con las series cantonales sugieren fuertemente que las grandes variaciones interanuales que se encuentran en cada cantón se compensan entre sí, de lo cual resulta una tendencia agregada hacia mayores ingresos.

Podeu consultar el document senser de la "XVI Setmana de Cinema Formatiu" a: http://hdl.handle.net/2445/22523

Nosocomial infection represents a prolongation of hospital stay and an increase of costs. The aim of the study was to estimate attributable costs by means of two methods: calculation of costs resulting from an increase of hospital stay and calculation of costs attributed to services.A matched case-control study was carried out with a cohort population. An appropriate control was found for 63 patients with surgical site infection, for 30 patients with respiratory infection and for 55 with urinary infection. The estimation of costs attributable to services includes the case-control pairs with surgical site infection and was performed of the sum of costs of diagnostic and therapeutic services rendered in the care of the surgical site infection.The median of postoperative stay was 21 days for cases with surgical site infection vs 10 days for controls (p0.001); the median length of stay was 21.5 days for cases with respiratory infection vs 11.5 days for controls (p0.01); and for urinary infection the median length of stay was 21 days for cases vs 15 days for controls (p0.01). The surgical site infection cost attributed to extra days was 310,310 pesetas and the surgical site infection cost attributed to service cost was 220,546 pesetas.Nosocomial infection produces a increase median hospital stay of 7-10 days. In absence of a precise accounting system, the prolongation of hospital stay was considered as the more objective date to estimate the costs.

The aim of this study was to know the clinical, etiopathogenic and microbiologic characteristics of pyogenic liver abscesses (PLA).A retrospective analysis of the cases of PLA diagnosed from 1978 to 1992 in the Internal Medicine, Infectious Disease, and Gastrointestinal Surgery Departments of the Hospital de Bellvitge in Barcelona, Spain was performed.A total of 63 cases of PLA (43 males and 20 females, mean age 54 +/- 19 years) were analyzed. The most frequent clinical and analytical data included fever (92%), leucocytosis (84%) and abnormal levels of alkaline phosphatase (81%). The PLA were single in 65% and multiple in 35%. Echography was diagnostic in 91% of the cases. A positive culture of the abscess was obtained in 40 cases, being monomicrobial in 27 cases (67.5%). Eleven of the 13 polymicrobial cultures were from single PLA. The most frequent bacteria found were the enterobacteria (44%) followed by the microaerophilic streptococci (28%) and the anaerobes (17%). The PLA was of biliary origin in 31.8%, contiguous in 12.7% and unknown in 38%. Percutaneous drainage was performed in 34 patients (54%). Mortality attributable to the abscess was 3%.The clinical presentation of pyogenic liver abscess has not varied over time. There has, however, been a change with respect to its epidemiology and therapeutic management. At present, the possibility of rapid diagnosis and image guided percutaneous drainage offers a better prognosis for this disease.

Primary central nervous system lymphoma (PCNSL) is the second cause of cerebral masses in patients with the acquired immunodeficiency syndrome (AIDS). The present study evaluated the possible presence of clinical or radiologic signs permitting differentiation of AIDS patients and PCNSL from those with cerebral masses of other etiologies.Clinical history and cranial computerized tomography (CT) of patients with PCNSL and AIDS from the Hospital Clinic i Provincial in Barcelona were reviewed. Results were compared with those of patients with PCNSL without evidence of immunosuppression and with those with AIDS and cerebral toxoplasmosis or tuberculoma diagnosed during the same period.Of 685 patients with AIDS, 10 were identified with PCNSL. The clinical picture was not different to that observed in patients with AIDS and cerebral toxoplasmosis or tuberculomas. In contrast to PCNSL in non immunodepressed patients, the cerebral CT in patients with PCNSL and AIDS demonstrated hyperdense lesions in only 44% and contrast enhancement was not homogeneous in any case. These characteristics were similar to those observed in the CT of patients with cerebral toxoplasmosis or tuberculoma with the exception that only 8% of the lesions by toxoplasmosis were spontaneously hyperdense.The clinical-radiological data of primary central nervous system lymphoma in patients with the acquired immunodeficiency syndrome are similar to those observed in other etiologies. However, the presence of a sole spontaneously hyperdense region in cranial computerized tomography is more suggestive of primary central nervous system lymphoma than cerebral toxoplasmosis.

Depuis la decouverte du monde bacterien et de son role dans la pathologie humaine, les recherches se sont constamment poursuivies pour ameliorer les moyens de prevenir et combattre l'infection. Dans cette lutte contre l'infection, certaines substances chimiques, les antiseptiques, jouent un role important. Un antiseptique, au sens strict du mot, est une substance qui previent ou arrete la croissance des germes, soit en inhibant leur activite, soit en les detruisant. Parmi les substances antibacteriennes, il faut grossierement distinguer deux categories: d'une part les antibiotiques, d'autre part les antiseptiques. Si, a l'origine, les antibiotiques etaient des substances antibacteriennes secretees par des micro-organismes vivants, actuellement quelques antibiotiques sont des produits de synthese dont la formule est proche des antibiotiques naturels. Aussi, antiseptiques et antibiotiques ne se differencient-ils que par leur mode d'action. Les antibiotiques agissent a dose faible, a l'echelle moleculaire, en interferant au niveau d'une ou plusieurs etapes metaboliques de la bacterie. D'ou leur action specifique sur la cellule bacterienne et, souvent meme, sur une categorie particuliere de bacteries, respectant l'organisme infecte. Cette action a dose faible permet de plus leur utilisation par voie interne, orale ou parenterale. A l'oppose les antiseptiques agissent de facon globale, par des processus physiques ou physico-chimiques, sur la cellule bacterienne (seuls certains antibiotiques polypeptidiques ont une activite comparable au niveau de la membrane bacterienne). Cette action est peu specifique et touche toutes les cellules vivantes qui se trouvent au contact de l'antiseptique.