Search

Background and Objectives: Descriptions of end-of-life in COVID-19 are limited to small cross-sectional studies. We aimed to assess end-of-life care in inpatients with COVID-19 at Alicante General University Hospital (ALC) and compare differences according to palliative and non-palliative sedation. Material and Methods: This was a retrospective cohort study in inpatients included in the ALC COVID-19 Registry (PCR-RT or antigen-confirmed cases) who died during conventional admission from 1 March to 15 December 2020. We evaluated differences among deceased cases according to administration of palliative sedation. Results: Of 747 patients evaluated, 101 died (13.5%). Sixty-eight (67.3%) died in acute medical wards, and 30 (44.1%) received palliative sedation. The median age of patients with palliative sedation was 85 years; 44% were women, and 30% of cases were nosocomial. Patients with nosocomial acquisition received more palliative sedation than those infected in the community (81.8% [9/11] vs 36.8% [21/57], p = 0.006), and patients admitted with an altered mental state received it less (20% [6/23] vs. 53.3% [24/45], p = 0.032). The median time from admission to starting palliative sedation was 8.5 days (interquartile range [IQR] 3.0-14.5). The main symptoms leading to palliative sedation were dyspnea at rest (90%), pain (60%), and delirium/agitation (36.7%). The median time from palliative sedation to death was 21.8 h (IQR 10.4-41.1). Morphine was used in all palliative sedation perfusions: the main regimen was morphine + hyoscine butyl bromide + midazolam (43.3%). Conclusions: End-of-life palliative sedation in patients with COVID-19 was initiated quite late. Clinicians should anticipate the need for palliative sedation in these patients and recognize the breathlessness, pain, and agitation/delirium that foreshadow death.

Background: The prevalence of multimorbidity and the number of chronic pathologies increases with age, and hospitalization rates are higher in very elderly patients. Aims: To identify predictors of mortality in patients aged 90 years or more at 6 and 12 months after admission to the internal medicine ward. Materials and methods: Prospective cohort study in patients aged 90 years or older who were admitted to the internal medicine ward of Alicante General University Hospital from November 2018 to March 2019. We collected data for patient scores on the Barthel, Lawton-Brody, and Short Portable Mental Status Questionnaire; a nutritional questionnaire; the Charlson index; PALIAR and PROFUND prognostic indexes; and mortality at 6 and 12 months. Results: In the bivariate analysis adjusted for gender and comorbidity, malnutrition was associated with mortality at 6 and 12 months (odds ratio (OR) 5.17, 95% confidence interval (C11 1.30, 20.50; OR 7.78, 95% CI 1.47, 40.9, respectively), as were moderate-severe cognitive impairment (6 months: OR 12.0, 95% CI 2.79, 52.0; 12 months: OR 10.73, 95% CI 2.40, 47.8) and high-risk scores on the PALIAR (6 months: OR 9.18, 95% CI 1.99, 42.27;12 months: OR 11.7, 95% CI 2.62, 51.60) and PROFUND (6 months: OR 10.7, 95% CI 1.68, 68.80; 12 months: OR 20.9, 95% CI 3.15, 139.0) prognostic indexes. The Barthel index was associated with mortality only at 6 months (OR 6.16; 95% CI 1.69, 22.4). Conclusions: In nonagenarian inpatients, a worse score on the comprehensive assessment and a higher score on prognostic indexes were associated with increased risk of mortality at 6 and 12 months. Copyright (C) 2021, Taiwan Society of Geriatric Emergency & Critical Care Medicine.

18 páginas, 1 figura, 2 tablas., Fasciola hepatica is a trematode parasite with a global distribution, which is responsible for considerable disease and production losses in a range of food producing species. It is also identified by WHO as a re-emerging neglected tropical disease associated with endemic and epidemic outbreaks of disease in human populations. In Europe, F. hepatica is mostly associated with disease in sheep, cattle and goats. This study reviews the most recent advances in our understanding of the transmission, diagnosis, epidemiology and the economic impact of fasciolosis. We also focus on the impact of the spread of resistance to anthelmintics used to control F. hepatica and consider how vaccines might be developed and applied in the context of the immune-modulation driven by the parasite. Several major research gaps are identified which, when addressed, will contribute to providing focussed and where possible, bespoke, advice for farmers on how to integrate stock management and diagnosis with vaccination and/or targeted treatment to more effectively control the parasite in the face of increasing the prevalence of infection and spread of anthelmintic resistance that are likely to be exacerbated by climate change., All authors are members of the Livestock Helminth Research Alliance (LiHRA), whose vision is to improve the health, wealth and productivity of European livestock by providing sustainable helminth control options. This review was commissioned by DISCONTOOLS (www.discontools.eu) as part of the process of identifying research gaps which impinge on effective and sustainable control of fasciolosis in food producing animals in Europe. DJLW, JC, LR, CC, JPA, AMM all received funding from the European Union through the following awards: FPVI‐FOOD‐CT‐200X‐023025‐DELIVER; FPVII‐KBBE‐2011‐5‐288975‐GLOWORM; FPVII‐KBBE‐2010‐4‐265862‐PARAVAC; H2020‐635408‐PARAGONE. DJLW, JEH, NJB received funding from the Biotechnology and Biological Sciences Research Council (BBSRC) through awards: BB/K015591/1 and BBI002480/1, and RJF was supported by BBSRC award BB/M018520/1. MMV was funded by the Spanish “Ramón y Cajal” Programme of the Ministry of Economy and Competitiveness (RYC‐2015‐18368). CC was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections at the University of Liverpool in partnership with Public Health England (PHE) and Liverpool School of Tropical Medicine (LSTM). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or PHE.

The original version of this Article contained an error in the spelling of the author P. Garcia-Alfonso, which was incorrectly given as P. Garcia. This error has now been corrected in the PDF and HTML versions of this Article.

Cetuximab is a standard-of-care treatment for RAS wild-type metastatic colorectal cancer (mCRC) but not for those harbor a KRAS mutation since MAPK pathway is constitutively activated. Nevertheless, cetuximab also exerts its effect by its immunomodulatory activity despite the presence of RAS mutation. The aim of this study was to determine the impact of polymorphism Fc gamma RIIIaV158F and killer immunoglobulin-like receptor (KIR) genes on the outcome of mCRC patients with KRAS mutations treated with cetuximab. This multicenter Phase II clinical trial included 70 mCRC patients with KRAS mutated. We found KIR2DS4 gene was significantly associated with OS (HR 2.27; 95% CI, 1.08-4.77; P = 0.03). In non-functional receptor homozygotes the median OS was 2.6 months longer than in carriers of one copy of full receptor. Multivariate analysis confirmed KIR2DS4 as a favorable prognostic marker for OS (HR 6.71) in mCRC patients with KRAS mutation treated with cetuximab. These data support the potential therapeutic of cetuximab in KRAS mutated mCRC carrying non-functional receptor KIR2DS4 since these patients significantly prolong their OS even after heavily treatment. KIR2DS4 typing could be used as predictive marker for identifying RAS mutated patients that could benefit from combination approaches of anti-EGFR monoclonal antibodies and other immunotherapies to overcome the resistance mediated by mutation in RAS.

19 páginas., An elicitation exercise was conducted to collect and identify pressing questions concerning the study of helminths in livestock, to help guide research priorities. Questions were invited from the research community in an inclusive way. Of 385 questions submitted, 100 were chosen by online vote, with priority given to open questions in important areas that are specific enough to permit investigation within a focused project or programme of research. The final list of questions was divided into ten themes. We present the questions and set them briefly in the context of the current state of knowledge. Although subjective, the results provide a snapshot of current concerns and perceived priorities in the field of livestock helminthology, and we hope that they will stimulate ongoing or new research efforts., We thank the officers and members of the Livestock Helminth Research Alliance (LiHRA) for encouraging this initiative and giving space to it in their annual meetings, to the World Association for the Advancement of Veterinary Parasitology for permitting elicitation of questions as part of their 26th biennial conference in Kuala Lumpur, Malaysia, and to the editors of Trends in Parasitology for commissioning this article. The authors credit the EU for funding leading to this work through FP7 STREP GLOWORM. We gratefully acknowledge Hassan Azaizeh, Sarah Beynon, Jacques Cabaret, Gerald Coles, Tina Alstrup Hansen, Alison Howell, Hamadi Karembe, Alvaro Martinez-Moreno, Francisco A. Rojo, Guillaume Sallé, Jože Starič, Eurion Thomas, and numerous anonymous participants for contributing generously to the exercise with questions and votes. This article is based in part upon work from COST Action COMBAR CA16230, supported by COST (European Cooperation in Science and Technology). MMV is funded by the Spanish “Ramón y Cajal” Programme, Ministry of Economy and Competitiveness (RYC-2015-18368), and ERM and HRV by UK BBSRC grant BB/M003949/1.

Trabajo presentado al: . 11th European Congress on Tropical Medicine & International Health (ECTMIH), oral presentation O89. Liverpool (Reino Unido), 16-20 septiembre, 2019., Over one billion people worldwide are infected with soil-transmitted helminths (STH). STH infections (Ascaris lumbricoides, Trichuris trichiura, hookworm and Strongyloides stercoralis) can contribute to anaemia, malnutrition, and delayed cognitive development among others. Currently, the cornerstone for controlling STH is mass drug administration (MDA) programs with benzimidazole drugs, albendazole or mebendazole. However, some studies start to suspect of benzimidazole-resistance, already observed in veterinary medicine in high rates.

Published