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Introduction: Bicuspid aortic valve (BAV) is the most frequent congenital cardiac disease. It is associated to a higher risk of cardiovascular complications, including infective endocarditis (IE)., Methods: Retrospective, observational and single centre study that included all patients with IE diagnosed between 1996 and 2014. An analysis was made of the epidemiological, clinical, microbiological and echocardiographic data, complications during hospital admission, need for surgery, in-hospital mortality, and 1-year follow-up. Cases with endocarditis on prosthetic valves or other locations were excluded, as well as those for which the aortic valve morphology had not been accurately defined. A comparative statistical analysis was performed between BAV and tricuspid (TAV)., Results: Of a total of 328 cases with IE, 118 (35.67%) were on aortic valve, with 18 (16.22%) of them being BAV. The BAV cases were younger than TAV (51±19.06 vs. 60.83±15.73 years, P=.021) and they had less comorbidity (Charlson 0.67±0.77 vs. 1.44±1.64, P=.03).). There was a higher tendency of Staphylococcal origin (38.9 vs. 21.5%, P=.137), and 55.6% showed peri-valvular complications (TAV 16.1%, P=.001), in particular, abscesses (38.9 vs.16.1%, P=.047). BAV was the only predictive factor of peri-valvular complications (OR 7.87, 95% CI; 2.38-26.64, P=.001). Patients with BAV had more surgery during their admission (83.3 vs. 44.1%, P=.004), had less in-hospital mortality, with no statistical significance (5.6 vs. 25.8%, P=.069), and 1-year survival was significantly superior (93.8 vs 69.3%, P=.048)., Conclusions: Patients with IE on BAV are young, with low comorbidity. They frequently present with peri-valvular complications and they often require early surgery. Compared to TAV cases, in-hospital mortality is lower and 1-year survival is significantly higher., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Background and Objective: It is well-known the relationship between Streptococcus bovis (S. bovis) bacteremia and colon cancer, liver cirrhosis and others neoplasms. However, a study protocol to rule out these underlying diseases has not been carried out yet. Our objective was to describe S. bovis bacteremia and associated diseases., Patients and Method: Multicenter, retrospective cohort study. S. bovis bacteremias episodes between 2001 and 2009 were included. Mean variables: colon neoplasm, non-colonic neoplasm or liver cirrhosis. Epidemiologist aspects, bacteremia related variables, personal and familiar history and clinical and analytical data were collected., Results: Ninety three patients were included. One out of four individuals had a colon neoplasm. Fifty seven per cent were concomitant cases with bacteremia and six cases were diagnosed after bacteremia (time bacteremia-diagnosis of neoplasm [months], median [Q1-Q3], 2.6 [1-11]). Fourteen (15%) patients were diagnosed with any non-colonic neoplasm (mainly biliary and pancreatic [6 cases] or esophagus-gastric [3 cases]). There were three patients (21%) with concomitant bacteremia non-colonic neoplasm and two after it (1.2 and 10.4 months). Twenty-one (23%) patients suffered from liver cirrhosis., Conclusions: Patients with S. bovis bacteremia must undergo a study designed to rule out underlying diseases. We suggest that this study should include: a colonic evaluation, ideally by colonoscopy, a liver evaluation by serum chemistry, an abdominal ultrasound scan or a method of liver fibrosis assessment, a gastroscopy and an evaluation of biliary and pancreatic areas by magnetic resonance imaging., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Introduction: The aim of this study is to describe the epidemiological, clinical characteristics, and outcome of patients with left-side endocarditis caused by gram-negative bacteria., Method: Prospective multicenter study of left-sided infective endocarditis reported in the Andalusian Cohort for the Study of Cardiovascular Infections between 1984 and 2008., Results: Among the 961 endocarditis, 24 (2.5%) were caused by gram-negative bacilli. The most common pathogens were Escherichia coli, Pseudomonas aeruginosa and Salmonella enterica. Native valves (85.7%) were mainly affected, most of them with previous valve damage (57%). Comorbidity was greater (90% vs 39%; P=.05) than in endocarditis due to other microorganism, the most frequent being, diabetes, hepatic cirrhosis and neoplasm. A previous manipulation was found in 47.6% of the cases, and 37% were considered hospital-acquired. Renal failure (41%), central nervous system involvement (33%) and ventricular dysfunction (45%) were the most frequent complications. Five cases (21%) required cardiac surgery, mostly due to ventricular dysfunction. More than 50% of cases were treated with aminoglycosides, but this did not lead to a better outcome or prognosis. Mortality (10 patients) was higher than that reported with other microorganisms (41% vs 35%; P=.05)., Conclusions: Left-sided endocarditis due to gram-negative bacilli is a rare disease, which affects patients with major morbidities and often with a previous history of hospital manipulations. Cardiac, neurological and renal complications are frequent and associated with a high mortality. The association of aminoglycosides in the antimicrobial treatment did not involve a better outcome or prognosis., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Objective: The criteria for disease severity established by the Global Initiative for Chronic Obstructive Lung Disease are based on forced expiratory volume in 1 second (FEV1) expressed as a percentage of the predicted value after application of a bronchodilator. This study aims to determine postbronchodilator spirometry reference values., Subjects and Methods: A cluster sample of subjects aged 40 years or over was chosen to be representative of the metropolitan areas of 5 Latin American cities (São Paulo, Mexico City, Montevideo, Santiago, and Caracas). Spirometry was performed on 5183 subjects following the recommendations of the American Thoracic Society before and after inhalation of 200 microg of salbutamol. Multiple linear regression equations were fitted for the postbronchodilator spirometric values-FEV1, forced expiratory volume in 6 seconds (FEV6), peak expiratory flow rate, forced vital capacity (FVC), FEV1/FEV6, FEV1/FVC and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75). These were adjusted for sex, age, and height in 887 asymptomatic subjects with no history of lung disease., Results: The postbronchodilator reference values for FEV1, FEV1/FVC, and FEV1/FEV6 were on average 3% higher than those obtained before bronchodilation. This apparently small difference caused an upward shift in the 5th percentile (lower limit of normal) of the predicted values. When prebronchodilation instead of postbronchodilation reference values were used, 3.2% of the results for airflow obstruction in our population of over-40-year-olds were false negatives., Conclusions: The reported reference values are more appropriate for postbronchodilator spirometry and make it possible to reduce the number of misclassifications.

Objective: In clinical practice, spirometry is a extremely useful test that requires strict quality control, an appropriate strategy for interpretation, and reliable reference values. The aim of this study was to report spirometric reference values for 5 cities in Latin America., Patients and Methods: From data for 5315 subjects who had undergone spirometry in the PLATINO study in Caracas, Mexico City, Santiago, São Paulo, and Montevideo, we selected information for 906 (17%) individuals aged between 40 years and 90 years to provide reference values. The chosen subjects had never smoked, were asymptomatic, had not been diagnosed with lung disease, and were not obese. Multiple regression models were constructed with the following spirometric parameters: forced expiratory volume in 1 second (FEV1) and in 6 seconds (FEV6), peak expiratory flow, forced vital capacity (FVC), FEV1/FEV6, FEV1/FVC, and forced midexpiratory flow rate. Height, sex, and age were also included in the model., Results: Average values for the subjects studied were similar to those for the white North American population and the Mexican-American population of the third National Health and Nutrition Examination Survey, but exceeded those of the black population of the same survey by 20%., Conclusions: The proposed reference values are an improvement on those currently available for Latin America because the participants were chosen by population sampling methods and standardized up-to-date methodology was used.

Introduction: Streptococcus pneumoniae is the most frequent cause of non-hospital acquired pneumonia and meningitis in adults, and bacterial otitis media in children. Moreover, it causes a third of all acute sinusitis cases. Penicillin has been the treatment of choice for almost 50 years. Gradually, penicillin-resistant pneumococci have appeared throughout the world. Our aim was to investigate the epidemiology, pattern of resistance and serotypes of Streptococcus pneumoniae infection in our area., Methods: Over a period of two years (May 1997-May 1999), Streptococcus pneumoniae strains were isolated in the Clinical Microbiology Unit of the University Hospital Virgen de la Victoria in Málaga, Spain. This is a 750-bed hospital covering a population of 407,480 inhabitants, and admitting 21,500 hospitalized patients per year. Streptococcus was identified by standard procedures: serotyping was done with the Quellung test and antibiotic susceptibility study by the disk diffusion method and E-test., Results: Streptococcus pneumoniae infection was diagnosed in 170 patients during the years studied. The microorganism was isolated from samples of sputum (82), blood (43), aspirated bronchial fluid, cerebrospinal fluid (6), and exudates (7). Non-hospital origin was identified in 88% of cases. The mean hospital stay was 12 days and mortality was 12.4%. Some 45.9% of the isolated strains were resistant to penicillin and 20% to cefotaxime. We found 31 different serotypes, with 77% of the isolated strains belonging to 12 serotypes. Serotypes 19, 3 and 6B were the most frequent in non-hospital infection, whereas 9V and 23F were related with nosocomial infection. Penicillin-resistant strains of Streptococcus pneumoniae belonged to 19 different serotypes; 6B, 9V, 14, 19 and 23F were the most important., Conclusions: As was expected, Streptococcus pneumoniae infections of mainly non-hospital origin in our area were characterized by elevated mortality and high-level resistance to penicillin. Immunosuppression was a predisposing factor.

Objectives: Our aim was to evaluate the validity and reliability of a questionnaire to measure the functional capacity in older people., Design: Observational cross-sectional study., Setting: Community level. Three basic health areas., Participants: 519 individuals over 64 selected by systematic random sampling taking as sampling units a list of household living at least an individual over 64 years., Measurements and Main Results: A new questionnaire was developed starting from the OARS-MFAQ, the CVA. This new questionnaire is shorter but it maintains the same structure. Ten interviews were recorded in a videotape and subsequently analyzed and marked by four different observers to evaluate the inter-observer agreement. To assess the criterion validity the rates of 40 individuals in the CVA were compared with the rates assigned to the same individuals by experts in each area of the questionnaire (physical health, mental health, daily activities, economic resources, and social support). The criterion validity of the version to proxies of CVA (CVA-I) was studied comparing the answers in the CVA of 31 individuals and the answers given in the CVA-I by proxies of the same 31 individuals. The internal consistency in both versions of the questionnaire was studied in 519 individuals, agreement showed values of kappa coefficient between 0.43 and 0.69. Correlation coefficients Interobserver between expert's rates showed values between 0.54 and 0.74. Correlation coefficients between CVA and CVA-I showed values between 0.60 and 0.74 except in the social support dimension (0.16). The Cronbach alpha coefficient were 0.73 for CVA and 0.62 for CVA-I., Conclusions: The CVA questionnaire showed an acceptable validity and reliability except in the social support dimension of the CVA-I.

We report the case of a 37 year old male from rural area who presented as an emergency with symptoms compatible with the existence of a retropharyngeal tumoration. By the clinic it suggested an abscess but the CT scan as compatible with a carcinoma. On complementary examinations it appeared in a chest X ray an image which strongly suggested the possibility of a hydatidic cyst of the lung. Specific serologic reactions supported this and post-surgical pathological study lately confirmed the diagnosis. We believe of interest reporting this case because of it's unusual localization and difficulty in diagnosis.