Search

Background and Objectives : Available studies confirm myocardial injury and its association with mortality in patients with COVID-19, but few data have been reported from echocardiographic studies. The aim of this study was to identify subclinical left ventricular dysfunction by global longitudinal strain (GLS) and its evolution in the short term in hospitalized patients with COVID-19. Materials and Methods : Thirty-one consecutive noncritical patients admitted for COVID-19 were included. Information on demographics, laboratory results, comorbidities, and medications was collected. Transthoracic echocardiograms were performed using a Philips Affinity 50, at the acute stage and at a 30-day follow-up. Automated left ventricular GLS was measured using a Philips Qlab 13.0. A GLS of <-15.9% was defined as abnormal. Results : The mean age was 65 ± 15.2 years, and 61.3% of patients were male. Nine patients (29%) had elevated levels of high-sensitivity troponin I. Left ventricular ejection fraction was preserved in all; however, 11 of them (35.5%) showed reduced GLS. These patients had higher troponin levels (median, 23.7 vs. 3.2 ng/L; p < 0.05) and NT-proBNP (median, 753 vs. 81 pg/mL; p < 0.05). The multivariate analysis revealed that myocardial injury, defined as increased troponin, was significantly associated with GLS values (coefficient B; p < 0.05). Follow-up at 30 days showed an improvement in GLS values in patients with subclinical left ventricular dysfunction (-16.4 ± 2.07% vs. -13.2 ± 2.40%; p < 0.01), without changes in the normal GLS group. Conclusions : Subclinical left ventricular dysfunction is common in noncritical hospitalized patients with COVID-19 (one in every three patients), even with preserved left ventricular ejection fraction. This impairment tends to be reversible on clinical recovery.

Objective: To evaluate the association between plasma levels of soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) and mortality of patients with sepsis., Design: Prospective cohort study., Setting: Two general Intensive Care Units., Patients: Patients with sepsis in whom sTREM-1 plasma levels were determined daily in the first 3 days of their presentation., Variables of Interest: Mortality at 28 days., Results: We analyzed 121 patients (23% severe sepsis, 44% septic shock, 33% non-severe sepsis). Mortality at 28 days was 24.8%. The initial sTREM-1 levels were slightly higher in nonsurvivors than in survivors (median 366.9 versus 266.5 pg/ml, p=0.2668). An increase in sTREM-1 levels higher than 90 pg/ml within the first 3 days (delta-TREM) was associated with an excess of mortality (hazard ratio [HR] 2.68, p=0.0047), with a sensitivity of 47% and a specificity of 78%. This excess of mortality disappeared after adjusting for severity by Cox analysis (adjusted HR 1.07, p=0.8665)., Conclusions: The increase in the levels of sTREM-1 during the first 3 days of evolution is associated with an excess of mortality in critically ill patients with sepsis. This is explained by the greater initial severity of these patients. The discriminative capacity of this finding is insufficient to be clinically useful., (Copyright 2009 Elsevier España, S.L. y SEMICYUC. All rights reserved.)

Dyslipidemia is common in HIV-infected patients receiving antiretroviral therapy (ART) and it is often associated with the use of specific antiretroviral drugs. The phenotypic profile can include elevated triglycerides or cholesterol alone, or mixed patterns with varying changes in LDL and HDL lipoproteins, which imply different levels of cardiovascular risk. Growing evidence indicates that ART-associated hyperlipidemia accelerates the development of atherosclerosis and coronary heart disease in HIV-infected patients. In recent years, a number of retrospective database reviews and prospective cohort studies have reported a higher incidence of coronary events in patients receiving ART, which seems to be closely related with the presence of dyslipidemia and the duration of exposure to ART. Although the clinical benefit of treating ART-related dyslipidemia remains unproven, most experts recommend a policy of cardiovascular disease prevention and management similar to that used in non-HIV-infected individuals. In addition, the use of antiretrovirals associated with a more favorable lipid profile is considered. Clinical experience with lipid-lowering therapy in HIV-infected patients is still limited, but there is increasing data confirming its efficacy and safety in this setting. Drug interactions should be taken into account when statins are used in patients receiving protease inhibitors.

Introduction: Antifungal therapy for mucosal candidiasis caused by fluconazole-resistant Candida species is problematic. The aim of this study was to investigate the in vitro activity of caspofungin against Candida strains with reduced susceptibility to fluconazole isolated from HIV-infected patients., Methods: The in vitro activity of caspofungin was assessed in 28 fluconazole-resistant Candida isolates obtained from the oral cavity of a cohort of 174 consecutive HIV-infected patients. Minimum inhibitory concentrations (MICs) were determined by a standardized broth microdilution method, as recommended by the NCCLS., Results: Overall, caspofungin MICs ranged from < or = 0.06 microg/ml to 1 microg/ml. MICs at which 50% (MIC50) and 90% (MIC90) of isolates were inhibited were 0.25 microg/ml and 0.5 microg/ml, respectively. MICs ranged from < or = 0.06 microg/ml to 0.5 microg/ml for Candida albicans (n = 11), and < 0.06 microg/ml to 1 microg/ml or Candida glabrata (n = 11). MICs for the two strains of Candida krusei were 0.125 microg/ml and 1 microg/ml. The range of MICs for Candida tropicalis and Candida inconspicua strains was 0.25 microg/ml to 0.5 microg/ml., Conclusion: Caspofungin was very active in vitro against a variety of fluconazole-resistant Candida strains recovered from a clinical cohort of HIV-infected patients. The MIC50 values and MIC ranges were slightly higher for Candida glabrata than for Candida albicans.

Basis: To know the factors associated with the inadequate admissions in patients with human immunodeficiency virus (HIV) infection., Patients and Methods: The adaptation of 710 hospital admissions of patients with HIV infection through the Appropriateness Evaluation Protocol criteria in two hospitals of the Comunidad Valenciana since 1995 to 1997 was analyzed., Results: One hundred twenty-eight (18%) admissions were considered inadequate. The proportion of inadequate admissions was significantly higher in patients admitted because of constitutional syndrome (OR: 4.12; CI 95%: 2.11-8.05), or because of digestive symptoms (OR: 2.33; CI 95%: 1.46-3.88), and in patients admitted in facilities without day hospital (OR: 2.38; CI 95%: 1.39-3.89). Furthermore, other situations associated with the inappropriateness were the patients with a disease not related to AIDS (OR: 3.13; CI 95%: 1.93-5.08), the patients with oral or esophageal candidiasis (OR: 6.25; CI 95%: 3.08-12.7), the patients with a hospital stay less than 8 days (OR: 2.55; CI 95%: 1.57-4.01), or the patients who no died (OR: 3.61; IC 95%: 1.20-10.82)., Conclusions: The reason for the admission and the availability of a day hospital unit had influence in the inadequate hospital admissions in this study.

Background and Objective: After the introduction of highly active antiretroviral therapy (HAART), there was a decrease in hospital admissions and mortality associated with human immunodeficiency virus (HIV) infection. The objective of this study was to analyze the changes in mortality and morbidity during the HAART era., Patients and Method: We reviewed 1,343 hospital admissions from 610 HIV-infected patients between January 1995 and December 2000. We analyzed the morbidity and mortality figures at the pre-HAART last biennium (1995-1996) and those at the first and second HAART biennium (1997-1998, HAART-1, and 1999-2000, HAART-2)., Results: Hospital admissions due to AIDS-defining illnesses decreased throughout the HAART era, whereas admissions caused by non-AIDS-defining illnesses increased (p < 0.001) with a significant growth in the frequency of respiratory tract infections (p = 0.004), digestive tract diseases (p < 0.001) and liver diseases (p = 0.03). There was a declining trend in hospital mortality throughout the study period. AIDS-defining illnesses decreased from the pre-HAART biennium to the HAART-1 and -2 periods (p = 0.03), whereas liver diseases increased (p = 0.03)., Conclusions: In the HAART era, hospital admissions and mortality due to AIDS-defining illnesses continue to decrease. Nevertheless, there is a steady increase in the number of admissions and deaths of patients with non-AIDS-defining illnesses.

There is an increased awareness of the morbidity and mortality associated with fungal infections caused by resistant fungi in various groups of patients. Epidemiological studies have identified risk factors associated with antifungal drug resistance. Selection pressure due to the continuous exposure to azoles seems to have an essential role in developing resistance to fluconazole in Candida species. Haematological malignancies, especially acute leukaemia with severe and prolonged neutropenia, seem to be the main risk factors for acquiring deep-seated mycosis caused by resistant filamentous fungi, such us Fusarium species, Scedosporium prolificans, and Aspergillus terreus. The still unacceptably high mortality rate associated with some resistant mycosis indicates that alternatives to existing therapeutic options are needed. Potential measures to overcome antifungal resistance ranges from the development of new drugs with better antifungal activity to improving current therapeutic strategies with the present antifungal agents. Among the new antifungal drugs, inhibitors of beta glucan synthesis and second-generation azole and triazole derivatives have characteristics that render them potentially suitable agents against some resistant fungi. Other strategies including the use of high doses of lipid formulations of amphotericin B, combination therapy, and adjunctive immune therapy with cytokines are under investigation. In addition, antifungal control programmes to prevent extensive and inappropriate use of antifungals may be needed.

Background: An increasing frequency of opportunistic fungal infections in immunosuppressed patients in recent years. Concurrent with this finding, it has been noted an increasing use of fluconazole. In addition, non-Candida albicans species (NCAS), most of which are fluconazole-resistant have been increasing isolated. The aim of this study was to investigate the epidemiology of colonization and infection due to NCAS in HIV-infected patients., Patients and Methods: A cross sectional study was conducted with HIV-infected patients in different stages, who were attended at two hospitals in Alicante, Spain. We assessed the prevalence and microbiology of oropharyngeal colonization and infection due to Candida spp., and its fluconazole susceptibility patterns. To determine the clinical risk factors for the development of fluconazole resistance, we carried out a case-control study with prevalent cases., Results: We studied 168 strains from 153 patients. NCAS were isolated in 32 (21%) of them, 25 (77%) were colonized, and 5 (26%) had infection due to NCAS. The most common isolate was Candida glabrata (n = 15). MICs were significantly higher for NCAS than for Candida albicans species, with a MIC50 of 16 and 0.25 microgram/ml, respectively, and a MIC90 of 128 micrograms/ml and 8 micrograms/ml (p = 0.0001). The median CD4 cell count in patients with NCAS was 0.06 x 10(9)/l, and 0.19 x 10(9)/l patients with Candida albicans (p = 0.009). Overall, 56% of the patients with NCAS and 41% of the patients with Candida albicans had been treated with fluconazole (p = 0.1)., Conclusions: NCAS are isolated in a high proportion of HIV infected patients. Most of the NCAS have a decreased susceptibility to fluconazole. The only risk factor associated with the acquisition of NCAS in HIV-infected patients is an advanced immunosuppression.

The necrotizing lymphadenitis of Kikuchi-Fujimoto is an uncommon disease in Spain. In a review of the literature we found only five cases reported until 1995. We report here two patients with the diagnosis of this entity in an area hospital during a one-year period. This fact contrasts with the low frequency of this disease reported so far in our country. The cases were two young women who were investigated because of cervical lymph node enlargement and headache. The lymph node biopsy revealed typical findings of the necrotic phase of the Kikuchi-Fujimoto disease in one case; the histology in the other case was characteristic of the so called proliferative phase. The two patients evolved spontaneously with a favorable outcome. Lymph node enlargements resolved in less than three months. All microbiological investigations performed were negative. One of the two patients was receiving intranasal calcitonin when symptoms developed. The incidence of Kikuchi-Fujimoto disease might be higher than considered. The spontaneous resolution of the disease and the requirement of the histological examination for its diagnosis are factors limiting its identification.