Dalbavancin as sequential therapy in infective endocarditis: Real-life experience in elder and comorbid patients.

OBJECTIVES: This study aimed to evaluate the effectiveness of dalbavancin as sequential therapy in patients with infective endocarditis (IE) due to gram positive bacteria (GPB) in a real-life heterogenous cohort with comorbid patients. METHODS: A single center retrospective cohort study including all patients with definite IE treated with dalbavancin between January 2017 and February 2022 was developed. A 6-month follow-up was performed. The main outcomes were clinical cure rate, clinical and microbiological relapse, 6-month mortality, and adverse effects (AEs) rate. RESULTS: The study included 61 IE episodes. The median age was 78.5 years (interquartile range [IQR] 63.2-85.2), 78.7% were male, with a median Charlson comorbidity index of 7 (IQR 4-9) points. Overall, 49.2% suffered native valve IE. The most common microorganism was Staphylococcus aureus (26.3%) followed by Enterococcus faecalis (21.3%). The median duration of initial antimicrobial therapy and dalbavancin therapy were 27 (IQR 20-34) and 14 days (IQR 14-28) respectively. The total reduction of hospitalization was 1090 days. The most frequent dosage was 1500mg of dalbavancin every 14 days (96.7%). An AE was detected in 8.2% of patients, only one (1.6%) was attributed to dalbavancin (infusion reaction). Clinical cure was achieved in 86.9% of patients. One patient (1.6%) with Enterococcus faecalis IE suffered relapse. The 6-month mortality was 11.5%, with only one IE-related death (1.6%). CONCLUSION: This study shows a high efficacy of dalbavancin in a heterogeneous real-world cohort of IE patients, with an excellent safety profile. Dalbavancin allowed a substantial reduction of in-hospital length of stay.

Aumento de la complejidad de los pacientes con endocarditis infecciosa izquierda / Increase in the complexity of patients with left-side infective endocarditis

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Cytokine profiles linked to fatal outcome in infective prosthetic valve endocarditis.

Infective endocarditis is a disease normally of bacterial cause which affects the endocardic tissue, specifically the valves (native or prosthetic). It is a serious illness and mortality rates remain high, ranging between 20% and 40%. Previous reports have evidenced the potential role of cytokines in the diagnosis of this disease, but no information is available on their relationship with outcome. We recruited 26 consecutive patients with late prosthetic valve endocarditis requiring surgical treatment according to Duke criteria. Eight cytokines were measured in plasma in the first 24 h following diagnosis by using a Bio-Rad multiplex assay. Levels of IL-6, IL-8 and interferon gamma (IFN-γ) were higher in non survivors. Receiver operating characteristic curve analysis evidenced that IL-6, IL-8 and IFN-γ behaved as good diagnostic tests for identifying those patients with fatal outcome (area under the curve, CI 95%, p): IL-6: [0.81 (0.61-1.00) 0.012]; IL-8 [0.76 (0.56-0.96) 0.035]; IFN-γ [0.79 (0.59-0.99) 0.021]. Levels of IL-6, IL-8 and IFN-γ correlated positively between them, indicating that they are produced as consequence of a simultaneous response to the infection. Our findings support the participation of IL-6, IL-8 and IFN-γ in the events linked to fatal outcome in infective prosthetic valve endocarditis.

[Running and its influence on smoking habits]. / Influencia de la carrera a pie sobre el hábito tabáquico.

OBJECTIVE: To investigate whether running influences smoking habits. DESIGN: Study of cases and controls, with 1:1 pairing. Retrospective longitudinal observational study. SETTING: Primary care. City of Toledo, Spain. CASES: 48 healthy volunteer runners of 47+/-7.8 years of age. CONTROLS: 48 healthy subjects, paired by gender and year of birth, chosen at random from the medical list assigned to the medical researcher. PRINCIPAL MEASUREMENTS: Smoking habits and alcohol consumption in grams per week using a questionnaire, weight, height, blood pressure, and heart rate at rest. The odds ratio (OR) was obtained on the proportion of subjects who smoked or smoked at some time, those who continued smoking and the probabilities of giving up tobacco in each group. RESULTS: The OR of the proportion of subjects who smoked or had smoked between the groups of runners (54.2%) and controls (70.9%) was 0.486 (95% confidence interval [CI], 0.205-1.149; chi(2)=2.8; P=.093). The OR for continuing the habit between groups of runners (8.4%) and controls (41.7%) was 0.127 (95% CI, 0.035-0.456; chi(2)=14.0; P=.0002). In the group of runners, 45.8% had stopped smoking, as well as 31.2% of the controls (OR=7.85; 95% CI, 1.89-32.52; chi(2)=11.8; P=.0007); 50% of the runners who smoked had given it up since starting to run and 76.9% of these had given it up just at the time of starting to run. CONCLUSIONS: There is a negative association between running and tobacco. If a smoker decides to run regularly he/she has high probabilities of giving up smoking and continue to do so.

Influencia de la carrera a pie sobre el hábito tabáquico / Running and its influence on smoking habits

Objetivo. Investigar si la carrera a pie influye sobre el hábito tabáquico. Diseño. Estudio de casos y controles, con emparejamiento 1:1. Observación longitudinal retrospectiva. Emplazamiento. Atención primaria. Ciudad de Toledo. Participantes. Casos: 48 corredores voluntarios sanos de 47 ± 7,8 años de edad. Controles: 48 sujetos sanos, emparejados por sexo y año de nacimiento, elegidos al azar entre la población adscrita al médico investigador. Mediciones principales. Hábito tabáquico y gramos semanales de alcohol mediante cuestionario, peso, talla, presión arterial y frecuencia cardíaca de reposo. Se obtuvieron las odds ratio (OR) de las proporciones de sujetos que fumaban o habían fumado alguna vez, de los que seguían fumando y de las probabilidades de abandono del tabaco de cada grupo. Resultados. La OR de la proporción de sujetos que fumaban o habían fumado entre los grupos de corredores (54,2%) y controles (70,9%) era de 0,486 (intervalo de confianza [IC] del 95%, 0,205-1,149; *2 = 2,8; p = 0,093). La OR para continuación del hábito entre los grupos de corredores (8,4%) y controles (41,7%) era de 0,127 (IC del 95%, 0,035-0,456; *2 = 14,0; p = 0,0002). En el grupo de corredores había abandonado el tabaco el 45,8% y en el de controles, el 31,2% (OR = 7,85; IC del 95%, 1,89-32,52; *2 = 11,8; p = 0,0007). El 50% de los corredores que fumaban lo había dejado desde que comenzó a correr y el 76,9% de éstos lo había dejado justo en el momento de comenzar a correr. Conclusiones. Hay una asociación negativa entre carrera a pie y tabaco. Si un fumador decide comenzar a correr regularmente, tiene muchas probabilidades de dejar de fumar y mantenerse así

Objective. To investigate whether running influences smoking habits. Design. Study of cases and controls, with 1:1 pairing. Retrospective longitudinal observational study. Setting. Primary care. City of Toledo, Spain. Participants. Cases: 48 healthy volunteer runners of 47±7.8 years of age. Controls: 48 healthy subjects, paired by gender and year of birth, chosen at random from the medical list assigned to the medical researcher. Principal measurements. Smoking habits and alcohol consumption in grams per week using a questionnaire, weight, height, blood pressure, and heart rate at rest. The odds ratio (OR) was obtained on the proportion of subjects who smoked or smoked at some time, those who continued smoking and the probabilities of giving up tobacco in each group. Results. The OR of the proportion of subjects who smoked or had smoked between the groups of runners (54.2%) and controls (70.9%) was 0.486 (95% confidence interval [CI], 0.205-1.149; *2=2.8; P=.093). The OR for continuing the habit between groups of runners (8.4%) and controls (41.7%) was 0.127 (95% CI, 0.035-0.456; *2=14.0; P=.0002). In the group of runners, 45.8% had stopped smoking, as well as 31.2% of the controls (OR=7.85; 95% CI, 1.89-32.52; *2=11.8; P=.0007); 50% of the runners who smoked had given it up since starting to run and 76.9% of these had given it up just at the time of starting to run. Conclusions. There is a negative association between running and tobacco. If a smoker decides to run regularly he/she has high probabilities of giving up smoking and continue to do so

Influencia de la carrera a pie sobre el hábito tabáquico

Objetivo. Investigar si la carrera a pie influye sobre el hábito tabáquico. Diseño. Estudio de casos y controles, con emparejamiento 1:1. Observación longitudinal retrospectiva. Emplazamiento. Atención primaria. Ciudad de Toledo. Participantes. Casos: 48 corredores voluntarios sanos de 47± 7,8 años de edad. Controles: 48 sujetos sanos, emparejados por sexo y año de nacimiento, elegidos al azar entre la población adscrita al médico investigador. Mediciones principales. Hábito tabáquico y gramos semanales de alcohol mediante cuestionario, peso, talla, presión arterial y frecuencia cardíaca de reposo. Se obtuvieron las odds ratio (OR) de las proporciones de sujetos que fumaban o habían fumado aguna vez, de los que seguían fumando y de las probabilidades de abandono do tabaco en cada grupo. Resultados. La OR de la proporción de sujetos que fumaban o habían fumado entre los grupos de corredores (54,2 por ciento) y controles (70,9 por ciento) era de 0,486 (intervalo de confianza [IC] del 95 por ciento, 0,205-1,149; x² = 2,8; p = 0,093). La OR para continuación del hábito entre los grupos de corredores (8,4 por ciento) y de controles (41,7 por ciento) era de 0,127 (IC del 95 por ciento, 0,035-0,456; x = 14,0; p = 0,0002). En el grupo de corredores había abandonado el tabaco el tabaco el 45,8 por ciento y en el de controles, el 31,2 por ciento (OR = 7,85; IC del 95 por ciento, 1,89-32,52; x = 11,8; p = 0,0007). El 50 por ciento de los corredores que fumaban lo había dejado desde que comenzó a correr y el 76,9 por ciento de estos lo había dejado justo en el momento de comenzar a correr. Conclusiones. Hay una asociasión negativa entre carrera a pie y tabaco. Si un fumador decide comenzar a correr regularmente, tiene muchas probabilidades de dejar de fumar y mantenerse así.(AU)

Los estudiantes de medicina ante la incertidumbre del ejercicio profesional / Medicine students in front of professional exercise incertitude

La incertidumbre en el ejercicio profesional de la medicina es un hecho actual y antiguo, sobre el que los estudiantes han recibido escasa formación. Partiendo de una encuesta a 100 alumnos del curso 1999-2000 y una exposición de caso clínico incierto, se discuten los resultados concluyendo que los pregraduados consultados tienen elevado interés por prepararse ante la incertidumbre en el ejercicio profesional. De igual manera, no se les ha facilitado competencias clínicas ante los casos dudosos, y tienen dificultades de aplicación práctica tanto en los casos difíciles como en los típicos (AU)