ABSTRACT
BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) has become a significant problem in terms of public health and clinical outcome. OBJECTIVE: To assess the epidemiology, treatment and mortality in patients with infection due to CPE. MATERIAL AND METHODS: A retrospective analysis of 163 patients with CPE infection was carried out in a university hospital from July 2013 to October 2015. RESULTS: A total of 163 patients were included over the study period. Klebsiella pneumoniae was isolated in 95.1% of cases, and most of carbapenemases belonged to the OXA-48 group (93.0%). Acquisition was nosocomial in 124 cases (77.0%), healthcare-associated in 30 (18.6%), and 7 cases (4.3%) were community-acquired. The most frequent infections identified in this study were urinary tract (48.4%) and respiratory (19.5%) infections. Approximately half of the patients received antibiotic monotherapy. The 30-day mortality rate was 23.3%. Multivariate analysis revealed that the presence of septic shock at diagnosis (OR 4.2; IC 95% 1.5-11) was independently associated with an increase in death during the first month, unable to identify association with inappropriate antibiotic treatment. DISCUSSION: Further studies are needed to clarify whether antibiotic treatment of EPC infections should be combined or if monotherapy might be sufficient in mild infections.
Subject(s)
Carbapenem-Resistant Enterobacteriaceae , Enterobacteriaceae Infections , Anti-Bacterial Agents , Bacterial Proteins , Humans , Klebsiella pneumoniae , Retrospective Studies , beta-LactamasesABSTRACT
Resumen Introducción: Las enterobacterias productoras de carbapenemasas (EPC) suponen un reto para la salud pública y la práctica clínica. Objetivo: Analizar la epidemiología, el tratamiento y la mortalidad en pacientes infectados por EPC. Material y Métodos: Análisis retrospectivo de 163 pacientes infectados por EPC en un hospital universitario desde julio de 2013 a octubre de 2015. Resultados: Klebsiella pneumoniae fue aislada en 95,1% de los casos, y la mayoría de las carbapenemasas pertenecían al grupo OXA-48 (93%). La adquisición fue nosocomial en 124 casos (77%), asociada a cuidados sanitarios en 30 (18,6%), y 7 (4,3%) fueron de adquisición comunitaria. Las infecciones más frecuentes fueron las del tracto urinario (48,4%) y las respiratorias (19,5%). Aproximadamente, la mitad de los pacientes recibieron monoterapia antimicrobiana. La tasa de mortalidad a los 30 días fue de 23,3%. El análisis multivariante identificó que la presencia de shock séptico al diagnóstico (OR 4,2; IC 95% 1,5-11) estaba asociada de manera independiente con mayor mortalidad en el primer mes, sin lograr identificar asociación con el tratamiento antimicrobiano inapropiado. Discusión: Son necesarios más estudios para aclarar si el tratamiento antimicrobiano de las infecciones por EPC debe ser combinado o si podría ser suficiente la monoterapia en infecciones leves.
Abstract Background: Carbapenemase-producing Enterobacteriaceae (CPE) has become a significant problem in terms of public health and clinical outcome. Objective: To assess the epidemiology, treatment and mortality in patients with infection due to CPE. Material and Methods: A retrospective analysis of 163 patients with CPE infection was carried out in a university hospital from July 2013 to October 2015. Results: A total of 163 patients were included over the study period. Klebsiella pneumoniae was isolated in 95.1% of cases, and most of carbapenemases belonged to the OXA-48 group (93.0%). Acquisition was nosocomial in 124 cases (77.0%), healthcare-associated in 30 (18.6%), and 7 cases (4.3%) were community-acquired. The most frequent infections identified in this study were urinary tract (48.4%) and respiratory (19.5%) infections. Approximately half of the patients received antibiotic monotherapy. The 30-day mortality rate was 23.3%. Multivariate analysis revealed that the presence of septic shock at diagnosis (OR 4.2; IC 95% 1.5-11) was independently associated with an increase in death during the first month, unable to identify association with inappropriate antibiotic treatment. Discussion: Further studies are needed to clarify whether antibiotic treatment of EPC infections should be combined or if monotherapy might be sufficient in mild infections.
Subject(s)
Humans , Enterobacteriaceae Infections , Carbapenem-Resistant Enterobacteriaceae , Bacterial Proteins , beta-Lactamases , Retrospective Studies , Klebsiella pneumoniae , Anti-Bacterial AgentsABSTRACT
Harnessing the patient's own immune system against an established cancer has proven to be a successful strategy. Within the last years, several antibodies blocking critical "checkpoints" that control the activation of T cells, the immune cells able to kill cancer cells, have been approved for the use in patients with different tumours. Unfortunately, these cases remain a minority. Over the last years, radiotherapy has been reported as a means to turn a patient's own tumour into an in situ vaccine and generate anti-tumour T cells in patients who lack sufficient anti-tumour immunity. Indeed, review data show that the strategy of blocking multiple selected immune inhibitory targets in combination with radiotherapy has the potential to unleash powerful anti-tumour responses and improve the outcome of metastatic solid tumours. Here, we review the principal tumours where research in this field has led to new knowledge and where radioimmunotherapy becomes a reality.
Subject(s)
Neoplasms/therapy , Radioimmunotherapy/methods , Humans , Neoplasms/immunology , Neoplasms/pathology , PrognosisABSTRACT
INTRODUCTION: Dementia units (DU) provide comprehensive and specialised care to patients with dementia. However, assessment in these units normally focuses on patient management. The aim of this study was to determine satisfaction of the caregivers of patients managed in a DU and how they rated DU care. METHODS: We created a self-administered questionnaire which was completed by 236 caregivers visiting the DU in 2015. The questionnaire included 6 dimensions (accessibility, organisation, professionalism, relationship with staff, information, and facilities); data were analysed using problem rates. RESULTS: A total of 53.4% caregivers completed the questionnaire; most were women, patients' spouses, or first-degree relatives. The overall problem rates was 15.0% (95% CI, 13.9-16.1), with sizeable differences between dimensions: from 0.1% (95% CI, 0.0-0.4) for 'relationship with staff' and 'professionalism' to 49.3% (95% CI, 45.4-53.2) for 'information'. Waiting times over 30minutes were perceived as excessive. Information problems were not directly related to patient management. Satisfaction was scored 8.29/10 (median 8; SD 1.45); 77.3% (95% CI, 69.8-74.8) of respondents were highly satisfied. Ninety-nine percent of the caregivers stated that they would recommend the DU. CONCLUSIONS: This questionnaire provides interesting data on care quality as perceived by patients' caregivers. Our results have allowed us to identify problems and implement corrective actions. Our questionnaire has proved to be a useful tool for evaluating and improving care quality in DUs.
Subject(s)
Caregivers/psychology , Consumer Behavior , Dementia/therapy , Hospitals/standards , Quality of Health Care/standards , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Patient Satisfaction , Spain , Surveys and QuestionnairesSubject(s)
Desensitization, Immunologic/methods , Egg Hypersensitivity/therapy , Eggs , Adolescent , Child , Child, Preschool , Female , Humans , Immunoglobulin E/blood , Male , Prospective StudiesABSTRACT
Objetivo. Estudiar con espectroscopia univóxel por resonancia magnética (1,5T) el efecto regional, de la edad y el sexo en las ratios metabólicas del lóbulo temporal medial, la región cerebral posteromedial (RPM) y el lóbulo frontal. Material y métodos. Estudiamos 31 personas sanas mayores de 55 años (grupo 1) y 20 menores de 30 años (grupo 2) con espectroscopia univóxel en el lóbulo frontal izquierdo, el lóbulo temporal medial izquierdo y la RPM, especialmente afectadas por las enfermedades neurodegenerativas. Se calcularon las ratios NAA/Cr, NAA/Cho, NAA/mI, Cho/Cr, y mI/Cr, de cada vóxel. En cada grupo se compararon regionalmente las ratios metabólicas, y se estudió la correlación ratio-edad dentro de sus rangos de edad. Finalmente, se analizaron las diferencias de las ratios metabólicas entre grupos y entre sexos. Resultados. En el grupo 1, las ratios Cho/Cr frontal y NAA/mI temporal se correlacionaron negativamente con la edad. En el grupo 2, las correlaciones con la edad fueron negativas para las ratios temporales mI/Cr y NAA/Cho, y positiva para la NAA/mI temporal. En el lóbulo frontal y la RPM, las ratios NAA/Cr, NAA/Cho y NAA/mI fueron menores en el grupo 1 (P<=0,003). Las ratios Cho/Cr y mI/Cr nunca mostraron diferencias entre grupos. Los valores de las ratios difirieron regionalmente en todos los casos (P<0,001). NAA/Cr y Cho/Cr en el lóbulo temporal medial fueron mayores en las mujeres (P<=0,034). Conclusiones. Cuando se utilice la espectroscopia univóxel por resonancia magnética, en particular en las enfermedades neurodegenerativas, siempre deben considerarse las variaciones inducidas por la región, la edad y el sexo (AU)
Objective. To determine the regional effects of age and sex on the metabolic ratios obtained in the medial temporal lobe, the posteromedial region, and the frontal lobe at 1.5T single-voxel magnetic resonance spectroscopy. Material and methods. We used single-voxel magnetic resonance spectroscopy to study the areas of the brain most affected in neurodegenerative disease (the left frontal lobe, the left medial temporal lobe, and the posteromedial region) in 31 healthy subjects older than 55 years of age (group 1) and in 20 healthy subjects under 30 years of age (group 2). We calculated the following ratios for each voxel: N-acetyl-aspartate/creatine-phosphocreatine (NAA/Cr), N-acetyl-aspartate/choline (NAA/Cho), N-acetyl-aspartate /myoinositol (NAA/mI), choline/creatine-phosphocreatine (Cho/Cr), and myoinositol (mI/Cr). We compared the metabolic ratios in each region in each group and the correlation between age and the ratios within age ranges. Finally, we analyzed the differences in the metabolic ratios between groups and between sexes. Results. In group 1, we found negative correlations between age and Cho/Cr in the frontal region and NAA/mI in the temporal region. In group 2, we found negative correlations between age and mI/Cr and NAA/Cho in the temporal region as well as a positive correlation between age and NAA/mI in the temporal region. In the frontal lobe and the posteromedial region, NAA/Cr, NAA/Cho, and NAA/mI were lower in group 1 (P<=0.003). No differences between groups were seen in Cho/Cr or mI/Cr. The values of the ratios differed regionally in all cases (P<0.001). In the temporal lobe, NAA/Cr and Cho/Cr were higher in women (P<=0.034). Conclusions. When using single-voxel magnetic resonance spectroscopy, especially in patients with neurodegenerative disease, variations due to region, age, and sex should always be taken into account (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Magnetic Resonance Spectroscopy/methods , Temporal Lobe/pathology , Temporal Lobe , Frontal Lobe/pathology , Frontal Lobe , Gyrus Cinguli , Magnetic Resonance Spectroscopy/instrumentation , Magnetic Resonance Spectroscopy/standards , Magnetic Resonance Imaging , Neuropsychology/methods , Superior Sagittal SinusABSTRACT
OBJECTIVE: To determine the regional effects of age and sex on the metabolic ratios obtained in the medial temporal lobe, the posteromedial region, and the frontal lobe at 1.5 T single-voxel magnetic resonance spectroscopy. MATERIAL AND METHODS: We used single-voxel magnetic resonance spectroscopy to study the areas of the brain most affected in neurodegenerative disease (the left frontal lobe, the left medial temporal lobe, and the posteromedial region) in 31 healthy subjects older than 55 years of age (group 1) and in 20 healthy subjects under 30 years of age (group 2). We calculated the following ratios for each voxel: N-acetyl-aspartate/creatine-phosphocreatine (NAA/Cr), N-acetyl-aspartate/choline (NAA/Cho), N-acetyl-aspartate /myoinositol (NAA/mI), choline/creatine-phosphocreatine (Cho/Cr), and myoinositol (mI/Cr). We compared the metabolic ratios in each region in each group and the correlation between age and the ratios within age ranges. Finally, we analyzed the differences in the metabolic ratios between groups and between sexes. RESULTS: In group 1, we found negative correlations between age and Cho/Cr in the frontal region and NAA/mI in the temporal region. In group 2, we found negative correlations between age and mI/Cr and NAA/Cho in the temporal region as well as a positive correlation between age and NAA/mI in the temporal region. In the frontal lobe and the posteromedial region, NAA/Cr, NAA/Cho, and NAA/mI were lower in group 1 (P≤0.003). No differences between groups were seen in Cho/Cr or mI/Cr. The values of the ratios differed regionally in all cases (P<0.001). In the temporal lobe, NAA/Cr and Cho/Cr were higher in women (P≤0.034). CONCLUSIONS: When using single-voxel magnetic resonance spectroscopy, especially in patients with neurodegenerative disease, variations due to region, age, and sex should always be taken into account.
Subject(s)
Brain Diseases/diagnosis , Magnetic Resonance Spectroscopy , Adult , Age Factors , Aged , Female , Humans , Male , Middle Aged , Sex Factors , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Male , Child , Respiratory Tract Diseases/epidemiology , Respiratory Tract Diseases/prevention & control , Catheterization , Asthma/diagnosis , Asthma/epidemiology , Albuterol/therapeutic use , Sensitivity and Specificity , Spirometry/trends , Spirometry , Pulmonary Artery/pathology , Pulmonary ArterySubject(s)
Arteriovenous Malformations/diagnosis , Asthma/diagnosis , Lung/pathology , Pulmonary Artery/abnormalities , Respiratory Tract Infections/diagnosis , Animals , Arteriovenous Malformations/complications , Arteriovenous Malformations/pathology , Arteriovenous Malformations/physiopathology , Asthma/complications , Asthma/pathology , Asthma/physiopathology , Child , Cough , Diagnosis, Differential , Fever , Humans , Lung/diagnostic imaging , Magnetic Resonance Angiography , Male , Pulmonary Artery/diagnostic imaging , Pyroglyphidae/immunology , Radionuclide Imaging , Respiratory Tract Infections/etiology , Respiratory Tract Infections/pathology , Respiratory Tract Infections/physiopathology , Spirometry , Tomography, X-Ray ComputedABSTRACT
We present 10 cases (6 males and 4 females) of children aged 4 to 12 years, who were diagnosed with allergy to clavulanic acid (CL) and treated in the Paediatric Allergy Section of the University Hospital Dr. Peset in Valencia from 2000 to 2005. The children reported symptoms of urticaria and angio-oedema after receiving orally-administered amoxicillin/clavulanic acid (A-CL) for an infection. Diagnosis was based on the confirmation of an IgE-mediated aetiology by an oral challenge test with amoxicillin-clavulanic acid. Following negative skin test results and CAP for penicilloyl G and V, amoxicillin, ampicillin and cefaclor < 0.35 KU/l, those patients who were allergic to clavulanic acid (positive oral challenge test) were shown to be tolerant to orally-administered Cefuroxime axetil.
Subject(s)
Anti-Bacterial Agents/adverse effects , Clavulanic Acid/adverse effects , Drug Hypersensitivity/diagnosis , Administration, Oral , Anti-Bacterial Agents/immunology , Child , Child, Preschool , Clavulanic Acid/immunology , Drug Hypersensitivity/immunology , Female , Humans , Immunoglobulin E/blood , Male , Retrospective Studies , Skin TestsABSTRACT
We present 10 cases (6 males and 4 females) of children aged 4 to 12 years, who were diagnosed with allergy to clavulanic acid (CL) and treated in the Paediatric Allergy Section of the University Hospital Dr. Peset in Valencia from 2000 to 2005. The children reported symptoms of urticaria and angio-oedema after receiving orally-administered amoxicillin/clavulanic acid (A-CL) for an infection. Diagnosis was basedon the confirmation of an IgE-mediated aetiology byan oral challenge test with amoxicillin-clavulanic acid. Following negative skin test results and CAP for penicilloy lG and V, amoxicillin, ampicillin and cefaclor< 0.35 KU/l, those patients who were allergic to clavulanic acid (positive oral challenge test) were shown to be tolerant to orally-administered Cefuroximeaxetil
No disponible
Subject(s)
Humans , Male , Female , Child , Hypersensitivity/complications , Hypersensitivity/diagnosis , Clavulanic Acid/adverse effects , Cefuroxime/administration & dosage , Cefuroxime/therapeutic use , Patch Tests/methods , Urticaria/chemically induced , Urticaria/therapy , Retrospective StudiesSubject(s)
Abnormalities, Multiple/diagnosis , Lung/abnormalities , Child , Humans , Lung Diseases/etiology , MaleABSTRACT
No disponible
Subject(s)
Male , Infant, Newborn , Humans , Lung/abnormalities , Respiratory Insufficiency/congenital , Down Syndrome/complications , Trisomy/diagnosis , Radiography, Thoracic , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency , Magnetic Resonance Angiography/methodsABSTRACT
No disponible
Subject(s)
Female , Child , Humans , Bronchopulmonary Sequestration/complications , Bronchopulmonary Sequestration/diagnosis , Bronchopulmonary Sequestration/surgery , Radiography, Thoracic/methods , Angiography/methods , Chest Pain/diagnosis , Diagnosis, Differential , Pneumonia/complications , Respiratory System Abnormalities/physiopathology , Respiratory System Abnormalities , Leukocytosis/complications , Respiratory System Abnormalities/complications , Lung Diseases, Interstitial/complicationsABSTRACT
BACKGROUND: most patients use their inhalers incorrectly and recent asthma management clinical guidelines recommend demonstrating skills and correcting performance at each asthma follow-up visit. However, this statement is poorly evidence-based and few intervention studies have assessed quantitatively the effectiveness of this recommendation. METHODS: from a total of 3,076 children and adolescents with asthma attending an outpatient clinic, a random, representative sample of 255 was obtained and assessed at baseline with a standardised questionnaire regarding their skills when using one of three inhaler devices: pressurised direct aerosol (PDA), dry powder (DP) and aerosol pressurised in expanded camera (APEC). Structured sessions of correct use and handling of inhalers were offered and a new assessment was undertaken after an average of 10.5 months (SD 4.5). RESULTS: only 142 asthmatics maintained the same inhaler device during the study period. An increase of correct manoeuvres was observed for all three devices, and the relative risk and 95% confidence interval (RR and 95% CI) of incorrect post-intervention use was 0.23 (95% CI 0.10-0.56) for PDA, 0.59 (95% CI 0.38-0.92) for DP, and 0.54 (95% CI 0.32-0.90) for APEC. A multivariate analysis indicates that this improvement was observed irrespective of gender and age interval, and that it was even better when parents cooperated with medical and nursing staff. CONCLUSIONS: a dramatic improvement in correct manoeuvres with any of three inhaler devices after active performance training was observed. This easy, highly effective, low cost (in terms of time and personnel) intervention should be routinely implemented in any control visit of asthmatics, leading to a better management of asthma.
Subject(s)
Asthma/drug therapy , Nebulizers and Vaporizers , Patient Education as Topic/methods , Administration, Inhalation , Adolescent , Adult , Child , Child, Preschool , Female , Humans , MaleABSTRACT
Conflict almost completely destroyed Rwanda's infrastructure in 1994. Natural disasters, as well as disasters caused by humans, have severely challenged humanitarian aid available within the country. In this study, we have analysed the experiences of nongovernmental organizations since the summer of 1994 to evaluate how these difficulties may be overcome. One of the problems identified has been restrictions on the ability to introduce effective health planning due to the poor quality of available local information. The implementation of effective plans that show due consideration to the environment and society is clearly necessary. Effective monitoring and detailed observation are identified as being essential to the continuity of existing humanitarian assistance.
