Days spent on non-invasive ventilation support: can it determine when to initiate VV- ECMO? Observational study in a cohort of Covid-19 patients.

BACKGROUND: The study evaluates the impact of the time between commencing non-invasive ventilation (NIV) support and initiation of venovenous extracorporeal membrane oxygenation (VV-ECMO) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS). METHODS: Prospective observational study design in an intensive Care Unit (ICU) of a tertiary hospital in Barcelona (Spain). All patients requiring VV-ECMO support due to COVID-19 associated ARDS between March 2020 and January 2022 were analysed. Survival outcome was determined at 90 days after VV-ECMO initiation. Demographic data, comorbidities at ICU admission, RESP (respiratory ECMO survival prediction) score, antiviral and immunomodulatory treatments received, inflammatory biomarkers, the need for vasopressors, the thromboprophylaxis regimen received, and respiratory parameters including the length of intubation previous to ECMO and the length of each NIV support (high-flow nasal cannula, continuous positive airway pressure and bi-level positive airway pressure), were also collated in order to assess risk factors for day-90 mortality. The effect of the time lapse between NIV support and VV-ECMO on survival was evaluated using logistic regression and adjusting the association with all factors that were significant in the univariate analysis. RESULTS: Seventy-two patients finally received VV-ECMO support. At 90 days after commencing VV-ECMO 35 patients (48%) had died and 37 patients (52%) were alive. Multivariable analysis showed that at VV-ECMO initiation, age (p = 0.02), lactate (p = 0.001), and days from initiation of NIV support to starting VV-ECMO (p = 0.04) were all associated with day-90 mortality. CONCLUSIONS: In our small cohort of VV-ECMO patients with COVID-19 associated ARDS, the time spent between initiation of NIV support and VV-ECMO (together with age and lactate) appeared to be a better predictor of mortality than the time between intubation and VV-ECMO.

Burnout syndrome and work engagement in nursing staff: a systematic review and meta-analysis.

Background: A difficult and demanding work environment, such as that often experienced in healthcare, can provoke fatigue, anxiety, distress, and discomfort. This study considers factors that may influence levels of burnout and work engagement among nurses and seeks to determine the relationship between these conditions. Method: A systematic scoping review was performed, in accordance with the PRISMA Extension for Scoping Reviews, based on data obtained from a search of the PubMed/MEDLINE and Scopus databases carried out in 2022 using the search equation: "work engagement AND nurs* AND burnout." This search identified nine quantitative primary studies suitable for inclusion in our analysis. Results: Work overload, type of shift worked, and/or area of hospital service, among other elements, are all relevant to the development of burnout. This syndrome can be countered by social support and appropriate personal resources and values, which are all positively associated with work engagement. Our analysis revealed a significant correlation between work engagement and the different domains of burnout. The correlation effect size between burnout and work engagement was -0.46 (95% CI -0.58, -0.31), with p < 0.001. Conclusion: Well-targeted interventions in the healthcare work environment can reduce burnout levels, strengthen work engagement, and enhance the quality of healthcare.

Cooperative Multiband Spectrum Sensing Using Radio Environment Maps and Neural Networks.

Cogitive radio networks (CRNs) require high capacity and accuracy to detect the presence of licensed or primary users (PUs) in the sensed spectrum. In addition, they must correctly locate the spectral opportunities (holes) in order to be available to nonlicensed or secondary users (SUs). In this research, a centralized network of cognitive radios for monitoring a multiband spectrum in real time is proposed and implemented in a real wireless communication environment through generic communication devices such as software-defined radios (SDRs). Locally, each SU uses a monitoring technique based on sample entropy to determine spectrum occupancy. The determined features (power, bandwidth, and central frequency) of detected PUs are uploaded to a database. The uploaded data are then processed by a central entity. The objective of this work was to determine the number of PUs, their carrier frequency, bandwidth, and the spectral gaps in the sensed spectrum in a specific area through the construction of radioelectric environment maps (REMs). To this end, we compared the results of classical digital signal processing methods and neural networks performed by the central entity. Results show that both proposed cognitive networks (one working with a central entity using typical signal processing and one performing with neural networks) accurately locate PUs and give information to SUs to transmit, avoiding the hidden terminal problem. However, the best-performing cognitive radio network was the one working with neural networks to accurately detect PUs on both carrier frequency and bandwidth.

¿Cuál es la calidad de vida de los adultos con vitiligo en México? / What is the quality of life of adults with vitiligo in Mexico?

Resumen Introducción: El vitiligo es incurable, lentamente progresivo, su prevalencia varía de 0.4 a 2.0 %. La calidad de vida relacionada con la salud (CVRS) se refiere al bienestar autopercibido asociado a la presencia de una enfermedad y su tratamiento. Métodos: Estudio transversal en un centro dermatológico. Se incluyeron adultos con vitiligo no segmentario (VNS), en tanto que se excluyeron pacientes con otros trastornos pigmentarios y otros tipos de vitiligo. Se aplicó el cuestionario VitiQoL (0 = sin afectación, 90 = máxima afectación), el Vitiligo Extent Score (VES) y el Vitiligo Area Scoring Index (VASI). Resultados: Participaron 492 pacientes, 63 % mujeres. Se obtuvieron 32.6 puntos de promedio en el VitiQoL (IC 95 % = 30.6-34.5). La autopercepción de gravedad y la CVRS se correlacionaron (r = 0.568, p < 0.001). La edad, el sexo femenino, la menor educación y la mayor gravedad autopercibida se asociaron a peor CVRS. La proporción de personas que reportaron una adicción fue similar en los grupos con peor y mejor CVRS (28 % versus 32 %, p = 0.23). Conclusión: La peor CVRS se explica por la autopercepción de gravedad, preocupación por la progresión de la enfermedad, aspecto de la piel y acciones necesarias para evitar la exposición al sol durante la recreación.

Abstract Introduction: Vitiligo is an incurable, slowly progressive skin condition, the prevalence of which ranges from 0.4 to 2.0%. Health-related quality of life (HRQoL) refers to self-perceived well-being associated with the presence of a disease and its treatment. Methods: Cross-sectional study at a dermatological center. Adults with non-segmental vitiligo (NSV) were included, while patients with other pigmentary disorders and other types of vitiligo were excluded. The VitiQoL questionnaire (0 = no skin involvement, 90 = maximum skin involvement), the Vitiligo Extent Score (VES) and the Vitiligo Area Scoring Index (VASI) were applied. Results: 492 patients did participate; 63% were women. An average score of 32.6 was obtained on VitiQoL (95% CI = 30.6-34.5). Self-perception of severity and HRQoL were correlated (r = 0.568, p < 0.001). Age, the female gender, lower education and higher self-perceived severity were associated with poorer HRQoL. The proportion of subjects who reported an addiction was similar in the worst and best HRQoL groups (28% vs. 32%, p = 0.23). Conclusion: Poorer HRQoL is explained by severity self-perception, concern about disease progression, appearance of the skin and necessary actions to avoid sun exposure during recreation.

Effects of Anonymity versus Examinee Name on a Measure of Depressive Symptoms in Adolescents.

There is evidence in the literature that anonymity when investigating individual variables could increase the objectivity of the measurement of some psychosocial constructs. However, there is a significant gap in the literature on the theoretical and methodological usefulness of simultaneously assessing the same measurement instrument across two groups, with one group remaining anonymous and a second group revealing identities using names. Therefore, the aim of this study was to compare the psychometric characteristics of a measure of depressive symptoms in two groups of adolescents as a consequence of identification or anonymity at the time of answering the measuring instrument. The participants were 189 adolescents from Metropolitan Lima; classrooms were randomly assigned to the identified group (n = 89; application requesting to write one's own name) or to the anonymous group (n = 100; application under usual conditions), who responded to the Childhood Depression Inventory, short version (CDI-S). Univariate characteristics (mean, dispersion, distribution), dimensionality, reliability, and measurement invariance were analyzed. Specific results in each of the statistical and psychometric aspects evaluated indicated strong psychometric similarity. The practical and ethical implications of the present results for professional and research activity are discussed.

Towards Deep Radar Perception for Autonomous Driving: Datasets, Methods, and Challenges.

With recent developments, the performance of automotive radar has improved significantly. The next generation of 4D radar can achieve imaging capability in the form of high-resolution point clouds. In this context, we believe that the era of deep learning for radar perception has arrived. However, studies on radar deep learning are spread across different tasks, and a holistic overview is lacking. This review paper attempts to provide a big picture of the deep radar perception stack, including signal processing, datasets, labelling, data augmentation, and downstream tasks such as depth and velocity estimation, object detection, and sensor fusion. For these tasks, we focus on explaining how the network structure is adapted to radar domain knowledge. In particular, we summarise three overlooked challenges in deep radar perception, including multi-path effects, uncertainty problems, and adverse weather effects, and present some attempts to solve them.

Genetic Characterization by SSR Markers of a Comprehensive Wine Grape Collection Conserved at Rancho de la Merced (Andalusia, Spain).

The IFAPA research center "Rancho de la Merced" (Jerez, Spain) hosts one of the oldest and most diverse grapevine germplasm repositories in Europe, and is aimed at providing feasible solutions to deal with any agronomic trait by exploring its genetic variability and by means of association and Deoxyribonucleic Acid (DNA) editing studies. In this work, we focused on a wine and dual-use grapevine subcollection that consists of 930 accessions. Genetic analysis allowed to identify 521 unique genotypes. After comparing them with several databases, matches were found for 476 genetic profiles while the remaining 45 have not been previously described. Combination with clustering analysis suggested a total pool of 481 Vitis vinifera accessions that included some table cultivars. Several synonymies, homonymies and mislabeling have also been detected. Structure analysis allowed identifying six clusters according to eco-geographic cultivation areas and one additional group including non-vinifera accessions. Diversity analysis pointed out that Spanish Mediterranean varieties are genetically closer to oriental genotypes than to European varieties typical of oceanic and continental climates. The origin of Spanish varieties is discussed in depth considering our data and previous studies. Analysis of molecular variance partition confirmed a well-structured germplasm, although differentiation among groups had a much lower effect on genetic variability than differences within groups, which are strongly related to a very high heterozygosity. A core collection that covers all allele richness is proposed. It is constituted of about 13% of total accessions, and each cluster inferred by structure analysis is represented.

A New Story on the Multidimensionality of the MSPSS: Validity of the Internal Structure through Bifactor ESEM.

The internal structure of the Multidimensional Scale of Perceived Social Support (MSPSS) in adolescents has been evaluated with some factorial analysis methodologies but not with bifactor exploratory structural equation modeling (ESEM), and possibly the inconsistency in the internal structure was dependent on these approaches. The objective of the study was to update evidence regarding its internal structure of MSPSS, by means of a detailed examination of its multidimensionality The participants were 460 adolescents from an educational institution in the Callao region, Lima, Peru. The structure was modeled using unidimensional, three-factor and bifactor models with confirmatory factor analysis (CFA) and ESEM approaches. The models showed good levels of fit, with the exception of the unidimensional model; however, the multidimensionality indicators supported the superiority of the bifactor ESEM. In contrast, the general factor was not strong enough, and the interfactorial correlations were substantially lower. It is concluded that the MSPSS can be interpreted by independent but moderately correlated factors, and there is possible systematic variance that potentially prevented the identification of a general factor.

What is the quality of life of adults with vitiligo in Mexico?

INTRODUCTION: Vitiligo is an incurable, slowly progressive skin condition, the prevalence of which ranges from 0.4 to 2.0%. Health-related quality of life (HRQoL) refers to self-perceived well-being associated with the presence of a disease and its treatment. METHODS: Cross-sectional study at a dermatological center. Adults with non-segmental vitiligo (NSV) were included, while patients with other pigmentary disorders and other types of vitiligo were excluded. The VitiQoL questionnaire (0 = no skin involvement, 90 = maximum skin involvement), the Vitiligo Extent Score (VES) and the Vitiligo Area Scoring Index (VASI) were applied. RESULTS: 492 patients did participate; 63% were women. An average score of 32.6 was obtained on VitiQoL (95% CI = 30.6-34.5). Self-perception of severity and HRQoL were correlated (r = 0.568, p < 0.001). Age, the female gender, lower education and higher self-perceived severity were associated with poorer HRQoL. The proportion of subjects who reported an addiction was similar in the worst and best HRQoL groups (28% vs. 32%, p = 0.23). CONCLUSION: Poorer HRQoL is explained by severity self-perception, concern about disease progression, appearance of the skin and necessary actions to avoid sun exposure during recreation.

INTRODUCCIÓN: El vitiligo es incurable, lentamente progresivo, su prevalencia varía de 0.4 a 2.0 %. La calidad de vida relacionada con la salud (CVRS) se refiere al bienestar autopercibido asociado a la presencia de una enfermedad y su tratamiento. MÉTODOS: Estudio transversal en un centro dermatológico. Se incluyeron adultos con vitiligo no segmentario (VNS), en tanto que se excluyeron pacientes con otros trastornos pigmentarios y otros tipos de vitiligo. Se aplicó el cuestionario VitiQoL (0 = sin afectación, 90 = máxima afectación), el Vitiligo Extent Score (VES) y el Vitiligo Area Scoring Index (VASI). RESULTADOS: Participaron 492 pacientes, 63 % mujeres. Se obtuvieron 32.6 puntos de promedio en el VitiQoL (IC 95 % = 30.6-34.5). La autopercepción de gravedad y la CVRS se correlacionaron (r = 0.568, p < 0.001). La edad, el sexo femenino, la menor educación y la mayor gravedad autopercibida se asociaron a peor CVRS. La proporción de personas que reportaron una adicción fue similar en los grupos con peor y mejor CVRS (28 % versus 32 %, p = 0.23). CONCLUSIÓN: La peor CVRS se explica por la autopercepción de gravedad, preocupación por la progresión de la enfermedad, aspecto de la piel y acciones necesarias para evitar la exposición al sol durante la recreación.

Medical outcomes study social support survey (MOS-SSS) in patients with chronic disease: A psychometric assessment.

Purpose: Currently, information on the psychometric properties of the Medical outcomes study-social support survey (MOS-SSS) for patients with chronic disease in primary health care, suggests problems in the dimensionality, specifically predominant unidimensionality in a multidimensional measure. The aim of this study was to determine the internal structure (dimensionality, measurement invariance and reliability) and association with other variables. Methods: A total of 470 patients with chronic disease from a Family Medicine Unit at the Instituto Mexicano del Seguro Social, IMSS, with a mean age of 51.51 years were included. Participants responded to the Questionnaire of Sociodemographic Variables (Q-SV), SF-36 Health-Related Quality of Life Scale-version 1.1, and MOS-SSS. Results: Non-parametric (Mokken scaling analysis) and parametric (confirmatory factor analysis) analyses indicated unidimensionality, and three-factor model was not representative. A new 8-item version (MOS-S) was developed, where measurement invariance, equivalence with the long version, reliability, and relationship with the SF-36 were satisfactory. Conclusion: The MOS-SSS scale is unidimensional, and the shortened version yields valid and reliable scores for measuring social support in patients with chronic disease at the primary health care.

Medication-related osteonecrosis of the jaw in cancer patients: Case series and review of the current literature.

Currently, a large proportion of cancer patients are treated with bone modifying agents (BMA). In this regard, the increase in the prescription of these drugs has lead to concerns in the increment of osteonecrosis of the jaws. This article describes four patients with BMA cancer treatments requested dental evaluation at our institution due to pain and swelling of the mandibular bone after tooth extraction, tooth loss, or unknown risk factor. Oral and radiographic evaluation reveals Medication-related osteonecrosis of the jaw (MRONJ) at different clinical stages according to the American Association of Oral and Maxillofacial Surgeons (AAOMS) classification. Some patients underwent abscess drainage, oral cleaning and antibiotic therapy with complete recovery. Follow-up showed treatment success in all patients. That is why we emphasize the importance of early establishment of appropriate treatment and emphasize the avoidance of dental procedures during BMA therapy.

En la actualidad, una gran cantidad de pacientes con cáncer son tratados con agentes modificadores óseos (AMO). En relación con esto, el aumento en la prescripción de estos fármacos ha generado preocupación por el incremento en la osteonecrosis de los maxilares. Este artículo describe cuatro casos de pacientes con cáncer, tratados con AMO, que acuden a nuestra institución debido a que padecen dolor e inflamación de la mandíbula, después de la extracción dental, así como pérdida de dientes con un factor de riesgo desconocido. La evaluación clínica y radiográfica evidenció osteonecrosis de los maxilares en diferentes etapas clínicas, según la clasificación de la Asociación Estadounidense de Cirujanos Orales y Maxilofaciales (AAOMS). Algunos de los pacientes fueron sometidos a drenaje de abscesos, limpieza bucal y antibioticoterapia con recuperación completa. El seguimiento clínico fue exitoso en todos los pacientes. Es por eso que hacemos énfasis en la importancia de establecer un tratamiento apropiado y evitar procedimientos dentales durante la terapia con AMO.

Pre-existing Autoantibodies Neutralizing High Concentrations of Type I Interferons in Almost 10% of COVID-19 Patients Admitted to Intensive Care in Barcelona.

BACKGROUND: It is important to predict which patients infected by SARS-CoV-2 are at higher risk of life-threatening COVID-19. Several studies suggest that neutralizing auto-antibodies (auto-Abs) against type I interferons (IFNs) are predictive of critical COVID-19 pneumonia. OBJECTIVES: We aimed to test for auto-Abs to type I IFN and describe the main characteristics of COVID-19 patients admitted to intensive care depending on whether or not these auto-Abs are present. METHODS: Retrospective analysis of all COVID-19 patients admitted to an intensive care unit (ICU) in whom samples were available, from March 2020 to March 2021, in Barcelona, Spain. RESULTS: A total of 275 (70.5%) out of 390 patients admitted to ICU were tested for type I IFNs auto-antibodies (α2 and/or ω) by ELISA, being positive in 49 (17.8%) of them. Blocking activity of plasma diluted 1/10 for high concentrations (10 ng/mL) of IFNs was proven in 26 (9.5%) patients. Almost all the patients with neutralizing auto-Abs were men (92.3%). ICU patients with positive results for neutralizing IFNs auto-Abs did not show relevant differences in demographic, comorbidities, clinical features, and mortality, when compared with those with negative results. Nevertheless, some laboratory tests (leukocytosis, neutrophilia, thrombocytosis) related with COVID-19 severity, as well as acute kidney injury (17 [65.4%] vs. 100 [40.2%]; p = 0.013) were significantly higher in patients with auto-Abs. CONCLUSION: Auto-Abs neutralizing high concentrations of type I IFNs were found in 9.5% of patients admitted to the ICU for COVID-19 pneumonia in a hospital in Barcelona. These auto-Abs should be tested early upon diagnosis of SARS-CoV-2 infection, as they account for a significant proportion of life-threatening cases.

Gestación en tiempos de pandemia COVID-19. Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Perú / Gestation in times of COVID-19 pandemic. Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Peru / Gestation in times of COVID-19 pandemic. Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Peru

RESUMEN Introducción . El COVID-19 y la gestación es una nueva intercurrencia en la valoración de riesgos para la atención de la gestante. Desde el inicio de la pandemia en el país, los casos han ido en aumento. El primer caso atendido en el Hospital San Bartolomé fue el 12 de abril. Desde los primeros reportes de gestantes COVID+ en China, a la fecha, se tiene cada vez mayor información, siendo importante para fines del manejo de la gestante COVID+ que se conozca su epidemiología y los resultados perinatales. Objetivo . Determinar la epidemiología y resultados materno perinatales de COVID-19 en las gestantes del Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Perú. Método . Estudio observacional de corte transversal, en los meses de abril a julio 2020. Se incluyó a todas las gestantes que llegaron a la emergencia obstétrica del Hospital San Bartolomé, a las cuales se les realizó una prueba de inmunocromatografía para IgM/IgG, para determinar la seroprevalencia de COVID-19. Las variables obstétricas y perinatales fueron recolectadas en una ficha de datos al ingreso a la emergencia. Resultados . Se realizó prueba rápida para SARS-CoV-19 a 345 gestantes que se hospitalizaron para atención de parto. La edad promedio fue 27 años, con 10% de adolescentes y 16% de mayores de 35 años; 60% tenía 2 a 4 embarazos, 38% de los partos fue vaginal, 15% de ellos pretérmino; 1,2% de las gestantes fue sintomática y 0,2% ingresó a la unidad de cuidados intensivos. El 61% de los recién nacidos pesó entre 2 500 y 3 500 g, 53% fue sexo masculino, 94% tuvo Apgar mayor de 7 al minuto, 3,3% con hisopado positivo dentro de las primeras 24 horas. Se presentaron 3% de óbitos. El 48% de las gestantes provino del Cono Norte de la ciudad de Lima. Conclusiones . Casi 100% de las gestantes fue asintomática y solo 0,2% tuvo complicaciones respiratorias. La culminación del parto por vía cesárea fue baja en relación a otras publicaciones; el motivo de cesárea fue por indicación obstétrica. Escaso número de neonatos tuvo hisopado positivo. Hubo mayor incidencia de óbitos en julio 2020. El mayor porcentaje de pacientes provino del Cono Norte de Lima. Palabras clave. Embarazo, Infecciones por coronavirus, SARS-CoV-19, COVID-19, óbito fetal, Lima, Perú.

ABSTRACT Introduction: COVID-19 and pregnancy is a new intercurrence in risk assessment for the care of the pregnant woman. Since the beginning of the pandemic in the country, cases have been increasing. The first case attended at the San Bartolomé Hospital was on April 12. Since the first reports of COVID+ pregnant women in China, to date, there is more important information on epidemiology and perinatal results for the management of the COVID+ pregnant woman. Objective: To determine the epidemiology and maternal perinatal outcomes of COVID-19 in pregnant women at the Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Peru. Methods: Observational cross-sectional study, from April to July 2020. All the pregnant women who arrived at the obstetric emergency at Hospital San Bartolomé were included, and they underwent an immunochromatography test for IgM / IgG, to determine the seroprevalence of COVID-19. Obstetric and perinatal variables were collected in a data sheet upon admission to the emergency room. Results: Rapid test for SARS-CoV-19 was performed in 345 pregnant women who were hospitalized for delivery care. The average age was 27 years, with 10% adolescents and 16% over 35 years; 60% had 2 to 4 pregnancies, 38% of deliveries were vaginal, 15% of them preterm; 1.2% of the pregnant women were symptomatic and 0.2% were admitted to the intensive care unit. 61% of the newborns weighed between 2 500 and 3 500 g, 53% were male, 94% had an Apgar score greater than 7 at one minute, 3.3% with a positive swab within the first 24 hours. There were 3% fetal deaths. 48% of the pregnant women came from the Northern Cone of the city of Lima. Conclusions: Almost 100% of the pregnant women were asymptomatic and only 0.2% had respiratory complications. The mode of delivery by cesarean section was low in relation to other publications, all had obstetric indication. A small number of neonates had a positive swab. There was a higher incidence of fetal deaths in July 2020. The highest percentage of patients came from the Northern Cone of Lima.

¿Es la fosfomicina una buena alternativa terapéutica para la gonorrea en nuestro medio? / Is fosfomycin a good alternative drug for gonorrhoea treatment in our setting?

No disponible

Pulmonary Infections with Nontuberculous Mycobacteria, Catalonia, Spain, 1994-2014.

In Spain, systematic reporting of pulmonary infections with nontuberculous mycobacteria is not mandatory. Therefore, to determine trends, we retrospectively identified cases for January 1994-December 2014 in Catalonia. Over the 21 years, prevalence increased and was associated with being male. Mycobacterium avium complex and M. abscessus prevalence increased; M. kansasii prevalence decreased.

Wearable Internet of Things - from human activity tracking to clinical integration.

Wearable devices for human activity tracking have been emerging rapidly. Most of them are capable of sending health statistics to smartphones, smartwatches or smart bands. However, they only provide the data for individual analysis and their data is not integrated into clinical practice. Leveraging on the Internet of Things (IoT), edge and cloud computing technologies, we propose an architecture which is capable of providing cloud based clinical services using human activity data. Such services could supplement the shortage of staff in primary healthcare centers thereby reducing the burden on healthcare service providers. The enormous amount of data created from such services could also be utilized for planning future therapies by studying recovery cycles of existing patients. We provide a prototype based on our architecture and discuss its salient features. We also provide use cases of our system in personalized and home based healthcare services. We propose an International Telecommunication Union based standardization (ITU-T) for our design and discuss future directions in wearable IoT.

MitraClip para el reparo de insuficiencia mitral severa / MitraClip for the repair of severe mitral insufficiency

Resumen Objetivo: Reportar el primer caso de implante de MitraClip realizado en la costa atlántica. Material y métodos: Paciente femenina de 69 años de edad, con diagnóstico de: cardiopatía dilatada de 10 años de evolución con aumento progresivo de deterioro funcional. Ha presentado edema pulmonar recidivante. Resultados: Se realiza procedimiento de implante del dispositivo. Mediante cateterismo transeptal, se procede a introducir el MitraClip con maniobras del sistema de posicionamiento pasando la válvula mitral guiado por el ETE 3 D y se realiza la captura de ambos bordes de la válvula en el sitio de mayor regurgitación A2/P2 sujetando los bordes por él. Se observa persistencia de la insuficiencia moderada por lo que se coloca un segundo MitraClip en forma satisfactoria. Se realizan las medicines Doppler observando una insuficiencia residual mínima. Se corrobora por la angiografía y el ETE su adecuada implantación. Se considera un éxito pudiendo realizar el implante del dispositivo en forma rápida, adecuada y sin complicaciones. Conclusiones: Se reporta el primer caso de implante de MitraClip para el manejo de la IM severa, en la ciudad de Barranquilla, siendo la segunda ciudad de Colombia, después de Cali, donde se implanta este tipo de dispositivos para el reparo de la insuficiencia mitral severa.

Abstract Objective: To report the first case if MitraClip implantation performed in the Atlantic coast. Material and methods: 69 year-old female patient diagnosed with dilated cardiomyopathy with a 10-year course suffering from gradual functional deterioration. She developed relapsing pulmonary edema. Results: Device implantation is performed. By means of a transseptal catheterization MitraClip is inserted with positioning system operations below the mitral valve guided by 3 D TEE and captures both vale leaflets on the place where most A2/P2 regurgitation is located, thus holding the leaflets. Mild insufficiency is still observed, so a second MitraClip is implanted succesfully. Doppler measurements reveal minimal residual insufficiency. Angiography and TEE confirm correct implantation. Procedure is considered a success, being able to conduct device implantation in a fast, proper and uncomplicated way. Conclusions: The first case of MitraClip implant for management of severe MI in Barranquilla is presented, this being the second Colombian city after Cali where this type of device is implanted for the repair of severe mitral insufficiency

Declining mortality from adult pneumococcal infections linked to children's vaccination.

OBJECTIVE: To determine changes in mortality among adults with invasive pneumococcal disease (IPD) after introducing pneumococcal conjugate vaccines (PCVs) in children. METHODS: An active surveillance of adults with culture-proven IPD in Barcelona. Serotype-specific mortality and rates of disease and death were analysed in three periods: baseline (1994-2001), PCV7 (2002-2009) and PCV13 (2010-2013). RESULTS: Overall, IPD caused by PCV7 serotypes was associated with increased case fatality rate (24 percent). In patients 18-64 years (baseline vs. PCV7 vs. PCV13 periods), case fatality rate from IPD decreased (22 vs.14 vs. 12 percent), and it was associated with a decline in PCV7 serotypes (3.56 vs. 2.80 vs. 1.49 cases/10(5) person-years) and in PCV7 serotypes-specific death (0.74 vs. 0.53 vs. 0.09 deaths/10(5) person-years). In patients ≥65 years, case fatality rate did not change (24 vs. 22 vs. 24 percent); however, there was a decline in PCV7 serotypes-specific death (4.94 vs. 3.58 vs. 2.45 deaths/10(5) person-years), and an increase in non-PCV serotypes-specific death (2.55 vs. 3.70 vs. 4.09 deaths/10(5) person-years). CONCLUSIONS: The use of PCVs for children was associated with a reduction of mortality from IPD in adults 18-64 years, through the indirect effect of herd protection. In older adults, age-related factors could play a role in IPD mortality.

Identification of recent HIV-1 infection among newly diagnosed cases in Catalonia, Spain (2006-08).

BACKGROUND: Quantification and description of patients recently infected by HIV can provide an accurate estimate of the dynamics of HIV transmission. Between 2006 and 2008 in Catalonia, we estimated the prevalence of recent HIV infection among newly diagnosed cases, described the epidemiological characteristics of the infection according to whether it was recent, long-standing or advanced, and identified factors associated with recent infection. METHODS: A Test for Recent Infection (TRI) was performed in serum samples from patients newly diagnosed with HIV. Two different TRI were used: the Vironostika-LS assay (January 2006-May 2007) and the BED-CEIA CEIA (June 2007 onwards). Samples were obtained within the first 6 months of diagnosis. Patients whose samples tested positive in the TRI were considered recently infected. RESULTS: Of 1125 newly diagnosed patients, 79.9% were men (median age, 35.4 years), 38.7% were born outside Spain, 48.9% were men who have sex with men (MSM) and 10.6% presented other sexually transmitted infections. The overall percentage of recent infection was 23.0%, which increased significantly, from 18.1% in 2006 to 26.2% in 2008. This percentage was higher for patients from South America (27.6%). Factors associated with recent infection were acquiring infection through sexual contact between MSM [odds ratio (OR) 2.0; 95% confidence interval (95% CI) 1.1-3.9], compared with acquiring infection through heterosexual relations and being under 30 years of age (OR 5.9; 95% CI 1.9-17.4), compared with being over 50 years of age. CONCLUSION: The highest percentage of recent infection was identified in MSM, suggesting either a higher incidence or a greater frequency of HIV testing. Information regarding testing patterns is necessary to correctly interpret data from recently infected individuals. Systems to monitor the HIV epidemic should include both parameters.