Epidemiology and Risk Factors of Mycotic Aneurysm in Patients With Infective Endocarditis and the Impact of its Rupture in Outcomes. Analysis of a National Prospective Cohort.

Background: Several aspects of the occurrence and management of mycotic aneurysm (MA) in patients with infective endocarditis (IE) have not been studied. Objectives: To determine the incidence and factors associated with MA presence and rupture and to assess the evolution of those initially unruptured MA. Methods: Prospective multicenter cohort including all patients with definite IE between January 2008 and December 2020. Results: Of 4548 IE cases, 85 (1.9%) developed MA. Forty-six (54.1%) had intracranial MA and 39 (45.9%) extracranial MA. Rupture of MA occurred in 39 patients (45.9%). Patients with ruptured MA had higher 1-year mortality (hazard ratio, 2.33; 95% confidence interval, 1.49-3.67). Of the 55 patients with initially unruptured MA, 9 (16.4%) presented rupture after a median of 3 days (interquartile range, 1-7) after diagnosis, being more frequent in intracranial MA (32% vs 3.3%, P = .004). Of patients with initially unruptured MA, there was a trend toward better outcomes among those who received early specific intervention, including lower follow-up rupture (7.1% vs 25.0%, P = .170), higher rate of aneurysm resolution in control imaging (66.7% vs 31.3%, P = .087), lower MA-related mortality (7.1% vs 16.7%, P = .232), and lower MA-related sequalae (0% vs 27.8%, P = .045). Conclusions: MA occurred in 2% of the patients with IE. Half of the Mas occurred in an intracranial location. Their rupture is frequent and associated with poor prognosis. A significant proportion of initially unruptured aneurysms result from rupture during the first several days, being more common in intracranial aneurysms. Early specific treatment could potentially lead to better outcomes.

Factors Associated with the Deterioration of Intrinsic Capacity among Older Adults in Mexico and Colombia.

BACKGROUND: Intrinsic capacity (IC) is defined as "all the physical and mental attributes possessed by the older person." This concept has gained momentum in recent years because it provides insights into the changes in the functional capacity of individuals during their life. This study examined common factors associated with IC decline among older adults in Mexico and Colombia. METHODS: This cross-sectional, correlational study included 348 community-dwelling older adults. Sociodemographic, clinical, and family conditions were assessed as possible associated factors, and IC was analyzed across five domains: cognitive, locomotor, psychological, vitality (malnutrition through deficiency and excess), and sensory (visual and auditory). Parametric and non-parametric statistical analyses were performed. RESULTS: The common factors associated with impairment according to domain were family dysfunctionality (cognitive domain); myocardial infarction, family dysfunctionality, age >80 years, home occupation, and not having a partner (locomotor domain); dysfunctional family and risk of falls (psychological domain); age >80 years and not having a partner (malnutrition by deficiency domain); age 60-79 years, walking <7,500 steps/day, and peripheral vascular disease (malnutrition by excess domain); risk of falling and being female (visual sensory domain); risk of falling (auditory sensory domain); and dysfunctional family and risk of falling (total intrinsic capacity). CONCLUSION: Both populations had common sociodemographic, clinical, and familial factors that directly affected total IC stocks and their domains.

Factores que afectan el estado nutricional en personas mayores mexicanas: Enasem, 2018.

OBJETIVO: Analizar los factores que afectan el estado nutricional en personas mayores mexicanas del Estudio Nacional de Salud y Envejecimiento en México 2018 (Enasem 2018). Material y métodos. Análisis transversal secundario de determinantes sociales, factores relativos a la salud y eventos estresantes de la vida con dos problemas nutricionales relevantes en personas mayores: 1) desnutrición y 2) exceso de peso considerando sobrepeso y obesidad, mediante regresión logística múltiple. RESULTADOS: 4 587 participantes. La prevalencia de desnutrición fue 16.1% y está relacionada con edad ≥80 años, sin pareja, sin escolaridad, sobrestimación de índice de masa corporal (IMC), dificultad motriz, dependencia funcional instrumental, hospitalización en año previo y caídas en los últimos dos años, autorreporte de fuerza prensil débil, reporte de desastre que afectó vivienda o accidente que afectó la salud. La prevalencia de exceso de peso fue 43.6%, relacionada con ser mujer, tener 60 a 79 años, percibirse sin sobrepeso u obesidad y subestimarlo contra IMC, tener ≥3 enfermedades, síntomas somáticos e inactividad física. CONCLUSIONES: Los factores que afectan el estado nutricional hacia desnutrición o exceso de peso en las personas mayores requieren considerarse como áreas de intervención importante en el envejecimiento.

Non-nosocomial Healthcare-Associated Infective Endocarditis: A Distinct Entity? Data From the GAMES Series (2008-2021).

Background: Patients who acquire infective endocarditis (IE) following contact with the healthcare system, but outside the hospital, are classified as having non-nosocomial healthcare-associated IE (HCIE). Our aim was to characterize HCIE and establish whether its etiology, diagnosis, and therapeutic approach suggest it should be considered a distinct entity. Methods: This study retrospectively analyzes data from a nationwide, multicenter, prospective cohort including consecutive cases of IE at 45 hospitals across Spain from 2008 to 2021. HCIE was defined as IE detected in patients in close contact with the healthcare system (eg, patients receiving intravenous treatment, hemodialysis, or institutionalized). The prevalence and main characteristics of HCIE were examined and compared with those of community-acquired IE (CIE) and nosocomial IE (NIE) and with literature data. Results: IE was diagnosed in 4520 cases, of which 2854 (63%) were classified as CIE, 1209 (27%) as NIE, and 457 (10%) as HCIE. Patients with HCIE showed a high burden of comorbidities, a high presence of intravascular catheters, and a predominant staphylococcal etiology, Staphylococcus aureus being identified as the most frequent causative agent (35%). They also experienced more persistent bacteremia, underwent fewer surgeries, and showed a higher mortality rate than those with CIE (32.4% vs 22.6%). However, mortality in this group was similar to that recorded for NIE (32.4% vs 34.9%, respectively, P = .40). Conclusions: Our data do not support considering HCIE as a distinct entity. HCIE affects a substantial number of patients, is associated with a high mortality, and shares many characteristics with NIE.

Effects of Socio-educational Interventions on the Quality of Life of People with a Digestive Ostomy.

Introduction: The creation of digestive stomata is associated with a change in people's lives. Causing a strong impact that influences all dimensions of life. This paper reports on the effects of socio-educational interventions on the quality of life (QOL) of people with a digestive ostomy. Objective: To describe the effect of a nursing intervention on the QOL of people with a digestive ostomy. Methods: A quasiexperimental study was conducted whose sample consisted of 12 people who were ostomized in a public hospital in Colombia. Participants were selected through convenience sampling and randomly assigned to the intervention group and the control group. For the control group, an educational process was carried out through a theoretical session with virtual mediation (educational video). The QOL was evaluated before and after the interventions through the Montreux questionnaire. Results: The average age was 57(+7) years. No statistical differences were found between the groups in the QOL index or for any of the dimensions that make up QOL. Pretest and post-test analysis for each intervention separately showed improvement in two dimensions of QOL for each group; in the intervention group body image dimension (p = .017) and the positive coping dimension (p = .027). In the control group, the physical well-being dimension (p = .037) and social concerns dimension (p = .034). Conclusions: The personalized educational intervention or carried out through virtual pedagogical mediation, generated a clinically significant increase in the dimensions of QOL, without statistical differences. The study adds knowledge about the impact that digestive stomata have on the QOL, which is why it is necessary to establish specialized interdisciplinary teams to care for the person's new condition at home during the following months.

Efficacy and safety of oral fosfomycin for asymptomatic bacteriuria in kidney transplant recipients: Results from a Spanish multicenter cohort.

Current guidelines recommend against systematic screening or treating asymptomatic bacteriuria (AB) among kidney transplant (KT) recipients, although the evidence regarding episodes occurring early after transplantation or in the presence of anatomical abnormalities is inconclusive. Oral fosfomycin may constitute a good option for the treatment of post-transplant AB, particularly due to the emergence of multidrug-resistant (MDR) uropathogens. Available clinical evidence supporting its use in this specific setting, however, remains scarce. We performed a retrospective study in 14 Spanish institutions from January 2005 to December 2017. Overall, 137 episodes of AB diagnosed in 133 KT recipients treated with oral fosfomycin (calcium and trometamol salts) with a test-of-cure urine culture within the first 30 days were included. Median time from transplantation to diagnosis was 3.1 months (interquartile range [IQR]: 1.1 - 10.5). Most episodes (96.4% [132/137]) were caused by gram-negative bacteria (GNB), and 56.9% (78/137) were categorized as MDR (extended-spectrum ß-lactamase-producing Enterobacterales [20.4%] and carbapenem-resistant GNB [2.9%]). Rate of microbiological failure at month 1 was 40.1% (95% confidence interval [95%CI]: 31.9 - 48.9) for the whole cohort and 42.3% (95%CI: 31.2 - 54.0) for episodes due to MDR pathogens. Previous urinary tract infection (odds ratio [OR]: 2.42; 95%CI: 1.11 - 5.29; P-value = 0.027) and use of fosfomycin as salvage therapy (OR: 8.31; 95%CI: 1.67 - 41.35; P-value = 0.010) were predictors of microbiological failure. No severe treatment-related adverse event were detected. Oral fosfomycin appears to be a suitable and safe alternative for the treatment (if indicated) of AB after KT, including those episodes due to MDR uropathogens.

Risk Factors for Nontuberculous Mycobacteria Infections in Solid Organ Transplant Recipients: A Multinational Case-Control Study.

BACKGROUND: Risk factors for nontuberculous mycobacteria (NTM) infections after solid organ transplant (SOT) are not well characterized. Here we aimed to describe these factors. METHODS: Retrospective, multinational, 1:2 matched case-control study that included SOT recipients ≥12 years old diagnosed with NTM infection from 1 January 2008 to 31 December 2018. Controls were matched on transplanted organ, NTM treatment center, and post-transplant survival greater than or equal to the time to NTM diagnosis. Logistic regression on matched pairs was used to assess associations between risk factors and NTM infections. RESULTS: Analyses included 85 cases and 169 controls (59% male, 88% White, median age at time of SOT of 54 years [interquartile range {IQR} 40-62]). NTM infection occurred in kidney (42%), lung (35%), heart and liver (11% each), and pancreas transplant recipients (1%). Median time from transplant to infection was 21.6 months (IQR 5.3-55.2). Most underlying comorbidities were evenly distributed between groups; however, cases were older at the time of NTM diagnosis, more frequently on systemic corticosteroids and had a lower lymphocyte count (all P < .05). In the multivariable model, older age at transplant (adjusted odds ratio [aOR] 1.04; 95 confidence interval [CI], 1.01-1.07), hospital admission within 90 days (aOR, 3.14; 95% CI, 1.41-6.98), receipt of antifungals (aOR, 5.35; 95% CI, 1.7-16.91), and lymphocyte-specific antibodies (aOR, 7.73; 95% CI, 1.07-56.14), were associated with NTM infection. CONCLUSIONS: Risk of NTM infection in SOT recipients was associated with older age at SOT, prior hospital admission, receipt of antifungals or lymphocyte-specific antibodies. NTM infection should be considered in SOT patients with these risk factors.

Humoral/Cellular Immune Discordance in Stem Cell Donors: Impact on Cytomegalovirus-Specific Immune Reconstitution after Related Hematopoietic Transplantation.

Cytomegalovirus (CMV) reactivation is an important cause of complications after hematopoietic stem cell transplantation (HSCT). Discrepancies between serologic and cellular CMV-specific immune response have been reported. This study evaluated the impact of lack of CMV-specific CD8+ T cell response in seropositive donors (ie, discordant donors) on the reconstitution of CMV-specific cell-mediated immunity (CMI) after related HSCT in seropositive recipients. CMV-CMI was assessed in donors and recipients using the QuantiFERON-CMV assay (QF). CMV-CMI was prospectively assessed for 1 year in 81 CMV-seropositive HSCT recipients with a haploidentical or matched related donor. A Cox proportional hazard regression analysis was performed. Of the 67 CMV-seropositive donors, 54 (80.6%) were D+QFpos. The remaining 13 CMV-seropositive donors (19.4%) had a QFneg result and thus were classified as discordant donors (D+QFneg). We found that patients with D+QFneg had a significantly higher risk of impaired CMV-CMI reconstitution compared with patients with D+QFpos (log-rank test, P = .001) or D- donors (log-rank test, P = .023). In addition, the D+QFneg group had a higher incidence of single-episode reactivation compared with D+QFpos or D- donors (69.2% versus 44.4% and 28.6%, respectively) but a lower incidence of CMV recurrence compared with the D- group (7.7% versus 57.1%; P = .003). After adjusting for other relevant variables, immune discordance in donors was independently associated with impaired CMV-CMI reconstitution compared with D+QFpos donors (adjusted hazard ratio [HR], 0.18; 95% confidence interval [CI], .06 to .52; P = .001) and D- donors (adjusted HR, .17; 95% CI, .05 to .59; P = .005). Discordant donors were associated with undetectable CMV-CMI during the 12-month follow-up period using the QF assay. The inability of these patients to become QFpos persisted even after CMV reactivation. This might be related to the low frequency of CMV recurrence in this group. CMV-CMI assessment, in conjunction with CMV serostatus, can be of utility to better classify stem cell donors as well as the risk of impaired CMV-CMI reconstitution after HSCT.

Cáncer de pulmón, tendencias desde la perspectiva del cuidado / Lung cancer, trends from a care perspective / Cancro do pulmão, tendências de uma perspectiva de cuidados

Objetivo: identificar las tendencias de investigación sobre el cáncer de pulmón durante los últimos cinco años, desde la perspectiva del cuidado de enfermería. Método: revisión bibliométrica y exploratoria realizada a partir de la base de datos de web of science. Se utilizaron los descriptores, lung neoplasm and nursing care con aplicación de filtros, obteniendo un total de 62 artículos publicados entre los años 2017-2021. El análisis bibliométrico fue realizado mediante bibliometrix con el total de los documentos obtenidos; para el análisis exploratorio se utilizaron 30 artículos que describen las principales tendencias temáticas identificadas en la estructura conceptual. Resultados: los indicadores bibliométricos muestran un promedio de publicación de 12 artículos por año, predominaron las publicaciones con enfoque cuantitativo (66,7 %) y de nivel de evidencia baja (56,7 %). El mayor número de artículos publicados por fuente y autor fue de 4. Los resultados exploratorios muestran cinco temáticas relevantes relacionadas con: el diagnóstico del cáncer de pulmón, síntomas, cuidado paliativo, calidad de vida y práctica avanzada de enfermería. Conclusión: se logra identificar publicaciones que enfatizan las temáticas mencionadas, con un nivel de evidencia bajo y con escasas intervenciones realizadas por parte de enfermería. Los estudios se enfocan en el control de síntomas y cuidados en el fin de vida.

Objective: identify trends in lung cancer research over the past five years from a nursing care perspective. Method: bibliometric and exploratory review based on the web of science database. The descriptors, lung neoplasm and nursing care were used with application of filters, obtaining a total of 62 articles published between the years 2017-2021. The bibliometric analysis was performed using bibliometrix with the total number of documents obtained; 30 articles describing the main thematic trends identified in the conceptual structure were used for the exploratory analysis. Results: bibliometric indicators show an average publication rate of 12 articles per year, with a predominance of publications with a quantitative approach (66.7 %) and a low level of evidence (56.7 %). The highest number of articles published per source and author was 4. The exploratory results show five relevant topics related to: lung cancer diagnosis, symptoms, palliative care, quality of life and advanced nursing practice. Conclusion: it is possible to identify publications that emphasize the aforementioned topics, with a low level of evidence and with few interventions carried out by nurses. The studies focus on symptom control and end-of-life care.

Objectivo: identificar tendências na investigação do cancro do pulmão ao longo dos últimos cinco anos, numa perspectiva de cuidados de enfermagem. Método: revisão bibliométrica e exploratória realizada utilizando a teia de dados científicos. Os descritores, neoplasma pulmonar e cuidados de enfermagem foram utilizados com a aplicação de filtros, obtendo um total de 62 artigos publicados entre 2017-2021. A análise bibliométrica foi realizada utilizando a bibliometria com o número total de documentos obtidos; 30 artigos descrevendo as principais tendências temáticas identificadas na estrutura conceptual foram utilizados para a análise exploratória. Resultados: os indicadores bibliométricos mostram uma taxa média de publicação de 12 artigos por ano, com uma predominância de publicações com uma abordagem quantitativa (66,7 %) e um baixo nível de evidência (56,7 %). O maior número de artigos publicados por fonte e autor foi de 4. Os resultados exploratórios mostram cinco tópicos relevantes relacionados com: diagnóstico do cancro do pulmão, sintomas, cuidados paliativos, qualidade de vida e prática avançada de enfermagem. Conclusão: conseguimos identificar publicações que enfatizam os tópicos acima mencionados, com um baixo nível de evidência e com poucas intervenções realizadas por enfermeiros. Os estudos centram-se no controlo dos sintomas e nos cuidados de fim de vida.

Fear of Falling and Environmental Factors: A Scoping Review.

Fear of falling is a geriatric condition that must be understood from both a clinical perspective and from the environment in which older adults live. This review aimed to describe the scientific evidence reported in the last 5 years regarding the fear of falling in older adults and its relationship with environmental factors. The relationships between fear of falling and environmental factors are mainly evidenced in the built environment. Older adults with a fear of falling are described as perceiving the built environment as dangerous when they do not meet the requirements of safety, accessibility, and comfort; they also report the importance of living in communities with controlled crime levels and available social support for older adults to improve their insecurity and feelings of vulnerability.

Barreras para el ejercicio físico en estudiantes universitarios de Manizales, Colombia: diferencias por programa académico / Barriers to physical exercise in university students in Manizales, Colombia: differences by academic program / Barreiras para o exercício físico em estudantes universitários de Manizales, Colômbia: diferenças por programa acadêmico

Resumen Objetivo: analizar las barreras que impiden la práctica de ejercicio físico en estudiantes universitarios pertenecientes a programas académicos de pregrado de la ciudad de Manizales. Materiales y métodos: estudio con enfoque cuantitativo de tipo correlacional, cuya muestra corresponde a 2.576 estudiantes de pregrado presencial pertenecientes a cuatro universidades de la ciudad de Manizales. Para la recolección de datos se utilizó la escala de beneficios y barreras que tiene el ejercicio (EEBS) de Nola Pender. Resultados: las barreras mayormente reportadas se relacionan con el cansancio (67,7 %), la fatiga (60,24 %) y la falta de tiempo para realizar ejercicio físico (48,91 %). Se encontraron 13 barreras asociadas a los programas académicos, siendo los estudiantes de Bellas Artes, quienes se asociaron a un mayor número de barreras. Conclusión: el área de estudio de Bellas Artes se asoció a una mayor percepción de barreras, mientras que los estudiantes de Educación y Agronomía no consideraron barreras para la práctica del ejercicio físico. Los planes de estudios deben incluir espacios académicos y/o lúdicos que permitan una mayor motivación intrínseca y extrínseca para la práctica deportiva acorde a los intereses del área de conocimiento.

Abstract Objective: To analyze the barriers that prevent the practice of physical exercise in university students belonging to undergraduate academic programs in the city of Manizales. Materials and methods: Study with a correlational quantitative approach with a sample of 2,576 undergraduate students from four universities in the city of Manizales. The Nola Pender exercise benefits and barriers scale (EBBS) was used for data collection. Results: The most reported barriers were related to tiredness (67.7%), fatigue (60.24%) and lack of time to perform physical exercise (48.91%). Thirteen barriers associated with academic programs were found, being the Fine Arts students those who were associated with a greater number of barriers. Conclusion: The Fine Arts area of study was associated with a greater perception of barriers while the Education and Agronomy students did not consider barriers to the practice of physical exercise. The study plans must include academic and/or recreational spaces that allow greater intrinsic and extrinsic motivation for the practice of sports according to the interests of the area of knowledge.

Resumo Objetivo: analisar as barreiras que impedem a prática de exercício físico em estudantes universitários pertencentes a programas académicos de formatura da cidade de Manizales. Materiais e métodos: estudo com enfoque quantitativo de tipo correlacional, cuja amostra corresponde a 2.576 estudantes de formatura presencial pertencentes a quatro universidades da cidade de Manizales. Para a coleita de dados se fez a escada de benefícios e barreiras que têm o exercício (EEBS) de Nola Pender. Resultados: as barreiras maiormente reportadas se relacionam com o cansaço (67,7 %), a fatiga (60,24 %) e a falta de tempo para fazer exercício físico (48,91 %). Acharam-se 13 barreiras associadas aos programas acadêmicos, sendo os estudantes de Belas Artes, quem se associaram a um maior número de barreiras. Conclusão: a área de estudo de Belas Artes se associou a uma maior percepção de barreiras, enquanto que os estudantes de Educação e Agronomia não consideraram barreiras para a prática do exercício físico. As diretrizes de estudos devem incluir espaços acadêmicos e/ou lúdicos que permitam uma maior motivação intrínseca e extrínseca para a prática esportiva acorde aos interesses da área de conhecimento.

Innate and Adaptive Immune Assessment at Admission to Predict Clinical Outcome in COVID-19 Patients.

During the COVID-19 pandemic, many studies have been carried out to evaluate different immune system components to search for prognostic biomarkers of the disease. A broad multiparametric antibody panel of cellular and humoral components of the innate and the adaptative immune response in patients with active SARS-CoV-2 infection has been evaluated in this study. A total of 155 patients were studied at admission into our center and were categorized according to the requirement of oxygen therapy as mild or severe (the latter being those with the requirement). The patients with severe disease were older and had high ferritin, D-dimer, C-reactive protein, troponin, interleukin-6 (IL-6) levels, and neutrophilia with lymphopenia at admission. Moreover, the patients with mild symptoms had significantly increased circulating non-classical monocytes, innate lymphoid cells, and regulatory NK cells. In contrast, severe patients had a low frequency of Th1 and regulatory T cells with increased activated and exhausted CD8 phenotype (CD8+CD38+HLADR+ and CD8+CD27-CD28-, respectively). The predictive model included age, ferritin, D-dimer, lymph counts, C4, CD8+CD27-CD28-, and non-classical monocytes in the logistic regression analysis. The model predicted severity with an area under the curve of 78%. Both innate and adaptive immune parameters could be considered potential predictive biomarkers of the prognosis of COVID-19 disease.

Molecular characterization of multidrug resistant Enterobacterales strains isolated from liver and kidney transplant recipients in Spain.

The objective of this study was to analyse the mechanisms of resistance to carbapenems and other extended-spectrum-ß-lactams and to determine the genetic relatedness of multidrug-resistant Enterobacterales (MDR-E) causing colonization or infection in solid-organ transplantation (SOT) recipients. Prospective cohort study in kidney (n = 142), liver (n = 98) or kidney/pancreas (n = 7) transplant recipients between 2014 and 2018 in seven Spanish hospitals. We included 531 MDR-E isolates from rectal swabs obtained before transplantation and weekly for 4-6 weeks after the procedure and 10 MDR-E from clinical samples related to an infection. Overall, 46.2% Escherichia coli, 35.3% Klebsiella pneumoniae, 6.5% Enterobacter cloacae, 6.3% Citrobacter freundii and 5.7% other species were isolated. The number of patients with MDR-E colonization post-transplantation (176; 71.3%) was 2.5-fold the number of patients colonized pre-transplantation (71; 28.7%). Extended-spectrum ß-lactamases (ESBLs) and carbapenemases were detected in 78.0% and 21.1% of MDR-E isolates respectively. In nine of the 247 (3.6%) transplant patients, the microorganism causing an infection was the same strain previously cultured from surveillance rectal swabs. In our study we have observed a low rate of MDR-E infection in colonized patients 4-6 weeks post-transplantation. E. coli producing blaCTX-M-G1 and K. pneumoniae harbouring blaOXA-48 alone or with blaCTX-M-G1 were the most prevalent MDR-E colonization strains in SOT recipients.

Usefulness of the COVID-GRAM and CURB-65 scores for predicting severity in patients with COVID-19.

AIM: The aim of this study was to determine the usefulness of COVID-GRAM and CURB-65 scores as predictors of the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Caucasian patients. METHODS: This was a retrospective observational study including all adults with SARS-CoV-2 infection admitted to Hospital Universitario Marqués de Valdecilla from February to May 2020. Patients were stratified according to COVID-GRAM and CURB-65 scores as being at low-medium or high risk of critical illness. Univariate analysis, multivariate logistic regression models, receiver operating characteristic curve, and area under the curve (AUC) were calculated. RESULTS: A total of 523 patients were included (51.8% male, 48.2% female; mean age 65.63 years (standard deviation 17.89 years)), of whom 110 (21%) presented a critical illness (intensive care unit admission 10.3%, 30-day mortality 13.8%). According to the COVID-GRAM score, 122 (23.33%) patients were classified as high risk; 197 (37.7%) presented a CURB-65 score ≥2. A significantly greater proportion of patients with critical illness had a high COVID-GRAM score (64.5% vs 30.5%; P < 0.001). The COVID-GRAM score emerged as an independent predictor of critical illness (odds ratio 9.40, 95% confidence interval 5.51-16.04; P < 0.001), with an AUC of 0.779. A high COVID-GRAM score showed an AUC of 0.88 for the prediction of 30-day mortality, while a CURB-65 ≥2 showed an AUC of 0.83. CONCLUSIONS: The COVID-GRAM score may be a useful tool for evaluating the risk of critical illness in Caucasian patients with SARS-CoV-2 infection. The CURB-65 score could be considered as an alternative.

Invasive aspergillosis in solid organ transplantation: Diagnostic challenges and differences in outcome in a Spanish national cohort (Diaspersot study).

BACKGROUND: The diagnosis of invasive aspergillosis (IA) can be problematic in solid organ transplantation (SOT). The prognosis greatly varies according to the type of transplant, and the impact of prophylaxis is not well defined. PATIENTS AND METHODS: The Diaspersot cohort analyses the impact of IA in SOT in Spain during the last 10 years. Proven and probable/putative IA was included. RESULTS: We analysed 126 cases of IA. The incidences of IA were as follows: 6.5%, 2.9%, 1.8% and 0.6% for lung, heart, liver and kidney transplantation, respectively. EORTC/MSG criteria confirmed only 49.7% of episodes. Tree-in-bud sign or ground-glass infiltrates were present in 56.3% of patients, while serum galactomannan (optical density index >0.5) was positive in 50.6%. A total of 41.3% received combined antifungal therapy. Overall mortality at 3 months was significantly lower (p < 0.001) in lung transplant recipients (14.8%) than in all other transplants [globally: 48.6%; kidney 52.0%, liver 58.3%, heart 31.2%, and combined 42.9%]. Fifty-four percent of episodes occurred despite the receipt of antifungal prophylaxis, and in 10%, IA occurred during prophylaxis (breakthrough infection), with both nebulised amphotericin (in lung transplant recipients) and candins (in the rest). CONCLUSIONS: Invasive aspergillosis diagnostic criteria, applied to SOT patients, may differ from those established for haematological patients. IA in lung transplants has a higher incidence, but is associated with a better prognosis than other transplants. Combination therapy is frequently used for IA in SOT. Prophylactic measures require optimisation of its use within this population.

Oral decontamination with colistin plus neomycin in solid organ transplant recipients colonized by multidrug-resistant Enterobacterales: a multicentre, randomized, controlled, open-label, parallel-group clinical trial.

OBJECTIVES: To evaluate the efficacy of oral colistin-neomycin in preventing multidrug-resistant Enterobacterales (MDR-E) infections in solid organ transplant (SOT) recipients. METHODS: Multicentre, open-label, parallel-group, controlled trial with balanced (1:1) randomization in five transplant units. SOT recipients were screened for MDR-E intestinal colonization (extended-spectrum ß-lactamase or carbapenemase producing) before transplantation and +7 and + 14 days after transplantation and assigned 1:1 to receive treatment with colistin sulfate plus neomycin sulfate for 14 days (decolonization treatment (DT) group) or no treatment (no decolonization treatment (NDT) group). The primary outcome was diagnosis of an MDR-E infection. Safety outcomes were appearance of adverse effects, mainly diarrhoea, rash, nausea and vomiting. Patients were monitored weekly until 30 days after treatment. Intention-to-treat analysis was performed. RESULTS: MDR-E rectal colonization was assessed in 768 SOT recipients; 105 colonized patients were included in the clinical trial, 53 receiving DT and 52 NDT. No significant decrease in the risk of infection by MDR-E was observed in the DT group (9.4%, 5/53) compared to the NDT group (13.5%, 7/52) (relative risk 0.70; 95% confidence interval 0.24-2.08; p 0.517). Four patients (5.6%), three (5.6%) in the DT group and one (1.9%) in the NDT group, developed colistin resistance. Twelve patients (22.7%) in the DT group had diarrhoea, eight related to treatment (15.0%); one patient (1.8%) developed skin rash and another (1.8%) nausea and vomiting. Two patients (3.8%) in the NDT group developed diarrhoea. CONCLUSIONS: DT does not reduce MDR-E infections in SOT. Colistin resistance and adverse effects such as diarrhoea are a potential issue that must be taken seriously.

Calidad de vida en personas portadoras de ostomías digestivas / Quality of life in people with digestive ostomies

INTRODUCCIÓN: La realización de una ostomía digestiva ha de ocasionar en las personas alteraciones en las dimensiones del ser como físicas, mentales, sociales y culturales lo que genera compromisos en la calidad de vida. OBJETIVO: Evaluar el impacto que se presenta en la calidad de vida de la persona en condición de ostomizadas en la ciudad de Manizales. METODOLOGÍA: estudio desarrollado a través de una fase cuantitativa con diseño observacional descriptivo utilizando el cuestionario Montreaux para la valoración de la calidad de vida y una fase cualitativa, fenomenológica realizada por medio de entrevistas semiestructruadas en el que participaron 16 personas en condicion de ostomizados. RESULTADOS: Promedio de edad 56 años, El 75% de ellos pertenecia a estrato socioeconómico bajo, el 50% tenia con estudios de primaria y el 50% con estudios de secundaria. El 75% pertenecía al régimen de salud contributivo. Los resultados cuantitativos mostraron un índice de calidad de vida del 44,5%; el aspecto con porcentaje mas alto en la calidad de vida fue el hecho de no tener preocupaciones sociales 73%, por el contrario, el porcentaje más bajo se obtuvo en el aspecto relacionado con la actividad sexual 25%. Se identificó un porcentaje de autosuficiencia del 80%, pero una adaptación negativa en el 50% de los casos. Los resultados cualitativos, evidenciaron siete categorías que describen los aspectos que alteran la calidad de vida y el autocuidado: sentimiento de discapacidad, pérdida laboral, alteración de la imagen corporal, afrontamiento según duración y posición de la ostomía, proyección del futuro, aislamiento social y alteración de la sexualidad. CONCLUSIÓN: el índice de calidad de vida fue bajo y las categorías encontradas confirman los aspectos de la vida diaria de las personas en condición de ostomizados y la necesidad de brindar un cuidado integral donde el rol de enfermería este visible ampliamente.

INTRODUCTION. The performance of a digestive ostomy must cause alterations in the dimensions of the being such as physical, mental, social and cultural, which generates compromisesin the quality of life. OBJECTIVE. To evaluate the impact on the quality of life of the person with an ostomy condition in the city of Manizales. METHODOLOGY. Study developed through a quantitative phase with a descriptive observational design using the Montreaux questionnaire for the assessment of quality of life and a qualitative, phenomenological phase carried out through semi-structured interviews in which 16 people with ostomized conditions participated. RESULTS. Average age 56 years, 75% of them belonged to low socioeconomic status, 50% had primary education and 50% had secondary education. 75% belonged to the contributory health scheme. The quantitative results showed a quality of life index of 44.5%; The aspect with the highest percentage in quality of life was the fact of not having social concerns, 73%, on the contrary, the lowest percentage was obtained in the aspect related to sexual activity, 25%. A self-sufficiency percentage of 80% was identified, but a negative adaptation in 50% of the cases. The qualitative results showed seven categories that describe the aspects that alter the quality of life and self-care: feeling of disability, job loss, alteration of body image, coping according to duration and position of the ostomy, projection of the future, social isolation and alteration of sexuality. CONCLUSIONS. The quality of life index was low and the categories found confirm the aspects of daily life of people with an ostomy condition and the need to provide comprehensive care where the role of nursing is widely visible.

Endometritis supurativa en una tití gris (Saguinus leucopus) en cautiverio: / Suppurative endometritis in a captive white-footed tamarin (Saguinus leucopus):

Resumen La endometritis es la inflamación del revestimiento interno del útero producida por distintos agentes infecciosos. Puede presentarse de forma clínica o subclínica, y tener curso agudo o crónico. Este documento describe el caso de una hembra de tití gris (Saguinus leucopus) en proceso de rehabilitación en la Unidad de Rescate y Rehabilitación de Animales Silvestres (URRAS), que manifestó enfermedad uterina, y cuyos hallazgos fueron compatibles con endometritis supurativa. No se conocen otros reportes de la patología en calitrícidos. Por tal motivo, se propone adelantar investigaciones que determinen los factores de riesgo en la presentación de estas enfermedades reproductivas, y para estandarizar pruebas paraclínicas que mejoren su diagnóstico en pequeños primates, teniendo en cuenta la escasa información disponible para la especie afectada y las repercusiones en su conservación.

Abstract Endometritis is inflammation of the intern uterus lining caused by different infectious microorganisms, and it can be clinical or subclinical and have an acute or chronic path. This paper describes the case of a female white-footed tamarin (Saguinus leucopus) in rehabilitation from the Unidad de Rescate y Rehabilitacion de Animales Silvestres (URRAS), that presented a uterus disease and the pathological findings were compatible with suppurative endometritis. There are no reports of endometritis in Callitrichidae, suggesting that more studies need to be done to determine the risk factors in the presentation of these reproductive diseases and to standardize paraclinical tests that improve their diagnosis in small primates, taking into account the limited information available for the affected species and the implications for its conservation.

Adherence to Human Colon Cells by Multidrug Resistant Enterobacterales Strains Isolated From Solid Organ Transplant Recipients With a Focus on Citrobacter freundii.

Enterobacteria species are common causes of hospital-acquired infections, which are associated with high morbidity and mortality rates. Immunocompromised patients such as solid organ transplant (SOT) recipients are especially at risk because they are frequently exposed to antibiotics in the course of their treatments. In this work, we used a collection of 106 Escherichia coli, 78 Klebsiella pneumoniae, 25 Enterobacter spp., and 24 Citrobacter spp. multidrug resistant strains isolated from transplant patients (hepatic, renal or renal/pancreatic) in order to examine their ability to adhere in vitro to HT-29 human colon cells, and to determine if some adhesive characteristics are associated with prevalence and persistence of these strains. A total of 33 E. coli (31%), 21 K. pneumoniae (27%), 7 Enterobacter spp. (28%), and 5 Citrobacter spp. (21%), adhered to the colon epithelial cells. Two main adherence patterns were observed in the four species analyzed, diffuse adherence, and aggregative adherence. Under transmission electronic microscopy (TEM), most bacteria lacked visible fimbria on their surface, despite their strong adherence to epithelial cells. None of the strains studied was able to induce any cytotoxic effect on HT-29 cells although some of them strongly colonizing both cells and glass coverslips at high density. Some of the strains failed to adhere to the epithelial cells but adhered strongly to the cover-slide, which shows that microscopy studies are mandatory to elucidate the adherence of bacteria to epithelial cells in vitro, and that quantitative assays using colony forming unit (CFUs) counting need to be supplemented with pictures to determine definitively if a bacterial strain adheres or not to animal cells in vitro. We report here, for the first time, the aggregative adherence pattern of two multidrug resistant (MDR) Citrobacter freundii strains isolated from human patients; importantly, biofilm formation in Citrobacter is totally dependent on the temperature; strong biofilms were formed at room temperature (RT) but not at 37°C, which can play an important role in the colonization of hospital surfaces. In conclusion, our results show that there is a great variety of adhesion phenotypes in multidrug-resistant strains that colonize transplanted patients.

Vivir con una enfermedad pulmonar obstructiva crónica: una historia condicionada por los síntomas / Living with chronic obstructive pulmonary disease: A story conditioned by the symptoms

OBJETIVO: Conocer el significado de las experiencias vividas por personas con enfermedad pulmonar obstructiva crónica. MÉTODO: Estudio con enfoque cualitativo de tipo fenomenológico hermenéutico. Se realizaron entrevistas en profundidad a 10 personas que presentaban enfermedad pulmonar obstructiva crónica grave y muy grave. RESULTADOS: Se describen los hallazgos encontrados en 3 temas emergentes y sus consecuentes subtemas que relatan: el proceso de la enfermedad enfatizado en 5 subtemas relacionados con el conocimiento de la enfermedad, el ahogo y cansancio como síntomas desagradables cotidianos, el ahogo como amenaza de muerte, la negación a la dependencia del oxígeno y los sistemas de afrontamiento para el control de la enfermedad; en el segundo tema se describe el apoyo familiar con 2 subtemas, pérdida de roles y carga de cuidado; y en el tercer tema se describe el apoyo del sistema de salud con 2 subtemas, atención médica y cuidado enfermero. CONCLUSIÓN: Los síntomas y los cambios funcionales, en general, denotan un significado distinto tanto en momentos cotidianos como en momentos de exacerbación. Así mismo, se develan cambios en el estilo de vida a causa de la pérdida de roles y de los procesos de atención en salud, como experiencias que no permiten un afrontamiento y adaptación efectivos

OBJECTIVE: To determine the meaning of the experience of people with chronic obstructive pulmonary disease. METHOD: A qualitative approach study rooted in hermeneutic phenomenology. In-depth interviews were conducted with 10 people with critical and severe chronic obstructive pulmonary disease. RESULTS: The findings obtained are described in three emerging topics and their consequent subtopics, which describe the process of the disease focusing on five subtopics related to awareness of the disease, the choking characteristic of the disease and tiredness as daily unpleasant symptoms, as well as choking as a death threat, rejection of oxygen dependency and coping systems to control the disease. In the second topic, family support with two subtopics are described: the loss of the patient's role, the burden of care; and the third topic concerns the support of health system on two subtopics: medical care and nursing care. CONCLUSION: The symptoms and functional changes in general, denote a different meaning not only in everyday life, but also in times of exacerbation of the condition. Likewise, changes in lifestyle due to the loss of roles and health care processes are revealed, as experiences that do not allow effective coping and adaptation