Impact of atrial fibrillation in onco-hematological patients in Europe: a targeted literature review.

INTRODUCTION: Atrial fibrillation (AF) is a common complication in cancer patients, and the increased risk associated with certain therapies poses a major challenge. The objective was to determine the clinical and economic burden of AF in onco-hematological patients in Europe. AREAS COVERED: A targeted literature review was completed for observational, retrospective and case studies, and reviews on AF in onco-hematology published between January 2010 and 2022 in PubMed, Science Direct, Medes and IBECS. The search was based on epidemiology, cost, health-related quality of life (HRQoL), disease burden and management, and patient journey. Thirty-one studies fulfilled eligibility criteria. Annual incidence of AF during treatment varies up to 25%, and increased with first-generation Bruton tyrosine kinase inhibitors (BTKi). Risk factors include age ≥65, prior AF or hypertension, hyperlipidemia and ibrutinib use. Complications are managed with anticoagulants and/or antiarrhythmics, and regular monitoring. When AF is no longer controllable, dose reduction or discontinuation is recommended. No data on costs, HRQoL and patient journey were identified. EXPERT OPINION: There is scarce and heterogeneous information on AF in onco-hematology in Europe. Available evidence reports a higher risk of AF associated with first-generation BTKi. Further studies are needed to understand the burden of AF in these patients.

Procalcitonin for selecting the antibiotic regimen in outpatients with low-risk community-acquired pneumonia using a rapid point-of-care testing: A single-arm clinical trial.

OBJECTIVE: We aimed to assess the role of procalcitonin (PCT) to guide the initial selection of the antibiotic regimen for low-risk community-acquired pneumonia (CAP). METHODS: A single-arm clinical trial was conducted including outpatients with CAP and Pneumonia Severity Index risk classes I-II. Antimicrobial selection was based on the results of PCT measured with a rapid point-of-care testing. According to serum PCT levels, patients were assigned to two treatment strategies: oral azithromycin if PCT was <0.5 ng/ml, or levofloxacin if levels were ≥0.5 ng/ml. Primary outcome was clinical cure rate. Short-term and long-term outcomes were assessed. Results were compared with those of a historical standard-of-care control-group treated in our centre. RESULTS: Of 253 subjects included, 216 (85.4%) were assigned to azithromycin. Pneumococcal infection was diagnosed in 26 (12%) and 21 (56.8%) patients allocated to azithromycin and levofloxacin groups, respectively. No patients in the azithromycin group developed bacteraemia. Atypical organisms were more common in patients given azithromycin (18.5% vs 8.1%, respectively). The majority (93%) of patients with atypical pneumonia had low PCT levels. Clinical cure rates were 95.8% in the azithromycin group, 94.6% in the levofloxacin group, and 94.4% in the historical control group. No 30-day mortality or recurrences were observed, and the 3-year rates of recurrence and mortality were very low in both groups. Adverse events occurrence was also infrequent. CONCLUSION: A PCT-guided strategy with a rapid point-of-care testing safely allowed selecting empirical narrow-spectrum antibiotics in outpatients with CAP. TRIAL REGISTRATION: The study is registered with ClinicalTrials.gov, number NCT02600806.

Muertes por enfermedades no asociadas directamente con el sida en pacientes con infección por el VIH: un estudio de 14 años (1998-2011) / Deaths due to non-AIDS diseases among HIV infected patients: A 14-year study (1998-2011)

FUNDAMENTO Y OBJETIVO: El objetivo del estudio fue analizar las muertes por enfermedades no asociadas directamente con el sida en una cohorte de pacientes con VIH atendidos entre 1998 y 2011. Pacientes y método: La información sobre las causas de la muerte se recogió retrospectivamente y se clasificaron siguiendo el algoritmo CoDe. Se compararon las características de los pacientes en 2 periodos: 1998-2004 y 2005-2011. Resultados: Fallecieron 159 de los 1.070 pacientes atendidos en ese espacio de tiempo, 56 (35%) por eventos sida y 86 (54%) por eventos no sida (ENOS); en 17 (11%) no pudo determinarse la causa. Globalmente, las principales causas de muerte fueron infecciones (32%), neoplasias (17%) y muertes no naturales (17%). Durante el segundo período hubo menor mortalidad por sida (18,5 vs 47%; p < 0,001) y mayor mortalidad por ENOS (68 vs 45%; p = 0,006). Se produjo un aumento muy acusado de las neoplasias no asociadas a sida (18,5 vs 2,1%; p = 0,001) y aumentaron las muertes por enfermedad cardiovascular (9,2 vs 2,1%; p = 0,06). Los pacientes que murieron en el segundo periodo tenían mayor edad, mejor situación inmunovirológica a la entrada en la cohorte y antes de fallecer, recibieron tratamiento antirretroviral (TAR) con mayor frecuencia, y estaban más a menudo suprimidos virológicamente antes del fallecimiento (61,5 vs 24%; p < 0,001). Conclusiones: Las neoplasias no asociadas a sida, las muertes no naturales y los eventos cardiovasculares constituyen ahora causas importantes de muerte en los pacientes con VIH. En los últimos años la mayoría de los pacientes fallecidos están en TAR y suprimidos virológicamente

BACKGROUND AND OBJECTIVE: The objective of this study was to analyze the deaths caused by non-AIDS diseases in a cohort of HIV-infected patients treated between 1998 and 2011. PATIENTS AND METHODS: Information on the causes of death was collected retrospectively, and then classified according to the deaths code (CoDe) algorithm. Patient characteristics and causes of death were compared for two periods: 1998-2004 and 2005-2011. RESULTS: A total of 159 out of the 1070 patients cared for in study period died, 56 (35%) due to AIDS events and 86 (54%) due to non-AIDS events (NAEs); in 17 (11%) the cause of death could not be determined. Overall, the main causes of death were infections (32%), cancer (17%), and unnatural deaths (17%). There was lower mortality from AIDS-related conditions during the second period (18.5% vs 47%;P < .001) and higher mortality from NAEs (68% vs 45%; P = .006). There was a very sharp increase in non-AIDS-defining cancers (18.5% vs 2.1%, p = 001), and increased deaths from cardiovascular disease (9.2% vs 2.1%, P = .06). Patients who died in the second period were older, and had a better immunological and virological status at cohort entry and before death. They received antiretroviral therapy (ART) more often and were more often virologically suppressed before death (61.5% vs 24%;P = .001). CONCLUSIONS: Non-AIDS-defining cancers, unnatural deaths, and cardiovascular diseases are now major causes of death in patients with HIV. In recent years the majority of deceased patients are on ART and with virological suppression

[Deaths due to non-AIDS diseases among HIV infected patients: A 14-year study (1998-2011)]. / Muertes por enfermedades no asociadas directamente con el sida en pacientes con infección por el VIH: un estudio de 14 años (1998-2011).

BACKGROUND AND OBJECTIVE: The objective of this study was to analyze the deaths caused by non-AIDS diseases in a cohort of HIV-infected patients treated between 1998 and 2011. PATIENTS AND METHODS: Information on the causes of death was collected retrospectively, and then classified according to the deaths code (CoDe) algorithm. Patient characteristics and causes of death were compared for two periods: 1998-2004 and 2005-2011. RESULTS: A total of 159 out of the 1070 patients cared for in study period died, 56 (35%) due to AIDS events and 86 (54%) due to non-AIDS events (NAEs); in 17 (11%) the cause of death could not be determined. Overall, the main causes of death were infections (32%), cancer (17%), and unnatural deaths (17%). There was lower mortality from AIDS-related conditions during the second period (18.5% vs 47%; P<.001) and higher mortality from NAEs (68% vs 45%; P=.006). There was a very sharp increase in non-AIDS-defining cancers (18.5% vs 2.1%, p=001), and increased deaths from cardiovascular disease (9.2% vs 2.1%, P=.06). Patients who died in the second period were older, and had a better immunological and virological status at cohort entry and before death. They received antiretroviral therapy (ART) more often and were more often virologically suppressed before death (61.5% vs 24%; P=.001). CONCLUSIONS: Non-AIDS-defining cancers, unnatural deaths, and cardiovascular diseases are now major causes of death in patients with HIV. In recent years the majority of deceased patients are on ART and with virological suppression.

Predators induce egg retention in prey.

To prevent predation on their eggs, prey often avoid patches occupied by predators. As a result, they need to delay oviposition until they reach predator-free patches. Because many species allocate energy to egg production in a continuous fashion, it is not clear what kind of mechanism prey use to delay oviposition. We used females of the phytoseiid mite Neoseiulus cucumeris to study these mechanisms. Females were placed in patches with pollen, a food source they use for egg production, and they were exposed to another phytoseiid mite, Iphiseius degenerans, which is an intraguild predator of N. cucumeris juveniles. We found that the oviposition of N. cucumeris females on patches with the predator was lower than on patches without the predator. Cues left by the intraguild predator were not sufficient to elicit such behaviour. Females of N. cucumeris reduced oviposition when exposed to the predator by retaining the egg inside their body, resulting in a lower developmental rate once these eggs were laid. Hence, females are capable of retaining eggs, but the development of these eggs continues inside the mother's body. In this way, females gain some time to search for less risky oviposition sites.