1.Determining the risk factors associated with the development of Clostridium difficile infection in patients with hematological diseases
Yu Ling LEE-TSAI ; Rodrigo LUNA-SANTIAGO ; Roberta DEMICHELIS-GÓMEZ ; Alfredo PONCE-DE-LEÓN ; Eric OCHOA-HEIN ; Karla María TAMEZ-TORRES ; María T BOURLON ; Christianne BOURLON
Blood Research 2019;54(2):120-124
BACKGROUND: Clostridium difficile infection (CDI) is a nosocomial condition prevalent in patients with hematological disorders. We aimed to identify the risk factors associated with the development of CDI and assess the mortality rate at 15 and 30 days among hematologic patients admitted to a tertiary care center. METHODS: We conducted a retrospective case-control study from January 2010 to December 2015. Forty-two patients with hematologic malignancy and CDI, and 84 with hematologic disease and without history of CDI were included in the case and control groups, respectively. RESULTS: Univariate analysis revealed that episodes of febrile eutropenia [odds ratio (OR), 5.5; 95% confidence interval (CI), 2.3–12.9; P<0.001], admission to intensive care unit (OR, 3.8; 95% CI, 1.4–10.2; P=0.009), gastrointestinal surgery (OR, 1.2; 95% CI, 1.1–1.4; P<0.001), use of therapeutic (OR, 6.4; 95% CI, 2.5–15.9; P<0.001) and prophylactic antibiotics (OR, 4.2; 95% CI, 1.6–10.7; P=0.003) in the last 3 months, and >1 hospitalization (OR, 5.6; 95% CI, 2.5–12.6; P<0.001) were significant risk factors. Multivariate analysis showed that use of therapeutic antibiotics in the last 3 months (OR, 6.3; 95% CI, 2.1–18.8; P=0.001) and >1 hospitalization (OR, 4.3; 95% CI, 1.7–11.0; P=0.002) were independent risk factors. Three (7.1%) and 6 (14.2%) case patients died at 15 and 30 days, respectively. CONCLUSION: The risk factors for developing CDI were exposure to therapeutic antibiotics and previous hospitalization. Hematological patients who developed CDI had higher early mortality rates, suggesting that new approaches for prevention and treatment are needed.
Anti-Bacterial Agents
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Case-Control Studies
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Clostridium difficile
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Clostridium
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Hematologic Diseases
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Hematologic Neoplasms
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Hospitalization
;
Humans
;
Intensive Care Units
;
Mortality
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Multivariate Analysis
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Retrospective Studies
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Risk Factors
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Tertiary Care Centers
2.Prognostic Factors and Decision Tree for Long-Term Survival in Metastatic Uveal Melanoma.
Daniel LORENZO ; María OCHOA ; Josep Maria PIULATS ; Cristina GUTIÉRREZ ; Luis ARIAS ; Jaume CATALÀ ; María GRAU ; Judith PEÑAFIEL ; Estefanía COBOS ; Pere GARCIA-BRU ; Marcos Javier RUBIO ; Noel PADRÓN-PÉREZ ; Bruno DIAS ; Joan PERA ; Josep Maria CAMINAL
Cancer Research and Treatment 2018;50(4):1130-1139
PURPOSE: The purpose of this study was to demonstrate the existence of a bimodal survival pattern in metastatic uveal melanoma. Secondary aims were to identify the characteristics and prognostic factors associated with long-term survival and to develop a clinical decision tree. MATERIALS AND METHODS: The medical records of 99 metastatic uveal melanoma patients were retrospectively reviewed. Patients were classified as either short (≤ 12 months) or long-term survivors (> 12 months) based on a graphical interpretation of the survival curve after diagnosis of the first metastatic lesion. Ophthalmic and oncological characteristicswere assessed in both groups. RESULTS: Of the 99 patients, 62 (62.6%) were classified as short-term survivors, and 37 (37.4%) as long-term survivors. The multivariate analysis identified the following predictors of long-term survival: age ≤ 65 years (p=0.012) and unaltered serum lactate dehydrogenase levels (p=0.018); additionally, the size (smaller vs. larger) of the largest liver metastasis showed a trend towards significance (p=0.063). Based on the variables significantly associated with long-term survival, we developed a decision tree to facilitate clinical decision-making. CONCLUSION: The findings of this study demonstrate the existence of a bimodal survival pattern in patients with metastatic uveal melanoma. The presence of certain clinical characteristics at diagnosis of distant disease is associated with long-term survival. A decision tree was developed to facilitate clinical decision-making and to counsel patients about the expected course of disease.
Clinical Decision-Making
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Decision Trees*
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Diagnosis
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Humans
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L-Lactate Dehydrogenase
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Liver
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Medical Records
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Melanoma*
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Multivariate Analysis
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Neoplasm Metastasis
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Retrospective Studies
;
Survivors
3.The Value of Transcranial Doppler Sonography in Hyperperfusion Syndrome after Carotid Artery Stenting: A Nationwide Prospective Study
Francisco MONICHE ; Irene ESCUDERO-MARTÍNEZ ; Fernando MANCHA ; Alejandro TOMASELLO ; Marc RIBÓ ; Fernando DELGADO-ACOSTA ; Juán José OCHOA ; Joaquín GIL ; Rosario GIL ; Montserrat GONZÁLEZ-DELGADO ; Eduardo MURIAS ; Alain LUNA ; Alberto GIL ; Sonia MOSTEIRO ; María Dolores FERNÁNDEZ-COUTO ; Luis Fernández de ALARCÓN ; José M. RAMÍREZ-MORENO ; Joaquín ZAMARRO ; Guillermo PARRILLA ; José L. CANIEGO ; Gustavo ZAPATA-WAINBERG ; Andrés GONZÁLEZ-MANDLY ; José A. de las HERAS ; Luis LÓPEZ-MESONERO ; Joaquín ORTEGA ; Juan F. ARENILLAS ; Ernesto GARCÍA ; Pedro P. ALCÁZAR ; Elena ZAPATA-ARRIAZA ; Asier de ALBÓNIGA-CHINDURZA ; Juan Antonio CABEZAS ; Pilar ALGABA ; Aurelio CAYUELA ; Joan MONTANER ; Alejandro González GARCÍA
Journal of Stroke 2020;22(2):254-257
4.Characteristics and in-hospital mortality of elderly patients with heart failure in Spanish hospitals.
Alberto ESTEBAN-FERNÁNDEZ ; Manuel ANGUITA-SÁNCHEZ ; Juan Luis BONILLA-PALOMAS ; María ANGUITA-GÁMEZ ; María GARCÍA ; José Luis BERNAL ; Náyade Del PRADO ; Cristina FERNÁNDEZ-PÉREZ ; Julián PÉREZ-VILLACASTIN ; Juan José GÓMEZ-DOBLAS ; Francisco Javier ELOLA
Journal of Geriatric Cardiology 2023;20(4):247-255
BACKGROUND:
The prevalence of heart failure (HF) increases with age, and it is one of the leading causes of hospitalization and death in older patients. However, there are little data on in-hospital mortality in patients with HF ≥ 75 years in Spain.
METHODS:
A retrospective analysis of the Spanish Minimum Basic Data Set was performed, including all HF episodes discharged from public hospitals in Spain between 2016 and 2019. Coding was performed using the International Classification of Diseases, 10th Revision. Patients ≥ 75 years with HF as the principal diagnosis were selected. We calculated: (1) the crude in-hospital mortality rate and its distribution according to age and sex; (2) the risk-standardized in-hospital mortality ratio; and (3) the association between in-hospital mortality and the availability of an intensive cardiac care unit (ICCU) in the hospital.
RESULTS:
We included 354,792 HF episodes of patients over 75 years. The mean age was 85.2 ± 5.5 years, and 59.2% of patients were women. The most frequent comorbidities were renal failure (46.1%), diabetes mellitus (35.5%), valvular disease (33.9%), cardiorespiratory failure (29.8%), and hypertension (26.9%). In-hospital mortality was 12.7%, and increased with age [odds ratio (OR) = 1.07, 95% CI: 1.07-1.07, P < 0.001] and was lower in women (OR = 0.96, 95% CI: 0.92-0.97, P < 0.001). The main predictors of mortality were the presence of cardiogenic shock (OR = 19.5, 95% CI: 16.8-22.7, P < 0.001), stroke (OR = 3.5, 95% CI: 3.0-4.0, P < 0.001) and advanced cancer (OR = 2.6, 95% CI: 2.5-2.8, P < 0.001). In hospitals with ICCU, the in-hospital risk-adjusted mortality tended to be lower (OR = 0.85, 95% CI: 0.72-1.00, P = 0.053).
CONCLUSIONS
In-hospital mortality in patients with HF ≥ 75 years between 2016 and 2019 was 12.7%, higher in males and elderly patients. The main predictors of mortality were cardiogenic shock, stroke, and advanced cancer. There was a trend toward lower mortality in centers with an ICCU.
5. Recognition of a multiple antigen peptide containing sequence from mimotope of the dengue type 3 virus NS4B protein by human antibodies
Nevis AMIN ; Alicia AGUILAR ; Rolando OCHOA ; Armando ACOSTA ; Maritza PUPO ; Susana VÁZQUEZ ; Yamira CABALLERO ; María G. GUZMÁN
Asian Pacific Journal of Tropical Medicine 2016;9(2):130-133
Objective: To evaluate the recognition of NS4B mimotope, as multiple antigen peptide (MAP), by dengue antibodies presents in serum samples from patients with different serotype infections. Methods: A MAP containing mimotope sequence was synthesized and used to evaluate the recognition of NS4B mimotope as MAP by a panel of 66 human sera from dengue cases by an indirect ELISA assay. Results: The MAP differentiated between sera from dengue viruses infected patients and sera from healthy individuals and the best reactivity was shown by serum from dengue type 3 virus patients. The recognition was more intense with serum from patients with secondary infection. Conclusions: The findings suggest the potential use of NS4B mimotope on the development of a multi-epitope diagnostic tool. These results are important for further immunogenicity studies.