Showing papers by "Nuria Fernández-Hidalgo published in 2020"
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TL;DR: To investigate the incidence of clinical, ultrasonographic and biochemical findings related to pre‐eclampsia (PE) in pregnancies with COVID‐19, and to assess their accuracy to differentiate between PE and the PE‐like features associated with CO VID‐19.
237 citations
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University of Zurich1, Mater Misericordiae University Hospital2, University of Bern3, McMaster University4, University of Freiburg5, Autonomous University of Barcelona6, Kaiser Permanente7, University of Copenhagen8, Cleveland Clinic9, Monash University10, Penn State Milton S. Hershey Medical Center11, Centers for Disease Control and Prevention12, European Centre for Disease Prevention and Control13, Public Health England14, Guy's and St Thomas' NHS Foundation Trust15, Masaryk University16, Radboud University Nijmegen17, Roy J. and Lucille A. Carver College of Medicine18, University of Texas Health Science Center at Tyler19, Mayo Clinic20, University of Barcelona21, Deakin University22, University of California, Los Angeles23, University of Zagreb24, Duke University25, Federal University of Rio de Janeiro26, Beth Israel Deaconess Medical Center27, University of Naples Federico II28, Liverpool School of Tropical Medicine29, University of Iowa30, University of Basel31, Charité32
TL;DR: In this document the International Society for Cardiovascular Infectious Diseases (ISCVID) covers aspects of prevention, clinical management, laboratory diagnostics, device management, and public health aspects.
42 citations
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TL;DR: FDG uptake, often seen in recently implanted PVs, shows a characteristic pattern of post-operative inflammation and, in the absence of associated anatomic lesions, could be considered a normal finding, so questioning the recommended 3-month safety period is questioned.
Abstract: Aims To define characteristic PET/CTA patterns of FDG uptake and anatomic changes following prosthetic heart valves (PVs) implantation over time, to help not to misdiagnose post-operative inflammation and avoid false-positive cases. Methods and results Prospective evaluation of 37 post-operative patients without suspected infection that underwent serial cardiac PET/CTA examinations at 1, 6, and 12 months after surgery, in which metabolic features (FDG uptake distribution pattern and intensity) and anatomic changes were evaluated. Standardized uptake values (SUVs) were obtained and a new measure, the valve uptake index (VUI), (SUVmax-SUVmean)/SUVmax, was tested to homogenize SUV results.In total, 111 PET/CTA scans were performed in 37 patients (19 aortic and 18 mitral valves). FDG uptake was visually detectable in 79.3% of patients and showed a diffuse, homogeneous distribution pattern in 93%. Quantitative analysis yielded a mean maximum standardized uptake value (SUVmax) of 4.46 ± 1.50 and VUI of 0.35 ± 0.10. There were no significant differences in FDG distribution or uptake values between 1, 6, or 12 months. No abnormal anatomic changes or endocarditis lesions were detected in any patient during follow-up. Conclusions FDG uptake, often seen in recently implanted PVs, shows a characteristic pattern of post-operative inflammation and, in the absence of associated anatomic lesions, could be considered a normal finding. These features remain stable for at least 1 year after surgery, so questioning the recommended 3-month safety period. A new measure, the VUI, can be useful for evaluating the FDG distribution pattern.
41 citations
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TL;DR: In a scenario of progressive increase in the age and frailty of IE patients, the use of aminoglycosides can be reduced or avoided in ∼90% cases, which should result in reduced incidence of renal failure, an important prognostic factor in IE.
23 citations
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TL;DR: Time from lung injury onset to tocilizumab administration may be critical to patient recovery, and could inform bedside decisions until more data from clinical trials becomes available.
Abstract: Background: Modulation of the immune system to prevent lung injury is being widely used against the new coronavirus disease (COVID19) despite the scarcity of evidence.
Methods: We report preliminary results from the Vall dHebron prospective cohort study at Vall dHebron University Hospital, in Barcelona (Spain), including all consecutive patients who had a confirmed infection with the severe acute respiratory syndrome coronavirus2 (SARSCoV2) and who were treated with tocilizumab until March 25th. The primary endpoint was mortality at 7 days after tocilizumab administration. Secondary endpoints were admission to the intensive care unit, development of ARDS and respiratory insufficiency among others.
Results: 82 patients with COVID19 received at least one dose of tocilizumab. The mean (SD) age was 59.1 (19.8) years, 63% were male, 22% were of non Spanish ancestry, and the median (IQR) ageadjusted Charlson index at baseline was 3 (1 to 4) points. Respiratory failure and ARDS developed in 62 (75.6%) and 45 (54.9%) patients, respectively. Median time from symptom onset to ARDS development was 8 (5 to 11) days. The median time from symptom onset to the first dose of tocilizumab was 9 (7 to 11) days. Mortality at 7 days was 26.8%. Hazard ratio for mortality was 3.3; 95% CI, 1.3 to 8.5 (age adjusted hazard ratio for mortality 2.1; 95% CI, 0.8 to 5.8) if tocilizumab was administered after the onset of ARDS.
Conclusion: Time from lung injury onset to tocilizumab administration may be critical to patient recovery. Our preliminary data could inform bedside decisions until more data from clinical trials becomes available.
21 citations
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TL;DR: Realizar una colonoscopia en the EIEF, sin tener en cuenta the puerta de entrada, puede ayudar a diagnosticar the enfermedad colorrectal en estos pacientes y evitar una nueva bacteriemia (y eventualmente endocarditis infecciosa) by el mismo u otro microorganismo.
Abstract: Resumen Introduccion y objetivos El objetivo del estudio fue determinar la prevalencia de patologia colorrectal en los pacientes con endocarditis infecciosa por Enterococcus faecalis (EIEF). Metodos Se realizo un estudio observacional, retrospectivo y multicentrico en 4 hospitales de referencia. Se incluyeron todos los episodios consecutivos de EIEF definitivas en adultos desde el momento en que se empezo a realizar una colonoscopia por protocolo en cada centro participante hasta octubre de 2018. Se recogieron los hallazgos endoscopicos de patologia colorrectal potencialmente causante de una bacteriemia. Resultados Se incluyeron 103 pacientes con EIEF; 83 (81%) eran varones, la edad mediana era 76 [rango intercuartilico, 67-82] anos, y la mediana del indice de Charlson ajustado por edad fue 5 [rango intercuartilico, 4-7]. El presunto origen de la infeccion fue desconocido en 63 (61%), urinario en 20 (19%), digestivo en 13 (13%), bacteriemia de cateter en 5 (5%), y otros en 2 (2%). En 78 (76%) pacientes se realizo una colonoscopia, y en 47 (60%) habia hallazgos endoscopicos que indicaban un potencial foco de bacteriemia. Treinta y nueve (83%) tenian una enfermedad colorrectal neoplasica, y 8 (17%) no neoplasica. De los 45 pacientes con puerta de entrada desconocida y colonoscopia, un posible origen gastrointestinal se identifico en 64%. En el subgrupo de 25 con foco de entrada conocido y colonoscopia, excluyendo aquellos con enfermedad colorrectal ya previamente diagnosticada, 44% tenian patologia colorrectal. Conclusiones Realizar una colonoscopia en la EIEF, sin tener en cuenta la puerta de entrada, puede ayudar a diagnosticar la enfermedad colorrectal en estos pacientes y evitar una nueva bacteriemia (y eventualmente endocarditis infecciosa) por el mismo u otro microorganismo.
19 citations
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TL;DR: In this Perspective, some of the most relevant aspects concerning the epidemiology, clinical presentation and outcomes, diagnostic approaches and antibiotic therapy of EFIE are addressed and several potential future clinical developments in the field are discussed.
Abstract: Enterococcus faecalis infective endocarditis (EFIE) is a complex entity in rapid evolution. Although largely relevant findings from recent studies have advanced the knowledge on EFIE and led to some changes in clinical guidelines, there are still a number of gaps to be filled. Coordinated, international, multicenter efforts are needed to obtain quality data that rend the health systems and scientific community prepared enough to understand and handle this infection. In this Perspective, some of the most relevant aspects concerning the epidemiology, clinical presentation and outcomes, diagnostic approaches and antibiotic therapy of EFIE are addressed. Also, several potential future clinical developments in the field are discussed.
19 citations
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TL;DR: Performing a colonoscopy in all EFIE patients, irrespective of the presumed source of infection, could be helpful to diagnose colorectal disease in these patients and to avoid a new bacteremia episode.
Abstract: Introduction and objectives The aim of this study was to determine the prevalence of colorectal disease in Enterococcus faecalis infective endocarditis (EFIE) patients. Methods An observational, retrospective, multicenter study was performed at 4 referral centers. From the moment that a colonoscopy was systematically performed in EFIE in each participating hospital until October 2018, we included all consecutive episodes of definite EFIE in adult patients. The outcome was an endoscopic finding of colorectal disease potentially causing bacteremia. Results A total of 103 patients with EFIE were included; 83 (81%) were male, the median age was 76 [interquartile range 67-82] years, and the median age-adjusted Charlson comorbidity index was 5 [interquartile range 4-7]. The presumed sources of infection were unknown in 63 (61%), urinary in 20 (19%), gastrointestinal in 13 (13%), catheter-related bacteremia in 5 (5%), and others in 2 (2%). Seventy-eight patients (76%) underwent a colonoscopy, and 47 (60%) had endoscopic findings indicating a potential source of bacteremia. Thirty-nine patients (83%) had a colorectal neoplastic disease, and 8 (7%) a nonneoplastic disease. Of the 45 with an unknown portal of entry who underwent a colonoscopy, gastrointestinal origin was identified in 64%. In the subgroup of 25 patients with a known source of infection and a colonoscopy, excluding those with previously diagnosed colorectal disease, 44% had colorectal disease. Conclusions Performing a colonoscopy in all EFIE patients, irrespective of the presumed source of infection, could be helpful to diagnose colorectal disease in these patients and to avoid a new bacteremia episode (and eventually infective endocarditis) by the same or a different microorganism.
17 citations
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TL;DR: Fetal skin edema in the second trimester might be associated with maternal coronavirus disease 2019 (COVID-19) and further research is needed to establish a causative mechanism.
11 citations
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TL;DR: Noninfected prosthetic heart valves often display a characteristic pattern of diffuse and homogeneous distribution and mild fluorodeoxyglucose (FDG) uptake when evaluated by 18F-FDG positron emission tomography/computed tomography angiography (PET/CTA) at least during 1 year after implantation.
Abstract: Noninfected prosthetic heart valves often display a characteristic pattern of diffuse and homogeneous distribution and mild fluorodeoxyglucose (FDG) uptake when evaluated by 18F-FDG positron emission tomography/computed tomography angiography (PET/CTA) at least during 1 year after implantation.
9 citations
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TL;DR: High biomass production was associated with CC5 and CC22 but not with higher hospital mortality, septic complications, type of endocarditis, methicillin-resistance, elevated vancomycin MIC or agr dysfunction.
Abstract: Introduction The aim of this study was to evaluate the association between biomass formation and the clinical characteristics and prognosis of Staphylococcus aureus infective endocarditis (IE). Methods We prospectively studied 209 S. aureus strains causing IE. Biomass formation was examined using the crystal violet assay and quantified spectrophotometrically. The average (SD) optical density of the biomass was compared for each clinical, microbiological (methicillin-resistance, vancomycin MIC ≥ 1.5 μg/ml) and molecular (clonal complex, agr type and agr dysfunction) variable according to their presence or absence. The primary clinical endpoints studied were in-hospital death, severe sepsis, persistent bacteraemia, symptomatic peripheral embolisms and prosthetic valve IE. Results Mean age was 66.1 years, 61.5% of patients were male and the median age-adjusted Charlson comorbidity index was 5 points (IQR 3–8). In-hospital mortality was 37.3%. Strains belonging to CC5 and CC22 had optical biomass densities [mean (SD) 1.573 (1.14) vs 0.942 (0.98) p Conclusions High biomass production was associated with CC5 and CC22 but not with higher hospital mortality, septic complications, type of endocarditis, methicillin-resistance, elevated vancomycin MIC or agr dysfunction.
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TL;DR: The authors evaluated the single-center adherence to a diagnostic flowchart previously reported by the same group, and re-assessed the usefulness of multidetector computed tomography angiography (MDCTA) and FDG-PET/CT in the diagnosis of IE.
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TL;DR: An uncommon case of isolated basal ganglia mucormycosis in a patient without any known cause of immunosuppression, but with a history of drug injection is presented.
Abstract: We present an uncommon case of isolated basal ganglia mucormycosis in a patient without any known cause of immunosuppression, but with a history of drug injection. The patient presented a good clinical and radiological response to antifungal treatment without aggressive surgical debridement (liposomal amphotericin B combined with isavuconazole for 4 weeks followed by isavuconazole as maintenance therapy for 10 months).
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TL;DR: Pericas et al. as mentioned in this paper read with great interest the paper by Pericas et. al. on enterococcal infective endocarditis in a recent issue of the Journal, and they completely agree that quality data from large studies is lacking (but necessary).