Hospital General Universitario Gregorio Marañón

About: Hospital General Universitario Gregorio Marañón is a healthcare organization based out in Madrid, Spain. It is known for research contribution in the topics: Population & Transplantation. The organization has 11975 authors who have published 12386 publications receiving 244847 citations.

Periannular Complications in Infective Endocarditis Involving Native Aortic Valves

Abstract: The extension of infection in native valve infective endocarditis (IE) from valvular structures to the periannular tissue is incompletely understood. It is unknown, for example, whether the prognosis of patients with aortocavitary fistulae is worse than that of those with nonruptured abscesses. The aims of this study were to determine the distinct clinical characteristics of patients with aortocavitary fistulae and nonruptured abscesses in native valve IE and to evaluate the impact of fistulization on the outcomes of patients with native aortic valve IE complicated with periannular lesions. In a retrospective multicenter study of 2,055 native valve IE episodes, 201 patients (9.8%) with periannular complications in aortic valve IE were identified (46 with aortocavitary fistulization and 155 with nonruptured abscesses). Rates of heart failure (p = 0.07), ventricular septal defect (p 60 years (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.3 to 5.2), renal failure (OR 3.0, 95% CI 1.5 to 6.0), and moderate or severe heart failure (OR 2.5, 95% CI 1.2 to 5.2) as independent risk factors for death. There was a trend toward increased in-hospital mortality in patients with aortocavitary fistulae (OR 1.5, 95% CI 0.7 to 3.0). The actuarial 5-year survival rate in surgical survivors was 80% in patients with fistulae and 92% in patients with nonruptured abscesses (log-rank p = 0.6). In conclusion, aortocavitary fistulous tract formation in the setting of native valve IE is associated with higher rates of heart failure, ventricular septal defect, and atrioventricular block than nonruptured abscess. Despite these higher rates of complications, fistulous tract formation in the current era of IE is not an independent risk factor for mortality.

Impact of Zygomycosis on Microbiology Workload: a Survey Study in Spain

Abstract: This multicenter, population-based study evaluated the laboratory workload produced by zygomycetes and the number of cases of zygomycosis in Spain during 2005. Less than 8% of the patients who harbored zygomycete isolates had zygomycosis. The incidence of zygomycosis (6 cases) was 0.43 cases/1,000,000 inhabitants and 0.62 cases/100,000 hospital admissions.

Direct E-Test (AB Biodisk) of Respiratory Samples Improves Antimicrobial Use in Ventilator-Associated Pneumonia

Abstract: Background Ventilator-associated pneumonia is the most frequently observed nosocomial infection in intensive care units, and it is associated with high morbidity and mortality. Early microbiological diagnosis and the initial administration of appropriate antimicrobial therapy are associated with decreased mortality and potentially reduced costs. Our study evaluates the clinical and financial impact of performing rapid antimicrobial susceptibility tests directly on samples obtained from the lower respiratory tract. Methods A prospective, randomized study was performed over a 2-year period. Patients who had a lower respiratory tract infection that was acquired during mechanical ventilation and for whom samples obtained from the respiratory tract were sent for culture were randomized to 1 of 2 groups. Samples were cultured for the control group, and results were reported using standard procedures. Samples were also cultured for the test subject group using standard procedures, but in addition, a rapid antibiogram was immediately performed by placing E-test antibiotic strips (AB Biodisk) directly on respiratory tract samples. Patients in the E-test group received a preliminary laboratory report when it became available. The 2 patient groups were compared according to the following variables: type and severity of underlying conditions, total days of antimicrobial use, number of defined daily doses, cost of acquisition of the antimicrobial agent per episode, days of fever, days receiving mechanical ventilation, days in the intensive care unit, incidence of Clostridium difficile-associated diarrhea, and mortality. Results Reporting a rapid E-test was associated with fewer days of fever, fewer days of antibiotic administration until resolution of the episode of ventilator-associated pneumonia, decreased antibiotic consumption, less C. difficile-associated diarrhea, lower costs of antimicrobial agents, and fewer days receiving mechanical ventilation. Conclusions A rapid E-test of respiratory tract samples improves antimicrobial use in cases of ventilator-associated pneumonia.

De novo mutations identified by exome sequencing implicate rare missense variants in SLC6A1 in schizophrenia

Abstract: Schizophrenia is a highly polygenic disorder with important contributions from both common and rare risk alleles. We analyzed exome sequencing data for de novo variants (DNVs) in a new sample of 613 schizophrenia trios and combined this with published data to give a total of 3,444 trios. In this new data, loss-of-function (LoF) DNVs were significantly enriched among 3,471 LoF-intolerant genes, which supports previous findings. In the full dataset, genes associated with neurodevelopmental disorders (n = 159) were significantly enriched for LoF DNVs. Within these neurodevelopmental disorder genes, SLC6A1, which encodes a γ-aminobutyric acid transporter, was associated with missense-damaging DNVs. In 1,122 trios for which genome-wide common variant data were available, schizophrenia and bipolar disorder polygenic risk were significantly overtransmitted to probands. Probands carrying LoF or deletion DNVs in LoF-intolerant or neurodevelopmental disorder genes had significantly less overtransmission of schizophrenia polygenic risk than did non-carriers, which provides a second robust line of evidence that these DNVs increase liability to schizophrenia.