Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 39
Filtrar
Mais filtros

Intervalo de ano de publicação
1.
Ann Surg ; 279(5): 727-733, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38116685

RESUMO

OBJECTIVE: To determine the feasibility and effectiveness of a Hospital at Home (HaH) enabled early transfer pathways for surgical patients. BACKGROUND: HaH serves as a safe alternative to traditional hospitalization by providing acute care to patients in their homes through a comprehensive range of hospital-level interventions. To our knowledge, no studies have been published to date reporting a large cohort of early home-transferred patients after surgery through a HaH unit. METHODS: Cohort study enrolling every patient admitted to the HaH unit of a tertiary hospital who underwent any of 6 surgeries with a predefined early transfer pathway and fitting both general and surgery inclusion criteria (clinical and hemodynamic stability, uncomplicated surgery, presence of a caregiver, among others) from November 2021 to May 2023. Protocols were developed for each pathway between surgical services and HaH to deliver the usual postoperative care in the home setting. Discharge was decided according to protocol. An urgent escalation pathway was also established. RESULTS: During the study period, 325 patients were included: 141 were bariatric surgeries, 85 kidney transplants, 45 thoracic surgeries, 37 cystectomies, 10 appendicectomies, and 7 ventral hernia repairs. The overall escalation of care during HaH occurred in 7.3% of patients and 30-day readmissions in 7%. Most adverse events were managed at home and the overall mortality was zero. The total mean length of stay was 8 days (interquartile range 2-14), and patients with HaH were transferred home 3 days (interquartile range 1-6) earlier than the usual pathway; a total of 1551 bed-days were saved. CONCLUSIONS: The implementation of early home transfer pathways for surgical patients through HaH is feasible and effective, with favorable safety outcomes.


Assuntos
Hospitalização , Readmissão do Paciente , Humanos , Estudos de Coortes , Alta do Paciente , Hospitais
2.
Eur J Haematol ; 112(3): 371-378, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37879842

RESUMO

BACKGROUND: We described the real-life epidemiology and causes of infections on the different therapy phases in patients undergoing chimeric antigen receptor (CAR) T-cells directed towards CD19+ or BCMA+ cells. METHODS: All consecutive patients receiving CAR T-cell therapy at our institution were prospectively followed-up. We performed various comparative analyses of all patients and subgroups with and without infections. RESULTS: Ninety-one adults mainly received CAR T-cell therapy for acute leukaemia (53%) and lymphoma (33%). We documented a total of 77 infections in 47 (52%) patients, 37 (48%) during the initial neutropenic phase and 40 (52%) during the non-neutropenic phase. Infections during the neutropenic phase were mainly due to bacterial (29, 78%): catheter infections (11 [38%] cases), endogenous source (5 [17%]), and Clostridioides difficile (5 [17%]). Patients receiving corticosteroids after CAR T-cell therapy had a higher risk of endogenous infection (100% vs. 16%; p = .006). During the non-neutropenic phase, bacterial infections remained very frequent (24, 60%), mainly with catheter source (8, 33%). Respiratory tract infections were common (17, 43%). CONCLUSIONS: Infections after CAR T-cell therapy were frequent. During the neutropenic phase, it is essential to prevent nosocomial infections and balance the use of antibiotics to lower endogenous bacteraemia and Clostridial infection rates.


Assuntos
Infecções Bacterianas , Neoplasias Hematológicas , Linfoma , Leucemia-Linfoma Linfoblástico de Células Precursoras , Adulto , Humanos , Imunoterapia Adotiva/efeitos adversos , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/epidemiologia , Neoplasias Hematológicas/terapia , Linfoma/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Antígenos CD19
3.
J Antimicrob Chemother ; 78(6): 1454-1459, 2023 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-37051877

RESUMO

OBJECTIVES: We aimed to describe the clinical outcomes and duration of viral shedding in high-risk patients with haematological malignancies hospitalized with COVID-19 during Omicron variant predominance who received early treatment with antivirals. METHODS: We conducted a prospective observational study on high-risk haematological patients admitted in our hospital between December 2021 and March 2022. We performed detection techniques on viral subgenomic mRNAs until negative results were obtained to document active, prolonged viral replication. RESULTS: This analysis included 60 consecutive adults with high-risk haematological malignancies and COVID-19. All of these patients underwent early treatment with remdesivir. Thirty-two (53%) patients received combined antiviral strategies, with sotrovimab or hyperimmune plasma being added to remdesivir. The median length of viral replication-as measured by real-time RT-PCR and/or subgenomic RNA detection-was 20 (IQR 14-28) days. Prolonged viral replication (6 weeks after diagnosis) was documented in six (10%) patients. Only two patients had prolonged infection for more than 2 months. Overall mortality was 5%, whereas COVID-19-related mortality was 0%. CONCLUSIONS: Current outcomes of high-risk patients with haematological malignancies hospitalized with COVID-19 during Omicron variant predminance are good with the use of early antiviral strategies. Persistent viral shedding is uncommon.


Assuntos
COVID-19 , Fármacos Dermatológicos , Neoplasias Hematológicas , Adulto , Humanos , Antivirais/uso terapêutico , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/tratamento farmacológico , SARS-CoV-2 , RNA Subgenômico
4.
Med Mycol ; 61(3)2023 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-36861308

RESUMO

We aimed to describe the current epidemiology of both hosts with invasive fungal infections (IFIs) and causative fungi. And, detail outcomes of these infections at 12 weeks in a real-life cohort of hospitalized patients. The study was retrospective and observational to describe IFI diagnosed in a tertiary hospital (February 2017-December 2021). We included all consecutive patients meeting criteria for proven or probable IFI according to EORTC-MSG and other criteria. A total of 367 IFIs were diagnosed. 11.7% were breakthrough infections, and 56.4% were diagnosed in the intensive care unit. Corticosteroid use (41.4%) and prior viral infection (31.3%) were the most common risk factors for IFI. Lymphoma and pneumocystis pneumonia were the most common baseline and fungal diseases. Only 12% of IFI occurred in patients with neutropenia. Fungal cultures were the most important diagnostic tests (85.8%). The most frequent IFIs were candidemia (42.2%) and invasive aspergillosis (26.7%). Azole-resistant Candida strains and non-fumigatus Aspergillus infections represented 36.1% and 44.5% of the cases, respectively. Pneumocystosis (16.9%), cryptococcosis (4.6%), and mucormycosis (2.7%) were also frequent, as well as mixed infections (3.4%). Rare fungi accounted for 9.5% of infections. Overall, IFI mortality at 12 weeks was 32.2%; higher rates were observed for Mucorales (55.6%), Fusarium (50%), and mixed infections (60%). We documented emerging changes in both hosts and real-life IFI epidemiology. Physicians should be aware of these changes to suspect infections and be aggressive in diagnoses and treatments. Currently, outcomes for such clinical scenarios remain extremely poor.


Current epidemiology of the host and fungi and IFI treatments are changing. Real-life data on this subject are scarce. We present our most recent evidence to highlight the importance of the ongoing challenges that require further investigation and clinical adjustments.


Assuntos
Aspergilose , Coinfecção , Infecções Fúngicas Invasivas , Pneumonia por Pneumocystis , Aspergilose/veterinária , Coinfecção/veterinária , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/epidemiologia , Infecções Fúngicas Invasivas/veterinária , Pneumonia por Pneumocystis/veterinária , Estudos Retrospectivos , Humanos
5.
J Antimicrob Chemother ; 77(7): 2017-2023, 2022 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-35466357

RESUMO

OBJECTIVES: To describe current resistance to the ß-lactams empirically recommended in the guidelines in bloodstream infection (BSI) episodes caused by Gram-negative bacilli (GNB). METHODS: Retrospective, multicentre cohort study of the last 50 BSI episodes in haematological patients across 14 university hospitals in Spain. Rates of inappropriate empirical antibiotic therapy (IEAT) and impact on mortality were evaluated. RESULTS: Of the 700 BSI episodes, 308 (44%) were caused by GNB, mainly Escherichia coli (141; 20.1%), Klebsiella spp. (56; 8%) and Pseudomonas aeruginosa (48; 6.9%). Among GNB BSI episodes, 80 (26%) were caused by MDR isolates. In those caused by Enterobacterales, 25.8% were ESBL producers and 3.5% were carbapenemase producers. Among P. aeruginosa BSI episodes, 18.8% were caused by MDR isolates. Overall, 34.7% of the isolated GNB were resistant to at least one of the three ß-lactams recommended in febrile neutropenia guidelines (cefepime, piperacillin/tazobactam and meropenem). Despite extensive compliance with guideline recommendations (91.6%), 16.6% of BSI episodes caused by GNB received IEAT, which was more frequent among MDR GNB isolates (46.3% versus 6.1%; P < 0.001). Thirty day mortality was 14.6%, reaching 21.6% in patients receiving IEAT. CONCLUSIONS: Current resistance to empirical ß-lactams recommended in febrile neutropenia guidelines is exceedingly high and IEAT rates are greater than desired. There is an urgent need to adapt guidelines to current epidemiology and better identify patients with a high risk of developing MDR GNB infection.


Assuntos
Bacteriemia , Neutropenia Febril , Infecções por Bactérias Gram-Negativas , Sepse , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Estudos de Coortes , Neutropenia Febril/tratamento farmacológico , Bactérias Gram-Negativas , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/epidemiologia , Humanos , Pseudomonas aeruginosa , Estudos Retrospectivos , Sepse/tratamento farmacológico , Espanha/epidemiologia , beta-Lactamas/uso terapêutico
6.
Eur J Pediatr ; 177(6): 1-12, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29556792

RESUMO

To propose a response criterion for analyzing the intervention success by verifying patient outcomes after a multidisciplinary obesity treatment program in Brazilian children and adolescents. Obese children and adolescents (n = 103) completed a 16-week multidisciplinary intervention (IG) and were compared to the control group (CG) (n = 66). A cluster of parameters (e.g. total domain of HRQoL; BMI z-score; cardiorespiratory fitness; body mass; waist circumference; fat mass; lean mass) were measured pre and post-intervention, and the sum of the median percentage variation and the percentile 25 and 75 were used from IG and CG to determine the responsiveness to the program. We are proposing four ranges in which children and adolescents may be classified after the intervention: (1) CG percentile 50 values or lower are considered non-responsive to the intervention, (2) values greater than CG percentile 50 but lower than IG percentile 50 are considered slightly responsive, (3) values greater than IG percentile 50 but lower than IG percentile 75 were considered as moderately responsive, and (4) values greater than IG percentile 75 were considered very responsive. CONCLUSIONS: This criterion may serve as a complementary tool that can be employed to monitor the response to this model of multidisciplinary intervention. What is Known: • The effectiveness of multidisciplinary obesity interventions is usually determined by comparing changes in selected outcomes in the intervention versus versus control group. • There is no consensus about what should be assessed before and after the intervention program, which makes difficult to compare different programs and to determine their rate of responsiveness. What is New: • This study proposes a response criteria to pediatric obesity interventions following a similar model compared to ours based on key variables that presents low cost and high applicability in different settings.


Assuntos
Avaliação de Resultados em Cuidados de Saúde/métodos , Obesidade Infantil/terapia , Programas de Redução de Peso , Adolescente , Brasil , Criança , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino
9.
Appetite ; 87: 229-35, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25558026

RESUMO

The obesity epidemic is a global challenge that requires evidence-based intervention to slow the emergence of weight-related illness in children and adolescents. Thus, effective treatments are urgently needed. This study aimed to analyze whether there is relationship between the initial stage of readiness for behavior change (SRBC) and the results obtained through participation in a multidisciplinary program of obesity treatment (MPOT). The study included 113 overweight or obese children and adolescents who participated in an intervention for 16 weeks, in which the categorical variable was the SRBC. The dependent variables included: anthropometric measures of body composition, hemodynamic parameters (e.g., blood pressure values), and health-related physical fitness. Although stages 1 and 2 had greater improvements in flexibility than those in stage 5, and stage 1 had greater percentage changes in abdominal strength than those in stage 5, children and adolescents in the highest stage had greater percentage changes for anthropometric, hemodynamic and cardiorespiratory fitness, suggesting an impact of the stage of change on the effects of a MPOT. This study suggests that SRBC plays a role in obesity treatment in Brazilian children and adolescents and warrants consideration when enrolling patients to intervention.


Assuntos
Comportamento Infantil , Comportamentos Relacionados com a Saúde , Obesidade Infantil/epidemiologia , Obesidade Infantil/terapia , Adolescente , Pressão Sanguínea , Composição Corporal , Índice de Massa Corporal , Peso Corporal , Brasil/epidemiologia , Criança , Feminino , Seguimentos , Hemodinâmica , Humanos , Modelos Lineares , Masculino , Atividade Motora , Consumo de Oxigênio , Cooperação do Paciente , Aptidão Física , Prevalência
10.
Pediatr Cardiol ; 35(4): 684-90, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24272169

RESUMO

The aim of this study was to investigate the association between cardiac parasympathetic activity and cardiorespiratory fitness, insulin, and hemodynamic profile in overweight and obese adolescent girls and boys (aged 12-16 years). Data were taken from the Multidisciplinary Obesity Treatment Program. Only post-intervention measurements are presented herein. Body composition, cardiorespiratory fitness, blood pressure, and metabolic profile (insulin and glucose profile) of adolescents were assessed. Cardiac parasympathetic activity was determined by resting heart rate variability, which was analyzed using a heart rate monitor. Greater parasympathetic cardiac activity was associated with higher levels of cardiorespiratory fitness in both girls and boys (0.375 ≤ r ≤ 0.900), while the sympathetic-vagal balance was negatively related to maximal oxygen uptake (VO2max) in girls (r = 0.478). An association between lower parasympathetic activity and insulin resistance was noted in girls (mean of R-R intervals [RRmean] and homeostasis model assessment insulin-resistance index [HOMA-IR]: r = -0.678), while greater systolic blood pressure (SBP) and lower parasympathetic activity were associated in both sexes (RRmean and SBP: r = -0.526; high frequency [HF (nu)] and SBP: r = -0.754). In conclusion, autonomic nervous system activity was associated with cardiorespiratory fitness, insulin resistance, and SBP in overweight and obese adolescents. The identification of these potential relationships assists with the establishment of future long-term exercise interventions that evaluate the improvements in parasympathetic nervous system activity, in addition to metabolic profile and cardiorespiratory fitness in overweight and obese adolescents.


Assuntos
Pressão Sanguínea/fisiologia , Terapia por Exercício/métodos , Exercício Físico/fisiologia , Coração/inervação , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Sistema Nervoso Parassimpático/fisiopatologia , Adolescente , Glicemia/metabolismo , Composição Corporal , Criança , Feminino , Seguimentos , Coração/fisiopatologia , Humanos , Insulina/sangue , Resistência à Insulina , Masculino , Obesidade/sangue , Obesidade/reabilitação , Sobrepeso/sangue , Sobrepeso/reabilitação , Consumo de Oxigênio/fisiologia , Estudos Retrospectivos
11.
Microbiol Spectr ; 12(6): e0061424, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38727230

RESUMO

We describe four cases of a novel carbapenem-resistant Pseudomonas aeruginosa ST179 clone carrying the blaKPC-2 or blaKPC-35 gene together with blaIMP-16, imported from Peru to Spain and isolated from leukemia patients. All isolates were multidrug-resistant but remained susceptible to fosfomycin, cefiderocol, and colistin. Whole-genome sequencing revealed that blaKPC-2 and blaKPC-35 were located in an IncP6 plasmid, whereas blaIMP-16 was in a chromosomal type 1 integron. This study highlights the global threat of multidrug-resistant P. aeruginosa clones and underscores the importance of monitoring and early detection of emerging resistance mechanisms to guide appropriate treatment strategies. The importation and spread of such clones emphasize the urgent need to implement strict infection control measures to prevent the dissemination of carbapenem-resistant bacteria. IMPORTANCE: This is the first documented case of a Pseudomonas aeruginosa ST179 strain carrying the blaKPC-35 gene, and it represents the first report of a P. aeruginosa co-harboring blaIMP-16 and either blaKPC-2 or blaKPC-35, which wre imported from Peru to Spain, highlighting a threat due to the capacity of spreading carbapenem-resistance via plasmid conjugation.


Assuntos
Antibacterianos , Carbapenêmicos , Farmacorresistência Bacteriana Múltipla , Infecções por Pseudomonas , Pseudomonas aeruginosa , beta-Lactamases , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/isolamento & purificação , Pseudomonas aeruginosa/enzimologia , Humanos , Espanha , Peru , Infecções por Pseudomonas/microbiologia , Carbapenêmicos/farmacologia , beta-Lactamases/genética , beta-Lactamases/metabolismo , Antibacterianos/farmacologia , Masculino , Farmacorresistência Bacteriana Múltipla/genética , Plasmídeos/genética , Testes de Sensibilidade Microbiana , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Sequenciamento Completo do Genoma , Feminino , Pessoa de Meia-Idade , Adulto
12.
Influenza Other Respir Viruses ; 18(3): e13264, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38468434

RESUMO

BACKGROUND: We aimed to describe a cohort of hematologic patients with COVID-19 treated with antivirals early. METHODS: Non-interventional chart review study. Comparison of baseline characteristics and outcomes in high-risk hematologic patients treated with remdesivir between December 2021 and April 2022 versus those treated with nirmatrelvir/ritonavir between May and August 2022. RESULTS: Eighty-three patients were analyzed. Forty-two received remdesivir, and 41 nirmatrelvir/ritonavir. Patients with remdesivir were younger, vaccinated with lower number of doses, and received prior corticosteroids less frequently and sotrovimab, hyperimmune plasma and corticosteroids more often. Viral shedding median (IQR) duration was 18 (13-23) and 11 (8-21) days in the remdesivir and nirmatrelvir/ritonavir groups, respectively (p = 0.004). Median (IQR) Ct values before treatment were similar in both groups. Within 5 days of treatment, median (IQR) Ct values were 26 (23-29) and 33 (30-37) in the remdesivir and nirmatrelvir/ritonavir groups, respectively (p < 0.0001). All patients were hospitalized for remdesivir administration and only four (9.8%) in the nirmatrelvir/ritonavir group. The overall outcomes in this cohort of COVID-19 patients with Omicron variant was good, as no patient needed oxygen or ICU admission. One patient in remdesivir group died from septic shock. No severe adverse event was recorded in both treatment groups. CONCLUSIONS: Patients with hematologic malignancies and non-severe COVID-19 who received nirmatrelvir/ritonavir experienced faster decrease in viral load and shorter viral shedding. Furthermore, besides the advantage of oral administration, nirmatrelvir/ritonavir administration reduced the need of hospital admission.


Assuntos
COVID-19 , Neoplasias Hematológicas , Lactamas , Leucina , Nitrilas , Prolina , Humanos , Ritonavir/uso terapêutico , SARS-CoV-2 , Corticosteroides , Antivirais/uso terapêutico , Tratamento Farmacológico da COVID-19
13.
Infect Dis Ther ; 13(4): 715-726, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38489118

RESUMO

INTRODUCTION: The impact of remdesivir on mortality in patients with COVID-19 is still controversial. We aimed to identify clinical phenotype clusters of COVID-19 hospitalized patients with highest benefit from remdesivir use and validate these findings in an external cohort. METHODS: We included consecutive patients hospitalized between February 2020 and February 2021 for COVID-19. The derivation cohort comprised subjects admitted to Hospital Clinic of Barcelona. The validation cohort included patients from Hospital Universitari Mutua de Terrassa (Terrassa) and Hospital Universitari La Fe (Valencia), all tertiary centers in Spain. We employed K-means clustering to group patients according to reverse transcription polymerase chain reaction (rRT-PCR) cycle threshold (Ct) values and lymphocyte counts at diagnosis, and pre-test symptom duration. The impact of remdesivir on 60-day mortality in each cluster was assessed. RESULTS: A total of 1160 patients (median age 66, interquartile range (IQR) 55-78) were included. We identified five clusters, with mortality rates ranging from 0 to 36.7%. Highest mortality rate was observed in the cluster including patients with shorter pre-test symptom duration, lower lymphocyte counts, and lower Ct values at diagnosis. The absence of remdesivir administration was associated with worse outcome in the high-mortality cluster (10.5% vs. 36.7%; p < 0.001), comprising subjects with higher viral loads. These results were validated in an external multicenter cohort of 981 patients. CONCLUSIONS: Patients with COVID-19 exhibit varying mortality rates across different clinical phenotypes. K-means clustering aids in identifying patients who derive the greatest mortality benefit from remdesivir use.

14.
Int J Infect Dis ; 144: 107070, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38663477

RESUMO

OBJECTIVES: Information is scarce on clinical experiences with non-neutropenic patients with invasive fungal infection (IFI) receiving isavuconazole. We aimed to report the safety and effectiveness of this drug as a first-line treatment or rescue in real life. METHODS: A retrospective, observational multicentric study of non-neutropenic patients who received isavuconazole as an IFI treatment at 12 different university hospitals (January 2018-2022). All patients met criteria for proven, probable or possible IFI according to EORTC-MSG. RESULTS: A total of 238 IFIs were treated with isavuconazole during the study period. Combination therapy was administered in 27.7% of cases. The primary IFI was aspergillosis (217, 91.2%). Other IFIs treated with isavuconazole were candidemia (n = 10), mucormycosis (n = 8), histoplasmosis (n = 2), cryptococcosis (n = 2), and others (n = 4). Median time of isavuconazole treatment was 29 days. Only 5.9% (n = 14) of cases developed toxicity, mainly hepatic-related (10 patients, 4.2%). Nine patients (3.8%) had treatment withdrawn. Successful clinical response at 12 weeks was documented in 50.5% of patients. CONCLUSION: Isavuconazole is an adequate treatment for non-neutropenic patients with IFIs. Toxicity rates were low and its effectiveness was comparable to other antifungal therapies previously reported.


Assuntos
Antifúngicos , Infecções Fúngicas Invasivas , Nitrilas , Piridinas , Triazóis , Humanos , Nitrilas/uso terapêutico , Nitrilas/efeitos adversos , Piridinas/uso terapêutico , Piridinas/efeitos adversos , Estudos Retrospectivos , Antifúngicos/uso terapêutico , Antifúngicos/efeitos adversos , Feminino , Masculino , Pessoa de Meia-Idade , Triazóis/uso terapêutico , Triazóis/efeitos adversos , Idoso , Infecções Fúngicas Invasivas/tratamento farmacológico , Adulto , Resultado do Tratamento , Idoso de 80 Anos ou mais , Aspergilose/tratamento farmacológico , Adulto Jovem
15.
Skin Res Technol ; 19(1): e273-8, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22672108

RESUMO

BACKGROUND/PURPOSE: Recent research on the age-dependent changes of facial skin has analyzed their correlation with changes in image and colorimetric properties using mainly first- and second-order statistics. The aim of this study is to reveal the importance of third-order statistics and relate those image properties to skin age perception. METHODS: Photographs of the faces of 118 Japanese women ranging in age from 13 to 80 years were taken in a controlled environment. Subsequently, 10 Japanese subjects rated the age perception of skin patches from the cheek area of the original facial images. RESULTS: The age estimation of the skin patches was highly correlated with its chronological age proving that our skin patches contain enough information for age estimation. Also, the perceived age was significantly high correlated to color and lightness statistical values. Specifically, age perception was significantly high correlated with third-order statistics of all channels in CIELAB1976. CONCLUSION: Our results reveal the importance of higher order statistics for the development of nonintrusive skin quality assessments of the skin.


Assuntos
Envelhecimento/psicologia , Processamento de Imagem Assistida por Computador/métodos , Percepção , Envelhecimento da Pele , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , Bochecha , Cor , Interpretação Estatística de Dados , Feminino , Humanos , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Julgamento , Pessoa de Meia-Idade , Fotografação , Adulto Jovem
16.
Microbiol Spectr ; 11(4): e0067423, 2023 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-37367629

RESUMO

Optimal coverage of Pseudomonas aeruginosa is challenging in febrile neutropenic patients due to a progressive increase in antibiotic resistance worldwide. We aimed to detail current rates of resistance to antibiotics recommended by international guidelines for P. aeruginosa isolated from bloodstream infections (BSI) in patients with hematologic malignancies. Secondarily, we aimed to describe how many patients received inappropriate empirical antibiotic treatment (IEAT) and its impact on mortality. We conducted a retrospective, multicenter cohort study of the last 20 BSI episodes caused by P. aeruginosa in patients with hematologic malignancies from across 14 university hospitals in Spain. Of the 280 patients with hematologic malignancies and BSI caused by P. aeruginosa, 101 (36%) had strains resistant to at least one of the ß-lactam antibiotics recommended in international guidelines, namely, cefepime, piperacillin-tazobactam, and meropenem. Additionally, 21.1% and 11.4% of the strains met criteria for MDR and XDR P. aeruginosa, respectively. Even if international guidelines were followed in most cases, 47 (16.8%) patients received IEAT and 66 (23.6%) received inappropriate ß-lactam empirical antibiotic treatment. Thirty-day mortality was 27.1%. In the multivariate analysis, pulmonary source (OR 2.22, 95% CI 1.14 to 4.34) and IEAT (OR 2.67, 95% CI 1.37 to 5.23) were factors independently associated with increased mortality. We concluded that P. aeruginosa-causing BSI in patients with hematologic malignancies is commonly resistant to antibiotics recommended in international guidelines, which is associated with frequent IEAT and higher mortality. New therapeutic strategies are needed. IMPORTANCE Bloodstream infection (BSI) caused by P. aeruginosa is related with an elevated morbidity and mortality in neutropenic patients. For this reason, optimal antipseudomonal coverage has been the basis of all historical recommendations in the empirical treatment of febrile neutropenia. However, in recent years the emergence of multiple types of antibiotic resistances has posed a challenge in treating infections caused by this microorganism. In our study we postulated that P. aeruginosa-causing BSI in patients with hematologic malignancies is commonly resistant to antibiotics recommended in international guidelines. This observation is associated with frequent IEAT and increased mortality. Consequently, there is a need for a new therapeutic strategy.


Assuntos
Bacteriemia , Neoplasias Hematológicas , Infecções por Pseudomonas , Sepse , Humanos , Antibacterianos/uso terapêutico , Pseudomonas aeruginosa , Estudos de Coortes , Estudos Retrospectivos , Infecções por Pseudomonas/tratamento farmacológico , Bacteriemia/tratamento farmacológico , Meropeném , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/tratamento farmacológico , Sepse/tratamento farmacológico
17.
Int J Infect Dis ; 118: 197-202, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35257905

RESUMO

OBJECTIVES: We described the current incidence and risk factors of bacterial co-infection in hospitalized patients with COVID-19. METHODS: Observational cohort study was performed at the Hospital Clinic of Barcelona (February 2020-February 2021). All patients with COVID-19 who were admitted for >48 hours with microbiological sample collection and procalcitonin (PCT) determination within the first 48 hours were included. RESULTS: A total of 1125 consecutive adults met inclusion criteria. Co-infections were microbiologically documented in 102 (9.1%) patients. Most frequent microorganisms were Streptococcus pneumoniae (79%), Staphylococcus aureus (6.8%), and Haemophilus influenzae (6.8%). Test positivity was 1% (8/803) for blood cultures, 10.1% (79/780) for pneumococcal urinary antigen test, and 11.4% (15/132) for sputum culture. Patients with PCT higher than 0.2, 0.5, 1, and 2 ng/mL had significantly more co-infections than those with lower levels (p=0.017, p=0.031, p<0.001, and p<0.001, respectively). In multivariate analysis, oxygen saturation ≤94% (OR 2.47, CI 1.57-3.86), ferritin levels <338 ng/mL (OR 2.63, CI 1.69-4.07), and PCT higher than 0.2 ng/mL (OR 1.74, CI 1.11-2.72) were independent risk factors for co-infection at hospital admission owing to COVID-19. CONCLUSIONS: Bacterial co-infection in patients hospitalized for COVID-19 is relatively common. However, clinicians could spare antibiotics in patients with PCT values <0.2, especially with high ferritin values and oxygen saturation >94%.


Assuntos
Infecções Bacterianas , COVID-19 , Coinfecção , Adulto , Infecções Bacterianas/microbiologia , COVID-19/epidemiologia , Coinfecção/epidemiologia , Ferritinas , Hospitais , Humanos , Pró-Calcitonina , Estudos Retrospectivos , SARS-CoV-2
18.
Appetite ; 54(2): 363-8, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20079392

RESUMO

We investigated the effect that the parameters of luminance distribution in fresh food have on our visual perception of its freshness. We took pictures of the degradation over 32 h in freshness of a cabbage. We used original images, which were patches of the pictures taken at different sampling hours, and artificially generated pictures, called "matched images," created by fitting the luminance histogram shape of the original image (taken at the 1st hour) to those at various freshness stages using a luminance histogram-matching algorithm. Nine participants rated the perceived freshness of the original and the matched images on a scale of degradation. As a result, we found that the participants could quantitatively estimate the degradation in freshness of the cabbage simply by looking at the presented images. Some parameters of the luminance histograms monotonically change with decreasing freshness, indicating that the freshness of cabbage can be estimated using these parameters. However, the freshness ratings for the matched images after the 8th hour of degradation had lower modification than those for the respective original images. These results suggest that the luminance distribution in the vegetable texture partly contributes to visual freshness perception but other variables, such as spatial patterns, might also be important for estimating visual freshness.


Assuntos
Brassica , Conservação de Alimentos/métodos , Iluminação , Percepção Visual , Adulto , Comportamento do Consumidor , Feminino , Conservação de Alimentos/normas , Humanos , Masculino , Fotografação , Fatores de Tempo , Adulto Jovem
19.
Data Brief ; 28: 105079, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32226816

RESUMO

This data article includes the visual stimuli used to model the freshness perception of four different vegetable textures, namely a cabbage, a carrot, a strawberry and a spinach. All four vegetables were optically measured during their degradation process in a humidity, temperature and light controlled environment. The visual data is in csv format for convenient usage. Each data point represents a pixel value using the hardware independent XYZ color space. The total size of the data can be related to an equivalent image of 1360 × 1024 resolution. Additionally, using the calibration data of an LCD-Display, the respective RGB color space images were derived from the XYZ data as an example. For interpretation and discussion, please see the original article entitled "Model of vegetable freshness perception using luminance cues" [1].

20.
Data Brief ; 22: 590-594, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30671504

RESUMO

This data article includes the visual stimuli used to test the categorization of a set of soft drink bottle silhouettes. Additionally, subjects' perceptual categorization was associated with each visual stimuli. The silhouette of the soft drink bottles was characterized by calculating the most common object shape measurements such as width, height and area and combining them with more complex and specific quantitative shape measurements such as the principal moment statistics. Finally, this data article includes the code for extracting these shape characteristics from image silhouettes. For interpretation and discussion, please see the original article entitled "Quantitative analysis of product categorization in soft drinks using bottle silhouettes" (Arboled and Arce-Lopera, 2015) [1].

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA