Role of age and comorbidities in mortality of patients with infective endocarditis.

PURPOSE: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. METHODS: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. RESULTS: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. CONCLUSION: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.

Diagnóstico, Evaluación y Manejo de la Enfermedad Renal en el Embarazo / Diagnosis, Evaluation, and Management of renal diseases during Pregnancy

Introducción: La elevada prevalencia de enfermedad renal crónica y otras enfermedades no transmisibles crónicas, unido al incremento en la edad de embarazo ha generado nuevas investigaciones y evidencias de la relación entre la enfermedad renal crónica, el embarazo y los resultados para la madre y el feto. Objetivo: Exponer las mejores prácticas actuales y ofrece una aproximación al diagnóstico, evaluación y tratamiento de la enfermedad renal en el contexto del embarazo y su repercusión en términos de morbilidad y mortalidad para la madre y el feto. Material y Métodos: Se realizó un análisis de la literatura describiendo los mejores resultados clínicos basado en los avances científicos a la fecha actual. Resultados: Se enfatiza la evolución continua entre el daño renal agudo (incipiente) y la falla renal aguda (con necesidad de métodos dialíticos sustitutivos), también de importancia pronóstica con incrementos en la mortalidad materna asociados a pequeños incrementos en la creatinina sérica. Conclusiones: Tanto el desarrollo de un daño renal agudo, la falla renal aguda y la enfermedad renal crónica son causas importantes de morbilidad y mortalidad materno fetal(AU)

Introduction: The high prevalence of chronic kidney disease and others non contagiables diseases, jointly with its increasing frequency in gestational age women have generated new investigations and evidences of the relationship between the chronic renal diseases, the pregnancy and its consequence for the mother and fetus.Objective: This paper summarizes the best practice up to this date and provides a reasonable approach to the diagnosis, evaluation, and treatment of the Renal Disease Disorders of Pregnancy to evaluate the impact of them on maternal and fetal morbidity and mortality.Material and Methods: An analysis of the published literature of the subject was performed, describing the best clinical results based on scientific advances available today. Results: Was emphasized the continuum evolution between acute kidney damage (incipient injury) and acute kidney failure (need to dialysis) also of importance for prognosis, with increasing of the mortality associated with small increases in serum creatinine. Conclusions: The acute kidney diseases/ acute renal failure and chronic renal diseases are important causes of maternal and perinatal morbidity - mortality(AU)

Diagnóstico, Evaluación y Manejo de la Enfermedad Renal en el Embarazo / Diagnosis, Evaluation, and Management of renal diseases during Pregnancy

Introducción: La elevada prevalencia de enfermedad renal crónica y otras enfermedades no transmisibles crónicas, unido al incremento en la edad de embarazo ha generado nuevas investigaciones y evidencias de la relación entre la enfermedad renal crónica, el embarazo y los resultados para la madre y el feto. Objetivo: Exponer las mejores prácticas actuales y ofrece una aproximación al diagnóstico, evaluación y tratamiento de la enfermedad renal en el contexto del embarazo y su repercusión en términos de morbilidad y mortalidad para la madre y el feto. Material y Métodos: Se realizó un análisis de la literatura describiendo los mejores resultados clínicos basado en los avances científicos a la fecha actual. Resultados: Se enfatiza la evolución continua entre el daño renal agudo (incipiente) y la falla renal aguda (con necesidad de métodos dialíticos sustitutivos), también de importancia pronóstica con incrementos en la mortalidad materna asociados a pequeños incrementos en la creatinina sérica. Conclusiones: Tanto el desarrollo de un daño renal agudo, la falla renal aguda y la enfermedad renal crónica son causas importantes de morbilidad y mortalidad materno fetal(AU)

Introduction: The high prevalence of chronic kidney disease and others non contagiables diseases, jointly with its increasing frequency in gestational age women have generated new investigations and evidences of the relationship between the chronic renal diseases, the pregnancy and its consequence for the mother and fetus. Objective: This paper summarizes the best practice up to this date and provides a reasonable approach to the diagnosis, evaluation, and treatment of the Renal Disease Disorders of Pregnancy to evaluate the impact of them on maternal and fetal morbidity and mortality. Material and Methods: An analysis of the published literature of the subject was performed, describing the best clinical results based on scientific advances available today. Results: Was emphasized the continuum evolution between acute kidney damage (incipient injury) and acute kidney failure (need to dialysis) also of importance for prognosis, with increasing of the mortality associated with small increases in serum creatinine. Conclusions: The acute kidney diseases/ acute renal failure and chronic renal diseases are important causes of maternal and perinatal morbidity - mortality(AU)

Películas infantiles como alternativa a la sedación en el estudio ecocardiográfico de pacientes pediátricos

Introducción. La realización del ecocardiograma se dificulta si el niño no coopera, por lo que es necesario sedarlo. Para evitar los posibles efectos adversos de la sedación se ha propuesto utilizar la proyección de películas infantiles durante el estudio. Material y métodos. Se formaron 2 grupos de pacientes no cooperadores entre 1 y 3 años de edad de manera aleatoria: uno sometido a sedación (13 niños) y otro al que se proyectó una película infantil (15 niños). En ambos grupos se evaluaron escalas semicuantitativas de cooperación, calidad de imagen y el tiempo de realización del estudio. Resultados. No se encontró diferencia estadísticamente significativa entre ambos grupos en cuanto a las escalas de cooperación y calidad de imagen, así como en el tiempo de realización del estudio. Conclusiones. Este método evita la exposición a los riesgos de la sedación, obteniendo cooperación e información similares, y pudiera disminuir los recursos necesarios para la realización del estudio.

Introduction. It is often difficult to perform echocardiograms in small children because of lack of cooperation, hence the need for sedation. In order to avoid the possible adverse effects of sedation, the projection of age-appropriate films during the study has been proposed as an alternative. Material and methods. Pediatric non-cooperative patients, ages between 1 and 3 years old with an indication for elective echocardiography were randomly assigned to either 1 of 2 groups: the first one (13 patients) with intranasal midazolam sedation (300 mg/kg), and the other group (15 patients) with video-projection of movies. Cooperation and image quality scores differences were evaluated (Mann-Whitney), as well as the mean study performance time between the 2 groups. Results. Cooperation and image quality scores were similar between the 2 groups. There was a trend toward a shorter mean study performance time in the video group, not reaching statistical significance. Conclusions. Projection of age-appropriate movies during echocardiographic studies in pediatric non-cooperative patients is a good alternative to sedation, avoiding related risks and resource expenditure with similar cooperation and echocardiographic information.