Miliary pattern, a classic pulmonary finding of tuberculosis disease.

INTRODUCTION: The increase in age of the population and in the use of immunosuppressive treatment makes tuberculosis (TB) with hematogenous or lymphatic dissemination a current problem. METHODS: We collected all the patients diagnosed with tuberculosis with miliary pulmonary pattern at the Santiago de Compostela University Teaching Hospital (NW Spain) from 1 January 2006 to 31 December 2015. RESULTS: A total of 27 patients were included, 70.4% women, with a median age of 69.0 years old. A cause of immunosuppression was observed only in 51.9% of patients. The majority of the cases (65.0%) presented pulmonary affectation. The most frequently isolated species was Mycobacterium tuberculosis (88.9%). Multiresistance to first-line antituberculosis drugs was observed only in 3.7%. 92.6% of the patients received treatment with Isoniazid, Rifampicin and Pyrazinamine, associated in 48.1% of them with Ethambutol. Two patients died during admission and there were no recurrences in the 2-years follow-up. CONCLUSIONS: Miliary tuberculosis remains a current pathology. Most patients do not have a known cause of immunosuppression. The response to the typical treatment is usually good.

Analysis of predisposing factors for the development of Clostridioides difficile infection recurrence.

AbstractThe purpose of this study is to evaluate the influence of several risk factors and, among them, the role of different types of antibiotics, in the development of the first recurrent episode of Clostridioides difficile (CD) infection. We performed a case control study from 2006 to 2016. We included patients admitted to the hospital with CD infection that received any antibiotic treatment during the year before the onset of the infection. First, we described the characteristics of CD infection in a Spanish third level hospital and then we compared first cases of CD infection that presented recurrence with those that did not. We included 110 cases, corresponding to 94 individuals. There were 14 first CD infection episodes that later presented recurrence (12.7%). Receiving more than 3 types of antibiotics during the year before the onset of symptoms was associated with higher risk of presenting a recurrent episode (OR = 4.69, 95% CI 1.01-21.78), as well as the past history of neoplasia (OR = 4.58, 95% CI 1.00-20.98). The number of previous hospital admissions was associated with the development of recurrences in the univariate study (p < 0.05). No differences were observed related to the type of antibiotic used immediately before the CD episode neither with the treatment received. The number of types of antibiotics used during the year before the first episode of CD infection or having a personal history of neoplasia was associated with 4 times higher risk of recurrent episodes. Type of antibiotic used did not show to influence recurrences.

Q fever in Spain: Description of a new series, and systematic review.

BACKGROUND: Forms of presentation of Q fever vary widely across Spain, with differences between the north and south. In the absence of reported case series from Galicia (north-west Spain), this study sought to describe a Q-fever case series in this region for the first time, and conduct a systematic review to analyse all available data on the disease in Spain. METHODS: Patients with positive serum antibodies to Coxiella burnetii from a single institution over a 5-year period (January 2011-December 2015) were included. Patients with phase II titres above 1/128 (or documented seroconversion) and compatible clinical criterial were considered as having Q fever. Patients with clinical suspicion of chronic Q-fever and IgG antibodies to phase I-antigen of over 1/1024, or persistently high levels six months after treatment were considered to be cases of probable chronic Q-fever. Systematic review: We conducted a search of the Pubmed/Medline database using the terms: Q Fever OR Coxiella burnetii AND Spain. Our search yielded a total of 318 studies: 244 were excluded because they failed to match the main criteria, and 41 were discarded due to methodological problems, incomplete information or duplication. Finally, 33 studies were included. RESULTS: A total of 155 patients, all of them from Galicia, with positive serological determination were located during the study period; 116 (75%) were deemed to be serologically positive patients without Q fever and the remaining 39 (25%) were diagnosed with Q fever. A potential exposure risk was found in 2 patients (5%). The most frequent form of presentation was pneumonia (87%), followed by isolated fever (5%), diarrhoea (5%) and endocarditis (3%). The main symptoms were headache (100%), cough (77%) and fever (69%). A trend to a paucisymptomatic illness was observed in women. Hospital admission was required in 37 cases, and 6 patients died while in hospital. Only 2 patients developed chronic Q-fever. Systematic review: Most cases were sporadic, mainly presented during the winter and spring, as pneumonia in 37%, hepatitis in 31% and isolated fever in 29.6% of patients. In the north of Spain, 71% of patients had pneumonia, 13.2% isolated fever and 13% hepatitis. In the central and southern areas, isolated fever was the most frequent form of presentation (40%), followed by hepatitis (38.4%) and pneumonia (17.6%). Only 31.7% of patients reported risk factors, and an urban-environment was the most frequent place of origin. Overall mortality was 0.9%, and the percentage of patients with chronic forms of Q-fever was 2%. CONCLUSIONS: This is the first study to report on a Q-fever case series in Galicia. It shows that in this region, the disease affects the elderly population -even in the absence of risk factors- and is linked to a higher mortality than reported by previous studies. While pneumonia is the most frequent form of presentation in the north of the country, isolated fever and hepatitis tend to be more frequent in the central and southern areas. In Spain, 32% of Q-fever cases do not report contact with traditional risk factors, and around 58% live in urban areas.

Skin and soft-tissue infections: Factors associated with mortality and re-admissions / Infecciones de piel y partes blandas: factores asociados a mortalidad y reingreso

INTRODUCTION: Skin and soft-tissue infections (SSTIs) are common and are linked to a wide variety of clinical conditions. Few studies have analysed the factors associated with mortality and re-admissions in medical patients with SSTIs. Accordingly, this study sought to describe the clinical and microbiological characteristics of patients diagnosed with SSTIs, and identify mortality and re-admission related factors. PATIENTS AND METHODS: A total of 308 patients were included in the study. Clinical, socio-demographic and microbiological characteristics were collected. Univariate and logistic regression multivariate analyses were performed in order to identify factors associated with mortality and re-admission. RESULTS: The bacteria responsible were identified in 95 (30.8%) patients, with gram-positive bacteria being isolated in 67.4% and gram-negative in 55.8% of cases. Multi-resistant bacteria were frequent (39%), and the initial empirical treatment proved inadequate in 25.3% of all cases. In-hospital mortality was 14.9%; the related variables were heart failure (OR=5.96; 95%CI: 1.93-18.47), chronic renal disease (OR=6.04; 95%CI: 1.80-20.22), necrotic infection (OR=4.33; 95%CI: 1.26-14.95), and inadequate empirical treatment (OR=44.74; 95%CI: 5.40-370.73). Six-month mortality was 8%, with the main related factors being chronic renal disease (OR: 3.03; 95%CI: 1.06-8.66), and a Barthel Index score of under 20 (OR: 3.62; 95%CI: 1.17-11.21). Re-admission was necessary in 26.3% of cases, with the readmission-related variables being male gender (OR: 2.12; 95%CI: 1.14-3.94), peripheral vascular disease (OR: 3.05; 95%CI: 1.25-7.41), and an age-adjusted Charlson Comorbidity Index score of over 3 (OR: 3.27; 95%CI: 1.40-7.63). CONCLUSIONS: Clinical variables such as heart failure, chronic renal disease, peripheral vascular disease, and necrotic infection could help identify high-risk patients. The main factor associated with higher mortality was inadequate initial empirical treatment. Physicians should consider gram-negative, and even extended-spectrum beta-lactamase-producing bacteria when assigning initial empirical treatment for SSTIs, especially in healthcare-associated cases

INTRODUCCIÓN: Las infecciones de piel y partes blandas (IPPB) son frecuentes y se asocian a una amplia variedad de presentaciones clínicas. Los factores asociados a mortalidad y reingreso en pacientes con IPPB han sido poco estudiados hasta ahora. En este sentido, el objetivo del presente trabajo es describir las características clínicas y microbiológicas de pacientes diagnosticados de IPPB e identificar factores asociados a mortalidad y reingreso en ellos. PACIENTES Y MÉTODOS: Fueron incluidos un total de 308 pacientes. Se realizó una descripción de las características clínicas, sociodemográficas y microbiológicas. Se llevaron a cabo análisis uni y multivariantes de regresión logística para identificar factores asociados a mortalidad y reingreso en pacientes con IPPB. RESULTADOS: Los microorganismos responsables fueron identificados en 95 (30,8%) pacientes, de ellos el 67,4% presentaban bacterias grampositivas y el 55,8%, gramnegativas. La presencia de bacterias multirresistentes fue frecuente (39%) y el tratamiento empírico fue inadecuado en el 25,3% de los casos. La mortalidad intrahospitalaria fue del 14,9% y las variables asociadas a ella fueron la insuficiencia cardiaca (OR=5,96; IC95%: 1,93-18,47), la insuficiencia renal crónica (OR=6,04; IC95%: 1,80-20,22), la infección necrótica (OR=4,33; IC95%: 1,26-14,95) y el tratamiento antibiótico empírico inadecuado (OR=44,74; IC95%: 5,40-370,73). La mortalidad a 6 meses fue del 8%, y los principales factores asociados, la insuficiencia renal crónica (OR=3,03; IC95%: 1,06-8,66) y una puntuación en el índice de Barthel inferior a 20 puntos (OR=3,62; IC95%: 1,17-11,21). Reingresaron durante el seguimiento a 6meses el 26,3% de los pacientes; las variables asociadas a este hecho fueron el sexo masculino (OR=2,12; IC95%: 1,14-3,94), la enfermedad vascular periférica (OR=3,05; IC95%: 1,25-7,41) y una puntuación en el índice de Charlson ajustado por edad superior a 3puntos (OR=3,27; IC95%: 1,40-7,63). CONCLUSIONES: Variables clínicas como la insuficiencia cardiaca, la insuficiencia renal crónica, la enfermedad vascular periférica y la infección necrótica podrían ayudar a identificar pacientes con IPPB de alto riesgo. El principal factor asociado a una mayor mortalidad fue el tratamiento antibiótico empírico inadecuado. Debería considerarse la posibilidad de que bacterias gramnegativas, o incluso enterobacterias productoras de betalactamasas de espectro extendido, sean las responsables de IPPB, sobre todo en casos asociados a los cuidados sanitarios, a la hora de plantear el tratamiento antibiótico empírico en estos pacientes

Skin and soft-tissue infections: Factors associated with mortality and re-admissions.

INTRODUCTION: Skin and soft-tissue infections (SSTIs) are common and are linked to a wide variety of clinical conditions. Few studies have analysed the factors associated with mortality and re-admissions in medical patients with SSTIs. Accordingly, this study sought to describe the clinical and microbiological characteristics of patients diagnosed with SSTIs, and identify mortality and re-admission related factors. PATIENTS AND METHODS: A total of 308 patients were included in the study. Clinical, socio-demographic and microbiological characteristics were collected. Univariate and logistic regression multivariate analyses were performed in order to identify factors associated with mortality and re-admission. RESULTS: The bacteria responsible were identified in 95 (30.8%) patients, with gram-positive bacteria being isolated in 67.4% and gram-negative in 55.8% of cases. Multi-resistant bacteria were frequent (39%), and the initial empirical treatment proved inadequate in 25.3% of all cases. In-hospital mortality was 14.9%; the related variables were heart failure (OR=5.96; 95%CI: 1.93-18.47), chronic renal disease (OR=6.04; 95%CI: 1.80-20.22), necrotic infection (OR=4.33; 95%CI: 1.26-14.95), and inadequate empirical treatment (OR=44.74; 95%CI: 5.40-370.73). Six-month mortality was 8%, with the main related factors being chronic renal disease (OR: 3.03; 95%CI: 1.06-8.66), and a Barthel Index score of under 20 (OR: 3.62; 95%CI: 1.17-11.21). Re-admission was necessary in 26.3% of cases, with the readmission-related variables being male gender (OR: 2.12; 95%CI: 1.14-3.94), peripheral vascular disease (OR: 3.05; 95%CI: 1.25-7.41), and an age-adjusted Charlson Comorbidity Index score of over 3 (OR: 3.27; 95%CI: 1.40-7.63). CONCLUSIONS: Clinical variables such as heart failure, chronic renal disease, peripheral vascular disease, and necrotic infection could help identify high-risk patients. The main factor associated with higher mortality was inadequate initial empirical treatment. Physicians should consider gram-negative, and even extended-spectrum beta-lactamase-producing bacteria when assigning initial empirical treatment for SSTIs, especially in healthcare-associated cases.

Estudio venezolano de nutrición y salud: perfil antropométrico y patrón de actividad física. Grupo del estudio latinoamericano de nutrición y salud / Venezuelan study of nutrition and health: anthropometric profile and physical activity pattern. Latin american nutrition and health study group

Investigaciones epidemiológicas reconocen la importancia de la actividad física en la promoción de la salud especialmente en el campo de las enfermedades cardiovasculares y la obesidad. El Estudio Latinoamericano de Nutrición y Salud (ELANS) en Venezuela, de corte transversal, ejecutado entre 2015, definió el perfil antropométrico y evaluó el patrón de actividad física de la población venezolana entre 15 y 65 años. La muestra polietápica, estratificada por regiones (Capital, Oriental, Llanos, Central, Guayana, Andes y Occidental), incluyó 1132 individuos según edad, sexo y estrato social. Se utilizó el cuestionario IPAQ, versión larga y se investigó actividades en el tiempo libre y transporte activo (caminata y bicicleta). Los hombres presentaron más sobrepeso y las mujeres más obesidad con predominio de distribución abdominal desde temprana edad. La obesidad cervical (OC) por circunferencia de cuello, fue mayor en hombres. El transporte principal fue el autobús (67%) en los tres estratos socioeconómicos y en todas las regiones. El 63% realizaron caminatas de al menos 10 minutos diarios para trasladarse de un lugar a otro con diferencias por sexo, región y frecuencia. Los hombres ejecutaron más actividad vigorosa (futbol) y en general 34,9% prefirió el baile y coreografías. La conducta sedentaria como ver televisión (92,1%), sentarse a hablar con amigos (80,5%), hablar por teléfono (74,8%) y uso de computadora e internet (52,6%), presentó diferencias significativas por región. El entorno de vivienda se caracterizó por buena accesibilidad a servicios en los alrededores, altos niveles de inseguridad y pobre iluminación en su zona y lugares de recreación(AU)

Epidemiological researches are aware of the importance of physical activity in health promotion, especially in the area of cardiovascular disease and obesity. The Latin American study of nutrition and health (ELANS) Venezuelan group, developed a polietapic cross-sectional research during years 2014-2015. Present study characterized anthropometric profiles and habitual physical activity, during leisure time and active transportation (walking and biking) using the long version of the IPAQ questionnaire. The study comprised 1132 Venezuelan subjects15 to 65 years of age, previously defined by socio-economic and demographic factors. Taking these parameters into account, the following regions were selected: Capital, Oriental, Los Llanos, Central, Guayana, Andes and Occidental. Males showed more overweight and females greater obesity. Abdominal obesity characterized both groups with dominance and at early age in women. The main transportation was BY bus (67%) in the three socio-economic strata and in all the regions. 63% performed for at least 10 minutes daily walking to move from one place to another with differences by sex, region and frequency. The male group performed more vigorous activity (soccer) and in general, 34.9% preferred dance and choreography. The environment of sedentary behavior with significant differences by region was defined by watching television (92.1%), sitting and talking with friends (80.5%), talking on the phone (74.8%), and the use of computer and internet (52.6%). The home environment was characterized by proximity to services in the surroundings, and high levels of insecurity in their area and places of recreation, mainly associated with the absence of street lighting(AU)

Piomiositis por Escherichia coli en un paciente en tratamiento crónico con glucocorticoides / Pyomiositis caused by Escherichia coli in a patient on chronic glucocorticoid treatment

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The influence of gender stereotypes on eating habits among Costa Rican adolescents.

PURPOSE: To identify the influence of gender stereotypes on eating habits among Costa Rican adolescents. DESIGN: Qualitative, descriptive research was used in this study. SETTING: Adolescents and parents were recruited from socioeconomically diverse populations in rural and urban areas of San José, Costa Rica. SUBJECTS: Subjects were 92 adolescents (14 to 17 years old) and 48 parents. METHODS: Focus group data were transcribed and entered into the qualitative data analysis software Atlas.ti version 5.0. Analyses were grounded on the social cognitive theory. RESULTS: Five themes emerged from the focus group discussions: (1) Costa Rican adolescents associate the consumption of moderate quantities of healthy foods with femininity and male homosexuality. (2) The consumption of hearty portions of nonhealthy foods was associated with masculinity and male heterosexuality. (3) There is an emerging view that it is acceptable for heterosexual male adolescents to take care of their bodies through healthy eating. (4) Body care among female adolescents is an element of femininity and body image. (5) Parents reinforce their daughters' persistent concern with weight control because they perceive it as feminine behavior. CONCLUSION: Health promoters should be aware of the existing and changing food stereotypes around gender as an avenue for the promotion of healthy eating.

Parental feeding styles and adolescents' healthy eating habits. Structure and correlates of a Costa Rican questionnaire.

This study designed and validated a questionnaire aimed at examining parental feeding styles to encourage healthy eating habits among Costa Rican adolescents. Adolescents (n=133; mean age 15.4 years), and their parents, participated in the study. The parents completed a parental feeding style questionnaire, and the adolescents completed 3-day food records. Confirmatory factor analyses suggest four distinct parental feeding styles, (a) verbal encouragement of healthy eating behaviors; (b) use of verbal sanctions to indirectly control the intake of healthy food; (c) direct control of access to and intake of food; and (d) use of food to regulate emotions and behavior. There were no correlations between dietary intake and the verbal encouragement of healthy eating behaviors, but there were significant negative correlations between (1) "the use of verbal sanctions to indirectly control the intake of healthy food", and the consumption of fruit and vegetable, of calcium, iron, vitamin B6 and folic acid intake, and (2) between the "direct control of access to and intake of food" and fast food consumption and total carbohydrates intake. The use of food to regulate emotions and behavior was positively correlated with high energy-dense food consumption. Stratification of the data shows significant differences by gender in the correlations between parental feeding style and dietary intake. Understanding parental feeding styles in a Latin American context is a first step in helping researchers develops culturally-appropriate parenting intervention/prevention strategies to encourage healthy eating behaviors during adolescence.