Efectividad y eficiencia de la dalbavancina en condiciones reales de uso / Effectiveness and efficiency of dalbavancin in real clinical practice use

Objetivos: El tratamiento de las infecciones por Gram positivos supone un reto asistencial, en un contexto en el que están aumentando las resistencias antibióticas. La dalbavancina, gracias a su alta vida media y alta actividad frente a Gram positivos, puede ser una buena opción terapéutica. Nuestros objetivos son conocer los usos, efectividad y eficiencia de la dalbavancina en pacientes del Hospital General Universitario de Valencia. Métodos: Se realiza un estudio descriptivo retrospectivo y un análisis de costes de los pacientes tratados con dalbavancina en el Hospital General Universitario de Valencia. Resultados: 15 pacientes (con 17 episodios de infección) fueron incluidos, con un Charlson medio de 3,7. Se trataron 4 infecciones de piel y partes blandas, 6 infecciones osteoarticulares y 7 infecciones intravasculares, aislándose en el 70,6% de los casos un Gram positivo. La tasa de curación fue del 59%, sin efectos adversos por la dalbavancina ni exitus en relación con la infección. Se evitaron 239 días de hospitalización, lo cual supone un ahorro de 6.556,02 € por paciente. Conclusiones: Series clínicas como la actual permiten analizar el papel de la dalbavancina en la práctica médica habitual y demuestran su importante función en el ahorro de recursos económicos. (AU)

Objectives: The treatment of Gram-positive infections it’s a medical challenge, in a context in which antibiotic resistances are increasing. Dalbavancin, due to its long half-life and high activity against Gram-positive bacteria, could be a good therapeutic option. Our objectives are to know the uses, effectiveness and efficiency of dalbavancin in patients of the General University Hospital of Valencia. Methods: A retrospective descriptive study and a cost analysis of patients treated with dalbavancin are carried out at the General University Hospital of Valencia. Results: 15 patients (with 17 episodes of infection) were included, with a mean Charlson index of 3.7. Were treated 4 skin and soft tissue infections, 6 osteoarticular infections and 7 intravascular infections. A Gram-positive bacteria was isolated in 70.6% of the patients. The cure rate was 59%, with no adverse effects due to dalbavancin or death in relation to infection. 239 days of hospitalization were saved with outpatient treatment, which means a saving of € 6,556.02 per patient. Conclusions: Clinical series like ours allow us to analyse the role of dalbavancin in routine medical practice and demonstrate its important function in saving economic resources. (AU)

Horses are susceptible to natural, but resistant to experimental, infection with the liver fluke, Fasciola hepatica.

Fasciola hepatica is a common parasite of livestock in Ireland, causing significant economic losses and affecting animal welfare. A previous abattoir study of 200 horses led to an estimated 9.5 % prevalence of infection in horses slaughtered in Ireland. However, the epidemiology and pathogenic significance of this infection in this species is not well-described. The objectives of this study were to determine the susceptibility of horses to oral challenge infection with F. hepatica metacercariae, and to document the course of the infection along with serological and biochemical response. We attempted an experimental infection of horses (n = 10; 9 geldings and 1 mare) with F. hepatica. Four were given 1000 metacercariae, four 500 metacercariae and two were sham-infected. Blood and faecal samples were taken at intervals up to 18 weeks post-infection (wpi). ELISA assays were used to assess sero-conversion in the experimental horses and also in a panel of sera from horses of known fluke status. No flukes were recovered from any of the livers, and neither were any lesions that could be attributed to F. hepatica infection observed. Coproantigen ELISA was negative throughout for all horses. Three antibody detection ELISAs, useful in diagnosing fasciolosis in other species, had limitations as diagnostic aids as determined using a panel of sera from horses of known F. hepatica infection status. This study is limited by the relatively small number of animals included, and the relatively short duration of the study period. Failure to establish infection after oral challenge raises fundamental questions on the pathophysiology and epidemiology of equine fasciolosis.

Afectación cardiaca en pacientes con enfermedad hepática avanzada, más allá del síndrome hepatopulmonar / Cardiac involvement in patients with end-stage liver disease, beyond the hepatopulmonary syndrome

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One-year parasitological screening of stray dogs and cats in County Dublin, Ireland.

To date, there are no recent studies identifying the prevalence of parasites of human and veterinary importance in dogs and cats in Ireland. The interaction between pets and wildlife species in the environment is an important source of parasite exposure to canids and felines, and one likely to be heightened in the stray animal population. This study aimed to establish the prevalence of endoparasites in unowned dogs and cats in County Dublin, Ireland. Feces from stray dogs (n = 627) and cats (n = 289) entering a rehoming centre were collected immediately after defecation. The main parasitic agents detected were ascarids (15.52 and 30.26%), Cystoisospora (3.27 and 3.69%), Giardia spp. (6.02 and 1.84%) and lungworms (0.64 and 2.08%), in dogs and cats respectively. Animals younger than 3 months of age were more likely to be infected with ascarids (P < 0.001) and Cystoisospora spp. (P = 0.008 and P = 0.014) than older animals. All lungworms were morphologically identified and dogs were infected with Angiostrongylus vasorum (0.48%) and Crenosoma vulpis (0.16%) whereas cats were only infected with Aelurostrongylus abstrusus (2.08%). This represents the first prevalence study of stray animals in Ireland. Data collected will inform the treatment and in addition, the future monitoring and control studies of parasite populations.

Effect of early conversion to everolimus together with prophylaxis with valganciclovir in the prevention of cytomegalovirus infection in heart transplant recipients.

INTRODUCTION: Viral infections, especially cytomegalovirus (CMV), are a leading cause of early death and morbidity after heart transplantation. Several strategies have been used to minimize the risk, including universal prophylaxis with ganciclovir or valganciclovir and preemptive therapy. Lately, everolimus (EVE) efficacy studies have shown a protective effect against CMV infection. METHODS: We studied retrospectively a series of 223 heart transplant patients, dividing them into 5 groups according to CMV prevention strategy: 16 patients were at low risk for infection (negative recipient [R-]/negative donor [D-]) and received no treatment; 26 patients received prophylactic therapy with ganciclovir, 8 patients prophylaxis with valganciclovir, 145 patients received preemptive therapy and 28 patients prophylaxis with valganciclovir and early conversion to EVE. RESULTS: There were no cases of CMV infection in the low-risk group. There was 1 case of CMV infection in the group that received valganciclovir and conversion to EVE. Among the patients who received prophylaxis with ganciclovir or valganciclovir or preemptive therapy, CMV infection was detected in 68 patients (37%). CONCLUSIONS: Early conversion to EVE in addition to valganciclovir prophylaxis was superior to other strategies in our series for the prevention of CMV infection.

The worm turns: trematodes steering the course of co-infections.

A reductionist approach to the study of infection does not lend itself to an appraisal of the interactions that occur between 2 or more organisms that infect a host simultaneously. In reality, hosts are subject to multiple simultaneous influences from multiple pathogens along the spectrum from symbiotic microflora to virulent pathogen. In this review, we draw from our own work on Fasciola hepatica and that of others studying helminth co-infection to give examples of how such interactions can influence not only the outcome of infection but also its diagnosis and control. The new tools of systems biology, including both the "omics" approaches and mathematical biology, have significant promise in unraveling the as yet largely unexplored complexities of co-infection.

Rendimiento diagnóstico del estudio ecocardiográfico en el accidente cerebrovascular: ¿debemos mejorar la selección de los pacientes? / Diagnostic yield of echocardiography in stroke: should we improve patient selection?

Introducción: El pasado año la Sociedad Europea de Ecocardiografía publicó las recomendaciones para el empleo del ecocardiograma en la identificación de las potenciales fuentes embolígenas como causa de accidente isquémico cerebral en ausencia de otra enfermedad cerebrovascular. Tanto el ecocardiograma transtorácico como el ecocardiograma transesofágico desempeñan un papel fundamental en la evaluación, el diagnóstico y el manejo de la fuente embolígena. Debido en parte a la mayor longevidad de la población y a la mejor supervivencia de los pacientes cardiológicos, asistimos, actualmente, a un incremento progresivo de la solicitud de estudios ecocardiográficos como prueba diagnóstica; esto nos ha llevado a analizar críticamente el rendimiento de los mismos. Objetivo: Analizar la rentabilidad diagnóstica del ecocardiograma transtorácico en pacientes con diagnóstico de ictus isquémico en un hospital de tercer nivel. Material y métodos: Hemos analizado retrospectivamente todos los estudios ecocardiográficos solicitados durante el año 2010 desde el servicio de neurología con diagnóstico de ictus isquémico. Se ha estudiado la eficacia diagnóstica de la prueba y su aportación al diagnóstico etiológico en función de los hallazgos ecocardiográficos mayores y menores, según las recomendaciones de la Sociedad Europea de Ecocardiografía. Resultados: Se encontraron criterios ecocardiográficos mayores en 6 pacientes (5%) de los catalogados como de perfil embólico y en 2 (0,7%) de los no embólicos, siendo la diferencia estadísticamente significativa, p=0,005. A la vista de nuestros resultados, la realización de ETT en pacientes con ictus no embólicos tiene un bajo rendimiento diagnóstico, lo que nos lleva a plantearnos la rentabilidad del uso sistemático de esta prueba(AU)

Introduction: Last year the European Society of Echocardiography published recommendations for the use of echocardiography in identifying potential sources of embolism as a cause of ischaemic stroke in the absence of other cerebrovascular disease. Both transthoracic echocardiography (TTE) and transoesophageal echocardiography play a fundamental role in the assessment, diagnosis and management of the embolic source. Due, in part, to the increased longevity of the population and improved survival of cardiac patients, we are now seeing a gradual increase in the application of echocardiographic studies as a diagnostic test. This has led us to critically analyse their performance in the various pathologies. Objective: Our aim was to analyse the diagnostic yield of TTE in patients with cerebrovascular accident in a tertiary hospital. Materials and methods: For this, we retrospectively analysed all echocardiographic studies during 2010 requested from the Neurology Department with a diagnosis of stroke. We have studied the diagnostic yield of the test and its contribution to the etiological diagnosis based on major and minor echocardiographic criteria as recommended by the European Society of Echocardiography. Results: We found major echocardiographic criteria in 6 patients (5%) with embolic stroke and in 2 (0.7%) non-embolic stroke, P=0.005. In view of our results, the performance of TTE in patients with embolic stroke has a low diagnostic yield, which leads us to consider the systematic use of this technique(AU)

Diagnostic yield of echocardiography in stroke: should we improve patient selection?

INTRODUCTION: Last year the European Society of Echocardiography published recommendations for the use of echocardiography in identifying potential sources of embolism as a cause of ischemic stroke in the absence of other cerebrovascular diseases. Both transthoracic echocardiography and transesophageal echocardiography play a fundamental role in the assessment, diagnosis and management of the embolic source. Due in part to the increased longevity of the population and improved survival of cardiac patients, we are now seeing a gradual increase in the application of echocardiographic studies as a diagnostic test. This has led us to critically analyse their performance in detecting various pathologies. OBJECTIVE: Our aim was to analyse the diagnostic yield of transthoracic echocardiography in patients with cerebrovascular accident in a tertiary hospital. MATERIAL AND METHODS: To this end, we retrospectively analysed all echocardiographic studies during 2010 requested from the Neurology Department with a diagnosis of stroke. We have studied the diagnostic yield of the test and its contribution to the etiological diagnosis based on major and minor echocardiographic criteria as recommended by the European Society of Echocardiography. RESULTS: We found major echocardiographic criteria in 6 patients (5%) with embolic stroke and in 2 (0.7%) non embolic, P=.005. In view of our results, the performance of transthoracic echocardiography in patients with embolic stroke has a low diagnostic yield, which leads us to question systematic use of this technique.