Resistance patterns of Enterobacteriaceae in urines are similar in symptomatic and asymptomatic patients.

Antibiograms of urine cultures are being used to guide empiric treatment for urinary tract infections (UTIs). However, roughly 50% of urine cultures are from patients with asymptomatic bacteriuria (ABU). It is unclear whether Enterobacteriaceae in ABU patients have similar resistance patterns as UTI patients. Hence, we aimed to compare the antimicrobial resistance patterns in patients with ABU to patients with symptomatic UTI. We found no major differences in resistance patterns, and therefore empiric treatment choices can be guided by antibiograms that include ABU patients.

Liver stiffness predicts the response to direct-acting antiviral-based therapy against chronic hepatitis C in cirrhotic patients.

The purpose of this investigation was to evaluate the impact of liver stiffness (LS) on the response to direct-acting antiviral (DAA)-based therapy against hepatitis C virus (HCV) infection in cirrhotic patients. Those patients included in two Spanish prospective cohorts of patients receiving therapy based on at least one DAA, who showed a baseline LS ≥ 12.5 kPa and who had reached the scheduled time point for sustained virological response evaluation 12 weeks after completing therapy (SVR12) were analysed. Pegylated interferon/ribavirin-based therapy plus an HCV NS3/4A protease inhibitor (PR-PI group) was administered to 198 subjects, while 146 received interferon-free regimens (IFN-free group). The numbers of patients with SVR12 according to an LS < 21 kPa versus ≥21 kPa were 59/99 (59.6%) versus 46/99 (46.5%) in the PR-PI group (p = 0.064) and 41/43 (95.3%) versus 90/103 (87.4%) in the IFN-free group (p = 0.232). Corresponding figures for the relapse rates in those who presented end-of-treatment response (ETR) were 3/62 (4.8%) versus 10/56 (17.9%, p = 0.024) and 1/42 (2.4%) versus 8/98 (8.2%, p = 0.278), respectively. In a multivariate analysis adjusted for age, sex and use of interferon, a baseline LS ≥ 21 kPa was identified as an independent predictor of relapse [adjusted odds ratio, AOR (95% confidence interval, CI): 4.228 (1.344-13.306); p = 0.014] in those patients with ETR. LS above 21 kPa is associated with higher rates of relapse to DAA-based therapy in HCV-infected patients with cirrhosis in clinical practice. LS could help us to tailor the duration and composition of DAA-based combinations in cirrhotic subjects, in order to minimise the likelihood of relapse.

Very low level viraemia and risk of virological failure in treated HIV-1-infected patients.

OBJECTIVES: The aim of the study was to investigate whether very low level viraemia (VLLV) (20-50 HIV-1 RNA copies/mL) was associated with increased risk of virological failure (VF) as compared with persistent full suppression (< 20 copies/mL). METHODS: From the VACH Cohort database, we selected those patients who started antiretroviral therapy (ART) after January 1997 and who achieved effective viral suppression [two consecutive viral loads (VLs) < 50 copies/mL] followed by full suppression (at least one VL <20 copies/mL). We carried out survival analyses to investigate whether the occurrence of VLLV rather than maintaining full suppression at < 20 copies/mL was associated with virological failure (two consecutive VLs > 200 copies/mL or one VL > 200 copies/mL followed by a change of ART regimen, administrative censoring or loss to follow-up), adjusted for nadir CD4 cell count, sex, age, ethnicity, transmission group, type of ART and time on effective suppression at < 50 copies/mL. RESULTS: Of 21 480 patients who started ART, 13 674 (63.7%) achieved effective suppression at < 50 copies/mL, of whom 4289 (31.4%) further achieved full suppression at < 20 copies/mL after May 2009. A total of 2623 patients (61.1%) remained fully suppressed thereafter, while 1666 had one or more episodes of VL detection > 20 copies/mL (excluding virological failure). A total of 824 patients had VLLV after suppression at < 20 copies/mL. VLLV was not associated with virological failure as compared with persistent full suppression [hazard ratio (HR) 0.67; 95% confidence interval (CI) 0.44-1.00], independently of the number of blips recorded (from one to 18). CONCLUSIONS: In our population of HIV-infected patients on ART who achieved viral suppression at < 20 copies/mL, the risk of virological failure was no different for patients who remained fully suppressed compared with those who experienced subsequent episodes of VLLV.

[Posterior reversible leukoencephalopathy in a patient with postpartum eclampsia]. / Leucoencefalopatía posterior reversible en una paciente con eclampsia posparto.

We report the clinical-radiological case of a 25 year-old female patient who developed reversible posterior leukoencephalopathy syndrome (RPLS) in the postpartum period, without evidence of preeclampsia-eclampsia or chronic arterial hypertension. RPLS is associated with diverse clinical entities including eclampsia. Ten days after giving birth, the patient presented with clinical symptoms of headache, elevated blood pressure and seizures. Reversible vasogenic oedema affecting the white matter in the posterior regions was the characteristic finding in magnetic resonance imaging (MRI) of the brain. Although the prognosis is favourable, treatment needs to be early and aggressive, with rapid control of the convulsions and arterial hypertension, with the aim of preventing ischemia and cerebral infarct from developing. There is a need to be highly alert and to consider the diagnosis of RPLS in women presenting with convulsions and other neurological symptoms in postpartum.

Leucoencefalopatía posterior reversible en una paciente con eclampsia posparto / Posterior reversible leukoencephalopathy in a patient with postpartum eclampsia

Describimos el caso clínico-radiológico de una paciente de 25 años que desarrolló una leucoencefalopatía posterior reversible (LPR) en el periodo posparto, sin evidencia de preeclampsiaeclampsia o hipertensión arterial crónica. La LPR se asocia a entidades clínicas diversas, incluyendo la eclampsia. La paciente presentó, diez días después del parto, un cuadro clínico compuesto por cefalea, hipertensión arterial y convulsiones. El edema vasogénico reversible que afecta a la sustancia blanca de las regiones posteriores constituye el hallazgo característico en la resonancia magnética cerebral. Aunque el pronóstico es favorable, el tratamiento debe ser precoz y agresivo, efectuando un control rápido de las convulsiones y de la hipertensión arterial, con la finalidad de evitar el desarrollo de isquemia e infarto cerebral. Es necesario tener un alto índice de sospecha y considerar el diagnóstico de eclampsia posparto y LPR en mujeres que presenten convulsiones y otros síntomas neurológicos en el puerperio

We report the clinical-radiological case of a 25 year-old female patient who developed reversible posterior leukoencephalopathy syndrome (RPLS) in the postpartum period, without evidence of preeclampsia-eclampsia or chronic arterial hypertension. RPLS is associated with diverse clinical entities including eclampsia. Ten days after giving birth, the patient presented with clinical symptoms of headache, elevated blood pressure and seizures. Reversible vasogenic oedema affecting the white matter in the posterior regions was the characteristic finding in magnetic resonance imaging (MRI) of the brain. Although the prognosis is favourable, treatment needs to be early and aggressive, with rapid control of the convulsions and arterial hypertension, with the aim of preventing ischemia and cerebral infarct from developing. There is a need to be highly alert and to consider the diagnosis of RPLS in women presenting with convulsions and other neurological symptoms in postpartum

Linfadenopatías axilares en un paciente con antecedentes de melanoma / No disponible

No disponible

Intoxicación por Nerium oleander / Nerium oleander poisoning

No disponible