RESUMO
BACKGROUND: To understand the effects of frailty, geriatric syndromes, and comorbidity on quality of life and mortality in older adults with HIV (OAWH). METHODS: Cross-sectional study of the FUNCFRAIL multicenter cohort. The setting was outpatient HIV-Clinic. OAWH, 50 year or over were included. We recorded sociodemographic data, HIV infection-related data, comorbidity, frailty, geriatric syndromes (depression, cognitive impairment, falls and malnutrition), quality of life (QOL) and the estimated risk of all-cause 5-year mortality by VACS Index. Association of frailty with geriatric syndromes and comorbidity was evaluated using the Cochran-Mantel-Haenszel test. RESULTS: Seven hundred ninety six patients were included. 24.7% were women, mean age was 58.2 (6.3). 14.7% were 65 or over. 517 (65%) patients had ≥3 comorbidities, ≥ 1 geriatric syndrome and/or frailty. There were significant differences in the estimated risk of mortality [(frailty 10.8%) vs. (≥ 3 comorbidities 8.2%) vs. (≥ 1 geriatric syndrome 8.2%) vs. (nothing 6.2%); p = 0.01] and in the prevalence of fair or poor QOL [(frailty 71.7%) vs. (≥ 3 comorbidities 52%) vs. (≥ 1 geriatric syndrome 58.4%) vs. (nothing 51%); p = 0.01]. Cognitive impairment was significantly associated to mortality (8.7% vs. 6.2%; p = 0.02) and depression to poor QOL [76.5% vs. 50%; p = 0.01]. CONCLUSIONS: Frailty, geriatric syndromes, and comorbidity had negative effects on mortality and QOL, but frailty had the greatest negative effect out of the three factors. Our results should be a wake-up call to standardize the screening for frailty and geriatric syndromes in OAWH in the clinical practice. TRIAL REGISTRATION: NCT03558438.
Assuntos
Fragilidade , Infecções por HIV , Humanos , Feminino , Idoso , Masculino , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Fragilidade/psicologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Qualidade de Vida , HIV , Síndrome , Estudos Transversais , Comorbidade , Avaliação Geriátrica/métodos , Idoso FragilizadoRESUMO
BACKGROUND AND OBJECTIVES: Available information about infection after spine instrumentation (IASI) and its management are scarce. We aimed to analyse DAIR (debridement, antibiotics and implant retention) prognosis and evaluate effectiveness of short antibiotic courses on early forms. METHODS: Multicentre retrospective study of patients with IASI managed surgically (January 2010-December 2016). Risk factors for failure were analysed by multivariate Cox regression and differences between short and long antibiotic treatment were evaluated with a propensity score-matched analysis. RESULTS: Of the 411 IASI cases, 300 (73%) presented in the first month after surgery, 48 in the second month, 22 in the third and 41 thereafter. Infections within the first 2 months (early cases) occurred mainly to older patients, with local inflammatory signs and predominance of Enterobacteriaceae, unlike those in the later periods. When managed with DAIR, prognosis of early cases was better than later ones (failure rate 10.4% versus 26.1%, respectively; P = 0.02). Risk factors for DAIR failure in early cases were female sex, Charlson Score, large fusions (>6 levels) and polymicrobial infections (adjusted HRs of 2.4, 1.3, 2.6 and 2.26, respectively). Propensity score matching proved shorter courses of antibiotics (4-6 weeks) as effective as longer courses (failure rates 11.4% and 10.5%, respectively; P = 0.870). CONCLUSIONS: IASIs within the first 2 months could be managed effectively with DAIR and shorter antibiotic courses. Clinicians should be cautious when faced with patients with comorbidities, large fusions and/or polymicrobial infections.
Assuntos
Infecções Relacionadas à Prótese , Antibacterianos/uso terapêutico , Desbridamento , Feminino , Humanos , Infecções Relacionadas à Prótese/tratamento farmacológico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: We present a case-control study of non-AIDS-defining cancers (NADCs) in a cohort of HIV-infected patients where we value the incidence, survival and prognostic factors of mortality. METHODS: All NADCs diagnosis conducted from 2007 to 2011 in 7 hospitals were collected prospectively, with a subsequent follow up until December 2013. A control group of 221 HIV patients without a diagnosis of cancer was randomly selected. RESULTS: Two hundred and twenty-one NADCs were diagnosed in an initial cohort of 7,067 HIV-infected patients. The most common were: hepatocellular carcinoma 20.5%, lung 18.7%, head and neck 11.9% and anal 10.5%. The incidence rate of NADCs development was 7.84/1,000 people-year. In addition to aging and smoking, time on ART (OR 1.11; 95% CI 1.05-1.17) and PI use (OR 1.72; 95% CI 1.0-2.96) increased the risk of developing a NADC. During follow-up 53.42% died, with a median survival time of 199.5 days. In the analysis of the prognostic factors of mortality the low values of CD4 at tumour diagnosis (OR 0.99; 95% CI 0.99-1.0; P=.033), and the previous diagnosis of AIDS (OR 2.06; 95% CI 1.08-3.92) were associated with higher mortality. CONCLUSIONS: Predictors of NADCs in our cohort were age, smoking, CD4 lymphocytes and time on ART. Mortality is high, with NADC risk factors being low CD4 count and previous diagnosis of AIDS.
Assuntos
Infecções por HIV/complicações , Neoplasias/complicações , Neoplasias/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Taxa de SobrevidaRESUMO
Introduction. The incidence of infective endocarditis is progressively increasing, especially in elderly patients. Outpatient parenteral antibiotic therapy (OPAT) is being an excellent alternative for treatment, but advanced age is one of the relative contraindications. The aim of this study is to compare the characteristics and prognosis of patients less or more than 80 years, treated with OPAT. Material and methods. One hundred and ninety four pa-tients were included between 1996 and 2015, 31 of them older than 80 years. Results. The most frequently affected valve is the aortic one, mainly native valves. Most used antibiotics are ceftriaxone, ampicillin, cloxacillin and daptomycin. Differences in surgery (39.9% vs 9.7%, p=0.001) and use of infusion pump (55.2% vs 35.5%; p= 0.044) were observed, under 80 years and older respectively. No differences in readmissions and mortality were observed. Conclusions. OPAT could be considered an effective alternative for appropriately-selected elderly patients with infective endocarditis (AU)
Introducción. La incidencia de la endocarditis infecciosa ha aumentado progresivamente, especialmente en pacientes de edad avanzada. La terapia antibiótica domiciliaria endovenosa (TADE) es una excelente alternativa de tratamiento, aunque la edad avanzada sea en algunas guías una contraindicación relativa. El objetivo de este estudio es comparar las características y el pronóstico de pacientes mayores y menores de 80 años tratados con TADE. Material y métodos. Fueron incluidos 194 pacientes entre los años 1996 y 2015, 31 de ellos con edades superiores a 80 años. Resultados. La válvula más frecuentemente afectada fue la aórtica, especialmente válvulas nativas. Los antibióticos más utilizados fueron la ceftriaxona, ampicilina, cloxacilina y daptomicina. Se observaron diferencias en cirugía (39,9% vs 9,7%, p=0,001) y en uso de bombas de infusión (55,2% vs 35,5%; p= 0,044), en los grupos menores y mayores de 80 años respectivamente. No se observaron diferencias significativas en reingresos y mortalidad. Conclusiones. La TADE podría considerarse una alternati-va adecuada en pacientes de edad avanzada con endocarditis infecciosa adecuadamente seleccionados (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Serviços de Assistência Domiciliar , Antibacterianos/administração & dosagem , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Prognóstico , Ceftriaxona/administração & dosagem , Ampicilina/administração & dosagem , Cloxacilina/administração & dosagem , Daptomicina/administração & dosagemRESUMO
Introducción: Presentamos un estudio caso-control de tumores no definitorios de sida (TNDS) en una cohorte de pacientes infectados por el VIH en la que valoramos las tasas de incidencia, supervivencia y factores pronósticos de mortalidad. Métodos: Se recogieron de forma prospectiva en 7 hospitales, los diagnósticos de TNDS realizados de 2007 a 2011, con seguimiento posterior hasta diciembre de 2013. Se seleccionaron de forma aleatoria un grupo control de 221 pacientes VIH sin diagnóstico de cáncer. Resultados: Se diagnosticaron 221 TNDS en una cohorte inicial de 7.067 pacientes VIH. Los más frecuentes: hepatocarcinoma 20,5%, pulmón 18,7%, cabeza y cuello 11,9% y anal 10,5%. La tasa de incidencia de desarrollo de TNDS fue de 7,84/1.000 pacientes-año. Además de la edad y el tabaco, el tiempo en TAR (OR 1,11; IC 95% 1,05-1,17) y el uso de IP (OR 1,72; IC 95% 1,0-2,96) aumentaron el riesgo de desarrollar un TNDS. Durante el seguimiento fallecieron el 53,42%, con una mediana de supervivencia de 199,5 días. En el análisis de los factores pronósticos de mortalidad, los valores bajos de CD4 en el momento del diagnóstico del tumor (OR 0,99; IC 95% 0,99-1,0; p=0,033) y el diagnóstico previo de sida (OR 2,06; IC 95% 1,08-3,92) se asociaron con una mayor mortalidad. Conclusiones: Los predictores de TNDS en nuestra cohorte fueron la edad, el consumo de tabaco, los linfocitos CD4 y el mayor tiempo en TAR. La mortalidad es alta, siendo factores de riesgo los CD4 bajos en el momento del diagnóstico del TNDS y el diagnóstico previo de sida
Introduction: We present a case-control study of non-AIDS-defining cancers (NADCs) in a cohort of HIV-infected patients where we value the incidence, survival and prognostic factors of mortality. Methods: All NADCs diagnosis conducted from 2007 to 2011 in 7 hospitals were collected prospectively, with a subsequent follow up until December 2013. A control group of 221 HIV patients without a diagnosis of cancer was randomly selected. Results: Two hundred and twenty-one NADCs were diagnosed in an initial cohort of 7,067 HIV-infected patients. The most common were: hepatocellular carcinoma 20.5%, lung 18.7%, head and neck 11.9% and anal 10.5%. The incidence rate of NADCs development was 7.84/1,000 people-year. In addition to aging and smoking, time on ART (OR 1.11; 95% CI 1.05-1.17) and PI use (OR 1.72; 95% CI 1.0-2.96) increased the risk of developing a NADC. During follow-up 53.42% died, with a median survival time of 199.5 days. In the analysis of the prognostic factors of mortality the low values of CD4 at tumour diagnosis (OR 0.99; 95% CI 0.99-1.0; P=.033), and the previous diagnosis of AIDS (OR 2.06; 95% CI 1.08-3.92) were associated with higher mortality. Conclusions: Predictors of NADCs in our cohort were age, smoking, CD4 lymphocytes and time on ART. Mortality is high, with NADC risk factors being low CD4 count and previous diagnosis of AIDS
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecções por HIV/complicações , Neoplasias/epidemiologia , Neoplasias/mortalidade , Estudos de Coortes , Estudos Prospectivos , Espanha/epidemiologia , Fatores de Risco , Prognóstico , Tabagismo/complicaçõesRESUMO
We present two cases of P. falciparum malaria in visitors to tourist resorts on the East Coast of the Dominican Republic, traditionally believed to be an area without risk of malaria. In both patients the malaria was severe (with 20% parasitization in one) and there was a long interval between the onset of symptoms and diagnosis. These cases are possibly related (along with a further 17 reports by the Centers for Disease Control and Prevention) to an increase in the population of Anopheles sp as a consequence of increased rainfall and floods provoked by a hurricane in September 2004, as well as to the presence of a semi-immune population (Haitian immigrants working in the construction and tourist sectors). Both physicians and patients should be aware of this outbreak so that adequate precautions can be taken and early diagnoses can be made.
Assuntos
Malária Falciparum/diagnóstico , Plasmodium falciparum/isolamento & purificação , Adulto , Animais , Antimaláricos/uso terapêutico , República Dominicana , Feminino , Humanos , Malária Falciparum/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , ViagemRESUMO
Se presentan 2 casos de paludismo por Plasmodium falciparum en viajeros a centros turísticos de la costa este de República Dominicana, considerados clásicamente como libres de riesgo de paludismo. En ambos casos, se trató de pacientes con paludismo grave (con una parasitación del 20% en uno de ellos), con un tiempo largo entre el inicio de la sintomatología y el diagnóstico. Es posible que estos casos (junto con otros 17 comunicados por los Center for Disease Control and Prevention [CDC]) estén relacionados con un aumento en la población de Anopheles sp. como consecuencia del aumento de lluvias e inundaciones provocados por el paso de un huracán en septiembre de 2004, junto con la existencia de población semiinmune (inmigrantes haitianos trabajando en la construcción y el sector turístico). Es muy importante que tanto los médicos como los pacientes sean conscientes de este brote para facilitar la toma adecuada de precauciones y un diagnóstico precoz (AU)
We present two cases of P. falciparum malaria in visitors to tourist resorts on the East Coast of the Dominican Republic, traditionally believed to be an area without risk of malaria. In both patients the malaria was severe (with 20% parasitization in one) and there was a long interval between the onset of symptoms and diagnosis. These cases are possibly related (along with a further 17 reports by the Centers for Disease Control and Prevention) to an increase in the population of Anopheles sp as a consequence of increased rainfall and floods provoked by a hurricane in September 2004, as well as to the presence of a semi-immune population (Haitian immigrants working in the construction and tourists sectors). Both physicians and patients should be aware of this outbreak so that adequate precautions can be taken and early diagnoses can be made (AU)