RESUMEN
INTRODUCTION: The objective of this study was to analyze the incidence, clinical features, microbiology and prognosis of patients with infective endocarditis (IE) in Iceland, and to compare the results with a previous study made in Iceland 1976-85. MATERIAL AND METHODS: A retrospective study including all patients diagnosed with IE in Iceland 2000-2009. Information was obtained from medical records. RESULTS: A total of 88 cases (71% men, mean age 59 years) were diagnosed and the incidence of IE was calculated 2.97/100.000 person-years. The mitral valve was infected in 35 patients (40%), aortic in 27 (31%) and tricuspid in 9 (10%). In 19 cases a prosthetic valve was infected (22%), one early (<<60 days from procedure) and 18 late. Sixteen patients were intravenous drug users. The most common causative organisms were streptococcus (33%), staphylococcus (25%) and enterococcus (16%). Surgical intervention was performed in 16 cases (18%). One and five year survival was 77% and 57% respectively. CONCLUSION: The incidence of IE in Iceland is still low compared to other countries. The clinical profile of the disease has changed since 1976-85, patients with prosthetic heart valves and intravenous drug users were more prominent than before. The microbiological spectrum has not changed much, streptococcus is still the most common pathogen, contrary to what is seen in other industrial countries where S. aureus is more frequent. Death rate is lower than before and one year survival good compared to other reports.
Asunto(s)
Endocarditis Bacteriana/epidemiología , Infecciones por Enterobacteriaceae/epidemiología , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Estafilocócicas/epidemiología , Infecciones Estreptocócicas/epidemiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Endocarditis Bacteriana/terapia , Infecciones por Enterobacteriaceae/diagnóstico , Infecciones por Enterobacteriaceae/microbiología , Infecciones por Enterobacteriaceae/mortalidad , Infecciones por Enterobacteriaceae/terapia , Femenino , Encuestas Epidemiológicas , Prótesis Valvulares Cardíacas/microbiología , Humanos , Islandia/epidemiología , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/mortalidad , Infecciones Relacionadas con Prótesis/terapia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/mortalidad , Infecciones Estafilocócicas/terapia , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/mortalidad , Infecciones Estreptocócicas/terapia , Abuso de Sustancias por Vía Intravenosa/epidemiología , Análisis de Supervivencia , Tasa de Supervivencia , Factores de TiempoRESUMEN
PURPOSE: To examine the risk of thromboembolic cardiovascular events in users of coxibs and NSAIDs in a nationwide cohort. METHODS: Data were synchronised from three nationwide databases, the Icelandic Medicines Registry (IMR), The Icelandic National Patient Registry (INPR) and the Registry for Causes of Death at Statistics Iceland (RCD), for prescriptions for NSAIDs or coxibs with respect to hospitalisation for unstable angina pectoris, myocardial infarction and cerebral infarction over a 3-year period. The Cox proportional hazards model and Poisson regression were used to analyse the data. RESULTS: A total of 108,700 individuals received prescriptions for NSAIDs or coxibs (ATC code M01A), of whom 78,539 received one drug only (163,406 person-years). Among those receiving only one drug 426 individuals were discharged from hospital with endpoint diagnoses. In comparison to diclofenac, the incidence ratios, adjusted for age and gender, were significantly higher for cerebral infarction (2.13; 95% CI 1.54-2.97; P < 0.001), for myocardial infarction (1.77; 95% CI 1.34-2.32; P < 0.001) and for unstable angina pectoris (1.52; 95% CI 1.01-2.30; P = 0.047) for patients who used rofecoxib. For naproxen users, the incidence ratio was 1.46 for myocardial infarction (95% CI 1.03-2.07; P = 0.03), but was reduced in ibuprofen users (0.63; 95% CI 0.40-1.00; P = 0.05). The youngest users of rofecoxib (< or =39 years) had the highest hazard ratio (HR) for cardiovascular events (8.34; P < 0.001), while those > or =60 years had a lower but still significantly elevated HR (1.35; P = 0.001). CONCLUSION: This Icelandic nationwide registry-based study amounting to 163,406 patient-years showed increased risk of cardiovascular events, i.e. cerebral infarction, myocardial infarction and unstable angina pectoris, among rofecoxib and naproxen users in comparison to diclofenac users. The added risk was most pronounced in young adults using rofecoxib.
Asunto(s)
Inhibidores de la Ciclooxigenasa 2/efectos adversos , Lactonas/efectos adversos , Pirazoles/efectos adversos , Sulfonamidas/efectos adversos , Sulfonas/efectos adversos , Tromboembolia/inducido químicamente , Tromboembolia/epidemiología , Angina Inestable/inducido químicamente , Angina Inestable/epidemiología , Celecoxib , Infarto Cerebral/inducido químicamente , Infarto Cerebral/epidemiología , Inhibidores de la Ciclooxigenasa 2/administración & dosificación , Bases de Datos Factuales , Muerte Súbita/etiología , Femenino , Humanos , Islandia/epidemiología , Incidencia , Lactonas/administración & dosificación , Masculino , Infarto del Miocardio/inducido químicamente , Infarto del Miocardio/epidemiología , Oportunidad Relativa , Pirazoles/administración & dosificación , Sistema de Registros , Factores de Riesgo , Sulfonamidas/administración & dosificación , Sulfonas/administración & dosificación , Tromboembolia/complicaciones , Adulto JovenRESUMEN
We report a middle aged smoker with recurrent pneumonia caused by endobronchial actinomycosis secondary to a tooth aspiration. Unlike previously reported cases, our patient was not chronically debilitated. The case suggests that a follow-up bronchoscopy is beneficial after the initiation of antibiotic therapy for endobronchial actinomycosis.
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Actinomicosis/diagnóstico , Enfermedades Bronquiales/diagnóstico , Broncoscopía/métodos , Reacción a Cuerpo Extraño/diagnóstico , Actinomicosis/terapia , Antibacterianos , Enfermedades Bronquiales/etiología , Enfermedades Bronquiales/terapia , Terapia Combinada , Quimioterapia Combinada/uso terapéutico , Estudios de Seguimiento , Reacción a Cuerpo Extraño/terapia , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Tomografía Computarizada por Rayos X , Diente , Resultado del TratamientoRESUMEN
Variants of hepatitis C virus (HCV) from a single infected blood donor and 13 viraemic recipients who were traced were examined by sequencing and cloning to determine the extent of virus diversity in hypervariable region 1. Serum-derived viral isolates were studied from the donor when his HCV infection was discovered in 1993, in his recipients that year (0.3-5 years post-transfusion) and 5 years later in the donor and six viraemic recipients who were still alive. Viral variants of broad diversity were readily demonstrated in the baseline samples of the donor (nucleotide p-distance 0.130), but significantly less (P<0.00003) diversity was observed in the recipients' first samples (p-distances within recipients 0.003-0.062). In the first blood samples of the recipients, many of the viral variants identified were closely related to a strain variant from the donor. In follow-up samples drawn 5 years later from the donor and six recipients, the p-distance among donor clones had increased (0.172, P<0.0005) compared with the recipients, who displayed significantly narrower quasispecies (0.011-0.086). A common finding was that recipients of blood components processed from the same donation differed substantially in persisting HCV infectious sequence. Markedly few changes leading to changes of amino acids had occurred during follow-up in four of six recipients. These results question the significance of the development of viral variants as a necessary phenomenon in the evolution of HCV and pathogenesis of the disease.