| 1. |
- Van Der Vaart, Thomas W., et al.
(författare)
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External Validation of the 2023 Duke-International Society for Cardiovascular Infectious Diseases Diagnostic Criteria for Infective Endocarditis
- 2024
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Ingår i: Clinical Infectious Diseases. - 1058-4838. ; 78:4, s. 922-929
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Tidskriftsartikel (refereegranskat)abstract
- Background. The 2023 Duke-International Society of Cardiovascular Infectious Diseases (ISCVID) criteria for infective endocarditis (IE) were introduced to improve classification of IE for research and clinical purposes. External validation studies are required. Methods. We studied consecutive patients with suspected IE referred to the IE team of Amsterdam University Medical Center (from October 2016 to March 2021). An international expert panel independently reviewed case summaries and assigned a final diagnosis of "IE"or "not IE,"which served as the reference standard, to which the "definite"Duke-ISCVID classifications were compared. We also evaluated accuracy when excluding cardiac surgical and pathologic data ("clinical"criteria). Finally, we compared the 2023 Duke- ISCVID with the 2000 modified Duke criteria and the 2015 and 2023 European Society of Cardiology (ESC) criteria. Results. A total of 595 consecutive patients with suspected IE were included: 399 (67%) were adjudicated as having IE; 111 (19%) had prosthetic valve IE, and 48 (8%) had a cardiac implantable electronic device IE. The 2023 Duke-ISCVID criteria were more sensitive than either the modified Duke or 2015 ESC criteria (84.2% vs 74.9% and 80%, respectively; P < .001) without significant loss of specificity. The 2023 Duke-ISCVID criteria were similarly sensitive but more specific than the 2023 ESC criteria (94% vs 82%; P < .001). The same pattern was seen for the clinical criteria (excluding surgical/pathologic results). New modifications in the 2023 Duke-ISCVID criteria related to "major microbiological"and "imaging"criteria had the most impact. Conclusions. The 2023 Duke-ISCVID criteria represent a significant advance in the diagnostic classification of patients with suspected IE.
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| 2. |
- Gurvits,, et al.
(författare)
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The science case and challenges of space-borne sub-millimeter interferometry
- 2022
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Ingår i: Acta Astronautica. - : Elsevier BV. - 0094-5765. ; 196, s. 314-333
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Tidskriftsartikel (refereegranskat)abstract
- Ultra-high angular resolution in astronomy has always been an important vehicle for making fundamental discoveries. Recent results in direct imaging of the vicinity of the supermassive black hole in the nucleus of the radio galaxy M87 by the millimeter VLBI system Event Horizon Telescope and various pioneering results of the Space VLBI mission RadioAstron provided new momentum in high angular resolution astrophysics. In both mentioned cases, the angular resolution reached the values of about 10???20 microarcseconds (0.05???0.1 nanoradian). Further developments towards at least an order of magnitude ???sharper???values, at the level of 1 microarcsecond are dictated by the needs of advanced astrophysical studies. The paper emphasis that these higher values can only be achieved by placing millimeter and submillimeter wavelength interferometric systems in space. A concept of such the system, called Terahertz Exploration and Zooming-in for Astrophysics, has been proposed in the framework of the ESA Call for White Papers for the Voyage 2050 long term plan in 2019. In the current paper we present new science objectives for such the concept based on recent results in studies of active galactic nuclei and supermassive black holes. We also discuss several approaches for addressing technological challenges of creating a millimeter/sub-millimeter wavelength interferometric system in space. In particular, we consider a novel configuration of a space-borne millimeter/sub-millimeter antenna which might resolve several bottlenecks in creating large precise mechanical structures. The paper also presents an overview of prospective space-qualified technologies of low-noise analogue front-end instrumentation for millimeter/sub-millimeter telescopes. Data handling and processing instrumentation is another key technological component of a sub-millimeter Space VLBI system. Requirements and possible implementation options for this instrumentation are described as an extrapolation of the current state-of-the-art Earth-based VLBI data transport and processing instrumentation. The paper also briefly discusses approaches to the interferometric baseline state vector determination and synchronisation and heterodyning system. The technology-oriented sections of the paper do not aim at presenting a complete set of technological solutions for sub-millimeter (terahertz) space-borne interferometers. Rather, in combination with the original ESA Voyage 2050 White Paper, it sharpens the case for the next generation microarcsecond-level imaging instruments and provides starting points for further in-depth technology trade-off studies.
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| 3. |
- Anderson, D J, et al.
(författare)
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Enterococcal prosthetic valve infective endocarditis: report of 45 episodes from the International Collaboration on Endocarditis-merged database.
- 2005
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Ingår i: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. - : Springer Science and Business Media LLC. - 0934-9723. ; 24:10, s. 665-70
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Tidskriftsartikel (refereegranskat)abstract
- Enterococcal prosthetic valve infective endocarditis (PVE) is an incompletely understood disease. In the present study, patients with enterococcal PVE were compared to patients with enterococcal native valve endocarditis (NVE) and other types of PVE to determine differences in basic clinical characteristics and outcomes using a large multicenter, international database of patients with definite endocarditis. Forty-five of 159 (29%) cases of definite enterococcal endocarditis were PVE. Patients with enterococcal PVE were demographically similar to patients with enterococcal NVE but had more intracardiac abscesses (20% vs. 6%; p=0.009), fewer valve vegetations (51% vs. 79%; p<0.001), and fewer cases of new valvular regurgitation (12% vs. 45%; p=0.01). Patients with either enterococcal PVE or NVE were elderly (median age, 73 vs. 69; p=0.06). Rates of in-hospital mortality, surgical intervention, heart failure, peripheral embolization, and stroke were similar in both groups. Patients with enterococcal PVE were also demographically similar to patients with other types of PVE, but mortality may be lower (14% vs. 26%; p=0.08). Notably, 93% of patients with enterococcal PVE came from European centers, as compared with only 79% of patients with enterococcal NVE (p=0.03). Thus, patients with enterococcal PVE have higher rates of myocardial abscess formation and lower rates of new regurgitation compared to patients with enterococcal NVE, but there are no differences between the groups with regard to surgical or mortality rates. In contrast, though patients with enterococcal PVE and patients with other types of PVE share similar characteristics, mortality is higher in the latter group. Importantly, the prevalence of enterococcal PVE was higher in the European centers in this study.
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| 4. |
- Athan, Eugene, et al.
(författare)
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Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices
- 2012
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Ingår i: JAMA - Journal of the American Medical Association. - : American Medical Association (AMA). - 0098-7484 .- 1538-3598. ; 307, s. 1727-1735
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Tidskriftsartikel (refereegranskat)abstract
- Context: Infection of implantable cardiac devices is an emerging disease with significant morbidity, mortality, and health care costs. Objectives: To describe the clinical characteristics and outcome of cardiac device infective endocarditis (CDIE) with attention to its health care association and to evaluate the association between device removal during index hospitalization and outcome. Design, Setting, and Patients: Prospective cohort study using data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), conducted June 2000 through August 2006 in 61 centers in 28 countries. Patients were hospitalized adults with definite endocarditis as defined by modified Duke endocarditis criteria. Main Outcome Measures: In-hospital and 1-year mortality. Results: CDIE was diagnosed in 177 (6.4% [95% CI, 5.5%-7.4%]) of a total cohort of 2760 patients with definite infective endocarditis. The clinical profile of CDIE included advanced patient age (median, 71.2 years [interquartile range, 59.8-77.6]); causation by staphylococci (62 [35.0% {95% CI, 28.0%-42.5%}] Staphylococcus aureus and 56 [31.6% {95% CI, 24.9%-39.0%}] coagulase-negative staphylococci); and a high prevalence of health care-associated infection (81 [45.8% {95% CI, 38.3%- 53.4%}]). There was coexisting valve involvement in 66 (37.3% [95% CI, 30.2%- 44.9%]) patients, predominantly tricuspid valve infection (43/177 [24.3%]), with associated higher mortality. In-hospital and 1-year mortality rates were 14.7% (26/177 [95% CI, 9.8%-20.8%]) and 23.2% (41/177 [95% CI, 17.2%-30.1%]), respectively. Proportional hazards regression analysis showed a survival benefit at 1 year for device removal during the initial hospitalization (28/141 patients [19.9%] who underwent device removal during the index hospitalization had died at 1 year, vs 13/34 [38.2%] who did not undergo device removal; hazard ratio, 0.42 [95% CI, 0.22- 0.82]). Conclusions: Among patients with CDIE, the rate of concomitant valve infection is high, as is mortality, particularly if there is valve involvement. Early device removal is associated with improved survival at 1 year. ©2012 American Medical Association. All rights reserved.
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| 5. |
- Benito, Natividad, et al.
(författare)
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Health care-associated native valve endocarditis: importance of non-nosocomial acquisition.
- 2009
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Ingår i: Annals of internal medicine. - : American College of Physicians. - 1539-3704 .- 0003-4819. ; 150:9, s. 586-94
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Tidskriftsartikel (refereegranskat)abstract
- The clinical profile and outcome of nosocomial and non-nosocomial health care-associated native valve endocarditis are not well defined.To compare the characteristics and outcomes of community-associated and nosocomial and non-nosocomial health care-associated native valve endocarditis.Prospective cohort study.61 hospitals in 28 countries.Patients with definite native valve endocarditis and no history of injection drug use who were enrolled in the ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) from June 2000 to August 2005.Clinical and echocardiographic findings, microbiology, complications, and mortality.Health care-associated native valve endocarditis was present in 557 (34%) of 1622 patients (303 with nosocomial infection [54%] and 254 with non-nosocomial infection [46%]). Staphylococcus aureus was the most common cause of health care-associated infection (nosocomial, 47%; non-nosocomial, 42%; P = 0.30); a high proportion of patients had methicillin-resistant S. aureus (nosocomial, 57%; non-nosocomial, 41%; P = 0.014). Fewer patients with health care-associated native valve endocarditis had cardiac surgery (41% vs. 51% of community-associated cases; P < 0.001), but more of the former patients died (25% vs. 13%; P < 0.001). Multivariable analysis confirmed greater mortality associated with health care-associated native valve endocarditis (incidence risk ratio, 1.28 [95% CI, 1.02 to 1.59]).Patients were treated at hospitals with cardiac surgery programs. The results may not be generalizable to patients receiving care in other types of facilities or to those with prosthetic valves or past injection drug use.More than one third of cases of native valve endocarditis in non-injection drug users involve contact with health care, and non-nosocomial infection is common, especially in the United States. Clinicians should recognize that outpatients with extensive out-of-hospital health care contacts who develop endocarditis have clinical characteristics and outcomes similar to those of patients with nosocomial infection.None.
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| 6. |
- Caby, F, et al.
(författare)
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CD4/CD8 Ratio and the Risk of Kaposi Sarcoma or Non-Hodgkin Lymphoma in the Context of Efficiently Treated Human Immunodeficiency Virus (HIV) Infection: A Collaborative Analysis of 20 European Cohort Studies
- 2021
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Ingår i: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. - : Oxford University Press (OUP). - 1537-6591. ; 73:1, s. 50-59
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundA persistently low CD4/CD8 ratio has been reported to inversely correlate with the risk of non-AIDS defining cancer in people living with human immunodeficiency virus (HIV; PLWH) efficiently treated by combination antiretroviral therapy (cART). We evaluated the impact of the CD4/CD8 ratio on the risk of Kaposi sarcoma (KS) or non-Hodgkin lymphoma (NHL), still among the most frequent cancers in treated PLWH.MethodsPLWH from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) were included if they achieved virological control (viral load ≤ 500 copies/mL) within 9 months following cART and without previous KS/LNH diagnosis. Cox models were used to identify factors associated with KS or NHL risk, in all participants and those with CD4 ≥ 500/mm3 at virological control. We analyzed the CD4/CD8 ratio, CD4 count and CD8 count as time-dependent variables, using spline transformations.ResultsWe included 56 708 PLWH, enrolled between 2000 and 2014. At virological control, the median (interquartile range [IQR]) CD4 count, CD8 count, and CD4/CD8 ratio were 414 (296–552)/mm3, 936 (670–1304)/mm3, and 0.43 (0.28–0.65), respectively. Overall, 221 KS and 187 NHL were diagnosed 9 (2–37) and 18 (7–42) months after virological control. Low CD4/CD8 ratios were associated with KS risk (hazard ratio [HR] = 2.02 [95% confidence interval {CI } = 1.23–3.31]) when comparing CD4/CD8 = 0.3 to CD4/CD8 = 1) but not with NHL risk. High CD8 counts were associated with higher NHL risk (HR = 3.14 [95% CI = 1.58–6.22]) when comparing CD8 = 3000/mm3 to CD8 = 1000/mm3). Similar results with increased associations were found in PLWH with CD4 ≥ 500/mm3 at virological control (HR = 3.27 [95% CI = 1.60–6.56] for KS; HR = 5.28 [95% CI = 2.17–12.83] for NHL).ConclusionsLow CD4/CD8 ratios and high CD8 counts despite effective cART were associated with increased KS/NHL risks respectively, especially when CD4 ≥ 500/mm3.
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| 7. |
- Durante-Mangoni, Emanuele, et al.
(författare)
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Current features of infective endocarditis in elderly patients: Results of the international collaboration on endocarditis prospective cohort study
- 2008
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Ingår i: Archives of Internal Medicine. - : American Medical Association (AMA). - 0003-9926 .- 1538-3679. ; 168, s. 2095-2103
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Tidskriftsartikel (refereegranskat)abstract
- Background: Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking. Methods: In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed. Results: Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9% vs 53.5%; P < .001). Elderly patients with IE showed a higher rate of in-hospital death (24.9% vs 12.8%; P < .001), and age older than 65 years was an independent predictor of mortality. Conclusions: In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care-associated acquisition and improve outcomes in this major subgroup of patients with IE. ©2008 American Medical Association. All rights reserved.
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| 8. |
- Gurvits, Leonid I., et al.
(författare)
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THEZA: TeraHertz Exploration and Zooming-in for Astrophysics
- 2021
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Ingår i: Experimental Astronomy. - : Springer Science and Business Media LLC. - 0922-6435 .- 1572-9508. ; 51:3, s. 559-594
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents the ESA Voyage 2050 White Paper for a concept of TeraHertz Exploration and Zooming-in for Astrophysics (THEZA). It addresses the science case and some implementation issues of a space-borne radio interferometric system for ultra-sharp imaging of celestial radio sources at the level of angular resolution down to (sub-) microarcseconds. THEZA focuses at millimetre and sub-millimetre wavelengths (frequencies above similar to 300 GHz), but allows for science operations at longer wavelengths too. The THEZA concept science rationale is focused on the physics of spacetime in the vicinity of supermassive black holes as the leading science driver. The main aim of the concept is to facilitate a major leap by providing researchers with orders of magnitude improvements in the resolution and dynamic range in direct imaging studies of the most exotic objects in the Universe, black holes. The concept will open up a sizeable range of hitherto unreachable parameters of observational astrophysics. It unifies two major lines of development of space-borne radio astronomy of the past decades: Space VLBI (Very Long Base-line Interferometry) and mm- and sub-mm astrophysical studies with "single dish" instruments. It also builds upon the recent success of the Earth-based Event Horizon Telescope (EHT) - the first-ever direct image of a shadow of the super-massive black hole in the centre of the galaxy M87. As an amalgam of these three major areas of modern observational astrophysics, THEZA aims at facilitating a breakthrough in high-resolution high image quality studies in the millimetre and sub-millimetre domain of the electromagnetic spectrum.
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| 9. |
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| 10. |
- Kourany, Wissam M, et al.
(författare)
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Influence of diabetes mellitus on the clinical manifestations and prognosis of infective endocarditis: a report from the International Collaboration on Endocarditis-Merged Database.
- 2006
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Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 38:8, s. 613-9
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this investigation was to study the influence of diabetes mellitus (DM) on outcomes of infective endocarditis (IE). Outcomes were compared between 150 diabetic and 905 non-diabetic patients with IE from the International Collaboration on Endocarditis Merged Database. Compared to non-diabetic patients, diabetic patients were older (median age 63 vs 57 y, p<0.001), were more often female (42.0% vs 31.9%, p=0.01), more often had comorbidities (41.5% vs 26.7%, p<0.001), and were more likely to be dialysis dependent (12.7% vs 4.0%, p<0.001). S. aureus was isolated more often (30.7% vs 21.7%, p=0.02), and microorganisms from the viridans Streptococcus group less often (16.7% vs 28.2%, p = 0.001) in the diabetic group. There was no difference with respect to the presence of congestive heart failure, embolism, intra-cardiac abscess, new valvular regurgitation, or valvular vegetation. Diabetic patients underwent surgical intervention less frequently (32.0% vs 44.9%, p = 0.003), and had higher overall in-hospital mortality (30.3% vs 18.6%, p = 0.001). On multivariable analysis, DM was an independent predictor of mortality (odds ratio (OR) = 1.71, 95% confidence interval (CI) 1.08-2.70), especially in male patients, as diabetic males had higher mortality than non-diabetic males (OR 2.18, CI 1.08-4.35). DM is an independent predictor of in-hospital mortality among patients hospitalized with IE.
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