Francisco Carmona-Torre

Hypothesis-oriented food patterns and incidence of hypertension: 6-year follow-up of the SUN (Seguimiento Universidad de Navarra) prospective cohort.

OBJECTIVE To study the association between adherence to several a priori-defined healthy food patterns and the risk of hypertension. DESIGN Prospective, multipurpose, dynamic cohort study (recruitment permanently open). We followed up 10 800 men and women (all of them university graduates), who were initially free of hypertension, for a variable period (range 2-6 years, median 4.6 years). During follow-up, 640 participants reported a new medical diagnosis of hypertension. Baseline diet was assessed using a validated 136-item FFQ. Validated information about non-dietary potential confounders was also gathered. We calculated adherence to fifteen different hypothesis-oriented food patterns and assessed the association between each of them and incident hypertension using multivariable Cox models. SETTING The SUN (Seguimiento Universidad de Navarra - University of Navarra Follow-up) Project, Spain. SUBJECTS Participants recruited to the SUN cohort before October 2005 were eligible for inclusion; after excluding those with self-reported hypertension or CVD at baseline, or with extreme total energy intake, data of 10 800 were analysed. RESULTS Higher adherence to the DASH (Dietary Approaches to Stop Hypertension) diet (range of the score: 0 to 5) was significantly associated with a lower risk for developing hypertension (P for trend = 0.02). The other food patterns showed no significant association with incident hypertension. CONCLUSIONS Our results support a long-term protection of the DASH diet against the incidence of hypertension, but we found no evidence of a similar inverse association with hypertension for any other a priori-defined healthy food pattern.

Relationship of Alcoholic Beverage Consumption to Food Habits in a Mediterranean Population

Purpose. Wine consumption has been related to a reduced cardiovascular risk. This effect has been attributed partly to the healthier diet of wine drinkers. We compared food habits according to alcoholic beverage preference in a Mediterranean population. Design. A cross-sectional study of a large sample of participants at high risk for cardiovascular disease. Setting. Primary care centers in a Mediterranean country, Spain. Participants. A total of 1675 men aged 55 to 80 years old and 2150 women aged 60 to 80 years old who had no documented cardiovascular disease but had either diabetes or at least three major cardiovascular risk factors. Measures. A food frequency questionnaire, alcoholic beverage consumption, adherence to Mediterranean diet, age, family history of cardiovascular disease, smoking, body mass index, diabetes, dyslipidemia, and educational level were measured. Analysis. We analyzed differences in food consumption according to the type of alcoholic beverage preferentially consumed and adjusted the estimates for age, body mass index, cholesterol level, and total energy intake. Results. We found no substantial differences in adherence to the Mediterranean diet according to the main type of alcoholic beverage consumed, and we found no evidence that Mediterranean wine drinkers at high cardiovascular risk have a healthier diet than other drinkers. However, a better dietary pattern was found among nondrinkers than among drinkers. Conclusion. This large, Mediterranean study does not support an association between wine consumption and healthier dietary habits.

Phase 1–2 pilot clinical trial in patients with decompensated liver cirrhosis treated with bone marrow–derived endothelial progenitor cells

&NA; The aim of this nonrandomized, open label, phase 1 clinical trial was to evaluate the safety and the feasibility of the treatment with autologous bone marrow–derived endothelial progenitor cells (EPC) in decompensated liver cirrhosis. In addition, the changes in liver function and hepatic venous pressure gradient (HVPG) and their relation with the characteristics of the cellular product were analyzed. Twelve patients with Child‐Pugh ≥8 liver cirrhosis underwent bone marrow harvest for ex vivo differentiation of EPC. The final product was administered through the hepatic artery in a single administration. Patients underwent clinical and radiologic follow‐up for 12 months. The phenotype and the ability to produce cytokines and growth factors of the final cellular suspension were analyzed. Eleven patients were treated (feasibility 91%). No treatment‐related severe adverse events were observed as consequence of any study procedure or treatment. Model for end‐stage liver disease score improved significantly (P 0.042) in the first 90 days after cells administration and 5 of the 9 patients alive at 90 days showed a decreased of HVPG. There was a direct correlation between the expression of acetylated‐low density lipoprotein and von Willebrand factor in the cellular product and the improvement in liver function and HVPG. The treatment with EPCs in patients with decompensated liver cirrhosis is safe and feasible and might have therapeutic potential. Patients receiving a higher amount of functionally active EPC showed an improvement of liver function and portal hypertension suggesting that the potential usefulness of these cells for the treatment of liver cirrhosis deserves further evaluation.

Mortality Prediction in Patients Undergoing Non-Invasive Ventilation in Intermediate Care

Background Intermediate Care Units (ImCU) have become an alternative scenario to perform Non-Invasive Ventilation (NIV). The limited number of prognostic studies in this population support the need of mortality prediction evaluation in this context. Objective The objective of this study is to analyze the performance of Simplified Acute Physiology Score (SAPS) II and 3 in patients undergoing NIV in an ImCU. Additionally, we searched for new variables that could be useful to customize these scores, in order to improve mortality prediction. Design Cohort study with prospectively collected data from all patients admitted to a single center ImCU who received NIV. The SAPS II and 3 scores with their respective predicted mortality rates were calculated. Discrimination and calibration were evaluated by calculating the area under the receiver operating characteristic curve (AUC) and with the Hosmer-Lemeshow goodness of fit test for the models, respectively. Binary logistic regression was used to identify new variables to customize the scores for mortality prediction in this setting. Patients The study included 241 patients consecutively admitted to an ImCU staffed by hospitalists from April 2006 to December 2013. Key Results The observed in-hospital mortality was 32.4% resulting in a Standardized Mortality Ratio (SMR) of 1.35 for SAPS II and 0.68 for SAPS 3. Mortality discrimination based on the AUC was 0.73 for SAPS II and 0.69 for SAPS 3. Customized models including immunosuppression, chronic obstructive pulmonary disease (COPD), acute pulmonary edema (APE), lactic acid, pCO2 and haemoglobin levels showed better discrimination than old scores with similar calibration power. Conclusions These results suggest that SAPS II and 3 should be customized with additional patient-risk factors to improve mortality prediction in patients undergoing NIV in intermediate care.

Staphylococcus aureus nasal carriage among medical students

www.thelancet.com/infection Vol 17 May 2017 477 transmission of S aureus to patients, with the caveat that their knowledge of standard infection control measures is poor during the early years of clinical practice, raising the possibility of transmission during this period. Meticillin-resistant Staphylococcus aureus (MRSA) was isolated in two preclinical students. Our findings emphasise the importance of education on standard infection control measures in medical schools as part of global and national action plans to address antimicrobial resistance. Further studies are needed to determine the role of S aureus nasal colonisation in medical students in nosocomial transmission.

Catheter-related bloodstream infections in patients with oncohaematological malignancies

www.thelancet.com/infection Vol 17 February 2017 139 visits to multiple countries as separate episodes, we identifi ed 321 overseas travel episodes for 234 outpatients. Specifi cally, 146 (45%) of 321 people had travelled to other parts of Asia, 76 (24%) to Europe, 64 (20%) to America, 19 (6%) to Oceania, and 16 (5%) to Africa. USA, Thailand, Japan, the UK, and Korea were the top five destinations (figure), three of which (Thailand, Japan, Korea) were considered high-risk destinations in the COMBAT study. Although the temporal relationship of travel and sampling in our retrospective analysis makes it difficult to conclude whether patients were colonised with ESBL-E at the time, during, or after travel, our fi ndings suggest that further studies, and perhaps microbiological surveillance, of ESBL-E in international travellers from areas with high colonisation prevalence are warranted.

Intracavitary and systemic daptomycin for successful treatment of a postpneumonectomy intrathoracic infection.

ABSTRACT Treatment of an infected postpneumonectomy cavity is very difficult. We present a patient with an infection of a postpneumonectomy cavity by Staphylococcus epidermidis treated with local daptomycin for different dwell times, maintaining high antibiotic levels above the MIC. Clinical and microbiological cure were achieved successfully.