EsSALUD

Prosthetic valve endocarditis after transcatheter aortic valve replacement (TAVR) is a rare and life-threatening complication, particularly in elderly patients. An 88-year-old man with a previous TAVR was readmitted 2 months after the procedure with fever (38.6 °C). Blood cultures were positive for methicillin-resistant Staphylococcus epidermidis. We performed extensive surgical debridement and reconstruction of the aortic root and tricuspid annulus, followed by a Bentall procedure and tricuspid valve replacement. The postoperative course was favorable, with good early recovery and normally functioning prostheses at follow-up. This case illustrates that, even in octogenarian patients with prohibitive surgical risk and extensive multivalvular involvement, aggressive surgical management guided by a multidisciplinary heart team may provide favorable outcomes when medical therapy alone fails to control infection. TAVR-associated prosthetic valve endocarditis may present with extensive perivalvular and multivalvular involvement. Surgical treatment, although rarely performed in this setting, can be lifesaving when guided by careful patient selection and multidisciplinary evaluation.

El feocromocitoma es un tumor neuroendocrino productor de catecolaminas cuya presentación clínica puede simular un síndrome coronario agudo y representar un reto diagnóstico en la cardiología clínica. Presentamos el caso de un varón de 63 años con dolor precordial intermitente, hipertensión paroxística e incremento leve de troponinas. Fue referido a nuestra institución con diagnóstico de síndrome coronario agudo. Los electrocardiogramas de ingreso no evidenciaron signos de isquemia aguda; el ecocardiograma transtorácico no mostró trastornos segmentarios de motilidad. Se propuso una estratificación isquémica no invasiva. Previo a la angiografía coronaria por tomografía computarizada (CCTA), se administró propranolol, tras lo cual el paciente desarrolló crisis hipertensiva y dolor precordial. El mismo episodio se presentó luego de una segunda dosis de betabloqueador. La CCTA no identificó estenosis coronarias significativas. Ante la sospecha de feocromocitoma, la tomografía abdominal con contraste mostró un nódulo suprarrenal izquierdo y en la orina se identificaron metanefrinas elevadas. Se realizó una adrenalectomía y la histopatología confirmó un feocromocitoma benigno. El paciente evolucionó favorablemente, asintomático hasta la fecha.

While higher pyrazinamide and isoniazid exposures and slow NAT2 acetylator status were each associated with increased hepatotoxicity, only pyrazinamide exposure was associated when considering pharmacokinetic variables together. Rifampin exposure was not associated with hepatotoxicity, supporting further evaluation of doses up to 20 mg/kg/day in a larger trial.

Background: This investigation compared the efficacy and safety of fexuprazan 40 mg and esomeprazole 40 mg in patients with acid reflux-related disorders, including erosive esophagitis (EE) and laryngopharyngeal reflux disease (LPRD). Methods: A systematic search was conducted across five databases until January 2025. Primary outcomes included esophageal lesion healing, complete resolution of symptoms (CRS), and 24 h symptom-free days. Meta-analyses used random-effects models with the inverse variance method. The Risk of Bias 2.0 tool and the certainty of evidence (CoE) using GRADE methodology were assessed. Results: Three randomized controlled trials (n = 695) conducted in Asian countries were included. Fexuprazan may have little to no effect compared to esomeprazole on EE healing rate at 4 weeks (RR 1.02, 95% CI 0.93 to 1.12, I2 = 0%, n = 2 studies, CoE very low) and 8 weeks. No significant differences were found between treatments regarding CRS at 1 week (RR 1.29; 95% CI: 0.84 to 1.99; I2 = 0%; n = 2 studies; CoE very low) and 8 weeks, or in the 24 h symptom-free days at 1 week (MD 2.67 days, 95% CI -2.76 to 8.10, I2 = 41%, n = 2 studies, CoE very low) and 8 weeks. Fexuprazan also showed little to no effect on treatment-emergent adverse events (RR 1.00, 95% CI 0.83 to 1.20, I2 = 0%, n = 3 studies, CoE very low). Nonetheless, the evidence for all outcomes was rated as very uncertain. Conclusions: Fexuprazan 40 mg may provide similar efficacy compared to esomeprazole 40 mg in EE, with a comparable safety profile to esomeprazole in EE and LPRD patients. However, the evidence is highly uncertain, requiring further studies.

ABSTRACT The ways in which people understand disability can influence how disabled people are treated and taught. As such, and grounded in critical disability theory, the purpose of this study was to explore Colombian pre-service physical education (PE) teachers’ conceptualizations of disability when teaching disabled students in integrated PE. This study used a story completion method and participants were 29 pre-service teachers (12 females; 17 males) from a public university in central Colombia. Pre-service teachers were randomly presented with one of two versions of a hypothetical story stem representing the presence of a disabled child in an integrated PE class and asked to complete the rest of the story. All data collected were subjected to thematic analysis which informed the construction of three themes: (a) understandings of disability based on deficit, (b) disabled students as inspirational role models, and (c) pedagogical practice informed by the individuality of disabled students. This study contributes to further understand cultural conceptualizations of disability within South American PE, and how these conceptualizations and understandings contribute, or not, to the wellbeing of disabled students in the Global South.

This study aimed to describe a contemporary cohort of triplet pregnancies from two tertiary centers in a middle-income country and evaluate the association between gestational age (GA) at birth and perinatal death. We developed and internally validated a GA-based risk model.Retrospective cohort from two tertiary hospitals (2015-2024). The unit of analysis was the fetus/neonate, with cluster-robust standard errors at the mother level. Primary outcome: Perinatal death (stillbirth ≥230/7 weeks or neonatal death ≤28 days). GA was modeled with logistic regression using restricted cubic splines; Firth penalization addressed separation where applicable. Internal validation used 200 bootstrap resamples.The cohort included 150 neonates; perinatal death occurred in 23 (15.4%). Median GA was 33 (31-34) weeks overall, 34.0 (32.0-34.0) in survivors, and 25.0 (24.0-28.0) in perinatal deaths. In the adjusted spline model, GA was the dominant predictor (overall Wald χ2 = 1,473.66, df = 3, p < 0.001; non-linearity χ2 = 424.92, df = 2, p < 0.001), while severe preeclampsia was not significant (χ2 = 0.10, p = 0.750). The category-based Firth model showed markedly elevated odds of perinatal death at earlier gestations versus ≥34 weeks: <28 weeks; adjusted odds ratio (aOR) = 871.15 (95% confidence interval [CI]: 81.25-124,006.80, p < 0.001); 28 to <32 weeks, aOR = 50.22 (5.45-6,682.53, p < 0.001); 32 to <34 weeks, aOR = 5.34 (0.26-804.14, p = 0.278); and severe preeclampsia, aOR = 1.02 (0.09-7.17, p = 0.984). The internally validated model demonstrated excellent discrimination (optimism-corrected area under the receiver operating characteristic curve [AUROC], 0.972) and good overall performance (Brier score, 0.047), with a calibration intercept of -0.129, a slope of 0.696, and a maximum absolute calibration error (E max) of 0.104.In triplet pregnancies, GA at birth is the dominant determinant of perinatal death, with a steep risk gradient at earlier gestations. A GA-based model demonstrates excellent discrimination and acceptable calibration following bootstrap internal validation, supporting its use in informing counseling and timing-of-delivery decisions in this high-risk population. · Perinatal mortality in triplet pregnancies decreases sharply after 32 weeks.. · Most perinatal deaths occur before 32 weeks of gestation.. · These findings support delivery planning around 32 to 33 weeks.. · Data from low- and middle-income countries' settings provide guidance for counseling and NICU planning.. · A simple GA-only model showed excellent discrimination (area under the curve = 0.97)..

BackgroundThe global prevalence of cancer has increased in recent decades. Cancer patients are particularly susceptible to invasive infections such as bacteremia. In Peru, the rising incidence of bloodstream infections caused by resistant pathogens represents a significant public health concern. However, limited information is available on this complication in the Peruvian oncologic population. No previous studies in the country have assessed mortality or examined the impact of antimicrobial resistance on patient outcomes in this population.MethodsThis study aimed to evaluate 28-day all-cause mortality and its associated factors among cancer patients with bacteremia at a referral cancer center in Lima. We retrospectively analyzed data from first episodes of bacteremia in hospitalized adult patients between July 2020 and June 2024.ResultsA total of 293 patients were included. The mean age was 65.42 ± 15.31 years, and 53.92% were female. Most patients had solid tumors (84.30%) and active disease (91.81%), with digestive cancers being the most common (34.13%). The 28-day all-cause mortality rate was 32.08%. Empirical antimicrobial therapy was appropriate in 80.70% of cases, Table 1. Gram-negative bacteria predominated (82.80%), with Escherichia coli being the most frequently isolated pathogen (45.70%). Among enterobacteria, 43.60% were ESBL producers, and 3.27% of gram-negative isolates were carbapenem-resistant, Figure 1 and Table 2. Multivariate Poisson regression identified the Charlson Comorbidity Index (IRR 1.11; 95% CI 1.02–1.21), sepsis (IRR 2.26; 95% CI 1.19–4.29), septic shock (IRR 2.74; 95% CI 1.58–4.76), and respiratory failure (IRR 1.66; 95% CI 1.05–2.62) as independent factors associated with increased 28-day mortality. A urinary source of infection was found to be protective (IRR 0.38; 95% CI 0.19–0.77), Table 3.ConclusionIn this cancer referral center, one-third of patients with bacteremia died within 28 days. Mortality was primarily driven by infection severity and specific comorbidities rather than antimicrobial resistance.DisclosuresAll Authors: No reported disclosures

Cyst nematodes are one of the economically important parasitic nematode groups worldwide. They are especially adapted to a parasitic mode of life and have sexual dimorphism with vermiform males and swollen sedentary females. Detailed information on their morphology, life cycle and plant-host relationships are provided, in addition to bionomics, control, pathotypes, biochemical and molecular identification, phylogenetic relationships and systematics of the genera and major species. A dichotomous key to the genera is included. The genera Betulodera, Cactodera, Dolichodera, Globodera, Heterodera, Paradolichodera, Punctodera and Vittatidera are fully diagnosed and several species are considered in more detail with information on morphology, diagnostics, bionomics and distribution. Descriptions of 19 economically important species of Heterodera and four species of Globodera are given in detail.