Predicting disease progression at the individual level is essential for personalized medicine. We previously developed machine-learning tools to estimate 5-year progression risk in people with multiple sclerosis (PwMS). Such models should account for disease-modifying therapy (DMT) and objective outcome definitions. In a retrospective multicenter case–control study, we evaluated adults with relapsing–remitting multiple sclerosis (RRMS) at baseline. Using machine-learning, we developed two complementary tools for individualized 5-year risk estimation: DAAE-M, optimized for transparency, software-neutral use, and mitigation of indication bias, and ELIE, optimized for dynamic landmark-based modeling, complex treatment histories, and mitigation of immortal-time bias. Disease progression was defined using both a clinical outcome (RRMS-to-progressive MS) and an objective outcome (late-stage confirmed progression independent of relapse activity). Among 34,510 people with RRMS (72.6
BACKGROUND:Multiple sclerosis (MS) predominantly affects women of childbearing age. Despite growing evidence supporting the safety of pregnancy in women with MS, the disease continues to influence reproductive choices due to concerns about maternal and infant outcomes, treatment safety, and disease prognosis. OBJECTIVE:To assess fertility preferences, MS-related knowledge, perceived risks, and sources of information among women with MS of reproductive age. METHODS:This cross-sectional study included women aged 18-45 years from the prospective Barcelona First-Attack Cohort. Participants completed a 62-item self-administered survey addressing sociodemographic factors, fertility preferences, disease-related concerns, knowledge regarding MS and pregnancy, and sources of reproductive information. Descriptive and bivariate analyses were performed. RESULTS:Between May and July 2023, 282 out of 409 MS women aged 18-45 years were contacted, and 200 consented to participate. Of these, 34% expressed a desire for children, 16% were undecided, and 50% did not wish to have children. MS influenced reproductive decisions in 59% of participants, particularly through changes in pregnancy timing and desired number of children. Key concerns included disease exacerbation postpartum (36.5%), the risk of MS development in offspring (24.5%), and fetal harm from disease-modifying therapies (DMTs) (23.5%). Significant misinformation was observed, especially regarding the safety of DMTs during breastfeeding, postpartum relapse risk, and epidural anesthesia. Only 24% of participants had received recent counseling on MS and pregnancy, predominantly initiated by the patient. CONCLUSION:Despite robust evidence supporting the safety of pregnancy in MS, misconceptions persist and influence reproductive choices. Proactive, individualized counseling-particularly by MS-specialized professionals-should be integrated into routine care to support informed reproductive decision-making.
A multicentre, laboratory-based analysis was conducted on aggregated data from 23 hospitals across Colombia. Of 1761 fungal isolates identified, 1642 were yeasts and constitute the focus of this study. Isolates were identified using the VITEK®2 system, with confirmatory identification by MALDI-TOF-MS for a subset. Antifungal susceptibility testing for fluconazole, voriconazole, amphotericin B, and the echinocandins was performed on Candida albicans, C. parapsilosis, and C. tropicalis. Data were stratified by clinical service: adult ICU, adult wards, paediatric ICU, neonatal ICU, and paediatric wards. Temporal trends were assessed using the Cochran–Armitage test. The most prevalent species were C. albicans (42%), C. parapsilosis (24%), C. tropicalis (11%), C. glabrata (7%), and C. auris (3%). C. albicans predominated in adult services, whereas C. parapsilosis was the leading pathogen across paediatric settings. Among species with validated breakpoints, the overall fluconazole resistance rate was 19%, driven primarily by C. parapsilosis (35%, exceeding 40% in some clinical services). Non-wild-type to voriconazole and amphotericin B was low (<5%), and echinocandin resistance was exceedingly rare. The substantial fluconazole resistance driven by C. parapsilosis, together with the emergence of C. auris, underscores the urgent need for sustained surveillance and species-directed antifungal stewardship programmes.
OBJECTIVES:To validate an ultrasound-based method for noninvasive estimation of central venous pressure (CVP) in critically ill patients and compare its performance with invasively measured CVP. METHODS:We conducted an analytical cross-sectional study in adults admitted to a general intensive care unit. Patients with a central venous catheter and CVP monitoring through an electronic transducer were included. Ultrasound-estimated CVP (CVPus) was calculated using the method described by Istrail et al, which combines right atrial depth and jugular venous distension height. Correlation, paired mean differences, Bland-Altman agreement, and discriminative performance for invasive CVP thresholds of ≥5 and ≥10 mmHg were assessed. RESULTS:Seventy-five patients were included; CVPus was feasible in 70. Mean invasive CVP was 5.50 ± 3.80 mmHg; 53.3% of patients had CVP ≥5 mmHg and 21.3% had CVP ≥10 mmHg. CVPus showed a moderate positive correlation with invasive CVP (r = 0.61; p < .001). Mean invasive CVP and mean CVPus were 5.26 and 5.59 mmHg, respectively (p = .375). Bland-Altman analysis showed a mean bias of -0.33 mmHg, with 95% limits of agreement from -6.37 to 5.72 mmHg. The area under the ROC curve was 0.83 (95% CI, 0.68-0.99) for invasive CVP ≥10 mmHg and 0.81 (95% CI, 0.71-0.91) for invasive CVP ≥5 mmHg. CONCLUSIONS:The Istrail et al ultrasound method showed favorable overall performance for noninvasive CVP estimation in critically ill patients. Its low mean bias and good discriminative ability support its use as a complementary bedside tool, although agreement with invasive measurement remains limited.
Purpose Invasive fungal infections, particularly candidemia, are a major cause of morbidity and mortality in hospitalised patients, yet contemporary multicentre data on species distribution and antifungal resistance in Colombia remain limited. This study aimed to characterise the species distribution and in vitro antifungal susceptibility of yeast bloodstream isolates across a network of Colombian hospitals over a six-year period (2019–2024). Methods A retrospective, laboratory-based analysis was conducted on aggregated data from 23 participating hospitals across Colombia, primarily located in Bogotá. Yeast isolates from blood cultures were identified using the VITEK® 2 system. Antifungal susceptibility testing for fluconazole, voriconazole, amphotericin B, and echinocandins was performed on Candida albicans , C. parapsilosis , and C. tropicalis isolates using the VITEK® 2 AST-YS08 card. Data were stratified by clinical service: adult intensive care unit (ICU), adult wards, paediatric ICU, neonatal ICU, and paediatric wards. Results A total of 1,642 yeast isolates were recovered. The most prevalent species were C. albicans (42%), C. parapsilosis (24%), C. tropicalis (11%), C. glabrata (7%), and C. auris (3%). In adult populations, C. albicans predominated, whereas C. parapsilosis was the most common species in paediatric services. Global fluconazole resistance was 19%, largely driven by C. parapsilosis , which exhibited an overall resistance rate of 35% (exceeding 40% in some clinical services). Resistance to voriconazole and amphotericin B was low (< 5%), and echinocandin resistance was exceedingly rare. Conclusion This multicentre study reveals a distinct epidemiological divergence between adult and paediatric patients, with C. parapsilosis dominating in paediatric settings. The substantial fluconazole resistance, driven primarily by C. parapsilosis , together with the emergence of C. auris , underscores the urgent need for sustained surveillance and species-directed antifungal stewardship programmes across Colombian hospital networks
