Evaluate the association between preoperative SIRI and early postoperative SSI and to assess its diagnostic performance. Retrospective cohort study was conducted including 500 consecutive adult patients who underwent posterior fusion lumbar spine surgery for degenerative pathology. Preoperative neutrophil, lymphocyte, and monocyte counts were used to calculate SIRI. The primary outcome was early acute deep postoperative SSI. Associations were analyzed using univariate and penalized multivariate logistic regression. Discriminatory performance was assessed using receiver operating characteristic curve analysis. Early postoperative SSI occurred in 27 patients (5.4
BACKGROUND:One third of patients with Escherichia coli bacteraemia develop a dysregulated inflammatory response (sepsis/septic shock). Our objective was to investigate whether specific microbiological determinants of E. coli are associated to presentation with sepsis/shock. METHODS:A matched case-control study was performed; 101 case-patients with E. coli bacteraemia presenting with sepsis (SEPSIS-3 criteria) and 101 control-patients with E. coli bacteraemia without sepsis were matched by service, sex, age, Charlson index, acquisition and source of the bacteraemia and empirical treatment. Whole genome sequencing of E. coli isolates was performed (Illumina MiSeq Inc.). Sequence type, serotype, fimH type, virulence factors, antibiotic resistance genes, plasmid replicons pathogenicity islands and prophages were determined. A multivariate model was built for presentation with sepsis/septic shock using conditional logistic regression. The predictive capacity on the observed data was measured with the area under the ROC curve (AUROC) with 95% confidence intervals (CI). RESULTS:Here we show that in the multivariate model (adjusted OR; 95% CI), the ST69 clone (7.53; 1.06-35.05) and pic gene (4.38; 1.53-12.54) are associated to presentation with sepsis/shock, while the genes papC (0.30; 0.12-0.74) and fdeC (0.18; 0.03-1.32) show a protective effect. The AUROC of this model is 0.81 (95% CI 0.74-0.87). CONCLUSIONS:We identify E. coli bacterial factors associated with severe clinical presentation in patients with bacteraemia. Further studies would be needed to consider these factors as potential preventive or therapeutic targets.
Introduction Drug-related problems (DRP) are common in emergency departments (ED) and may compromise patient safety, highlighting the need to identify patients at greatest risk and prioritize pharmaceutical care. Aim To determine the levels of multidisciplinary consensus on the relevance of candidate factors for identifying patients at risk of DRP in ED, and on the real-time availability and ease of retrieval of the corresponding data in clinical practice. Method Multinational, multidisciplinary consensus study using a modified Delphi method (RAND/UCLA Appropriateness Method) involving healthcare professionals from a wide range of hospitals, predominantly in Spain, with additional representation from Australia and the United States. Participants were recruited from secondary and tertiary care settings across different healthcare systems, providing a diverse representation of emergency care practice. A total of 51 healthcare professionals with expertise in emergency medicine and pharmacotherapy were invited to participate. Response rates were 75% (n=38) during the open consultation, 84% (n=43) in Round 1, and 78% (n=40) in Round 2. The panel included hospital pharmacists, physicians, nurses, and other healthcare professionals involved in emergency care. The primary outcome was consensus on the appropriateness of each DRP risk factor, defined using the RAND/UCLA method based on median scores and interpercentile range analysis. Secondary outcomes included the assessment of real-time data availability and ease of data retrieval in clinical practice. Participants were selected based on their clinical expertise and active involvement in emergency care. Results Following an open consultation, 53 risk factors were evaluated. Participants added 22 new factors, modified 1, and excluded 2. After Round 2, 1 factor (employment status) was classified as inappropriate, 7 as uncertain, and disagreement was observed in 21 factors. High-risk prehospital drug administration, pharmacist intervention requests, and chronic drug use identified by STOPP criteria were among the most relevant factors. Conclusion This study provides a consensus-based set of clinically relevant DRP risk factors in ED. The variability in agreement highlights the complexity of DRP risk stratification and underscores the need for prospective validation studies. These findings support the future development of screening tools to prioritise pharmaceutical care in emergency settings.
Renal involvement is a major determinant of morbidity and mortality in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Accurate assessment of disease activity and renal prognosis remains challenging due to the complex interplay between immune-mediated injury and chronic damage. This review summarizes recent advances in understanding the pathogenesis of renal involvement in AAV and the contributions of renal biopsy and urinary biomarkers to disease assessment and outcome prediction. Current studies have elucidated key mechanisms underlying renal injury in AAV, including endothelial damage, complement pathway amplification, neutrophil activation, and dysregulated immune responses. Although renal biopsy remains the diagnostic gold standard, histopathological classifications and prognostic tools have refined prediction of kidney failure but are limited by sampling variability and invasiveness. AAV-glomerulonephritis activity evaluation still relies on evaluation of kidney function biomarkers (serum creatinine or cystatin-C), along with proteinuria and hematuria. Emerging urinary biomarkers, such as monocyte chemoattractant protein-1 (MCP-1), kidney injury molecule-1 (KIM-1), and soluble CD163, among others, reflect glomerular and tubular injury and show promise for non-invasive disease monitoring. However, heterogeneity in study design, small sample sizes, and lack of standardization limit their clinical application. Integrating histopathological data with urinary biomarkers offers a more precise evaluation of renal activity and chronicity in AAV. Future research should focus on validating biomarker panels in large, longitudinal cohorts and combining them with biopsy findings to develop personalized monitoring and treatment strategies. Such integration may enable early detection of renal relapse, reduce treatment toxicity, and improve long-term outcomes for patients with AAV.
Background and Objectives Although the relationship between clinical and cognitive insight in individuals with bipolar disorder remains unclear, both concepts are potentially related to cognitive performance, particularly to executive function. We aimed to explore associations among cognitive variables, cognitive insight, and clinical insight. Methods We assessed 64 clinically stable bipolar patients with a battery of clinical and cognitive tests, the Insight Scale for Affective Disorders to assess clinical insight, and the Beck Cognitive Insight Scale (BCIS) to assess cognitive insight. We used bivariate linear regression models to explore associations between cognitive insight, clinical insight, cognition, and sociodemographic and clinical variables, followed by stepwise multiple regression analyses to account for potential confounders. Results Global (F = 4.149; B = 0.201; p = 0.047; R2=0.071) and self-reflectiveness BCIS subscale (F = 4.690; B = 0.265; p = 0.043; R2=0.153) scores were positively associated with executive functions. Self-reflectiveness was negatively associated with premorbid intelligence quotient (F = 4.156; B=-0.170; p = 0.046; R2=0.071). Clinical insight was associated only with the self-certainty subscale of the BCIS (F = 4.120; B = 0.360; p = 0.047; R2=0.063). Conclusions Reduced cognitive insight is associated with cognitive impairment, especially diminished executive functioning. Elevated self-certainty scores are associated with diminished clinical insight.
