OBJECTIVE:To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure.DESIGN:Prospective, multicentrico SCOPE: 62 ICU from Spain between February 2018 and March 2019.PATIENTS:Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure.INTERVENTIONS:None.MAIN INTEREST VARIABLES:Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge.RESULTS:A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99).CONCLUSIONS:Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

Objectives To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as first biologic drug in refractory uveitis with cystoid macular oedema (CME) associated to BD. Methods Multicenter study of 40 patients with BD-associated uveitis with CME refractory or intolerant to standard treatment (corticosteroids and at least one conventional immunosuppressive agent). CME was considered if macular thickness was greater than 300 µm. Comparative outcome measures were macular thickness, improvement of visual acuity (VA), activity of anterior chamber inflammation and vitritis. Results were expressed as mean ±SD for variables with a normal distribution, or as median [25th-75th interquartile range- IQR] when not normally distributed. The comparison of continuous variables among time-periods was performed with the Wilcoxon signed rank test. Results We selected patients with CME from a cohort of 177 patients with refractory BD-related uveitis (n=40). IFX was used in 15 cases and ADA in 25. No significant differences at baseline were observed between IFX vs ADA groups in sex (♂/♀ 8/7 vs 13/12, p=0.93), mean age (38±9 vs 41±10 years, p=0.53), HLA-B51 + (10 vs 19, p=0.87), uveitis pattern (panuveitis 67% vs 80%, posterior uveitis 33% vs 20%, p=0.34), previous conventional treatment (intravenous pulses of methylprednisolone 60% vs 52%, p=0.62, oral corticosteroids 93% vs 72%, p=0.1, methotrexate 53% vs 52%, p=0.93, cyclosporin A 73% vs 88%, p=0.23, azathioprine 53% vs 56%, p=0.86, other drugs 47% vs 68%, p=0.18), and combined treatment (67% vs 64%, p=0.86). After 1 year of therapy, ocular remission was achieved in 60% of cases with IFX and in 76% of cases with ADA (p=0.28). Regarding CME, 65% of patients with IFX reached a macular thickness <250 µm vs 87% of patients with ADA, with no statistically significant differences (p=0.07). Evolution of ocular parameters is shown in the table 1. Only 2 adverse effects were observed, both in ADA group (local rash and bacteremia). Conclusions IFX and ADA show a similar efficacy in the treatment of CME in BD-related refractory uveitis. Reference [1] Calvo-Río V, Blanco R, Beltran E, Sanchez-Burson J, Mesquida M, Adan A, et al. Anti-TNF- therapy in patients with refractory uveitis due to Behcet’s disease: a 1-year follow-up study of 124 patients. Rheumatology (Oxford)2014;53(12):2223–31. Disclosure of Interest None declared

Background Uveitis is the most common ocular manifestation in Behçet’s Disease (BD), which can cause irreversible blindness.1–2 Objectives To assess efficacy, safety and cost-effectiveness of adalimumab (ADA) therapy optimisation in a series of patients with uveitis due to BD. Methods Multicenter study of 74 ADA-treated patients with BD uveitis refractory to conventional immunosuppressants. Following remission, optimisation was performed by increasing the ADA dosing interval. Comparison between optimised and non-optimised group was performed. Results Ocular remission was achieved in 65 (86.6%) patients after a median ADA duration of 63–12 months. ADA was optimised in 23 cases. In the remaining 42 ADA was maintained at 40 mg/sc/2 weeks. No baseline differences were found at ADA onset between the optimised and non-optimised groups. Ocular outcomes were similar after a mean ±S.D. follow-up of 34.7±13.3 and 26±21.3 months in the both groups (table 1). Adverse effects were seen in non-optimised group (lymphoma, pneumonia, local reaction and bacteremia). Mean ADA treatment costs were lower in the optimised vs non-optimised group (6101.25 €/patient/year vs 12339.48). Conclusions ADA optimisation in BD uveitis refractory to conventional therapy is effective, safe and cost-effective. References [1] Calvo-Río V, Blanco R, Beltrán E, et al. Anti-TNF-alfa therapy in patients with refractory uveitis due to Behçet’s disease: a 1-year- follow-up study of 124 patients. Rheumatol. 2014; 53(12):2223–31 [2] Santos-Gómez M, Calvo-Río V, Blanco R, et al. The effect of biologic therapy different from infliximab or adalimumab in patients with refractory uveitis due to Behçet’s disease: results of a multicentre open-label study. Clin Exp Rheumatol. 2016; 34 (6Suppl 102):S34-S40 Disclosure of Interest None declared

Background Cystoid macular oedema (CME) is the most serious complication of uveitis. This potentially severe complication may lead to irreversible visual loss.1–2 Objectives To compare efficacy and safety of Tocilizumab (TCZ) vs. Anti-TNF-α drugs in patients with refractory CME to conventional immunosuppressant (IS). Methods Multicenter study of patients with refractory CME to treatment with glucocorticoids and at least 1 conventional IS. The main objective was the improvement of macular thickness. Secondary objectives were the enhancement in best corrected visual acuity (BCVA) and the degree of ocular inflammatory activity. Results 59 patients/112 affected eyes. Causes of uveitis were: Behçet’s disease (n=41), Birdshot’s retinochoroidopathy (n=4), Juvenile Idiopathic Arthritis (n=9), Sarcoidosis (n=1) and idiopathic (n=4). No significant differences were observed at baseline in both groups (TCZ vs Anti-TNF-α) in sex (♂/♀; 8/17 vs. 15/19), mean age (35.6±18.9 vs 40.0±9.1), BCVA (0.40±0.31 vs. 0.48±0.31), Tyndall (1 [0–1] vs. 1 [0–2]), vitritis (1 [0–2] vs. 1 [0–3]) and macular thickness (431.8±165.9 vs. 397.1±138.1) (table 1). 25 patients were treated with TCZ as follows: 8 mg/kg/4 weeks (n=24) and 162 mg sc/2 weeks (n=1). Anti-TNF-α therapy was used in the remaining 34 as follows: IFX (n=12) (5 mg/kg 0, 2 y 6 weeks and every 4–8 weeks) and ADA (n=22) (40 mg/sc/2 weeks). We observed a rapid and sustained improvement in macular thickness after 1 year follow-up in both groups, without objectifying significant differences between them. In the same way, secondary ocular parameters also improved (table 1). Conclusions TCZ and Anti-TNF-α are effective in the treatment of CME refractory to conventional therapy. References [1] Calvo-Río V, Blanco R, Beltrán E, et al. Anti-TNF-alfa therapy in patients with refractory uveitis due to Behçet’s disease: a 1-year-follow-up study of 124 patients. Rheumatol. 2014;53(12):2223–31. [2] Calvo-Río V, Blanco R, Santos-Gómez M, et al. Efficacy of anti-il6-receptor tocilizumab in refractory cystoid macular edema of Birdshot retinochoroidopathy report of two cases and literature review. Ocul Immunol Inflamm. 2017;25(5):604–609. Disclosure of Interest None declared

Background Cystoid macular oedema (CME) represents the leading cause of blindness in uveitis of different immune-mediated inflammatory diseases (IMIDs). Objectives Our aim was to evaluate the efficacy of Tocilizumab (TCZ) in different IMIDs with refractory CME. Methods Multicentre study of 24 patients with CME due to uveitis of different IMIDs refractory to traditional treatment with systemic corticosteroids and at least one conventional immunosuppressive drug including in most cases biological therapy (n=21). CME was defined by (OCT >300 µm). We studied CME with TCZ in 4 different IMID; juvenile idiopathic arthritis (JiA), Behçet’s disease (BD), Birdshot retinochoroidopathy (BR) and idiopathic. The main outcome was the improvement of macular thickness. Other variables assessed were inflammation of the anterior chamber and vitreous and best corrected visual acuity (BCVA) Results We studied 16 ♀/8 ♂, mean age 35.2±19.3 years. The associated diseases were: JiA (n=9), BD,7 BR4 and idiopathic.4 The ocular patterns were: panuveitis,9 anterior uveitis,6 posterior uveitis5 and intermediate uveitis.4 Most patients had bilateral involvement.22 The biological therapy used before the administration of TCZ were infliximab,8 adalimumab,18 etanercept,2 golimumab,2 rituximab,2 abatacept,3 anakinra1 and daclizumab.1 TCZ administration schedule was 8 mg/kg/4 weeks iv.23 or every 2 weeks.1 TCZ was used in monotherapy12 or combined with conventional immunosuppressive drugs.12 OCT values improved considerably in 12 months: in JiA from 340.6±134.1 µm to 252.5±30 µm, in BD from 375.1±117 µm to 235±7.1 µm, in BR from 550.7±214.4 µm to 295.5±43.2 µm and in idiopathic from 515±219.6 µm to 208.3±46.7 µm (figure 1). Inflammation in anterior chamber and vitritis and BCVA also improved in the 4 subtypes. No minor side effects were observed, so no patient had to stop treatment. Conclusions TCZ seems a rapid effective treatment in severe and refractory uveitic CME, regardless of the underlying IMIDs. References [1] Calvo-Río V, de la Hera D. et al. Tocilizumab in uveitis refractory to other biologic drugs: a study of 3 cases and a literature review. Clin Exp Rheumatol2014;32(Suppl 84):S54–S57. [2] Calvo-Río V, Santos-Gomez M, et al. Anti-IL6-R Tocilizumab for Severe Juvenile Idiopathic Arthritis-Associated Uveitis Refractory to anti-TNF therapy. A multicenter study of 25 patients. Arthritis Rheumatol 2016;69:668–75. [3] Calvo-Río V, Blanco R, Santos-Gómez M, et al. Efficacy of Anti-IL6-Receptor Tocilizumab in Refractory Cystoid Macular Edema of Birdshot Retinochoroidopathy Report of Two Cases and Literature Review. Ocul Immunol Inflamm2017Oct;25(5):604–609. Disclosure of Interest None declared

Objectives To assess the efficacy of Tocilizumab (TCZ) in refractory uveitis associated to extraocular manifestations due to Behçet’s disease (BD). Methods Multicenter study of patients with BD refractory to standard systemic treatment (conventional immunosuppressive drugs and/or anti-TNF-α agents). Results We studied 11 patients (7 men/4 women) (20 affected eyes); mean age 38.4±20.4 years. Uveitis was bilateral in 9 patients. The pattern of ocular involvement was: panuveitis (n=8; with retinal vasculitis in 4), anterior uveitis (n=2) and posterior uveitis (n=1). Cystoid macular oedema (CME) was present in 7 patients. The clinical course was recurrent (n=7) or chronic (n=4). Apart from the visual complications, at TCZ onset the following extraocular manifestations were present: oral and/or genital ulcers (n=7), arthritis (n=4), folliculitis/pseudofolliculitis (n=4), erythema nodosum (n=2), livedo reticularis (n=1), intestinal affection (n=1), and neurological involvement (n=2). Before TCZ, they had received systemic corticosteroids, conventional immunosuppressive drugs and biologic agents, adalimumab (n=8), infliximab (n=4), golimumab (n=3), canakinumab (n=1), or etanercept (n=1). TCZ was used in monotherapy or combined with conventional immunosuppressive drugs at 8 mg/kg/iv/4 weeks (n=10) or 162 mg/sc/week (n=1). TCZ yielded rapid and maintained improvement in all ocular parameters (TABLE). After a mean follow-up of 9.5±8.05 months using TCZ, all patients experienced ocular improvement, with complete remission in 8 of them. However, TCZ was only effective in 3 of the patients with extraocular manifestations. This biologic agent had to be withdrawn in 2 cases, 1 due to a severe infusion reaction and 1 due to arthritis impairment. Abbreviations: CME, cystoid macular oedema; MRI, magnetic resonance imaging; TCZ, tocilizumab. Conclusions TCZ appears to be useful in highly refractory BD-related uveitis. However, there are controversial results regarding its efficacy in the treatment of extraocular manifestations of BD. References [1] Santos-Gómez M, Calvo-Río V, Blanco R, Beltrán E, Mesquida M, Adán A. The effect of biologic therapy different from infliximab or adalimumab in patients with refractory uveitis due to Behcet’s disease: results of a multicenter open label study. Clin Exp Rheumatol2016;34(6Suppl 102):S34–S40. [2] Calvo-Río V, de la Hera D, Beltran-Catalan E, Blanco R, Hernandez M., Martinez-Costa L. Tocilizumab in uveitis refractory to other biologic drugs: a study of 3 cases and a literature review. Clin Exp Rheumatol2014;32(Suppl 84):S54–S57. [3] Calvo-Río V, Santos-Gomez M, Calvo I, et al. Anti-IL6-R Tocilizumab for Severe Juvenile Idiopathic Arthritis-Associated Uveitis Refractory to anti-TNF therapy. A multicenter study of 25 patients. Arthritis Rheumatol2016;69:668–75. Disclosure of Interest None declared

Background In uveitis rapid and effective remission-inducing therapy is mandatory to avoid irreversible damage. Objectives To evaluate the efficacy and safety of high-dose intravenous methylprednisolone (IVMP) pulse therapy in uveitis. Methods Multicentre study of 129 patients (203 eyes) with uveitis who received IVMP. The underlying diseases were: Idiopathic (n=30), Vogt Koyanagy Harada,29 Behçet disease,19 Sarcoidosis,6 Multifocal Choroidopathy,4 Birdshot chorioretinopathy,2 Acute posterior multifocal placoid pigment epitheliopathy,1 Granulomatosis with polyangiitis,2 Aortitis,1 Immune thrombocytopenic purpura,1 Rheumatoid arthritis,2 Axial Spondylitis,6 Psoriatic arthritis,2 Juvenile Idiopathic Arthritis,1 Thrombophilia synd.,1 Eales Disease,2 Sympathetic Ophthalmia,2 Multiple Sclerosis,2 Relapsing Polychondritis,1 Cogan’s synd.,1 Sjögren synd.,2 Crohn’s disease,1 Reactive arthritis,1 Toxic oil synd. and brain ischemia,1 Raynaud’s Disease and brain ischemia,1 Pseudotumor,1 Cataract surgery,1 Herpes Simplex,1 Varicella Zoster-associated acute retinal necrosis,1 T.pallidum3 and M.tuberculosis.1 The inflammatory ocular patterns were: panuveitis (66), posterior uveitis (PU),31 intermediate uveitis (IU),5 anterior uveitis (AU),12 AU and PU,2 AU and IU,1 IU and PU,1 exudative retinal detachment,3 vasculitis,4 pseudotumor,1 scleritis2 and sclero-uveitis.1 Bilateral ocular involvement was observed in 74 cases. Patients were assessed at basal visit and day 2–5, 7, 15 and 30 after IVMP. The main outcome variable was best corrected visual acuity (BCVA), the degree of inflammation of the anterior chamber and vitreous, and macular thickness (macular oedema defined by OCT >300 µm). The results are expressed as mean ±SD for normally distributed variables, or as median [interquartile range] when are not. Comparison of continuous variables was performed using the Wilcoxon test. Results We studied 74 &x2640;/55 &x2642;; mean age 42±14.3 years. IVMP dose ranged from 40–1000 mg/day for 3–5 consecutive days. Prior to IVMP, cycloplegic and corticosteroid eye drops were used in all cases. Improvement was faster among patients with inflammation in anterior chamber and vitritis than in BCVA, CME, retinitis and retinal vasculitis (TABLE). Total remission was achieved in 19.4% of the 129 patients after IVMP. In 126 of the patients continued with oral corticosteroids and 4 received an intraocular dose of steroids. These immunosuppressive drugs were added: Methotrexate (52), Cyclosporine A,48 Azathioprine40 and others.5 In a few cases biological therapy (64) was administered afterwards. In general, acute respiratory infection was the side-effect most frequent.Abstract SAT0622 – Table 1 Conclusions High-dose IVMP pulse therapy is beneficial in the prompt control of severe uveitis and it is well tolerated. Disclosure of Interest None declared

Background Retinal vasculitis (RV) is a serious complication of uveitis due to Behçet’s disease (BD).1–2 Objectives We assess the short/long-term efficacy of Infliximab (IFX) in refractory RV of BD. Methods Multicenter study of patients with RV of BD refractory to corticosteroids and at least 1 conventional immunosuppressant (IS). We compared efficacy of IFX between baseline, 1st week, 1–6 months and 1–6 years. Results 72 patients/129 affected eyes (40♂/32♀) with mean age of 39.6±9.7 years. HLA-B51 was (+) in 63%. Before IFX onset, patients had received: oral/e.v. glucocorticoids (n=98), CyA (n=56), AZA (n=43), MTX (n=34) and other IS (n=22). IFX was used as monotherapy in 17 patients and combined with conventional IS in the remaining 55. IFX dose was as follows: 3 mg/kg/4–8 w (n=5), 4 mg/kg/4 w (n=1), 5–5.5 mg/kg/4–8 w (n=66). Following IFX onset, an improvement in RV was seen, as well as in the other ocular outcomes. This enhancement was maintained (table 1). After a mean follow-up of 26.5±22.1 months, IFX was discontinued in 44: remission (n=15), primary failure (n=16), preference of another route of administration (n=8), pregnancy (n=1) and adverse effects (n=4). Conclusions IFX seems an effective short/long-term treatment in RV of BD. References [1] Calvo-Río V, Blanco R, Beltrán E, et al. Anti-TNF-alfa therapy in patients with refractory uveitis due to Behçet’s disease: a 1-year-follow-up study of 124 patients. Rheumatol. 2014; 53(12):2223–31 [2] Santos-Gómez M, Calvo-Río V, Blanco R, et al. The effect of biologic therapy different from infliximab or adalimumab in patients with refractory uveitis due to Behçet’s disease: results of a multicentre open-label study. Clin Exp Rheumatol. 2016; 34 (6Suppl 102):S34-S40 Disclosure of Interest None declared

Objectives Cystic macular edema (CME) is the most serious complication of uveitis and the most common cause of blindness. Our objective was to compare the efficacy and safety of adalimumab (ADA) vs infliximab (IFX) as the first biological drug in uveitic cystoid macular edema (CME) due to Behçet9s disease (BD) during 1 year follow-up. Methods In a multicentre study of 175 patients with BD and uveitis refractory to conventional therapy, 34 patients had CME, defined by (OCT >300μ) at baseline. IFX (3–5 mg/kg 0,2, and 6 weeks and then every 4–8 weeks) was used in 12 cases and ADA (40 mg/2 weeks) in 22 cases. The main objective was the absence of CME. Secondary objectives: improvement in visual acuity (VA) (increased AV >20% in at least one of two eyes), inactive anterior chamber inflammation, vitritis, retinitis and retinal vasculitis. A bivariate analysis was performed to compare the response to biological therapy (ADA and IFX). Results We studied 34 patients (63 affected eyes). No statistically significant baseline differences were observed between both groups (IFX vs ADA) sex (men/women 4/6 vs 11/11; p=0.35), mean age (37.3±10.1 vs 41.5±8.3; p=0.2) HLAB51 positive (70% vs 80.9%; p=0.5), duration of uveitis before anti TNF alpha treatment [median (IQR]; 36 [10–82] vs 33 months [15.5 to 83]; p=0.8), VA (0.4 ± 0.33 vs 0.46±0.29; p=0.44); retinal vasculitis (75% vs 77%; p=0.87); retinitis (46% vs 30%; p=0.2); macular thickening (140.9±410.13 vs 409.46±138.55; p=0.98); combined treatment (58.33% vs 59.1%; p=0.96). We found differences in the presence of cells in the anterior chamber (Median [IQR]; 1 [0–1.2] vs 1 [0–3]; p=0.02) and vitritis (median [IQR], 1 [0–2] vs. 3 [0.5 -3]; p=0.002). Regarding the main objective, the improvement of CME is higher in patients treated with ADA during first month of treatment maintained at a year, although the difference is not statistically significant (table). With IFX we observed an improvement during the first month of treatment in vitritis, that became inactive, in the disappearance of the anterior chamber cells, and in retinitis and vasculitis that also became inactive. In no case statistically significant differences are reached. When adjusting for duration of illness, age and sex these differences remain. After a year of treatment all patients with retinitis and vasculitis in its baseline improve (ADA and IFX). Conclusions Our study suggests that ADA and IFX don9t show statistically significant differences in treatment of CME due to refractory uveitis in BD after 1 year follow-up. Disclosure of Interest None declared

Background Increased incidence of syphilis has been observed in developed countries in the last decade. In some cases uveitis indistinguishable from that related to non-infectious autoimmune uveitis may be the presenting manifestation of syphilis. Objectives From a wide series of patients with syphilitic uveitis our aims were: 1) To describe the clinical features and visual outcomes. 2) To assess differences with syphilitic patients without uveitis in demographic features, HIV status, viral load and CD4 count and cerebrospinal fluid findings. Methods Retrospective and comparative case series study. Since year 2000, 50 patients (19 females/31 males) with 45±17 years were diagnosed as having syphilitic uveitis in 8 centers from Spain. Other 86 randomly selected syphilitic patients without uveitis diagnosed in the same centers during the same period were included. Clinical and laboratory data were collected from the clinical records. Continuous variables (normally and not normally distributed) were compared with the 2-tailed Student’ Results The most frequent anatomic uveitic pattern was posterior; 26 (52%) cases. Granulomatous inflammation of the anterior chamber was observed in 3 (6%) patients. Several types of posterior segment inflammation were observed: optic neuritis (40%), vitritis (35%), necrotizing retinopathy (35%), retinal vasculitis (20%), posterior placoid chorioretinitis (10%), multifocal chorioretinitis (10%), macular edema (7.5%), serous retinal detachment (5%), neuroretinitis (5%), multifocal choroiditis (2.5%). Mean ± SD initial visual acuity (VA) of right and left eyes (RE, LE) was 0.43±0.37 and 0.49±0.37 respectively. After a mean follow-up of 27.1±3 months final VA was statistically better in both eyes (RE: 0.72±0.34; p=0.012 and LE: 0.75±0.33; p=0.012). We did not find differences in syphilitic patients with and without uveitis in age and sex distribution. We observed more frequently homosexual and HIV+ patients in the group of uveitis (p=0.002 and p=0.032). HIV patients from both groups did not presented differences in CD4 count and viral load. Patients with uveitis had higher amount of cells in cerebrospinal fluid: 5 (0-10400) vs 1 (0-50) p=0.020. No differences were observed in the concentration of proteins and frequency of positive serology. Conclusions We observed an increased incidence of syphilis presenting as uveitis in our Uveitis Units. High level of suspicion for this infection is required to establish an early diagnosis and appropriate treatment. In this relatively large series of patients with syphilitic uveitis, posterior uveitis was the most frequent type of uveitis. Prognosis was favourable in terms of VA. Patients with syphilitic uveitis presented more frequently homosexual practices, HIV+ and presented a greater number of cells in the cerebrospinal fluid. Disclosure of Interest None Declared

Introduction: During the 2009 influenza pandemic, several reports were published, nevertheless, data on the clinical profiles of critically ill patients with the new virus infection during this second outbreak are still lacking.Material methods: Prospective, observational, multi-center study conducted in 148 Spanish intensive care units (ICU) during epidemiological weeks 50-52 of 2010 and weeks 1 - 4 of 2011.Results: Three hundred patients admitted to an intensive care unit (ICU) with confirmed An/H1N1 infection were analyzed. The median age was 49 years [IQR = 38-58] and 62% were male. The mean APACHE II score was 16.9 +/- 7.5 and the mean SOFA score was 6.3 +/- 3.5 on admission. Comorbidities were present in 76% (n = 228) of cases and 111(37.4%) patients were reportedly obese and 59 (20%) were COPD. The main presentation was viral pneumonia with severe hypoxemia in 65.7% (n = 197) of the patients whereas co-infection was identified in 54 (18%) patients. All patients received antiviral treatment and initiated empirically in 194 patients (65.3%), however only 53 patients (17.6%) received early antiviral treatment. Vaccination was only administered in 22 (7.3%) patients. Sixty-seven of 200 patients with ICU discharge died. Haematological disease, severity of illness, infiltrates in chest X-ray and need for mechanical ventilation were variables independently associated with ICU mortality.Conclusions: In patients admitted to the ICU in the post-pandemic seasonal influenza outbreak vaccination was poorly implemented and appear to have higher frequency of severe comorbidities, severity of illness, incidence of primary viral pneumonia and increased mortality when compared with those observed in the 2009 pandemic outbreak. (C) 2011 Elsevier Espana, S.L. and SEMICYUC. All rights reserved.

OBJECTIVES: This study examined whether past condom failure (breakage, slippage, or both) can predict future failure and evaluated other predictors of condom failure. METHODS: At each of 3 international sites, approximately 130 male condom users were enrolled and given 5 condoms to use for vaginal intercourse over a 3-week period. RESULTS: Men at increased risk (history of 1 or more condoms that broke or slipped off) reported approximately twice as many condom failures as those not in this group. Condom failure increased with the number of adverse condom use behaviors reported per participant. Opening condom packages with sharp objects and unrolling condoms before donning were associated with breakage. Unrolling condoms before donning and lengthy or intense intercourse were associated with slippage. Of background characteristics evaluated, having less education was associated with condom failure. CONCLUSIONS: These data suggest that a history of condom failure predicts future failure, a finding that may be useful for targeted intervention. Moreover, these data provide further evidence that certain behaviors and lower educational attainment are associated with condom failure.

A convenience sample of 162 family planning clients in Kenya, the Dominican Republic and Mexico provided data for an evaluation of the acceptability of two woman-controlled contraceptive methods that may also provide disease protection. Women significantly preferred contraceptive film over foaming tablets at two sites: In Kenya, 86% of participants said they would rather use the film and 14%, the tablets; in Mexico, these proportions were 58% and 30%, respectively. Although a slight majority of women in the Dominican Republic preferred the film also, about one-half of participants there and in Mexico complained that the film sometimes stuck to their fingers during insertion.

An unusual tumor was observed in a 67-year-old man. Microscopically, the tumor was composed of epithelial cells forming glands (CEA, EMA-positive) and spindle-shaped cells (vimentin-positive). A third component was a cell population ultrastructurally characterized by intracytoplasmic granules surrounded by a membrane; these proved to be chromogranin A-positive in the immunoperoxidase study.