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Ruiz-Cabello Subiela J, Martinez-Sepulveda T, Medina J, Varona JF, Zorita B, Fuertes B, Pastor A, Osende J, Palomo J, Castellano JM, Parra Jimenez FJ, Fernandez-Friera L, Lopez-Melgar B. Usefulness of carotid and femoral plaque burden quantification by 3-dimensional vascular ultrasound for cardiovascular risk assessment in the cardiovascular disease prevention unit. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Subclinical atherosclerosis improves cardiovascular risk assessment and is considered a risk modifier in individuals at borderline-to-intermediate estimated risk by clinical risk scores.
Purpose
We seek to propose a new decision algorithm for statin allocation based on the quantification of carotid and/or femoral atherosclerosis burden by novel 3-dimensional vascular ultrasound (3DVUS) and to explore its potential additive value when used in combination with conventional risk evaluation.
Methods
We conducted an observational study in all outpatients without previous history of cardiovascular events assessed in the Cardiovascular Disease Prevention Unit during 2017–2020. Cardiovascular risk was assessed with the ACC/AHA 10-year atherosclerotic cardiovascular disease (ASCVD) risk algorithm to establish the indication for initiating statin therapy following current clinical guidelines. All patients underwent 3DVUS evaluation for carotid plaque burden (CPB) calculated as the sum of all plaque volumes present in bilateral carotid arteries. Femoral 3DVUS evaluation was included later in the study protocol. Global plaque burden (GPB) was calculated in patients with both carotid and femoral 3DVUS as the sum of all plaque volumes present in bilateral carotid and femoral arteries. Carotid and global plaque burden was classified as high, moderate and low if a patient presented a percentile (p) >75, p50–75 and p<50, respectively, based on the age and sex-adjusted reference values reported by PESA study (1). We determined the percentage of patients reclassified for considering (p>75) or discouraging (p<50) statin therapy over clinical recommendation.
Results
One hundred sixty-three patients (age 51±8 years; 72,4% men; 10y-ASCVD 5,9%±4,8%) were included, being the most frequent reason for referral the presence of metabolic syndrome (37%), followed by intermediate or indeterminate estimated CV risk (33%), one markedly elevated single risk factor (15%) and family history of early CVD (13%). 10y-ASCVD score classified 80 (49%) patients as low-risk without recommendation for initiating statins, 18 (11%) as high-risk indicating statin therapy and 65 (40%) patients that needed clinical-patient risk discussion. Among patients under risk discussion, the CPB percentile re-stratified 51 (78%) of them, recommending statins in 26 (40%) and discouraging statins in 25 (38%). In addition, CPB re-stratified 24 (30%) low-risk patients to recommend statins. A sub-group of 114 patients additionally underwent femoral 3DVUS, and calculated GPB led to similar results of patient re-stratification (Figure).
Conclusions
Quantification of 3D atherosclerosis burden and its percentile would re-stratify a significant number of patients with intermediate risk, becoming a potentially useful tool for clinical decision making. In addition, it possibly improves the detection of low-risk patients who would benefit from statin therapy.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dr. Lόpez-Melgar has received a grant from the Spanish Society of Cardiology “Proyecto de investigaciόn traslacional en Cardiología 2020” Patient re-stratification with CPB/GPB
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Affiliation(s)
| | | | - J Medina
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - J F Varona
- University Hospital HM Montepríncipe, Internal Medicine Department, Boadilla del Monte, Spain
| | - B Zorita
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - B Fuertes
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - A Pastor
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - J Osende
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - J Palomo
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - J M Castellano
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - F J Parra Jimenez
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
| | - L Fernandez-Friera
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiovascular Imaging Unit, Madrid, Spain
| | - B Lopez-Melgar
- HM Hospitales–Centro Integral de Enfermedades Cardiovasculares HM CIEC, Cardiology Department, Madrid, Spain
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Beck M, Plötzing T, Maussang K, Palomo J, Colombelli R, Sagnes I, Mangeney J, Tignon J, Dhillon SS, Klatt G, Bartels A. High-speed THz spectroscopic imaging at ten kilohertz pixel rate with amplitude and phase contrast. Opt Express 2019; 27:10866-10872. [PMID: 31052940 DOI: 10.1364/oe.27.010866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/28/2019] [Indexed: 06/09/2023]
Abstract
By combining the advantages of the high-speed ASOPS technology and efficient THz generation, we have realized a high-speed laser-based spectroscopic THz imaging system with more than 10,000 pixels per second acquisition speed and an excellent signal-to-noise ratio of more than 100. Unlike THz line cameras or mm-wave intensity detectors, the present device allows for a much higher spatial resolution and attributes each imaging pixel with phase and amplitude information up to several THz while simultaneously maintaining a very high scanning speed unmatched by any other technique presented so far. The high-speed acquisition allows for samples to be scanned even at sample velocities of 5 m/s or higher while preserving the fundamental resolution limit of the THz radiation, which is on the order of 500 µm in the present case.
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Palomo J, Quesniaux VFJ, Togbe D, Reverchon F, Ryffel B. Unravelling the roles of innate lymphoid cells in cerebral malaria pathogenesis. Parasite Immunol 2019; 40. [PMID: 29117626 DOI: 10.1111/pim.12502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 10/31/2017] [Indexed: 12/17/2022]
Abstract
Cerebral malaria (CM) is one complication of Plasmodium parasite infection that can lead to strong inflammatory immune responses in the central nervous system (CNS), accompanied by lung inflammation and anaemia. Here, we focus on the role of the innate immune response in experimental cerebral malaria (ECM) caused by blood-stage murine Plasmodium berghei ANKA infection. While T cells are important for ECM pathogenesis, the role of innate lymphoid cells (ILCs) is only emerging. The role of ILCs and non-lymphoid cells, such as neutrophils and platelets, contributing to the host immune response and leading to ECM and human cerebral malaria (HCM) is reviewed.
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Affiliation(s)
- J Palomo
- Laboratory of Experimental and Molecular Immunology and Neurogenetics (INEM), UMR 7355 CNRS, University of Orleans, Orleans-Cedex2, France.,Division of Rheumatology, Departments of Internal Medicine Specialties and of Pathology-Immunology, University of Geneva School of Medicine, Geneva, Switzerland
| | - V F J Quesniaux
- Laboratory of Experimental and Molecular Immunology and Neurogenetics (INEM), UMR 7355 CNRS, University of Orleans, Orleans-Cedex2, France
| | - D Togbe
- Laboratory of Experimental and Molecular Immunology and Neurogenetics (INEM), UMR 7355 CNRS, University of Orleans, Orleans-Cedex2, France.,Artimmune SAS, Orléans, France
| | - F Reverchon
- Laboratory of Experimental and Molecular Immunology and Neurogenetics (INEM), UMR 7355 CNRS, University of Orleans, Orleans-Cedex2, France
| | - B Ryffel
- Laboratory of Experimental and Molecular Immunology and Neurogenetics (INEM), UMR 7355 CNRS, University of Orleans, Orleans-Cedex2, France.,IDM, Medical School, University of Cape Town, Cape Town, Republic of South Africa
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Elshebiny T, Palomo J, Pugliese F, Strohl K. 0512 Velopharynx and Oropharynx Dimension Changes with Stimulation and Positive Pressure. Sleep 2018. [DOI: 10.1093/sleep/zsy061.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Elshebiny
- Case Western Reserve University, Beachwood, OH
| | - J Palomo
- Case Western, Case Western Reserve University, OH
| | - F Pugliese
- Case Western, Case Western Reserve University, OH
| | - k Strohl
- Case Western, Case Western Reserve University, OH
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Rosso A, Aragón P, Acevedo F, Doadrio I, García-Barros E, Lobo JM, Munguira ML, Monserrat VJ, Palomo J, Pleguezuelos JM, Romo H, Triviño V, Sánchez-Fernández D. Effectiveness of the Natura 2000 network in protecting Iberian endemic fauna. Anim Conserv 2017. [DOI: 10.1111/acv.12387] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. Rosso
- Universidad Pablo de Olavide; Sevilla Spain
| | - P. Aragón
- Departamento de Biogeografía y Cambio Global; Museo Nacional de Ciencias Naturales (CSIC); Madrid Spain
| | - F. Acevedo
- Departamento de Zoología y Antropología Física; Universidad Complutense de Madrid; Madrid Spain
| | - I. Doadrio
- Departamento de Biogeografía y Cambio Global; Museo Nacional de Ciencias Naturales (CSIC); Madrid Spain
| | - E. García-Barros
- Departamento de Biología; Universidad Autónoma de Madrid; Madrid Spain
| | - J. M. Lobo
- Departamento de Biogeografía y Cambio Global; Museo Nacional de Ciencias Naturales (CSIC); Madrid Spain
| | - M. L. Munguira
- Departamento de Biología; Universidad Autónoma de Madrid; Madrid Spain
| | - V. J. Monserrat
- Departamento de Zoología y Antropología Física; Universidad Complutense de Madrid; Madrid Spain
| | - J. Palomo
- Departamento de Biología Animal; Universidad de Málaga; Malaga Spain
| | | | - H. Romo
- Departamento de Biología; Universidad Autónoma de Madrid; Madrid Spain
| | - V. Triviño
- Instituto de Ciencias Ambientales; Universidad de Castilla-La Mancha; Campus Tecnológico de la Fábrica de Armas; Toledo Spain
| | - D. Sánchez-Fernández
- Instituto de Ciencias Ambientales; Universidad de Castilla-La Mancha; Campus Tecnológico de la Fábrica de Armas; Toledo Spain
- Departamento de Ecología de Humedales; Estación Biológica de Doñana (CSIC); Americo Vespucio; Sevilla Spain
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Elshebiny T, Strohl K, Palomo J. 0507 EFFECT ON RETRO-PALATAL AND RETRO-GLOSSAL DIMENSIONS WITH PRESSURE FORCING COMPARING TO HYPOGLOSSAL NERVE STIMULATION. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Baillergeau M, Maussang K, Nirrengarten T, Palomo J, Li LH, Linfield EH, Davies AG, Dhillon S, Tignon J, Mangeney J. Diffraction-limited ultrabroadband terahertz spectroscopy. Sci Rep 2016; 6:24811. [PMID: 27142959 PMCID: PMC4855139 DOI: 10.1038/srep24811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/05/2016] [Indexed: 11/09/2022] Open
Abstract
Diffraction is the ultimate limit at which details of objects can be resolved in conventional optical spectroscopy and imaging systems. In the THz spectral range, spectroscopy systems increasingly rely on ultra-broadband radiation (extending over more 5 octaves) making a great challenge to reach resolution limited by diffraction. Here, we propose an original easy-to-implement wavefront manipulation concept to achieve ultrabroadband THz spectroscopy system with diffraction-limited resolution. Applying this concept to a large-area photoconductive emitter, we demonstrate diffraction-limited ultra-broadband spectroscopy system up to 14.5 THz with a dynamic range of 10(3). The strong focusing of ultrabroadband THz radiation provided by our approach is essential for investigating single micrometer-scale objects such as graphene flakes or living cells, and besides for achieving intense ultra-broadband THz electric fields.
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Affiliation(s)
- M Baillergeau
- Laboratoire Pierre Aigrain, Ecole Normale Supérieure, CNRS (UMR 8551), Université P. et M. Curie, Université D. Diderot, 75231 Paris Cedex 05, France
| | - K Maussang
- Laboratoire Pierre Aigrain, Ecole Normale Supérieure, CNRS (UMR 8551), Université P. et M. Curie, Université D. Diderot, 75231 Paris Cedex 05, France
| | - T Nirrengarten
- Laboratoire Pierre Aigrain, Ecole Normale Supérieure, CNRS (UMR 8551), Université P. et M. Curie, Université D. Diderot, 75231 Paris Cedex 05, France
| | - J Palomo
- Laboratoire Pierre Aigrain, Ecole Normale Supérieure, CNRS (UMR 8551), Université P. et M. Curie, Université D. Diderot, 75231 Paris Cedex 05, France
| | - L H Li
- School of Electronic and Electrical Engineering, University of Leeds, Woodhouse Lane, Leeds LS29JT, UK
| | - E H Linfield
- School of Electronic and Electrical Engineering, University of Leeds, Woodhouse Lane, Leeds LS29JT, UK
| | - A G Davies
- School of Electronic and Electrical Engineering, University of Leeds, Woodhouse Lane, Leeds LS29JT, UK
| | - S Dhillon
- Laboratoire Pierre Aigrain, Ecole Normale Supérieure, CNRS (UMR 8551), Université P. et M. Curie, Université D. Diderot, 75231 Paris Cedex 05, France
| | - J Tignon
- Laboratoire Pierre Aigrain, Ecole Normale Supérieure, CNRS (UMR 8551), Université P. et M. Curie, Université D. Diderot, 75231 Paris Cedex 05, France
| | - J Mangeney
- Laboratoire Pierre Aigrain, Ecole Normale Supérieure, CNRS (UMR 8551), Université P. et M. Curie, Université D. Diderot, 75231 Paris Cedex 05, France
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Delgado JF, Alonso-Pulpón L, Mirabet S, Almenar L, Villa FP, González-Vílchez F, Palomo J, Blasco T, Dolores García-Cosio M, González-Costello J, de la Fuente L, Rábago G, Lage E, Pascual D, Molina BD, Arizón JM, Muñiz J, Crespo-Leiro MG. Cancer Incidence in Heart Transplant Recipients With Previous Neoplasia History. Am J Transplant 2016; 16:1569-78. [PMID: 26613555 DOI: 10.1111/ajt.13637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 10/14/2015] [Accepted: 11/15/2015] [Indexed: 01/25/2023]
Abstract
Neoplasm history increases morbidity and mortality after solid organ transplantation and has disqualified patients from transplantation. Studies are needed to identify factors to be considered when deciding on the suitability of a patient with previous tumor for heart transplantation. A retrospective epidemiological study was conducted in heart transplant (HT) recipients (Spanish Post-Heart Transplant Tumor Registry) comparing the epidemiological data, immu-nosuppressive treatments and incidence of post-HT tumors between patients with previous malignant noncardiac tumor and with no previous tumor (NPT). The impact of previous tumor (PT) on overall survival (OS) was also assessed. A total of 4561 patients, 77 PT and 4484 NPT, were evaluated. The NPT group had a higher proportion of men than the PT group (p < 0.001). The incidence of post-HT tumors was 1.8 times greater in the PT group (95% confidence interval [CI] 1.2-2.6; p < 0.001), mainly due to the increased risk in patients with a previous hematologic tumor (rate ratio 2.3, 95% CI 1.3-4.0, p < 0.004). OS during the 10-year posttransplant period was significantly lower in the PT than the NPT group (p = 0.048) but similar when the analysis was conducted after a first post-HT tumor was diagnosed. In conclusion, a history of PT increases the incidence of post-HT tumors and should be taken into account when considering a patient for HT.
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Affiliation(s)
- J F Delgado
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - S Mirabet
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - L Almenar
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - F P Villa
- Hospital Clínic i Provincial, Barcelona, Spain
| | | | - J Palomo
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - T Blasco
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - L de la Fuente
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - G Rábago
- Clínica Universidad de Navarra, Pamplona, Spain
| | - E Lage
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - D Pascual
- Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - B D Molina
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J M Arizón
- Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J Muñiz
- Instituto Universitario de Ciencias de la Salud, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, La Coruña, Spain
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Carbone J, Diez P, Fernandez-Yañez J, Palomo J, Muñoz P, Hortal J, Sarmiento E. Personalized Therapeutic Use of Intravenous Immunoglobulin in Heart Recipients With Severe Infections and IgG Hypogammaglobulinemia: Impact on Clinical Outcomes. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Carbone J, Calahorra L, Diez P, Palomo J, Fernandez-Yanez J, Sarmiento E. Pretransplant Serum BAFF in Heart Transplantation: A Potential New Biomarker for Acute Cellular Rejection Risk. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Gonzalez Vilchez F, Crespo-Leiro M, Palomo J, Mirabet S, Diaz Molina B, Almenar L, Arizon J, Rangel D, Perez Villa F, Delgado J, Garrido I, de la Fuente L, Gomez Bueno M, Sanz M. Multicentre Study to Evaluate Conversion From Standard-Release Tacrolimus (SRT) to Extended-Release Tacrolimus (ERT) in a Large Series of Heart Transplanted Patients. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Carbone J, Arraya M, Lozano F, Palomo J, Sarmiento E. Mannose-Binding Lectin Serum Levels and Pre-Tranplant Genotypes for Personalized Anti-CMV Prophylaxis in Heart Recipients. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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13
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Sarmiento E, Arraya M, Jaramillo M, Diez P, Fernandez-Yañez J, Palomo J, Navarro J, Carbone J. Intravenous immunoglobulin as an intervention strategy of risk factor modification for prevention of severe infection in heart transplantation. Clin Exp Immunol 2015; 178 Suppl 1:156-8. [PMID: 25546803 DOI: 10.1111/cei.12552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- E Sarmiento
- Transplant Immunology Group, Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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Sarmiento E, Navarro J, Fernandez-Yañez J, Palomo J, Muñoz P, Carbone J. Evaluation of an immunological score to assess the risk of severe infection in heart recipients. Transpl Infect Dis 2014; 16:802-12. [PMID: 25179534 DOI: 10.1111/tid.12284] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/14/2014] [Accepted: 06/18/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND We previously reported how specific humoral and cellular immunological markers that are readily available in clinical practice can be used to identify heart transplant recipients (HTR) at risk of developing severe infections. In this study, we perform an extended analysis to identify immunological profiles that could prove to be superior to individual markers in assessing the risk of infection early after heart transplantation. METHODS In a prospective follow-up study, we evaluated 100 HTR at 1 week after transplantation. Laboratory tests included determination of immunoglobulin (Ig) levels (IgG, IgA, IgM), complement factors (C3 and C4), and lymphocyte subsets (CD3+, CD4+, CD8+ T cells, B cells, and natural killer [NK] cells). The prevalence of infection during the first 3 months was registered at scheduled visits after transplantation. Severe infections were defined as all infections requiring hospitalization and intravenous antimicrobial therapy. RESULTS During follow-up, 33 patients (33%) developed severe infections. The individual risk factors of severe infection, according to the Cox regression analysis, were as follows: IgG <600 mg/dL (hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.21-4.78; P = 0.012), C3 <80 mg/dL (HR, 4.65; 95% CI, 2.31-9.38; P < 0.0001), C4 <18 mg/dL (HR 2.30, 95% CI, 1.15-4.59; P = 0.018), NK count <30 cells/μL (HR 4.07, 95% CI, 1.76-9.38; P = 0.001), and CD4 count <350 cells/μL (HR, 3.04; 95% CI, 1.47-6.28; P = 0.0027). An immunological score was created. HRs were used to determine the number of points assigned to each of the 5 previously mentioned individual risk factors. The score was obtained from the sum of these factors. In the multivariate Cox regression analysis, the immunological score was useful for identifying patients at risk of infection and was the only variable that maintained a significant association with the development of infection, after adjustment for the 5 individual factors. CONCLUSION Patients with an immunological score ≥13 were at the highest risk of severe infections (HR, 9.29; 95% CI, 4.57-18.90; P < 0.0001). This score remained significantly associated with the risk of severe infection after adjustment for clinical risk factors of infection. An immunological score was useful for identifying HTR at risk of developing severe infections. If this score is validated in multicenter studies, it could be easily introduced into clinical practice.
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Affiliation(s)
- E Sarmiento
- Clinical Immunology Department, University Hospital Gregorio Marañon, Madrid, Spain
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15
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Sarmiento E, Jaramillo M, Navarro J, Rodriguez-Molina J, Fernandez-Yañez J, Palomo J, Gomez-Sanchez M, Crespo-Leiro M, Paniagua M, Almenar L, Cebrian M, Segovia J, Gomez M, Rabago G, Levy B, Mirabet S, Lopez J, Garcia-Guereta L, Carbone J. Humoral Immunity Profiles to Identify CMV-seropositive Heart Recipients at Risk of CMV Disease: A Prospective Multicenter Study. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sarmiento E, Rodriguez-Molina J, Navarro J, Palomo J, Fernandez-Yañez J, Carbone J. Heart Recipients With a Lower Response To the 23-Valent Pneumococcal Polysaccharide Vaccine Are at Significant Risk of Bacterial Infection After Transplantation. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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Carbone J, Rodriguez-Molina J, Navarro J, Fernandez-Yañez J, Palomo J, Alonso R, Sarmiento E. CMV-Seronegative Heart Recipients Disclose a Lower Immunocompetence Status Before Transplantation in Comparison With Seropositive Patients. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Valerio M, Rodriguez-Gonzalez CG, Munoz P, Caliz B, Sanjurjo M, Bouza E, Anaya F, Banares R, Bouza E, Bustinza A, Caliz B, Escribano P, Fernandez-Cruz A, Fernandez-Quero J, Frias I, Gayoso J, Gijon P, Guinea J, Hortal J, Martinez MC, Marquez I, Menarguez MC, Munoz P, Navarro M, Padilla B, Palomo J, Pelaez T, Peral J, Pinilla B, Rincon D, Rodriguez CG, Rodriguez M, Salcedo M, Sanchez-Somolinos M, Sanjurjo M, Valerio M, Verde E, Vilalta E, Zamora E. Evaluation of antifungal use in a tertiary care institution: antifungal stewardship urgently needed. J Antimicrob Chemother 2014; 69:1993-9. [DOI: 10.1093/jac/dku053] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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González-Vílchez F, Arizón J, Segovia J, Almenar L, Crespo-Leiro M, Palomo J, Delgado J, Mirabet S, Rábago G, Pérez-Villa F, Díaz B, Sanz M, Pascual D, de la Fuente L, Guinea G. Chronic Renal Dysfunction in Maintenance Heart Transplant Patients: The ICEBERG Study. Transplant Proc 2014; 46:14-20. [DOI: 10.1016/j.transproceed.2013.09.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 09/26/2013] [Indexed: 12/01/2022]
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20
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Lanio N, Sarmiento E, Gallego A, Navarro J, Palomo J, Fernandez-Yañez J, Ruiz M, Fernandez-Cruz E, Carbone J. Kinetics of functionally distinct T-lymphocyte subsets in heart transplant recipients after induction therapy with anti-CD25 monoclonal antibodies. Transpl Immunol 2013; 28:176-82. [DOI: 10.1016/j.trim.2013.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 04/13/2013] [Accepted: 04/15/2013] [Indexed: 12/18/2022]
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Sarmiento E, Fernandez-Yañez J, Palomo J, Gomez-Sanchez M, Crespo-Leiro M, Paniagua M, Almenar L, Cebrian M, Rabago G, Levy B, Segovia J, Gomez-Bueno M, Lopez J, García-Guereta L, Mirabet S, Jaramillo M, Navarro J, Rodriguez-Molina J, Carbone J. Validation of Humoral Immunity Profiles To Identify Heart Recipients at Risk for Development of Severe Infections: A Multicenter Prospective Study. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sarmiento E, del Pozo N, Gallego A, Fernández-Yañez J, Palomo J, Villa A, Ruiz M, Muñoz P, Rodríguez C, Rodríguez-Molina J, Navarro J, Kotsch K, Fernandez-Cruz E, Carbone J. Decreased levels of serum complement C3 and natural killer cells add to the predictive value of total immunoglobulin G for severe infection in heart transplant recipients. Transpl Infect Dis 2012; 14:526-39. [DOI: 10.1111/j.1399-3062.2012.00757.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E. Sarmiento
- Clinical Immunology Department; University Hospital Gregorio Marañón; Madrid; Spain
| | - N. del Pozo
- Clinical Immunology Department; University Hospital Gregorio Marañón; Madrid; Spain
| | - A. Gallego
- Clinical Immunology Department; University Hospital Gregorio Marañón; Madrid; Spain
| | - J. Fernández-Yañez
- Cardiology Department; University Hospital Gregorio Marañón; Madrid; Spain
| | - J. Palomo
- Cardiology Department; University Hospital Gregorio Marañón; Madrid; Spain
| | - A. Villa
- Cardiology Department; University Hospital Gregorio Marañón; Madrid; Spain
| | - M. Ruiz
- Cardiovascular Surgery Department; University Hospital Gregorio Marañón; Madrid; Spain
| | - P. Muñoz
- Microbiology Department; University Hospital Gregorio Marañón; Madrid; Spain
| | - C. Rodríguez
- Biochemistry Department; University Hospital Gregorio Marañón; Madrid; Spain
| | - J. Rodríguez-Molina
- Clinical Immunology Department; University Hospital Gregorio Marañón; Madrid; Spain
| | - J. Navarro
- Clinical Immunology Department; University Hospital Gregorio Marañón; Madrid; Spain
| | - K. Kotsch
- Transplant Immunology Group; Immunology Institute; Universitätsmedizin Charité; Berlin; Germany
| | - E. Fernandez-Cruz
- Clinical Immunology Department; University Hospital Gregorio Marañón; Madrid; Spain
| | - J. Carbone
- Clinical Immunology Department; University Hospital Gregorio Marañón; Madrid; Spain
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Carbone J, Sarmiento E, Del Pozo N, Rodriguez-Molina J, Navarro J, Fernandez-Yañez J, Palomo J, Villa A, Muñoz P, Fernandez-Cruz E. Restoration of humoral immunity after intravenous immunoglobulin replacement therapy in heart recipients with post-transplant antibody deficiency and severe infections. Clin Transplant 2012; 26:E277-83. [DOI: 10.1111/j.1399-0012.2012.01653.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J. Carbone
- Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - E. Sarmiento
- Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - N. Del Pozo
- Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | | | - J. Navarro
- Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - J. Fernandez-Yañez
- Cardiology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - J. Palomo
- Cardiology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - A. Villa
- Cardiology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - P. Muñoz
- Microbiology Department; University Hospital Gregorio Marañon; Madrid; Spain
| | - E. Fernandez-Cruz
- Clinical Immunology Department; University Hospital Gregorio Marañon; Madrid; Spain
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Carbone J, Lanio N, Gallego A, Navarro J, Palomo J, Fernandez-Yañez J, Sarmiento E. 409 Dynamic Changes in the Immunophenotypic Maturation Status of CD19 B Lymphocytes in Patients with Acute Cellular Rejection after Heart Transplantation. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Díaz-Molina B, Brossa V, Rábago G, Alonso-Pulpón L, Vilchez F, Palomo J, Manito N, Almenar L, Delgado J, Arizón J, Lage E, Lambert J, Pérez-Villa F, Blasco T, Pascual D, Fuente L, Crespo-Leiro M. 666 Prostate Cancer after Heart Transplantation: Incidence and Prognosis. Data from the Spanish Post-Heart-Transplant Tumour Registry. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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26
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Carbone J, Del Pozo N, Gallego A, Lanio N, Rodriguez-Molina J, Navarro J, Palomo J, Fernandez-Yañez J, Villa A, Muñoz P, Ruiz M, Hortal J, Rodriguez C, Fernandez-Cruz E, Kotsch K, Sarmiento E. 476 Identification of Immune Profiles That Are Associated with Development of Severe Infection in Heart Recipients. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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27
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Segovia J, Gómez-Bueno M, Goicolea J, Elízaga J, Fernández-Yáñez J, Palomo J, González-Vílchez F, Alonso-Pulpón L. 206 Effect of Everolimus in Patients with Established Cardiac Allograft Vasculopathy: Results of a Randomized, Multicenter Intravascular Ultrasound Study. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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28
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Sarmiento E, Del Pozo N, Rodriguez-Molina J, Navarro J, Fernandez-Yañez J, Palomo J, Carbone J. 102 Maintenance of Antibody Response to Pneumococcal Capsular Polysaccharide Vaccination in Adult Patients after Heart Transplantation. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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29
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Delgado J, Manito N, Almenar L, Crespo-Leiro M, Roig E, Segovia J, Vázquez de Prada J, Lage E, Palomo J, Campreciós M, Arizón J, Rodríguez-Lambert J, Blasco T, de la Fuente L, Pascual D, Rábago G. Risk factors associated with cytomegalovirus infection in heart transplant patients: a prospective, epidemiological study. Transpl Infect Dis 2010; 13:136-44. [DOI: 10.1111/j.1399-3062.2010.00573.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lanio N, Sarmiento E, Gallego A, Fernández-Yánez J, Palomo J, Pérez-Rojas J, Carbone J. The potential role of T-cell memory distribution as predisposing factor for rejection in heart transplant recipients. Transplant Proc 2010; 41:2480-4. [PMID: 19715957 DOI: 10.1016/j.transproceed.2009.06.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CD4 T cells play a significant role in the pathogenesis of rejection, providing help to alloreactive CD8 and B cells, however, the exact contribution of each memory compartment in vivo has not been defined. They are also important for the maintenance of tolerance due to regulatory activity of specialized subsets. In this study, we assessed changes in frequencies of functionally distinct lymphocyte subsets of peripheral blood (PBLs) in 26 heart transplant recipients (HT) in association with rejection episodes. Patients who developed rejection (n = 7), namely Grade 3B (n = 1), 3A (n = 4), or 2 (n = 2), in comparison with those with stable graft function displayed at baseline (pre-HT) higher percentages of naive (CCR7+CD45RA+) CD4 T cells (median 48 vs 36.6%; P = .035) and lower percentages of central memory (CCR7+CD45RA-) CD4 T cells (33.3 vs 46.5%; P = .035). At 30 days post-HT, CD4/CD127(low)FoxP3+ T cells were significantly reduced among patients with rejection episodes (0.84 vs 2.15%; P = .042). CD8 final effector T cells were increased at 90 days post-HT among those patients who experienced rejection (TEM2: 60.8 vs 31.9%; P < .1), at the expense of shrinking CD8 central memory compartment (TCM: 8.6 vs 12.9%; P = .046). The potential role of T-cell memory distribution should be further evaluated in HT patients as possible markers to discriminate patients at risk for rejection.
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Affiliation(s)
- N Lanio
- Clinical Immunology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Bayarri MJ, Walsh D, Berger JO, Cafeo J, Garcia-Donato G, Liu F, Palomo J, Parthasarathy RJ, Paulo R, Sacks J. Computer model validation with functional output. Ann Stat 2007. [DOI: 10.1214/009053607000000163] [Citation(s) in RCA: 185] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Díaz B, González Vilchez F, Almenar L, Delgado JF, Manito N, Paniagua MJ, Crespo MG, Kaplinsky E, Pascual DA, Fernández-Yáñez J, Mirabet S, Palomo J. Gastrointestinal Complications in Heart Transplant Patients: MITOS Study. Transplant Proc 2007; 39:2397-400. [PMID: 17889201 DOI: 10.1016/j.transproceed.2007.07.061] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The most frequent immunosuppressive treatment complications in solid organ transplant recipients are gastrointestinal (GI) disorders. MATERIALS AND METHODS An observational, cross-sectional study to evaluate the prevalence and management of GI complications in transplanted patients was conducted via a written questionnaire given to doctors at their practice. RESULTS This study included 1788 patients; 181 corresponded to heart transplant recipients. The mean age for the heart transplant patients was 58.7 +/- 11.8 years. The mean time from the transplantation was 5.2 +/- 4.4 years. GI complications were seen in 38.7% of cases. Regarding the clinical management, in 72.9% of cases patients with GI complications received pharmacologic treatment, 86.3% with gastric protectors, 32.8% reduced the dose of some drug, 8.1% interrupted the drug temporarily, and 10.9% discontinued the drug permanently. The drug that was always discontinued was mycophenolate mofetil (MMF), and in 85.7% of cases in which the dose of an immunosuppressive drug was reduced, the reduced drug was also MMF. CONCLUSIONS Almost 40% of heart transplant recipients suffered GI complications which affected daily activities in most cases. The most used strategy to manage these complications was based on a treatment with gastric protectors together with dose reduction and/or partial or definitive MMF discontinuation.
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Affiliation(s)
- B Díaz
- Hospital Central de Asturias, Oviedo, Spain.
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Carbone J, Sarmiento E, Palomo J, Fernandez-Yañez J, Muñoz P, Bouza E, Rodríguez-Molina J, Lanio N, Fernandez-Cruz E. The Potential Impact of Substitutive Therapy With Intravenous Immunoglobulin on the Outcome of Heart Transplant Recipients With Infections. Transplant Proc 2007; 39:2385-8. [PMID: 17889198 DOI: 10.1016/j.transproceed.2007.06.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hypogammaglobulinemia has been proposed to be a risk factor for infection after heart transplantation (OHT). Infection is a leading cause of morbility and mortality among these patients. In a retrospective study we analyzed the impact of substitutive therapy with nonspecific intravenous immunoglobulin (IVIG) on the outcomes of heart transplant patients with infections. We analyzed the outcome of 123 consecutive heart transplant recipients in our center from June 1996 to November 2005. Their mean age was 53 years (range = 22 to 69 years), and the mean follow-up = 51 months, (range = 1 to 124 months). Twenty-nine patients with hypogammaglobulinemia (mean serum immunoglobulin G levels = 480 mg/dL) experienced severe infections due to cytomegalovirus (CMV) disease, n = 4; CMV disease + another infection, n = 6; CMV infection, n = 4; CMV infection + other infection, n = 3; pulmonary nocardiosis, n = 2; recurrent pneumonia, n = 2; clostridium-difficile-associated diarrhea, n = 2; pulmonary tuberculosis, n = 1; bacterial infections, n = 5. They were treated with IVIG (400 mg/kg every 21 days) with the goal to reach normal serum immunoglobulin G levels (>700 mg/dL). Overall (n = 123), a logistic regression analysis showed IVIG therapy to be associated with a decreased risk of death [odds ratio (OR) = 0.204, 95% confidence interval (CI) = 0.04 to 0.92, P = .03]. Among patients who developed infections during follow-up (n = 70), IVIG therapy was also associated with a lower risk of death (OR = 0.104, CI = 0.02 to 0.50, P = .0047). When we stratified patients with CMV disease (n = 24) according to the presence (n = 10) or absence (n = 14) of IVIG therapy, the mortality rate of IVIG-treated patients was 20% versus 71% for non-IVIG treated patients [OR = 0.06, CI = 0.0060 to 0.63, P = .01]. The use of nonspecific IVIG in OHT with hypogammaglobulinemia and infections might reduce the risk of death. Randomized studies in a larger cohort of patients are necessary to confirm these results.
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Affiliation(s)
- J Carbone
- Clinical Immunology Unit, University Hospital Gregorio Marañón, Madrid, Spain.
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Delgado J, Crespo M, Pulpon L, Arizon J, Almenar L, Palomo J, Manito N, Rabago G, Lage E, Diaz B, Roig E, Pascual D, Blasco T, Fuente L, Vals M, Camprecios M, Muniz J. 181: Pre-existing neoplasms and risk for malignancy after heart transplantation. Data from the Spanish Post-Heart Transplant Tumors Registry. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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35
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Sarmiento E, Rodríguez-Hernández C, Rodríguez-Molina J, Fernández-Yánez J, Palomo J, Anguita J, Pérez JL, Lanio N, Fernández-Cruz E, Carbone J. Impaired anti-pneumococcal polysaccharide antibody production and invasive pneumococcal infection following heart transplantation. Int Immunopharmacol 2006; 6:2027-30. [PMID: 17161358 DOI: 10.1016/j.intimp.2006.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Accepted: 09/15/2006] [Indexed: 11/20/2022]
Abstract
An increased risk of invasive pneumococcal infection has been described among adult heart transplant (HT) recipients. Vaccination has been recommended before HT but the appropriate time for revaccination is not known. In a preliminary analysis of a prospective study involving a cohort of 32 HT recipients receiving daclizumab and triple immunosuppresion therapy, a progressive decline in pneumococcal polysaccharide antibody (anti-PPS) levels was observed during the first year after HT. One of the patients who was found to have a decrease in the levels of anti-PPS developed severe pneumococcal meningitis 20 months after HT. Before HT he had received non-conjugated 23-valent pneumococcal vaccine and showed a normal post-immunization anti-PPS production. The data suggest that long-term immunologic monitoring might be useful to recognize impairment of antibody responses under immunosuppressive therapy in HT.
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Affiliation(s)
- E Sarmiento
- Immunology Department, University General Hospital Gregorio Marañon, Madrid, Spain
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36
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Sarmiento E, Rodriguez-Molina JJ, Fernandez-Yañez J, Palomo J, Urrea R, Muñoz P, Bouza E, Fernandez-Cruz E, Carbone J. IgG monitoring to identify the risk for development of infection in heart transplant recipients. Transpl Infect Dis 2006; 8:49-53. [PMID: 16623821 DOI: 10.1111/j.1399-3062.2006.00136.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Infectious complication represents a significant source of morbidity and mortality in heart transplant recipients. To assess humoral immunity markers that can predict the development of infection, 38 consecutive recipients of heart transplants performed at a single center were prospectively studied. Induction therapy included daclizumab. Immunoglobulin (IgG, IgA, IgM) and complement factors (C3, C4, and factor B) were performed by nephelometry in peripheral blood samples obtained before transplantation, and 7 days and 1 month after transplantation. During a mean follow-up of 16.9 months, 13 patients had at least one episode of infection (34.2%). Eight of these were cytomegalovirus (CMV) infections treated with intravenous ganciclovir, 2 were bacterial pneumonia, 1 patient had bacterial septicemia, 1 patient had urinary tract infection, and 1 patient had pulmonary nocardiosis. No significant association was found between infection and age, sex, immunosuppression, CMV serostatus of donor and recipient, or treated rejection episodes. Pre-transplant IgG (below median value=1140 mg/dL; relative risk [RR] 3.69; 95% confidence interval [CI] 1.01-13.54; P=0.04) and post-transplant IgG levels at day 7 (below median value=679 mg/dL; RR 11.21; CI 1.04-89.48; P=0.022) were associated with an increase in the risk for developing infections. Early monitoring of immunoglobulin levels might help to identify the risk for developing infection in heart transplantation.
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Affiliation(s)
- E Sarmiento
- Clinical Immunology Unit, Cardiology Department, University Hospital Gregorio Maranon, Madrid, Spain
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37
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Almenar L, Alonso-Pulpon L, Crespo-Leiro M, Arizon J, Glez-Vilchez F, Palomo J, Brossa V, Delgado J, Manito N, Rabago G, Lage E, Rodriguez-Lambert J, Roig E, Pascual D, Sanz L, De-la-Fuente L. 44. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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38
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Crespo-Leiro M, Pulpon L, Arizon J, Almenar L, Delgado J, Palomo J, Manito N, Rabago G, Lage E, Diaz B, Roig E, Pascual D, Blasco T, Fuente L, Vals M, Camprecios M, Muniz J. 224. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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39
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Sarmiento E, Rodríguez-Molina J, Muñoz P, Fernández-Yánez J, Palomo J, Fogueda M, Fernández-Cruz E, Bouza E, Carbone J. Decreased Levels of Serum Immunoglobulins as a Risk Factor for Infection After Heart Transplantation. Transplant Proc 2005; 37:4046-9. [PMID: 16386623 DOI: 10.1016/j.transproceed.2005.09.153] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We aimed to assess humoral immunity markers that provide prognostic value for the development of infections in heart transplant recipients. PATIENTS AND METHODS Forty-one heart transplant recipients underwent humoral immunity studies, including Immunoglobulin (IgG, IgA, IgM) and IgG subclasses determined by nephelometry on serum samples obtained before transplantation and 1 month after transplantation. Potential clinical risk factors were evaluated: waiting time for transplantation, pretransplant cytomegalovirus (CMV) serologic status of donor and recipient; recipient age; gender; cardiac disease severity before transplantation; type of immunosuppression; and occurrence of rejection. OUTCOME MEASURES We measured infections requiring intravenous (IV) drug therapy during the first year. The association between variables and outcome was assessed using Cox proportional hazards modelling. Immunoglobulin levels were split into two groups using the median value observed as the cut-off. RESULTS Of 41 patients studied, 19 (46%) had at least one episode of infection, 16 of which were CMV infections treated with IV gancyclovir, 1 CMV disease + aspergillosis and 2 bacterial pneumonia. Pretransplant IgG (<1055 mg/dL; RR 5.32; 95% confidence interval [CI] 1.73 to 16.29; P = .0034); pretransplant IgG1 (<695 mg/dL; RR 4.80; CI 1.57 to 14.68; P = .006), and posttransplant IgG levels (<589 mg/dL; RR 3.38; CI 1.21 to 9.44, P = .019) were associated with an increased risk of developing infections. Both waiting time for transplantation (RR 0.95; CI 0.91 to 0.98, P = .007) and pretransplant cardiac disease severity (RR 1.94; CI 1.17 to 3.21, P = .009) were significant risk factors for infection. After adjustment for clinical predictive variables, decreased values of posttransplant IgG remained significant predictors. CONCLUSIONS The existence of decreased levels of IgG in the setting of heart transplantation was associated with an higher risk for infection. Monitoring of immunoglobulin levels, a rapid and well-standardized nephelometric determination, in heart transplantation, may identify a subset of patients at risk for development of infections.
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Affiliation(s)
- E Sarmiento
- Clinical Immunology Unit, University Hospital Gregorio Marañón, Madrid, Spain
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40
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Sarmiento E, Fernàndez-Yáñez J, Muñoz P, Palomo J, Rodríguez-Molina JJ, Bermejo J, Catalan P, Bouza E, Fernández-Cruz E, Carbone J. Hypogammaglobulinemia after heart transplantation: use of intravenous immunoglobulin replacement therapy in relapsing CMV disease. Int Immunopharmacol 2005; 5:97-101. [PMID: 15589466 DOI: 10.1016/j.intimp.2004.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Secondary hypogammaglobulinemia after heart transplantation may follow immunosuppressive therapy with the resultant increased risk of infections, including cytomegalovirus (CMV) disease. There is limited information on the use of intravenous immunoglobulin replacement therapy (IVIG) in heart-transplanted patients with hypogammaglobulinemia and CMV disease. We present data on five consecutive heart-transplanted patients with relapsing CMV disease, four of whom developed gastrointestinal disease. The immunosuppressive regimen included prednisone, cyclosporine A, azathioprine, mycophenolate mofetil, tacrolimus and antithymocyte globulin (ATG). Evaluation revealed CMV antigenemia. All the patients had been treated with intravenous ganciclovir. In addition, hyperimmune CMV immunoglobulin was administered in three patients. Significantly reduced levels of immunoglobulin G (IgG) were observed in the patients as compared with 15 heart-transplanted individuals without CMV disease [mean IgG levels: 323+/-18 and 639+/-63 mg/dl, respectively (p=0.003)]. IVIG [FLEBOGAMMA], 200-400 mg/kg every 21 days with the goal of maintaining normal serum IgG levels, was added for the treatment of CMV disease. Selected batches with the highest anti-CMV titers were set apart for the treatment of the patients. IVIG treatment, in combination with antiviral therapy, proved able to control CMV disease. There was a favorable clinical response and the patients became free of gastrointestinal symptoms. Detection of CMV antigens was negative after treatment. During IVIG therapy no immediate or delayed adverse effects were observed. Even if our survey was limited to five cases, the results suggest that addition of IVIG to antiviral chemotherapy might improve outcome in heart-transplanted patients with hypogammaglobulinemia and CMV disease.
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Affiliation(s)
- E Sarmiento
- Clinical Immunology Unit. Department of Immunology, University Hospital Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain
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Gonzalez-Pinto A, Gonzalez C, Enjuto S, Fernandez de Corres B, Lopez P, Palomo J, Gutierrez M, Mosquera F, Perez de Heredia JL. Psychoeducation and cognitive-behavioral therapy in bipolar disorder: an update. Acta Psychiatr Scand 2004; 109:83-90. [PMID: 14725587 DOI: 10.1046/j.0001-690x.2003.00240.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review the available literature on psychoeducation and cognitive-behavioral therapy (CBT) in bipolar disorder (BD) and to give an integral view of these therapies. METHOD Studies were identified through Medline searches in English language publications between 1971 and 2003. This was supplemented by a hand search and the inclusion of selected descriptive articles on good clinical practice. RESULTS A number of studies demonstrate that psychoeducation enhances adherence to treatment, and one finds that it improves outcome in BD. Other studies find that CBT diminishes depressive symptoms and improves quality of life in BD. Occasionally some adverse effects may occur with psychotherapy and, although they are sporadic, should not be overlooked. CONCLUSION When combined with pharmacological treatment, psychoeducation helps to improve adherence. Training in the identification of early manic symptoms helps to improve outcomes and decreases the number of manic relapses in BD.
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Affiliation(s)
- A Gonzalez-Pinto
- Psychiatric Department, Santiago Apostol Hospital, Osakidetza Mental Health System, Vitoria, Spain.
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42
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Crespo M, Manito N, Rábago G, Delgado J, Arizón J, Lage E, Palomo J. Sirolimus(SRL) in heart transplantation: preliminary results of a multicenter registry in Spain. J Heart Lung Transplant 2004. [DOI: 10.1016/j.healun.2003.11.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Fernández-Yáñez J, Palomo J, Elízaga J, Moreno J, Sánchez A, Almendral J. Results of percutaneous revascularization in cardiac allograft vascular disease. Transplant Proc 2003; 35:1996-8. [PMID: 12962874 DOI: 10.1016/s0041-1345(03)00649-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the outcome of transplant patients with CGD treated by PTCA in our center. METHODS We retrospectively analyzed the medical records of all PTCA procedures performed on heart transplant patients in our hospital. RESULTS Among 13 patients (11 men, 52.9+/-9.7 years), 20 lesions were treated with PTCA with 95% initial angiographic success. The indications for PTCA was heart failure or ventricular systolic dysfunction (n=4), of ischemia (n=4) and angiographic criteria alone (n=5). Ten lesions were treated with balloon angioplasty. A stent was implanted in 10 lesions, including one patient with a previous atherectomy. There were no complications. Angiographic follow-up was performed on 11 patients, four of whom (36%) showed restenosis. Mean follow-up was 33 months. Four patients (30.8%) are alive without retransplantation, two (15.4%) are alive after retransplantation, and seven (53.4%) died, all from cardiac causes. Graft survival rates estimated by the Kaplan-Meier method were 62% in the first year and 46% in the second year. CONCLUSIONS Our results suggest that PTCA represents a palliative method of treatment for heart transplant patients with CGD.
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Affiliation(s)
- J Fernández-Yáñez
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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44
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45
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Pérez Calle JL, Salcedo M, Núñez O, Barrio J, Bañares R, de Diego A, Álvarez E, Palomo J, Clemente G. Ductopenia asociada a hepatitis por citomegalovirus en un paciente portador de trasplante cardíaco. Gastroenterol Hepatol 2003. [DOI: 10.1157/13042211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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46
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Pérez Calle JL, Salcedo M, Núñez O, Barrio J, Bañares R, de Diego A, Alvarez E, Palomo J, Clemente G. [Cytomegalovirus hepatitis and ductopenia in a heart transplant recipient]. Gastroenterol Hepatol 2003; 26:26-8. [PMID: 12525325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- J L Pérez Calle
- Servicio de Aparato Digestivo. Unidad de Trasplante Hepático. Hospital General Universitario Gregorio Marañón. Madrid. España.
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47
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Rabago G, Manito N, Almenar L, Arizón J, Lage E, Palomo J, Roig E. Induction therapy with two doses of daclizumab in heart transplantation: a prospective, multi centric clinical study. interim analysis. J Heart Lung Transplant 2003. [DOI: 10.1016/s1053-2498(02)00848-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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48
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Muñoz P, Bermejo J, Sarmiento E, Palomo J, Yañez J, Fernãndez-Cruz E, Carbone J. Use of intravenous immunoglobulin (IVIg) in addition to antiviral therapy for the treatment of CMV disease in heart transplanted patients with secondary hypogammaglobulinemia. Int J Infect Dis 2002. [DOI: 10.1016/s1201-9712(02)90252-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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49
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Muñoz P, Palomo J, Yáñez J, Bouza E. Clinical microbiological case: a heart transplant recipient with diarrhea and abdominal pain. Clin Microbiol Infect 2001. [DOI: 10.1046/j.1198-743x.2001.00316.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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50
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Muñòz P, Palomo J, Yáñèz J, Bouza E. Clinical microbiological case: a heart transplant recipient with diarrhea and abdominal pain. Recurring C. difficile infection. Clin Microbiol Infect 2001; 7:451-2, 458-9. [PMID: 11591211 DOI: 10.1046/j.1198-743x.2001.00315.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- P Muñòz
- Clinical Microbiology-Infectious Diseases, Hospital General Gregorio Marañón, Madrid, Spain.
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