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A novel sensor based on etched few-mode fiber for Staphylococcus Aureus detection is proposed. We reduced the cladding diameter to improve the interaction with the surrounding medium and functionalized selecting the binding aptamer for detection.

Introduction/Background* The aim of this study was to correlate the serum concentrations of tumor markers HE4 and CA125 with the tumor burden evaluated through the volumetric parameters of FDG-PET/CT FDG in patients with advanced epithelial ovarian cancer (EOC) before primary treatment. Methodology Sixty-six patients with advanced stage high grade serous ovarian carcinoma (HGSOC) or undifferentiated carcinoma (UOC) were included. Serum HE4, serum CA125 and FDG PET/CT were performed before primary treatment. Volumes of interest (VOIs) were delimited on every pathological uptake in PET images. Whole-body metabolic tumor volume (wbMTV) and total lesion glycolysis (wbTLG) were calculated as the sum of every single VOI value. SUVmax thresholds were set at 40% and 50%. Four VOIs subgroups were defined for analysis: carcinomatosis, retroperitoneal, supradiaphragmatic and metastases. MTV and TLG values were calculated for each of them. The associations between these parameters and serum tumor markers were assessed through Pearson and Spearman tests. Result(s)* When correlating wbMTV and wbTLG with both CA125 and HE4, significant associations were found. The strongest correlation was observed between HE4 and wbMTV40% (r=0.61, p Conclusion* Peritoneal tumor burden measured by FDG PET/CT volumetric parameters correlates better with HE4 than with CA125 in patients with advanced epithelial ovarian cancer. These results support the increasing utility of HE4 to improve the stratification of these patients in clinical practice

Additional file 1. Supplementary information.

BackgroundThe COVID-19 pandemic has had profound effects on the Rheumatology department; we wanted to see if consequently referrals for Rheumatoid arthritis (RA), Crystal Arthritis (CA), Osteoarthritis (OA) and Giant cell arteritis (GCA) were affected. A greater understanding of the impact may enable adequate number of clinics and resources to be made available where needed.ObjectivesTo evaluate the impact of COVID-19 pandemic on volume of new referrals to the Rheumatology department for RA, CA, OA and GCA.MethodsA retrospective analysis of data was conducted from the period of January 2016 to December 2021. The Rheumatology department database was closely analysed and information about new referrals for GCA, RA, OA and CA were evaluated. Statistical analysis was conducted using t-test to compare the mean value pre and during the COVID19 outbreak (2020).ResultsFrom 2016 to 2021 a total number of 9998 new patients were referred to the Rheumatology department. There were 2768 new referrals for GCA (15%), RA (34%), OA (40%) and CA (11%) made during this period. In 2020, there was a significant decrease in OA, RA and CA referrals (p value 0.000004, 0.00017, 0.0042 respectively) but an insignificant decrease in GCA referrals (p value 0.243).DiagnosesNumber of referralsp valueMean nº 2016-20192020GCA79.75 (14%)63 (33%)0.24334236RA204 (36%)55 (28%)0.000175427OA219.7 (39%)59 (30%)4.26975E-06CA64.5(11%)18 (9%)0.004278881100%100%ConclusionDuring COVID19 pandemic in 2020 there was a significant reduction in the number of new referrals for RA, OA, and CA in contrast to GCA where the referrals have been constant. This may be due to the detrimental consequences of untreated GCA with regards to risk of sight loss. However, with less RA referrals, this may result in a delayed diagnosis with an impact on the disease course.References[1]Kay L, Lanyon P, MacGregor A. February 2021. GIRFT Programme National Specialty Report. Available at: https://www.gettingitrightfirsttime.co.uk/wp- content/uploads/2021/08/Rheumatology-Jul21h-NEW.pdf [Accessed 9th December 2021][2]Romão VC, Cordeiro I, Macieira C, et al. Rheumatology practice amidst the COVID-19 pandemic: a pragmatic view.RMD Open 2020;6:e001314. doi: 10.1136/rmdopen-2020-001314Disclosure of InterestsNone declared

BackgroundRheumatology departments across the UK have adapted to the COVID-19 pandemic, implementing novel methods of working via remote consultations.ObjectivesWe wanted to explore the rates of telemedicine consultations for patients with Rheumatoid Arthritis (RA), Giant cell arteritis (GCA), Osteoarthritis (OA), and Crystal arthritis (CA). We also wanted to check how effective the telemedicine consultations had been in terms of avoiding the need for a face-to-face appointment.MethodsNo telemedicine consultations took place before the COVID-19 pandemic in patients diagnosed with GCA, RA, CA and OA. We assessed the number of telemedicine consultations (telephone or videocall) using data from the departmental database covering September 2020 to December 2021. We analysed the rates of face-to-face versus telemedicine appointments for both new referrals and follow-up consultations. The statistical analysis was conducted using chi-square test.ResultsThere were 20,648 patients assessed in our department from September 2020 to December 2021. In total 1786 face-to-face and 2079 telemedicine consultations were conducted for GCA (18%), RA (66%), OA (13%) and CA (3%). The highest percentage of telemedicine consultations versus face-to-face for new referrals were observed for OA (30% Vs 70%) followed by RA (14% Vs 86%), CA (12% Vs 88%) and GCA (2% Vs 98%) (Table 1). Combining all these conditions, 68% of clinicians felt the telemedicine appointment avoided a face-to-face appointment. However, 33% of clinicians seeing new patients with RA did not feel the telemedicine appointment avoided a face-to-face appointment.Table 1.DiagnosesNew referralsFollow-upTelemedicineFace-to-faceTelemedicineFace-to-faceRA36 (14%)227 (86%)1480 (65%)783 (35%)CA7 (12%)50 (88%)41 (61%)26 (39%)OA82 (30%)187 (70%)115 (51%)109 (49%)GCA3 (2%)21 (98%)315 (53%)283 (47%)In contrast, follow-up appointments were mainly conducted by telemedicine when compared with face-to-face; RA (65% Vs 35%), GCA (53%Vs 47%), OA (51% Vs 49%) and CA (61% Vs 39%). For the follow-ups, an overall majority of 90% of telemedicine consultations avoided the need for a face-to-face appointment, particularly observed for patients with CA and GCA (98% and 93% respectively).We noted that patients with RA were more likely than GCA to have a telemedicine follow-up (p valueConclusionTelemedicine appointments for new referrals and follow-up patients with Rheumatological diagnoses has been a new development because of COVID-19 pandemic. Our analysis shows that most of our new RA, GCA, OA, and CA referrals are still being seen face-to-face but most follow-up appointments are telemedicine consultations. In most cases, clinicians felt that telemedicine consultations avoided the need for a face-to-face appointment.References[1]Kay L, Lanyon P, MacGregor A. February 2021. GIRFT Programme National Specialty Report. Available at: https://www.gettingitrightfirsttime.co.uk/wpcontent/uploads/2021/08/Rheumatology-Jul21h-NEW.pdf [Accessed 9th December 2021][2]Romão VC, Cordeiro I, Macieira C, et al. Rheumatology practice amidst the COVID-19 pandemic: a pragmatic view.RMD Open 2020;6:e001314. doi: 10.1136/rmdopen-2020-001314Disclosure of InterestsNone declared

BackgroundTargeted therapy has gradually become the first-line clinical therapy for solid tumors and hematologic disorders (1). Immune related adverse side effects (irAE) due to checkpoint inhibitors are well recognized side effects in patients with underlying oncologic disorders; however, information regarding rheumatic side effects due to several targeted therapies are rarely reported.ObjectivesOur aim was to describe the main rheumatic syndromes induced by targeted therapies.MethodsThis observational study included patients from 2 referral University centers in Barcelona. We included patients referred from Oncology and Hematology departments visited from January 2017 to January 2022 at Hospital Clinic and Hospital de Bellvitge, Barcelona, Spain.ResultsFifteen patients were included (Female 60%), with a mean age 63.3± 10.8 years. Nine patients had hematological disorders and 8 solid tumors. Main diagnosis included Multiple Myeloma in 3 (20%) patients, Non-Hodgkin Lymphoma 2 (13%), Acute Myeloid Leukemia 2 (13%), Melanoma 2 (13%), Colon carcinoma 1 (6.7%), Breast carcinoma 1 (6.7%), Glioblastoma multiforme 1 (6.7%), Chronic lymphatic leukemia 1 (6.7%), Renal cell carcinoma 1 (6.7%) and Sésary Syndrome in 1 (6.7%) patient. Targeted therapies included MAP kinases in 4 (26.7%) patients, Anti CD-38 in 3 (20%), Anti BRAF in 2 (13.3%), and anti STAT-3, anti VEGF, BTK inhibitor, anti CCR4, Isocitrate dehydrogenase 2 inhibitor and Halichondrin B analoge in 1 (6.7%) patient each. Treatment was administrated as monotherapy in 9 (60%) and as combined therapy in 6 (40%).Mean time from the initiation of targeted therapies and rheumatic syndrome onset was 5.0 ± 3.8 months. Main rheumatic syndrome were: Polymyalgia rheumatica (PMR) in 4 (26%) patients, Raynaud’s phenomenon in 2 (13%), Tenosynovitis in 2 (13%), RA-like 2 (13%), cutaneous vasculitis, amyopathic dermatomyositis, oligoarthritis, spondyloarthropathy-like and non-inflammatory arthralgias in 1 (6.7%) case each. Main clinical characteristics are summarized in Table 1.In 8 (53%) cases, targeted therapies were stopped due side effects. Rheumatic syndrome were treated with, glucocorticoids (GC) 12 (80%), calcium antagonist 2 (13%), Hydroxychloroquine in 2 (13%), Methotrexate in 1 (6.7%), Sulfasalazine in 1 (6.7%) and NSAID in 1 (6.7%) patient.Mean follow-up were 15.4± 20 months. Most of the patients remain alive (86%). According oncologic prognosis, 4 (26%) had complete response, 6 (40%) had partial response and 5 (33%) had disease progression. At the time of the last visit, 6 (40%) patients remain on GC (mean dose 6.7 ± 4.7 mg/d) and 4 (26%) patients on DMARD therapy.ConclusionIn this heterogeneous group of patients treated with targeted therapies, we described a variety of induced rheumatic syndromes including PMR, arthritis, and even vasculitis or dermatomyositis. An important proportion of patients stopped the treatment due to side effects and some of them required sustained treatment including GC and DMARD.References[1]Castelli MS et al. Pharmacol Res Perspect. 2019 Dec;7(6):e00535.Table 1.Main clinical rheumatic syndromes induced by targeted therapiesDisclosure of InterestsJosé A Gómez-Puerta Speakers bureau: Abbvie, BMS, Galápagos, GSK, Janssen, Lilly, MSD, Pfizer and Roche, Consultant of: Galápagos, Roche and Sanofi, Marian Tormo-Ratera: None declared, ANDRES PONCE FERNANDEZ Speakers bureau: Lilly, Novartis, Laura Farran: None declared, Beatriz Frade-Sosa Speakers bureau: Abbvie, Juan Camilo Sarmiento Monroy Speakers bureau: GSK, J. Narváez: None declared

Background Azacitidine is the recommended treatment for higher-risk myelodysplastic syndromes (MDS) in patients who are not candidates for haematopoietic transplantation. It is also used in low-risk MDSs where supportive treatment fails. Despite its widespread use, there are no pharmacoeconomic data of azacitidine based in the real-world setting, outside the context of clinical trials. Purpose To evaluate the incremental cost-effectiveness ratio of azacitidine versus supportive care in patients with MDS treated in a public hospital, from the payers’ perspective. Material and methods Observational retrospective study: two cohorts of patients with MDS (n=53 patients each one), with similar demographic, clinical, biological and haematological characteristics. Medication consumption, transfusion support and hospital resources were accounted for each patient, according to the Valencian Community Fees Law (2016 fiscal year), and to the 2017 final hospital sale price for medicines. Overall survival since diagnosis was the measure of effectiveness. Mean based cost-effectiveness ratio was estimated with the bootstrapping resampling technique. The average cost was calculated with the Bang–Tsiatis reweigted estimator and restricted mean survival time (RMST) was used for effectiveness.1 Patients were stratified according to the International Prognostic Score System for risk: 25 high-risk/intermediate-2 treated with azacitidine, and 21 with supportive care. Results Patients treated with azacitidine showed improved survival in high-risk/intermediate-2 patients (RMST: 33 versus 19 months; Kaplan–Meier median survival: 13 versus 6 months). The mean-based cost-effectiveness ratio was €16 812 per life-year gained. According to the cost-effectiveness plane, 91% of values lie in the northeast quadrant, where increased survival is achieved at increased cost. Sixty-eight per cent of the values are within the threshold (€30 000 per life-year gained) of willingness to pay commonly accepted for cost effectiveness in Spain. Conclusion Azacitidine shows a favourable cost-effectiveness ratio in high-risk intermediate-2 patients, although with the uncertainty derived from the small sample size. This result corroborates what is reflected in the bibliography for azacitidine cost-effectiveness, but is based on data obtained from the usual healthcare practice. On the contrary, azacitidine cost-effectiveness publications are usually based on mathematical models and data from clinical trials, which shows more favourable results than real-world practice. Reference and/or acknowledgements Bang H, Tsiatis AA. Estimating medical costs with censored data. Biometrika 2000;87;329–43. https://doi.org/10.1093/biomet/87.2.329 No conflict of interest.

Background:There is controversy surrounding the use of systemic corticosteroids in psoriatic arthritis (PsA). It’s an accepted fact that the use of systemic corticosteroids can trigger severe flare-up of erythroderma or pustular psoriasis. Nevertheless, corticosteroids have been used to achieve faster improvement of joint symptoms of PsA.Objectives:To analyze the use of systemic corticosteroids at intermediate doses in a short regimen in patients with PsA, as well as the serious complications of psoriasis upon withdrawal.Methods:Retrospective analysis of an observational cohort of 453 patients from a university hospital, following a specific protocol from 1992 to 2019. The following variables have been collected: corticosteroid treatment (methylprednisolone ≤16mg /day in a slow tapering regimen in 2 months), demographic and disease factors, comorbidities that could be associated (diabetes mellitus, high blood pressure, severe infections) and serious complications of psoriasis (erythroderma or pustular psoriasis). To assess the activity of psoriasis, physician global assessment is mostly used and occasionally to a lesser extent body surface area and psoriasis area severity index.Statistical analysis (SPSS v.25): descriptive analysis, Chi-squared test for qualitative variables and t-student test for quantitative variables.Results:In our series, 35.98% (163/453) of patients have received short corticosteroid regimen at some point in follow-up care, of which 93.8% received concomitant treatment with disease modifying antirheumatic drugs (DMARD).Only 6.2% of the patients who received short corticosteroid regimen presented a flare-up of psoriasis, most of them mildly. No patient developed an erythroderma or severe pustular psoriasis.After analyzing the data, a greater use of this regimen of treatment has been observed in patients with dactylitis (44.6% with dactylitis vs 27.8% without dactylitis, pThere were no significant differences in the use of corticosteroids in respect to sex, age, age of onset of PsA, duration of PsA or high blood pressure. Nor in factors of poor radiographic prognosis: number of damaged joints, mutilating PsA and carpitis.Conclusion:In our series, no patient developed an erythroderma or severe pustular psoriasis and most of the flare-ups of psoriasis were mild. The use of systemic corticosteroids at intermediate doses in a slow tapering regimen concomitantly with DMARD can be safely used in patients with PsA.References:NoneDisclosure of Interests:None declared

Table S1. Frequency and type of CDKN2A/ARF/CDKN2B gene deletions as detected by qPCR in adult T-ALL (n = 64). Table S2. Comparison between the CNA status of the CDKN2A/ARF and CDKN2B genes in adult T-ALL as assessed by qPCR, SNP-array and iFISH techniques. Table S3. Adult T-ALL: prognostic factors for overall survival. Table S4. Adult T-ALL patient characteristics at diagnosis and follow-up. Table S5. (A) RCN values obtained for the CDKN2A/ARF and CDKN2B genes in selected samples with a 100% blast cell content. (B). Most robust cut-off values to distinguish between normal, heterozygous and homozygous genotypes. The mean and standard deviation (SD) of the values obtained in panel A are indicated for each genotype. Figure S1. Prognostic impact of the CDKN2B gene CNA status on overall survival of adult T-ALL patients (n = 62). In panel A all CDKN2B gene deletions were analyzed together, while in panel B bi-allelic and mono-allelic CDKN2B gene deletions were separately considered. Figure S2. Flowchart summarizing the HR-20011 PETHEMA treatment protocol, including the time points at which MRD assessment was performed (highlighted in red). Figure S3. Calibration curves used to calculate RCN values according to the different percentage contamination of the sample by normal (i.e. non-blastic) cells. In panel A, a pure (100% blasts) homozygous sample was mixed with different amounts of normal (2 N) DNA, as shown on the x-axis. RCN values are shown on the y-axis. In panel B a pure (100%) heterozygous sample was mixed with different amounts of normal (2 N) DNA, as shown on the x-axis; RCN values are depicted on the y-axis. (PDF 274 kb)

A RP-HPLC method for the analysis of oxalic, citric, formic, succinic, orotic, uric, pyruvic, acetic, propionic, lactic and butyric acids in dairy products with a simple treatment of the sample has been developed. A gradient programme pumping phosphate buffer at pH 2.20 and acetonitrile was used to separate the compounds on a C18 column. Various parameters affecting analysis have been optimised to take18 min with an excellent linearity (R0.999). The precision was good (R.S.D.5%) and the recovery found close to 100%. Its application to analyse the quality of some dairy products has been investigated.

The recently described single-nucleotide polymorphism CT60, located in the 3'-untranslated region of the CTLA4 (cytotoxic T-lymphocyte antigen 4) gene, has been associated with susceptibility to several autoimmune diseases and has also been shown to be involved in immune responses following allogeneic stem cell transplantation (SCT). However, the contribution of the CTLA4 genotype to the control of minimal residual disease in patients with acute myeloid leukemia (AML) has yet to be explored. We investigated the association between the CTLA4 CT60 A/G genotype and the incidence of leukemic relapse in 143 adult patients with AML in first complete remission after the same chemotherapy protocol (CETLAM LAM'03). The CT60 AA genotype was associated with a higher rate of leukemic relapse (56.4 vs 35.6%, P = 0.004; hazard ratio (HR) 2.64, 95% confidence interval (CI) 1.36-5.14) and lower overall survival at 3 years (39.4 vs 68.4%, P 0.004; HR 2.80, 95% CI 1.39-5.64). This is the first study to report an association between polymorphisms at CTLA-4 and AML relapse.

Acute myeloid leukemia (AML) is a heterogeneous group of malignant diseases, often characterized by coexistence of more than one subpopulation of blast cells. Multiparametric flow cytometry immunophenotyping has proven to be a reliable and sensitive approach for the discrimination of myeloid blast cells from residual normal cells present in bone marrow samples from AML patients and, at the same time, allows the identification of different maturation compartments among myeloid blasts. Therefore, it provides a unique tool for assessing apoptotic and multidrug resistance (MDR)-associated phenotypes in individual subsets of leukemic cells.The aim of the present study was to explore the simultaneous expression of proteins related to both apoptosis (APO2.7, bcl-2, bax) and multidrug resistance (MDR1, MRP, LRP) in the different blast cell subpopulations detected at diagnosis in a group of 72 elderly patients with AML. In addition, we included 5 bone marrow samples from healthy adult donors in the analysis.Immature blast cells (CD34+: subset I) showed a significantly higher level of bcl-2 expression (p0.0001) together with a lower reactivity for APO 2.7 (p=0.02) as compared to the other more mature CD34- cell subsets. The expression of Bax parallelled that of APO 2.7, although the difference between immature CD34+ blast cells and the mature blast cell subsets did not reach statistical significance (p=0.18). These results translated into a significantly (p0.0001) higher bcl-2/bax ratio for the CD34+ blast cells as compared to that of the two CD34- blast cell subpopulations. Regarding the expression of the multidrug resistance-associated proteins Pgp and MRP, CD34+ blast cells displayed a greater expression of both proteins as compared to the more mature CD34- AML blast cells, but differences according to maturation stage of AML blast cells did not reach statistical significance. In contrast, LRP expression was significantly lower in the more immature CD34+ blast cell subset than in the more mature ones (p=0.01).As far as normal bone marrow is concerned our results suggest that all blast cell subpopulations are more protected from apoptosis than their normal counterparts. We conclude that in elderly patients with AML the more immature blast cells are more resistant to apoptotic processes, which could explain why, when AML relapses, the blast cells frequently display a more immature phenotype than that observed at diagnosis. Contradictory results in multidrug resistance profile support the hypothesis that failure to respond to chemotherapeutic drugs in AML is a multifactorial phenomenon.

Of 167 newly diagnosed acute promyelocytic leukaemia patients, 83 patients were long (L)-form (50%), eight variable (V)-form (5%) and 76 short (S)-form (45%). The V-form and S-form groups presented a significantly higher percentage of patients with white blood cell counts10 x 10(9)/l (P0.05). The S-form cases displayed a significantly higher number of cases with M3v microgranular features (P = 0.005) and CD34 expression (P0.0001). There were no differences between the three isoforms in complete remission (CR) rate (overall CR 90%), but the 3-year disease-free survival was lower for V-form cases than it was for L- and S-form cases (62% vs. 94% and 89%, P = 0.056). We conclude that the V-form and S-form types are associated with some negative prognostic features at diagnosis. However, our data were only able to demonstrate an association with adverse prognosis in the V-form type and, moreover, as the number of cases was limited, needs to be confirmed in large, uniformly treated series.

To analyse the results of the treatment with 2-chlorodeoxyadenosine (2CdA) in 9 patients with refractory or relapsed Langerhans cell histiocytosis (LCH) tracted in 8 Spanish hospitals between 1993 and 1999.In the 9 patients the following data were recorded: age, sex, organ involvement by LCH, first treatment and response, dose, number of cycles and schedule of administration 2CdA, response to 2CdA treatment, toxicity, disease-free survival (DFS) and overall survival (OS).Median age was 25 years (range, 6-63). All patients had multiorganic involvement by LCH, with severe organ dysfunction in 4. 2CdA was administered as second line treatment in 7 cases and as third line in 2. The 2CdA dose was 0.1 mg/kg per day during 5 days in the majority of patients, and interval between cycles was 4 weeks. In 2 cases a complete remission (CR) was achieved and 4 cases attained a partial remission (PR) (overall response rate 66%). The main toxicity was hematologic, with neutropenia grade2 in 5 cases and thrombocytopenia2 in 5. Four patients had infections, with fatal evolution in one of them. After a median follow-up of 8 months (range 2-17), 2 patients remained in CR (12 months both), 4 in PR (range 2-12 months) and one had active disease (17 months). The other two died due to progressive disease and Aspergillus spp. sepsis, respectively. The actuarial probabilities of DFS and OS were 58% (95% CI, 38-78%) and 71% (95% CI, 54-88%), respectively.2CdA is an active drug for patients with refractory or relapsed LCH, and its main toxicity is myelosuppression. The usefulness of 2CdA, isolated or in combination with other drugs, in patients with refractory or relapsed LCH must be assessed in controlled studies.

Rev Esp Anestesiol Reanim. 2011;58:400 Paciente varon de 4 meses de edad, con antecedentes de ureterohidronefrosis grado 3 derecha (ureterocele y displasia renal). Ingreso para intervencion programada de heminefroureterectomia polar superior derecha. Tras la anestesia general con IOT sin incidencias se coloco en decubito lateral izquierdo para la realizacion de bloqueo caudal con cateter para analgesia postoperatoria. La localizacion del espacio caudal se realizo sin problemas, inyectando 6 ml de bupivacaina con adrenalina al 0,25% (1 ml/kg) y posteriormente insercion del cateter, momento en el cual se aprecio cierta resistencia en el avance. Durante la retirada de la aguja, esta secciono el cateter quedando unos 6 cm dentro. Una radiografia de abdomen en el quirofano no aporto ninguna informacion. Se decidio suspender la intervencion quirurgica. Consultamos con el servicio de neurocirugia que recomendo actitud conservadora. El paciente quedo ingresado para control de posibles complicaciones. Se valora por el servicio de neurologia la ausencia de focalidad neurologica ni otra sintomatologia. Se realizo TC de la columna lumbosacra, en la que se observo una estructura tubular discretamente densa que sugeria la porcion del cateter seccionada, fuera del canal raquideo, laterovertebral izquierdo y prevertebral de la zona sacrocoxigea (Figs. 1-3), de unos 6 cm de longitud. El canal raquideo no presentaba anomalias. El paciente fue dado de alta a las 48 h y se programo nuevamente para intervencion quirurgica. La intervencion se realizo sin incidencias con anestesia general combinada sin colocacion de cateter caudal. Las comunicaciones de complicaciones mecanicas asociadas al uso de cateteres epidurales son poco frecuentes. La conducta recomendada en la revision bibliografica es adoptar una conducta expectante, valorando el riesgo beneficio que implica llegar a procedimientos quirurgicos innecesarios y realizar una vigilancia estrecha del paciente que permita identificar el desarrollo de sintomas de forma temprana y determinar la conducta seguir. Hoy en dia, dos anos despues del incidente, el paciente continua asintomatico.

We present 57 cases of infectious endocarditis (IE) in 51 parenterally drug addicts (PDA) admitted at the Internal Medicine Service of the Hospital Clínico of Valencia between January ist, 1988 and January 15th, 1992. The disease affected young patients, 84% of them being HIV-1+ and 86% presenting CD4+ lymphocytes lower than 200 cells/mm3. Fever was the most constant symptom, with radiological disorders and presence of vegetations by echocardiogram in 65% and 53% of episodes, respectively, and affectation of the tricuspid valve in 59% of patients. The diagnosis of endocarditis was definitive in 51% of cases, possible in 15% and probable in 22%, being cardiac failure the most severe complication, present in 23% of episodes. The detection of significant valve regurgitation in patients with IE and without developing cardiac failure is not predictive of future complications, nor its absence identifies patients with a favourable prognosis. Staphylococcus aureus was the most frequently isolated germ (48%), being methicillin-resistant in 15% of cases and with a slower response to the treatment with vancomycin than the methicillin-sensitive. Five patients died, all of them with CD4+ lower than 50 cells/mm3, which may have a predictive value in the follow-up of these patients.