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IntroductionSex-dependent differences of infective endocarditis (IE) have been reported. Women suffer from IE less frequently than men and tend to present more severe manifestations. Our objective was to analyse the sex-based differences of IE in the clinical presentation, treatment, and prognosis.Material and methodsWe analysed the sex differences in the clinical presentation, modality of treatment and prognosis of IE in a national-level multicentric cohort between 2008 and 2018. All data were prospectively recorded by the GAMES cohort (Spanish Collaboration on Endocarditis).ResultsA total of 3451 patients were included, of whom 1105 were women (32.0%). Women were older than men (mean age, 68.4 vs 64.5). The most frequently affected valves were the aortic valve in men (50.6%) and mitral valve in women (48.7%). Staphylococcus aureus aetiology was more frequent in women (30.1% vs 23.1%; p<0.001).Surgery was performed in 38.3% of women and 50% of men. After propensity score (PS) matching for age and estimated surgical risk (European System for Cardiac Operative Risk Evaluation II (EuroSCORE II)), the analysis of the matched cohorts revealed that women were less likely to undergo surgery (OR 0.74; 95% CI 0.59 to 0.91; p=0.05).The observed overall in-hospital mortality was 32.8% in women and 25.7% in men (OR for the mortality of female sex 1.41; 95% CI 1.21 to 1.65; p<0.001). This statistical difference was not modified after adjusting for all possible confounders.ConclusionsFemale sex was an independent factor related to mortality after adjusting for confounders. In addition, women were less frequently referred for surgical treatment.

We describe the first known case of symptomatic infection resulting from human herpesvirus-6 (HHV-6) in simultaneous pancreas-kidney transplant recipients. The role of HHV-6 in solid-organ transplant recipients is not well defined. In hematopoietic stem cell transplantation (SCT) HHV-6 may cause fever, rash, myelosuppression, interstitial pneumonitis, and encephalitis.

ObjectiveTo assess the frequency of genetic syndromes and childhood neurodevelopmental impairment in non‐malformed term infants with severely low birthweight and no evidence of placental insufficiency.MethodsThis case series was constructed of infants delivered at term between 2013 and 2018 with severely low birthweight defined as below ‐2.5 SD, with normal maternal and fetal Doppler studies (umbilical artery, fetal middle cerebral artery, cerebroplacental ratio, and uterine artery) and no hypertensive disorders during pregnancy or structural anomalies at prenatal ultrasound examination. Clinical exome sequencing and copy number variation (CNV) analysis were performed in DNA extracted from the children's saliva. Cognitive and psychomotor development was evaluated via The Bayley Scales of Infant and Toddler Development‐Third Edition (BSID‐III) or the Wechsler Intelligence Scale for Children‐Fifth Edition (WISC‐V) tests according to the child's age at testing.ResultsAmong the 36,405 infants born within the study period, 274 had a birthweight below ‐2.5 SD (0.75%), of which 98 met the inclusion criteria. Median gestational age at delivery was 38.0 weeks (IQR, 37.3–38.5), and median birthweight was 2020 g (IQR, 1907.5–2247.5). Among the 63 families contacted, seven (11%) reported a postnatal diagnosis of a genetic syndrome and a further 18 consented to participate in the study. All 18 children showed a normal result upon clinical exome sequencing and CNV analysis, but six (33%) of them showed low scores at neurodevelopmental testing.ConclusionsNon‐malformed severely small term infants with no clinical or Doppler signs of placental insufficiency present an exceedingly high rate of genetic syndromes (11%) and neurodevelopmental impairment (33%) during childhood.This article is protected by copyright. All rights reserved.

Bacterial infections are the most common infections in solid organ transplant recipients. These infections occur mainly in the first month after transplantation and are hospital-acquired. Nosocomial infections cause significant morbidity and are the most common cause of mortality in this early period of transplantation. These infections are caused by multi-drug resistant (MDR) microorganisms, mainly Gram-negative enterobacteria, non-fermentative Gram-negative bacilli, enterococci, and staphylococci. The patients at risk of developing nosocomial bacterial infections are those previously colonized with MDR bacteria while on the transplant waiting list. Intravascular catheters, the urinary tract, the lungs, and surgical wounds are the most frequent sources of infection. Preventive measures are the same as those applied in non-immunocompromised, hospitalized patients except in patients at high risk for developing fungal infection. These patients need antifungal therapy during their hospitalization, and for preventing some bacterial infections in the early transplant period, patients need vaccinations on the waiting list according to the current recommendations. Although morbidity and mortality related to infectious diseases have decreased during the last few years in haematopoietic stem cell transplant recipients, they are still one of the most important complications in this population. Furthermore, as occurs in the general population, the incidence of nosocomial infections has increased during the different phases of transplantation. It is difficult to establish general preventive measures in these patients, as there are many risk factors conditioning these infections. Firstly, they undergo multiple antibiotic treatments and interventions; secondly, there is a wide variability in the degree of neutropenia and immunosuppression among patients, and finally they combine hospital and home stay during the transplant process. However, some simple measures could be implemented to improve the current situation.