To evaluate the potential role of PCR-based assays in the over-diagnosis of Clostridium difficile infection (CDI) by using a validated diagnostic algorithm in daily clinical practice.
We performed a ...retrospective cohort study evaluating all C. difficile-positive stool samples identified at our institution during a 12-month period, to compare outcomes and recurrence rates between patients with a positive enzyme immunoassay (EIA) for both glutamate dehydrogenase (GDH) and toxin A/B (‘toxin-positive group’), with those with GDH-positive, toxin-negative samples in whom the diagnosis was made by a positive PCR-based assay (‘toxin–/PCR+ group’). Medical records were reviewed by two independent investigators blinded to the mode of diagnosis.
We analysed 231 first CDI episodes (106 (45.8 %) in the ‘toxin-positive group’ and 125 (54.1%) in the ‘toxin–/PCR+ group’). Both groups had similar baseline characteristics. Patients in the ‘toxin-positive group’ presented more frequently with a severe/severe complicated form than those in the ‘toxin–/PCR+ group’ (36 (33.9%) versus 24 (19.2%); p 0.011) and had more recurrences (27 (25.5%) versus 9 (7.2%); p 0.001). Diagnosis of CDI based on a GDH/toxin-positive EIA independently predicted severe/severe-complicated course (adjusted OR 2.11; 95% CI 1.06–4.22; p 0.033) and recurrence (adjusted OR 3.79; 95% CI 1.65–8.69; p 0.002). There were no differences in all-cause mortality (12.3% versus 12.0%; p 0.95) or CDI-attributable mortality (4.7% versus 4.8%; p 0.93).
Toxin-positive patients were more likely to have severe-complicated forms of CDI and recurrences. Nevertheless, CDI-related complications may still occasionally occur among toxin-negative patients diagnosed by PCR, which stresses the need for individualized clinical evaluation.
This study examines the frequency, associated factors, and characteristics of healthcare personnel coronavirus disease 2019 cases in a healthcare department that comprises a tertiary hospital and its ...associated 12 primary healthcare centers.
This study included healthcare personnel that showed symptoms or were in contact with a coronavirus disease 2019 case patient from March 2, 2020 to April 19, 2020. Their evolution and characteristics (age, sex, professional category, type of contact) were recorded. Correlations between the different characteristics and risk of developing coronavirus disease 2019 and severe coronavirus disease 2019 were analyzed using chi-square tests. Their magnitudes were quantified with ORs, AORs, and their 95% CIs using a logistic regression model.
Of the 3,900 healthcare professionals in the department, 1,791 (45.9%) showed symptoms or were part of a contact tracing study. The prevalence of those with symptoms was 20.1% (784/3,900; 95% CI=18.8, 21.4), with coronavirus disease 2019 was 4.0% (156/3,900; 95% CI=3.4, 4.6), and with severe coronavirus disease 2019 was 0.5% (18/3,900; 95% CI=0.2, 0.7). The frequency of coronavirus disease 2019 in symptomatic healthcare personnel with a nonprotected exposure was 22.8% (112/491) and 13.7% (40/293) in those with a protected exposure (AOR=2.2, 95% CI=1.2, 3.9). The service in which the healthcare personnel performed their activity was not significantly associated with being diagnosed with coronavirus disease 2019. A total of 26.3% (10/38) of male healthcare personnel with coronavirus disease 2019 required hospitalization, compared with 6.8% (8/118) among female healthcare personnel (OR=4.9, 95% CI=1.8, 13.6).
A surveillance and monitoring program centred on healthcare personnel enables an understanding of the risk factors that lead to coronavirus disease 2019 among this population. This knowledge allows the refinement of the strategies for disease control and prevention in healthcare personnel during the coronavirus disease 2019 pandemic.
We aimed to analyze the incidence, risk factors and impact of hypogammaglobulinemia (HGG) in 226 kidney transplant (KT) recipients in which serum immunoglobulin (Ig) levels were prospectively ...assessed at baseline, month 1 (T1), and month 6 (T6). The prevalence of IgG HGG increased from 6.6% (baseline) to 52.0% (T1) and subsequently decreased to 31.4% (T6) (p < 0.001). The presence of IgG HGG at baseline (odds ratio OR 26.9; p = 0.012) and a positive anti‐HCV status (OR 0.17; p = 0.023) emerged as risk factors for the occurrence of posttransplant IgG HGG. Patients with HGG of any class at T1 had higher incidences of overall (p = 0.018) and bacterial infection (p = 0.004), bacteremia (p = 0.054) and acute pyelonephritis (p = 0.003) in the intermediate period (months 1–6). Patients with HGG at T6 had higher incidences of overall (p = 0.004) and bacterial infection (p < 0.001) in the late period (>6 month). A complementary log–log model identified posttransplant HGG as an independent risk factor for overall (hazard ratio HR 2.03; p < 0.001) and bacterial infection (HR 2.68; p < 0.0001). Monitoring of humoral immunity identifies KT recipients at high risk of infection, offering the opportunity for preemptive immunoglobulin replacement therapy.
The authors analyze the incidence and clinical impact of hypogammaglobulinemia in kidney transplant recipients, and conclude that the systematic monitoring of humoral immunity identifies patients at high risk of posttransplant infection, offering the opportunity for preemptive immunoglobulin replacement therapy.
The purpose of this study was to investigate the effect of empagliflozin on diastolic function in a nondiabetic heart failure with reduced ejection fraction (HFrEF) scenario and on the pathways ...causing diastolic dysfunction.
This group demonstrated that empagliflozin ameliorates adverse cardiac remodeling, enhances myocardial energetics, and improves left ventricular systolic function in a nondiabetic porcine model of HF. Whether empagliflozin also improves diastolic function remains unknown. Hypothetically, empagliflozin would improve diastolic function in HF mediated both by a reduction in interstitial myocardial fibrosis and an improvement in cardiomyocyte stiffness (titin phosphorylation).
HF was induced in nondiabetic pigs by 2-h balloon occlusion of proximal left anterior descending artery. Animals were randomized to empagliflozin or placebo for 2 months. Cardiac function was evaluated with cardiac magnetic resonance (CMR), 3-dimensional echocardiography, and invasive hemodynamics. In vitro relaxation of cardiomyocytes was studied in primary culture. Myocardial samples were obtained for histological and molecular evaluation. Myocardial metabolite consumption was analyzed by simultaneous blood sampling from coronary artery and coronary sinus.
Despite similar initial ischemic myocardial injury, the empagliflozin group showed significantly improved diastolic function at 2 months, assessed by conventional echocardiography (higher e′ and color M-mode propagation velocity, lower E/e′ ratio, myocardial performance Tei index, isovolumic relaxation time, and left atrial size), echocardiography-derived strain imaging (strain imaging diastolic index, strain rate at isovolumic relaxation time and during early diastole, and untwisting), and CMR (higher peak filling rate, larger first filling volume). Invasive hemodynamics confirmed improved diastolic function with empagliflozin (better peak LV pressure rate of decay (–dP/dt), shorter Tau, lower end-diastolic pressure-volume relationship (EDPVR), and reduced filling pressures). Empagliflozin reduced interstitial myocardial fibrosis at the imaging, histological and molecular level. Empagliflozin improved nitric oxide signaling (endothelial nitric oxide synthetase eNOS activity, nitric oxide NO availability, cyclic guanosine monophosphate (cGMP) content, protein kinase G PKG signaling) and enhanced titin phosphorylation (which is responsible for cardiomyocyte stiffness). Indeed, isolated cardiomyocytes exhibited better relaxation in empagliflozin-treated animals. Myocardial consumption of glucose and ketone bodies negatively and positively correlated with diastolic function, respectively.
Empagliflozin ameliorates diastolic function in a nondiabetic HF porcine model, mitigates histological and molecular remodeling, and reduces both left ventricle and cardiomyocyte stiffness.
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Islands at the Crossroads Curet, L. Antonio; Hauser, Mark W; Armstrong, Douglas V ...
2011, 2011-07-15, 20110101
eBook
This volume looks beyond cultural boundaries and colonial frontiers to explore the complex and layered ways in which both distant and more intimate sociocultural, political, and economic interactions ...have shaped Caribbean societies from 7000 years ago to recent times.
In this study we addressed the polluting potential that constitutes the disposal of wastewater from the fish meal and oil industries into the sea. With this aim we have analysed some physico-chemical ...and bacteriologic aspects of the effluents of these industries, including: weight percentage of organic matter, chemical oxygen load, fatty acids saturation, and presence of Salmonella. The results suggest a low polluting potential for these effluents, although the acid pH and the high rate of saturation found in fatty acids of oil fishes could imply a certain toxicity for the marine environment.
We describe an optical transduction mechanism to measure the flexural mode vibrations of vertically aligned nanowires on a flat substrate with high sensitivity, linearity, and ease of implementation. ...We demonstrate that the light reflected from the substrate when a laser beam strikes it parallel to the nanowires is modulated proportionally to their vibration, so that measuring such modulation provides a highly efficient resonance readout. This mechanism is applicable to single nanowires or arrays without specific requirements regarding their geometry or array pattern, and no fabrication process besides the nanowire generation is required. We show how to optimize the performance of this mechanism by characterizing the split flexural modes of vertical silicon nanowires in their full dynamic range and up to the fifth mode order. The presented transduction approach is relevant for any application of nanowire resonators, particularly for integrating nanomechanical sensing in functional substrates based on vertical nanowires for biological applications.
A primary sink of air pollutants and their precursors is dry deposition. Dry deposition estimates differ across chemical transport models, yet an understanding of the model spread is incomplete. ...Here, we introduce Activity 2 of the Air Quality Model Evaluation International Initiative Phase 4 (AQMEII4). We examine 18 dry deposition schemes from regional and global chemical transport models as well as standalone models used for impact assessments or process understanding. We configure the schemes as single-point models at eight Northern Hemisphere locations with observed ozone fluxes. Single-point models are driven by a common set of site-specific meteorological and environmental conditions. Five of eight sites have at least 3 years and up to 12 years of ozone fluxes. The interquartile range across models in multiyear mean ozone deposition velocities ranges from a factor of 1.2 to 1.9 annually across sites and tends to be highest during winter compared with summer. No model is within 50 % of observed multiyear averages across all sites and seasons, but some models perform well for some sites and seasons. For the first time, we demonstrate how contributions from depositional pathways vary across models. Models can disagree with respect to relative contributions from the pathways, even when they predict similar deposition velocities, or agree with respect to the relative contributions but predict different deposition velocities. Both stomatal and nonstomatal uptake contribute to the large model spread across sites. Our findings are the beginning of results from AQMEII4 Activity 2, which brings scientists who model air quality and dry deposition together with scientists who measure ozone fluxes to evaluate and improve dry deposition schemes in the chemical transport models used for research, planning, and regulatory purposes.
Since the 1980s, several experimental analyses have been able to differentiate some lithic tool types and some of their raw materials according to the morphology of cut marks imprinted by such tools ...when used for butchering activities. Thus, metal tool use has been differentiated in contexts with an abundance of lithic tools, or even the use of hand axes has been documented in carcass processing, in contrast with simple unretouched or retouched flakes. As important as this information is, there are still other important aspects to be analysed. Can cut marks produced with different lithic raw material types be differentiated? Can cut marks made with different types of the same raw material type be characterized and differentiated? The objective of this study is to evaluate if cut marks resulting from the use of different flints and different quartzites are distinguishable from each other. In the present work, an experimental analysis of hundreds of cut marks produced by five types of flint and five varieties of quartzite was carried out. Microphotogrammetry and geometric–morphometric techniques were applied to analyse these cut marks. The results show that flint cut marks and quartzite cut marks can be characterized at the assemblage level. Different types of flint produced cut marks that were not significantly different from each other. Cut marks made with Olduvai Gorge quartzite were significantly different from those produced with a set comprising several other types of quartzites. Crystal size, which is larger in Olduvai Gorge quartzites (0.5 mm) than Spanish quartzites (177–250 μm), is discussed as being the main reason for these statistically significant differences. This documented intra‐sample and inter‐sample variance does not hinder the resolution of the approach to differentiate between these two generic raw material types and opens the door for the application of this method in archaeological contexts.
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