•Most tuberculosis (TB) units reported changes in their TB team operations.•TB patients diagnosed during COVID-19 showed more extended pulmonary forms.•Latent TB infections in children household ...contacts were higher in 2020.•Active TB in children household contacts were higher in 2020.
The impact of COVID-19 on the diagnosis and management of tuberculosis (TB) patients is unknown.
Participating centres completed a structured web-based survey regarding changes to TB patient management during the COVID-19 pandemic. The study also included data from participating centres on patients aged ≥18 diagnosed with TB in 2 periods: March 15 to June 30, 2020 and March 15 to June 30, 2019. Clinical variables and information about patient household contacts were retrospectively collected.
A total of 7 (70%) TB units reported changes in their usual TB team operations. Across both periods of study, 169 patients were diagnosed with active TB (90 in 2019, 79 in 2020). Patients diagnosed in 2020 showed more frequent bilateral lesions in chest X-ray than patients diagnosed in 2019 (P = 0.004). There was a higher percentage of latent TB infection and active TB among children in households of patients diagnosed in 2020, compared with 2019 (P = 0.001).
The COVID-19 pandemic has caused substantial changes in TB care. TB patients diagnosed during the COVID-19 pandemic showed more extended pulmonary forms. The increase in latent TB infection and active TB in children of patient households could reflect increased household transmission due to anti-COVID-19 measures.
Mortality related to methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) remains high, despite changes in the epidemiology. To analyze the current predictive factors for ...mortality we conducted a prospective study in a large cohort of patients with MRSA-BSI from 21 Spanish hospitals. Epidemiology, clinical data, therapy and outcome were recorded. All MRSAstrains were analysed, including susceptibility to antibiotics and molecular characterization. Vancomycin MICs (V-MIC) were tested by the E-test and microdilution methods. Time until death was the dependent variable in a Cox regression analysis. Overall, 579 episodes were included. Acquisition was nosocomial in 59% and vascular catheter was the most frequent source (38%). A dominant PFGE genotype was found in 368 (67%) isolates, which belonged to Clonal Complex (CC)5 and carried SCCmecIV and agr2. Microdilution V-MIC50 and V-MIC90 were 0.7 and 1.0 mg/L, respectively. Initial therapy was appropriate in 66% of episodes. Overall mortality was observed in 179 (32%) episodes. The Cox-regression analysis identified age >70 years (HR 1.88), previous fatal disease (HR 2.16), Pitt score >1 (HR 3.45), high-risk source (HR 1.85) and inappropriate initial treatment (HR 1.39) as independent predictive factors for mortality. CC5 and CC22 (HR 0.52 and 0.45) were associated with significantly lower mortality rates than CC8. V-MIC ≥ 1.5 did not have a significant impact on mortality, regardless of the method used to assess it.
Skin testing-guided elimination diet has proved unsuccessful for adult eosinophilic oesophagitis (EoE), whereas empiric six-food elimination diet (SFED) achieves an efficacy of 70%.
To compare the ...efficacy of food-specific serum IgE-targeted elimination diet (sIgE-ED) and SFED.
Prospective study in adult patients with EoE. Food-specific serum IgE, skin prick test (SPT) and atopy patch test (APT) to foods included in SFED were performed. Those with ≥1 positive IgE test, defined by ≥0.1 kU/l, followed a 6-week sIgE-ED, whereas non-IgE-sensitized patients underwent a 6-week SFED. Responders to diet (<15 eos/HPF) underwent individual reintroduction of foods followed by histological assessment.
Forty-three EoE patients were included (26 sIgE-ED and 17 SFED). Regarding sIgE-ED, the mean number of eliminated foods per patient was significantly lower than in SFED (3.81 vs 6; P < 0.001), being wheat (85%), nuts (73%) and cow's milk (61%) the most commonly foods withdrawn. No difference in histological response was observed between sIgE-ED and SFED (73% vs 53%, P = 0.17). Causative foods identified by food challenge were cow's milk (64%), wheat (28%), egg (21%) and legumes (7%), with a single food trigger in 71% of patients. sIgE exhibited the higher accuracy to predict offending foods in IgE-sensitized patients (sensitivity 87.5%, specificity 68% (κ = 0.43)), with k values of 1 for cow's milk. APT results were all negative.
Histological remission was accomplished in 73% of patients undergoing sIgE-ED, which was nonsignificantly superior to SFED. sIgE effectively identified cow's milk as a food trigger in IgE-sensitized patients.
Summary
Background
The molecular basis and effects of proton pump inhibitor (PPI) therapy on PPI‐responsive oesophageal eosinophilia (PPI‐REE) and eosinophilic oesophagitis (EoE) remain unknown.
Aim
...To compare symptom‐histological and cytokine gene expression in PPI‐REE and EoE patients, at baseline and after specific treatment.
Methods
In consecutive adult patients with an EoE phenotype (dysphagia/food impaction, typical endoscopic findings and > 15 eos/HPF), gene expression of eotaxin‐3, IL‐13, and IL‐5 were determined in distal and proximal oesophagus, at baseline and after omeprazole 40 mg b.d. for 8 weeks. PPI‐REE was defined by clinicohistological response. PPI nonresponders (EoE) were offered treatment with topical steroids.
Results
Fifty three patients were re‐evaluated on PPI therapy. 23 patients (43%) had PPI‐REE and 30 patients (57%) had EoE. At baseline, eotaxin‐3/IL‐13/IL‐5 gene expression was indistinguishable between EoE and PPI‐REE, excepting increased IL‐5 expression in proximal oesophagus (12.54 vs. 57, P = 0.029). PPI therapy significantly decreased eotaxin‐3/IL‐13 in PPI‐REE, at both oesophageal sites (P ≤ 0.008), and IL‐5 in distal (P = 0.016), but not in proximal oesophagus. Patients with steroid‐responsive EoE also showed a significant decrease in eotaxin‐3/IL‐5 expression at both oesophageal sites. In EoE patients, initial PPI trial significantly decreased distal oesophageal eosinophilia (63.78 to 41.79 eos/HPF, P = 0.025) and led to symptom remission in 16%, but did not influence Th2 markers.
Conclusions
Baseline cytokine gene expression in PPI‐REE was nearly indistinguishable from EoE. PPI therapy significantly downregulated oesophageal eotaxin‐3/Th2‐cytokine gene expression in PPI‐REE, similarly to that seen in steroid‐responsive EoE. A subset of EoE patients showed clinicohistological improvement on PPI therapy.
Summary
Background
Conflicting results have been recently reported for the accuracy of the Endoscopic Reference Score (EREFS), an standardised endoscopic classification, to predict the histological ...activity of eosinophilic oesophagitis (EoE).
Aim
To evaluate the accuracy of the EREFS to predict either histological or clinical activity of EoE.
Methods
Prospective multicentre study conducted in eight Spanish centres evaluating adult EoE patients, either naïve or after treatment. Symptoms were evaluated before upper endoscopy through the Dysphagia Symptom Score, whereas researchers scored the EREFS immediately after the endoscopic procedure, unaware of the histological outcome.
Results
One hundred and forty‐five EoE patients undergoing 240 consecutive endoscopic procedures were included. Exudates (P = 0.03), furrows (P = 0.03) and a composite score of inflammatory signs (exudates, furrows and oedema) (P < 0.001) accurately predicted histological activity. Exudates were the only endoscopic sign showing a good correlation with histological outcome after therapy. Furrows and oedema persisted in 50% and 70% of patients despite histological remission. No endoscopic feature exceeded 70% accuracy to predict histological activity. Likewise, no endoscopic finding could adequately predict dysphagia severity. Crepe paper mucosa, diffuse exudates and severe rings correlated with higher symptom scores.
Conclusions
Endoscopic findings assessed by the Endoscopic Reference Score did not correlate with histological or clinical disease activity in adult EoE patients. Only exudates correlated with peak eosinophil count and histological outcome, whereas furrows and oedema persisted in over half of patients despite histological remission.
Objective. We aim to characterize the viscoelastic behavior of Polyether-Block-Amide (PEBA 90A), provide reference values for the parameters of a constitutive model for the simulation of mechanical ...behaviors, and paying attention to the influence of the manufacturing conditions. Methods. Uniaxial relaxation tests of filaments of PEBA were used to determine the values of the parameters of a Prony series for a Quasi-Linear Visco-Elastic (QLVE) model. Additional, fast cyclic loading tests were used to corroborate the adequacy of the model under different test criteria in a second test situation. Results. The QLVE model predicts the results of the relaxation tests very accurately. In addition, the behavior inferred from this model fits very well with the measurements of fast cyclic loading tests. The viscoelastic behavior of PEBA under small strain polymer fits very well to a six-parameter QLVE model.
Contourite deposits are significant facies in deep-water sedimentary environments because they record critical paleoclimatological and paleoceanographic data. Contourite research also informs ...slope-stability/geological hazard assessment and petroleum exploration. Scientific consensus has not converged on several key aspects of contourite interpretation however. Some researchers interpret bioturbation as a diagnostic feature that differentiates contourites from associated facies (e.g., turbidites), while other researchers consider bioturbation to be of second order importance. This work reviews existing literature and relevant field data to better define the role of ichnological analysis in contourite research. Review of significant contributions by earlier studies, including formalization of terminology (bioturbation, burrow, etc.) can help constrain wider usage of ichnological concepts (e.g., ichnofacies) and ichnotaxonomic analysis. This paper also revisits ichnological data in paleoenvironmental interpretations, reservoir characterization, and the rare example of ichnofacies and ichnofabric analyses. Designation of diagnostic criteria can promote the use of ichnological information in contourite research. Regardless of consensus concerning bioturbation as a diagnostic criterion in contourite characterization, ichnological data can still inform interpretations and integrate with other techniques to advance understanding of contourite sedimentary facies for a broad range of applications.
•A revision on the role of bioturbation in contourite research is present.•Scarcity of ichnological studies, inappropriate terms and misintepretations are revealed.•Bioturbation can be considered a valuable proxy for contourite characterization.•Detailed ichnological analysis, including ichnofabric approach, must be conducted.
In this paper, a 4 times 4 indoor multiple-input multiple-output (MIMO) measurement campaign at a frequency of 2.45 GHz is presented. The main contribution of this work is the analysis of the impact ...of radio-wave polarization in MIMO systems operating at a typical indoor scenario through the calculation-from the measurements carried out-of a great deal of parameters such as the mean path loss, the cross polarization discrimination (XPD), and the RMS delay spread, which are all essential to estimate the performance of real MIMO systems. In this sense, some path loss models-which have been adjusted according to the measurements-are given, taking into account polarization, attenuation through walls, and the effect of T-junctions existing in the considered indoor scenario. Moreover, additional parameters such as the K-factor and statistical distribution, as well as spatial parameters, are discussed.
Catalysts based on pillared clays with Pd–Al were synthesized from a commercial bentonite and tested for catalytic hydrodechlorination (HDC) using 4-chlorophenol (4-CPhOH) as target compound and ...formic acid as hydrogen source. Stable Pd–Al pillared clays, with a strong fixation of the active phase to the solid support were obtained since no Pd was detected in the reaction media. The incorporation of Pd to the pillared clay structure yielded catalysts with high activity in the reaction studied reaching a complete removal of the 4-CPhOH under mild conditions of temperature (50–70
°C). Phenol was not the only reaction product formed, since a more hydrogenated product such as cyclohexanone was detected in the effluent, which indicates additional hydrogenation of phenol. The influence of the method of introduction of Pd in the pillared clay (ion-exchange or impregnation) and Pd concentration in the catalytic activity were studied as well as other important operating variables such as reaction temperature, catalyst concentration, 4-CPhOH initial concentration and formic acid to 4-CPhOH molar ratio. The catalysts prepared suffered deactivation after three consecutive runs, probably due to carboneous deposits formation since no appreciable Pd leaching was observed.
Different pilot-scale outdoor photobioreactors using medium recycling were operated in a greenhouse under different environmental conditions and the growth rates (0.1 to 0.5 day⁻¹) obtained evaluated ...in order to compare them with traditional systems used in aquaculture. The annualized volumetric growth rate for Nannochloropsis gaditana was 0.26 g l⁻¹ day⁻¹ (peak 0.4 g l⁻¹ day⁻¹) at 0.4 day⁻¹ in a 5-cm wide flat-panel bioreactor (FP-PBR). The biomass productivity achieved in this reactor was 10-fold higher than in traditional reactors, reaching values of 28 % and 45 % dry weight (d.w.) of lipids and proteins, respectively, with a 4.3 % (d.w.) content of eicosapentaenoic acid (EPA). A model for predicting EPA productivity from N. gaditana cultures that takes into account the existence of photolimitation and photoinhibition of growth under outdoor conditions is presented. The effect of temperature and average irradiance on EPA content is also studied. The maximum EPA productivity attained is 30 mg l⁻¹ day⁻¹.
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