ABSTRACT
BACKGROUND: Infections caused by carbapenemase-producing Enterobacterales (CPE) are not well represented in pivotal trials with ceftazidime/avibactam. The best strategy for the treatment of these infections is unknown. METHODS: We conducted a multicentre retrospective observational study of patients who received ≥48â h of ceftazidime/avibactam or best available therapy (BAT) for documented CPE infections. The primary outcome was 30â day crude mortality. Secondary outcomes were 21â day clinical response and microbiological response. A multivariate logistic regression model was used to identify factors predictive of 30â day crude mortality. A propensity score to receive treatment with ceftazidime/avibactam was used as a covariate in the analysis. RESULTS: The cohort included 339 patients with CPE infections. Ceftazidime/avibactam treatment was used in 189 (55.8%) patients and 150 (44.2%) received BAT at a median of 2â days after diagnosis of infection. In multivariate analysis, ceftazidime/avibactam treatment was associated with survival (OR 0.41, 95% CI 0.20-0.80; P = 0.01), whereas INCREMENT-CPE scores of >7 points (OR 2.57, 95% CI 1.18-1.5.58; P = 0.01) and SOFA score (OR 1.20, 95% CI 1.08-1.34; P = 0.001) were associated with higher mortality. In patients with INCREMENT-CPE scores of >7 points, ceftazidime/avibactam treatment was associated with lower mortality compared with BAT (16/73, 21.9% versus 23/49, 46.9%; P = 0.004). Ceftazidime/avibactam was also an independent factor of 21â day clinical response (OR 2.43, 95% CI 1.16-5.12; P = 0.02) and microbiological eradication (OR 0.40, 95% CI 0.18-0.85; P = 0.02). CONCLUSIONS: Ceftazidime/avibactam is an effective alternative for the treatment of CPE infections, especially in patients with INCREMENT-CPE scores of >7 points. A randomized controlled trial should confirm these findings.
Subject(s)
Anti-Bacterial Agents , Ceftazidime , Anti-Bacterial Agents/therapeutic use , Azabicyclo Compounds/therapeutic use , Bacterial Proteins , Ceftazidime/therapeutic use , Drug Combinations , Humans , Microbial Sensitivity Tests , beta-LactamasesABSTRACT
Our objective was to evaluate the effectiveness of protected areas (PAs) in the Paraná-Paraguay basin on multiple facets of ichthyofauna, both currently and in future climate change scenarios, based on reaching the 17% of conserved terrestrial and inland water defined by Aichi Target 11. Analyses were carried out vis-à-vis a distribution of 496 native species, modeling for the present and for the future, and in moderate and pessimistic scenarios of greenhouse gases. We calculated species richness, functional richness, and phylogenetic diversity, overlapping the combination of these facets with the PAs. The results indicate that the current PAs of the Paraná-Paraguay basin are not efficient in protecting the richest areas of ichthyofauna in their multiple facets. While there is a larger overlap between PAs and the richest areas in phylogenetic diversity, the values are too low (2.37%). Currently, the overlap between PAs and areas with larger species richness, functional richness, and phylogenetic diversity is only 1.48%. Although this value can increase for future projections, the values of the indices decrease substantially. The relevant aquatic environments, biological communities, and climate change should be considered as part of the systematic planning of PAs that take into consideration the terrestrial environments and their threats.(AU)
Nosso objetivo foi avaliar a efetividade das áreas protegidas da bacia Paraná-Paraguai sobre múltiplas facetas da ictiofauna, atualmente e em cenários futuros de mudanças climáticas baseado em alcançar 17% de áreas protegidas, de acordo com os objetivos de Aichi. Análises foram feitas a partir da distribuição de 496 espécies para o presente e futuro, em diferentes cenários climáticos. Foram calculadas a riqueza de espécies, a riqueza funcional e a diversidade filogenética, sobrepondo a combinação destas facetas com as áreas protegidas. Os resultados indicaram que as áreas protegidas da bacia Paraná-Paraguai não são eficientes em proteger as áreas mais ricas em ictiofauna considerando diversas facetas. A maior sobreposição se dá entre as áreas protegidas e as áreas mais ricas em diversidade filogenética, mas os valores são muito baixos (2,37%). A sobreposição entre as áreas protegidas e os 17% das áreas com maior riqueza de espécies, riqueza funcional e diversidade filogenética é de apenas 1,48%. Para o futuro as projeções indicaram que a sobreposição pode aumentar, mas os valores dos índices caem consideravelmente. Os ambientes aquáticos e as mudanças climáticas são componentes que devem ser considerados no planejamento sistemático de áreas protegidas que consideram essencialmente ambientes terrestres e suas ameaças.(AU)
Subject(s)
Animals , Climate Change , Protected Areas/analysis , Fishes , Phylogeny , Genetic VariationABSTRACT
Although it is widely known that dams can have large impacts on the environmental and biological characteristics of downstream rivers, there is a substantial lack of studies focusing on which ecological processes cause longitudinal changes in biological communities downstream of reservoirs. We investigated longitudinal patterns in the total beta diversity and its replacement and richness difference components for actively (fish) and passively (phytoplankton) dispersing biological groups. Our results, obtained from a 230â¯km sampling stretch, demonstrated the key role played by tributaries in the downstream direction from main river impoundment, which influenced local environmental conditions and beta diversity patterns of each biological group. Both replacement and richness difference contributed to high values of total beta diversity for fish (averageâ¯=â¯0.77) and phytoplankton (averageâ¯=â¯0.79), but their relative importance was more associated with the replacement component for both biological groups (averageâ¯=â¯0.45 and 0.52, respectively). Moreover, we observed clear differences between fish and phytoplankton in beta diversity patterns operating at small and broad scales, as well as in the mechanisms driving each beta diversity component. Directional dispersal-related processes and environmental filtering played a major role in shaping total beta diversity and its components for fish, while temporal factors explained considerable parts of phytoplankton beta diversity. Our findings contributed to understanding of tributary-induced heterogeneity and highlight the importance of dam-free stretches of rivers for preserving the integrity of dammed river basins.
Subject(s)
Biodiversity , Ecosystem , Rivers/chemistry , Animals , Biota , Ecology , Environmental Monitoring , Fishes , Phytoplankton , Population Density , Population Dynamics , SeasonsABSTRACT
Fatigue, anorexia and involuntary weight loss have been included under the term constitutional syndrome. These manifestations accompany many diseases in which the diagnosis is made by specific symptoms and signs. However, these events are generally the main reason for consultation and the patient does not report other specific data. This forces us to rigorously investigate the possible causes of the disorder. Usually, three manifestations coexist: asthenia, anorexia and weight loss, but sometimes the patient has only one or two of them. The causes of constitutional symptoms are varied and can be divided into three groups: psychiatric diseases, neoplasms and non-neoplastic diseases. The etiological identification is usually done with a simple protocol, which rules out malignancy; the rest of the cases of uncertain etiology are subject to evolution. The constitutional syndrome correlates well with good prognosis or medical functional processes. Although no clinical guidelines have been developed, score scales may help for the etiological assessment. Given the myriad of different causes of the constitutional syndrome, the treatment of this illness depends primarily on the etiology.
Bajo el término de síndrome constitucional se engloba la manifestación de astenia, anorexia y pérdida involuntaria de peso. Por separado o juntas, estas manifestaciones acompañan a muchas enfermedades cuyo diagnóstico se formula por otros síntomas y signos específicos. Sin embargo, en ocasiones, son el motivo principal de consulta, sin que el paciente refiera otros datos orientadores. Ello obliga a indagar de forma rigurosa las posibles causas del trastorno. Por lo general coexisten las tres manifestaciones (astenia, anorexia y pérdida de peso), pero a veces solo existe una o dos. Las causas del síndrome constitucional son variadas, pero en una primera aproximación pueden dividirse en tres grandes grupos: psiquiátricas, neoplásicas y orgánicas no neoplásicas. Generalmente la identificación etiológica se realiza con un protocolo sencillo que descarta neoplasia; algunos casos de etiología incierta se correlacionan con enfermedades médicas de buen pronóstico o con procesos funcionales. Aunque no existen guías de estudio, se han creado tablas de puntuación que ayudan a la valoración etiológica. Dada la miríada de causas de naturaleza diversa, el tratamiento del síndrome constitucional depende básicamente de su etiología.
Subject(s)
Anorexia/diagnosis , Asthenia/diagnosis , Fatigue/diagnosis , Weight Loss , Humans , SyndromeSubject(s)
Ambulatory Care/methods , Anemia/blood , Hemoglobinometry/methods , Spectrophotometry/methods , Aged , Aged, 80 and over , Ambulatory Care/economics , Anemia/diagnosis , Anemia/therapy , Blood Transfusion , Costs and Cost Analysis , Female , Hemoglobinometry/economics , Hemoglobinometry/instrumentation , Hemoglobinometry/standards , Humans , Male , Microchemistry/economics , Microchemistry/methods , Middle Aged , Prospective Studies , Reproducibility of Results , Spain , Spectrophotometry/economics , Spectrophotometry/instrumentation , Spectrophotometry, Infrared/economics , Spectrophotometry, Infrared/instrumentation , Spectrophotometry, Infrared/methods , Time FactorsABSTRACT
Using a methodology similar to that proposed by Barro & Sala-i-Martin (1995), it is found that, in the period 1990-2006, there was strong convergence among state-level life expectancy series, but a distancing in life expectancy in the Mexican Republic compared with more developed countries, especially during the new millennium. The interior convergence had taken place at the expense of the exterior; that is, not so much as a result of an improvement in living conditions in the poorer states, but more due to the low performance of the richer states. The causes of this situation are explained using the concept of 'epidemiological transition'.
Subject(s)
Life Expectancy/trends , Aged , Data Collection , Developing Countries , Geography , Gross Domestic Product , Health Status , Humans , Mexico , Models, Statistical , Vital StatisticsABSTRACT
Non-ulcerous dyspepsia is common among sub-Saharan people migrating into Spain. Given the high prevalence of H. pylori (HP) infection in their countries of origin, we studied the prevalence of infection in this population, and specifically the prevalence of infection by the more virulent, cagA-positive strains (CAP). 140 sub-Saharan immigrants recently arrived to Gran Canaria (Canary Islands, Spain) were studied. 80.7% were male, with a mean age of 24.2 y. 90.7% tested seropositive for HP and 72.2% of them carried antibodies against the 'pathogenicity island' cagA. We did not find any relationship between the presence of these antibodies and the clinical variables studied. We can conclude that HP infection is virtually universal in this population, with a high percentage of infection by CAP strains.
Subject(s)
Antibodies, Bacterial/blood , Antigens, Bacterial/immunology , Bacterial Proteins/immunology , Emigrants and Immigrants , Helicobacter Infections/epidemiology , Helicobacter pylori/immunology , Adult , Africa South of the Sahara , Antigens, Bacterial/metabolism , Bacterial Proteins/metabolism , Female , Helicobacter Infections/immunology , Helicobacter Infections/microbiology , Helicobacter pylori/pathogenicity , Humans , Male , Seroepidemiologic Studies , Spain/epidemiology , Young AdultSubject(s)
Emigrants and Immigrants/statistics & numerical data , HTLV-I Infections/epidemiology , Adult , Africa South of the Sahara/ethnology , Comorbidity , Female , HIV Infections/epidemiology , HTLV-I Antibodies/blood , Hepatitis B/epidemiology , Hepatitis C/epidemiology , Humans , Male , Prevalence , Seroepidemiologic Studies , Spain/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Human T-lymphotropic virus 1/isolation & purification , HTLV-I Infections/epidemiology , Transients and Migrants , Africa South of the Sahara/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Histoplasma/pathogenicity , Histoplasmosis/epidemiology , Immunocompromised Host , Transients and Migrants , Africa South of the Sahara/epidemiologyABSTRACT
En la última década, la inmigración en España desde países con un menor desarrollo ha aumentado notablemente. En este trabajo se revisan la evolución temporal de la inmigración, la heterogeneidad de este colectivo, la distribución geográfica de la población inmigrante en España, las fases de relación entre sanitarios e inmigrantes y finalmente los escenarios de atención clínica a esta población (AU)
The number of immigrants arriving from developing nations has increased dramatically in the last ten years. In this paper we review the temporal profile of immigration to Spain, the heterogeneity of this group, the geographical distribution of immigrant population in Spain, the phases of relationship of sanitary and immigrant people and finally, the clinical scenarios of attention to immigrants (AU)
Subject(s)
Humans , Emigrants and Immigrants/statistics & numerical data , Health Services Accessibility , SpainABSTRACT
En general, los trabajos de la literatura española acerca de los problemas sanitarios de los inmigrantes se han centrado en las infecciones. Sin embargo, otros aspectos no relacionados directamente con las infecciones son relevantes en esta población. En esta revisión se señalan inicialmente algunos problemas sanitarios generales de este colectivo. Posteriormente se indican las características específicas de varios tipos de enfermedades: genéticas, malnutrición, traumatismos y accidentes laborales, neoplasias y problemas psicológicos (AU)
Infectious diseases are the main topic covered in the Spanish medical literature on sanitary problems in immigrants. However, other non-infectious aspects are also relevant in this population. In the first part of this paper we review the general sanitary problems of this group. In the second part, we indicate the specific characteristics of several types of diseases: with genetic origin, malnutrition, traumatisms and work accidents, neoplasias and psychological problems (AU)
Subject(s)
Humans , Emigration and Immigration/statistics & numerical data , Disease/classification , Spain/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Tuberculosis/epidemiology , Emigration and Immigration/statistics & numerical data , Communicable Disease Control/trends , Spain/epidemiology , Developed Countries , Developing CountriesABSTRACT
No disponible
Subject(s)
Humans , Tuberculosis/drug therapy , Antitubercular Agents/therapeutic use , Antibiotic Prophylaxis , Transients and Migrants/statistics & numerical data , Risk FactorsABSTRACT
La presente revisión pretende proporcionar al clínico una perspectiva global y concisa de la tuberculosis. Se revisan los conocimientos más relevantes sobre los aspectos microbiológicos, epidemiológicos y patogénicos, así como de diagnóstico y tratamiento de esta enfermedad en la actualidad (AU)
The aim of this review is to provide a comprehensive, yet concise perspective on tuberculosis for the clinician. The most relevant knowledge about microbiologic, epidemiologic and pathogenetic aspects are reviewed, as well as those related to the diagnosis and therapy of this disease in the present time (AU)
Subject(s)
Humans , Tuberculosis/epidemiology , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Mycobacterium tuberculosis/pathogenicity , Contact TracingABSTRACT
Se revisaron 37 historias médicas extraídas del Archivo de Historias Médicas del Hospital Pérez de León (HPL) de Petare del total de pacientes ingresados en el servicio de traumatología con diagnóstico de fractura (fx) de cadera, en el lapso comprendido entre enero de 1989 y diciembre de 1992. El 51.60 por ciento de los casos corresponde al sexo femenino. El 72.97 por ciento está en el grupo etário entre 54 y 97 años. Las fracturas más frecuentes según la localización son las intertrocantéricas. El 72.97 por ciento de los pacientes fueron tratados quirúrgicamente. El 27.03 por ciento fueron tratados en forma conservadora. La complicación mediata más frecuente fue la infección de la herida operatoria y la muerte en el post-operatorio mediato, representando una mortalidad del 10 por ciento
