On the need to integrate interannual natural variability into coastal multihazard assessments.

The co-occurrence of multiple hazards can either exacerbate or mitigate risks. The interrelationships between multiple hazards greatly depend on the spatiotemporal scale and can be difficult to detect from large to local scales. In this paper, we identified coastal regions worldwide where the leading tropical (El Niño-Southern Oscillation, ENSO) and polar (Arctic Oscillation, AO; Southern Annular Mode, SAM) modes of climate variability simultaneously modify the seasonal conditions of multiple hazards, including the near-surface wind speed and swell and wind-sea wave powers. We classified the results at the national and municipal levels, with a focus on multiple hazards simultaneously occurring in space and time. The results revealed that the ENSO modulates multiple hazards, affecting approximately 40% of coastal countries, while the polar annular modes affect approximately 30% of coastal countries. The ENSO induced a greater diversity of multiple hazards, with Asian countries (e.g., Indonesia experienced increases of + 2% in wind and + 7% in swell) and countries in the Americas (e.g., Peru exhibited increases of + 1.5% in wind and + 6% in wind-sea) the most notably affected. The SAM imposed a greater influence on swells in the eastern countries of ocean basins (+ 2.5% in Chile) than in other countries, while the influence of the AO was greater in Norway and the UK (+ 12% for wind-sea and 8% for swell). Low-lying islands exhibited notable variations in pairwise hazards between phases and seasons. Our results could facilitate the interpretation of multihazard interactions and pave the way for a wide range of potential implementations of different coastal industries.

Prevalence and clinical characteristics of pulmonary TB among pregnant and post-partum women.

SETTING: Antenatal care (ANC) and postpartum care (PPC) clinic in Manhiça District, Mozambique.OBJECTIVE: To estimate the prevalence of TB among pregnant and post-partum women and describe the clinical characteristics of the disease in a rural area of Southern Mozambique.METHODS: We conducted a cross-sectional TB prevalence study among pregnant and post-partum women recruited from September 2016 to March 2018 at the Manhiça Health Care Center (MHC). We recruited two independent cohorts of women consecutively presenting for routine pregnancy or post-partum follow-up visits.RESULTS: A total of 1,980 women from the ANC clinic and 1,010 from the PPC clinic were enrolled. We found a TB prevalence of 505/100,000 (95% CI: 242-926) among pregnant women and 297/100,000 (95% CI: 61-865) among post-partum women. Among HIV-positive pregnant women, TB prevalence was 1,626/100,000 (95% CI: 782-2,970) and among postpartum HIV-positive women, TB prevalence was 984/100,000 (95% CI: 203-2,848).CONCLUSIONS: The burden of TB was not higher in postpartum women than in pregnant women. Most TB cases were detected in HIV-positive women. TB screening and diagnostic testing among pregnant and postpartum women attending ANC and PPC clinics in Manhiça District is acceptable and feasible.

Significance of the isolation of Staphylococcus aureus from a central venous catheter tip in the absence of concomitant bacteremia: a clinical approach.

The optimal approach following the isolation of Staphylococcus aureus from an intravascular catheter tip in the absence of concomitant bacteremia remains unclear. We aimed to determine the rate of delayed complications in these patients. We performed a retrospective observational study (during the period 2002-2012) including patients with a catheter tip culture yielding S. aureus. Patients were followed up for ≥6 months. The primary endpoint was the occurrence of delayed staphylococcal complications (either bacteremia and/or metastatic distant infections). A total of 113 patients were included (75 % male, median age 61 years): 46 and 67 with negative and positive blood cultures, respectively. We found a lower rate of delayed staphylococcal complications in cases with no bacteremia within 48 h since catheter removal than in cases of confirmed S. aureus catheter-related bacteremia (0.0 % vs. 25.4 %; p-value < 0.001). In the group without bacteremia, there was a subgroup of 15 patients (32.6 %) who did not receive antimicrobial treatment. Again, delayed complications occurred less commonly in this subgroup of patients without bacteremia (0.0 % vs. 25.4 %; p-value = 0.033). In contrast to patients with S. aureus catheter-related bacteremia, no delayed infectious complications were observed in patients with an isolated catheter tip culture yielding S. aureus and negative blood cultures within 48 h of catheter removal. Futures studies are needed to assess if the therapeutic approach could be different for this group of patients.

[Cytomegalovirus sensitivity to anti-retroviral agents in patients infected with the human immunodeficiency virus with chorioretinitis in Spain]. / Sensibilidad del citomegalovirus frente a fármacos antivíricos en pacientes infectados por el virus de la inmunodeficiencia humana con coriorretinitis en España.

OBJECTIVES: To determine the prevalence of the in vitro resistance rate of cytomegalovirus (CMV) to gancyclovir (GCV) and foscarnet (FOS) among patients with AIDS and chorioretinitis. Furthermore, in vitro sensitivity results were compared with the clinical response to therapy. PATIENTS AND METHODS: Thirty-six patients with the diagnosis of CMV retinitis and AIDS were included in the study. Antiviral sensitivity testing was performed to 51 clinical CMV strains from these patients. The in vitro sensitivity was compared with the clinical response to therapy. The resistance criteria were the inhibitory dose50 (ID50) GCV > 5 M and ID50 FOS > 400 M. RESULTS: None of the CMV tested strains was resistant to GCV or FOS; however, six patients who had relapses of chorioretinitis while on maintenance therapy and isolation during the condition had mean ID50 of strains (n=8) of 1,95 M for GCV (standard deviation [SD] of 0.71) and 115.2 for FOS (SD, 34.7). These patients responded well when drugs were used at induction doses. CONCLUSION: The in vitro sensitivity testing is not a good predictor of infection control when the drug is used at maintenance doses. This suggests that these strains should be classified in the intermediate resistant category.

[Should cefminox substitute cefoxitin in infectionscaused by bacteria susceptible to both drugs?] / ¿Debe sustituir cefminox a cefoxitinaen en las infecciones por bacterias sensibles a ambos?

We studied the in vitro activity of cefminox (MIC by agar dilution) and cefoxitin against 477 facultative Gram-positive and Gram-negative isolates which were recovered from clinical specimens and identified by standard methods. Cefminox has proved to be 4-16 times more active than cefoxitin against enteric Gram-negative bacilli commonly involved in cholecystitis, secondary peritonitis, intraabdominal abscesses and gynecological infections. On the contrary, cefoxitin has proved to be four times more active against Gram-positive cocci. Both have been ineffective against Enterobacter spp., Pseudomonas aeruginosa and Acinetobacter spp. The microbiological activity and pharmacokinetic parameters of cefminox make it one of the first choice treatments for community-acquired intraabdominal and pelvic infections with the presence of anaerobes.

[Should cefminox substitute cefoxitin in infections caused by bacteria susceptible to both drugs?]. / Debe sustituir cefminox a cefoxitinaen en las infecciones por bacterias sensibles a ambos?

We studied the in vitro activity of cefminox (MIC by agar dilution) and cefoxitin against 477 facultative Gram-positive and Gram-negative isolates which were recovered from clinical specimens and identified by standard methods. Cefminox has proved to be 4-16 times more active than cefoxitin against enteric Gram-negative bacilli commonly involved in cholecystitis, secondary peritonitis, intraabdominal abscesses and gynecological infections. On the contrary, cefoxitin has proved to be four times more active against Gram-positive cocci. Both have been ineffective against Enterobacter spp., Pseudomonas aeruginosa and Acinetobacter spp. The microbiological activity and pharmacokinetic parameters of cefminox make it one of the first choice treatments for community-acquired intraabdominal and pelvic infections with the presence of anaerobes.

Sertaconazole in the treatment of pediatric patients with cutaneous dermatophyte infections.

Sertaconazole is a new topical anti-mycotic with demonstrated efficacy against dermatophyte infections in adults. An open-label, multicenter study was conducted to assess the efficacy and tolerability of sertaconazole in children in primary care. Twenty-nine children were initially included in the study and tolerability was assessed in all of them. The 16 children examined for efficacy (8 girls and 8 boys, aged 2 to 16 years) all had culture-confirmed cutaneous mycoses. Fourteen children had tinea corporis, 1 had tinea cruris, and 1 had tinea pedis. Microsporum canis was identified in 50% of cultures and Trichophyton rubrum in 42%. Patient lesions were treated with 2% sertaconazole cream during a 2-week period. Clinical cure was achieved in 31% of patients after 1 week, 75% after 2 weeks, and 100% after 4 weeks. No local or systemic adverse effects were observed. It is concluded that once-daily topical sertaconazole is an effective and well-tolerated treatment for pediatric patients with dermatophytosis.

[Mediterranean boutonneuse fever in children. Study of 139 cases]. / Fiebre botonosa mediterránea en la infancia. Estudio de 139 casos.

A prospective study of 139 children suffering mediterranean spotted fever, all of them hospitalized during the summer time of the last five years is presented. Clinical features were high fever, maculopapulous rash and black eschar ("tàche noire"). Among analytical findings, leucocyte count was decreased in a 38.8% of children during the first week of illness. Weil-Felix test was positive in 47.2% for OX-2 and 52.7% for OX-19 of cases. The indirect immunofluorescence for rickettsial conorii was positive in 100% of cases in the second determination. 74.1% of patients received antimicrobial therapy and 25.9% symptomatic treatment. All children cured without complications.