Tuberculosis treatment adherence and fatality in Spain

<p>Abstract</p> <p>Background</p> <p>The adherence to long tuberculosis (TB) treatment is a key factor in TB control programs. Always some patients abandon the treatment or die. The objective of this study is to identify factors associated with defaulting from or dying during antituberculosis treatment.</p> <p>Methods</p> <p>Prospective study of a large cohort of TB cases diagnosed during 2006-2007 by 61 members of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Predictive factors of completion outcome (cured plus completed treatment vs. defaulters plus lost to follow-up) and fatality (died <it>vs. </it>the rest of patients) were based on logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI).</p> <p>Results</p> <p>Of the 1490 patients included, 29.7% were foreign-born. The treatment outcomes were: cured 792 (53.2%), completed treatment 540 (36.2%), failure 2 (0.1%), transfer-out 33 (2.2%), default 27 (1.8%), death 27 (1.8%), lost to follow-up 65 (4.4%), other 4 (0.3%). Completion outcome reached 93.5% and poor adherence was associated with: being an immigrant (OR = 2.03; CI:1.06-3.88), living alone (OR = 2.35; CI:1.05-5.26), residents of confined institutions (OR = 4.79; CI:1.74-13.14), previous treatment (OR = 2.93; CI:1.44-5.98), being an injecting drug user (IDU) (OR = 9.51; CI:2.70-33.47) and treatment comprehension difficulties (OR = 2.93; CI:1.44-5.98). Case fatality was 1.8% and it was associated with the following variables: age 50 or over (OR = 10.88; CI:1.12-105.01), retired (OR = 12.26;CI:1.74-86.04), HIV-infected (OR = 9.93; CI:1.48-66.34), comprehension difficulties (OR = 4.07; CI:1.24-13.29), IDU (OR = 23.59; CI:2.46-225.99) and Directly Observed Therapy (DOT) (OR = 3.54; CI:1.07-11.77).</p> <p>Conclusion</p> <p>Immigrants, those living alone, residents of confined institutions, patients treated previously, those with treatment comprehension difficulties, and IDU patients have poor adherence and should be targeted for DOT. To reduce fatality rates, stricter monitoring is required for patients who are retired, HIV-infected, IDU, and those with treatment comprehension difficulties.</p

Estudio del Síndrome de apnea-hipopnea del sueño y la resistencia a la insulina

El nostre objectiu fou analitzar la prevalença de la resistència a la insulina (RI) en una cohort de pacients amb síndrome d'apnea-hipopnea de la son (SAHS) sota la hipòtesi que el SAHS és un factor de risc independent per al desenvolupament de RI. Realitzarem un estudi prospectiu transversal incloent-hi pacients consecutius diagnosticats de SAHS. Estudiarem les diferències entre pacients SAHS amb i sense RI. Incloem 103 pacients (73,8% homes). El 46,7% (n=42) tenien RI, i aquest grup va tenir major IMC i paràmetres més greus d'hipòxia intermitent nocturna. Els factors de risc independents per a la RI van ser l'IMC i l'ODINuestro objetivo fue analizar la prevalencia de la resistencia a la insulina (RI) en una cohorte de pacientes con síndrome de apnea-hipopnea del sueño (SAHS) bajo la hipótesis de que el SAHS es un factor de riesgo independiente para el desarrollo de RI. Realizamos un estudio prospectivo transversal incluyendo pacientes consecutivos diagnosticados de SAHS. Estudiamos las diferencias entre pacientes SAHS con y sin RI. Incluímos 103 pacientes (73,8% hombres). El 46,7% (n=42) tenían RI, y éste grupo tuvo mayor IMC y parámetros de mayor gravedad de hipoxia intermitente nocturna. Los factores de riesgo independientes para la RI fueron el IMC y el ODI

OMWS: A Web Service Interface for Ecological Niche Modelling

[EN] Ecological niche modelling (ENM) experiments often involve a high number of tasks to be performed. Such tasks may consume a significant amount of computing resources and take a long time to complete, especially when using personal computers. OMWS is a Web service interface that allows more powerful computing back-ends to be remotely exploited by other applications to carry out ENM tasks. Its latest version includes a new operation that can be used to specify complex workflows in a single request, adding the possibility of using workflow management systems on parallel computing back-end. In this paper we describe the OMWS protocol and compare its most recent version with the previous one by running the same ENM experiment using two functionally equivalent clients, each designed for one of the OMWS interface versions. Different back-end configurations were used to investigate how the performance scales for each protocol version when more processing power is made available. Results show that the new version outperforms (in a factor of 2) the previous one when more computing resources are used.The latest version of OMWS contains improvements coming from different sets of requirements originated from two projects that funded their corresponding implementation: EUBrazilOpenBio14, with grants from the European Commission and the National Council for Scientific and Technological Development of Brazil (CNPq) of the Brazilian Ministry of Science and Technology (MCT), and BioVeL, with grants from the European Commission. Server infrastructure was operated through a provisioning system developed in the frame of the Spanish project CLUVIEM (TIN2013-44390-R) funded by the "Ministerio de Economía y Competitividad".Giovanni, RD.; Torres Serrano, E.; Amaral, RB.; Blanquer Espert, I.; Rebello, V.; Canhos, VP. (2015). OMWS: A Web Service Interface for Ecological Niche Modelling. Biodiversity Informatics. 10:35-44. https://doi.org/10.17161/bi.v10i0.4853S35441

Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study

Introduction: Healthcare-associated pneumonia (HCAP) is actually considered a subgroup of hospital-acquired pneumonia due to the reported high risk of multidrug-resistant pathogens in the USA. Therefore, current American Thoracic Society/Infectious Diseases Society of America guidelines suggest a nosocomial antibiotic treatment for HCAP. Unfortunately, the scientific evidence supporting this is contradictory. Methods: We conducted a prospective multicentre case-control study in Spain, comparing clinical presentation, outcomes and microbial aetiology of HCAP and community-acquired pneumonia (CAP) patients matched by age (±10 years), gender and period of admission (±10 weeks). Results: 476 patients (238 cases, 238 controls) were recruited for 2 years from June 2008. HCAP cases showed significantly more comorbidities (including dysphagia), higher frequency of previous antibiotic use in the preceding month, higher pneumonia severity score and worse clinical status (Charslon and Barthel scores). While microbial aetiology did not differ between the two groups (HCAP and CAP: Streptococcus pneumoniae: 51% vs 55%; viruses: 22% vs 12%; Legionella: 4% vs 9%; Gram-negative bacilli: 5% vs 4%; Pseudomonas aeruginosa: 4% vs 1%), HCAP patients showed worse mortality rates (1-month: HCAP, 12%; CAP 5%; 1-year: HCAP, 24%; CAP, 9%), length of hospital stay (9 vs 7 days), 1-month treatment failure (5.5% vs 1.5%) and readmission rate (18% vs 11%) (p<0.05, each). Conclusions: Despite a similar clinical presentation, HCAP was more severe due to patients' conditions (comorbidities) and showed worse clinical outcomes. Microbial aetiology of HCAP did not differ from CAP indicating that it is not related to increased mortality and in Spain most HCAP patients do not need nosocomial antibiotic coverage

Social, Clinical and Microbiological Differential Characteristics of Tuberculosis among Immigrants in Spain

BACKGROUND: To identify the differential tuberculosis (TB) characteristics within the immigrant population with respect to natives in Spain. METHODOLOGY/PRINCIPAL FINDINGS: A prospective cohort study design was implemented to examine the TB cases diagnosed and starting standard antituberculous treatment in Spain, between January 1st 2006 and March 31st 2007. A logistic regression analysis was performed to determine differential characteristics. 1,490 patients were included in the study population, 1,048 natives and 442 (29.7%) immigrants. According to the multivariate analysis, the following variables were significantly associated with immigrant TB cases: younger age (OR = 3.79; CI:2.16-6.62), living in group situation (OR = 7.61; CI:3.38-12.12), lower frequency of disabled (OR:0.08; CI:0.02-0.26) and retired (OR:0.21; CI:0.09-0.48) employment status, lower frequency of pulmonary disease presentation (OR = 0.47; CI:0.24-0.92), primary or emergency care admission (OR = 1.80; CI:1.05-3.06 and OR = 2.16; CI:1.36-3.45), drug resistance (OR = 1.86; CI:1.01-3.46), treatment default (OR:2.12; CI:1.18-3.81), lower frequency of alcohol and cigarette consumption (OR = 2.10; CI:1.42-3.11 and OR = 2.85; CI:2.10-3.87 respectively), more directly observed treatment (OR = 1.68; CI:1.04-2.69), and poor understanding of TB disease and its treatment (OR = 3.11; CI:1.86-5.20). The low percentage of primary MDR-TB in the native population (0.1% vs. 2.2% of immigrants) should be noted. CONCLUSIONS/SIGNIFICANCE: The differences show the need to introduce specific strategies in the management of TB within the immigrant population, including the improvement of social and work conditions

Consenso sobre la vacunación frente a la gripe en el personal sanitario

Health care workers (HCW) are included each year among risk groups for vaccination against influenza. However, vaccination coverage among this group in our country is very low, not exceeding 25%. Convinced that one of the best tools to increase this coverage among professionals in our country are the scientific evidence, 19 scientific societies and associations professionals bringing together health professionals more directly related to influenza as an health problem, and the General Nursing Council, met to discuss and develop this consensus document in order to inform HCW about the appropriateness of their vaccination against influenza and the benefits that flow from it for themselves, for their patients and for the rest of the population. This recommendation is based on 3 pillars: argument of necessity, ethics and exemplary

Waveguide efficient directional coupling and decoupling via an integrated plasmonic nanoantenna

International audienceThe development of integrated photonic devices has led to important advancements in the field of light-matter interaction at the nanoscale. One of the main focal points is the coupling between single photon emitters and optical waveguides aiming to achieve efficient optical confinement and propagation. In this work, we focus on the characterization of a hybrid dielectric/plasmonic waveguide consisting of a gold triangular nanoantenna placed on top of a TiO2 waveguide. The strong directionality of the device is experimentally demonstrated by comparing the intensity scattered by the nanotriangle to the one scattered by a SNOM tip for different illumination geometries. The ability of the plasmonic antenna to generate powerful coupling between a single emitter and the waveguide will also be highlighted through numerical simulations

Study of Galfenol direct cytotoxicity and remote microactuation in cells

Remote microactuators are of great interest in biology and medicine as minimally-invasive tools for cellular stimulation. Remote actuation can be achieved by active magnetostrictive transducers which are capable of changing shape in response to external magnetic fields thereby creating controlled displacements. Among the magnetostrictive materials, Galfenol, the multifaceted iron-based smart material, offers high magnetostriction with robust mechanical properties. In order to explore these capabilities for biomedical applications, it is necessary to study the feasibility of material miniaturization in standard fabrication processes as well as evaluate the biocompatibility. Here we develop a technology to fabricate, release, and suspend Galfenol-based microparticles, without affecting the integrity of the material. The morphology, composition and magnetic properties of the material itself are characterized. The direct cytotoxicity of Galfenol is evaluated in vitro using human macrophages, osteoblast and osteosarcoma cells. In addition, cytotoxicity and actuation of Galfenol microparticles in suspension are evaluated using human macrophages. The biological parameters analyzed indicate that Galfenol is not cytotoxic, even after internalization of some of the particles by macrophages. The microparticles were remotely actuated forming intra- and extracellular chains that did not impact the integrity of the cells. The results propose Galfenol as a suitable material to develop remote microactuators for cell biology studies and intracellular applications.This study was supported by the Spanish Government through the project MINAHE 5 (No. TEC2014-51940-C1) and ENVBIOPORAL (No. MAT2014-57960-C3-3-R), the predoctoral FPI grant (No. BES- 2012-052105), the NANONEURO project PIE201350E110 (CSIC) and the Generalitat de Catalunya (2014-SGR-524). A.B. was supported by a predoctoral grant from the Universitat Aut onoma de Barcelona. We wish to thank as well the IMB-CNM Clean Room (Barcelona, Spain), Prof. William P. Robbins of University of Minnesota (Minneapolis, USA) for his support to perform the magnetostrictive measurements and the Institute for Rock Magnetism (Minneapolis, USA) for its facilities.Peer reviewe