41 research outputs found
Mediterranean spotted fever in southeastern Romania.
Although cases of Mediterranean spotted fever (MSF) have been reported for decades in southeastern Romania, there are few published data. We retrospectively studied 339 patients, diagnosed with MSF at the National Institute of Infectious Diseases "Prof. Dr. Matei Bals" between 2000 and 2011, in order to raise awareness about MSF in certain regions of Romania. According to the Raoult diagnostic criteria 171 (50.4%) had a score >25 points. Mean age was 52.5 years. One hundred and fifty-five (90.6%) patients were from Bucharest and the surrounding region. Almost all patients presented with fever (99.4%) and rash (98.2%), and 57.9% had evidence of a tick bite. There were no recorded deaths. Serologic diagnosis was made by indirect immunofluorescence assay. Of the 171 patients, serology results for R. conorii were available in 147. One hundred and twenty-three (83.7%) of them had a titer IgG â„1:160 or a fourfold increase in titer in paired samples. MSF is endemic in southeastern Romania and should be considered in patients with fever and rash even in the absence of recognized tick exposure. Since the disease is prevalent in areas highly frequented by tourists, travel-associated MSF should be suspected in patients with characteristic symptoms returning from the endemic area
Clinical Study Mediterranean Spotted Fever in Southeastern Romania
Although cases of Mediterranean spotted fever (MSF) have been reported for decades in southeastern Romania, there are few published data. We retrospectively studied 339 patients, diagnosed with MSF at the National Institute of Infectious Diseases "Prof. Dr. Matei Bals" between 2000 and 2011, in order to raise awareness about MSF in certain regions of Romania. According to the Raoult diagnostic criteria 171 (50.4%) had a score >25 points. Mean age was 52.5 years. One hundred and fifty-five (90.6%) patients were from Bucharest and the surrounding region. Almost all patients presented with fever (99.4%) and rash (98.2%), and 57.9% had evidence of a tick bite. There were no recorded deaths. Serologic diagnosis was made by indirect immunofluorescence assay. Of the 171 patients, serology results for R. conorii were available in 147. One hundred and twenty-three (83.7%) of them had a titer IgG â„1 : 160 or a fourfold increase in titer in paired samples. MSF is endemic in southeastern Romania and should be considered in patients with fever and rash even in the absence of recognized tick exposure. Since the disease is prevalent in areas highly frequented by tourists, travel-associated MSF should be suspected in patients with characteristic symptoms returning from the endemic area
Risk factors for treatment failure and mortality among hospitalized patients with complicated urinary tract infection: A multicenter retrospective cohort study (RESCUING study group)
Background. Complicated urinary tract infections (cUTIs) are responsible for a major share of all antibiotic consumption in hospitals. We aim to describe risk factors for treatment failure and mortality among patients with cUTIs. Methods. A multinational, multicentre retrospective cohort study, conducted in 20 countries in Europe and the Middle East. Data were collected from patients' files on hospitalised patients with a diagnosis of cUTI during 2013-2014. Primary outcome was treatment failure, secondary outcomes included 30 days all-cause mortality,among other outcomes. Multivariable analysis using a logistic model and the hospital as a random variable was performed to identify independent predictors for these outcomes. Results. A total of 981 patients with cUTI were included. Treatment failure was observed in 26.6% (261/981), all cause 30-day mortality rate was 8.7% (85/976), most of these in patients with catheter related UTI (CaUTI). Risk factors for treatment failure in multivariable analysis were ICU admission (OR 5.07, 95% CI 3.18-8.07), septic shock (OR 1.92, 95% CI 0.93-3.98), corticosteroid treatment (OR 1.92, 95% CI 1.12-3.54), bedridden (OR 2.11, 95%CI 1.4-3.18), older age (OR 1.02, 95% CI 1.0071.03-), metastatic cancer (OR 2.89, 95% CI 1.46-5.73) and CaUTI (OR 1.48, 95% CI 1.04-2.11). Management variables, such as inappropriate empirical antibiotic treatment or days to starting antibiotics were not associated with treatment failure or 30-day mortality. More patients with pyelonephritis were given appropriate empirical antibiotic therapy than other CaUTI [110/171; 64.3% vs. 116/270; 43%, p <0.005], nevertheless, this afforded no advantage in treatment failure rates nor mortality in these patients. Conclusions. In patients with cUTI we found no benefit of early appropriate empirical treatment on survival rates or other outcomes. Physicians might consider supportive treatment and watchful waiting in stable patients until the causative pathogen is defined
Rapid clinical score for the diagnosis of tuberculous meningitis: A retrospective cohort study
Objective: The aim of our study was to retrospectively validate a previously described rapid clinical score (RCS) in distinguishing tuberculous meningitis (TBM) from viral meningitis (VM) in people who are at increased risk of tuberculosis, as well as from cryptococcal meningitis (CM) in HIV-infected patients. Methods: We performed a retrospective study of patients admitted with a diagnosis of aseptic meningitis between January 2012 and December 2015, to a referral hospital for infectious diseases. The variables included in RCS were duration of symptoms before admission, neurological stage, cerebrospinal fluid (CSF) to blood glucose ratio, and CSF protein. We included in this retrospective study 31 patients with definite or probable TBM including 14 HIV-infected patients, 62 HIV-noninfected patients with VM, and 18 HIV-infected patients with CM. Results: The sensitivity of RCS to distinguish TBM from VM was 96.7%, with a specificity of 81.1% and the area under the receiver operating characteristic (ROC) curve was 0.949 (0.90â0.99). When all four criteria from the RCS were present, the specificity increased at 100%. In HIV-infected patients, the sensitivity and specificity of RCS in differentiating TBM from CM were 86.6% and 27.7%, respectively, and the area under the ROC curve was 0.669 (0.48â0.85). Conclusion: This easy-to-use RCS was found to be helpful in differentiating TBM from VM, with a better sensitivity than molecular amplification techniques and a relatively good specificity. However, the RCS was not useful to differentiate between TBM and CM in HIV-infected patients
Chromatic transitions in the emergence of syntax networks
The emergence of syntax during childhood is a remarkable example of how complex correlations unfold in nonlinear ways through development. In particular, rapid transitions seem to occur as children reach the age of two, which seems to separate a two-word, tree-like network of syntactic relations among words from the scale-free graphs associated with the adult, complex grammar. Here, we explore the evolution of syntax networks through language acquisition using the chromatic number, which captures the transition and provides a natural link to standard theories on syntactic structures. The data analysis is compared to a null model of network growth dynamics which is shown to display non-trivial and sensible differences. At a more general level, we observe that the chromatic classes define independent regions of the graph, and thus, can be interpreted as the footprints of incompatibility relations, somewhat as opposed to modularity considerations
LâĂ©lectromyostimulation pendant la dialyse a-t-elle sa place dans le rĂ©entraĂźnement Ă lâeffort des dialysĂ©s ?
National audienceIntroduction Les patients dialysĂ©s subissent une dysfonction musculaire progressive. Une part dâentre eux ne peut pas suivre de rĂ©entraĂźnement classique. LâĂ©lectromyostimulation (EMS) qui entraĂźne une contraction musculaire non volontaire par stimulation percutanĂ©e est utilisĂ©e avec succĂšs chez les patients insuffisants cardiaques et respiratoires. LâĂ©tude EMS Dialyse est une Ă©tude randomisĂ©e, contrĂŽlĂ©e Ă©valuant lâefficacitĂ© dâun programme standardisĂ© dâEMS des muscles quadriceps rĂ©alisĂ© au cours des dialyses sur 3 mois. Patients et mĂ©thodes Soixante-six patients, avec un score faible dâactivitĂ© (score de Voorips < 9,4) randomisĂ©s en 33 contrĂŽlĂ©s (C), 33 entraĂźnĂ©s (E) par EMS sur 39 sĂ©ances, 30 min/dialyse, frĂ©quence 35 Hz, intensitĂ© augmentĂ©e en fonction de la tolĂ©rance du patient par un STAPS ou une IDE du centre. Les critĂšres dâĂ©valuation Ă M0, M3 sont la distance lors du test de marche de 6 min (TM6), le volume du quadriceps, le test Time up and go (TUG), la qualitĂ© de vie (SF-36). RĂ©sultats Population : pas de diffĂ©rence entre (E) et (C) pour lâĂąge (70,9 ± 12,8, p = 0,2), le poids (69,2 ± 15,2, p = 0,9), lâIMC (25,5 ± 4,9, p = 0,8), lâalbumine (38,5 ± 3,6, p = 0,8), les comorbiditĂ©s (diabĂšte 24 %, AVC 19 %, Angor 22 %, ArtĂ©riopathie 43 %, Cancer 34 %, DĂ©pression 12 %). RĂ©sultats : seuls 54 % des patients ont rĂ©alisĂ© un nombre de sĂ©ances > 35. TM6 : variation de distance entre M0 et M3 [M0 335, M3 345m (E) ; M0 334, M3 354m (C) ; p = 0,6]. TUG : variation entre M0 et M3 : [â0,1 % (E et C) ; p = 0,3]. Variation du volume musculaire : [+0,02 % (E)/â00,1(C) ; p = 0,03]. Aucune diffĂ©rence pour les scores SF-36. Discussion Aucun bĂ©nĂ©fice nâest notĂ© sur les tests fonctionnels mais seulement une variation faible du volume des quadriceps. Plusieurs facteurs dâĂ©checs peuvent ĂȘtre discutĂ©s comme le mode intermittent des sĂ©ances, la durĂ©e de sĂ©ance et du rĂ©entraĂźnement trop brĂšve et surtout lâadhĂ©rence mĂ©diocre Ă la mĂ©thode due sans doute en partie Ă des sensations douloureuses. Celles-ci font discuter le rĂŽle du soutien motivationnel dans lâacceptation de la mĂ©thode. Conclusion Cette Ă©tude pilote montre quâun rĂ©entraĂźnement de 3 mois basĂ© sur des sĂ©ances dâEMS lors des dialyses nâamĂ©liore pas la dysfonction musculaire des patients dialysĂ©s. Le biais le plus important semble la non adhĂ©rence au traitement pour un pourcentage Ă©levĂ© de patient
Epstein-Barr Virus in the Cerebrospinal Fluid: Pathogen or Innocent Bystander? Observational Cross-Sectional Study
Detection of Mycobacterium tuberculosis resistance mutations to rifampin and isoniazid by real-time PCR
Objective: The objective of our study was to evaluate the use of a
real-time polymerase chain reaction (PCR)-based technique for the
prediction of phenotypic resistance of Mycobacterium tuberculosis .
Materials and Methods: We tested 67 M tuberculosis strains (26 drug
resistant and 41 drug susceptible) using a method recommended for the
LightCycler platform. The susceptibility testing was performed by the
absolute concentration method. For rifampin resistance, two regions of
the rpoB gene were targeted, while for identification of isoniazid
resistance, we searched for mutations in katG and inhA genes. Results:
The sensitivity and specificity of this method for rapid detection of
mutations for isoniazid resistance were 96% (95% CI: 88% to 100%) and
95% (95% CI: 89% to 100%), respectively. For detection of rifampin
resistance, the sensitivity and specificity were 92% (95% CI: 81% to
100%) and 74% (95% CI: 61% to 87%), respectively. The main isoniazid
resistance mechanism identified in our isolates is related to changes
in the katG gene that encodes catalase. We found that for rifampin
resistance the concordance between the predicted and observed phenotype
was less than satisfactory. Conclusions: Using this method, the best
accuracy for genotyping compared with phenotypic resistance testing was
obtained for detecting isoniazid resistance mutations. Although
real-time PCR assay may be a valuable diagnostic tool, it is not yet
completely satisfactory for detection of drug resistance mutations in M
tuberculosis