Evidence Associated with the Use of Oxazolidinones for the Treatment of Skin and Skin Structure Infections: A Retrospective Study

INTRODUCTION: Skin and skin structure infections are an increasing cause of hospitalization. Although mortality is relatively low, skin and skin structure infections are associated with prolonged hospital length of stay and high costs. Oxazolidinones have been suggested as a tool to treat infected patients in the ambulatory setting in order to decrease hospital length of stay. We wanted to address the evidence associated with the use of oxazolidinones in the treatment of skin and skin structure infections. MATERIAL AND METHODS: In this observational retrospective study we analyzed the anonymized diagnosis related group coded information from the Portuguese database for hospital admissions, that included all adult patients with a diagnosis of oxazolidinone use and a SSSI, discharged between 2010 and 2015. RESULTS: During the study period, a total of 5518 patients had a diagnosis of oxazolidinone treatment. We selected 483 of those who were also diagnosed with a skin and skin structure infections. Their mean age was 64.9 years and 62.7% were male. The median hospital length of stay was 27 days (Inter quartile range 13 - 56) and the mortality rate was 12.6%. The prevalence of secondary anemia and of thrombocytopenia in the whole group treated with oxazolidinones was 2.5% and 3%, respectively. DISCUSSION: Despite the high bioavailability of oxazolidinones, we were not able to find evidence that its use was associated with a decrease of mortality or hospital length of stay (due to early discharge) of patients with skin and skin structure infections. CONCLUSION: In this study we were not able to find evidence that oxazolidinones had any clinically significant benefit. A structured approach, including antibiotics with favorable pharmacokinetic and safety profile as well as a carefully planned ambulatory follow up may be needed.info:eu-repo/semantics/publishedVersio

Tympanoplasty:Restrospecüve review of result

O objetivo deste trabalho é determinar os resultados de timpanoplastias realizadas a doentes com otite media crónica. O estudo baseia-se na análise retrospetiva de resultados de 201 timpanoplasüas realizadas em doentes com diagnóstico de oüte media crónica, operados no serviço de Otorrinolarìngologia do Hospital Prof. Doutor Fernando Fonseca EPE, nos anos 2005-2010. Os doentes foram avaliados segundo o sexo, idade, antecedentes pessoais otorrinolaringológicos, tipo de perfuração, técnica cirúrgica, enxerto utilizado, audiograma pre e pós-operatório e follow- up pós-operatório. Verifi cou-se melhoria estrutural e funcional com encerramento de 80% das perfurações e diminuição do gap aero-ósseo (AO) medio de 4 frequências (0.5, 1,,2,4kH2\ de 22dB no pré-operatório para 13dB no pós-operatório, com 80% dos doentes a apresentarem melhoria funcional. Estes resultados confirmam a eficácia da técnica cirúrgica

Pediatric cholesteatoma: 12-year retrospective analysis of Hospital Prof. Doutor Fernando Fonseca´s experience

Objectivo: revisão de casos de colesteatoma em idade pediátrica do HFF durante um período de 12 anos. Desenho do estudo: retrospectivo. Material e métodos: análise de 30 casos de cirurgia para colesteatoma em doentes dos 0 - 18 anos de Janeiro de 2000 a Dezembro de 2011. Resultados: o colesteatoma inicial foi extenso na maioria dos casos. Realizou-se mastoidectomia com técnica aberta (66,7%), mastoidectomia com técnica fechada (26,7%), aticomia transmeática (3,3%) e remoção de colesteatoma da membrana timpânica (3,3%). O GAP pós-operatório médio foi de 22,5 dB, com GAP 0-10dB em 16,7%, GAP 11-20dB em 10%, GAP 21-30 dB em 30%, mais de 30dB em 16,7% e desconhecido em 26,7%. A taxa de recorrência de colesteatoma foi de 23,3% Conclusões: Na nossa amostra o colesteatoma foi extenso e agressivo. Realizámos mastoidectomia com técnica aberta na maioria dos casos. Para obter bons resultados a abordagem deverá ser individualizada, atendendo a factores clínicos, anatómicos e capacidade de adesão à terapêutica.Objective: To review cases of cholesteatoma in pediatric age HFF during a period of 12 years. Study design: Retrospective review. Material and methods: Analysis of 30 cases of children undergoing surgical intervention for cholesteatoma from January 2000 to December 2011.Results: At presentation, cholesteatoma was extensive in most cases. These children were managed with open technique mastoidectomy (66.7%), closed technique mastoidectomy (26.7%), transmeatal atticotomy (3.3%) and cholesteatoma removal from tympanic membrane (3.3%). The mean postoperative air-bone GAP was 22.5 dB. Postoperative air-bone GAP distributed as follows: 16,7% of children had 0-10dB GAP, 10% of chlidren had a 11-20dB GAP, 30% of children had a GAP 21-30 dB in 30%, and 16.7% had a more than 30 dB GAP. The auditory results were unknown in 26.7% of cases. The recurrence rate of cholesteatoma was 23.3% Conclusions: In our study, cholesteatoma was extensive and aggressive. Most children were managed with open technique. For good results the approach should be individualized, taking into account clinical, anatomical and social factors

Co-authorship Network Analysis: A Powerful Tool for Strategic Planning of Research, Development and Capacity Building Programs on Neglected Diseases

The selection and prioritization of research proposals is always a challenge, particularly when addressing neglected tropical diseases, as the scientific communities are relatively small, funding is usually limited and the disparity between the science and technology capacity of different countries and regions is enormous. When the Ministry of Health and the Ministry of Science and Technology of Brazil decided to launch an R&D program on neglected diseases for which at least 30% of the Program's resources were supposed to be invested in institutions and authors from the poorest regions of Brazil, it became clear to us that new strategies and approaches would be required. Social network analysis of co-authorship networks is one of the new approaches we are exploring to develop new tools to help policy-/decision-makers and academia jointly plan, implement, monitor and evaluate investments in this area. Publications retrieved from international databases provide the starting material. After standardization of names and addresses of authors and institutions with text mining tools, networks are assembled and visualized using social network analysis software. This study enabled the development of innovative criteria and parameters, allowing better strategic planning, smooth implementation and strong support and endorsement of the Program by key stakeholders

Selection of Saccharomyces cerevisiae strains for efficient very high gravity bio-ethanol fermentation processes

An optimized very high gravity (VHG) glucose medium supplemented with low cost nutrient sources was used to evaluate bio-ethanol production by 11 Saccharomyces cerevisiae strains. The industrial strains PE-2 and CA1185 exhibited the best overall fermentation performance, producing an ethanol titre of 19.2% (v/v) corresponding to a batch productivity of 2.5 g l-1 h-1, while the best laboratory strain (CEN.PK 113-7D) produced 17.5% (v/v) ethanol with a productivity of 1.7 g l-1 h-1. The results presented here emphasize the biodiversity found within S. cerevisiae species and that naturally adapted strains, such as PE-2 and CA1185, are likely to play a key role in facilitating the transition from laboratory technological breakthroughs to industrialscale bio-ethanol fermentations.Fundação para a Ciência e a Tecnologia (FCT) - PTDC/BIO/66151/2006, SFRH/ BD/64776/2009, SFRH/BPD/44328/ 200

Robustness Through Regime Flips in Collapsing Ecological Networks

© 2019, Crown. There has been considerable progress in our perception of organized complexity in recent years. Recurrent debates on the dynamics and stability of complex systems have provided several insights, but it is very difficult to find identifiable patterns in the relationship between complex network structure and dynamics. Traditionally an arena for theoreticians, much of this research has been invigorated by demonstration of alternate stable states in real world ecosystems such as lakes, coral reefs, forests and grasslands. In this work, we use topological connectivity attributes of eighty six ecological networks and link these with random and targeted perturbations, to obtain general patterns of behaviour of complex real world systems. We have analyzed the response of each ecological network to individual, grouped and cascading extinctions, and the results suggest that most networks are robust to loss of specialists until specific thresholds are reached in terms of network geodesics. If the extinctions persist beyond these thresholds, a state change or ‘flip’ occurs and the structural properties are altered drastically, although the network does not collapse. As opposed to simpler or smaller networks, we find larger networks to contain multiple states that may in turn, ensure long-term persistence, suggesting that complexity can endow resilience to ecosystems. The concept of critical transitions in ecological networks and the implications of these findings for complex systems characterized by networks are likely to be profound with immediate significance for ecosystem conservation, invasion biology and restoration ecology.Non

A prediction rule to stratify mortality risk of patients with pulmonary tuberculosis

Tuberculosis imposes high human and economic tolls, including in Europe. This study was conducted to develop a severity assessment tool for stratifying mortality risk in pulmonary tuberculosis (PTB) patients. A derivation cohort of 681 PTB cases was retrospectively reviewed to generate a model based on multiple logistic regression analysis of prognostic variables with 6-month mortality as the outcome measure. A clinical scoring system was developed and tested against a validation cohort of 103 patients. Five risk features were selected for the prediction model: hypoxemic respiratory failure (OR 4.7, 95% CI 2.8-7.9), age >= 50 years (OR 2.9, 95% CI 1.7-4.8), bilateral lung involvement (OR 2.5, 95% CI 1.44.4), >= 1 significant comorbidity-HIV infection, diabetes mellitus, liver failure or cirrhosis, congestive heart failure and chronic respiratory disease-(OR 2.3, 95% CI 1.3-3.8), and hemoglobin = 6) mortality risk. The mortality associated with each group was 2.9%, 22.9% and 53.9%, respectively. The model performed equally well in the validation cohort. We provide a new, easy-to-use clinical scoring system to identify PTB patients with high-mortality risk in settings with good healthcare access, helping clinicians to decide which patients are in need of closer medical care during treatment.This work was supported by Fundacao Amelia de Mello/Jose de Mello Saude and Sociedade Portuguesa de Pneumologia (SPP). This work was developed under the scope of the project NORTE-01-0145-FEDER-000013, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER). NSO is a FCT (Fundacao para a Ciencia e Tecnologia) investigator. MS is an Associate FCT Investigator. The fundershad no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript