Infective endocarditis in intravenous drug abusers: an update

Infective endocarditis despite advances in diagnosis remains a common cause of hospitalization, with high morbidity and mortality rates. Through literature review it is possible to conclude that polymicrobial endocarditis occurs mainly in intravenous drug abusers with predominance in the right side of the heart, often with tricuspid valve involvement. This fact can be associated with the type of drug used by the patients; therefore, knowledge of the patient's history is critical for adjustment of the therapy. It is also important to emphasize that the most common combinations of organisms in polymicrobial infective endocarditis are: Staphylococcus aureus, Streptococcus pneumonia and Pseudomonas aeruginosa, as well as mixed cultures of Candida spp. and bacteria. A better understanding of the epidemiology and associated risk factors are required in order to develop an efficient therapy, although PE studies are difficult to perform due to the rarity of cases and lack of prospective cohorts.This work was supported by Portuguese Foundation for Science and Technology (FCT) through the grants SFRH/BPD/47693/2008, SFRH/BPD/20987/2004 and SFRH/BPD/72632/2010 attributed to Claudia Sousa, Claudia Botelho and Diana Rodrigues, respectively

Regional-scale scenario modeling for coral reefs: a decision support tool to inform management of a complex system

The worldwide decline of coral reefs threatens the livelihoods of coastal communities and puts at risk valuable ecosystem services provided by reefs. There is a pressing need for robust predictions of potential futures of coral reef and associated human systems under alternative management scenarios. Understanding and predicting the dynamics of coral reef systems at regional scales of tens to hundreds of kilometers is imperative, because reef systems are connected by physical and socioeconomic processes across regions and often across international boundaries. We present a spatially explicit regional-scale model of ecological dynamics for a general coral reef system. In designing our model as a tool for decision support, we gave precedence to portability and accessibility; the model can be parameterized for dissimilar coral reef systems in different parts of the world, and the model components and outputs are understandable for nonexperts. The model simulates local-scale dynamics, which are coupled across regions through larval connectivity between reefs. We validate our model using an instantiation for the Meso-American Reef system. The model realistically captures local and regional ecological dynamics and responds to external forcings in the form of harvesting, pollution, and physical damage (e.g., hurricanes, coral bleaching) to produce trajectories that largely fall within limits observed in the real system. Moreover, the model demonstrates behaviors that have relevance for management considerations. In particular, differences in larval supply between reef localities drive spatial variability in modeled reef community structure. Reef tracts for which recruitment is low are more vulnerable to natural disturbance and synergistic effects of anthropogenic stressors. Our approach provides a framework for projecting the likelihood of different reef futures at local to regional scales, with important applications for the management of complex coral reef systems

The influence of Gulf of Mexico Loop Current intrusion on the transport of the Florida Current

Based on an empirical orthogonal function analysis of satellite altimeter data, guidance from numerical model results, and CANEK transport estimates, we propose an index, based on differences in satellite-measured sea surface height anomalies, for measuring the influence of Gulf of Mexico Loop Current intrusion on vertically integrated transport variability through the Yucatan Channel. We show that the new index is significantly correlated at low frequencies (cut-off 120 days) with the cable estimates of transport between Florida and the Bahamas. We argue that the physical basis for the correlation is the geometric connectivity between the Yucatan Channel and the Straits of Florida

A numerical study of the circulation and monthly-to-seasonal variability in the Caribbean Sea: the role of Caribbean eddies

This study examines the circulation and associated monthly-to-seasonal variability in the Caribbean Sea using a regional ocean circulation model. The model domain covers the region between 99.0 and 54.0°W and between 8.0 and 30.3°N, with a horizontal resolution of 1/6°. The ocean circulation model is driven by 6-hourly atmospheric reanalysis data from the National Center for Environmental Prediction and boundary forcing extracted from 5-day global ocean reanalysis data produced by Smith et al. (Mercator Newsletter 36:39–49, 2010), and integrated for 7 years. A comparison of model results with observations demonstrates that the regional ocean circulation model has skill in simulating circulation and associated variability in the study region. Analysis of the model results, as well as a companion model run that uses steady annual mean forcing, illustrates the role of Caribbean eddies for driving monthly-to-seasonal circulation variability in the model. It is found that vertically integrated transport between Nicaragua and Jamaica is influenced by the interaction between the density perturbations associated with Caribbean eddies and the Nicaraguan Ridge. The impact of Caribbean eddies squeezing through the Yucatan Channel is also discussed

Appropriateness of antibiotic treatment in intravenous drug users, a retrospective analysis

Abstract Background Infectious disease is often the reason for intravenous drug users being seen in a clinical setting. The objective of this study was to evaluate the appropriateness of treatment and outcomes for this patient population in a hospital setting. Methods Retrospective study of all intravenous drug users hospitalized for treatment of infectious diseases and seen by infectious diseases specialists 1/2001–12/2006 at a university hospital. Treatment was administered according to guidelines when possible or to alternative treatment program in case of patients for whom adherence to standard protocols was not possible. Outcomes were defined with respect to appropriateness of treatment, hospital readmission, relapse and mortality rates. For statistical analysis adjustment for multiple hospitalizations of individual patients was made by using a generalized estimating equation. Results The total number of hospitalizations for infectious diseases was 344 among 216 intravenous drug users. Skin and soft tissue infections (n = 129, 37.5% of hospitalizations), pneumonia (n = 75, 21.8%) and endocarditis (n = 54, 15.7%) were most prevalent. Multiple infections were present in 25%. Treatment was according to standard guidelines for 78.5%, according to an alternative recommended program for 11.3%, and not according to guidelines or by the infectious diseases specialist advice for 10.2% of hospitalizations. Psychiatric disorders had a significant negative impact on compliance (compliance problems in 19.8% of hospitalizations) in multiple logistic regression analysis (OR = 2.4, CI 1.1–5.1, p = 0.03). The overall readmission rate and relapse rate within 30 days was 13.7% and 3.8%, respectively. Both non-compliant patient behavior (OR = 3.7, CI 1.3–10.8, p = 0.02) and non-adherence to treatment guidelines (OR = 3.3, CI 1.1–9.7, p = 0.03) were associated with a significant increase in the relapse rate in univariate analysis. In 590 person-years of follow-up, 24.6% of the patients died: 6.4% died during hospitalization (1.2% infection-related) and 13.6% of patients died after discharge. Conclusion Appropriate antibiotic therapy according to standard guidelines in hospitalized intravenous drug users is generally practicable and successful. In a minority alternative treatments may be indicated, although associated with a higher risk of relapse.</p