The characteristics of stress cardiomyopathy in an ethnically heterogeneous population

OBJECTIVES: Stress cardiomyopathy is a cardiac syndrome that is characterized by transient left ventricular systolic dysfunction in the absence of obstructive coronary artery disease. Its epidemiology has been described in homogeneous Asian, Caucasian and Black populations, but its characteristics in heterogeneous populations are poorly understood. Our aim was to assess the characteristics of stress cardiomyopathy in a heterogeneous population that included a large percentage of Hispanics. METHODS: We reviewed 59 consecutive cases of stress cardiomyopathy that were confirmed by coronary angiography and were in agreement with the Mayo Clinic diagnostic criteria. RESULTS: The mean age of the patients was 74 years (range, 39-91 years), and 37 patients were female (62.7%). Twenty-nine patients (49.2%) were Latino/Hispanic, 26 (44%) were Caucasian, 3 (5%) were Asian, and 1 patient (1.7%) was Black. The most common chief symptom was dyspnea, followed by chest pain and an absence of symptoms in 54.2, 28.8, and 18.6% of the patients, respectively. The primary EKG abnormalities consisted of a T wave inversion, an ST segment elevation, and ST segment depression in 69.5%, 25.4%, and 15.3% of the patients, respectively. The stressor event was identified in 90% of the cases. In 32 cases (54%), the stressor event was physical stress or a medical illness, and in 21 cases (35.6%), the stressor event was emotional stress. The in-hospital mortality rate was 8.5%. CONCLUSIONS: In our heterogeneous study population, stress cardiomyopathy presented with a 3:2 female-to-male ratio, and dyspnea was the most common chief complaint. Stress cardiomyopathy exhibited a T wave inversion as the primary EKG abnormality. These findings differ from previous cases that have been reported, and further studies are needed

An experimental study of fog and cloud computing in CEP-based Real-Time IoT applications

Internet of Things (IoT) has posed new requirements to the underlying processing architecture, specially for real-time applications, such as event-detection services. Complex Event Processing (CEP) engines provide a powerful tool to implement these services. Fog computing has raised as a solution to support IoT real-time applications, in contrast to the Cloud-based approach. This work is aimed at analysing a CEP-based Fog architecture for real-time IoT applications that uses a publish-subscribe protocol. A testbed has been developed with low-cost and local resources to verify the suitability of CEP-engines to low-cost computing resources. To assess performance we have analysed the effectiveness and cost of the proposal in terms of latency and resource usage, respectively. Results show that the fog computing architecture reduces event-detection latencies up to 35%, while the available computing resources are being used more efficiently, when compared to a Cloud deployment. Performance evaluation also identifies the communication between the CEP-engine and the final users as the most time consuming component of latency. Moreover, the latency analysis concludes that the time required by CEP-engine is related to the compute resources, but is nonlinear dependent of the number of things connected

iCanCloud: a flexible and scalable cloud infrastructure simulator

Simulation techniques have become a powerful tool for deciding the best starting conditions on pay-as-you-go scenarios. This is the case of public cloud infrastructures, where a given number and type of virtual machines (in short VMs) are instantiated during a specified time, being this reflected in the final budget. With this in mind, this paper introduces and validates iCanCloud, a novel simulator of cloud infrastructures with remarkable features such as flexibility, scalability, performance and usability. Furthermore, the iCanCloud simulator has been built on the following design principles: (1) it's targeted to conduct large experiments, as opposed to others simulators from literature; (2) it provides a flexible and fully customizable global hypervisor for integrating any cloud brokering policy; (3) it reproduces the instance types provided by a given cloud infrastructure; and finally, (4) it contains a user-friendly GUI for configuring and launching simulations, that goes from a single VM to large cloud computing systems composed of thousands of machines.This research was partially supported by the following projects: Spanish MEC project TESIS (TIN2009-14312-C02-01), and Spanish Ministry of Science and Innovation under the grant TIN2010-16497.Publicad

Curving Tuberculosis: Current Trends and Future Needs

Tuberculosis (TB) presents new challenges as a global public health problem, especially at a time of increasing threats to some particular patients due to Human Immunodeficiency Virus (HIV) infection and multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis. The World Health Assembly strives to reduce TB deaths by 95% and to decrease TB incidence by 95% by 2035. However, new approaches are necessary in order to attain these objectives. Such approaches include active ascertainment of cases in high risk populations, increasing the availability of accurate point-of-care testing, rapid detection of drug resistance, novel vaccines, and new prophylaxis and treatment regimens (particularly for MDR and XDR TB). The ultimate objective of those programs is to develop highly effective drug regimens that can achieve high cure rates regardless of strains’ resistance patterns

Atunero congelador al cerco de 1935 m3 de capacidad de cubas

Tipo de buque: Atunero congelador al cerco. Capacidad de cubas de salmuera: 1935 m3. Volumen de combustible: 960 m3 (gasoil en cubas de salmuera incluido). Sociedad de clasificación: ABS con cota A1E + AMS + RMC * Fishing service. Velocidad: 15 nudos a plena carga al 90% MCR en pruebas. Equipo propulsor: Motor Diesel con reductor. Habilitación para 32 tripulante

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

Rapid test for identification of a highly transmissible Mycobacterium tuberculosis beijing strain of sub-Saharan origin

The development of a rapid test to identify Mycobacterium tuberculosis Beijing isolates and specifically strain GC1237, coming from a sub-Saharan country, is needed due to its alarming wide spread on Gran Canaria Island (Spain). A rapid test that detects IS6110 present between dnaA and dnaN in the Beijing strains and in a specific site for GC1237 (Rv2180c) has been developed. This test would be a useful tool in the surveillance of subsequent cases

Classifying new anti-tuberculosis drugs: Rationale and future perspectives

The classification of anti-tuberculosis (TB) drugs is important as it helps the clinician to build an appropriate anti-TB regimen for multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB cases that do not fulfil the criteria for the shorter MDR-TB regimen. The World Health Organization (WHO) has recently approved a revision of the classification of new anti-TB drugs based on current evidence on each drug. In the previous WHO guidelines, the choice of drugs was based on efficacy and toxicity in a step-down manner, from group 1 first-line drugs and groups 2-5 second-line drugs, to group 5 drugs with potentially limited efficacy or limited clinical evidence. In the revised WHO classification, exclusively aimed at managing drug-resistant cases, medicines are again listed in hierarchical order from group A to group D. In parallel, a possible future classification is independently proposed. The aim of this viewpoint article is to describe the evolution in WHO TB classification (taking into account an independently proposed new classification) and recent changes in WHO guidance, while commenting on the differences between them. The latest evidence on the ex-group 5 drugs is also discussed

Factors Associated with Fatality during the Intensive Phase of Anti-Tuberculosis Treatment

Ajuda rebuda: Sociedad Española de Pneumología y Cirugía Torácica (207/2011)Objective: To determine the case-fatality rate (CFR) at the end of the intensive phase of tuberculosis (TB) treatment, and factors associated with fatality. Methods: TB patients diagnosed between 2006 and 2013 were followed-up during treatment. We computed the CFR at the end of the intensive phase of TB treatment, and the incidence of death per 100 person-days (pd) of follow-up. We performed survival analysis using the Kaplan-Meier method and Cox regression, and calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: A total of 5,182 patients were included, of whom 180 (3.5%) died; 87 of these deaths (48.3%) occurred during the intensive phase of treatment, with a CFR of 1.7%. The incidence of death was 0.028/100 pd. The following factors were associated with death during the intensive phase: being >50 years (HR = 36.9;CI:4.8-283.4); being retired (HR = 2.4;CI:1.1-5.1); having visited the emergency department (HR = 3.1;CI:1.2-7.7); HIV infection (HR = 3.4;CI:1.6-7.2); initial standard treatment with 3 drugs (HR = 2.0;CI:1.2-3.3) or non-standard treatments (HR = 2.68;CI:1.36-5.25); comprehension difficulties (HR = 2.8;CI:1.3-6.1); and smear-positive sputum (HR = 2.3-CI:1.0-4.8). Conclusion: There is a non-negligible CFR during the intensive phase of TB, whose reduction should be prioritised. The CFR could be a useful indicator for evaluating TB programs