Factores de riesgo asociados a pacientes tuberculosos con microscopía del esputo positiva

ResumenObjetivoEl factor determinante para la producción de casos de tuberculosis por transmisión exógena es la existencia de pacientes con baciloscopias positivas. El objetivo de este estudio fue determinar los factores de riesgo asociados a pacientes con microscopía positiva en secreciones respiratorias.MétodosSe estudiaron los casos incidentes de tuberculosis del período 1992–1998 en la provincia de Lleida. Las variables del estudio fueron: edad, sexo, infección por el VIH, uso de drogas por vía parenteral (UDVP), consumo de alcohol, existencia de cavernas y resultado de la microcopia del esputo. Se calculó la tasa de incidencia por 100.000 personas-año. La asociación de la variable dependiente –caso de tuberculosis con baciloscopia positiva– con el resto de variables independientes se determinó con la odds ratio (ORc, cruda, y ORa, ajustada mediante regresión logística no condicional) con su intervalo de confianza (IC) del 95%.ResultadosSe detectaron 905 casos nuevos de tuberculosis. La tasa de incidencia del período 1992–1998 decreció desde 38,8 a 30,8. El 44,9% de los casos (n = 406) presentó una baciloscopia positiva. El riesgo de ser bacilífero se asoció positivamente con la presencia de cavernas en la radiografía de tórax (ORa = 6,8; IC del 95%, 4,8-9,5), el género masculino (ORa = 1,8; IC del 95%, 1,3-2,6) y el consumo de alcohol (ORa = 1,6; IC del 95%, 1,1–2,3) y fue inferior en los menores de 15 años (ORa = 0,2; IC del 95%, 0,1-0,5) y coinfectados por el VIH (ORa = 0,5; IC del 95%, 0,3-0,9).ConclusionesLa infección por el VIH implica un reducido impacto en la endemia tuberculosa. El estudio de contactos y la implantación de tratamientos directamente observados se deben considerar no sólo para los coinfectados por el VIH y UDVP, sino para adultos varones, con consumo excesivo de alcohol, especialmente si presentan lesiones cavernosas.SummaryObjectiveThe main factor responsible for producing new cases of tuberculosis by exogen transmission is the existence of Mycobacterium tuberculosis in the sputum of tuberculosis patients. The objective of this study was to determine the risk factors associated to positive smear tuberculosis cases in Lleida (Spain).MethodsWe studied new cases of tuberculosis over the period 1992-1998. The variables considered were: age, gender, coinfection with HIV, injection drug use (IDU), consumption of alcohol, existence of caverns in thorax X-ray, and laboratory results of direct smear examination. We calculated the incidence rates for 100,000 persons-year. The association between the dependent variable –case of tuberculosis with positive Mycobacterium tuberculosis smear– and the remaining independent variables were assessed obtaining odds ratios (OR) and 95% confidence intervals (CI) (crude –cOR– and adjusted –aOR– by non conditional logistic regression).ResultsWe detected 905 new cases of tuberculosis. The rates in the period 1992–1998 decreased from 38.8 to 30.8. 44.9% of cases (n = 406) presented a positive direct smear. There was a positive association between the risk of being a positive smear patient and having caverns in thorax x-ray (aOR = 6.8; 95% CI, 4.8-95), being male (aOR = 1.8; 95% CI, 1.3-2.6) and consuming alcohol (aOR = 1.6; 95% CI, 1.1-2.3) and this risk was significant lower in those under 15 years old (aOR = 0.2; 95% CI, 0.1-0.5), and coinfection with HIV (aOR = 0.5; 95% CI, 0.3-0.9).ConclusionsHIV infection implies a reduced impact in endemecity of tuberculosis. Study of contacts and the implementation of directly observed treatment must be considered not only for coinfected HIV cases and IDU but also for adult males, especially those who consume alcohol, particularly when they have caverns

Rotation sets of billiards with one obstacle

We investigate the rotation sets of billiards on the $m$-dimensional torus with one small convex obstacle and in the square with one small convex obstacle. In the first case the displacement function, whose averages we consider, measures the change of the position of a point in the universal covering of the torus (that is, in the Euclidean space), in the second case it measures the rotation around the obstacle. A substantial part of the rotation set has usual strong properties of rotation sets

Rapid field identification of subjects involved in firearm-related crimes based on electroanalysis coupled with advanced chemometric data treatment

We demonstrate a novel system for the detection and discrimination of varying levels of exposure to gunshot residue from subjects in various control scenarios. Our aim is to address the key challenge of minimizing the false positive identification of individuals suspected of discharging a firearm. The chemometric treatment of voltammetric data from different controls using Canonical Variate Analysis (CVA) provides several distinct clusters for each scenario examined. Multiple samples were taken from subjects in controlled tests such as secondary contact with gunshot residue (GSR), loading a firearm, and postdischarge of a firearm. These controls were examined at both bare carbon and gold-modified screen-printed electrodes using different sampling methods: the 'swipe' method with integrated sampling and electroanalysis and a more traditional acid-assisted q-tip swabbing method. The electroanalytical fingerprint of each sample was examined using square-wave voltammetry; the resulting data were preprocessed with Fast Fourier Transform (FFT), followed by CVA treatment. High levels of discrimination were thus achieved in each case over 3 classes of samples (reflecting different levels of involvement), achieving maximum accuracy, sensitivity, and specificity values of 100% employing the leave-one-out validation method. Further validation with the 'jack-knife' technique was performed, and the resulting values were in good agreement with the former method. Additionally, samples from subjects in daily contact with relevant metallic constituents were analyzed to assess possible false positives. This system may serve as a potential method for a portable, field-deployable system aimed at rapidly identifying a subject who has loaded or discharged a firearm to verify involvement in a crime, hence providing law enforcement personnel with an invaluable forensic tool in the field

Maximizing entropy of cycles on trees

In this paper we give a partial characterization of the periodic tree patterns of maximum entropy. More precisely, we prove that each periodic pattern with maximal entropy is irreducible and simplicial. Moreover, it is also maximodal in the sense that for every monotone representative of the pattern every periodic point is a "turning point"

On the Lebesgue measure of Li-Yorke pairs for interval maps

We investigate the prevalence of Li-Yorke pairs for $C^2$ and $C^3$ multimodal maps $f$ with non-flat critical points. We show that every measurable scrambled set has zero Lebesgue measure and that all strongly wandering sets have zero Lebesgue measure, as does the set of pairs of asymptotic (but not asymptotically periodic) points. If $f$ is topologically mixing and has no Cantor attractor, then typical (w.r.t. two-dimensional Lebesgue measure) pairs are Li-Yorke; if additionally $f$ admits an absolutely continuous invariant probability measure (acip), then typical pairs have a dense orbit for $f \times f$. These results make use of so-called nice neighborhoods of the critical set of general multimodal maps, and hence uniformly expanding Markov induced maps, the existence of either is proved in this paper as well. For the setting where $f$ has a Cantor attractor, we present a trichotomy explaining when the set of Li-Yorke pairs and distal pairs have positive two-dimensional Lebesgue measure.Comment: 41 pages, 3 figure

Piecewise Linear Models for the Quasiperiodic Transition to Chaos

We formulate and study analytically and computationally two families of piecewise linear degree one circle maps. These families offer the rare advantage of being non-trivial but essentially solvable models for the phenomenon of mode-locking and the quasi-periodic transition to chaos. For instance, for these families, we obtain complete solutions to several questions still largely unanswered for families of smooth circle maps. Our main results describe (1) the sets of maps in these families having some prescribed rotation interval; (2) the boundaries between zero and positive topological entropy and between zero length and non-zero length rotation interval; and (3) the structure and bifurcations of the attractors in one of these families. We discuss the interpretation of these maps as low-order spline approximations to the classic ``sine-circle'' map and examine more generally the implications of our results for the case of smooth circle maps. We also mention a possible connection to recent experiments on models of a driven Josephson junction.Comment: 75 pages, plain TeX, 47 figures (available on request

Simple deterministic dynamical systems with fractal diffusion coefficients

We analyze a simple model of deterministic diffusion. The model consists of a one-dimensional periodic array of scatterers in which point particles move from cell to cell as defined by a piecewise linear map. The microscopic chaotic scattering process of the map can be changed by a control parameter. This induces a parameter dependence for the macroscopic diffusion coefficient. We calculate the diffusion coefficent and the largest eigenmodes of the system by using Markov partitions and by solving the eigenvalue problems of respective topological transition matrices. For different boundary conditions we find that the largest eigenmodes of the map match to the ones of the simple phenomenological diffusion equation. Our main result is that the difffusion coefficient exhibits a fractal structure by varying the system parameter. To understand the origin of this fractal structure, we give qualitative and quantitative arguments. These arguments relate the sequence of oscillations in the strength of the parameter-dependent diffusion coefficient to the microscopic coupling of the single scatterers which changes by varying the control parameter.Comment: 28 pages (revtex), 12 figures (postscript), submitted to Phys. Rev.

Azithromycin to Prevent Pertussis in Household Contacts, Catalonia and Navarre, Spain, 2012-2013

We retrospectively assessed the effectiveness of azithromycin in preventing transmission of pertussis to a patient's household contacts. We also considered the duration between symptom onset in the primary patient and azithromycin administration. We categorized contacts into 4 groups: those treated within 21 days after illness onset in the primary patient. We studied 476 primary index patients and their 1,975 household contacts, of whom 4.5% were later identified as having pertussis. When contacts started chemoprophylaxis within 14 days after primary patient's symptom onset was less effective. We recommend that contacts of persons with pertussis begin chemoprophylaxis within <14 days after primary patient's symptom onset