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INTRODUCTION: Sexually transmitted diseases such as cervicitis, proctitis and urethritis are associated with high rates of HIV infection. When these pathologies are suspected, HIV serology should be requested. MATERIAL AND METHODS: A retrospective study was performed during 2018 at the Hospital Costa del Sol (Marbella, Málaga, Spain). HIV serologies requested in patients who were asked for PCR for Chlamydia trachomatis and Neisseria gonorrhoeae were reviewed. RESULTS: A total of 1818 patients were evaluated, in which HIV serology was performed in 44.7%, of which 14 (1.7%) were positive. The remaining 55.3% were missed diagnostic opportunities. CONCLUSIONS: C. trachomatis and N. gonorrhoeae infections are associated with a high rate of occult HIV infection. The degree of suspicion of HIV in this population remains low and it is essential that it be reinforced in the presence of the possibility of infection by these pathologies.
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Infecções por Chlamydia , Gonorreia , Infecções por HIV , Infecções Sexualmente Transmissíveis , Feminino , Humanos , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Estudos Retrospectivos , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/complicações , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Chlamydia trachomatisRESUMO
Reverse transcription polymerase chain reaction (RT-PCR) tests are commonly utilized in commercial settings but pose challenges due to labor-intensive procedures and extended response times during peak demand. In contrast, real-time fluorescence and isothermal amplification assays using Crossing Priming Amplification (CPA) offer faster genetic material analysis, eliminate subjectivity, and require less manipulation and personnel training. This study aimed to validate the EasyNAT SARS-CoV-2 Assay, a diagnostic kit based on CPA, using oral and nasopharyngeal samples. The EasyNAT kit was compared to the Xpert Xpress SARS-CoV-2 kit, evaluating 873 samples obtained during routine analysis at the Microbiology Laboratory of the Hospital Costa del Sol (Marbella, Spain). The overall sensitivity and specificity for the EasyNAT SARS-CoV-2 Assay were 79.1% (95%CI 74.5-83.7) and 99.5% (95%CI 98.7-100), respectively; with, validity index of 91.9%, positive predictive value of 98.9%, negative predictive value of 88.9%, positive likelihood ratio of 144.5, negative likelihood ratio of 0.21 and a total Youden Index of 0.79. Notably, sensitivity improved in fresh samples (91.4%), along with a high Youden Index (0.91). The EasyNAT SARS-CoV-2 Assay achieved a higher percentage of concordance in positive samples with Xpert Xpress SARS-CoV-2 when analyzing cycle threshold (Ct) intervals below 30 compared to intervals equal or greater than 30, and demons. In conclusion, the EasyNAT SARS-CoV-2 Assay demonstrated high sensitivity and agreement with Xpert Xpress SARS-CoV-2, particularly in fresh samples or when the signal was detected at Ct intervals below 30, indicating higher viral loads. This makes it suitable for rapid screening in various settings, including those with limited access to conventional molecular laboratory setting.
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COVID-19 , Humanos , COVID-19/diagnóstico , SARS-CoV-2/genética , Teste para COVID-19 , Técnicas de Laboratório Clínico/métodos , Sensibilidade e Especificidade , Reação em Cadeia da PolimeraseRESUMO
BACKGROUND: Nannizziopsis is a genus of fungi with several known cases in reptiles of pyogranulomatous infections at cutaneous and musculoskeletal level, of rapid and fatal evolution. There are few cases of this genus described in humans, mainly skin affection but also with visceral abcesses, typically in immunosuppressed patients, with a recent visit to Africa. CASE PRESENTATION: A 45-year-old woman immunosuppressed after renal transplantation and with a recent visit to Nigeria presented with a painless breast abcess, ulceration to the skin and bleeding, and non hematic telorrhea. The mammogram, also completed with an ultrasound scan, showed a polylobulated nodule, BI-RADS 4C. Due to the suspicion of breast cancer, a core needle biopsy was performed and the pathology study showed abundant presence of fungal spores and hyphae. It was identified by genomic amplification of the internal transcription spacer region-2 and a percentage of similarity with sequences of Nannizziopsis obscura from GenBank of 98% was obtained. An empiric treatment with anidulafungin was initiated, and after the surgical resection, it was replaced by isavuconazole, with a total time of treatment of one month. CONCLUSIONS: This is the first case report of a successful treatment of Nannizziopsis obscura with isavuconazole, with the shortest time of treatment published for this fungi. We highlighted the importance of referring difficult to diagnose species to reference centers, as well as achieving the most complete resection in order to shorten the antibiotic therapy.
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Transplante de Rim , Feminino , Humanos , Pessoa de Meia-Idade , Transplante de Rim/efeitos adversos , Nigéria , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Fungos , Hospedeiro ImunocomprometidoRESUMO
ABSTRACT We describe a case of keratomycosis caused by Arthographis kalrae after excimer laser keratomileusis. A 38-year-old female developed stromal keratitis eight weeks after refractive surgery. She developed severe corneal stromal infiltration and mild anterior segment inflammation, which could not be treated with topical voriconazole 1%, but topical natamycin 5% ameliorated her condition. A reactivation of keratomycosis symptoms was observed; therefore, longer treatment was administered to the patient. It has been reported that A. kalrae keratomycosis is associated with exposure to soil and contact lens usage. However, the patient, who lived in a rural location, was neither involved in gardening activities nor had a history of wearing contact lenses. This is the first case of post-refractive A. kalrae keratomycosis.
RESUMO Descrevemos um caso de ceratomicose por Arthographis kalrae após ceratomileusis por excimer laser. Uma mulher de 38 anos desenvolveu ceratite estromal oito semanas após a cirurgia refrativa. Ela desenvolveu infiltração estromal grave da córnea e uma leve inflamação do segmento anterior, que não pode ser tratada com voriconazol tópico a 1%, mas a natamicina tópica a 5% melhorou sua condição. Uma reativação dos síntomas de ceratomicose foi observada; portanto, tratamento mais prolongado foi administrado a paciente. Tem sido relatado que a ceratomicose por A. kalrae está associada à exposição ao solo e ao uso de lentes de contato. No entanto, a paciente, que vivía em um local rural, não estava envolvida em atividades de jardinagem e nem tinha histórico de uso de lentes de contato. Este é o primeiro caso de ceratomicose pós-refrativa por A. kalrae.
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Humanos , Feminino , Adulto , Infecções Oculares Fúngicas/microbiologia , Ceratite/microbiologia , Ascomicetos/isolamento & purificação , Infecções Oculares Fúngicas/tratamento farmacológico , Natamicina/uso terapêutico , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Voriconazol/uso terapêutico , Ceratite/tratamento farmacológicoRESUMO
We describe a case of keratomycosis caused by Arthographis kalrae after excimer laser keratomileusis. A 38-year-old female developed stromal keratitis eight weeks after refractive surgery. She developed severe corneal stromal infiltration and mild anterior segment inflammation, which could not be treated with topical voriconazole 1%, but topical natamycin 5% ameliorated her condition. A reactivation of keratomycosis symptoms was observed; therefore, longer treatment was administered to the patient. It has been reported that A. kalrae keratomycosis is associated with exposure to soil and contact lens usage. However, the patient, who lived in a rural location, was neither involved in gardening activities nor had a history of wearing contact lenses. This is the first case of post-refractive A. kalrae keratomycosis.
Assuntos
Infecções Oculares Fúngicas/microbiologia , Ceratite/microbiologia , Adulto , Ascomicetos/isolamento & purificação , Infecções Oculares Fúngicas/tratamento farmacológico , Feminino , Humanos , Ceratite/tratamento farmacológico , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Natamicina/uso terapêutico , Voriconazol/uso terapêuticoRESUMO
BACKGROUND: Extra virgin olive oil (EVOO) has shown beneficial effects on the lipid profile and inflammatory parameters in general population. Our goal is to analyze these changes together with those of intestinal microbiota in human immunodeficiency virus (HIV)-infected patients over 50 years of age. METHODS: Experimental single arm open study. HIV patients over the age of 50 with undetectable viral load were selected. EVOO was distributed among the patients so that each one consumed 50âg daily for 12 weeks. Lipid profile, C-reactive protein (CRP), and intestinal microbiota composition were analyzed at the beginning and at the end of the intervention. RESULTS: Total cholesterol decreased significantly (5âmg/dL), and a nonsignificant decrease in low-density lipoprotein cholesterol (12âmg/dL), triglycerides (21âmg/dL), and CRP (1.25âmg/dL) was observed. There was a significant increase in alpha diversity after the intervention in men and a decrease in proinflammatory genera such as Dethiosulfovibrionaceae was observed. Differences were also observed in the microbiota of men and women and according to the type of antiretroviral treatment. CONCLUSION: Sustained consumption of 50âg of EVOO in elderly HIV-infected patients might be associated with an improvement in lipid profile and alfa diversity of intestinal microbiota.
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Microbioma Gastrointestinal/efeitos dos fármacos , Infecções por HIV/sangue , Infecções por HIV/microbiologia , Lipídeos/sangue , Azeite de Oliva/administração & dosagem , Idoso , Antirretrovirais/uso terapêutico , Proteína C-Reativa/análise , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Dieta/métodos , Feminino , HIV , Humanos , Masculino , Pessoa de Meia-Idade , Triglicerídeos/sangueRESUMO
Pin tract infection in external fixation (ExFix) is a frequent finding which can eventually lead to loosening, osteomyelitis and loss of fixation. Its diagnosis is based on high empiricism and low validity, although it is possible to distinguish between minor and major infection. The first is limited to soft tissues, whereas the latter includes bone involvement. The rate of infection after conversion of external fixation to intramedullary nailing (IMN) is not well known. Unfortunately, papers referring to infection after the conversion of ExFix to intramedullary nailing (IMN) are of evidence level IV or V. It is suggested that conversion of ExFix to IMN should be carried out in a 2 step regimen. The time interval of 2 step regimen is uncertain although some authors have recommended to occur within 9 days. There is no consensus as to which prophylaxis protocol should be applied prior to conversion. In order to throw more light into this important issue, registries capturing important related parameters to the development of infection should be established.
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Antibioticoprofilaxia/estatística & dados numéricos , Fixadores Externos/efeitos adversos , Fixação Intramedular de Fraturas , Fraturas Ósseas/cirurgia , Osteomielite/cirurgia , Complicações Pós-Operatórias/microbiologia , Fixadores Externos/microbiologia , Consolidação da Fratura , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/patologia , Humanos , Osteomielite/prevenção & controle , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Reoperação/estatística & dados numéricos , Infecções dos Tecidos Moles/patologia , Infecções dos Tecidos Moles/prevenção & controle , Infecção da Ferida Cirúrgica/patologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
PURPOSE: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. METHODS: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65â¯years,65 to 80â¯years,andâ¯≥â¯80â¯years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. RESULTS: A total of 3120 patients with IE (1327â¯<â¯65â¯years;1291 65-80â¯years;502â¯≥â¯80â¯years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80â¯years who underwent surgery were significantly lower compared with other age groups (14.3%,65â¯years; 20.5%,65-79â¯years; 31.3%,≥80â¯years). In-hospital mortality was lower in the <65-year group (20.3%,<65â¯years;30.1%,65-79â¯years;34.7%,≥80â¯years;pâ¯<â¯0.001) as well as 1-year mortality (3.2%, <65â¯years; 5.5%, 65-80â¯years;7.6%,≥80â¯years; pâ¯=â¯0.003).Independent predictors of mortality were ageâ¯≥â¯80â¯years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCIâ¯≥â¯3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65â¯years(pâ¯<â¯0.001) for both in-hospital and 1-year mortality. CONCLUSION: There were no differences in the clinical presentation of IE between the groups. Ageâ¯≥â¯80â¯years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.
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Fatores Etários , Comorbidade , Endocardite/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Bases de Dados Factuais , Endocardite/etiologia , Feminino , Insuficiência Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Curva ROC , Fatores de Risco , Espanha/epidemiologia , Infecções Estafilocócicas/mortalidadeRESUMO
INTRODUCTION: The incidence of high-grade anal intraepithelial neoplasia (HGAIN) -with an aetiological based on high-risk types of human papillomavirus- is increasing in some high-risk groups. Screening for HGAIN includes routine anal cytology and, more recently, HPV genotyping. The main objective of this study was to determine the sensitivity and specificity of anal cytology and HPV genotyping for the detection of HGAIN. MATERIALS AND METHODS: This is a study to determine the correlation of cytological and microbiological findings with anal biopsy findings in a cohort of patients at high risk of developing AIN referred to the department of sexually transmitted infections of the Hospital Costa del Sol, Spain, between January 2008 and December 2014. RESULTS: Of the 151 patients subjected to screening, a total of 92 patients, all of them with the result of three screening test (anal cytology, genotyping and biopsy) were included in the study. Just under two-thirds (62%) of them were HIV-positive. The sensitivity and specificity of anal cytology to detect HGAIN were 52.8 and 85.7%, respectively (k: 0.328), and 78 and 62.8% to detect two or more HPV oncogenic genotypes (k: 0.417). The detection of oncogenic HPV genotypes allowed the identification of 23 new cases of HGAIN that had been underdiagnosed with anal cytology, with 14 cases containing at least three high-risk genotypes. CONCLUSION: Anal cytology did not show enough sensitivity in HGAIN screening. HPV genotyping has shown to be a useful tool to detect HGAIN cases, although it could lead to an over-diagnosis as a solitary screening procedure.
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Neoplasias do Ânus/diagnóstico , Neoplasias do Ânus/virologia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/virologia , Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , Adulto , Neoplasias do Ânus/patologia , Carcinoma in Situ/patologia , Estudos Transversais , Feminino , Genótipo , Técnicas de Genotipagem , Humanos , Masculino , Sensibilidade e Especificidade , EspanhaRESUMO
BACKGROUND: The eradication of Helicobacter pylori (HP) using clarithromycin (CLA)-based triple therapy depends on the resistance of HP to antibiotics. The Maastricht III conference recommends the implementation of locoregional surveillance programmes for primary resistance of HP to CLA. In Andalusia, there are no previous data in this respect. The aim of this study was to determine the prevalence of the primary resistance of HP to CLA and levofloxacin (LF) in southern Spain. METHODS: Multicentre cross sectional study was carried out in 6 hospitals in Andalusia. Patients of both sexes numbering 401 were included (male 48%), aged 18-80 years and naïve to HP eradication. Resistance of HP to CLA (CLAr) and LF (LFr) was assessed by determining mutations by PCR: mutations of the 23S rRNA gene define CLAr and mutations of the gene gyrA define LFr. Four hundred one gastric samples were collected. CLAr was detected in 72 patients (17.9%) and LFr was detected in 56 patients (13.9%). Heteroresistance was detected for both antibiotics: CLA 37/72 (51.3%) and LF 28/56 (50%). Variability for CLAr was detected among the centres, ranging from 11.5% to 24.7% without statistical significance (p = 0.12). Female sex was related to CLAr. CONCLUSIONS: In Andalusia, there is a high rate of primary CLAr and LFr. CLA-based triple therapy should be avoided as the primary eradication regimen in this region. There is a wide variability in the rate of CLAr among centres.
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Antibacterianos/farmacologia , Claritromicina/farmacologia , Erradicação de Doenças , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Levofloxacino/farmacologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Estudos Transversais , Feminino , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/genética , Humanos , Levofloxacino/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mutação , Reação em Cadeia da Polimerase , Prevalência , RNA Bacteriano/genética , RNA Ribossômico 23S/genética , Espanha/epidemiologia , Adulto JovemRESUMO
INTRODUCTION: The incidence of intraepithelial anal neoplasia is increasing in certain risk behaviour groups, and human papillomavirus (HPV) infection is involved in its pathogenesis. The systematic use of anal cytology, and more recently HPV detection by hybrid capture and genotyping, have been introduced into screening programs in recent decades. MATERIAL AND METHODS: A retrospective cohort study was carried out on individuals with risk behaviours of developing intraepithelial anal neoplasia and who attended Sexually Transmitted Infections clinics in the Dermatology area of the Hospital Costa del Sol from January 2010 to December 2012. The intraepithelial anal neoplasia screening was performed using anal cytology and HPV genotyping. RESULTS: Half (50%) of the study population were HIV positive. A high frequency of anal dysplasia and presence of HPV in cytology (82.1%) and genotype (79%) was found. A statistically significant association (P<.005) was obtained between the presence of high-risk HPV genotypes and the presence of high-grade dysplasia in the second directed cytology. HPV genotyping enabled 17 cases (22%) of severe dysplasia to be identified that were under-diagnosed in the first cytology. CONCLUSION: Cases of high-grade dysplasia can be under-diagnosed by a first anal cytology. Detection of HPV can supplement this procedure, leading to the identification of those patients most at risk of developing high-grade anal dysplasia.
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Neoplasias do Ânus/virologia , Carcinoma in Situ/virologia , Detecção Precoce de Câncer/métodos , Infecções por Papillomavirus/diagnóstico , Infecções Tumorais por Vírus/diagnóstico , Adulto , Neoplasias do Ânus/epidemiologia , Neoplasias do Ânus/patologia , Neoplasias do Ânus/prevenção & controle , Carcinoma in Situ/epidemiologia , Carcinoma in Situ/patologia , Carcinoma de Células Escamosas/prevenção & controle , Feminino , Genótipo , Humanos , Masculino , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Papillomaviridae/patogenicidade , Infecções por Papillomavirus/epidemiologia , Estudos Retrospectivos , Risco , Assunção de Riscos , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Método Simples-Cego , Espanha/epidemiologia , Infecções Tumorais por Vírus/epidemiologiaRESUMO
BACKGROUND AND OBJECTIVE: Occult bacteremia represents 3% of blood cultures drawn in the Emergency Department. In most cases, the evolution is unknown. The aim of the study is to analyze the results obtained after implementation of an intervention program for these patients. PATIENTS AND METHODS: We describe the results of an early intervention program for patients with bacteremia in the Emergency Department discharged at home, which was implemented in daily clinical activity in Costa del Sol Hospital in Marbella (Malaga). We analyze the epidemiological, microbiological, Charlson comorbidity index, Pitt bacteremia index and 30-day mortality. RESULTS: During 15 months, 90 patients were located. The median age was 67 years. There was a predominance of males with 54 of cases (60%). The acquisition place was predominantly the community with 51 cases (56.6%), being the most frequent microorganism Escherichia coli with 31 cases (34.4%). The median Charlson index and the bacteremia Pitt index were 1. Thirty-eight of the cases required hospitalization (42.2%). Pitt bacteremia index>1 and exchange antibiotic treatment were the related variables with need for admission. One patient died (1.2%) and 6 patients could not be located (6.6%). CONCLUSIONS: The implementation of programs of early identification and management of patients with bacteremia in Emergency Department discharged al home allows early recovery of patients who require hospital admission and antibiotic treatment optimization. In our series, mortality after early intervention was low (1.2%).
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Bacteriemia/tratamento farmacológico , Intervenção Médica Precoce , Serviço Hospitalar de Emergência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Candidemia/tratamento farmacológico , Candidemia/mortalidade , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Comorbidade , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Alta do Paciente , Avaliação de Programas e Projetos de Saúde , Índice de Gravidade de Doença , Adulto JovemRESUMO
In this paper, we show, by means of a linear scaling in time and coordinates, that the Chen system, given by x=a(y-x), y=(c-a)x+cy-xz, z=-bz+xy, is, generically (c≠0), a special case of the Lorenz system. First, we infer that it is enough to consider two parameters to study its dynamics. Furthermore, we prove that there exists a homothetic transformation between the Chen and the Lorenz systems and, accordingly, all the dynamical behavior exhibited by the Chen system is present in the Lorenz system (since the former is a special case of the second). We illustrate our results relating Hopf bifurcations, periodic orbits, invariant surfaces, and chaotic attractors of both systems. Since there has been a large literature that has ignored this equivalence, the aim of this paper is to review and clarify this field. Unfortunately, a lot of the previous papers on the Chen system are unnecessary or incorrect.
RESUMO
BACKGROUND: Healthcare-associated (HCA) bloodstream infections (BSI) have been associated with worse outcomes, in terms of higher frequencies of antibiotic-resistant microorganisms and inappropriate therapy than strict community-acquired (CA) BSI. Recent changes in the epidemiology of community (CO)-BSI and treatment protocols may have modified this association. The objective of this study was to analyse the etiology, therapy and outcomes for CA and HCA BSI in our area. METHODS: A prospective multicentre cohort including all CO-BSI episodes in adult patients was performed over a 3-month period in 2006-2007. Outcome variables were mortality and inappropriate empirical therapy. Adjusted analyses were performed by logistic regression. RESULTS: 341 episodes of CO-BSI were included in the study. Acquisition was HCA in 56% (192 episodes) of them. Inappropriate empirical therapy was administered in 16.7% (57 episodes). All-cause mortality was 16.4% (56 patients) at day 14 and 20% (71 patients) at day 30. After controlling for age, Charlson index, source, etiology, presentation with severe sepsis or shock and inappropriate empirical treatment, acquisition type was not associated with an increase in 14-day or 30-day mortality. Only an stratified analysis of 14th-day mortality for Gram negatives BSI showed a statically significant difference (7% in CA vs 17% in HCA, p = 0,05). Factors independently related to inadequate empirical treatment in the community were: catheter source, cancer, and previous antimicrobial use; no association with HCA acquisition was found. CONCLUSION: HCA acquisition in our cohort was not a predictor for either inappropriate empirical treatment or increased mortality. These results might reflect recent changes in therapeutic protocols and epidemiological changes in community pathogens. Further studies should focus on recognising CA BSI due to resistant organisms facilitating an early and adequate treatment in patients with CA resistant BSI.
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Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Adulto , Análise de Variância , Farmacorresistência Bacteriana , Feminino , Humanos , Modelos Logísticos , Masculino , Estudos Prospectivos , Curva ROC , Fatores de Risco , Resultado do TratamentoAssuntos
Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Pneumopatias Parasitárias/diagnóstico , Síndrome do Desconforto Respiratório/etiologia , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Adulto , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Líquido da Lavagem Broncoalveolar/parasitologia , Emergências , Evolução Fatal , Humanos , Larva , Pneumopatias Parasitárias/complicações , Pneumopatias Parasitárias/diagnóstico por imagem , Pneumopatias Parasitárias/tratamento farmacológico , Pneumopatias Parasitárias/parasitologia , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , Radiografia , Strongyloides stercoralis/crescimento & desenvolvimento , Estrongiloidíase/complicações , Estrongiloidíase/diagnóstico por imagem , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/parasitologiaRESUMO
In the referenced paper, the authors use the undetermined coefficient method to prove analytically the existence of homoclinic and heteroclinic orbits in a Lorenz-like system. If the proof was correct, the existence of horseshoe chaos would be guaranteed via the Sil'nikov criterion. However, we hereby show that their demonstration is incorrect for two reasons. On the one hand, they wrongly use a symmetry the Lorenz-like system exhibits. On the other hand, they try to find structurally unstable global bifurcations by means of a series that is uniformly convergent in an open set of the parameter space: this would imply that the dynamical object they have found is structurally stable.
RESUMO
Numerical methods are often used to put in evidence the existence of global connections in differential systems. The principal reason is that the corresponding analytical proofs are usually very complicated. In this work we give an analytical proof of the existence of a pair of homoclinic connections in a continuous piecewise linear system, which can be considered to be a version of the widely studied Michelson system. Although the computations developed in this proof are specific to the system, the techniques can be extended to other piecewise linear systems.