Analysis of the Asymmetry between Both Eyes in Early Diagnosis of Glaucoma Combining Features Extracted from Retinal Images and OCTs into Classification Models.

This study aims to analyze the asymmetry between both eyes of the same patient for the early diagnosis of glaucoma. Two imaging modalities, retinal fundus images and optical coherence tomographies (OCTs), have been considered in order to compare their different capabilities for glaucoma detection. From retinal fundus images, the difference between cup/disc ratio and the width of the optic rim has been extracted. Analogously, the thickness of the retinal nerve fiber layer has been measured in spectral-domain optical coherence tomographies. These measurements have been considered as asymmetry characteristics between eyes in the modeling of decision trees and support vector machines for the classification of healthy and glaucoma patients. The main contribution of this work is indeed the use of different classification models with both imaging modalities to jointly exploit the strengths of each of these modalities for the same diagnostic purpose based on the asymmetry characteristics between the eyes of the patient. The results show that the optimized classification models provide better performance with OCT asymmetry features between both eyes (sensitivity 80.9%, specificity 88.2%, precision 66.7%, accuracy 86.5%) than with those extracted from retinographies, although a linear relationship has been found between certain asymmetry features extracted from both imaging modalities. Therefore, the resulting performance of the models based on asymmetry features proves their ability to differentiate healthy from glaucoma patients using those metrics. Models trained from fundus characteristics are a useful option as a glaucoma screening method in the healthy population, although with lower performance than those trained from the thickness of the peripapillary retinal nerve fiber layer. In both imaging modalities, the asymmetry of morphological characteristics can be used as a glaucoma indicator, as detailed in this work.

Maize dispersal patterns associated with different types of endosperm and migration of indigenous groups in lowland South America.

BACKGROUND AND AIMS: The lowlands of South America appear to be remarkably important in the evolutionary history of maize, due to new evidence that suggests that maize dispersed from Mexico and arrived in this region in a state of partial domestication. This study aimed to identify dispersal patterns of maize genetic diversity in this part of the continent. METHODS: A total of 170 maize accessions were characterized with 4398 single nucleotide polymorphisms (SNPs) and analysed to determine if maize dispersal was associated with types of endosperm and indigenous language families. KEY RESULTS: Four genetic groups were identified in the discriminant analysis of principal components and five groups in the cluster analysis (neighbour-joining method). The groups were structured according to the predominance of endosperm types (popcorn, floury, flint/semi-flint). Spatial principal component analysis of genetic variation suggests different dispersal patterns for each endosperm type and can be associated with hypotheses of expansions of different indigenous groups. CONCLUSIONS: From a possible origin in Southwestern Amazonia, different maize dispersal routes emerged: (1) towards Northern Amazonia, which continued towards the Caatinga and south-eastern Atlantic Forest (Floury); (2) towards Southern Brazil, passing through the Cerrado and Southern Atlantic Forest reaching the Pampa region (Floury); and (3) along the Atlantic Coast, following Tupi movements originating from two separate expansions: one (Tupinamba) from north to south, and the other (Guarani) in the opposite direction, from south to north (flint, floury and popcorn).

Energy Consumption Model of SCHC Packet Fragmentation over Sigfox LPWAN.

The Internet Engineering Task Force (IETF) has standardized a new framework, called Static Context Header Compression and fragmentation (SCHC), which offers adaptation layer functionality designed to support IPv6 over Low Power Wide Area Networks (LPWANs). The IETF is currently profiling SCHC, and in particular its packet fragmentation and reassembly functionality, for its optimal use over certain LPWAN technologies. Considering the energy constraints of LPWAN devices, it is crucial to determine the energy performance of SCHC packet transfer. In this paper, we present a current and energy consumption model of SCHC packet transfer over Sigfox, a flagship LPWAN technology. The model, which is based on real hardware measurements, allows to determine the impact of several parameters and fragment transmission strategies on the energy performance of SCHC packet transfer over Sigfox. Among other results, we have found that the lifetime of a device powered by a 2000 mAh battery, transmitting packets every 5 days, is 168 days for 2250-byte packets, while it increases to 1464 days for 77-byte packets.

Decision Trees for Glaucoma Screening Based on the Asymmetry of the Retinal Nerve Fiber Layer in Optical Coherence Tomography.

Purpose: The aim of this study was to analyze the relevance of asymmetry features between both eyes of the same patient for glaucoma screening using optical coherence tomography. Methods: Spectral-domain optical coherence tomography was used to estimate the thickness of the peripapillary retinal nerve fiber layer in both eyes of the patients in the study. These measurements were collected in a dataset from healthy and glaucoma patients. Several metrics for asymmetry in the retinal nerve fiber layer thickness between the two eyes were then proposed. These metrics were evaluated using the dataset by performing a statistical analysis to assess their significance as relevant features in the diagnosis of glaucoma. Finally, the usefulness of these asymmetry features was demonstrated by designing supervised machine learning models that can be used for the early diagnosis of glaucoma. Results: Machine learning models were designed and optimized, specifically decision trees, based on the values of proposed asymmetry metrics. The use of these models on the dataset provided good classification of the patients (accuracy 88%, sensitivity 70%, specificity 93% and precision 75%). Conclusions: The obtained machine learning models based on retinal nerve fiber layer asymmetry are simple but effective methods which offer a good trade-off in classification of patients and simplicity. The fast binary classification relies on a few asymmetry values of the retinal nerve fiber layer thickness, allowing their use in the daily clinical practice for glaucoma screening.

The SF12 Well in LoRaWAN: Problem and End-Device-Based Solutions.

LoRaWAN has become a popular technology for the Internet of Things (IoT) device connectivity. One of the expected properties of LoRaWAN is high network scalability. However, LoRaWAN network performance may be compromised when even a relatively small number of devices use link-layer reliability. After failed frame delivery, such devices typically tend to reduce their physical layer bit rate by increasing their spreading factor (SF). This reaction increases channel utilization, which may further degrade network performance, even into congestion collapse. When this problem arises, all the devices performing reliable frame transmission end up using SF12 (i.e., the highest SF in LoRaWAN). In this paper, we identify and characterize the described network condition, which we call the SF12 Well, in a range of scenarios and by means of extensive simulations. The results show that by using alternative SF-management techniques it is possible to avoid the problem, while achieving a packet delivery ratio increase of up to a factor of 4.7.

Validity and Reliability of an Instrumented Treadmill with an Accelerometry System for Assessment of Spatio-Temporal Parameters and Impact Transmission.

Running retraining programs focused on concurrent feedback of acceleration impacts have been demonstrated to be a good strategy to reduce running-related injuries (RRI), as well as to improve running economy and reduce acceleration impacts and injury running incidence. Traditionally, impacts have been registered by mean of accelerometers attached directly to the athletes, which is inaccessible to the entire population, because it requires laboratory conditions. This study investigated the validity and reliability of a new device integrated directly into the treadmill, compared to a traditional acceleration impact system. Thirty healthy athletes with no history of RRI were tested on two separate days over the instrumented treadmill (AccTrea) and simultaneously with an acceleration impact system attached to the participant (AccAthl). AccTrea was demonstrated to be a valid and reliable tool for measuring spatio-temporal parameters like step length (validity intraclass correlation coefficient (ICC) = 0.94; reliability ICC = 0.92), step time (validity ICC = 0.95; reliability ICC = 0.96), and step frequency (validity ICC = 0.95; reliability ICC = 0.96) during running. Peak acceleration impact variables showed a high reliability for the left (reliability ICC = 0.88) and right leg (reliability ICC = 0.85), and peak impact asymmetry showed a modest validity (ICC = 0.55). These results indicated that the AccTrea system is a valid and reliable way to assess spatio-temporal variables, and a reliable tool for measuring acceleration impacts during running.

Automatic Segmentation of the Retinal Nerve Fiber Layer by Means of Mathematical Morphology and Deformable Models in 2D Optical Coherence Tomography Imaging.

Glaucoma is a neurodegenerative disease process that leads to progressive damage of the optic nerve to produce visual impairment and blindness. Spectral-domain OCT technology enables peripapillary circular scans of the retina and the measurement of the thickness of the retinal nerve fiber layer (RNFL) for the assessment of the disease status or progression in glaucoma patients. This paper describes a new approach to segment and measure the retinal nerve fiber layer in peripapillary OCT images. The proposed method consists of two stages. In the first one, morphological operators robustly detect the coarse location of the layer boundaries, despite the speckle noise and diverse artifacts in the OCT image. In the second stage, deformable models are initialized with the results of the previous stage to perform a fine segmentation of the boundaries, providing an accurate measurement of the entire RNFL. The results of the RNFL segmentation were qualitatively assessed by ophthalmologists, and the measurements of the thickness of the RNFL were quantitatively compared with those provided by the OCT inbuilt software as well as the state-of-the-art methods.

A Sigfox Energy Consumption Model.

Sigfox has become one of the main Low-Power Wide Area Network (LPWAN) technologies, as it has attracted the attention of the industry, academy and standards development organizations in recent years. Sigfox devices, such as sensors or actuators, are expected to run on limited energy sources; therefore, it is crucial to investigate the energy consumption of Sigfox. However, the literature has only focused on this topic to a very limited extent. This paper presents an analytical model that characterizes device current consumption, device lifetime and energy cost of data delivery with Sigfox. In order to capture a realistic behavior, the model has been derived from measurements carried out on a real Sigfox hardware module. The model allows quantifying the impact of relevant Sigfox parameters and mechanisms, as well as frame losses, on Sigfox device energy performance. Among others, evaluation results show that the considered Sigfox device, powered by a 2400 mAh battery, can achieve a theoretical lifetime of 1.5 or 2.5 years while sending one message every 10 min at 100 bit/s or 600 bit/s, respectively, and an asymptotic lifetime of 14.6 years as the message transmission rate decreases.

Opportunistic Sensor Data Collection with Bluetooth Low Energy.

Bluetooth Low Energy (BLE) has gained very high momentum, as witnessed by its widespread presence in smartphones, wearables and other consumer electronics devices. This fact can be leveraged to carry out opportunistic sensor data collection (OSDC) in scenarios where a sensor node cannot communicate with infrastructure nodes. In such cases, a mobile entity (e.g., a pedestrian or a vehicle) equipped with a BLE-enabled device can collect the data obtained by the sensor node when both are within direct communication range. In this paper, we characterize, both analytically and experimentally, the performance and trade-offs of BLE as a technology for OSDC, for the two main identified approaches, and considering the impact of its most crucial configuration parameters. Results show that a BLE sensor node running on a coin cell battery can achieve a lifetime beyond one year while transferring around 10 Mbit/day, in realistic OSDC scenarios.

Modeling the Energy Performance of LoRaWAN.

LoRaWAN is a flagship Low-Power Wide Area Network (LPWAN) technology that has highly attracted much attention from the community in recent years. Many LoRaWAN end-devices, such as sensors or actuators, are expected not to be powered by the electricity grid; therefore, it is crucial to investigate the energy consumption of LoRaWAN. However, published works have only focused on this topic to a limited extent. In this paper, we present analytical models that allow the characterization of LoRaWAN end-device current consumption, lifetime and energy cost of data delivery. The models, which have been derived based on measurements on a currently prevalent LoRaWAN hardware platform, allow us to quantify the impact of relevant physical and Medium Access Control (MAC) layer LoRaWAN parameters and mechanisms, as well as Bit Error Rate (BER) and collisions, on energy performance. Among others, evaluation results show that an appropriately configured LoRaWAN end-device platform powered by a battery of 2400 mAh can achieve a 1-year lifetime while sending one message every 5 min, and an asymptotic theoretical lifetime of 6 years for infrequent communication.

Archaeological findings show the extent of primitive characteristics of maize in South America.

Scientific research has suggested that maize spread from Mexico and arrived in lowland South America in a state of partial domestication. However, archaeological samples with primitive morphological characteristics that corroborate this finding have not been recorded in the region thus far. Unexpectedly, many samples were identified in the Peruaçu Valley with characteristics never previously observed in South America. These archaeological samples with primitive characteristics, which are the focus of this work, represent the furthest records from the center of origin of the species and the longest duration of the maintenance of such characteristics (between 1010 and 570 years before present). The findings of this study, including archaeological samples, native races, and samples of teosinte, attest to a long history of maize diversification in lowland South America.

Acoustic recognition of predators by mantled howler monkeys (Alouatta palliata): A playback experiment with naïve and experienced subjects.

OBJECTIVES: When the production of antipredator behaviors is costly, prey is expected to stop displaying such behaviors and lose the ability to recognize extirpated predators. However, the loss or maintenance of predator recognition abilities is conditional on the eco-evolutionary context of prey. Here, we examined the behavioral responses of naïve and experienced mantled howler monkeys (Alouatta palliata) to simulated acoustic cues from natural predators. METHODS: We studied experienced individuals in the Uxpanapa Valley and naïve individuals in Los Tuxtlas (Veracruz, México). Jaguars (Panthera onca) and harpy eagles (Harpia harpyja), the main predators of howler monkeys, are extant in the Uxpanapa Valley but have been extirpated in Los Tuxtlas for approximately 70 and 45 years, respectively. We exposed six naïve and six experienced groups to playbacks of acoustic stimuli from the two predators and a non-predator control species (plain chachalacas, Ortalis vetula), and recorded the latency, frequency, and duration of antipredation behaviors (n = 127 trials). RESULTS: In contrast with experienced mantled howler monkeys, naïve subjects did not respond to trials from harpy eagles. However, response patterns were generally similar between naïve and experienced individuals when exposed to jaguar stimuli. DISCUSSION: Our findings suggest that naïve mantled howler monkeys do not recognize harpy eagle calls, but they respond to jaguar calls in a manner consistent with experienced individuals. These results illustrate how different mechanisms for the recognition of extirpated predators operate within a single species according to evolutionary and ecological experience.

Diversity of vegetable landraces in the Pampa biome of Brazil and Uruguay: utilization and conservation strategies.

The historical meeting between originally American people, European colonizers, and slaved peoples from Africa in the biome Pampa in South Brazil and Uruguay involved a cultural syncretism and a great genetic diversity of landraces of cultivated species. Genetic richness evolved by selection and cultural processes in response to different environments, cultural backgrounds, and needs. This review summarized the knowledge on vegetable and maize landraces in South Brazilian and Uruguayan Pampa biome, to design a strategy towards the rediscovery, conservation, and sustainable use. Landraces diversity maintained in situ and ex situ is described, specific case studies are presented, and the main problems and tools towards landraces re-valorization are discussed. We show that traditional family farming systems maintain diverse vegetable species, mainly squashes (Cucurbita spp.), sweet potato (Ipomoea batatas), beans (Phaseolus spp.), onion (Allium cepa), peppers (Capsicum spp.), tomato (Solanum lycopersicum), next to leafy vegetables and maize, among others. We propose the priority of systematic surveys as a basis for monitoring genetic erosion, increasing complementariness between in situ and ex situ conservation, and implementing sustainable conservation and utilization. The case studies highlight genetic diversity within each cultivated species, with different crop physiological responses; disease resistances, different quality traits and associated uses, from animal feeding in maize to a range of culinary uses linked to traditional culture in maize and vegetable species, and ornamental uses of specific Capsicum and Cucurbita. Some landraces were the basis for breeding, where improved cultivars allowed the competitiveness of landrace germplasm in the markets. Renewed industrialized products allowed the competitive and sustainable use of Capsicum landraces in Brazilian farmers communities. Strategies towards in situ conservation improvements and valorization are discussed; emphasizing the role played by agroecology, community seed banks and custodian farmers, participatory plant breeding, promotion of landraces specialties among consumers, and the need of research and capacity building, among others. Farmers' participation in the decisions is a key factor, along with the academia and the public sector. Landraces and associated knowledge are treasures to be used to benefit from farmers to consumers, directing the course of agriculture towards sustainable directions.

A predictive scoring instrument for tuberculosis lost to follow-up outcome.

BACKGROUND: Adherence to tuberculosis (TB) treatment is troublesome, due to long therapy duration, quick therapeutic response which allows the patient to disregard about the rest of their treatment and the lack of motivation on behalf of the patient for improved. The objective of this study was to develop and validate a scoring system to predict the probability of lost to follow-up outcome in TB patients as a way to identify patients suitable for directly observed treatments (DOT) and other interventions to improve adherence. METHODS: Two prospective cohorts, were used to develop and validate a logistic regression model. A scoring system was constructed, based on the coefficients of factors associated with a lost to follow-up outcome. The probability of lost to follow-up outcome associated with each score was calculated. Predictions in both cohorts were tested using receiver operating characteristic curves (ROC). RESULTS: The best model to predict lost to follow-up outcome included the following characteristics: immigration (1 point value), living alone (1 point) or in an institution (2 points), previous anti-TB treatment (2 points), poor patient understanding (2 points), intravenous drugs use (IDU) (4 points) or unknown IDU status (1 point). Scores of 0, 1, 2, 3, 4 and 5 points were associated with a lost to follow-up probability of 2,2% 5,4% 9,9%, 16,4%, 15%, and 28%, respectively. The ROC curve for the validation group demonstrated a good fit (AUC: 0,67 [95% CI; 0,65-0,70]). CONCLUSION: This model has a good capacity to predict a lost to follow-up outcome. Its use could help TB Programs to determine which patients are good candidates for DOT and other strategies to improve TB treatment adherence.

Treadmill and Running Speed Effects on Acceleration Impacts: Curved Non-Motorized Treadmill vs. Conventional Motorized Treadmill.

An increase in the popularity of running can be seen over the last decades, with a large number of injuries on it. Most of the running injuries are related to impact accelerations and are due to overuse. In order to reduce the risk of injury or to improve performance and health new treadmill designs have been created, as it can be the curved non-motorized treadmill. The aim of this study was to analyse impact accelerations, spatio-temporal parameters and perceptual differences while running on curved non-motorized treadmill (cNMT) compared to motorized treadmill (MT) at different speeds. Therefore, 27 recreational runners completed two tests consisting of 10 min warm-up and three bouts of 8 min running at 2.77 m/s, 3.33 m/s and self-selected speed on cNMT and MT, previously randomised. Although the surface did not influence spatio-temporal parameters, a reduction in impact accelerations, head acceleration rate (mean effect size [ES] = 0.86), tibia peak (mean ES = 0.45) and tibia magnitude (mean ES = 0.55), was observed while running on cNMT in comparison with running on MT. Moreover, higher heart rate (HR) (mean ES = 0.51) and rating of perceived effort (RPE) (mean ES = 0.34) were found while running on cNMT. These findings demonstrated that higher intensity training and lower impact accelerations are experimented on cNMT, what can be used by trainers and athletes while planning training sessions.

[Consensus document on the diagnosis, treatment and prevention of tuberculosis]. / Documento de consenso sobre diagnóstico, tratamiento y prevención de la tuberculosis.

Pulmonary TB should be suspected in patients with respiratory symptoms longer than 2-3 weeks. Immunosuppression may modify clinical and radiological presentation. Chest x-ray shows very suggestive, albeit sometimes atypical, signs of TB. Complex radiological tests (CT scan, MR) are more useful in extrapulmonary TB. At least 3 serial representative samples of the clinical location are used for diagnosis whenever possible. Bacilloscopy and liquid medium cultures are indicated in all cases. Genetic amplification techniques are coadjuvant in moderate or high TB suspicion. Administration of isoniazid, rifampicin, ethambutol and pyrazinamide (HREZ) for 2 months and HR for 4 additional months is recommended in new cases of TB, except in cases of meningitis in which treatment should continue for up to 12 months and up to 9 months in spinal TB with neurological involvement, and in silicosis. Appropriate adjustments with antiretroviral treatment should be made in HIV patients. Combined therapy is recommended to avoid development of resistance. An antibiogram to first line drugs should be performed in all the initial isolations of new patients. Treatment control is one of the most important activities in TB management. The Tuberculin Skin Test (TST) is positive in TB infection when >or=5mm, and Interferon-Gamma Release Assays (IGRA) are recommended in combination with TT. The standard treatment schedule for infection is 6 months with isoniazid. In pulmonary TB, respiratory isolation is applied for 3 weeks or until 3 negative bacilloscopy samples are obtained.

Factors associated with differences between conventional contact tracing and molecular epidemiology in study of tuberculosis transmission and analysis in the city of Barcelona, Spain.

The aim of this study was to analyze the factors associated with conventional contact tracing (CCT) and molecular epidemiology (ME) methods in assessing tuberculosis (TB) transmission, comparing the populations studied and the epidemiological links established by both methods. Data were obtained from TB case and CCT registries, and ME was performed using IS6110-based restriction fragment length polymorphism (RFLP) analysis and mycobacterial interspersed repetitive unit 12 (MIRU12) typing as a secondary typing method. During two years (2003 and 2004), 892 cases of TB were reported, of which 687 (77%) were confirmed by culture. RFLP analysis was performed with 463 (67.4%) of the 687 isolated strains, and MIRU12 types in 75 strains were evaluated; 280 strains (60.5%) had a unique RFLP pattern, and 183 (39.5%) shared patterns, grouping into 65 clusters. CCT of 613 (68.7%) of 892 cases detected 44 clusters involving 101 patients. The results of both CCT and ME methods yielded 96 clusters involving 255 patients. The household link was the one most frequently identified by CCT (corresponding to 80.7% of the cases clustered by this method), whereas nonhousehold and unknown links were associated with 94.1% of the strains clustered by ME. When both methods were used in 351 cases (39.3%), they showed the same results in 214 cases (61%). Of the remainder, 106 (30.2%) were clustered only by ME, 19 (5.5%) were clustered only by CCT, and 12 (3.4%) were clustered by both methods but into different clusters. Patients with factors potentially associated with social problems were less frequently studied by CCT (P = 0.002), whereas patients of <15 years of age, most with negative cultures, were less frequently studied by ME (P = 0.005). Significant differences in the populations studied by ME versus CCT were observed, possibly explaining the scarce correlation found between the results of these methods. Moreover, ME allowed the detection of nonhousehold contact relationships, whereas CCT was more useful for tracing transmission chains involving patients of <15 years of age. In conclusion, the two methods are complementary, suggesting the need to improve the methodology of contact study protocols.

Tuberculosis treatment adherence and fatality in Spain.

BACKGROUND: 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. METHODS: 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 vs. the rest of patients) were based on logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI). RESULTS: 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). CONCLUSION: 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.

[Effectiveness and tolerance of antituberculosis treatment regimens without isoniazid and rifampicin: analysis of 85 cases]. / Efectividad y tolerancia de las pautas de tratamiento antituberculoso sin isoniacida y/o rifampicina. Análisis de 85 casos.

OBJECTIVE: To determine if isoniazid- and/or rifampicin-free antituberculosis treatment regimens are safe and effective and to identify any factors that might require changes in the regimens. PATIENTS AND METHODS: We carried out a retrospective study of patients treated with isoniazid- and/or rifampicin-free regimens between 1995 and 2005 at 2 specialized hospitals in Barcelona, Spain. Predictive factors were studied by logistic regression and the odds ratio; 95% confidence intervals were calculated. RESULTS: Eighty-five patients were included in the study: 35% were immigrants and 34% were infected with human immunodeficiency virus. The reason for omitting isoniazid or rifampicin was toxicity (53%), followed by multidrug resistance (39%). Rifampicin-free regimens were most common (42%). A change in the isoniazid- and/or rifampicin-free regimen was required in 30% of cases, but was not associated with being an immigrant. The rate of toxicity with these regimens was higher (36%), although progress was always satisfactory. Clinical course was satisfactory in 77% of patients and they were discharged. CONCLUSIONS: Isoniazid- and/or rifampicin-free regimens with adequate follow-up showed similar treatment outcomes compared with standardized treatment regimens. Although these regimens were more toxic, patient progress was good.

[Anti-factor Xa activity of enoxaparin for thromboprophylaxis in nonsurgical patients is dependent on body mass]. / La actividad anti-Xa depende del peso en pacientes médicos que reciben tromboprofilaxis con enoxaparina.

OBJECTIVE: Thromboprophylaxis with a fixed dose of low-molecular-weight heparin is recommended for hospitalized acutely ill medical patients. The purpose of this study was to assess whether the anti-factor Xa (anti-Xa) activity of enoxaparin prescribed for venous thromboembolism prophylaxis depends on body mass index (BMI) in patients hospitalized for an acute respiratory disease. PATIENTS AND METHODS: All patients admitted to the respiratory medicine department (January-December 2006) for an acute respiratory disease, and for whom pharmacologic thromboprophylaxis was indicated, were included in the study. Anti-Xa activity was measured 4 hours after administration of enoxaparin on the third day of hospitalization. The primary outcome was anti-Xa activity in relation to BMI. RESULTS: One hundred twelve patients were enrolled. Mean anti-Xa activity decreased with each BMI quartile (0.28, 0.23, 0.15, and 0.13 U/mL for quartiles 1, 2, 3, and 4, respectively). In the multivariate analysis, BMI was the only predictor of inadequate anti-Xa activity (odds ratio, 1.14; 95% confidence interval, 10.5-1.24; P< .002) after adjustment for age, sex, and serum creatinine levels. Two episodes of symptomatic proximal deep vein thrombosis were diagnosed in the month after hospitalization; both occurred in patients who had inadequate anti-Xa activity. CONCLUSIONS: Anti-Xa activity is dependent on BMI in hospitalized acute medical patients receiving enoxaparin for thromboprophylaxis.