Staphylococcus aureus meningitis in adults: A comparative cohort study of infections caused by meticillin-resistant and meticillin-susceptible strains.

BACKGROUND: Staphylococcus aureus meningitis is an uncommon nosocomial infection usually associated with neurosurgical procedures, but spontaneous infections may occasionally appear. AIMS: To compare the features of meningitis caused by meticillin-resistant (MRSA) and meticillin-susceptible (MSSA) S. aureus and examine the prognostic factors for mortality, including MRSA infection and combined antimicrobial therapy. METHODS: Retrospective cohort study of 350 adults with S. aureus meningitis admitted to 11 hospitals in Spain (1981-2015). Logistic regression and propensity score matching were used to analyse prognostic factors. RESULTS: There were 118 patients (34%) with MRSA and 232 (66%) with MSSA. Postoperative infection (91% vs 73%) and nosocomial acquisition (93% vs 74%) were significantly more frequent in MRSA than in MSSA meningitis (P < 0.001). Combined therapy was given to 118 (34%) patients. Overall 30-day mortality rate was 23%. On multivariate analysis, mortality was associated with severe sepsis or shock (odds ratio (OR) 9.9, 95% confidence interval (CI) 4.5-22.0, P < 0.001), spontaneous meningitis (OR 4.2, 95% CI 1.9-9.1, P < 0.001), McCabe-Jackson score rapidly or ultimately fatal (OR 2.8, 95% CI 1.4-5.4, P = 0.002), MRSA infection (OR 2.6, 95% CI 1.3-5.3, P = 0.006), and coma (OR 2.6, 95% CI 1.1-6.1, P < 0.029). In postoperative cases, mortality was related to retention of cerebrospinal devices (OR 7.9, 95% CI 3.1-20.3, P < 0.001). CONCLUSIONS: Clinical and epidemiological differences between MRSA and MSSA meningitis may be explained by the different pathogenesis of postoperative and spontaneous infection. In addition to the severity of meningitis and underlying diseases, MRSA infection was associated with increased mortality. Combined antimicrobial therapy was not associated with increased survival.

[Effect of pentoxifylline on survival, cardiac function and both portal and systemic hemodynamics in advanced alcoholic cirrhosis--a randomized double-blind placebo-controlled trial]. / Effecto de la pentoxifilina en la supervivencia, la función cardiaca y en la hemodinámica portal y sistémica de la cirrosis alcohólica avanzada.

OBJECTIVE: To assess the effect of pentoxiphylline (a potent inhibitor of tumor necrosis factor alpha) on survival, on systemic and portal hemodynamics, and on cardiac function in patients with alcoholic cirrhosis. DESIGN: A randomized double-blind placebo-controlled trial. SETTING: A single center using parallel groups of patients to compare pentoxiphylline with placebo. PATIENTS: We recruited 24 patients with alcoholic cirrhosis (8 Child-Pugh B and 16 Child-Pugh C). INTERVENTIONS: Patients were randomly assigned to receive pentoxiphylline (400 mg tid; n = 12) or placebo (n = 12) over a 4-week period. OUTCOME MEASURES: The primary outcome was to extend short-term and long-term survival. Secondary outcomes included hemodynamic benefits (improvement in cardiac function and/or systemic vascular resistance index, or decrease in portal pressure). RESULTS: Portal pressure and cardiac function remained unchanged and there were no significant differences in short-term or long-term survival between treatment and placebo groups. The group on pentoxiphylline increased systemic vascular resistance and decreased cardiac indices (from 1,721 +/- 567 to 2,082 +/- 622 dyn.sec(-1) cm(-5) m(-2) and from 4.17 +/- 1.4 to 3.4 +/- 0.9 l.m(-2), p = 0.05). CONCLUSIONS: Although pentoxiphylline seems to provide some short-term hemodynamic benefits in patients with advanced alcoholic cirrhosis, this drug has no effect on survival or portal pressure in these patients.

Comparative study on the customization of natural language interfaces to databases.

In the last decades the popularity of natural language interfaces to databases (NLIDBs) has increased, because in many cases information obtained from them is used for making important business decisions. Unfortunately, the complexity of their customization by database administrators make them difficult to use. In order for a NLIDB to obtain a high percentage of correctly translated queries, it is necessary that it is correctly customized for the database to be queried. In most cases the performance reported in NLIDB literature is the highest possible; i.e., the performance obtained when the interfaces were customized by the implementers. However, for end users it is more important the performance that the interface can yield when the NLIDB is customized by someone different from the implementers. Unfortunately, there exist very few articles that report NLIDB performance when the NLIDBs are not customized by the implementers. This article presents a semantically-enriched data dictionary (which permits solving many of the problems that occur when translating from natural language to SQL) and an experiment in which two groups of undergraduate students customized our NLIDB and English language frontend (ELF), considered one of the best available commercial NLIDBs. The experimental results show that, when customized by the first group, our NLIDB obtained a 44.69 % of correctly answered queries and ELF 11.83 % for the ATIS database, and when customized by the second group, our NLIDB attained 77.05 % and ELF 13.48 %. The performance attained by our NLIDB, when customized by ourselves was 90 %.

Association of spontaneous fetal heart rate decelerations during antepartum nonstress testing and intrauterine growth retardation.

Two hundred one patients with high-risk pregnancy and 66 patients with term uncomplicated pregnancy underwent a nonstress test 7 days or less prior to delivery. The incidence of spontaneous fetal heart rate decelerations in the high-risk group was 5.5%. None of the fetuses in the normal group showed this finding. Among those infants presenting with spontaneous decelerations, there was an 18.2% mortality. Disturbances of intrauterine growth were found in 63.6% of cases. The possible metabolic mechanisms and clinical implications underlying this finding are discussed.

Effect of long-term strength training on glucose metabolism. Implications for individual impact of high lean mass and high fat mass on relationship between BMI and insulin sensitivity.

The aim of this study was to examine the independent effect of high lean mass on glucose metabolism, as well as its consequences on the classic relationship between BMI and insulin sensitivity (SI) in 3 groups: 1) 8 strength-trained males with BMI >27 kg/m2 (athletes); 2) 10 sedentary males with BMI >27 kg/m2 (obese); and 3) 12 sedentary males with BMI 22-25 kg/m2 (control). Body composition was measured with impedance analysis. Iv glucose tolerance test was performed at 09:00 h after overnight fast. Estimation of insulin sensitivity and glucose effectiveness by Minimal Model Approach. Plasma glucose and insulin determination by glucose-oxidase and RIA respectively. BMI and lean mass (LM) were greater in athletes than in controls, but there were no differences in fat mass (FM), basal glucose (Gb), basal insulin (Ib), glucose tolerance (Kg), SI, glucose effectiveness (Sg), acute insulin response to glucose (AIRG) and leptin. Obese showed greater FM, leptin, lb and AIRG than athletes, while SI was lower; BMI, LM, Gb, Kg and Sg were similar. BMI, FM, LM, Ib, AIRG and leptin were lower in controls than in obese, while SI index was greater; Gb, Sg and Kg were similar. We found that: 1) Resistance exercise does not modify glucose effectiveness, but can improve insulin sensitivity through FM reduction (LM augmentation alone has no effect on glucose metabolism); and 2) High BMI causes insulin resistance only if it depends on adipose tissue hypertrophy.

Efecto de la pentoxifilina en la supervivencia, la función cardiaca y en la hemodinámica portal y sistémica de la cirrosis alcohólica avanzada / No disponible

Objetivo: valorar el efecto de la pentoxifilina (un potente inhibidordel factor de necrosis tumoral alfa) en la supervivencia, en lahemodinámica sistémica y portal y en la función cardiaca en la cirrosisalcohólica avanzada.Diseño: estudio aleatorizado, doble-ciego, controlado con placebo.Contexto: estudio unicéntrico utilizando grupos de pacientesen paralelo para comparar pentoxifilina y placebo.Pacientes: se incluyeron 24 pacientes con cirrosis alcohólica(8 en estadio B de Child-Pugh y 16 en estadio C de Child-Pugh).Intervención: los pacientes fueron aleatorizados a recibirpentoxifilina (400 mg, 3 veces al día, n = 12) o placebo (n = 12)durante 4 semanas.Determinaciones: el objetivo principal fue la supervivencia acorto/largo plazo. Los objetivos secundarios fueron observar beneficioshemodinámicos (mejoría en la función cardiaca y/o en elíndice de resistencias vasculares sistémicas o disminución de lapresión portal).Resultados: la presión portal y la función cardiaca no se modificarony no hubo diferencias en la supervivencia a corto y largoplazo entre los grupos tratados y placebo. Los índices de resistenciavascular sistémica y cardiaco cambiaron en el grupo de pentoxifilina(de 1.721 ± 567 a 2.082 ± 622 Din.seg1 cm-5 m-2 y de4,17 ± 1,4 a 3,4 ± 0,9 lm-2, p = 0,05).Conclusiones: aunque la pentoxifilina parece producir algúnbeneficio hemodinámico a corto plazo en pacientes con cirrosis alcohólicaavanzada, no tiene efecto sobre la tasa de supervivencia, lafunción cardiaca ni sobre la presión portal en estos pacientes

Objective: to assess the effect of pentoxiphylline (a potent inhibitorof tumor necrosis factor alpha) on survival, on systemicand portal hemodynamics, and on cardiac function in patientswith alcoholic cirrhosis.Design: a randomized double-blind placebo-controlled trial.Setting: a single center using parallel groups of patients tocompare pentoxiphylline with placebo.Patients: we recruited 24 patients with alcoholic cirrhosis (8Child-Pugh B and 16 Child-Pugh C).Interventions: patients were randomly assigned to receivepentoxiphylline (400 mg tid; n = 12) or placebo (n = 12) over a 4-week period.Outcome measures: the primary outcome was to extendshort-term and long-term survival. Secondary outcomes includedhemodynamic benefits (improvement in cardiac function and/orsystemic vascular resistance index, or decrease in portal pressure).Results: portal pressure and cardiac function remained unchangedand there were no significant differences in short-term orlong-term survival between treatment and placebo groups. Thegroup on pentoxiphylline increased systemic vascular resistanceand decreased cardiac indices (from 1,721 ± 567 to 2,082 ± 622dyn.sec-1 cm-5 m-2 and from 4.17 ± 1.4 to 3.4 ± 0.9 l.m-2, p =0.05).Conclusions: although pentoxiphylline seems to providesome short-term aemodynamic benefits in patients with advancedalcoholic cirrhosis, this drug has no effect on survival or portalpressure in these patients