RESUMO
BACKGROUND: Whole genome sequencing provides better delineation of transmission clusters in Mycobacterium tuberculosis than traditional methods. However, its ability to reveal individual transmission links within clusters is limited. Here, we used a 2-step approach based on Bayesian transmission reconstruction to (1) identify likely index and missing cases, (2) determine risk factors associated with transmitters, and (3) estimate when transmission happened. METHODS AND FINDINGS: We developed our transmission reconstruction method using genomic and epidemiological data from a population-based study from Valencia Region, Spain. Tuberculosis (TB) incidence during the study period was 8.4 cases per 100,000 people. While the study is ongoing, the sampling frame for this work includes notified TB cases between 1 January 2014 and 31 December 2016. We identified a total of 21 transmission clusters that fulfilled the criteria for analysis. These contained a total of 117 individuals diagnosed with active TB (109 with epidemiological data). Demographic characteristics of the study population were as follows: 80/109 (73%) individuals were Spanish-born, 76/109 (70%) individuals were men, and the mean age was 42.51 years (SD 18.46). We found that 66/109 (61%) TB patients were sputum positive at diagnosis, and 10/109 (9%) were HIV positive. We used the data to reveal individual transmission links, and to identify index cases, missing cases, likely transmitters, and associated transmission risk factors. Our Bayesian inference approach suggests that at least 60% of index cases are likely misidentified by local public health. Our data also suggest that factors associated with likely transmitters are different to those of simply being in a transmission cluster, highlighting the importance of differentiating between these 2 phenomena. Our data suggest that type 2 diabetes mellitus is a risk factor associated with being a transmitter (odds ratio 0.19 [95% CI 0.02-1.10], p < 0.003). Finally, we used the most likely timing for transmission events to study when TB transmission occurred; we identified that 5/14 (35.7%) cases likely transmitted TB well before symptom onset, and these were largely sputum negative at diagnosis. Limited within-cluster diversity does not allow us to extrapolate our findings to the whole TB population in Valencia Region. CONCLUSIONS: In this study, we found that index cases are often misidentified, with downstream consequences for epidemiological investigations because likely transmitters can be missed. Our findings regarding inferred transmission timing suggest that TB transmission can occur before patient symptom onset, suggesting also that TB transmits during sub-clinical disease. This result has direct implications for diagnosing TB and reducing transmission. Overall, we show that a transition to individual-based genomic epidemiology will likely close some of the knowledge gaps in TB transmission and may redirect efforts towards cost-effective contact investigations for improved TB control.
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Busca de Comunicante/métodos , Genoma Bacteriano , Mycobacterium tuberculosis/genética , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/transmissão , Sequenciamento Completo do Genoma , Adolescente , Adulto , Idoso , Teorema de Bayes , Biomarcadores , Feminino , Genômica , Soropositividade para HIV/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Filogenia , Polimorfismo de Nucleotídeo Único , Fatores de Risco , Espanha/epidemiologia , Resultado do Tratamento , Tuberculose Pulmonar/epidemiologia , Adulto JovemRESUMO
Previous studies suggested that herpes simplex virus (HSV) PCR testing can be safely deferred in patients with normal cerebrospinal fluid (CSF) white blood cell (WBC) counts and protein levels as long as they are older than 2 years of age and are not immunocompromised, the so-called Reller criteria. In this multicenter study, we retrospectively assessed the validity of these screening criteria in our setting. A total of 4,404 CSF specimens submitted for HSV PCR testing to the respective microbiology laboratories at the participating hospitals between 2012 and 2018 were included. Six commercially available HSV PCR assays were used across the participating centers. Ninety-one of the 4,404 CSF specimens (2.1%) tested were positive for HSV DNA (75 samples for HSV-1 and 16 for HSV-2). Nine patients failed to meet the Reller criteria, of whom seven were deemed to truly have HSV encephalitis. Overall, no significant correlation between HSV PCR cycle threshold (CT ) values and WBC counts or total protein levels was found. In addition, median HSV PCR CT s were comparable between patients who met the Reller criteria and those who did not (P = 0.531). In summary, we show that HSV DNA may be detected in CSF specimens with normal WBC and protein levels collected from immunocompetent individuals older than 2 years with HSV encephalitis. Nevertheless, the data also indicate that the number of cases detected could be lowered at least by half if CSF specimens with borderline WBC counts (4 cells/mm3) as well as children of any age are systematically tested.
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Líquido Cefalorraquidiano/virologia , Erros de Diagnóstico/estatística & dados numéricos , Testes Diagnósticos de Rotina/métodos , Encefalite por Herpes Simples/diagnóstico , Reação em Cadeia da Polimerase/métodos , Simplexvirus/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Líquido Cefalorraquidiano/química , Líquido Cefalorraquidiano/citologia , Criança , Pré-Escolar , DNA Viral/genética , DNA Viral/isolamento & purificação , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Simplexvirus/genética , Adulto JovemRESUMO
A questionnaire-based cross-sectional study was conducted to gather information on current microbiological practices for active surveillance of carriage of multidrug-resistant (MDR) bacteria in hospitals from 14 health departments of the Autonomous Community of Valencia (ACV), Spain, which together provided medical attention to 3,271,077 inhabitants in 2017, approximately 70% of the population of the ACV. The survey consisted of 35 questions on MDR bacteria screening policies, surveillance approach chosen (universal vs. targeted), and microbiological methods and processes in use for routine detection and reporting of colonization by MDR bacteria, including the anatomical sites scheduled to be sampled for each MDR bacterial species, and the methodology employed (culture-based, molecular-based, or both). Our study revealed striking differences across centers, likely attributable to the lack of consensus on optimal protocols for sampling, body sites for screening, and microbiological testing, thus underscoring the need for consensus guidelines on these issues.
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Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Infecção Hospitalar , Farmacorresistência Bacteriana Múltipla , Hospitais Comunitários , Infecções Bacterianas/transmissão , Estudos Transversais , Geografia , Humanos , Vigilância em Saúde Pública , Espanha/epidemiologia , Inquéritos e QuestionáriosRESUMO
We demonstrate a monolithically integrated dual-output DFB-SOA, and conduct the field trial on a multi-user bidirectional coherent ultradense wavelength division multiplexing-passive optical network (UDWDM-PON). To the best of our knowledge, this is the first achievement of simplified single integrated laser-based neighboring coherent optical network units (ONUs) with a 12.5 GHz channel spaced ultra-dense access network, including both downstream and upstream, taking the benefits of low footprint and low-temperature dependence.
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Hemocultura , Laboratórios Hospitalares/estatística & dados numéricos , Técnicas Microbiológicas/estatística & dados numéricos , Fluxo de Trabalho , Estudos Transversais , Testes Diagnósticos de Rotina/estatística & dados numéricos , Humanos , Espanha , Inquéritos e Questionários , Fatores de TempoRESUMO
STATEMENT OF PROBLEM: New technologies have led to the introduction of new materials, so an evaluation of the adhesion of ceramics to these materials is needed. PURPOSE: The purpose of this study was to compare the shear bond strength of dental porcelain to cast, milled, and laser-sintered cobalt-chromium alloys, and to investigate the adhesive bond and failure type after thermocycling, 90 metal cylinders (10 mm diameter and 10 mm height) were prepared from cast (30 specimens), milled (30 specimens), and laser-sintered (30 specimens) alloys. MATERIAL AND METHODS: Ceramic cylinders (2.5 mm diameter and 4 mm length) were fused to the alloy cylinders. For each group, 15 specimens were thermocycled 5500 times at temperatures between 4°C and 60°C before testing. After testing, the specimen surfaces were visually examined to determine the failure mode. Differences in adhesion values according to manufacturing method, testing condition (thermocycling or no thermocycling), and interaction between the factors were evaluated with a 2-way ANOVA. The χ(2) test (95% confidence level) was performed to determine whether the failure mode was associated with the testing condition. RESULTS: Adhesion strengths for the nonthermocycled specimens were 42.79 ±14.14 MPa (cast), 37.56 ±9.18 MPa (milled), and 29.09 ±6.95 MPa (laser-sintered), and, for the thermocycled specimens, 16.52 ±8.96 MPa (cast), 22.21 ±13.25 MPa (milled), and 24.28 ±10.13 MPa (laser-sintered). Two-way ANOVA results indicated no statistically significant differences in adhesion among the manufacturing methods (P=.257), but statistically significant differences were observed according to both testing conditions (P<.001) and interaction between the factors (P=.015). The χ(2) test indicated that the failure mode was not associated with the testing condition (thermocycled, P=.280; nonthermocycled, P=.240). CONCLUSIONS: The porcelain adhesion values for all the materials were adequate for clinical applications. No significant adhesion differences were observed between cast, milled, and laser-sintered specimens, or among thermocycled and nonthermocycled laser-sintered specimens. However, significant adhesion differences were observed among the thermocycled and nonthermocycled cast and the milled specimens.
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Ligas de Cromo/química , Colagem Dentária , Porcelana Dentária/química , Silicatos de Alumínio/química , Desenho Assistido por Computador , Técnica de Fundição Odontológica , Análise do Estresse Dentário/instrumentação , Temperatura Alta , Humanos , Lasers , Teste de Materiais , Ligas Metalo-Cerâmicas/química , Compostos de Potássio/química , Resistência ao Cisalhamento , Estresse Mecânico , Propriedades de Superfície , TemperaturaRESUMO
BACKGROUND: In June, 2021, WHO published the most complete catalogue to date of resistance-conferring mutations in Mycobacterium tuberculosis. Here, we aimed to assess the performance of genome-based antimicrobial resistance prediction using the catalogue and its potential for improving diagnostics in a real low-burden setting. METHODS: In this retrospective population-based genomic study M tuberculosis isolates were collected from 25 clinical laboratories in the low-burden setting of the Valencia Region, Spain. Culture-positive tuberculosis cases reported by regional public health authorities between Jan 1, 2014, and Dec 31, 2016, were included. The drug resistance profiles of these isolates were predicted by the genomic identification, via whole-genome sequencing (WGS), of the high-confidence resistance-causing variants included in the catalogue and compared with the phenotype. We determined the minimum inhibitory concentration (MIC) of the isolates with discordant resistance profiles using the resazurin microtitre assay. FINDINGS: WGS was performed on 785 M tuberculosis complex culture-positive isolates, and the WGS resistance prediction sensitivities were: 85·4% (95% CI 70·8-94·4) for isoniazid, 73·3% (44·9-92·2) for rifampicin, 50·0% (21·1-78·9) for ethambutol, and 57·1% (34·0-78·2) for pyrazinamide; all specificities were more than 99·6%. Sensitivity values were lower than previously reported, but the overall pan-susceptibility accuracy was 96·4%. Genotypic analysis revealed that four phenotypically susceptible isolates carried mutations (rpoB Leu430Pro and rpoB Ile491Phe for rifampicin and fabG1 Leu203Leu for isoniazid) known to give borderline resistance in standard phenotypic tests. Additionally, we identified three putative resistance-associated mutations (inhA Ser94Ala, katG Leu48Pro, and katG Gly273Arg for isoniazid) in samples with substantially higher MICs than those of susceptible isolates. Combining both genomic and phenotypic data, in accordance with the WHO diagnostic guidelines, we could detect two new multidrug-resistant cases. Additionally, we detected 11 (1·6%) of 706 isolates to be monoresistant to fluoroquinolone, which had been previously undetected. INTERPRETATION: We showed that the WHO catalogue enables the detection of resistant cases missed in phenotypic testing in a low-burden region, thus allowing for better patient-tailored treatment. We also identified mutations not included in the catalogue, relevant at the local level. Evidence from this study, together with future updates of the catalogue, will probably lead in the future to the partial replacement of culture testing with WGS-based drug susceptibility testing in our setting. FUNDING: European Research Council and the Spanish Ministerio de Ciencia.
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Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Humanos , Mycobacterium tuberculosis/genética , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Isoniazida/uso terapêutico , Rifampina/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Espanha/epidemiologia , Farmacorresistência Bacteriana Múltipla/genética , Mutação/genética , Genômica , Organização Mundial da SaúdeRESUMO
A homodyne coherent receiver for ultra-dense WDM-PON with off the shelf components is presented. It consists of a conventional DFB, phase switched clock signal, an optical coupler instead of a 90° hybrid, balanced photodetectors and digital signal processing. The phase swing for a DBPSK signal was optimized and the performance was experimentally evaluated in terms of the sensitivity for several laser linewidths. The acceptable frequency offset and clock time delay was also assessed. The results exhibit a sensitivity of -48 dBm at a BER of 10(-3) and indicate a high tolerance to phase noise.
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Dispositivos Ópticos , Fotometria/instrumentação , Processamento de Sinais Assistido por Computador/instrumentação , Telecomunicações/instrumentação , Desenho de Equipamento , Análise de Falha de EquipamentoRESUMO
BACKGROUND: Quantification and description of patients recently infected by HIV can provide an accurate estimate of the dynamics of HIV transmission. Between 2006 and 2008 in Catalonia, we estimated the prevalence of recent HIV infection among newly diagnosed cases, described the epidemiological characteristics of the infection according to whether it was recent, long-standing or advanced, and identified factors associated with recent infection. METHODS: A Test for Recent Infection (TRI) was performed in serum samples from patients newly diagnosed with HIV. Two different TRI were used: the Vironostika-LS assay (January 2006-May 2007) and the BED-CEIA CEIA (June 2007 onwards). Samples were obtained within the first 6 months of diagnosis. Patients whose samples tested positive in the TRI were considered recently infected. RESULTS: Of 1125 newly diagnosed patients, 79.9% were men (median age, 35.4 years), 38.7% were born outside Spain, 48.9% were men who have sex with men (MSM) and 10.6% presented other sexually transmitted infections. The overall percentage of recent infection was 23.0%, which increased significantly, from 18.1% in 2006 to 26.2% in 2008. This percentage was higher for patients from South America (27.6%). Factors associated with recent infection were acquiring infection through sexual contact between MSM [odds ratio (OR) 2.0; 95% confidence interval (95% CI) 1.1-3.9], compared with acquiring infection through heterosexual relations and being under 30 years of age (OR 5.9; 95% CI 1.9-17.4), compared with being over 50 years of age. CONCLUSION: The highest percentage of recent infection was identified in MSM, suggesting either a higher incidence or a greater frequency of HIV testing. Information regarding testing patterns is necessary to correctly interpret data from recently infected individuals. Systems to monitor the HIV epidemic should include both parameters.
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Infecções por HIV/diagnóstico , HIV-1/isolamento & purificação , Adulto , Distribuição por Idade , Algoritmos , Contagem de Linfócito CD4 , Emigrantes e Imigrantes/estatística & dados numéricos , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Infecções por HIV/virologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Distribuição por Sexo , Comportamento Sexual , Espanha/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Fatores de Tempo , Carga Viral , Adulto JovemRESUMO
Transmission is a driver of tuberculosis (TB) epidemics in high-burden regions, with assumed negligible impact in low-burden areas. However, we still lack a full characterization of transmission dynamics in settings with similar and different burdens. Genomic epidemiology can greatly help to quantify transmission, but the lack of whole genome sequencing population-based studies has hampered its application. Here, we generate a population-based dataset from Valencia region and compare it with available datasets from different TB-burden settings to reveal transmission dynamics heterogeneity and its public health implications. We sequenced the whole genome of 785 Mycobacterium tuberculosis strains and linked genomes to patient epidemiological data. We use a pairwise distance clustering approach and phylodynamic methods to characterize transmission events over the last 150 years, in different TB-burden regions. Our results underscore significant differences in transmission between low-burden TB settings, i.e., clustering in Valencia region is higher (47.4%) than in Oxfordshire (27%), and similar to a high-burden area as Malawi (49.8%). By modeling times of the transmission links, we observed that settings with high transmission rate are associated with decades of uninterrupted transmission, irrespective of burden. Together, our results reveal that burden and transmission are not necessarily linked due to the role of past epidemics in the ongoing TB incidence, and highlight the need for in-depth characterization of transmission dynamics and specifically tailored TB control strategies.
Assuntos
Epidemias , Mycobacterium tuberculosis , Tuberculose , Humanos , Mycobacterium tuberculosis/genética , Dinâmica Populacional , Tuberculose/epidemiologia , Sequenciamento Completo do GenomaRESUMO
OBJECTIVES: The objectives of this study were to assess the prevalence of transmitted HIV-1 drug resistances (TDR) and HIV-1 subtypes in recently infected patients in Catalonia between 2003 and 2005 and to describe the characteristics of these patients according to the presence or absence of TDR and HIV-1 subtype. METHODS: After application of the Serological Testing Algorithm for Recent HIV Seroconversion (STARHS), residual aliquots of serum samples from recently infected antiretroviral-naïve individuals were genotyped. FASTA sequences were analyzed using the HIVDB Program. The World Health Organization 2009 List of Mutations for Surveillance of Transmitted HIV-1 Drug Resistant HIV Strains was used to estimate the prevalence of TDR. RESULTS: Of 182 recently infected patients, 14 (7.7%) presented TDR. Seven (3.8%) had genotypic evidence of TDR against non-nucleoside reverse transcriptase inhibitors, 6 (3.3%) against nucleoside reverse transcriptase inhibitors, 3 (1.6%) against protease inhibitors (PIs), and only 2 individuals (1.1%) presented TDR against more than one class of drugs. Thirty-five (19.2%) patients were infected with a non-B HIV-1 subtype. CONCLUSION: This is the first study to estimate the prevalence of TDR in recently infected patients in Catalonia. The results are similar to those of studies performed in other Spanish regions. Correct monitoring of these parameters requires systematic epidemiologic surveillance of transmitted resistance.
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Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral , Infecções por HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , Adulto , Fármacos Anti-HIV/farmacologia , Farmacorresistência Viral Múltipla/genética , Farmacorresistência Viral/genética , Emigrantes e Imigrantes , Feminino , Genes pol , Genes rev , Genótipo , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Infecções por HIV/virologia , Protease de HIV/genética , Transcriptase Reversa do HIV/genética , HIV-1/genética , HIV-1/isolamento & purificação , Humanos , Masculino , Mutação , Vigilância da População , RNA Viral/genética , Estudos Retrospectivos , Análise de Sequência de RNA , Espanha/epidemiologia , Manejo de EspécimesRESUMO
INTRODUCTION: The sensitivities of conventional mycobacterial culture in solid or liquid media and acid-fast bacilli (AFB) smear microscopy for Mycobacterium tuberculosis complex (MTBC) detection in extrapulmonary specimens are suboptimal. We evaluated the field performance of the Abbott RealTime MTB assay for the diagnosis of extrapulmonary tuberculosis in a low-prevalence setting. METHODS: The total number of extrapulmonary specimens with mycobacterial culture and PCR results was 566: sterile fluids (n=278), non-sterile fluids (n=147), lymph node material (n=69) tissue biopsies (n=63), and abscess aspirates (n=9). A composite standard consisting of mycobacterial culture results, clinical treatment response to anti-TB drugs, when administered, and histopathology, radiological and laboratory findings were used as a reference for sensitivity and specificity calculations. RESULTS: Mycobacterial cultures and PCR were positive in 17 and 28 specimens, respectively. The overall agreement between culture and PCR was moderate (Cohen's kappa coefficient: 0.549; P=0.0001). Taking as a reference our composite standard, the sensitivity of the Abbott PCR assay was 77.7%, the specificity 99.5%, the PPV 95.4%, and the NPV 98.8%. In turn, the sensitivity of the mycobacterial culture was 62.9%, the specificity and PPV 100%, and the NPV 97.9%. CONCLUSION: The good field performance of the Abbott RealTime MTB assay makes it valuable for the diagnosis of extrapulmonary tuberculosis in a low-prevalence setting. The use of molecular methods along with culture improves the diagnosis of extrapulmonary tuberculosis.
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Técnicas Bacteriológicas/métodos , Mycobacterium tuberculosis , Tuberculose , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e Especificidade , Tuberculose/diagnósticoRESUMO
BACKGROUND AND OBJECTIVE: Stroke is a very important cause of mortality and disability. This study has the objective of identifying predictor factors and the clinical consequences of nosocomial infection in acute stroke. PATIENTS AND METHOD: We prospectively identified a consecutive cohort of patients who were admitted after an acute stroke. We used predefined diagnostic criteria by the World Health Organization and Sociedad Española de Neurología for stroke, and by Centers for Disease Control and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica for infection. RESULTS: 258 patients with acute stroke were included. 102 (39.5%) had at least one nosocomial infection -45.5% women; age (standard deviation) 78.2 (9.7) years-. The mean hospital stay was 14.9 days (8.4) in infection patients and 8.4 days (5.6) in no infection patients (p < 0.001). 31 patients died and 22 (71%) had at least one cause of infection. Using logistic regression analysis, the dysphagia (odds ratio [OR] = 12.7; 95% confidence interval [CI], 5.3-30.1; p < 0.001) is the strongest and independent predictor of nosocomial infection. Others factors are crural motor affectation (OR = 4.5; 95% CI, 1.7-12.3; p = 0.003), urinary incontinence (OR = 2.9; 95% CI, 1.3-6.4; p = 0.009) and diabetes mellitus (OR = 2.3; 95% CI, 1.1-4.7; p = 0.03). Baseline imbalance National Institutes of Health Stroke Scale (NIHSS) > 20 during the admission (OR = 17.3; 95% CI, 5.1-59.5; p < 0.001), mass effect diagnosticated on computerized axial tomography (OR = 4.4; 95% CI, 1.4-14; p = 0.012), poor neurological outcome during the first day (OR = 11.6; 95% CI, 3.6-37.2; p < 0.001), chest infection (OR = 5.7; 95% CI, 1.8-18.3; p = 0.003) and the hyperglucemia in admission (OR = 6; 95% CI, 1.5-25.6; p = 0.015) are the independient predictor factors that increased the likelihood for mortality in acute stroke. Baseline imbalance NIHSS > 20 (OR = 8.9; 95% CI, 2.7-29; p < 0.001), poor outcome neurological during the first day (OR = 8.1; 95% CI, 2.2-29.6%; p = 0.002) and the urinary incontinence (OR = 10.1; 95% CI, 5-20.6; p < 0.001) are the independient predictor factors that increased the likelihood of poor functional state in discharge. CONCLUSIONS: Dysphagia, crural motor affectation, urinary incontinence and diabetes mellitus are the independient predictor factors that increase the likelihood for nosocomial infection in acute stroke. The chest infection increases significantly the likelihood of mortality during the hospital stay.
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Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Doença Aguda , Idoso , Estudos de Coortes , Infecção Hospitalar/microbiologia , Transtornos de Deglutição/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hiperglicemia/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Reabilitação do Acidente Vascular Cerebral , Taxa de Sobrevida , Resultado do Tratamento , Incontinência Urinária/epidemiologiaRESUMO
A hybrid WDM/TDM PON architecture implemented by means of two cascaded Arrayed Waveguide Gratings (AWG) is presented. Using the Free Spectral Range (FSR) periodicity of AWGs we transmit unicast and multicast traffic on different wavelengths to each Optical Network Unit (ONU). The OLT is equipped with two laser stacks, a tunable one for unicast transmission and a fixed one for multicast transmission. We propose the ONU to be reflective in order to avoid any light source at the Costumer Premises Equipment (CPE). Optical transmission tests demonstrate correct transmission at 2.5 Gbps up to 30 km.
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The combination of pulmonary fibrosis and emphysema (CPFE) is a recently defined syndrome, in which an upper lobe emphysema and lower lobe fibrosis coexist in a single patient. These patients have a characteristic lung function profile, with dynamic and static lung volumes apparently normal or minimally altered, contrasting with a significant reduction of carbon monoxide transfer (DLco) and exercise hypoxemia. Pulmonary hypertension is highly prevalent and is the principal negative prognostic factor for this condition. High resolution computed axial tomography (HRCT) is the main tool to confirm the diagnosis. Cigarette smoking has been proposed as the main factor in its etiology; however, neither pathogenic mechanisms nor the sequence of events involved in this syndrome has been clarified yet. Experimental studies in animal models are providing information on the involvement of some inflammatory mediators in the pathogenesis. There is currently no consensus on the therapeutic approach to be followed in these patients, since those published to date on this subject are limited to well-characterised series of cases. Therefore, it is a pathology with many unknowns yet to be resolved and highly likely to be underdiagnosed, unless its functional clinical characteristics are taken into account.
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Enfisema Pulmonar/complicações , Fibrose Pulmonar/complicações , Humanos , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/epidemiologia , Fibrose Pulmonar/diagnóstico , Fibrose Pulmonar/epidemiologiaRESUMO
INTRODUCTION: The sensitivities of conventional mycobacterial culture in solid or liquid media and acid-fast bacilli (AFB) smear microscopy for Mycobacterium tuberculosis complex (MTBC) detection in extrapulmonary specimens are suboptimal. We evaluated the field performance of the Abbott RealTime MTB assay for the diagnosis of extrapulmonary tuberculosis in a low-prevalence setting. METHODS: The total number of extrapulmonary specimens with mycobacterial culture and PCR results was 566: sterile fluids (n = 278), non-sterile fluids (n = 147), lymph node material (n = 69) tissue biopsies (n = 63), and abscess aspirates (n = 9). A composite standard consisting of mycobacterial culture results, clinical treatment response to anti-TB drugs, when administered, and histopathology, radiological and laboratory findings were used as a reference for sensitivity and specificity calculations. RESULTS: Mycobacterial cultures and PCR were positive in 17 and 28 specimens, respectively. The overall agreement between culture and PCR was moderate (Cohen's kappa coefficient: 0.549; P = 0.0001). Taking as a reference our composite standard, the sensitivity of the Abbott PCR assay was 77.7%, the specificity 99.5%, the PPV 95.4%, and the NPV 98.8%. In turn, the sensitivity of the mycobacterial culture was 62.9%, the specificity and PPV 100%, and the NPV 97.9%. CONCLUSIÓN: The good field performance of the Abbott RealTime MTB assay makes it valuable for the diagnosis of extrapulmonary tuberculosis in a low-prevalence setting. The use of molecular methods along with culture improves the diagnosis of extrapulmonary tuberculosis
INTRODUCCIÓN: La sensibilidad del cultivo convencional de micobacterias en medios sólidos o líquidos y la de la microscopía de bacilos ácido-alcohol resistentes para detectar el complejo Mycobacterium tuberculosis en muestras extrapulmonares es subóptima. Evaluamos el rendimiento del ensayo Abbott RealTime MTB para el diagnóstico de la tuberculosis extrapulmonar en un entorno de baja prevalencia. MÉTODOS: El número total de muestras extrapulmonares con cultivo de micobacterias y resultados de la reacción en cadena de la polimerasa fue de 566: líquidos estériles (n = 278), líquidos no estériles (n = 147), material de los ganglios linfáticos (n = 69), biopsias de tejido (n = 63) y aspiraciones de abscesos (n = 9). Para calcular la sensibilidad y la especificidad del ensayo se utilizó como referencia un parámetro que incluyó: resultados del cultivo, respuesta clínica al tratamiento con antituberculosos y hallazgos de laboratorio, radiológicos e histopatológicos. RESULTADOS: Los cultivos de micobacterias y la PCR fueron positivos en 17 y 28 muestras, respectivamente. La concordancia de los resultados obtenidos por ambos métodos fue moderada (coeficiente kappa de Cohen: 0,549; p = 0,0001). La sensibilidad de la PCR de Abbott fue del 77,7%, especificidad del 99,5 %, valor predictivo positivo del 95,4% y valor predictivo negativo del 98,8%. La sensibilidad del cultivo fue del 62,9%, la especificidad y el valor predictivo positivo del 100% y el valor predictivo negativo del 97,9%. CONCLUSIÓN: El buen rendimiento del ensayo Abbott RealTime MTB lo hace valioso para el diagnóstico de la tuberculosis extrapulmonar en un entorno de baja prevalencia. El uso de métodos moleculares junto al cultivo mejora el diagnóstico de la tuberculosis extrapulmonar
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Humanos , Masculino , Feminino , Lactente , Criança , Adulto , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Mycobacterium tuberculosis/genética , Tuberculose/diagnóstico , Sensibilidade e Especificidade , Estudos RetrospectivosRESUMO
Theoretical and experimental study of channel crosstalk effects in time-switched phase-diversity optical homodyne reception is presented, focused toward ultradense WDM passive optical networks. This receiver achieves ultralow channel spacing of 3 GHz per 1 dB power penalty at 1 Gbit/s and feasible implementation.
RESUMO
Management of snoring is part of the treatment offered to patients with obstructive sleep apnea syndrome. In patients who do not have this syndrome, however, snoring should be treated according to the severity of the condition. General or specific therapeutic measures should be applied to snorers that have concomitant cardiovascular disease or unrefreshing sleep and in cases in which an individual's snoring disturbs his/her partner's sleep. The present review examines the treatments currently available for snorers and the current state of knowledge regarding each option. It will also focus on the possible indications of these treatments and evaluate their effectiveness.
Assuntos
Ronco/terapia , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Criança , Comorbidade , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Hábitos , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/complicações , Obstrução Nasal/terapia , Otolaringologia/instrumentação , Procedimentos Cirúrgicos Otorrinolaringológicos , Sobrepeso/epidemiologia , Prevalência , Privação do Sono/etiologia , Privação do Sono/prevenção & controle , Transtornos Intrínsecos do Sono/complicações , Transtornos Intrínsecos do Sono/terapia , Abandono do Hábito de Fumar , Ronco/complicações , Ronco/epidemiologia , Redução de PesoRESUMO
A differential phase shift keying homodyne optical receiver is experimentally demonstrated based on time-switching phase diversity, without the need for a 90 degrees optical hybrid. It achieves high tolerance to phase noise and feasible implementation with off-the-shelf electrical and optical components.