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Search Results: 1 - 10 of 1297 matches for " Hernando Knobel "
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Eosinophil Count and Neutrophil-Lymphocyte Count Ratio as Prognostic Markers in Patients with Bacteremia: A Retrospective Cohort Study
Roser Terradas, Santiago Grau, Jordi Blanch, Marta Riu, Pere Saballs, Xavier Castells, Juan Pablo Horcajada, Hernando Knobel
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0042860
Abstract: Introduction There is scarce evidence on the use of eosinophil count as a marker of outcome in patients with infection. The aim of this study was to evaluate whether changes in eosinophil count, as well as the neutrophil-lymphocyte count ratio (NLCR), could be used as clinical markers of outcome in patients with bacteremia. Methods We performed a retrospective study of patients with a first episode of community-acquired or healthcare-related bacteremia during hospital admission between 2004 and 2009. A total of 2,311 patients were included. Cox regression was used to analyze the behaviour of eosinophil count and the NLCR in survivors and non-survivors. Results In the adjusted analysis, the main independent risk factor for mortality was persistence of an eosinophil count below 0.0454·103/uL (HR = 4.20; 95% CI 2.66–6.62). An NLCR value >7 was also an independent risk factor but was of lesser importance. The mean eosinophil count in survivors showed a tendency to increase rapidly and to achieve normal values between the second and third day. In these patients, the NLCR was <7 between the second and third day. Conclusion Both sustained eosinopenia and persistence of an NLCR >7 were independent markers of mortality in patients with bacteremia.
Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit
Francisco álvarez-Lerma, Elena Maull, Roser Terradas, Concepción Segura, Irene Planells, Pere Coll, Hernando Knobel, Antonia Vázquez
Critical Care , 2008, DOI: 10.1186/cc6778
Abstract: Over a period of 18 days, isolates of Burkholderia cepacia were recovered from different biological samples from five patients who were admitted to a multidisciplinary 18-bed intensive care unit. Isolation of B. cepacia was associated with bacteraemia in three cases, lower respiratory tract infection in one and urinary tract infection in one. Contact isolation measures were instituted; new samples from the index patients and adjacent patients were collected; and samples of antiseptics, eau de Cologne and moisturizing body milk available in treatment carts at that time were collected and cultured.B. cepacia was isolated from three samples of the moisturizing body milk that had been applied to the patients. Three new hermetically closed units, from three different batches, were sent for culture; two of these were positive as well. All strains recovered from environmental and biological samples were identified as belonging to the same clone by pulsed-field gel electrophoresis. The cream was withdrawn from all hospitalization units and no new cases of B. cepacia infection developed.Moisturizing body milk is a potential source of infection. In severely ill patients, the presence of bacteria in cosmetic products, even within accepted limits, may lead to severe life-threatening infections.Burkholderia cepacia is a nonfermenting Gram-negative aerobic bacillus that was until recently considered an opportunistic pathogen in oncological patients or in those with cystic fibrosis. This pathogen is associated with low morbidity and mortality despite high intrinsic resistance to numerous antimicrobial and antiseptic agents [1]. It is characterized by a capacity to survive in a large variety of hospital microenvironments, resulting in its dissemination via contaminated respiratory equipment, disinfectants, blood analyzers and running water supply [2-5]. In intensive care units (ICUs) outbreaks of B. cepacia in association with contaminated nebulizers [6], indigo-carmine dye in pati
Prevalence and Factors Associated with Vitamin D Deficiency and Hyperparathyroidism in HIV-Infected Patients Treated in Barcelona
Elisabet Lerma,M. Ema Molas,M. Milagro Montero,Ana Guelar,Alicia González,Judith Villar,Adolf Diez,Hernando Knobel
ISRN AIDS , 2012, DOI: 10.5402/2012/485307
Abstract: Vitamin D deficiency is an important problem in patients with chronic conditions including those with human immunodeficiency virus (HIV) infection. The aim of this cross-sectional study was to identify the prevalence and factors associated with vitamin D deficiency and hyperparathyroidism in HIV patients attended in Barcelona. Cholecalciferol (25OH vitamin D3) and PTH levels were measured. Vitamin D insufficiency was defined as 25(OH) D < 20?ng/mL and deficiency as <12?ng/mL. Hyperparathyroidism was defined as PTH levels >65?pg/mL. Cases with chronic kidney failure, liver disease, treatments or conditions potentially affecting bone metabolism were excluded. Among the 566 patients included, 56.4% were exposed to tenofovir. Vitamin D insufficiency was found in 71.2% and 39.6% of those had deficiency. PTH was measured in 228 subjects, and 86 of them (37.7%) showed high levels. Adjusted predictors of vitamin D deficiency were nonwhite race and psychiatric comorbidity, while lipoatrophy was a protective factor. Independent risk factors of hyperparathyroidism were vitamin D < 12?ng/mL (OR: 2.14, CI 95%: 1.19–3.82, P: 0.01) and tenofovir exposure (OR: 3.55, CI 95%: 1.62–7.7, P: 0.002). High prevalence of vitamin deficiency and hyperparathyroidism was found in an area with high annual solar exposure. 1. Introduction Vitamin D is a steroid liposoluble hormone and can be made available to the individuals in two forms. First, vitamin D3 or cholecalciferol is synthesized in the skin in response to ultraviolet B radiation and is present in oil-rich fish (salmon, mackerel, and herring), egg yolks, and liver [1]. Second, vitamin D2 or ergocalciferol is obtained from the UV irradiation of the yeast sterol ergosterol and is found in sun-exposed mushrooms [2]. Both vitamins undergo identical metabolism, and as they are biologically inert, they require two hydroxylations, in the liver and in the kidney, to become 1,25dihydroxyvitamin D [1,25(OH)2D] which is the biologically active form of the hormone [3, 4]. In the intestine this stimulates the absorption of calcium and phosphorus, and it helps to regulate the metabolism of both minerals within bone and kidney interaction [5]. Assessment of vitamin D is based on measurement of serum 25(OH)D [6, 7] that is the most stable and plentiful metabolite of vitamin D in serum and has a half-life about 21 days [8]. The main source of vitamin D is exposure to sunlight [9, 10]. Therefore, an insufficient exposure to sunlight is a major cause of vitamin D deficiency. Other causes of vitamin deficiency are sunscreen sun protection [2],
Taking fingerprints from a decomposed body using the \'indirect cadaver hand skin-glove method\'
GJ Knobel
South African Medical Journal , 2005,
Técnicas de Acupuntura para Alívio da Dor no Trabalho de Parto: Ensaio Clínico
Knobel Roxana
Revista Brasileira de Ginecologia e Obstetrícia , 2002,
Cardiogenic shock
Knobel Elias
Arquivos Brasileiros de Cardiologia , 1999,
An Introduction into the Theory of Cosmological Structure Formation
Christian Knobel
Physics , 2012,
Abstract: This text aims to give a pedagogical introduction into the main concepts of the theory of structure formation in the universe. The text is suited for graduate students of astronomy with a moderate background in general relativity. A special focus is laid on deriving the results formally from first principles. In the first chapter we introduce the homogeneous and isotropic universe defining the framework for the theory of structure formation, which is discussed in the three following chapters. In the second chapter we describe the theory in the Newtonian framework and in the third chapter for the general relativistic case. The final chapter discusses the generation of perturbations in the very early universe for the simplest models of inflation.
Epidemiological characteristics and predictors of late presentation of HIV infection in Barcelona (Spain) during the period 2001-2009
Patricia de Olalla, Christian Manzardo, Maria A Sambeat, Inma Oca?a, Hernando Knobel, Victoria Humet, Pere Domingo, Esteve Ribera, Ana Guelar, Andres Marco, Maria J Belza, Josep M Miró, Joan A Caylà, the HIV Surveillance Group
AIDS Research and Therapy , 2011, DOI: 10.1186/1742-6405-8-22
Abstract: Demographic and epidemiological characteristics of cases reported to the Barcelona HIV surveillance system were analysed. Late presentation was defined for individuals with a CD4 count below 350 cells/ml upon HIV diagnosis or diagnosis of AIDS within 3 months of HIV diagnosis. Multivariate logistic regression were used to identify predictors of late presentation.Of the 2,938 newly diagnosed HIV-infected individuals, 2,507 (85,3%) had either a CD4 cell count or an AIDS diagnosis available. A total of 1,139 (55.6%) of the 2,507 studied cases over these nine years were late presenters varying from 48% among men who have sex with men to 70% among heterosexual men. The proportion of late presentation was 62.7% in 2001-2003, 51.9% in 2004-2005, 52.6% in 2006-2007 and 52.1% in 2008-2009. A decrease over time only was observed between 2001-2003 and 2004-2005 (p = 0.001) but remained constant thereafter (p = 0.9). Independent risk factors for late presentation were older age at diagnosis (p < 0.0001), use of injected drugs by men (p < 0.0001), being a heterosexual men (p < 0.0001), and being born in South America (p < 0.0001) or sub-Saharan Africa (p = 0.002).Late presentation of HIV is still too frequent in all transmission groups in spite of a strong commitment with HIV prevention in our city. It is necessary to develop interventions that increase HIV testing and facilitate earlier entry into HIV care.In the European Union it is estimated that 15-38% of cases of HIV infection are diagnosed late [1] and 30% of infected individuals are not aware of their serological status, with proportions that vary between 12% and 20% in Sweden to more than 50% in Poland [2]. In Spain 56.3% of new diagnoses of HIV infection between 2003 and 2007 required treatment (CD4 < 350 cells/μl) at the time of diagnosis and 30.2% of these presented severe immunosuppression (CD4 < 200 cells/μl) [3].Reducing the time elapsed between infection and the initiation of antiretroviral therapy (ART) is import
Trade, Technology, Income Distribution and Growth  [PDF]
Hernando Zuleta, Luiza Pogorelova
Theoretical Economics Letters (TEL) , 2014, DOI: 10.4236/tel.2014.46061

The standard Hecksher-Ohlin model predicts that trade liberalization leads to a decline in the rate of return of the scarce factor of production. However, the empirical evidence of the falling labor share in some developing countries contrasts with the theory. We show that if a simple change in technology is introduced into the standard model, conditions exist for the rate of return of the scarce factor of production to increase. In particular, the price of the exported good and the amount of capital the country owns can serve as determinants whether the rate of return of the abundant factor will increase.

Problemas asociados con la metodología de la investigación cualitativa
Colin Lankshear,Michele Knobel
Perfiles educativos , 2000,
Abstract: A menudo los investigadores adoptan acercamientos cualitativos porque rechazan los presupuestos positivistas que, suponen, integran la investigación cuantitativa. Sin embargo, dicha investigación enfatiza "virtudes" de investigación que muchas veces no existen o están subdesarrolladas en la investigación cualitativa. éstas son: 1) un problema o pregunta de investigación bien concebido; 2) un problema o pregunta bien informado; 3) un dise o de investigación conveniente; 4) un acercamiento a la recopilación de datos conveniente; un componente de análisis y interpretación. Los autores apuntan que estos rasgos deben ser bien desarrollados en la investigación cualitativa, y proporcionan ejemplos específicos sobre cómo asegurarse de que las investigaciones cualitativas han sido bien desarrolladas.
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