We performed a prospective study of all patients with bacteremic pneumonia due to Staphylococcus aureus over a period of 6 years during an outbreak of methicillin-resistant S. aureus (MRSA). Patients with bacteremic pneumonia due to MRSA (32 cases) or methicillin-susceptible S. aureus (MSSA; 54 cases) were compared. The patients with MRSA pneumonia were older and were more likely than those with MSSA pneumonia to have predisposing factors for acquisition of the infection. There were no differences in clinical findings, radiological pattern, or complications in clinical evolution among patients with MRSA and MSSA pneumonia. Mortality was significantly higher among MSSA-infected patients treated with vancomycin than among those treated with cloxacillin (47% vs. none; P <.01). Multivariate analysis (stepwise logistic regression method) showed a relationship between mortality and the following variables: septic shock (odds ratio [OR], 61), vancomycin treatment (OR, 14), and respiratory distress (OR, 8).

We prospectively studied all cases of Staphylococcus aureus bacteremia that occurred during an extensive outbreak of methicillin-resistant S. aureus (MRSA) in our hospital over a 4-year period (January 1990 through September 1993). We report the results of a comparative analysis of the clinical characteristics and mortality rates among patients with nosocomial bacteremia caused by MRSA (84 cases) or methicillin-susceptible S. aureus (MSSA; 100 cases). The patients with MRSA bacteremia were older than those with MSSA bacteremia (69 years vs. S4 years, respectively; P < .01) and were more likely than those with MSSAbacteremia to have the following predisposing factors: a prolonged hospitalization (32 days vs. 14 days, respectively; P < .01); prior antimicrobial therapy (61% vs. 34%, respectively; P < .01); urinary catheterization (58% vs. 27%, respectively; P < .01); nasogastric tube placement (31% vs. 13%, respectively; P < .01); and prior surgery (45% vs. 31%, respectively; P = .05). Multivariate analysis with use of the stepwise logistic regression method showed a relationship between mortality and the following variables: methicillin resistance (odds ratio [OR], 3), meningitis (OR, 13), and inadequate treatment (OR, 11).

Tamoxifen is a pro-drug widely used in breast cancer patients to prevent tumor recurrence. Prior work has revealed a role of cytochrome and sulfotransferase enzymes in tamoxifen metabolism. In this descriptive study, correlations were examined between concentrations of tamoxifen metabolites and genotypes for CYP2D6, CYP3A4, CYP3A5, SULT1A1, SULT1A2 and SULT1E1 in 135 patients with estrogen receptor-positive breast cancer. Patients were genotyped using the Roche-AmpliChip® CYP450 Test, and Real-Time and conventional PCR-RFLP. Plasma tamoxifen, 4-hydroxy-tamoxifen, N-desmethyl-tamoxifen, endoxifen and tamoxifen-N-oxide were isolated and quantified using a high-pressure liquid chromatography-tandem mass spectrometry system. Significantly higher endoxifen levels were detected in patients with the wt/wt CYP2D6 compared to the v/v CYP2D6 genotype (p<0.001). No differences were detected in the remaining tamoxifen metabolites among CYP2D6 genotypes. Patients featuring the SULT1A2*2 and SULT1A2*3 alleles showed significantly higher plasma levels of 4-hydroxy-tamoxifen and endoxifen (p = 0.025 and p = 0.006, respectively), as likely substrates of the SULT1A2 enzyme. Our observations indicate that besides the CYP2D6 genotype leading to tamoxifen conversion to potent hydroxylated metabolites in a manner consistent with a gene-dose effect, SULT1A2 also seems to play a role in maintaining optimal levels of both 4-hydroxy-tamoxifen and endoxifen.

Student participation and the use of active methodologies in classroom learning are being increasingly emphasized. The use of intelligent systems can be of great help when designing and developing these types of activities. Recently, emerging disciplines such as 'educational data mining' and 'learning analytics and knowledge' have provided clear examples of the importance of the use of artificial intelligence techniques in education. The main objective of this study was to gather expert opinions regarding the benefits of using complementary methods that are supported by intelligent systems, specifically, by intelligent information access systems, when processing texts written in natural language and the benefits of using these methods as companion tools to the learning activities that are employed by biomedical and health sciences teachers. Eleven teachers of degree courses who belonged to the Faculties of Biomedical Sciences (BS) and Health Sciences (HS) of a Spanish university in Madrid were individually interviewed. These interviews were conducted using a mixed methods questionnaire that included 66 predefined close-ended and open-ended questions. In our study, three intelligent information access systems (i.e., BioAnnote, CLEiM and MedCMap) were successfully used to evaluate the teacher's perceptions regarding the utility of these systems and their different methods in learning activities. All teachers reported using active learning methods in the classroom, most of which were computer programs that were used for initially designing and later executing learning activities. All teachers used case-based learning methods in the classroom, with a specific emphasis on case reports written in Spanish and/or English. In general, few or none of the teachers were familiar with the technical terms related to the technologies used for these activities such as "intelligent systems" or "concept/mental maps". However, they clearly realized the potential applicability of such approaches in both the preparation and the effective use of these activities in the classroom. Specifically, the themes highlighted by a greater number of teachers after analyzing the responses to the open-ended questions were the usefulness of BioAnnote system to provide reliable sources of medical information and the usefulness of the bilingual nature of CLEiM system for learning medical terminology in English. Three intelligent information access systems were successfully used to evaluate the teacher's perceptions regarding the utility of these systems in learning activities. The results of this study showed that integration of reliable sources of information, bilingualism and selective annotation of concepts were the most valued features by the teachers, who also considered the incorporation of these systems into learning activities to be potentially very useful. In addition, in the context of our experimental conditions, our work provides useful insights into the way to appropriately integrate this type of intelligent information access systems into learning activities, revealing key themes to consider when developing such approaches.