Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic, with a first wave during spring followed by the current second wave in late summer and autumn. Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. Those characteristics are compared in this study using data from two equal periods of 3 and a half months. The first period, between 15th March and 30th June, corresponding to the entire first wave, and the second, between 1st July and 15th October, corresponding to part of the second wave, still present at the time of writing this article. Two hundred and four patients were hospitalized during the first period, and 264 during the second period. Patients in the second wave were younger and the duration of hospitalization and case fatality rate were lower than those in the first wave. In the second wave, there were more children, and pregnant and post-partum women. The most frequent signs and symptoms in both waves were fever, dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases. Patients from the second wave more frequently presented renal and gastrointestinal symptoms, were more often treated with non-invasive mechanical ventilation and corticoids, and less often with invasive mechanical ventilation, conventional oxygen therapy and anticoagulants. Several differences in mortality risk factors were also observed. These results might help to understand the characteristics of the second wave and the behaviour and danger of SARS-CoV-2 in the Mediterranean area and in Western Europe. Further studies are needed to confirm our findings.
Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic, with a first wave during spring followed by the current second wave in late summer and autumn. Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. Those characteristics are compared in this study using data from two equal periods of 3 and a half months. The first period, between 15th March and 30th June, corresponding to the entire first wave, and the second, between 1st July and 15th October, corresponding to part of the second wave, still present at the time of writing this article. Two hundred and four patients were hospitalized during the first period, and 264 during the second period. Patients in the second wave were younger and the duration of hospitalization and case fatality rate were lower than those in the first wave. In the second wave, there were more children, and pregnant and post-partum women. The most frequent signs and symptoms in both waves were fever, dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases. Patients from the second wave more frequently presented renal and gastrointestinal symptoms, were more often treated with non-invasive mechanical ventilation and corticoids, and less often with invasive mechanical ventilation, conventional oxygen therapy and anticoagulants. Several differences in mortality risk factors were also observed. These results might help to understand the characteristics of the second wave and the behaviour and danger of SARS-CoV-2 in the Mediterranean area and in Western Europe. Further studies are needed to confirm our findings.
To determine the impact of initial antimicrobial choice on 30-day mortality rate in patients with community-acquired pneumonia due to Streptococcus pneumoniae (CAP-SP), a prospective, observational study was conducted in 35 Spanish hospitals. A total of 638 patients with CAP-SP were identified. Antimicrobials were chosen by the attending physician. Patients were grouped into the following categories: b-lactam monotherapy (n5251), macrolide monotherapy (n537), b-lactam plus macrolide (n5198), levofloxacin alone/combination (n548), and other combinations (n5104). The reference category was b-lactam+macrolide.The 30-day survival probability was 84.9%. Using multivariate survival analysis, factors related to mortality in the entire population were: bilateral disease, suspected aspiration, shock, HIV infection, renal failure and pneumonia severity index (PSI) score Class IV versus I-III and categories V versus I-III. The association of b-lactams+macrolides was not better than the use of b-lactams alone. The current authors analysed the different groups of patients with significant mortality/morbidity: intensive care unit, PSI Class .III, renal failure, chronic lung disease and bacteraemia. Only in patients with PSI Class .III, who had undergone initial antimicrobial choice classified as other combinations, were associated with higher mortality.In conclusion, the current authors have not demonstrated an independent association between initial antimicrobial regimen and 30-day mortality in community-acquired pneumococcal pneumonia patients, except for those with a higher pneumonia severity index score.
FABP4 is directly associated with obstructive sleep apnea severity and did not change with continuous positive airway pressure treatment, while FABP5 was not associated with obstructive sleep apnea severity and increased with continuous positive airway pressure treatment. FABP4 and FABP5 have different associations with obstructive sleep apnea. FABP4 but not FABP5 could be considered a marker of metabolic alterations in obstructive sleep apnea patients.
Reports on the isolation and identification of unusual Mycobacteria species in humans, animals and plants have increased considerably recently due, largely, to the implementation of Molecular Biology methods which have higher discriminative powers than the classical phenotype-based techniques [1] . Since the year 2000, several authors have identified a variety of Mycobacteria in clinical specimens, including M. elephantis [2,3] , M. branderi [4] , M. monacense [5,6] , and M. poriferae [7] .M. madagascariense was first described by Kazda et al. [8] . It grows rapidly at temperatures ranging between 22 ° C and 31 ° C and is scotochromogenic [1] . Phylogeny studies based on DNA sequence classify M. madagascariense within the group of thermo-tolerant rapid growers, phylo-genetically close to M. confluentis [9] . Experimental studies in animals indicate that this microorganism is not a pathogen [1] . To date, M. madagascariense has not been identified in any human sample. The present letter reports, to the best of our knowledge for the first time in the literature, the identification of M. madagascariense in the sputum of a patient with tracheobronchitis.In August 2009, a 22-year-old Russian male was admitted to the Pneumology Department of the Hospital Universitari Sant Joan de Reus (Catalonia, Spain). He complained of a cough with purulent sputum dating from a year previously, with bloody sputum on occasions. He had no evidence of fever or toxic syndrome. Standard biochemical and hematological tests were normal. Serology for hepatitis B and C and human immunonodeficiency virus (HIV) infection were negative. Thorax X-ray showed calcified adenopathies in the right mediastinum and hilium, indicating previous tuberculosis. Three serial sputum samples were collected and Zhiel-Neelsen staining was negative. A standard culture in agar plates was negative for bacterial respiratory pathogens. Cultures in Lowenstein-Jensen (LJ) medium with pyruvate (but not LJ medium alone) showed, 7 days later, abundant mucous, 2 mm sized, acid-fast, orange colonies, that were composed of Grampositive rods. Acid fast bacilli staining was performed in the sputum samples before and after decontamination, and prior to inoculation into the LJ medium. These colonies were identified as M. madagascariense using molecular and phenotypic methods in a reference laboratory at the Hospital Universitari de Bellvitge (Barcelona, Spain). Currently, this mycobacterial species cannot be identified by routine commercial tests since the organism is not recognized with the available diagnostic systems. Although growth and chromogenic characteristics as well as biochemical tests (Table 1 ) were important for microbiology diagnosis, definitive identification relied on partial 16S rRNA gene sequencing (first 500 bp) [10] . The patient was
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