Background
Whether active therapy with β‐lactam/β‐lactamase inhibitors (BLBLI) is as affective as carbapenems for extended‐spectrum β‐lactamase‐producing Enterobacterales (ESBL‐E) bloodstream ...infection (BSI) secondary to urinary tract infection (UTI) in kidney transplant recipients (KTRs) remains unclear.
Methods
We retrospectively evaluated 306 KTR admitted to 30 centers from January 2014 to October 2016. Therapeutic failure (lack of cure or clinical improvement and/or death from any cause) at days 7 and 30 from ESBL‐E BSI onset was the primary and secondary study outcomes, respectively.
Results
Therapeutic failure at days 7 and 30 occurred in 8.2% (25/306) and 13.4% (41/306) of patients. Hospital‐acquired BSI (adjusted OR aOR: 4.10; 95% confidence interval CI: 1.50‐11.20) and Pitt score (aOR: 1.47; 95% CI: 1.21‐1.77) were independently associated with therapeutic failure at day 7. Age‐adjusted Charlson Index (aOR: 1.25; 95% CI: 1.05‐1.48), Pitt score (aOR: 1.72; 95% CI: 1.35‐2.17), and lymphocyte count ≤500 cells/μL at presentation (aOR: 3.16; 95% CI: 1.42‐7.06) predicted therapeutic failure at day 30. Carbapenem monotherapy (68.6%, primarily meropenem) was the most frequent active therapy, followed by BLBLI monotherapy (10.8%, mostly piperacillin‐tazobactam). Propensity score (PS)‐adjusted models revealed no significant impact of the choice of active therapy (carbapenem‐containing vs any other regimen, BLBLI‐ vs carbapenem‐based monotherapy) within the first 72 hours on any of the study outcomes.
Conclusions
Our data suggest that active therapy based on BLBLI may be as effective as carbapenem‐containing regimens for ESBL‐E BSI secondary to UTI in the specific population of KTR. Potential residual confounding and unpowered sample size cannot be excluded (ClinicalTrials.gov identifier: NCT02852902).
BACKGROUNDOral opioid analgesics have been used for management of peri- and postoperative analgesia in patients undergoing axillary dissection. The axillary region is a difficult zone to block and ...does not have a specific regional anesthesia technique published that offers its adequate blockade.METHODSAfter institutional review board approval, anatomic and radiological studies were conducted to determine the deposition and spread of methylene blue and local anesthetic injected respectively into the axilla via the thoracic inter-fascial plane. Magnetic Resonance Imaging studies were then conducted in 15 of 34 patients scheduled for unilateral breast surgery that entailed any of the following: axillary clearance, sentinel node biopsy, axillary node biopsy, or supernumerary breasts, to ascertain the deposition and time course of spread of solution within the thoracic interfascial plane in vivo.RESULTSRadiological and cadaveric studies showed that the injection of local anesthetic and methylene blue via the thoracic inter-fascial plane, using ultrasound guide technique, results in reliable deposition into the axilla. In patients, the injection of the local anesthetic produced a reliable axillary sensory block. This finding was supported by Magnetic Resonance Imaging studies that showed hyper-intense signals in the axillary region.CONCLUSIONSThese findings define the anatomic characteristics of the thoracic interfascial plane nerve block in the axillary region, and underline the clinical potential of this novel nerve block.
Analysis Of COVID-19 In Adult Asthmatic Outpatients Alvarez, Maria Somoza; Prieto-Moreno Pfeifer, Ana MarÃa; Rojas, Isabel Torres ...
Journal of allergy and clinical immunology,
February 2021, 2021-02-00, 20210201, Letnik:
147, Številka:
2
Journal Article
Matrix metalloproteinases (MMPs) participate in the degradation of extracellular matrix compounds, maintaining the homeostasis between fibrogenesis and fibrolytic processes in the liver. However, ...there are few studies on the regulation of liver MMPs in fibrosis progression in humans.
To assess the production activity and regulation of matrix metalloproteinases in liver fibrosis stages in chronic hepatitis C (CHC).
A prospective, cross-sectional, multicenter study was conducted. CHC patients were categorized in fibrosis grades through FibroTest
and/or FibroScan
. Serum MMP-2, -7, and -9 were determined by western blot and multiplex suspension array assays. Differences were validated by the Kruskal-Wallis and Mann-Whitney U tests. The Spearman correlation coefficient and area under the receiver operating characteristic curve were calculated. Collagenolytic and gelatinase activity was determined through the Azocoll substrate and zymogram test, whereas tissue inhibitor of metalloproteinase-1 production was determined by dot blot assays.
Serum concentrations of the MMPs evaluated were higher in CHC patients than in healthy subjects. MMP-7 distinguished early and advanced stages, with a correlation of 0.32 (
< 0.001), and the area under the receiver operating characteristic displayed moderate sensitivity and specificity for MMP-7 in F4 (area under the receiver operating characteristic, 0.705; 95% confidence interval: 0.605-0.805;
< 0.001). Collagenolytic activity was detected at F0 and F1, whereas gelatinase activity was not detected at any fibrosis stage. Tissue inhibitor of metalloproteinase-1 determination showed upregulation in F0 and F1 but downregulation in F2 (
< 0.001).
High concentrations of inactive MMPs were present in the serum of CHC patients, reflecting the impossibility to restrain liver fibrosis progression. MMPs could be good diagnostic candidates and therapeutic targets for improving novel strategies to reverse liver fibrosis in CHC.
Nosocomial infections (NI) are a major healthcare problem. National surveillance systems enable data to be compared and to implement new measures to improve our practice.
A multicentre, prospective, ...descriptive and observational study was conducted using the data from surveillance system for nosocomial infections created in 2007 for Spanish pediatric intensive care units. Data were collected for one month, between 01 and 31 March, for every study year (2008-2012). The objective was to report 5-years of NI surveillance data, as well as trends in infections by multidrug resistant organisms in Spanish pediatric intensive care units.
A total of 3667 patients were admitted to the units during the study period. There were 90 (2.45%) patients with nosocomial infections. The mean rates during the 5 years study were: central line-associated bloodstream infection, 3.8/1000 central venous catheter-days, Ventilator-associated pneumonia 7.5/1000 endotracheal tube-days, and catheter-associated urinary tract infections 4.1/1000 urinary catheter-days. The comparison between the 2008 and 2009 rates for nosocomial infections did not show statistically significant differences. All rates homogeneously decreased from 2009 to 2012: central line-associated bloodstream infection 5.83 (95% CI 2.67-11.07) to 0.49 (95% CI 0.0125-2.76), P=0.0029; ventilator-associated pneumonia 10.44 (95% CI 5.21-18.67) to 4.04 (95% CI 1.48-8.80), P=0.0525; and Catheter-associated urinary tract infections 7.10 (95% CI 3.067-13.999) to 2.56 (95% CI 0.697-6.553), P=0.0817; respectively. The microorganism analysis: 63 of the 99 isolated bacteria (63.6%) were Gram-negative bacteria (36.5% were resistant), 19 (19.2%) Gram-positive bacteria, and 17 (17.2%) were Candida spp. infections.
The local surveillance systems provide information for dealing with nosocomial infections rates.
The endoplasmic reticulum (ER) of cancer cells needs to adapt to the enhanced proteotoxic stress associated with the accumulation of unfolded, misfolded and transformation-associated proteins. One ...way by which tumors thrive in the context of ER stress is by promoting ER-Associated Degradation (ERAD), although the mechanisms are poorly understood. Here, we show that the Small p97/VCP Interacting Protein (SVIP), an endogenous inhibitor of ERAD, undergoes DNA hypermethylation-associated silencing in tumorigenesis to achieve this goal. SVIP exhibits tumor suppressor features and its recovery is associated with increased ER stress and growth inhibition. Proteomic and metabolomic analyses show that cancer cells with epigenetic loss of SVIP are depleted in mitochondrial enzymes and oxidative respiration activity. This phenotype is reverted upon SVIP restoration. The dependence of SVIP hypermethylated cancer cells on aerobic glycolysis and glucose was also associated with sensitivity to an inhibitor of the glucose transporter GLUT1. This could be relevant to the management of tumors carrying SVIP epigenetic loss, because these occur in high-risk patients who manifest poor clinical outcomes. Overall, our study provides insights into how epigenetics helps deal with ER stress and how SVIP epigenetic loss in cancer may be amenable to therapies that target glucose transporters.
Introducción: la ausencia de tratamientos específicos para COVID-19 ha promovido el diseño de estrategias en salud pública para reducir tasas de contagio y disminuir la mortalidad por el virus. En ...Colombia se decretó una cuarentena obligatoria a partir del 24 de marzo de 2020. Esta medida se convirtió en una oportunidad para la implementación de programas de consulta mediante telesalud, con el fin de continuar la prestación de servicios de salud. La Unidad de Neuropsicología del Instituto Neurológico de Colombia (INDEC) decidió instaurar un modelo de atención en neuropsicología mediante la metodología de telesalud. Métodos: en el presente artículo se exponen los detalles de esta experiencia, considerando y describiendo los aspectos administrativos, informáticos, clínicos, logísticos, éticos y legales. Resultados y conclusiones: esta modalidad de trabajo de una unidad de neuropsicología, revela que es posible capitalizar la madurez que se ha alcanzado en el campo clínico, tecnológico y administrativo, para generar transformaciones de forma rápida y que respondan de manera oportuna a las necesidades del medio.
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