Epidemiology of bacteremia in a pediatric population - A 10-year study.

INTRODUCTION: With the widespread introduction of conjugate meningococcal and pneumococcal vaccines, the prevalence and etiology of invasive bacterial infections have changed. We aimed to review all cases of bacteremia in a level II pediatric department over a ten-year period in the post-pneumococcal conjugate vaccine era. METHODS: We reviewed all positive blood cultures (BC) obtained in our department between 2007 and 2016. Results were classified as contaminants, potential pathogens or confirmed pathogens, based on species, number of positive BC in the episode and the patients' medical history. Demographic and clinical data were collected for patients with identified pathogens. RESULTS: A total of 638 positive BC were identified (6.6% of total BC); 120 (1.2%) were considered to represent true bacteremia. The most frequently identified microorganism was Streptococcus pneumoniae (29.2%), with a decrease in the number of cases between 2008 and 2015. Staphylococcus aureus was the second most common organism (19.2%) being 21.7% of these methicillin-resistant. Escherichia coli was the most common isolate in children aged less than three months. CONCLUSION: We found a rate of true bacteremia in children similar to recent studies. Although Streptococcus pneumoniae remains the most common microorganism, its prevalence may be declining. Monitoring microbiological data in children has implications in practice, particularly in local antibiotic prescription.

Epidemiology of bacteremia in a pediatric population – A 10-year study / Epidemiología de la bacteriemia en una población pediátrica: un estudio de 10 años

Introduction: With the widespread introduction of conjugate meningococcal and pneumococcal vaccines, the prevalence and etiology of invasive bacterial infections have changed. We aimed to review all cases of bacteremia in a level II pediatric department over a ten-year period in the post-pneumococcal conjugate vaccine era. Methods: We reviewed all positive blood cultures (BC) obtained in our department between 2007 and 2016. Results were classified as contaminants, potential pathogens or confirmed pathogens, based on species, number of positive BC in the episode and the patients’ medical history. Demographic and clinical data were collected for patients with identified pathogens. Results: A total of 638 positive BC were identified (6.6% of total BC); 120 (1.2%) were considered to represent true bacteremia. The most frequently identified microorganism was Streptococcus pneumoniae (29.2%), with a decrease in the number of cases between 2008 and 2015. Staphylococcus aureus was the second most common organism (19.2%) being 21.7% of these methicillin-resistant. Escherichia coli was the most common isolate in children aged less than three months. Conclusion: We found a rate of true bacteremia in children similar to recent studies. Although Streptococcus pneumoniae remains the most common microorganism, its prevalence may be declining. Monitoring microbiological data in children has implications in practice, particularly in local antibiotic prescription.(AU)

Introducción: Con la introducción generalizada de las vacunas conjugadas meningocócicas y neumocócicas, la prevalencia y la etiología de las infecciones bacterianas invasivas han cambiado. Nuestro objetivo fue revisar todos los casos de bacteriemia en un departamento de pediatría de nivel II durante un período de 10 años en la era de la vacuna conjugada posneumocócica. Métodos: Revisamos todos los hemocultivos (HC) positivos obtenidos en nuestro departamento entre 2007 y 2016. Los resultados se clasificaron como contaminantes, patógenos potenciales o patógenos confirmados, según la especie, el número de HC positivos en el episodio y la historia clínica de los pacientes. Se recopilaron datos demográficos y clínicos de pacientes con patógenos identificados. Resultados: Se identificaron un total de 638 HC positivos (6,6% del total de HC); se consideró que 120 (1,2%) representaban una bacteriemia verdadera. El microorganismo identificado con mayor frecuencia fue Streptococcus pneumoniae (29,2%), con una disminución en el número de casos entre 2008 y 2015. Staphylococcus aureus fue el segundo aislado más común (19,2%); El 21,7% eran resistentes a la meticilina. Escherichia coli fue el aislado más común en niños menores de 3 meses. Conclusión: Encontramos una tasa de bacteriemia verdadera similar a la de estudios recientes. Aunque el Streptococcus pneumoniae sigue siendo el microorganismo más común, su prevalencia puede estar disminuyendo. El seguimiento de datos microbiológicos como este tiene implicaciones en la práctica, especialmente en la prescripción local de antibióticos.(AU)

Analysis of glucose and xylose metabolism in new indigenous Meyerozyma caribbica strains isolated from corn residues.

Aiming to broaden the base of knowledge about wild yeasts, four new indigenous strains were isolated from corn residues, and phylogenetic-tree assemblings on ITS and LSU regions indicated they belong to Meyerozyma caribbica. Yeasts were cultivated under full- and micro-aerobiosis, starting with low or high cell-density inoculum, in synthetic medium or corn hydrolysate containing glucose and/or xylose. Cells were able to assimilate both monosaccharides, albeit by different metabolic routes (fermentative or respiratory). They grew faster in glucose, with lag phases ~ 10 h shorter than in xylose. The hexose exhaustion occurred between 24 and 34 h, while xylose was entirely consumed in the last few hours of cultivation (44-48 h). In batch fermentation in synthetic medium with high cell density, under full-aerobiosis, 18-20 g glucose l-1 were exhausted in 4-6 h, with a production of 6.5-7.0 g ethanol l-1. In the xylose medium, cells needed > 12 h to consume the carbohydrate, and instead of ethanol, cells released 4.4-6.4 g l-1 xylitol. Under micro-aerobiosis, yeasts were unable to assimilate xylose, and glucose was more slowly consumed, although the ethanol yield was the theoretical maximum. When inoculated into the hydrolysate, cells needed 4-6 h to deplete glucose, and xylose had a maximum consumption of 57%. Considering that the hydrolysate contained ~ 3 g l-1 acetic acid, it probably has impaired sugar metabolism. Thus, this study increases the fund of knowledge regarding indigenous yeasts and reveals the biotechnological potential of these strains.

Coarctation of Aorta in Turner Mosaicism.

The prevalence of hypertension in the pediatric age range is estimated at 1-5% worldwide, with higher rates in adolescence. Although primary hypertension is more common, due to the increasing prevalence of obesity and metabolic syndrome among adolescents, secondary hypertension should be always considered and excluded. We present the case of an adolescent with secondary hypertension and a challenging diagnosis associated with coarctation of aorta and Turner Mosaicism.

Epidemiology of bacteremia in a pediatric population - A 10-year study.

INTRODUCTION: With the widespread introduction of conjugate meningococcal and pneumococcal vaccines, the prevalence and etiology of invasive bacterial infections have changed. We aimed to review all cases of bacteremia in a level II pediatric department over a ten-year period in the post-pneumococcal conjugate vaccine era. METHODS: We reviewed all positive blood cultures (BC) obtained in our department between 2007 and 2016. Results were classified as contaminants, potential pathogens or confirmed pathogens, based on species, number of positive BC in the episode and the patients' medical history. Demographic and clinical data were collected for patients with identified pathogens. RESULTS: A total of 638 positive BC were identified (6.6% of total BC); 120 (1.2%) were considered to represent true bacteremia. The most frequently identified microorganism was Streptococcus pneumoniae (29.2%), with a decrease in the number of cases between 2008 and 2015. Staphylococcus aureus was the second most common organism (19.2%) being 21.7% of these methicillin-resistant. Escherichia coli was the most common isolate in children aged less than three months. CONCLUSION: We found a rate of true bacteremia in children similar to recent studies. Although Streptococcus pneumoniae remains the most common microorganism, its prevalence may be declining. Monitoring microbiological data in children has implications in practice, particularly in local antibiotic prescription.

Unattended versus two attended, ambulatory and central blood pressure measurements in hypertensive patients with and without diabetes.

OBJECTIVE: To compare unattended blood pressure (BP) with two attended BP, with 24-h ambulatory (ABPM) and central BP measurements in hypertensive patients with (DMs) and without diabetes (HTs). METHODS: In the same hypertension clinic we evaluate 129 consecutive HTs (56% female, 59 + 16 yrs) and 91 DMs (62% female, 64 + 9 yrs) who were referred for 24-h ABPM. During 48 hours they underwent a first attended BP (5 minutes resting, 3 recordings 2 minutes apart), (AT1), an unattended BP (UnAT), 3 measurements 2 minutes apart with a pre-programmed oscillometric Omron M10- IT, a second attended BP (AT2) similar to AT1, a 24-h ABPM and an evaluation of central BP (C) from the aortic wave form (SpygmoCor). RESULTS: BP (mm Hg) and differences (Δ) from UnAT = 135/82 ± 17/10 were 1AT = +13.8/3.9 ± 10.3/5.6, AT2 = +7.3/2.9 ± 7.4/4.9, 24-h = -1.3/-1.7 ± 7.5/7.5 and C = -2.4/1.2 ± 10.3/9.1, all p < .01 vs UnAT. Limits of agreement (2 SDs in Bland-Altman plots) were between AT1 and UnAT systolic BP, +34.2 to -6.8 mm Hg and between AT2 and UnAT BP were +21.7 to -7.0 mm Hg. Unattended systolic BP values were similar to that of 24-h in HTs and to that of daytime in DMs. Intraclass correlation coefficients of systolic BP and diastolic BP between UnAT and AT1 and between UnAT and AT2 were within the range 0.78 to 0.83, all p < .01. CONCLUSIONS: In HTs with and without DM the unattended BP significantly underestimates attended BP being more close to ambulatory BP values. These differences should be taken into account since targets based on these BP measurements are not equivalent.

Aspartic vinyl sulfones: inhibitors of a caspase-3-dependent pathway.

In this article we describe an expanded structure-activity relationship study for vinyl sulfones as caspase-3 inhibitors, a topic virtually unexplored in the existing literature. Most remarkably, and to our surprise, tripeptidyl vinyl sulfones were not active for caspase-3, opposite to other examples described in literature for peptidyl vinyl sulfones as potent cysteine protease inhibitors of clan CA. Moreover, the caspase-3 inhibitory activity of vinyl sulfones using an in vitro assay was then confirmed using a yeast cell-based assay. The results show that Fmoc-protected vinyl sulfones containing only the Asp moiety are inhibitors of a caspase-3-dependent pathway and the IC50 values obtained in the yeast assay are in the same order of magnitude of that obtained with the caspase-3 inhibitor tetrapeptidyl chloromethyl ketone, Ac-DEVD-CMK. This observation is consistent with appropriate cell permeability properties displayed by the vinyl sulfone inhibitors, as reflected by logP values ranging from 1.1 to 3.4. Overall, these results suggest that vinyl sulfones containing Asp at P1 should be considered for further optimization as caspase inhibitors and modulators of caspase-3-dependent pathways.

[Cryptorchidism in adolescence]. / Criptorquidia na adolescência.

INTRODUCTION: An early investigation and management op cryptorchidism are essential for the diagnosis of associated pathologies, because intra-abdominal testis are associated with infertility and neoplasic risk. The authors describe a case of late presentation of cryptorchidism associated with genetic disorder. CASE REPORT: Adolescent male with 17 years old, referred to Adolescent Clinic for short stature and bilateral cryptorchidism. Hypertension, short stature and bilateral cryptorchidism were detected in clinical evaluation. Bone age is coincident with chronological age and testosterone was slightly below normal values. The study of secondary hypertension was negative. He underwent bilateral orchidopexy, and histological analysis revealed severe bilateral testicular atrophy. The karyotype showed 45,X[15]/46,X,+mar.ish der(Y)(SRY+)[117] mosaicism. COMMENTS: With this case report the authors intend to enhance the need of early management of cryptorchidism and short stature, in order to improve the prognosis.

Immobilization of drugs for glaucoma treatment.

Recently there have been some developments in the preparation of controlled drug delivery systems for glaucoma. Many materials are being used in this area, namely gelatine and chitosan. Both of them present high levels of biocompatibility and biodegradability. In this paper, we wish to report the work we have been doing on the preparation and characterization of hydrogels based on gelatine and chitosan. The crosslinking agents used were 1-(3-(Dimethylamino)propyl)-3-Ethylcarbodiimide hydrocholide (CDI), 1,4-Butanodiol diglycidyl ether (epoxyde 1), Ethylene glycol diglycidyl ether (epoxyde 2) and genipin. The results obtained showed that all of the films were hydrogels. The surface and transversal cut showed a porous surface in all the films. The thermal analysis proved the modifications in the polymeric chains, with the stabilization of all of them by the crosslinking agents. The release pattern indicates that the gelatine films were the best since they release the adequate proportion of drug. Finally, the cytotoxicity showed that the gelatine films were all biocompatible, specially the ones crosslinked with one of the Epoxydes.