ABSTRACT
Data on pediatric antibiotic prescribing and utilization practices at urgent care centers (UCC) remain limited. In this study, an electronic medical record-based review of UCC encounters for respiratory tract infections (RTI) of patients belonging to one mid-sized pediatric practice was performed. Antibiotic prescribing and guideline adherence were compared between UCCs that were staffed exclusively by pediatric-trained providers to those staffed otherwise. Of a total of 457 RTI visits, 330 (72%) occurred at the pediatric UCC. Across all bacterial RTIs, 82% of encounters at the pediatric UCC were guideline-adherent versus 59% at nonpediatric UCCs (P < .001). At nonpediatric UCCs, pharyngitis was the most common RTI encounter diagnosis (40%), and full streptococcal management guideline adherence was 41%. While 93% of RTI-UCC encounters for <2 years were at pediatric UCCs, the majority of children >10 presented to nonpediatric UCCs. RTI guideline education to UCCs should be a focus of ambulatory stewardship efforts.
Subject(s)
Pharyngitis , Respiratory Tract Infections , Child , Humans , Anti-Bacterial Agents/therapeutic use , Respiratory Tract Infections/drug therapy , Ambulatory Care Facilities , Pharyngitis/drug therapy , Guideline Adherence , Inappropriate Prescribing , Practice Patterns, Physicians'Subject(s)
Fluid Therapy/methods , Hypernatremia/etiology , Hypernatremia/therapy , Adolescent , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Female , Glucose/therapeutic use , Humans , Hypernatremia/blood , Infant, Newborn , Klebsiella Infections/blood , Klebsiella Infections/complications , Klebsiella Infections/drug therapy , Klebsiella pneumoniae , Male , Saline Solution/therapeutic use , Sodium Chloride/administration & dosage , Sodium Chloride/adverse effects , Sodium Chloride/bloodABSTRACT
Endothelin-1 (ET-1) is a potent vasoconstrictor and blood pressure modulator. Renin secretion from juxtaglomerular (JG) cells is crucial for blood pressure and electrolyte homeostasis and has been shown to be modulated by ET-1; however, the cellular and molecular mechanism of this regulation is not clear. The purpose of this study was to gain a better understanding of the cellular and molecular pathways activated by ET-1 by using a renin-producing cell line As4.1. ET-1 caused an increase in As4.1 cell intracelluar Ca(2+) concentration ([Ca(2+)](i)) mediated by the ET(A) receptor as its antagonist, BQ-123, abolished the response. The nitric oxide donor nitroprusside, but not 8-bromo-cGMP, reduced the time necessary for successive ET-1 responses. Endothelin-3 had no effect on [Ca(2+)](i). ET-1 dose dependently increased total inositol phosphates with an EC(50) of 2.1 nM. ET-1 reduced renin mRNA by 68% independently of changes in message decay. With the use of a renin-luciferase reporter system in As4.1 cells, ET-1 reduced luciferase activity by 51%, suggesting that renin gene transcription is directly modified by ET-1.
Subject(s)
Calcium/metabolism , Cyclic GMP/analogs & derivatives , Endothelin-1/pharmacology , Gene Expression Regulation/physiology , Kidney/metabolism , Renin/metabolism , Animals , Cell Line , Clone Cells , Cyclic GMP/pharmacology , Dose-Response Relationship, Drug , Endothelin Receptor Antagonists , Endothelin-3/pharmacology , Gene Expression Regulation/drug effects , Inositol Phosphates/metabolism , Juxtaglomerular Apparatus/cytology , Juxtaglomerular Apparatus/drug effects , Juxtaglomerular Apparatus/metabolism , Kidney/cytology , Kidney/drug effects , Kidney Neoplasms , Mice , Mice, Transgenic , Nitric Oxide Donors/pharmacology , Peptides, Cyclic/pharmacology , RNA, Messenger/metabolism , Receptor, Endothelin A , Renin/genetics , Second Messenger Systems/drug effects , Second Messenger Systems/physiology , Signal Transduction/drug effects , Signal Transduction/physiologyABSTRACT
-We have used comparative sequence analysis to evaluate a putative silencer element that has been proposed to be involved in the differential tissue-expression of the murine renin genes: Ren-1 and Ren-2. In the mouse, these genes share a similar pattern of tissue-specific renin expression. One significant difference is seen in the submandibular gland (SMG) where renin expression from the Ren-2 locus is 100-fold greater than the expression from the Ren-1 locus. One model proposes that this differential expression arises from the interplay among a negative regulatory element and a cAMP responsive element, their respective binding factors, and the disruption of the negative regulatory element by an insertion (M2) that is found in Ren-2 but not in Ren-1. The abrogation of the negative regulatory element's function as a result of the M2 insertion was proposed to be specifically responsible for the higher level of Ren-2 expression in the SMG as compared with Ren-1. We have assessed this hypothesis by looking at an allelic variant in the closely related mouse species M. hortulanus. This species shares the same high level of Ren-2 expression in the SMG as seen in other Ren-2 positive mouse strains. However, the Ren-2 M. hortulanus allele does not appear to contain the disruptive M2 element according to restriction-enzyme mapping. Our sequence analysis confirms that the M. hortulanus Ren-2 allele contains the same sequence elements present in the DBA/2 Ren-2 allele except for the M2 element. Moreover, the proposed negative regulatory element is intact at the sequence level in Ren-2 M. hortulanus allele. This analysis suggests that any involvement of the negative regulatory element in differential Ren-1 and Ren-2 expression in the SMG is not as straightforward as previously hypothesized.