Competency assessment of residents of Intensive Care Medicine through a simulation-based objective structured clinical evaluation (OSCE). A multicenter observational study.

OBJECTIVES: The current official model of training in Intensive Care Medicine (ICM) in Spain is based on exposure to experiences through clinical rotations. The main objective was to determine the level of competency (I novice to V independent practitioner) achieved by the residents at the end of the 3rd year of training (R3) in ICM through a simulation-based OSCE. Secondary objectives were: (1) To identify gaps in performance, and (2) To investigate the reliability and feasibility of conducting simulation-based assessment at multiple sites. DESIGN: Observational multicenter study. SETTING: Thirteen Spanish ICU Departments. PARTICIPANTS: Thirty six R3. INTERVENTION: The participants performed on five, 15-min, high-fidelity crisis scenarios in four simulation centers. The performances were video recorded for later scoring by trained raters. MAIN VARIABLES OF INTEREST: Via a Delphi technique, an independent panel of expert intensivists identified critical essential performance elements (CEPE) for each scenario to define the levels of competency. RESULTS: A total of 176 performances were analyzed. The internal consistency of the check-lists were adequate (KR-20 range 0.64-0.79). Inter-rater reliability was strong [median Intraclass Correlation Coefficient across scenarios: 0.89 (0.65-0.97)]. Competency levels achieved by R3 were: Level I (18.8%), II (35.2%), III (42.6%), IV/V (3.4%). Overall, a great heterogeneity in performance was observed. CONCLUSION: The expected level of competency after one year in the ICU was achieved only in half of the performances. A more evidence-based educational approach is needed. Multiple center simulation-based assessment showed feasibility and reliability as an evaluation method of competency. TRIAL REGISTRATION: COBALIDATION. NCT04278976. (https://register. CLINICALTRIALS: gov).

Competency assessment of residents of Intensive Care Medicine through a simulation-based objective structured clinical evaluation (OSCE). A multicenter observational study / Evaluación del nivel de competencia de residentes de Medicina Intensiva mediante una evaluación clínica, objetiva y estructurada basada en simulación (ECOE). Estudio multicéntrico observacional

Objectives The current official model of training in Intensive Care Medicine (ICM) in Spain is based on exposure to experiences through clinical rotations. The main objective was to determine the level of competency (I novice to V independent practitioner) achieved by the residents at the end of the 3rd year of training (R3) in ICM through a simulation-based OSCE. Secondary objectives were: (1) To identify gaps in performance, and (2) To investigate the reliability and feasibility of conducting simulation-based assessment at multiple sites. Design Observational multicenter study. Setting Thirteen Spanish ICU Departments. Participants Thirty six R3. Intervention The participants performed on five, 15-min, high-fidelity crisis scenarios in four simulation centers. The performances were video recorded for later scoring by trained raters. Main variables of interes Via a Delphi technique, an independent panel of expert intensivists identified critical essential performance elements (CEPE) for each scenario to define the levels of competency. Results A total of 176 performances were analyzed. The internal consistency of the check-lists were adequate (KR-20 range 0.64–0.79). Inter-rater reliability was strong [median Intraclass Correlation Coefficient across scenarios: 0.89 (0.65–0.97)]. Competency levels achieved by R3 were: Level I (18.8%), II (35.2%), III (42.6%), IV/V (3.4%). Overall, a great heterogeneity in performance was observed. Conclusio The expected level of competency after one year in the ICU was achieved only in half of the performances. A more evidence-based educational approach is needed. Multiple center simulation-based assessment showed feasibility and reliability as an evaluation method of competency (AU)

Objetivos El modelo de formación en medicina intensiva (MI) en España se basa en la experiencia adquirida durante una serie de rotaciones programadas por diferentes áreas clínicas. El objetivo principal del estudio fue determinar el nivel de competencia (I principiante – V autónomo) de los residentes de MI al finalizar el tercer año de residencia (R3) mediante una ECOE basada en simulación. Objetivos secundarios: 1) identificar brechas en el desempeño; 2) investigar la fiabilidad y validez de una ECOE simulada multicéntrica como método de evaluación. Diseño Estudio multicéntrico observacional. Ámbito Trece servicios españoles de Medicina Intensiva. Participantes Treinta y seis R3. Intervención Los 36 R3 participaron en cinco escenarios clínicos simulados de 15 minutos de duración en cuatro centros de simulación. Las actuaciones se grabaron en video y posteriormente se calificaron por pares de expertos. Variables de interés principales Un panel de intensivistas expertos seleccionó mediante el método Delphi los elementos críticos esenciales de cada escenario para definir los niveles de competencia. Resultados La consistencia interna de los listados de verificación fue adecuada (KR-20:0,64-0,79). La fiabilidad interjueces fue elevada (coeficiente de correlación intraclase [mediana]: 0,89 [0,65-0,97]). Los niveles de competencia conseguidos fueron: nivel I (18,8%), II (35,2%), III (42,6%), IV/V (3,4%). Globalmente, se observó una gran heterogeneidad en el desempeño. Conclusión El nivel de competencia esperado se logró únicamente en la mitad de las actuaciones. Se necesita un modelo de formación más basado en objetivos y evidencias. La evaluación mediante escenarios simulados en múltiples centros demostró ser factible y fiable (AU)

Diagnóstico serológico de Neospora caninum en vacas del municipio de Tuta, Boyacá / Serological diagnosis of Neospora caninum in cows of Tuta, Boyacá

RESUMEN Neospora caninum es un parásito protozoario del filo Apicomplexa que ha sido reconocido como causante de abortos y fallas reproductiva en el ganado de todo el mundo. Aunque en Colombia existen algunos estudios sobre la seroprevalencia de esta enfermedad, la información sigue siendo limitada. Objetivo: establecer la seroprevalencia de N. caninum en vacas lecheras del municipio de Tuta (Boyacá, Colombia). Materiales y Métodos: se muestrearon 375 animales. Las muestras se procesaron bajo la técnica de ELISA indirecta y se realizó un análisis estadístico con la prueba de chi-cuadrado de asociación-independencia para determinar si existía relación entre la presencia de anticuerpos contra N. caninum y las diferentes variables reproductivas. Resultados: el 52% de los individuos fueron positivos a anticuerpos contra N. caninum y la única variable reproductiva que presentó relación estadística con la presencia del protozoo fue la repetición de celo; por otra parte, no existió relación entre edad y raza de los bovinos y la presencia de N. caninum. Conclusión: la seroprevalencia es elevada si se compara con los datos reportados con anterioridad en otras regiones del país; no obstante, estos resultados no demostraron la presencia de enfermedad en los animales analizados, pero sí la evidencia antigénica, lo que sugiere que en algún momento de la vida se infectaron con el agente y promovieron la formación de anticuerpos específicos.

ABSTRACT Neospora caninum is a protozoan parasite of the phylum Apicomplexa, and has been recognized as a major cause of abortion and reproductive failure in cattle in the world, Although in Colombia there are some studies on the seroprevalence of this disease, even so the information remains limited. Objective: the aim of this study was to establish the seroprevalence of N. caninum in dairy cows of Tuta, (Boyacá, Colombia). Materials and methods: 375 animals were sampled. The samples were processed under indirect ELISA technique, a statistical analysis was performed with the chi-square association independence test to determine if there was a relationship between the presence of antibodies against N. caninum and the different reproductive variables. Results: it was observed that 52% of the individuals were positive for antibodies against N. caninum. the only reproductive variable that presented a statistical relationship with the presence of the protozoan was repetition of estrus, there was no relationship between age and breed of the cattle and the presentation of N.caninum. Conclusions: the seroprevalence is high if they if you keep in mind the seroprevalence data previously reported in other regions of the country, however, these results do not demonstrate the presence of disease in the animals analyzed, but the antigenic evidence, which implies that at some point life they became infected with the agent and promoted the formation of specific antibodies.

Resistance index measured by Doppler ultrasound as a predictor of graft function after kidney transplantation.

INTRODUCTION: Doppler ultrasound (US) has become the primary imaging technique for the evaluation of renal transplants. It provides information about the intrarenal resistance index (RI). A high RI is seen in every form of graft dysfunction. In this article, we review the utility of sonography, particularly the intrarenal RI measured early after renal transplant, as a predictor of acute and chronic clinical outcome in patients. RESULTS: RI is a valuable marker to determine graft function and related vascular complications. It reveals a strong correlation with serum creatinine levels measured days after transplant. Its elevation is typical for acute tubular necrosis and can be used to predict its duration. An RI >1 (absent end-diastolic flow) seen in the first weeks after transplant is associated with impaired renal graft recovery. In addition, it is an early predictor of chronic allograft nephropathy (even correlated with biopsy results), which will allow a change in therapy. CONCLUSIONS: RI measured serially in the early period after kidney transplantation is a valuable marker for determining renal graft function. It is also useful for demonstrating various types of graft dysfunction; however, it cannot differentiate between them. In recent studies, extrarenal factors in kidney transplantation (eg, recipient's age) may significantly influence RI in the recipient, demonstrating that RI depends on the vascular characteristics of the recipient and not on the graft itself.

Diabetes mellitus and renal transplantation in adults: is there enough evidence for diagnosis, treatment, and prevention of new-onset diabetes after renal transplantation?

BACKGROUND: New-onset diabetes after renal transplantation (NODAT) is one of the most frequent metabolic complications after transplantation; it is present in ∼25% of kidney transplant recipients, increasing their cardiovascular risk and inducing graft damage. The medical approach of this entity is still a matter of controversy, so our aim was to review the evidence available and offer a practical approach for diagnosis, treatment, and follow-up. METHODS: A systematic review of the literature in the Medline, Embase, Cochrane, and Lilacs databases was carried out with the use of the terms "Diabetes Mellitus," "Kidney Transplantation," "Drug Therapy," "Prognosis," "Therapeutics," and "Risk Factors." Randomized controlled trials, meta-analyses, and observational studies were included. RESULTS: The main risk factors were elevated body mass index, family history of diabetes, recipient >60 years old, hepatitis C virus infection, and treatment with tacrolimus/corticosteroids or sirolimus. Some small studies suggest that thiazolidinediones, sulfonylureas, glinides, and dipeptidyl peptidase 4 inhibitors could be useful in the treatment of the disease. NODAT constitutes a prognostic factor for the renal transplant. Although there is a higher risk of developing diabetes in kidney transplant recipients than in the general population, both populations share the same diagnostic criteria. CONCLUSIONS: There is no consensus on the treatment regimen for these patients. It is necessary to review the diagnostic criteria and the screening methods for NODAT, given the higher susceptibility of kidney transplant recipients to develop this entity; therefore, an earlier intervention could be implemented to decrease the negative effects that this disease has on the kidney graft and the recipient.

Sexual dysfunction in patients with chronic renal disease: does it improve with renal transplantation?

INTRODUCTION: Currently in the medical literature there is controversy about the role and effects of renal transplantation (RTx) on the sexual functioning of patients with terminal chronic renal disease (TCRD). There is no clear evidence of the real impact of RTx on sexual functioning in these patients. This article makes a brief summary of the literature, describing the most important clinical concepts, evaluates results, and compares the impact of renal transplantation on sexual function before and after the procedure. MATERIAL AND METHODS: Medline and the Embase database were consulted; Medical Subject Headings used were "Kidney Failure, Chronic," "Kidney Transplantation," "Sexual Dysfunction," "Pleasure," "Sexual Behavior," and "Quality of Life." Search was limited to articles within the last 15 years. RESULTS: Sexual dysfunction affects almost 87% of male and 60% to 80% of female patients; 40% to 78% of male patients with RTx report a sense of improvement on global sexual function, 25% to 30% of female patients of reproductive age with RTx report improvement in sexual performance and decreasing of menstrual cycle alterations. Fewer than 10% of patients receiving an RTx reported a decrease of sexual satisfaction. DISCUSSION: Despite controversy, reviewed results show significant improvement of sexual functioning after receiving an RTx. Those who report no improvement of sexual functioning may have conditions attributable to implicit characteristics of TCRD (age, neuroendocrine/metabolic problems) and/or RTx (immunosuppressive therapy). RTx improves sexual functioning by improving sexual desire and overall sexual satisfaction. CONCLUSION: Identified determinants associated with improvement of sexual functioning are decreased prolactin serum level, age younger than 45 years, and onset of dialysis less than 6 months.

Pregnancy and kidney transplantation, triple hazard? Current concepts and algorithm for approach of preconception and perinatal care of the patient with kidney transplantation.

INTRODUCTION: Kidney transplantation (KT) increases fertility in patients with chronic kidney disease (CKD); their pregnancies are considered of high risk because of higher incidence of complications. The objective of this study was to propose, based on current concepts, an algorithm for preconception and perinatal care of KT recipients with a desire for parity. MATERIALS AND METHODS: We searched for literature published within the last 10 years related to pregnancy and KT. Based on the results, we developed an algorithm for the approach to preconception/perinatal care of these patients. RESULTS: Preconception care begins with pre-KT study of women of childbearing age, continues with contraception, and ends with the proper selection of candidates; an exhaustive study of health condition, function of renal graft, and infections that may affect the fetus is required; fetotoxic drugs must be suspended, immunosuppression must be based in corticosteroids, azathioprine, and tacrolimus or cyclosporine. Once conception is achieved, prenatal care should be done by a multidisciplinary team; follow-up of graft function and maternal-fetal health must be strict. Pregnancy has no deleterious effect on graft function; pelvic localization of graft does not contraindicate vaginal delivery; breastfeeding is indicated if immunosuppressive levels in the newborn are low. CONCLUSIONS: KT returns the possibility of motherhood to women with CKD. Proper selection and optimal care of patients determines success in maternal, fetal, and graft results.

Early feeding to modify digestive enzyme activity in broiler chickens / La alimentación temprana como modificador de la actividad de enzimas digestivas en pollos de engorde

Objetive. To evaluate the effect on digestive enzyme activity in broiler chickens by providing food in the first 48 hrs. after birth. Materials and methods. After incubating 300 fertile eggs from Hubbard breeding and immediately after hatching, the chicks were randomly assigned to treatments: fasting (from hatching to 48 hrs.); Hydrated Balanced Food (HBF) from birth to 48 hrs.; commercial hydrating supplement (CHS) from birth to 48 hrs. The diets were provided ad libitum. After 48 hrs. a commercial diet was fed. At birth and at 48 and 72 hrs. of age 30 chicks/treatment were sacrificed to determine the enzyme activity of maltase, sucrase, alkaline phosphatase, phytase, a-amylase, trypsin and lipase in samples of duodenal or pancreatic homogenate. Results. The supply of HBF or CHS during the first 48 hrs. of life increased the activity of maltase, sucrase and phytase in the first 3 days of life, with values ​​between 1.2 and up to 4-fold compared to the control (p<0.05). Chickens that fasted for the first 48 hrs. had higher activity of the pancreatic enzymes a-amylase, trypsin, and lipase at 72 hrs. of life (p<0.05). Conclusions. The food supply in the first 48 hrs. after hatching increases the duodenal enzyme activity in the intestinal brush border during the first 3 days of age in broiler chickens.

Objectivo. Evaluar el efecto sobre la actividad de enzimas digestivas en pollos de engorde al suministrar alimento en las primeras 48 h de nacidos. Materiales y métodos. Después de incubar 300 huevos fértiles provenientes de reproductoras Hubbard e inmediatamente después de la eclosión, los pollos fueron asignados al azar a los tratamientos: ayuno (desde la eclosión hasta 48 h); alimento balanceado hidratado (ABH) desde el nacimiento hasta las 48 h; suplemento hidratante comercial (SHC) desde el nacimiento hasta las 48 h. Las dietas fueron suministradas ad libitum. A partir de las 48 h se suministró una dieta comercial. Al nacer y a las 48 y 72 h de nacidos, fueron sacrificados 30 pollos/tratamiento para las determinaciones de las actividades de las enzimas maltasa, sacarasa, fosfatasa alcalina, fitasa, α-amilasa, tripsina y lipasa en muestras de homogenado duodenal o pancreático. Resultados. El suministro de ABH o SHC durante las primeras 48 h de vida aumentó la actividad de maltasa, sacarasa y fitasa en los primeros 3 días de edad, con valores entre 1.2 y hasta 4 veces en comparación con el control (p<0.05). Los pollos en ayuno durante las primeras 48 h presentaron mayor actividad de las enzimas pancreáticas α-amilasa, tripsina y lipasa a las 72 h de vida (p<0.05). Conclusiones. El suministro de alimentos en las primeras 48 h después de la eclosión aumenta la actividad de las enzimas duodenales del borde en cepillo intestinal durante los primeros 3 días de edad en pollos de engorde.

Urinary tract infection and kidney transplantation: a review of diagnosis, causes, and current clinical approach.

Urinary tract infection (UTI), including bacteriuria, cystitis, and pyelonephritis, is the most common infectious complication after kidney transplantation (KTx). Over the past few years, many medical groups assumed this pathological process to be a "benign" disease in kidney transplant recipients (KTxR). However, increased medical and scientific advances in knowledge and management of KTx complications have raised questions about UTI as a pathological process that decreases and worsens kidney allograft function and survival. This review sought to clarify diagnostic criteria, as well as to describe factors associated with UTI in KTxR that expose its effects on the allograft. We sought to show the uncertainty of important topics within the field of UTI among kidney allograft recipients and to propose a practical clinical approach to KTxRs with UTI.

Growth, chronic kidney disease and pediatric kidney transplantation: is it useful to use recombinant growth hormone in Colombian children with renal transplant?

Kidney transplantation has become the best treatment for children with chronic kidney disease (CKD). In recent times, knowledge concerning the effect of CKD and kidney transplantation over the normal growth rate has increased; now it is known that 40% of children with CKD do not reach the expected height for age. Growth retardation has been associated with the type of nephropathy, metabolic and endocrine disorders that are secondary to kidney disease, immunosuppressive therapy with glucocorticoids, and suboptimal function of renal allograft. Nowadays, we know better the role of the growth hormone/insulin-like growth factor 1 axis in growth retardation we can see it in children with CKD or recipients of renal allograft. Several studies have shown that administration of recombinant growth hormone (rhGH) has a positive effect on the longitudinal growth of children and teenagers who have received a kidney transplant. On the other hand, there have been reported side effects associated with using rhGH; however, these are not statistically significant. In this article, we show a small review about growth in children with CKD and/or recipients of renal allografts the growth pattern of three children who were known by the Transplant Group of National University of Colombia, and the results obtained with the use of rhGH in one of these cases. We want to show the possibility of achieving a secure use of rhGH in children with CKD and its use as a therapeutic option for treating the growth retardation in children with kidney transplantation, and set out the need of typifying the growth pattern of Colombian children with CKD and/or who are recipients of renal allografts through multicenter studies to propose and analyze the inclusion of rhGH in the therapeutic scheme of Colombian children with these two medical conditions. rhGH could be a useful tool for treating children with CKD or kidney transplantation who have not reached the expected longitudinal growth for age. However, it is necessary to know the growth pattern standards for Colombian children with CKD or kidney transplant in Bogotá-Colombia to include the rhGH in clinical protocols for treatment of these patients.

Antibody persistence in young adults 1 year after MMR immunization by aerosol or by subcutaneous route.

Information on antibody persistence after aerosol revaccination with MMR components is limited. Thus, antibody titers were determined in 283 adult participants in a MMR vaccine trial 12 months after revaccination. One group had received aerosolized Triviraten vaccine while two other groups received either injected Triviraten or MMR II vaccine. Both MMR vaccines contained the same rubella strain, but different measles and mumps strains. Seropositivity to measles persisted in 98% of aerosolized vaccine recipients, 92% of injected Triviraten, and 95% of injected MMR II. All participants in the three groups retained seropositivity to rubella, while less than 50% remained seropositive to mumps.

Integration of ion exchange and non-dispersive solvent extraction processes for the separation and concentration of Cr(VI) from ground waters.

The focus of this work has been the study of simultaneous removal and recovery of Cr(VI) from ground waters with a high concentration of the metal (700 mg/l). The main objectives of water cleaning were the decrease of the Cr(VI) concentration down to the limits indicated by the Spanish regulations for discharge into channel waters (0.5 mg/l) and the recovery of the chromate compounds up to 15 g/l. The integration of two technologies: non-dispersive solvent extraction and anion exchange is presented as an environmental compatible solution. The final hybrid process allows the individual shortcomings of each technology to be overcome and leads to an optimum process configuration. Non-dispersive solvent extraction (NDSX) is used mainly for the concentration of the metal in a back-extraction solution and ion exchange (IE) is used for the depuration of the metal in the ground water down to 0.5 mg/l. The integrated process has been carried out on two different scales: laboratory and pilot plant, with satisfactory results being obtained.

Macroscopic evidence of microscopic dynamics in the Fermi-Pasta-Ulam oscillator chain from nonlinear time-series analysis.

The problem of detecting specific features of microscopic dynamics in the macroscopic behavior of a many-degrees-of-freedom system is investigated by analyzing the position and momentum time series of a heavy impurity embedded in a chain of nearest-neighbor anharmonic Fermi-Pasta-Ulam oscillators. Results obtained in a previous work [M. Romero-Bastida, Phys. Rev. E 69, 056204 (2004)] suggest that the impurity does not contribute significantly to the dynamics of the chain and can be considered as a probe for the dynamics of the system to which the impurity is coupled. The (r,tau) entropy, which measures the amount of information generated by unit time at different scales tau of time and r of the observable, is numerically computed by methods of nonlinear time-series analysis using the position and momentum signals of the heavy impurity for various values of the energy density epsilon (energy per degree of freedom) of the system and some values of the impurity mass M. Results obtained from these two time series are compared and discussed.

Anticonvulsant activity of progesterone and neurosteroids in progesterone receptor knockout mice.

Many of the biological actions of progesterone are mediated through the progesterone receptor (PR), a nuclear transcription factor. Progesterone is well recognized to protect against seizures in animal models. Although this activity has been attributed to the progesterone metabolite allopregnanolone, a GABAA receptor-modulating neurosteroid with anticonvulsant properties, PRs could also play a role. Here, we used PR knockout (PRKO(-/-)) mice bearing a targeted deletion of the PR gene that eliminates both isoforms of the PR to investigate the contribution of the PR to the anticonvulsant activity of progesterone. The protective activity of progesterone was examined in female and male homozygous PRKO mice and isogenic wild-type controls in the pentylenetetrazol (PTZ), maximal electroshock, and amygdala-kindling seizure models. In all three models, the anticonvulsant potency of progesterone was undiminished in PRKO mice compared with control mice. On the contrary, there was a substantial increase in the anticonvulsant potency of progesterone in the PTZ and kindling models. The antiseizure activity of progesterone in PRKO mice was reversed by pretreatment with finasteride, a 5alpha-reductase inhibitor that blocks the metabolism of progesterone to allopregnanolone. Unlike progesterone, the neurosteroids allopregnanolone and allotetrahydrodeoxycorticosterone exhibited comparable anticonvulsant potency in PRKO and wild-type mice. The basis for the heightened progesterone responsiveness of PRKO mice is not attributable to pharmacokinetic factors, because the plasma allopregnanolone levels achieved after progesterone administration were not greater in the PRKO mice. These studies provide strong evidence that the PR is not required for the antiseizure effects of progesterone, which mainly occurs through its conversion to the neurosteroid allopregnanolone.

Capture-recapture to estimate the number of street children in a city in Brazil.

BACKGROUND: Street children are an increasing problem in Latin America. It is however difficult to estimate the number of children in the street as this is a highly mobile population. AIMS: To estimate the number of street children in Aracaju, northeast Brazil, and describe the characteristics of this population. METHODS: Three independent lists of street children were constructed from a non-governmental organisation and cross-sectional surveys. The number of street children was estimated using the capture-recapture method. The characteristics of the children were recorded during the surveys. RESULTS: The estimated number of street children was 1456. The estimated number of street children before these surveys was 526, although non-official estimates suggested that there was a much larger population. Most street children are male, maintain contact with their families, and are attending school. Children contribute to the family budget a weekly average of R21.2 dollars (4.25 pounds sterling, 6.0 euros, US7.5 dollars) for boys and R17.7 dollars(3.55 pounds sterling, 5.0 euros, US6.3 dollars) for girls. CONCLUSION: Street children of Aracaju have similar characteristics to street children from other cities in Brazil. The capture-recapture method could be a useful method to estimate the size of this highly mobile population. The major advantage of the method is its reproducibility, which makes it more acceptable than estimates from interested parties.

Immunostimulatory DNA sequences inhibit respiratory syncytial viral load, airway inflammation, and mucus secretion.

BACKGROUND: Immunostimulatory DNA sequences (ISS) activate the innate immune system to generate antiviral cytokines, such as IFN-gamma. OBJECTIVE: This study investigated whether ISS could reduce viral load, mucus secretion, airway inflammation, and airway hyperreactivity to methacholine in a mouse model of respiratory syncytial virus (RSV) infection. METHODS: Mice were pretreated with ISS 6 days before RSV infection, and lung indices of RSV viral load (viral titer and PCR), bronchoalveolar lavage fluid cytokines (IFN-gamma), airway inflammation (peribronchial inflammation and periodic acid-Schiff-positive mucus cells), and airway hyperreactivity (methacholine responsiveness) were assessed 4 to 6 days after RSV infection. RESULTS: ISS induced the expression of the antiviral cytokine IFN-gamma in the lung, and this was associated with significantly reduced RSV viral titers, mucus secretion, and peribronchial inflammation. ISS reduced, but did not significantly inhibit, RSV-induced airway hyperreactivity to methacholine. CONCLUSION: Because ISS induced significant levels of lung IFN-gamma, an immunization strategy based solely on the administration of IFN-gamma may be insufficient to inhibit RSV-induced airway hyperreactivity to methacholine, an endpoint important in the subset of RSV-infected subjects with asthma.