Short-course empiric antibiotic therapy for possible early-onset sepsis in the NICU.

OBJECTIVE: On 2/2019, the Neonatal Antimicrobial Stewardship Program at Nationwide Children's Hospital recommended reducing empirical antibiotic therapy for early-onset sepsis (EOS) from 48 to 24 hours with a TIME-OUT. We describe our experience with this guideline and assess its safety. METHODS: Retrospective review of newborns evaluated for possible EOS at 6 NICUs from 12/2018-7/2019. Safety endpoints were re-initiation of antibiotics within 7 days after discontinuation of the initial course, positive bacterial blood or cerebrospinal fluid culture in the 7 days after antibiotic discontinuation, and overall and sepsis-related mortality. RESULT: Among 414 newborns evaluated for EOS, 196 (47%) received a 24 hour rule-out sepsis antibiotic course while 218 (53%) were managed with a 48 hour course. The 24-hour rule-out group were less likely to have antibiotics re-initiated and did not differ in the other predefined safety endpoints. CONCLUSION: Antibiotic therapy for suspected EOS may be discontinued safely within 24 hours.

Securing access to a comprehensive diagnostic panel for children with suspected acute lymphoblastic leukemia: Results from the Mexico in Alliance with St. Jude "Bridge Project".

Background: The "Bridge Project" is a Mexico in Alliance with St. Jude (MAS) initiative developed in 2019 to improve access, accuracy, and timeliness of specialized diagnostic studies for patients with suspected acute lymphoblastic leukemia (ALL). The project strategy relies on service centralization to improve service delivery, biological characterization, risk-group classification, and support proper treatment allocation. Methods: This is an ongoing prospective multisite intersectoral quality improvement (QI) project available to all patients 0-18 years of age presenting with suspected ALL to the 14 actively participating institutions in 12 Mexican states. Institutions send specimens to one centralized laboratory. From a clinical standpoint, the project secures access to a consensus-derived comprehensive diagnostic panel. From a service delivery standpoint, we assess equity, timeliness, effectiveness, and patient-centeredness. From an implementation science standpoint, we document feasibility, utility, and appropriateness of the diagnostic panel and centralized approach. This analysis spans from July 2019 to June 2023. Results: 612 patients have accessed the project. The median age was 6 years (IQR 3-11), and 53% were males. 94% of the specimens arrived within 48 hours, which documents the feasibility of the centralized model, and 100% of the patients received precise and timely diagnostic results, which documents the effectiveness of the approach. Of 505 (82.5%) patients with confirmed ALL, 463/505 (91.6%) had B-cell ALL, and 42/505 (8.3%) had T-cell ALL. High-hyperdiploidy was detected by DNA index in 36.6% and hypodiploidy in 1.6%. 76.6% of the patients had conclusive karyotype results. FISH studies showed t(12;21) in 15%, iAMP21 in 8.5%, t(1;19) in 7.5%, t(4;11) in 4.2%, t(9;22) in 3.2%, del(9)(p21) in 1.8%, and TRA/D (14)(q11.2) rearrangement in 2.4%. Among B-cell ALL patients, 344/403 (85.1%) had Day 15 MRD<1% and 261/305 (85.6%) Day 84 MRD<0.01. For T-cell ALL patients 20/28 (71.4%) had Day 29 MRD<0.01% and 19/22 (86.4%) Day 84 MRD<0.01%. Conclusions: By securing access to a standardized consensus-derived diagnostic panel, the Bridge Project has allowed better characterization of childhood ALL in Mexico while producing unprecedented service improvements and documenting key implementation outcomes. We are using these results to inform iterative changes to the diagnostic panel and an associated treatment guideline (MAS-ALL18).

Efectos para la salud respiratoria de los trabajadores que usan sustancias químicas en su medio laboral. Una revisión sistemática

Introducción: A nivel laboral se presentan muchas afecciones en la salud de los trabajadores debido a riesgos químicos a los que están expuestos diariamente; a esto se suma la falta de compromiso de los empleadores con la salud de sus subordinados, ya que estos manejan diariamente sustancias químicas nocivas sin la debida protección personal. Objetivo: Identificar los efectos nocivos para la salud respiratoria de los trabajadores expuestos en su área laboral a sustancias químicas. Metodología: Se realizó una revisión sistemática de la literatura, se consideraron artículos de investigación realizados a partir de 2014 hasta 2020. Las palabras claves fueron "trabajadores" OR "laboral" AND "contaminantes" OR "agentes" AND "enfermedad reconocida", y se revisaron artículos de bases de datos como Google académico, SciELO (Scientific Electronic Library Online), ProQuest, Redalyc y Biblioteca Digital Universidad Cooperativa de Colombia. Conclusión: La salud de los trabajadores, sin importar en qué área laboral se desempeñen, se ve afectada en varios aspectos, los cuales pueden variar; entre ellos se encuentran los sistemas respiratorios, el sistema reproductor, el sistema nervioso, el sistema tegumentario y el sistema gastrointestinal de forma crónica o aguda. Entre los agentes más comunes causantes de las enfermedades respiratorias se reportan los pesticidas, el plomo y solventes.

Introduction: At work, there are many health conditions for workers due to chemical risks to which they are daily exposed, in addition to the lack of commitment of employers to the health of their subordinates, since they handle harmful chemical substances on a daily basis without proper personal protection. Objective: to identify the harmful effects for the respiratory health of workers exposed in their workplace to chemical substances. Methodology: A systematic review of the literature was carried out, research articles from 2014 to 2020 were considered. The keywords were "Workers" OR "Labor" AND "Contaminants" OR "Agents" AND "Recognized disease", and articles from databases such as Google Academic, SciELO (Scientific Electronic Library Online), ProQuest, Redalyc, and the Cooperative University of Colombia Digital Library were reviewed. Conclusion: The health of workers, regardless of their work area, is affected in several aspects which may vary. Among them, the respiratory systems, the reproductive system, the nervous system, the integumentary system, and the gastrointestinal system, in a chronic or acute manner. Among the most common causative agents of respiratory diseases are pesticides, lead, and solvents.

Synthesis and Electronic Applications of Particle-Templated Ti3C2Tz MXene-Polymer Films via Pickering Emulsion Polymerization.

MXene/polymer composites have gained widespread attention due to their high electrical conductivity and extensive applications, including electromagnetic interference (EMI) shielding, energy storage, and catalysis. However, due to the difficulty of dispersing MXenes in common polymers, the fabrication of MXene/polymer composites with high electrical conductivity and satisfactory EMI shielding properties is challenging, especially at low MXene loadings. Here, we report the fabrication of MXene-armored polymer particles using dispersion polymerization in Pickering emulsions and demonstrate that these composite powders can be used as feedstocks for MXene/polymer composite films with excellent EMI shielding performance. Ti3C2Tz nanosheets are used as the representative MXene, and three different monomers are used to prepare the armored particles. The presence of nanosheets on the particle surface was confirmed by X-ray photoelectron spectroscopy and scanning electron microscopy. Hot pressing the armored particles above Tg of the polymer produced Ti3C2Tz/polymer composite films; the films are electrically conductive because of the network of nanosheets templated by the particle feedstocks. For example, the particle-templated Ti3C2Tz/polystyrene film had an electrical conductivity of 0.011 S/cm with 1.2 wt % of Ti3C2Tz, which resulted in a high radio frequency heating rate of 13-15 °C/s in the range of 135-150 MHz and an EMI shielding effectiveness of ∼21 dB within the X band. This work provides a new approach to fabricate MXene/polymer composite films with a templated electrical network at low MXene loadings.

Flocculation of MXenes and Their Use as 2D Particle Surfactants for Capsule Formation.

MXenes, transition metal carbides or nitrides, have gained great attention in recent years due to their high electrical conductivity and catalytic activity, hydrophilicity, and diverse surface chemistry. However, high hydrophilicity and negative ζ potential of the MXene nanosheets limit their processability and interfacial assembly. Previous examples for modifying the dispersibility and wettability of MXenes have focused on the use of organic ligands, such as alkyl amines, or covalent modification with triethoxysilanes. Here, we report a simple method to access MXene-stabilized oil-in-water emulsions by using common inorganic salts (e.g., NaCl) to flocculate the nanosheets and demonstrate the use of these Pickering emulsions to prepare capsules with shells of MXene and polymer. Ti3C2Tz nanosheets are used as the representative MXene. The salt-flocculated MXene nanosheets produce emulsions that are stable for days, as determined by optical microscopy imaging. The incorporation of a diisocyanate in the discontinuous oil phase and diamine in the continuous water phase led to interfacial polymerization and the formation of capsules. The capsules were characterized by Fourier transform infrared (FTIR) spectroscopy, X-ray photoelectron spectroscopy (XPS), and scanning electron microscopy (SEM), confirming the presence of both polymer and nanosheets. The addition of ethanol to the capsules led to the removal of the toluene core and retention of the shell structure. The ability to assemble MXene nanosheets at fluid-fluid interfaces without the use of ligands or cosurfactants expands the accessible material constructs relevant for biomedical engineering, water purification, energy storage, electromagnetic electronics, catalysis, and so on.

Risk Factors Associated With Health Care Utilization in Preschool Recurrent Wheezers in a Tropical Environment.

Introduction: The severity of wheezing episodes is related with the need for health services, but the factors associated with health care utilization in preschool recurrent wheezers in underdeveloped regions are unclear. Objective: To evaluate the factors associated with health care utilization in preschool recurrent wheezers in Cartagena, Colombia. Methods: One hundred twenty-seven recurrent wheezers (age 2-6 years old) who were admitted to the emergency room (ER) due to wheezing in a Pediatric reference hospital in Cartagena were included. Children were evaluated by means of questionnaires and classified according to the number of ER visits, need for hospitalization and history of intensive care unit (ICU) admission due to wheezing within the last year. Total serum IgE and specific IgE to house dust mite allergens (HDM) were measured by ImmunoCAP® and allergen sensitization was evaluated by skin prick tests (SPT). Results: The maternal report of nocturnal cough without fever in their children increased the risk to have ≥5 ER visits in the last year due to wheezing. The use of montelukast was negatively associated with hospitalization, while a history of pneumonia and lack of tap water, increased the risk of hospitalization due to wheezing. A history of bronchiolitis, family history of asthma, cohabiting with two or more siblings, passive exposure to smoke and lack of sewage facilities increased the risk of ICU admission due to wheezing. The presence of atopy evaluated by SPT reactivity, total IgE levels or specific IgE to HDM were not associated with health care utilization. We also found that seroprevalence of positive IgE (≥0.35 kU/L) was 27% to B. tropicalis and 20.3% to D. pteronyssinus but the prevalence of positive IgE sensitization to these allergens was below 2% and 8% when evaluated by SPT, respectively. Conclusions: Poverty indicators are associated with ICU admission in a group of preschool recurrent wheezers and should be considered as aggravating factors for wheezing. These factors must be systematically assessed in the medical approach in underdeveloped regions in the tropics. Nocturnal cough without fever is a symptom associated with frequent ER visits while atopy was not associated with health care utilization in preschool recurrent wheezers.

COVID-19 and Multisystem Inflammatory Syndrome in Latin American Children: A Multinational Study.

BACKGROUND: To date, there are no comprehensive data on pediatric COVID-19 from Latin America. This study aims to assess COVID-19 and Multisystem Inflammatory Syndrome (MIS-C) in Latin American children, to appropriately plan and allocate resources to face the pandemic on a local and international level. METHODS: Ambispective multicenter cohort study from 5 Latin American countries. Children 18 years of age or younger with microbiologically confirmed SARS-CoV-2 infection or fulfilling MIS-C definition were included. FINDINGS: Four hundred nine children were included, with a median age of 3.0 years (interquartile range 0.6-9.0). Of these, 95 (23.2%) were diagnosed with MIS-C. One hundred ninety-one (46.7%) children were admitted to hospital and 52 (12.7%) required admission to a pediatric intensive care unit. Ninety-two (22.5%) patients required oxygen support: 8 (2%) were started on continuous positive airway pressure and 29 (7%) on mechanical ventilation. Thirty-five (8.5%) patients required inotropic support. The following factors were associated with pediatric intensive care unit admission: preexisting medical condition (P < 0.0001), immunodeficiency (P = 0.01), lower respiratory tract infection (P < 0.0001), gastrointestinal symptoms (P = 0.006), radiologic changes suggestive of pneumonia and acute respiratory distress syndrome (P < 0.0001) and low socioeconomic conditions (P = 0.009). CONCLUSIONS: This study shows a generally more severe form of COVID-19 and a high number of MIS-C in Latin American children, compared with studies from China, Europe and North America, and support current evidence of a more severe disease in Latin/Hispanic children or in people of lower socioeconomic level. The findings highlight an urgent need for more data on COVID-19 in Latin America.

Allergic Rhinitis and OSA in Children Residing at a High Altitude.

BACKGROUND: OSA affects 2% to 4 % of the pediatric population; allergic rhinitis (AR) has been identified as a risk factor in sleep-disordered breathing, but no studies evaluating such an association have been conducted in high-altitude environments. The goal of this study was to assess whether the severity of AR is associated with the severity of OSA in children undergoing polysomnography (PSG) in the high-altitude city of Bogotá, Colombia. METHODS: A cross-sectional observational study of children with AR was conducted. Severity of AR was evaluated by using the AR health-related quality of life questionnaire for children (ESPRINT-15) and the Allergic Rhinitis and its Impact on Asthma (ARIA) classification. Diagnosis and severity of OSA were established by using PSG. Potential associations between AR severity and OSA severity were assessed by using binary logistic regression and the Spearman correlation coefficient (ρ). RESULTS: A total of 99 children (mean age, 7.9 years; 45% female) were included; 53% had OSA. An ESPRINT-15 score was associated with severe OSA (OR, 2.0; 95% CI, 1.12-6.04; P = .01). Patients with moderate/severe persistent rhinitis according to ARIA exhibited a 10.1-fold greater risk of severe OSA (OR, 10.15; 95% CI, 1.15-89.0). Furthermore, the apnea-hypopnea index was associated with the ESPRINT-15 score (ρ = 0.215; P = .03) and with the ARIA severity scale (P = .04; ρ = 0.203). CONCLUSIONS: In symptomatic children with AR residing at a high altitude, increasing AR severity is associated with more severe OSA.

Stabilization of oil-in-water emulsions with graphene oxide and cobalt oxide nanosheets and preparation of armored polymer particles.

Pickering emulsions are emulsions stabilized by particles instead of small molecules or polymers, and commonly consist of oil droplets dispersed into a continuous water phase with particles lying at the fluid-fluid interface. New particle surfactants are important for tuning the composition and properties of assemblies and enabling advanced applications, such as energy harvesting and management. Although most particle surfactants are spherical, graphene oxide (GO) nanosheets and clay platelets have garnered recent attention as 2D (i.e., planar) particle surfactants. Herein, we report the preparation of Pickering emulsions stabilized by a composite of GO nanosheets and cobalt oxide (CoOx) nanosheets, and illustrate the impact of GO:CoOx ratio, oil identity, and flocculating agent (i.e., salts) on emulsion formation and stability. Distinct effects were noted for salt concentration and identity, as well as GO: CoOx ratio. We further illustrate the applicability of these GO-CoOx-stabilized emulsions in dispersion polymerization, preparing polystyrene particles armored with both nanosheets. This work provides a method for facilitating oil-in-water emulsions with composite particle surfactants that are stable for at least a week and offers the foundation for using the fluid-fluid interface to architect structures of dissimilar materials.

Prostate-Specific Membrane Antigen Targeted Gold Nanoparticles for Theranostics of Prostate Cancer.

Prostate cancer is one of the most common cancers and among the leading causes of cancer deaths in the United States. Men diagnosed with the disease typically undergo radical prostatectomy, which often results in incontinence and impotence. Recurrence of the disease is often experienced by most patients with incomplete prostatectomy during surgery. Hence, the development of a technique that will enable surgeons to achieve a more precise prostatectomy remains an open challenge. In this contribution, we report a theranostic agent (AuNP-5kPEG-PSMA-1-Pc4) based on prostate-specific membrane antigen (PSMA-1)-targeted gold nanoparticles (AuNPs) loaded with a fluorescent photodynamic therapy (PDT) drug, Pc4. The fabricated nanoparticles are well-characterized by spectroscopic and imaging techniques and are found to be stable over a wide range of solvents, buffers, and media. In vitro cellular uptake experiments demonstrated significantly higher nanoparticle uptake in PSMA-positive PC3pip cells than in PSMA-negative PC3flu cells. Further, more complete cell killing was observed in Pc3pip than in PC3flu cells upon exposure to light at different doses, demonstrating active targeting followed by Pc4 delivery. Likewise, in vivo studies showed remission on PSMA-expressing tumors 14 days post-PDT. Atomic absorption spectroscopy revealed that targeted AuNPs accumulate 4-fold higher in PC3pip than in PC3flu tumors. The nanoparticle system described herein is envisioned to provide surgical guidance for prostate tumor resection and therapeutic intervention when surgery is insufficient.

Efficient fluoride removal using Al-Cu oxide nanoparticles supported on steel slag industrial waste solid.

A SSW/Al-Cu formed from an industrial solid waste and Al-Cu Nps are utilized for the removal of fluoride from aqueous solutions. The SSW/Al-Cu was obtained by a chemical reduction method. The SSW/Al-Cu was characterized by TEM, SEM, FT-IR, XRD, BET, and pHzpc techniques. The Nps were formed as bimetallic oxides and deposited in the form of spheroidal particles forming agglomerations. The sizes of these particles range from 1 to 3 nm. The surface area and average pore width of SSW/Al-Cu were 2.99 m2/g and 17.09 nm, respectively. The adsorption kinetics were better described using the second-order model, pointing to chemical adsorption with an equilibrium time of 540 min. The thermodynamic parameters obtained here confirm the spontaneous and endothermic nature of the process. The percentage of fluoride removal was 89.5% using the four-bladed disk turbine, and computational fluid dynamics (CFD) modeling demonstrated that using the four-bladed disk turbine helped improve the fluoride removal process. The maximum adsorption capacity was 3.99 mg/g. The Langmuir-Freundlich model best describes the adsorption process, which occurred by a combination of mechanisms, such as electrostatic interactions between the ions involved in the process. This study proves that the chemical modification of this waste solid created an efficient bimetallic nanomaterial for fluoride removal. Furthermore, the method of preparation of these nanocomposites is quite scalable.

Depresión y estrés postraumátíco en mujeres con pérdidas gestacíonales inducidas e involuntarias / Depression and Posttraumatic Stress in Women with Induced and Involuntary Gestational Losses / Depressão e estresse pós-traumático em mulheres com perdas gestacionais induzidas e involuntárias

Objetivo. Evaluar y comparar la aparición de trastornos de depresión (TD) y de estrés postraumático (TEPT) en mujeres después de una pérdida gestacional inducida o involuntaria que solicitaron atención psicológica. Método. Participaron 287 mujeres de la Ciudad de México atendidas en el Instituto para la Rehabilitación de la Mujer y la Familia A.C. (IRMA), de 2013 a 2016, de las cuales 201 vivieron pérdida inducida y 86 pérdida involuntaria. En la primera sesión se aplicaron las escalas de Depresión de Beck, de Depresión del Centro de Estudios Epidemiológicos (CES-D), de Trauma de Davidson (DTS) y de Gravedad de Síntomas del Trastorno de Estrés Postraumático (GS-TEPT). Resultados. Se encontró que el 61.2% de las mujeres con pérdida inducida presentan TEPT. No se hallaron diferencias significativas entre los grupos de mujeres evaluadas. Por otro lado, en las pruebas de Beck y CES-D, los puntajes son significativamente más altos en las mujeres con pérdidas inducidas. Conclusión. Los resultados confirman que los dos tipos de pérdida gestacional, inducida o involuntaria, pueden causar TEPT intenso, y las mujeres con pérdidas inducidas pueden presentar estados depresivos más severos.

Objetive. To evaluate and compare depression disorders (DD) and posttraumatic stress disorder (PTSD) after induced or involuntary pregnancy loss in women who requested psychological assistance. Method. A total of 287 individuals from Mexico City attended in the Instituto para la Rehabilitación de la Mujer y la Familia, A.C. (IRMA) from 2013 to 2016; 201 with induced pregnancy loss and 86 with involuntary loss. The women were applied the Beck Depression Inventory, the Center for Epidemiologic Studies Depression Scale (CES-D), the Davidson Trauma Scale (DTS) and the PTSD Symptoms Scale (PSS-I) in the first session. Results. In the (PSS-I) scale 61.2% of women with induced loss showed PTSD. There were no significant differences between the scores of the two types of loss in both tests that evaluated PTSD. For depression disorders (DD), significantly higher scores were found in the Beck Depression Inventory and CES-D in women with induced loss. Conclusion. The results confirm that induced and involuntary pregnancy losses can cause intense PTSD and women with induced pregnancy loss may experience more severe depressive states.

Escopo. Avaliar e comparar a aparição de transtornos de depressão (TD) e estresse pós-traumático (TEPT) em mulheres depois de uma perda gestacional induzida ou involuntária que solicitaram atenção psicológica. Metodologia. Participaram 287 mulheres da Cidade de México atendidas no Instituto para a Reabilitação da Mulher e a Família, A.C (IRMA), de 2013 a 2016, das quais 201 viveram perda induzida e 86 perda involuntária. Na primeira sessão foram aplicadas as escadas de Depressão de Beck, Depressão do Centro de Estudos Epidemiológicos (CES-D), Trauma de Davidson (DTS) e Gravidade de Sintomas do Transtorno do Estresse Pós-Traumático (GS-TEPT). Resultados. Foi encontrado que o 62.1% das mulheres com perda induzida apresentam TEPT, não se encontraram diferencias significativas entre os grupos de mulheres avaliadas. Entre tanto, foram encontradas maiores pontuações nas provas de Beck e CES-D significativamente mais altas nas mulheres com perdas induzidas. Conclusão. Os resultados confirmam que as perdas gestacionais tanto induzidas como involuntárias podem causar TEPT intenso nos dois tipos de perda e nas mulheres com perda induzida podem apresentar estados depressivos mais severos.

Meningioma paucisintomático en una paciente joven / Paucisymptomatic meningioma in a young patient

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[Hyperbilirrubinemia as a predictive factor of perforated appendicitis]. / Hiperbilirrubinemia como factor predictivo de apendicitis perforada.

BACKGROUND: Recent studies considered hyperbilirubinemia as a marker to identify the presence of perforated appendix. The aim of the study is to verify that the presence of hyperbilirubinemia is a useful marker to identify the presence of perforated appendix before surgery, and thereby, provide early treatment to avoid progression of the disease and its complications. METHODS: This is a retrospective study, which identified 225 patients, who met the inclusion and exclusion criteria, from January 2012 to October 2014 at the IMSS General Hospital 29, taking into account laboratory results and postoperative, performing a univariate, bivariate and multivariate analysis. RESULTS: 56.9% showed bilirubin < 1, from which 16.4% presented perforation, while 43.1% showed bilirubin > 1, 62.88% presented perforated appendicitis. Hyperbilirubinemia increases 17 times the risk of perforated appendix (RMP: 17.63; IC 95%: 6.882-45.207; p < 0.001) which is statistically significant. CONCLUSIONS: Considering the limitations of this study, it can be inferred that hyperbilirubinemia is present in a great number of patients with perforated appendicitis, so it could be considered a relevant laboratory test to include within the protocol of appendicitis, which in turn, may determine a better planning for the surgical approach.

Introducción: en estudios recientes se considera la hiperbilirrubinemia como un marcador para identificar la presencia de apendicitis perforada. El objetivo del estudio es comprobar que la presencia de hiperbilirrubinemia es un marcador útil para identificar preoperatoriamente a los pacientes con presencia de perforación apendicular, y de esta manera proporcionar un tratamiento oportuno evitando la progresión de la patología y sus complicaciones. Métodos: estudio retrospectivo, con 225 pacientes, los cuales contaban con los criterios de inclusión y exclusión, del periodo de enero de 2012 a octubre del 2014 en el HGZ 29 del IMSS, tomando en cuenta resultados de laboratorio y posquirúrgico, realizando análisis univariado, bivariado y multivariado. Resultados: el 56.9% presentó bilirrubina < 1, de los cuales el 16.4% presentó perforación, mientras que el de 43.1% con bilirrubina > 1, el 62.88% presentó apendicitis perforada. La hiperbilirrubinemia incrementa 17 veces más el riesgo de presentar apendicitis perforada (RMP: 17.63; IC 95%: 6.882-45.207; p < 0.001), lo que resulta estadísticamente significativo. Conclusiones: considerando las limitaciones de este estudio, se puede inferir que la hiperbilirrubinemia está presente en un mayor número de pacientes con apendicitis perforada, por lo cual podría ser considerado como un estudio de laboratorio relevante para incluir dentro del protocolo de apendicitis, lo cual, a su vez, puede determinar una mejor planeación para el abordaje quirúrgico.