How Far Are We From Achieving Delabeling of False Penicillin/ß-Lactam Allergy Alerts? A Population Problem.

BACKGROUND: Interest in finding efficient ways to remove penicillin allergy alerts has grown as a result of awareness of the considerable excess of false-negative diagnoses in patients with penicillin allergy labels (90%-95%), the poorer course with non-ß-lactam antibiotics, the increase in bacterial resistance, and the fact that these problems can affect up to 20% of the population in some countries. The strategies proposed have generated many publications in countries where the number of allergists to conduct such studies is low. In many cases where delabeling is performed, the risk of ß-lactam allergy is low, and a single penicillin challenge is sufficient to delabel the alert. However, other less "ultrarapid" strategies can be used to administer a ß-lactam during an admission for infection and thus postpone delabeling until traditional drug allergy consultations. However, the definitive withdrawal of ß-lactam alerts is threatened by nonremoval of alerts in electronic health records and by the reactivation or nonsynchronization of alerts between electronic systems at different levels of care. Allergy departments need to reflect on how to implement practices that enable rapid and efficient delabeling of drug allergy alerts, especially in patients with major comorbidities.

Incidence of Fatal Anaphylaxis: A Systematic Review of Observational Studies.

BACKGROUND: Fatal anaphylaxis is very rare, with an incidence ranging from 0.5 to 1 deaths per million person-years. OBJECTIVE: Based on a systematic review, we aimed to explain differences in the reported incidence of fatal anaphylaxis based on the methodological and demographic factors addressed in the various studies. METHODS: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for relevant retrospective and prospective cohort studies and registry studies that had assessed the anaphylaxis mortality rate for the population of a country or for an administrative region. The research strategy was based on combining the term "anaphylaxis" with "death", "study design", and "main outcomes" (incidence). RESULTS: A total of 46 studies met the study criteria and included 16,541 deaths. The range of the anaphylaxis mortality rate for all causes of anaphylaxis was 0.002-2.51 deaths per million person-years. Fatal anaphylaxis due to food (range 0.002-0.29) was rarer than deaths due to drugs (range 0.004-0.56) or Hymenoptera venom (range 0.02-0.61). The frequency of deaths due to anaphylaxis by drugs increased during the study period (IRR per year, 1.02; 95%CI, 1.00-1.04). We detected considerable heterogeneity in almost all of the meta-analyses carried out. CONCLUSION: The incidence of fatal anaphylaxis is very low and differs according to the various subgroups analyzed. The studies were very heterogeneous. Fatal anaphylaxis due to food seems to be less common than fatal anaphylaxis due to drugs or Hymenoptera venom.

Una revisión sistemática sobre las variables relacionadas con las habilidades sociales y la creatividad en el periodo de la adolescencia / A systematic review on the variables related to Social skills and Creativity in Adolescence

Las habilidades sociales y la creatividad son dos constructos de vital importancia en el desarrollo de los adoles-centes, ya que mediante el correcto desarrollo de ambos los jóvenes son capaces de resolver los conflictos de manera adecuada y establecer relaciones interpersonales de calidad. La evidencia científica revela que la existencia de estudios que traten ambos constructos de manera conjunta es escasa, por lo que el objetivo de este trabajo es identificar qué va-riables son las que se relacionan con las habilidades sociales y la creatividad en la población adolescente. Este estudio ha seguido una metodología de revisión sistemática, donde se ha realizado una búsqueda en las bases de datos de Web of Science, Scopus y PsyCINFO a partir de dos búsquedas diferenciadas: una enfocada en las habilidades sociales y otra en la creatividad. Los resultados muestran la diversidad de variables que han sido relacionadas tanto en las habilidades sociales como en la creatividad, pudiendo así establecer cuáles son las que han sido estudiadas en ambos constructos: rendimiento académico, factores estresantes y autoestima. Se propone establecer una serie de estrategias educativas para trabajar estos factores con el alumnado adolescente, debido a los beneficios que conlleva poseer unos buenos niveles de habilidades sociales y creatividad (AU)

Social skills and creativity are two vitally important constructs in the development of adolescents, since through the correct development of both, young people are able to resolve conflicts appropriately and establish quality interpersonal relationships. Scientific evidence reveals that the existence of studies that treat both constructs together is scarce, so the objective of this work is to identify which variables are related to social skills and creativity in the adolescent population. This study has followed a systematic review methodology, where a search has been carried out in the Web of Science, Scopus and PsyCINFO databases from two differentiated searches: one focused on social skills and the other on crea-tivity. The results show the diversity of variables that have been related to both social skills and creativity, thus being able to establish which ones have been studied in both constructs: academic performance, stressors and self-esteem. It is proposed to establish a series of educational strategies to work on these factors with adolescent students, due to the benefits of having good levels of social skills and creativity (AU)

Effects of Botanical Insecticides on Hymenopteran Parasitoids: a Meta-analysis Approach.

Botanical insecticides (BIs) are considered a valuable alternative for plant protection in sustainable agriculture. The use of both BIs and parasitoids are presumed to be mutually compatible pest management practices. However, there is controversy on this subject, as various studies have reported lethal and sublethal effects of BIs on hymenopteran parasitoids. To shed new light on this controversy, a meta-analytic approach of the effects of BIs on adult mortality, parasitism, and parasitoid emergence under laboratory conditions was performed. We show that BIs increased mortality, decreased parasitism, and decreased parasitoid emergence. Botanical insecticides derived from Nicotiana tabacum and Caceolaria andina were particulary lethal. Most of the parasitoid groups showed susceptibility to BIs, but the families Scelionidae and Ichneumonidae were not significantly affected. The negative effects of BIs were seen regardless of the type of exposure (topical, ingestion, or residual). In conclusion, this meta-analysis showed that under laboratory conditions, exposure of hymenopteran parasitoids to BIs had significant negative effects on adult mortality, parasitism, and parasitoid emergence.

Explaining variations in the diversity of parasitoid assemblages in a biosphere reserve of Mexico: evidence from vegetation, land management and seasonality.

Insect fauna biodiversity in natural protected areas has not been thoroughly studied. Therefore, the aim of this work was to assess whether and how vegetation types, land management and seasonality influence the diversity of Ichneumonidae (Hymenoptera) in the Ría Lagartos Biosphere Reserve (Mexico). A sampling programme was conducted using Malaise traps from 2008 to 2009 in three vegetation types, each with two conservation zones (core and buffer zones). Three seasons were considered: rainy, dry and north-winds (isolated storms from November to February). A total of 336 species were identified. Rarefaction and Generalized Linear Model indicated higher species richness and abundance, respectively, in the buffer zone of the dry forest; possible explanations for this finding include the intermediate disturbance hypothesis, wherein diversity can be higher in sites where disturbance is not very frequent or very intense, and the 'enemies hypothesis', wherein structural complexity and high plant diversity favour increased predators or, in this case, parasitoids. Diversity was higher during the rainy season, which may have been due to the higher availability of resources. Vegetation and management had a positive impact on the Coc (attack cocoons and pupae) and Myc (attack concealed larvae living in the fruiting bodies of mushrooms) parasitoid guilds. Members of the Coc guild are generalist parasitoids, which may be favoured in complex vegetation with a high richness of potential hosts and non-hosts. The Myc guild requires certain environmental conditions that promote fungal growth, such as humidity, that is absent in the other vegetation types of savannah and coastal dune scrubland.

Clinical Profile of Patients With Severe Anaphylaxis Hospitalized in the Spanish Hospital System: 1997-2011.

BACKGROUND AND OBJECTIVE: Studies assessing the severity of anaphylaxis lack a comprehensive approach to collecting data on comorbidities that may worsen prognosis. Objective: Using the Elixhauser score (a systematic index associated with longer stay, hospital charges, and mortality), we determined which comorbidities were associated with more severe anaphylaxis. METHODS: We based our study on the Spanish Ministry of Health database of hospital discharges in Spain between 1997 and 2011. We constructed logistic regression models in which the dependent variables were outcomes related to greater severity (death, cardiac arrest, need for invasive mechanical ventilation or vasopressor drugs, admission to the intensive care unit, and length of stay) and the independent variables were the 30 comorbidities that comprise the Elixhauser score, age, sex, and main causes of anaphylaxis. RESULTS: We found that a higher risk of severe anaphylaxis was associated (3 or more logistic regressions) with age >50 years or having experienced cardiac arrhythmia, coagulation disorder, associated fluid-electrolyte imbalance, chronic pulmonary disease, or Echinococcus anaphylaxis. Likewise, in the adjusted analysis, a higher Elixhauser score was associated with most of the outcomes analyzed for severity of anaphylaxis. CONCLUSIONS: Cardiovascular and respiratory diseases increase the severity of anaphylaxis, and the resulting poor health status (represented as a higher Elixhauser score) is associated with more severe anaphylaxis.

Clinical profile of patients with severe anaphylaxis hospitalized in the Spanish Hospital System: 1997-2011

Background: Studies assessing the severity of anaphylaxis lack a comprehensive approach to collecting data on comorbidities that may worsen prognosis. Objective: Using the Elixhauser score (a systematic index associated with longer stay, hospital charges, and mortality), we determined which comorbidities were associated with more severe anaphylaxis. Methods: We based our study on the Spanish Ministry of Health database of hospital discharges in Spain between 1997 and 2011. We constructed logistic regression models in which the dependent variables were outcomes related to greater severity (death, cardiac arrest, need for invasive mechanical ventilation or vasopressor drugs, admission to the intensive care unit, and length of stay) and the independent variables were the 30 comorbidities that comprise the Elixhauser score, age, sex, and main causes of anaphylaxis. Results: We found that a higher risk of severe anaphylaxis was associated (3 or more logistic regressions) with age >50 years or having experienced cardiac arrhythmia, coagulation disorder, associated fluid-electrolyte imbalance, chronic pulmonary disease, or Echinococcus anaphylaxis. Likewise, in the adjusted analysis, a higher Elixhauser score was associated with most of the outcomes analyzed for severity of anaphylaxis. Conclusions: Cardiovascular and respiratory diseases increase the severity of anaphylaxis, and the resulting poor health status (represented as a higher Elixhauser score) is associated with more severe anaphylaxis (AU)

Antecedentes: Los estudios que recogen datos sobre comorbilidades que empeoran la gravedad de la anafilaxia, carecen de un acercamiento exhaustivo. Objetivo: Usando la puntuación de Elixhauser (un sistema de puntuación asociado con mayor estancia hospitalaria, mayor gasto hospitalario y muerte), establecimos que comorbilidades fueron asociadas con anafilaxia grave. Métodos: Usamos para el estudio la base de datos de altas hospitalarias del Ministerio Español de Sanidad, entre 1997 a 2011. Se obtuvo varios modelos de regresión logística, en las cuales las variables dependientes fueron desenlaces relacionados con eventos asociados habitualmente a una gran gravedad de los episodios (muerte, parada cardio-respiratoria, necesidad de uso de ventilación mecánica invasiva o medicamentos vaso-presores, ingreso en la Unidad de Cuidados Intensivos y duración de la estancia) y las variables independientes fueron las 30 comorbilidades que comprenden la puntuación Elixhauser, junto con edad, sexo y las grandes causas de anafilaxia. Resultados: Encontramos que un mayor riesgo para anafilaxia grave estuvo asociado (3 o más regresiones logísticas con significación estadística) con una edad de más de 50 años, o haber experimentado arritmias cardiacas, alteraciones de la coagulación, disbalance hidro-electrolítico, enfermedad pulmonar crónica o anafilaxia por Echinococcus. Así mismo, en un análisis ajustado, una puntuación mayor del sistema Elixhauser se asoció con la mayoría de las variables de desenlace usadas para analizar la gravedad de la anafilaxia. Conclusiones: Enfermedades cardio-vasculares y respiratorias incrementan la gravedad de la anafilaxia y un mal estado de salud (representado por mayores puntuaciones del Sistema de puntuación de Elixhauser) se asocian con mayor gravedad de la anafilaxia (AU)

Review of Mexican species of Podogaster Brullé (Hymenoptera: Ichneumonidae: Anomaloninae) with description of two new species.

Two new species of Podogaster Brullé, Podogaster brunneus n. sp. and Podogaster lagartensis n. sp., are described. The material was collected with Malaise traps operated for a year in the Ría Lagartos Biosphere Reserve, a dry tropical area of Southeast Mexico. Podogaster rosteri Gauld & Bradshaw is synonymized with Podogaster mexicanus (Cresson). A key to the Mexican species is also provided.

Diurnal flight behavior of Ichneumonoidea (Insecta: Hymenoptera) related to environmental factors in a tropical dry forest.

The biology and behavior of insects are strongly influenced by environmental conditions such as temperature and precipitation. Because some of these factors present a within day variation, they may be causing variations on insect diurnal flight activity, but scant information exists on the issue. The aim of this work was to describe the patterns on diurnal variation of the abundance of Ichneumonoidea and their relation with relative humidity, temperature, light intensity, and wind speed. The study site was a tropical dry forest at Ría Lagartos Biosphere Reserve, Mexico; where correlations between environmental factors (relative humidity, temperature, light, and wind speed) and abundance of Ichneumonidae and Braconidae (Hymenoptera: Ichneumonoidea) were estimated. The best regression model for explaining abundance variation was selected using the second order Akaike Information Criterion. The optimum values of temperature, humidity, and light for flight activity of both families were also estimated. Ichneumonid and braconid abundances were significantly correlated to relative humidity, temperature, and light intensity; ichneumonid also showed significant correlations to wind speed. The second order Akaike Information Criterion suggests that in tropical dry conditions, relative humidity is more important that temperature for Ichneumonoidea diurnal activity. Ichneumonid wasps selected toward intermediate values of relative humidity, temperature and the lowest wind speeds; while Braconidae selected for low values of relative humidity. For light intensity, braconids presented a positive selection for moderately high values.

Reduced dopamine function in depressed patients is related to suicidal behavior but not its lethality.

Several lines of evidence suggest a role for dopamine in the control of suicidal behaviour. Previously, we suggested an involvement of D2-dopaminergic function in the biology of suicide by demonstrating a smaller growth hormone (GH) response to apomorphine, a dopaminergic agonist, in depressed patients who later died by suicide. The purpose of the present study was to assess GH response to apomorphine in major depressed in-patients with a history of highly lethal suicide attempt compared to depressed patients with a low lethal lifetime suicide attempt history and non-attempters. The study was performed in a sample of 26 male depressed in-patients with a history of suicide attempt compared to 26 male depressed non-attempters. We observed a significant difference between suicide attempters and non-attempters (for GH peak, 6.3+/-5.1 ng/ml vs 15.8+/-14.2 ng/ml, F=10.3, df=1, 50, P=0.002). Moreover, GH peak responses to apomorphine did not differ between depressed patients with a high lethal lifetime suicide attempt history and patients who made low lethal lifetime suicide attempt. In conclusion, the results of the present study support a role for dopamine in the biology of suicidal behaviour. More specifically, an impaired GH response to apomorphine could be a marker of suicide risk.

The tridimensional personality questionnaire (TPQ) and depression.

The relationships between the Tridimensional Personality Questionnaire (TPQ) and depression were examined in a sample of 53 major depressive patients and 33 healthy controls. Depressed patients exhibit higher harm avoidance scores as well as lower novelty seeking sub-scale exploratory excitability (NS1) scores as compared to healthy controls. However, the other dimensions and their sub-scales do not differ between depressive patients and controls. In the depressive group, the harm avoidance dimension is related to the severity of depression as assessed by the Hamilton scale. This study confirms the state dependence of the harm avoidance dimension and suggests a relationship between the novelty seeking sub-scale NS1 and depression.

Suicidal behavior in depressive disorder: an event-related potential study.

P300 and contingent negative variation (CNV) were recorded in depressive inpatients with and without history of suicide attempt. The results showed a significant reduction of P200, P300, and CNV and a significant increase of postimperative negative variation (PINV) in patients who had attempted suicide compared to patients with a negative history. Moreover, P300 amplitude was negatively related with the Suicidal Risk and the Hopelessness but not with the Hamilton scales. These results stress the need to differentiate clinical subgroups of patients to assess the psychophysiology of depression, and indicate that patients who attempted suicide exhibit lower cortical resources and poorer cortical performance than patients without history of suicide attempt.

The flesinoxan 5-HT1A receptor challenge in major depression and suicidal behavior.

The prevailing neurochemical theory about biological correlates of suicidal behavior focuses on the serotonergic system. In this study, we assessed the cortisol, ACTH, GH, prolactin and temperature responses to flesinoxan, a5-HT1A agonist, in 30 DSM-III-R major depressed inpatients subgrouped into suicide attempters (n = 15) and nonattempters (n = 15). The patients were assessed after a drug-free period of at least 3 weeks. A subsample of 16 patients completed the Buss-Durkee Hostility Inventory as a measure of impulsive aggressive behavior. Mean delta cortisol responses to flesinoxan were significantly lower in the group of depressed patients with a history of suicide attempts than in the group without history of suicidal behavior: for the delta cortisol values 14.5 +/- 16.3 micrograms/l vs 101 +/- 94 micrograms/l (F = 8.9, df = 5.25, p = 0.006). There was also a very significant difference between suicide attempters and nonattempters for the temperature (delta T degrees) responses to flesinoxan: 0.20 +/- 0.24 degrees C vs. 0.60 +/- 0.24 degrees C (F = 18.1, df = 5.25, p = 0.0003). Hormonal and temperature responses to flesinoxan were not correlated with BDHI irritability or assault subscale scores. The results of the present study support the implication of the serotonergic system, particularly 5-HT1A receptors, in the control of self-directed aggressive behavior. Moreover, in depressed patients, serotonergic abnormalities do not appear to be related to aggressive behavior.

[The biological basis of suicidal behavior: neuroendocrine and psychophysiological approach to the role of catecholamines]. / Bases biologiques du comportement suicidaire: approche neuroendocrinienne et psychophysiologique du rôle des catécholamines.

The current main neurochemical theories of the biological correlates of suicidal behavior principally involve the serotonergic system. Few data are available about the possible role of the catecholaminergic (noradrenergic and dopaminergic) function. In the present study, in a first part, we assessed the growth hormone (GH) response to clonidine, a selective alpha 2-adrenergic agonist, and to apomorphine, a dopaminergic agonist, in 22 DSM-III-R major depressive male inpatients with a history of suicide attempts compared to 22 age-matched major depressive inpatients without history of suicidal behavior. Hormonal responses to clonidine and apomorphine were also compared with 4.00 PM postdexamethasone cortisol levels. The two groups differed significantly in the GH peak response after apomorphine: 6.27 +/- 3.18 ng/ml in suicide attempters vs 17.40 +/- 14.87 ng/ml in nonattempters (F = 11.78, p = 0.001). There was no statistically significant difference between the two groups for GH peak responses after clonidine. Moreover, mean postdexamethasone cortisol levels did not exhibit any significant difference between suicide attempters and nonattempters. Violent and nonviolent attempters did not differ on any of the biological measures. In a second part, P300 and contingent negative variation (CNV) were recorded in 20 depressive inpatients subgrouped into suicide attempters (n = 10) and nonattempters (n = 10). The results showed a significant reduction of both P300 and CNV amplitudes in patients who attempted suicide compared to patients without history of suicide attempts. Moreover, a significant correlation was found between the Suicidal Risk scale and CNV amplitude. In conclusion, these results suggest that a dopaminergic hypoactivity as assessed by a blunted GH response to apomorphine and by a reduction of both P300 and CNV amplitudes, could be considered as a biological correlate of suicidal behavior. In contrast, noradrenergic disturbances, particularly at the level of alpha 2-adrenergic receptors, seem to play a more minor role. Moreover, DST nonsuppression cannot be considered as a biological marker of suicidal behavior.