Differences Between Methicillin-susceptible Versus Methicillin-resistant Staphylococcus aureus Infections in Pediatrics: Multicenter Cohort Study Conducted in Bogotá, Colombia, 2014-2018.

BACKGROUND: The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) has changed in recent years. The present article is intended to establish differences between clinical, laboratory and imaging findings and outcomes of MSSA and MRSA infections, as well as among subgroups of infection such as skin and soft tissue infection, osteoarticular, bacteremia or pneumonia in a pediatric population from Bogota, Colombia. METHODS: Retrospective cohort study using clinical records of patients under 18 years of age treated at the participating centers in Bogota, Colombia, between 2014 and 2018. The first positive S. aureus culture was studied. MSSA and MRSA were compared. The χ2 test, Fisher exact test, and Kruskal-Wallis test were calculated, and the statistical significance was presented using the difference and its 95% CI. RESULTS: Five hundred fifty-one patients were included; 211 (38%) corresponded to MRSA and 340 (62%) to MSSA for a total of 703 cultures. A significantly higher probability of having an MSSA infection than MRSA was found in patients with previous heart disease (3.3% vs. 0.5%), neurologic disease (5.9% vs. 2.5%), recent major surgeries (11% vs. 5%) or who has an implanted device (11% vs. 4%). In contrast, in severe MRSA infections (bacteremia, osteoarticular infections and pneumonia), a higher rate of complications was seen (admission to the pediatric intensive care unit, mechanical ventilation and vasoactive support), and in osteoarticular MRSA, more than 1 surgery per case was seen (89% vs. 61%). Laboratory results and mortality were similar. CONCLUSIONS: MRSA was associated with a more severe course in bacteremia, osteoarticular infections and pneumonia. Some classical risk factors associated with MRSA infections were found to be related to MSSA. In general, with the exception of skin and soft tissue infection, there was an increased risk of pediatric intensive care unit admission and mechanical and inotropic support with MRSA in a pediatric population.

NFAT5 Amplifies Antipathogen Responses by Enhancing Chromatin Accessibility, H3K27 Demethylation, and Transcription Factor Recruitment.

The ability of innate immune cells to respond to pathogen-associated molecular patterns across a wide range of intensities is fundamental to limit the spreading of infections. Studies on transcription responses to pathogen-activated TLRs have often used relatively high TLR ligand concentrations, and less is known about their regulation under mild stimulatory conditions. We had shown that the transcription factor NFAT5 facilitates expression of antipathogen genes under TLR stimulation conditions corresponding to low pathogen loads. In this study, we analyze how NFAT5 optimizes TLR-activated responses in mouse macrophages. We show that NFAT5 was required for effective recruitment of central effectors p65/NF-κB and c-Fos to specific proinflammatory target genes, such as Nos2, Il6, and Tnf in primary macrophages responding to low doses of the TLR4 ligand LPS. By contrast, NFAT5 was not required for p65/NF-κB recruitment in response to high LPS doses. Using the transposase-accessible chromatin with high-throughput sequencing assay, we show that NFAT5 facilitated chromatin accessibility mainly at promoter regions of multiple TLR4-responsive genes. Analysis of various histone marks that regulate gene expression in response to pathogens identified H3K27me3 demethylation as an early NFAT5-dependent mechanism that facilitates p65 recruitment to promoters of various TLR4-induced genes. Altogether, these results advance our understanding about specific mechanisms that optimize antipathogen responses to limit infections.

¿Cómo la comprensión de lectura en estudiantes sordos se ve facilitada por el uso de tecnologías de la comunicación e información? / How reading comprehension in deaf students is facilitated by the use of information and communication technologies?

Antecedentes. Las habilidades de las personas sordas en los procesos de comprensión lectora son débiles debido a elmentos relacionados con los procesos de adquisición tardía de la Lengua de Señas. Objetivo. Identificar, analizar y reflexionar sobre la utilidad del empleo de las tecnologías de la comunicación e información (TIC) en los procesos de comprensión lectora de los sujetos sordos, caracterizada por ser una competencia bilingüe entre L1 (lengua de señas colombiana) y L2 (español escrito). Materiales y métodos. Se trata de un estudio de tipo investigación-acción realizado en una institución educativa privada de la Ciudad de Bogotá, en la que se analizó el desempeño de cinco estudiantes sordos en habilidades de comprensión lectora en L2 a partir del uso de las TICS. Resultados. Cada uno de los sujetos aumentó sus habilidades en la comprensión lectora, el porcentaje de incremento fue heterogéneo tanto en los desempeños iniciales, como en texto superficie, mientras que la base, el modelo y la situación en cada escolar también fueron diferentes. De igual forma, al comparar los resultados obtenidos por los sujetos en la Prueba Saber 11, componente de lenguaje, con los obtenidos en años anteriores, se observó un ascenso considerable en los puntajes de los escolares que participaron en el programa de comprensión lectora a través del uso de las TIC. Conclusiones. Las TIC dinamizan el proceso lector aportando herramientas que incorporan e integran la utilización de todo recurso sensorial, lo cual facilita e integra la información gráfica del texto con códigos de procesamiento viso-espacial y viso-construccional, propios de los mecanismos del procesamiento de la información de los sordos, facilitando la flexibilidad y modificabilidad cognitiva e incrementando el uso de las estrategias metacognitivas para la solución de problemas.

Background. The skills of deaf people in reading comprehension processes are weak due to elements related to the own processes of the late acquisition of the Sign Language. Objective. To identify, analyze and reflect on the usefulness of the use of communication and information technologies (TIC) in the processes of reading comprehension of deaf subjects, characterized by being a bilingual competition between L1 (Colombian sign language) and L2 (Spanish written). Materials and Methods. Action research like study carried out in a private educational institution in the city of Bogota, where the performance of five deaf students in reading comprehension skills in L2 was analyzed through the use of TIC. Results. Each of the subjects increased their skills in reading comprehension; the percentage increase was heterogeneous in both the text initial performances and the surface text, while the base, the model and the situation in each individual were also different. Similarly by comparing the results obtained by the test subjects in Saber 11 test, language component, to those obtained in previous years, a significant increase was observed in the scores of the students who participated in the reading comprehension program through the use of TIC. Conclusions. The ICT streamlines the reading process by providing tools that incorporate and integrate the use of all sensory resources, which facilitates and integrates the graphic text information with visual-spatial processing codes and visual-constructional codes inherent to the mechanisms of deaf people information processing deaf, providing flexibility and cognitive modifiability and increasing the use of metacognitive strategies for solving problems.

Prognostic value of estimated glomerular filtration rate in hospitalized elderly patients.

A multicenter observational study, REPOSI (REgistro POliterapie Società Italiana di Medicina Interna), was conducted to assess the prognostic value of glomerular filtration rate (eGFR) on in-hospital mortality, hospital re-admission and death within 3 months, in a sample of elderly patients (n = 1,363) admitted to 66 internal medicine and geriatric wards. Based on eGFR, calculated by the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, subjects at hospital admission were classified into three groups: group 1 with normal eGFR (≥60 ml/min/1.73 m(2), reference group), group 2 with moderately reduced eGFR (30-59 ml/min/1.73 m(2)) and group 3 with severely reduced eGFR (<30 ml/min/1.73 m(2)). Patients with the lowest eGFR (group 3) on admission were more likely to be older, to have a greater cognitive and functional impairment and a high rate of comorbidities. Multivariable logistic regression analysis showed that severely reduced eGFR at the time of admission was associated with in-hospital mortality (OR 3.00; 95% CI 1.20-7.39, p = 0.0230), but not with re-hospitalization (OR 0.97; 95% CI 0.54-1.76, p = 0.9156) or mortality at 3 months after discharge (OR 1.93; 95% CI 0.92-4.04, p = 0.1582). On the contrary, an increased risk (OR 2.60; 95% CI 1.13-5.98, p = 0.0813) to die within 3 months after discharge was associated with decreased eGFR measured at the time of discharge. Our study demonstrates that severely reduced eGFRs in elderly patients admitted to hospital are strong predictors of the risk of dying during hospitalization, and that this measurement at the time of discharge helps to predict early death after hospitalization.

Mortalidad por tumores malignos más frecuentes en el adulto mayor / Mortality due to more frequent malignant tumors in elderly person

Introducción: actualmente, las neoplasias malignas constituyen un grupo de enfermedades de gran importancia en la población anciana. Con la edad aumenta la incidencia de la mayoría de los tumores. En Cuba el 65 por ciento de las personas que fallecen por cáncer son mayores de 60 años. Objetivos: caracterizar el comportamiento de la mortalidad por los tumores malignos más frecuentes en el adulto mayor del municipio Plaza de la Revolución durante el quinquenio 2004-2008. Métodos: estudio descriptivo en el que se tomaron todos los fallecidos por esta causa, y que tuvieran residencia en el municipio a partir de las bases de datos de mortalidad de la Dirección Nacional de Estadísticas. Se tuvieron en cuenta las variables: localización anatómica, sexo y edad. Resultados: la localización en próstata ocupó el primer lugar como causa de muerte, con una tasa de 254,1 por 100 000 hab, seguido por el pulmón (189,6). En hombres fueron más frecuentes próstata (254,1) y pulmón (234,8), y en mujeres pulmón (116,5) y mama (112,1). Según la edad, el grupo de 75 años y más fue el más afectado en ambos sexos. Conclusiones: los datos de este estudio confirman un importante crecimiento de la mortalidad en las principales localizaciones, lo que, junto al progresivo envejecimiento de la población, determinará un crecimiento del número anual de casos diagnosticados que generará, a su vez, un aumento de demanda de distintos servicios relacionados con la atención de los pacientes oncológicos en la tercera edad(AU)

Introduction: nowadays, the malignant neoplasias are a diseases group very significant in elderly persons. With advanced age increases the incidence of most tumors. In Cuba the 65 percent of deceased persons due to cancer is aged over 65. Objectives: to characterize the behavior of mortality due to malignant tumors more frequent in elderly persons from the Plaza de la Revolución municipality during the five-year period 2004-2008. Methods: a descriptive study was conducted including all deceased persons due to this cause and residents of this municipality from the mortality database of National Management of Statistics. The following variables were into account: anatomical location, sex and age. Results: prostate location was in the first place as death cause with a rate of 254, 1 by 1000 000 inhabitants, followed by lungs (189,6). In men was predominance of prostate (254,1) and lungs (234,8) and in female predominance was of lungs (116,5) and breast (112,1). According to age, the group aged 75 and more was the more involved in both sexes. Conclusions: the data from present study confirm a significant increase of mortality in main locations what, together with progressive aging of population, will determine a growth in the yearly number of diagnosed cases, that will generate at the same time, an demand increase of different services related to care of third-age oncology patients(AU)

Mortalidad por tumores malignos más frecuentes en el adulto mayor / Mortality due to more frequent malignant tumors in elderly person

Introducción: actualmente, las neoplasias malignas constituyen un grupo de enfermedades de gran importancia en la población anciana. Con la edad aumenta la incidencia de la mayoría de los tumores. En Cuba el 65 por ciento de las personas que fallecen por cáncer son mayores de 60 años. Objetivos: caracterizar el comportamiento de la mortalidad por los tumores malignos más frecuentes en el adulto mayor del municipio Plaza de la Revolución durante el quinquenio 2004-2008. Métodos: estudio descriptivo en el que se tomaron todos los fallecidos por esta causa, y que tuvieran residencia en el municipio a partir de las bases de datos de mortalidad de la Dirección Nacional de Estadísticas. Se tuvieron en cuenta las variables: localización anatómica, sexo y edad. Resultados: la localización en próstata ocupó el primer lugar como causa de muerte, con una tasa de 254,1 por 100 000 hab, seguido por el pulmón (189,6). En hombres fueron más frecuentes próstata (254,1) y pulmón (234,8), y en mujeres pulmón (116,5) y mama (112,1). Según la edad, el grupo de 75 años y más fue el más afectado en ambos sexos. Conclusiones: los datos de este estudio confirman un importante crecimiento de la mortalidad en las principales localizaciones, lo que, junto al progresivo envejecimiento de la población, determinará un crecimiento del número anual de casos diagnosticados que generará, a su vez, un aumento de demanda de distintos servicios relacionados con la atención de los pacientes oncológicos en la tercera edad

Introduction: nowadays, the malignant neoplasias are a diseases group very significant in elderly persons. With advanced age increases the incidence of most tumors. In Cuba the 65 percent of deceased persons due to cancer is aged over 65. Objectives: to characterize the behavior of mortality due to malignant tumors more frequent in elderly persons from the Plaza de la Revolución municipality during the five-year period 2004-2008. Methods: a descriptive study was conducted including all deceased persons due to this cause and residents of this municipality from the mortality database of National Management of Statistics. The following variables were into account: anatomical location, sex and age. Results: prostate location was in the first place as death cause with a rate of 254, 1 by 1000 000 inhabitants, followed by lungs (189,6). In men was predominance of prostate (254,1) and lungs (234,8) and in female predominance was of lungs (116,5) and breast (112,1). According to age, the group aged 75 and more was the more involved in both sexes. Conclusions: the data from present study confirm a significant increase of mortality in main locations what, together with progressive aging of population, will determine a growth in the yearly number of diagnosed cases, that will generate at the same time, an demand increase of different services related to care of third-age oncology patients