[Bloodstream infections with Candida glabrata in a neonatal intensive care unit that uses prophylaxis with fluconazole]. / Infección del torrente sanguíneo por Candida glabrata en una unidad de cuidados intensivos neonatales con prescripción de profilaxis con fluconazol.

BACKGROUND: Candida glabrata is an emerging pathogen with the ability to develop tolerance and resistance to azole antifungals, which creates uncertainty about the usefulness of antifungal prophylaxis in newborns. AIMS: The aim of this study was to describe the factors associated with C. glabrata infection in a NICU that uses prophylaxis with fluconazole. METHODS: A case-control study paired by gestational age was designed and conducted at the Civil Hospital of Guadalajara Dr. Juan I. Menchaca. Newborns with C. glabrata infection were studied and for each one a matched control was selected by gestational age. Odds ratios (OR) were estimated with 95% confidence intervals (95% CI) and McNemar test for contrast of hypothesis was applied. RESULTS: Twenty-one infected patients were identified, from whom 66.7% were male; the median gestational age was 31.5 weeks. Increased risk of infection with C. glabrata was observed when there was a prescription of more than one antimicrobial scheme (OR 21, 95% CI, 1.23 - 358.3; p=0.006) and also among patients with surgical comorbidities (OR 8, 95% CI 1.01 - 63.9; p=0.04). During the study period, exposure to fluconazole showed no difference in the risk of infection. CONCLUSIONS: Neonates with more than one antimicrobial regimen and those with surgical comorbidities had a higher risk of C. glabrata infection.

Infección del torrente sanguíneo por Candida glabrata en una unidad de cuidados intensivos neonatales con prescripción de profilaxis con fluconazol / Bloodstream infections with Candida glabrata in a neonatal intensive care unit that uses prophylaxis with fluconazole

ANTECEDENTES: Candida glabrata es un patógeno emergente con capacidad de desarrollar tolerancia y resistencia a los antifúngicos azólicos, lo que genera incertidumbre sobre la utilidad de la profilaxis antifúngica en recién nacidos. OBJETIVOS: El objetivo de este estudio fue describir los factores asociados a la infección por C. glabrata en una UCIN que utiliza la profilaxis con fluconazol. MÉTODOS: Se diseñó un estudio de casos y controles pareado por edad gestacional realizado en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se estudiaron los recién nacidos con infección por C. glabrata y para cada uno se seleccionó un control pareado por edad gestacional; se estimaron razones de momios (RM) con intervalos de confianza del 95% (IC 95%) y prueba de McNemar para contraste de hipótesis. RESULTADOS: Veintiún pacientes presentaron infección, con el 66,7% de ellos de género masculino; la mediana de edad gestacional fue de 31,5 semanas. Se observó mayor riesgo de infección por C. glabrata cuando hubo prescripción de más de un esquema antimicrobiano (RM 21, IC 95% 1,23 - 358,3; p = 0,006) y en pacientes con comorbilidades quirúrgicas (RM 8, IC 95% 1,01 - 63,9; p = 0,04). Durante el periodo de estudio el riesgo de infección no se vio aumentado por la exposición a fluconazol. CONCLUSIONES: Presentaron mayor riesgo de infección por C. glabrata los neonatos con más de un esquema antimicrobiano y aquellos con comorbilidades quirúrgicas

BACKGROUND: Candida glabrata is an emerging pathogen with the ability to develop tolerance and resistance to azole antifungals, which creates uncertainty about the usefulness of antifungal prophylaxis in newborns. AIMS: The aim of this study was to describe the factors associated with C. glabrata infection in a NICU that uses prophylaxis with fluconazole. METHODS: A case-control study paired by gestational age was designed and conducted at the Civil Hospital of Guadalajara Dr. Juan I. Menchaca. Newborns with C. glabrata infection were studied and for each one a matched control was selected by gestational age. Odds ratios (OR) were estimated with 95% confidence intervals (95% CI) and McNemar test for contrast of hypothesis was applied. RESULTS: Twenty-one infected patients were identified, from whom 66.7% were male; the median gestational age was 31.5 weeks. Increased risk of infection with C. glabrata was observed when there was a prescription of more than one antimicrobial scheme (OR 21, 95% CI, 1.23 - 358.3; p = 0.006) and also among patients with surgical comorbidities (OR 8, 95% CI 1.01 - 63.9; p = 0.04). During the study period, exposure to fluconazole showed no difference in the risk of infection. CONCLUSIONS: Neonates with more than one antimicrobial regimen and those with surgical comorbidities had a higher risk of C. glabrata infection

Thyroid dysfunction induced by nivolumab: searching for disease patterns and outcomes.

PURPOSE: Nivolumab is a monoclonal antibody that blocks the activation of programmed death-1 receptor, promoting T-cell activation against cancer cells. Thyroid dysfunction (TD) is a common immune-related adverse event (irAE) induced by nivolumab. We report the prevalence, patterns and outcomes of nivolumab-induced TD among cancer patients in our center. METHODS: All patients treated with nivolumab during 2016 were included. We assessed thyroid function tests, thyroid autoimmunity, thyroid imaging, and clinical outcome during nivolumab therapy as well as overall survival (OS). RESULTS: Seventy-three patients (55 with non-small-cell lung cancer [NSCLC], 9 with melanoma and 9 with Hodgkin lymphoma) were included. Median of follow up: 390.5 days. Seventeen patients (23.3%) developed TD during treatment. Thyrotoxicosis was reported in seven patients. Serum thyroid-stimulating hormone (TSH) nadir occurred after a median of 51 days (95% CI: 35-71). Thyroid antibodies were positive in three of the seven patients. Five of the seven hyperthyroid patients became hypothyroid later, and four of them required levothyroxine treatment. Primary hypothyroidism occurred in ten patients. Serum TSH peak occurred after a median of 110 days [95% CI: 85.2-197]. Thyroid autoimmunity was positive in one patient. In patients with NSCLC, TD was associated with better OS (HR = 0.4 [95% CI: 0.17-0.94]; p = 0.035). CONCLUSIONS: TD induced by nivolumab is a common and heterogeneous irAE. Thyrotoxicosis develops earlier than hypothyroidism. A pattern consistent with a transient thyroiditis followed by hypothyroidism was observed in one-third of patients. Our results suggest that patients with NSCLC and nivolumab-induced TD might have better survival.

Early detection of graft incompatibility in apricot (Prunus armeniaca) using in vitro techniques.

Graft compatibility has been studied in vitro using callus tissues of apricot (Prunus armeniaca) and different Prunus rootstocks to form scion/rootstock combinations with different degrees of graft compatibility. In these species, incompatibility is manifested by a breakdown of the trees at the union area that can occur some years after grafting. Here, the possibility of obtaining an early detection method to determine graft incompatibility is explored by callus fusion in vitro. The adhesion of the two callus partners, the development of the cells at the contact surface (cell arrangement, intensity of cell-wall staining), and the presence of lipid and phenolic compounds have been studied during the first 3 weeks after grafting in both compatible and incompatible combinations. Differences were observed at the second and the third week of callus co-culture in most of the characters determined, although these differences were present as early as the first week in the case of phenolic compounds. The behaviour of the grafts grown in vitro was correlated to that of the same combinations in the field, suggesting that callus fusion in vitro could be a possible and reliable method for an early detection of graft incompatibility in different Prunus combinations.