Fecal shedding of Clostridioides difficile in calves in Sao Paulo state, Brazil.

OBJECTIVE: This study aimed to evaluate the fecal shedding of C. difficile in calves on farms in Sao Paulo State, Brazil. MATERIALS AND METHODS: Fecal samples (n = 300) were collected from diarrheic (n = 78) and nondiarrheic (n = 222) calves less than 60 days of age from 20 farms. Fecal samples were inoculated into enrichment broth supplemented with taurocholate and cultured under anaerobic conditions. Colonies suspected to be C. difficile were harvested for DNA extraction and then multiplex PCR for the detection of genes encoding toxins A and B and binary toxins. All toxigenic isolates were ribotyped and tested for antimicrobial susceptibility, and five selected strains were subjected to whole-genome sequencing to determine their sequence type. RESULTS AND DISCUSSION: C. difficile was isolated from 29.3 % (88/300) of the samples. All toxigenic isolates (17/88, 19.3 %) were classified as ribotypes RT046 (13/17-79.47 %, A+B+ CDT-) and RT126 (4/17 = 20.53 %, A+B+ CDT+). The sequenced strains from RT046 were classified as ST35 (Clade 1), while those from RT126 were classified as ST11 (Clade 5). No associations between the epidemiological factors in any of the groups and C. difficile isolation were observed. Most of the toxigenic isolates (16/17 = 94.41 %) were classified as multidrug-resistant. Calves can be an important source of toxigenic C. difficile strains, including multidrug-resistant isolates from ribotypes commonly observed in humans.

Vaccination coverage in children under one year of age and associated socioeconomic factors: maps of spatial heterogeneity.

OBJECTIVE: to analyze vaccination coverage spatial distribution in children under one year old and the socioeconomic factors associated with meeting the recommended goals in Minas Gerais. METHODS: an ecological study, carried out in 853 municipalities in the state. Pentavalent, poliomyelitis, meningococcal conjugate, yellow fever, rotavirus, and 10-valent pneumococcal conjugate vaccination coverage were analyzed. Scan statistics and multiple logistic regression were performed to identify spatial clusters and factors associated with meeting coverage goals. RESULTS: spatial analysis revealed clusters with risk of low coverage for all vaccines. Number of families with per capita income of up to 1/2 wage, Minas Gerais Social Responsibility Index and percentage of the poor or extremely poor population were associated with meeting the established goals. CONCLUSIONS: the results are useful for designing interventions regarding the structuring of vaccination services and the implementation of actions to increase vaccination coverage in clusters with less propensity to vaccinate.

Effect of dietary iron supplementation on the equine fecal microbiome.

Iron is an essential element for all living organisms, including bacteria, as several virulence factors and replication components are influenced by iron concentration. The objective of this study was to determine whether the composition and diversity of the fecal microbiota of adult horses are affected by supplemental dietary iron. Ten clinically healthy horses were randomly divided into a control and an iron-supplemented group (n = 5). The treated group was supplemented with oral ferrous sulphate monohydrate (720 ppm of iron), whereas the control group received 320 ppm of iron daily for 15 d. Fecal samples were collected before and 5, 10, 15, and 30 d after supplementation and frozen at -80°C. DNA was sequenced using an Illumina MiSeq platform and data were analyzed using the software Mothur and linear discriminant analysis (LDA) effect size (LEfSe). Iron supplementation caused no change in the overall composition of the fecal microbiota, but some minor changes were observed in the low-abundant bacteria, as well as an increased alpha diversity after 15 d of supplementation. Significant differences in community composition of the fecal microbiota over time were observed in both groups, highlighting the importance of a control group, as there are variables that cannot be controlled in microbiome studies.

Le fer est un élément essentiel pour tous les organismes vivants, y compris les bactéries, car plusieurs facteurs de virulence et composants de réplication sont influencés par la concentration en fer. L'objectif de cette étude était de déterminer si la composition et la diversité du microbiote fécal des chevaux adultes sont affectées par la supplémentation en fer alimentaire. Dix chevaux cliniquement sains ont été divisés au hasard en un groupe témoin et un groupe supplémenté en fer, n = 5 par groupe. Le groupe traité a reçu un supplément oral de sulfate ferreux monohydraté (720 ppm de fer) et le groupe témoin a reçu 320 ppm de fer par jour pendant 15 jours. Des échantillons fécaux ont été prélevés avant la supplémentation et 5, 10, 15 et 30 jours après la supplémentation puis congelés à −80 °C. L'ADN a été séquencé à l'aide de la plateforme Illumina MiSeq et les données ont été analysées à l'aide des logiciels Mothur et analyse de la fonction discriminante linéaire taille de l'effet LefSe. La supplémentation en fer n'a provoqué aucun changement dans la composition du microbiote fécal, mais certains changements ont été observés chez les bactéries peu abondantes, ainsi qu'une augmentation de la diversité alpha après 15 jours de supplémentation. Au fil du temps, des différences significatives dans la composition de la communauté bactérienne ont été observées dans les deux groupes, soulignant l'importance d'un groupe témoin, car il existe des variables qui ne peuvent être contrôlées dans les études sur le microbiome.(Traduit par les auteurs).

Vaccination coverage in children under one year of age and associated socioeconomic factors: maps of spatial heterogeneity / Coberturas de vacunación en menores de un año y factores socioeconómicos asociados: mapas de heterogeneidad espacial / Cobertura vacinal em menores de um ano e fatores socioeconômicos associados: mapas da heterogeneidade espacial

ABSTRACT Objective: to analyze vaccination coverage spatial distribution in children under one year old and the socioeconomic factors associated with meeting the recommended goals in Minas Gerais. Methods: an ecological study, carried out in 853 municipalities in the state. Pentavalent, poliomyelitis, meningococcal conjugate, yellow fever, rotavirus, and 10-valent pneumococcal conjugate vaccination coverage were analyzed. Scan statistics and multiple logistic regression were performed to identify spatial clusters and factors associated with meeting coverage goals. Results: spatial analysis revealed clusters with risk of low coverage for all vaccines. Number of families with per capita income of up to 1/2 wage, Minas Gerais Social Responsibility Index and percentage of the poor or extremely poor population were associated with meeting the established goals. Conclusions: the results are useful for designing interventions regarding the structuring of vaccination services and the implementation of actions to increase vaccination coverage in clusters with less propensity to vaccinate.

RESUMEN Objetivo: analizar la distribución espacial de las coberturas de vacunación en menores de un año y los factores socioeconómicos asociados al cumplimiento de las metas recomendadas en Minas Gerais. Métodos: estudio ecológico, realizado en 853 municipios del estado. Se analizaron las coberturas vacunales de pentavalente, poliomielitis, meningococo C, fiebre amarilla, rotavirus y neumococo conjugado decavalente. Se realizaron estadísticas de escaneo y regresión logística múltiple para identificar grupos espaciales y factores asociados con el cumplimiento de los objetivos de cobertura. Resultados: el análisis espacial reveló conglomerados con riesgo de baja cobertura para todas las vacunas. Número de familias con renta per cápita de hasta 1/2 salario, Índice de Responsabilidad Social Minas Gerais y porcentaje de población pobre o extremadamente pobre se asociaron al cumplimiento de las metas establecidas. Conclusiones: los resultados son útiles para el diseño de intervenciones en cuanto a la estructuración de los servicios de vacunación y la implementación de acciones para aumentar las coberturas de vacunación en los conglomerados con menor propensión a vacunar.

RESUMO Objetivo: analisar a distribuição espacial da cobertura vacinal em menores de um ano e os fatores socioeconômicos associados ao cumprimento das metas preconizadas em Minas Gerais. Métodos: estudo ecológico, realizado nos 853 municípios do estado. Foram analisadas as coberturas vacinais da pentavalente, poliomielite, meningocócica C, febre amarela, rotavírus, e pneumocócica conjugada 10-valente. Realizou-se estatística de varredura e regressão logística múltipla para identificar agrupamentos espaciais e fatores associados ao cumprimento das metas de cobertura. Resultados: a análise espacial revelou aglomerados com risco de baixas coberturas para todas as vacinas. Número de famílias com renda per capita até 1/2 salário, Índice Mineiro de Responsabilidade Social e percentual da população pobre ou extremamente pobre se mostraram associados ao cumprimento das metas preconizadas. Conclusões: os resultados são úteis para projetar intervenções quanto à estruturação dos serviços de vacinação e implementação de ações para aumentar a cobertura vacinal nos aglomerados com menor propensão à vacinação.

Streptococcus equi culture prevalence, associated risk factors and antimicrobial susceptibility in a horse population from Colombia.

The objectives of this study were to determine the prevalence of S. equi in a horse population in Colombia, to determine the risk factors associated with its detection in the guttural pouches and to report the antimicrobial susceptibility of the isolates. Fifteen farms and 137 horses >6 months of age were enrolled. Sampling was randomly, stratified and proportional to the population size of each farm. The guttural pouch (GP) was swabbed via endoscopic guidance and culture was performed. DNA extraction and conventional PCR were performed in colonies compatibles with S. equi, the PCR products were sequenced and subjected to BLAST analysis. Antimicrobial drug sensitivity was assessed using an antimicrobial disc diffusion assay including penicillin, ceftiofur, trimethoprim-sulfamethoxasole (TMS), enrofloxacin and oxytetracycline. A mixed logistic regression model was constructed to evaluate risk factors associated with the presence of S. equi. The S. equi culture prevalence in the GP was 15%; 13.5 % for S. equi subsp. equi and 1.5% for S. equi subsp. zooepidemicus. History of travel was associated with the presence of S. equi, whereas every 1-year increase in age decreased the risk for S. equi detection in the GP. All isolates were susceptible to TMS, ceftiofur and penicillin, but resistant to enrofloxacin and oxytetracycline. S. equi is present in horses in Colombia, with a high prevalence and appear to be endemic in the tested population. Younger horses and horses with recent history of travelling had higher odds of testing positive for S. equi in swabs of the GP.

Admisiones por bronquiolitis en 13 unidades de cuidados intensivos pediátricos del Uruguay: ¿es igual en Montevideo que en el interior? / Bronchiolitis admissions in 13 pediatric intensive care units in Uruguay: is it the same in Montevideo (capital city) and the provinces? / Internações por bronquiolite em 13 unidades de terapia intensiva pediátrica do Uruguai: são iguais em Montevidéu e no Interior do país?

Resumen: Objetivos: describir las características clínicas y epidemiológicas de niños admitidos por bronquiolitis en 13 unidades de cuidados intensivos pediátricos (UCIP) del Uruguay y comparar los resultados asistenciales finales entre UCIP de Montevideo (UM) y del interior del país (UI). Material y método: estudio observacional retrospectivo multicéntrico de los registros ingresados a base de datos prospectiva de LARed Network. Se incluyeron niños mayores de 1 mes y menores de 2 años admitidos en el período 1 de mayo de 2017 y 30 de abril de 2019 con diagnóstico de bronquiolitis comunitaria. Se analizaron datos demográficos, clínicos, así como intervenciones y desenlaces al alta. Resultados: se analizaron 666 casos. No se detectaron diferencias significativas de comorbilidades ni en el soporte respiratorio al ingreso. En UI los pacientes fueron derivados con más frecuencia desde otro hospital. La distancia y tiempo medio, así como el porcentaje de traslados mayor de 50 km, fue también mayor. En UI los pacientes tuvieron mayor gravedad clínica y gasométrica al ingreso. El perfil radiológico y etiológico fue similar. Virus respiratorio sincicial (VRS) aislado > 50%. La indicación global de corticoides superó el 25% y el de broncodilatadores el 85%. La prescripción de antibióticos y adrenalina nebulizada fue mayor en UI. La cánula nasal de alto flujo (CNAF) fue globalmente el método de soporte respiratorio más utilizado, aunque se observó un mayor uso de ventilación mecánica invasiva (VMI) y CPAP en UI (47% vs 28% en UM). No hubo diferencias en el número de complicaciones por VMI o ventilación no invasiva, ni en el uso de terapias de rescate. Tampoco se notaron diferencias significativas en la duración de la estadía en UCIP, ni en la mortalidad absoluta y ajustada, y hubo un solo caso de nueva morbilidad. Conclusiones: los niños admitidos en UI tuvieron mayor gravedad al ingreso y más factores de riesgo relacionados con mal pronóstico en el traslado, recibiendo más antibióticos y soporte invasivo que aquellos ingresados en UM. El CNAF fue el tipo de soporte respiratorio más utilizado en el país. Se detectó alto porcentaje de prescripción de terapias no recomendadas, como broncodilatadores y corticoides. La mortalidad y complicaciones fueron bajas, así como la generación de morbilidad residual.

Summary: Objectives: to describe the clinical and epidemiological characteristics of children admitted for bronchiolitis in 13 Pediatric Intensive Care Units (UCIP) in Uruguay and compare the final care outcomes between Montevideo (UM) and Interior of the country (IU). Method: multicenter, retrospective, observational study of data entered in the LARed Network prospective database. Children over 1 month and younger than 2 years admitted between May 1, 2017 and April 30, 2019 with a diagnosis of Community Bronchiolitis were included in the study. Demographic and clinical data were analyzed, as well as interventions and discharge outcomes. Results: 666 cases were analyzed. No significant differences in comorbidity and respiratory support were detected at admission. In IU patients were referred more frequently from another hospital. The distance and average time, as well as the percentage of transfers greater than 50 km, was also higher. In IU, patients had greater clinical and gasometrical severity at admission. The radiological and etiological profile was similar (VRS at > 50%). The overall indication of corticosteroids exceeded 25% and that of bronchodilators exceeded 85%. The prescription for antibiotics and nebulized adrenaline was higher in IU. The high flow nasal cannula (HFNC) was globally the most widely used respiratory support method, although increased use of invasive mechanical ventilation (IMV) and CPAP in IU (43% vs 28% in UM) was observed. There were no differences in the number of complications from IVF or non-invasive ventilation, nor in the use of rescue therapies. There were also no significant differences in the length of stay at UCIP or in absolute and adjusted mortality and there was only one case of new morbidity. Conclusions: children admitted to IU had higher severity scores and more transfer-related risk factors, received more antibiotics and invasive support. HFNC was the most widely used type of respiratory support in the country. A high prescription of non-recommended therapies such as bronchodilators and corticosteroids was detected. Mortality and complications were low, as were the generation of new morbidity.

Resumo: Objetivos: descrever as características clínicas e epidemiológicas de crianças internadas por bronquiolite em 13 Unidades de Terapia Intensiva Pediátrica (UTIP) do Uruguai e comparar os resultados finais do atendimento entre UTIP de Montevidéu (UM) e do Interior do país (IU). Material e métodos: estudo observacional retrospectivo multicêntrico dos dados inseridos no banco de dados prospectivo da Rede LARed. Foram incluídas crianças maiores de 1 mês e menores de 2 anos internadas no período de 1º de maio de 2017 a 30 de abril de 2019 com diagnóstico de bronquiolite comunitária. Dados demográficos e clínicos, bem como intervenções e desfechos na alta, foram analisados. Resultados: foram analisados 666 casos. Não foram detectadas diferenças significativas nas comorbidades ou no suporte respiratório na admissão. No IU, os pacientes foram encaminhados com maior frequência a outro hospital. A distância e o tempo médios, assim como o percentual de transferências superiores a 50 km, também foram maiores. No IU, os pacientes apresentaram maior gravidade clínica e gasométrica na admissão. O perfil radiológico e etiológico foi semelhante. O vírus sincicial respiratório (RSV) foi isolado em > 50%. A indicação global de corticosteroides ultrapassou 25% e a de broncodilatadores 85%. A prescrição de antibióticos e adrenalina nebulizada foi maior no IU. A cânula nasal de alto fluxo (CNAF) foi o método de suporte respiratório mais utilizado, embora tenha sido observado um maior uso de ventilação mecânica invasiva (VMI) e CPAP no IU (47% vs 28% em UM). Não houve diferenças no número de complicações devido à VMI ou Ventilação Não Invasiva, ou no uso de terapias de resgate. Também não foram observadas diferenças significativas no tempo de internação na UTIP ou na mortalidade absoluta e ajustada, havendo apenas um caso de nova morbidade. Conclusões: as crianças admitidas no IU apresentaram maior gravidade na admissão e mais fatores de risco relacionados ao mau prognóstico na transferência, recebendo mais antibióticos e suporte invasivo do que as internadas em UM. O CNAF foi o tipo de suporte respiratório mais utilizado no país. Detectou-se alto percentual de prescrição de terapias não recomendadas, como broncodilatadores e corticosteroides. A mortalidade e as complicações foram baixas, assim como a geração de morbidade residual.

Análisis bibliométrico de los artículos científicos publicados en Medicina Veterinaria y Zootecnia en Colombia 2010-2019

RESUMEN Objetivo. Analizar la producción científica en Medicina Veterinaria y Zootecnia en Colombia en el período 2010-2019. Materiales y métodos. Se realizó un estudio descriptivo transversal retrospectivo, mediante el análisis bibliométrico de los artículos publicados en nueve revistas del área de la Medicina Veterinaria y Zootecnia en Colombia. La información se obtuvo mediante la búsqueda en internet de la página web de cada revista. Los artículos incluidos fueron artículos originales, revisiones de literatura, comunicaciones breves, casos clínicos y editoriales. Resultados. El total de artículos fue 3.000; 2.250 (75%) publicados en español, 673 (22.4%) en inglés y 77 (2.6%) en portugués. 2.282 (76.1%) fueron originales, 224 (7.5%) revisiones de literatura, 165 (5.5%) casos clínicos, 105 (3.5%) comunicaciones breves, 204 (6.8%) editoriales y 21 (0.6%) otros. Hubo 10.296 autores; 7.109 (69%), nacionales y 3.187 (31%) extranjeros. Del total de autores, 6.659 (64.7%) fueron hombres; 3.199 (31%) mujeres y 438 (4.3%) sin identificación; con un promedio de 3.38 autores/artículo. Las entidades públicas aportaron el 77.9% de la producción científica y las privadas el 22.1%. Las áreas con mayor número de publicaciones fueron zootecnia, salud animal, agricultura y fauna silvestre. El top 5 de las filiaciones de los autores correspondió a universidades públicas. Conclusiones. Las revistas que publican en inglés consiguen un mejor posicionamiento internacional y en ellas publican el mayor número de autores extranjeros. Los artículos más publicados fueron los originales. El top 10 de los artículos más citados arrojó un total de 810 citas que contribuyen con la internacionalización de las revistas colombianas y de Colombia.

ABSTRACT Objective. Analyze the scientific production in Veterinary Medicine and Animal Husbandry in Colombia in the period 2010-2019. Materials and methods. A retrospective cross-sectional descriptive study was carried out, through the bibliometric analysis of articles published in nine journals in the area of Veterinary Medicine and Animal Husbandry in Colombia. The information was obtained by searching theinternet for each journal's website. The articles included were original articles, literature reviews, brief communications, clinical cases and editorials. Results. The total number of articles was 3.000; 2.250 (75%) published in Spanish, 673 (22.4%) in English and 77 (2.6%) in Portuguese. 2.282 (76.1%) were original, 224 (7.5%) literature reviews, 165 (5.5%) clinical cases, 105 (3.5%) brief communications, 204 (6.8%) editorials and 21 (0.6%) others. There were 10,296 authors; 7.109 (69%), nationals and 3.187 (31%) foreigners. Of the total Authors, 6.659 (64.7%) were men; 3.199 (31%) women and 438 (4.3%) without identification, with an average of 3.38 authors/article. Public entities contributed 77.9% of scientific production and private entities 22.1%. The areas with the highest number of publications were zootechnics, animal health, agriculture and wildlife. The top 5 of affiliations of the authors corresponded to public universities. Conclusions. The journal that publish in English achieve a better international positioning and in them the largest number of foreign authors publishes. The most published articles were the original ones. The top 10 of the most cited articles yielded a total of 810 citations that contribute to the internationalization of Colombia and Colombian journals.

Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis. / Variabilidad terapéutica en lactantes con bronquiolitis hospitalizados en unidades de cuidados intensivos latinoamericanas.

The objective of this study was to describe the management of infants with acute bronchiolitis admit ted to 20 pediatric intensive care units (PICU) members of LARed in 5 Latin American countries. Pa tients and Method: Retrospective, multicenter, observational study of data from the Latin American Registry of Acute Pediatric Respiratory Failure. We included children under 2 years of age admitted to the PICU due to community-based acute bronchiolitis between May and September 2017. Demo graphic and clinical data, respiratory support, therapies used, and clinical results were collected. A subgroup analysis was carried out according to geographical location (Atlantic v/s Pacific), type of insurance (Public v/s Private), and Academic v/s non-Academic centers. Results: 1,155 patients were included in the registry which present acute respiratory failure and 6 were excluded due to the lack of information in their record form. Out of the 1,147 patients, 908 were under 2 years of age, and out of those, 467 (51.4%) were diagnosed with acute bronchiolitis, which was the main cause of admission to the PICU due to acute respiratory failure. The demographic and severity characteristics among the centers were similar. The most frequent maximum ventilatory support was the high-flow nasal can nula (47%), followed by non-invasive ventilation (26%) and invasive mechanical ventilation (17%), with a wide coefficient of variation (CV) between centers. There was a great dispersion in the use of treatments, where the use of bronchodilators, antibiotics, and corticosteroids, representing a CV up to 400%. There were significant differences in subgroup analysis regarding respiratory support and treatments used. One patient of this cohort passed away. Conclusion: we detected wide variability in respiratory support and treatments among Latin American PICUs. This variability was not explained by demographic or clinical differences. The heterogeneity of treatments should encourage collabora tive initiatives to reduce the gap between scientific evidence and practice.

Variabilidad terapéutica en lactantes con bronquiolitis hospitalizados en unidades de cuidados intensivos latinoamericanas / Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis

Resumen: Objetivo: describir las terapias utilizadas en lactantes con bronquiolitis aguda admitidos en 20 Uni dades de Cuidados Intensivos (UCI) pediátricos miembros de LARed en 5 países latinoamerica nos. Pacientes y Método: Estudio observacional retrospectivo, multicéntrico, de datos del Registro Latinoamericano de Falla Respiratoria Aguda Pediátrica. Se incluyeron niños menores de 2 años ingresados a UCI pediátrica por bronquiolitis aguda comunitaria entre mayo-septiembre 2017. Se recolectaron datos demográficos, clínicos, soporte respiratorio, terapias utilizadas y resultados clí nicos. Se realizó análisis de subgrupos según ubicación geográfica, tipo financiación y presencia de academia. Resultados: Ingresaron al registro 1155 pacientes con falla respiratoria aguda. Seis casos fueron excluidos por no tener formulario completo. De los 1147 pacientes, 908 eran menores de 2 años. De ellos, 467 tuvieron diagnóstico de bronquiolitis aguda, correspondiendo a la principal causa de ingreso a UCI pediátrica por falla respiratoria aguda (51,4%). Las características demográficas y de gravedad entre los centros fueron similares. El soporte máximo respiratorio más frecuente fue cánula nasal de alto flujo (47%), seguido por ventilación mecánica no invasiva (26%) y ventilación mecánica invasiva (17%), con un coeficiente de variación (CV) amplio entre los centros. Hubo una gran dispersión en uso de terapias, siendo frecuente el uso de broncodilatadores, antibióticos y corticoides, con CV hasta 400%. El análisis de subgrupos mostró diferencias significativas en soporte respiratorio y tratamientos utilizados. Un paciente falleció en esta cohorte. Conclusión: Detectamos gran variabilidad en el soporte respiratorio y tratamientos entre UCI pediátricas latinoamericanas. Esta variabilidad no es explicada por disparidades demográficas ni clínicas. Esta heterogeneidad de tratamientos debería promover iniciativas colaborativas para disminuir la brecha entre la evidencia científica y la práctica asistencial.

Abstract: The objective of this study was to describe the management of infants with acute bronchiolitis admit ted to 20 pediatric intensive care units (PICU) members of LARed in 5 Latin American countries. Pa tients and Method: Retrospective, multicenter, observational study of data from the Latin American Registry of Acute Pediatric Respiratory Failure. We included children under 2 years of age admitted to the PICU due to community-based acute bronchiolitis between May and September 2017. Demo graphic and clinical data, respiratory support, therapies used, and clinical results were collected. A subgroup analysis was carried out according to geographical location (Atlantic v/s Pacific), type of insurance (Public v/s Private), and Academic v/s non-Academic centers. Results: 1,155 patients were included in the registry which present acute respiratory failure and 6 were excluded due to the lack of information in their record form. Out of the 1,147 patients, 908 were under 2 years of age, and out of those, 467 (51.4%) were diagnosed with acute bronchiolitis, which was the main cause of admission to the PICU due to acute respiratory failure. The demographic and severity characteristics among the centers were similar. The most frequent maximum ventilatory support was the high-flow nasal can nula (47%), followed by non-invasive ventilation (26%) and invasive mechanical ventilation (17%), with a wide coefficient of variation (CV) between centers. There was a great dispersion in the use of treatments, where the use of bronchodilators, antibiotics, and corticosteroids, representing a CV up to 400%. There were significant differences in subgroup analysis regarding respiratory support and treatments used. One patient of this cohort passed away. Conclusion: we detected wide variability in respiratory support and treatments among Latin American PICUs. This variability was not explained by demographic or clinical differences. The heterogeneity of treatments should encourage collabora tive initiatives to reduce the gap between scientific evidence and practice.

Investigating the impact of Hurricane Maria on an ongoing birth cohort in Puerto Rico.

Prior to Hurricane Maria, Puerto Rico already had 200+ hazardous waste sites, significant contamination of water resources, and among the highest rates of preterm birth in the US. To address these issues, the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) Center was formed in 2010 to investigate prenatal environmental exposures, particularly phthalates, and adverse birth outcomes. Recent work from the PROTECT study confirms that in utero exposure to certain phthalates is associated with shorter gestation and increased risk of preterm birth. However, previous research also suggests that pregnant women who experience a natural disaster such as Hurricane Maria are at higher risk of adverse birth outcomes, but it is unknown whether this is due to stress, hazardous exposures, or a combination of factors. Thus, the aim of this analysis was to characterize hurricane-related changes in phthalate exposures and experiences within the PROTECT cohort. Among 176 participants who were pregnant during or within 5 months after Maria, 122 completed a questionnaire on hurricane-related experiences. Questionnaire results and biomarkers of exposure suggest that participants did not have regular access to fresh foods and water during hurricane recovery, and almost half reported structural damage to their home. In addition, biomarker concentrations of phthalates commonly used in food packaging were higher among participants post-hurricane, while phthalates commonly used in personal care products were lower compared to pre-hurricane levels. Hurricane-related increases in phthalate exposure, as well as widespread structural damage, food and water shortages, and long-term absence of electricity and cell phone service, likely increased the risk of adverse birth outcomes among this already vulnerable population.

Is subretinal surgery feasible for a non-responsive juxtafoveal type 2 choroidal neovascular membrane?

PURPOSE: To describe the long-term outcome of a patient with multifocal choroiditis, who underwent surgical removal of a type 2 choroidal neovascular membrane employing 23 G pars plana vitrectomy. OBSERVATIONS: A 50-year-old man was treated with 3 monthly intravitreal bevacizumab injections, but despite treatment, visual acuity continued to worsen from 20/40 to 20/100, and bleeding was not receding. A minimal invasive pars plana vitrectomy was performed for surgical removal of the neovascular complex without any complicating incident. Subsequent visual acuity was 20/25 for more than eleven years. CONCLUSIONS AND IMPORTANCE: Surgical removal of choroidal neovascular membranes employing minimal invasive surgery in addition to anti-VEGF therapy, and OCT evaluation can be a viable approach for selected cases of juxtafoveal type 2 CNV.

Abscesos suprarrenales bilaterales en un recién nacido / Bilateral suprarrenal abscess in a newborn child

La hemorragia suprarrenal bilateral es una entidad rara en recién nacidos y lactantes pequeños. Sus factores predisponentes son el traumatismo obstétrico, la hipoxia-isquemia perinatal, la sepsis y las alteraciones de la coagulación. Una evolución posible es la formación de abscesos, sobre todo cuando hay un componente infeccioso en su desarrollo.La persistencia de leucocitosis y marcadores inflamatorios elevados en el contexto de una sepsis con compromiso hipóxico-isquémico perinatal nos debe hacer pensar, como posibilidad diagnóstica, en la evolución a absceso de una hemorragia suprarrenal. La ecografía, en primer lugar, y la tomografía de abdomen para evaluación quirúrgica son las técnicas diagnósticas de elección, obteniéndose la confirmación mediante la punción de masas suprarrenales. El tratamiento mediante la colocación de drenajes percutáneos bajo guía ecográfica o la resección quirúrgica son la terapéutica de elección, junto a la administración de antibióticos intravenosos adecuados a la sensibilidad del germen. Presentamos el caso clínico de un paciente con abscesos suprarrenales bilaterales en el contexto de una sepsis connatal por Escherichia coli con compromiso hipóxico-isquémico severo. Se revisan los principales aspectos etiológicos, diagnósticos y terapéuticos de esta entidad.

Bilateral suprarenal bleeding is a rare disease in the newborn and young infant. Obstetric trauma, perinatal hypoxic-ischemic syndrome, sepsis and coagulopathy disorders are predisposing factors. Sometimes an abscess forms if an infection is present since the beginning.A possible complication in patients with neonatal septicemia and hypoxic-ischemic syndrome with persistent leukocytes and inflammatory markers is suprarenal abscess. Abdominal ultrasound and a CAT scan are needed for surgical evaluation. Percutaneous punction of the suprarenal masses is useful in order to confirm diagnosis and etiology. Percutaneous drainage through ultrasound or tomography should be considered as treatment, as intravenous antibiotics according to microbiological sensibility.A case of a newborn with sepsis to Escherichia Coli with severe hypoxic-ischemic compromise complicated with bilateral suprarenal abscess is presented. Main etiologies, diagnosis and therapeutic aspects of this entity are reviewed.

Abscesos suprarrenales bilaterales en un recién nacido / Bilateral suprarrenal abscess in a newborn child

La hemorragia suprarrenal bilateral es una entidad rara en recién nacidos y lactantes pequeños. Sus factores predisponentes son el traumatismo obstétrico, la hipoxia-isquemia perinatal, la sepsis y las alteraciones de la coagulación. Una evolución posible es la formación de abscesos, sobre todo cuando hay un componente infeccioso en su desarrollo.La persistencia de leucocitosis y marcadores inflamatorios elevados en el contexto de una sepsis con compromiso hipóxico-isquémico perinatal nos debe hacer pensar, como posibilidad diagnóstica, en la evolución a absceso de una hemorragia suprarrenal.La ecografía, en primer lugar, y la tomografía de abdomen para evaluación quirúrgica son las técnicas diagnósticas de elección, obteniéndose la confirmación mediante la punción de masas suprarrenales.El tratamiento mediante la colocación de drenajes percutáneos bajo guía ecográfica o la resección quirúrgica son la terapéutica de elección, junto a la administración de antibióticos intravenosos adecuados a la sensibilidad del germen.Presentamos el caso clínico de un paciente con abscesos suprarrenales bilaterales en el contexto de una sepsis connatal por Escherichia coli con compromiso hipóxico-isquémico severo. Se revisan los principales aspectos etiológicos, diagnósticos y terapéuticos de esta entidad.

Bilateral suprarenal bleeding is a rare disease in the newborn and young infant. Obstetric trauma, perinatal hypoxic-ischemic syndrome, sepsis and coagulopathy disorders are predisposing factors. Sometimes an abscess forms if an infection is present since the beginning.A possible complication in patients with neonatal septicemia and hypoxic-ischemic syndrome with persistent leukocytes and inflammatory markers is suprarenal abscess.Abdominal ultrasound and a CAT scan are needed for surgical evaluation. Percutaneous punction of the suprarenal masses is useful in order to confirm diagnosis and etiology.Percutaneous drainage through ultrasound or tomography should be considered as treatment, as intravenous antibiotics according to microbiological sensibility.A case of a newborn with sepsis to Escherichia Coli with severe hypoxic-ischemic compromise complicated with bilateral suprarenal abscess is presented. Main etiologies, diagnosis and therapeutic aspects of this entity are reviewed.

Chemical and biological characterization of slaughterhouse wastes compost.

The chemical and biological properties of compost made from yard trimmings (YT) composted alone or mixed with slaughterhouse wastes (SHW) were evaluated in seven phases. Mixtures were weighed in a 2:1 proportion (YT:SHW) and placed in composting bins (0.91 m2). Temperature was recorded to determine the time (d) needed to reach the first (1HC) and second heat cycles (2HC). Composting characteristics were measured at 0 d, at the peak of the 1HC and 2HC, and at maturation (0, 20, 50 and 70 d). During 1HC, bacterial isolates were cultivated in both treatments and identified using the Biolog System. Chemical composition was statistically analyzed using a 2 (layers of SHW)x7 (composting phases) factorial arrangement of treatments with the ANOVA procedure of SAS. The pH was neutral for YT and ranged from 7.41 to 6.82 for SHW throughout the process. There was a decrease in organic matter (OM) and carbon (C), and a relative increase in nitrogen (N) in both treatments. At 70 d of maturation, C:N values were similar between treatments, but lower (P>0.05) than the initial values. Final N concentration was higher (P>0.05) for the treatment with SHW. Only the SHW treatment exhibited thermophilic temperatures. At the 1HC in both treatments, different populations of bacteria responsible for the breakdown of OM were identified showing an active heterogeneous population. The presence of pathogenic microorganisms was not detected in treatments containing SHW.

Hematuria e hipercalciuria: una forma excepcional de presentación de la artritis / Hematuria and hypercalciuria: an excepcional presentation of juvenile reumathoid arthritis

Se presenta un caso de una niña de cinco años que ingresa con una historia de 2 días de evolución caracterizada por disuria, dolor abdominal, orina de color rojo parduzco e hiperemia conjuntival bilateral. Los exámenes paraclínicos mostraron hematuria y calciuria elevada. En la evolución agrega compromiso de pequeñas y grandes articulaciones acompañado de fiebre. Se realiza diagnóstico de artritis reumatoidea juvenil, recibiendo tratamiento con antiinflamatorios no esteroideos y corticoides, permaneciendo asintomática hasta el momento actual. Se destaca la presencia de macrohematuria e hipercalciuria como forma inusual de presentación de la enfermedad.

Hematuria e hipercalciuria: una forma excepcional de presentación de la artritis / Hematuria and hypercalciuria: an excepcional presentation of juvenile reumathoid arthritis

Se presenta un caso de una niña de cinco años que ingresa con una historia de 2 días de evolución caracterizada por disuria, dolor abdominal, orina de color rojo parduzco e hiperemia conjuntival bilateral. Los exámenes paraclínicos mostraron hematuria y calciuria elevada. En la evolución agrega compromiso de pequeñas y grandes articulaciones acompañado de fiebre. Se realiza diagnóstico de artritis reumatoidea juvenil, recibiendo tratamiento con antiinflamatorios no esteroideos y corticoides, permaneciendo asintomática hasta el momento actual. Se destaca la presencia de macrohematuria e hipercalciuria como forma inusual de presentación de la enfermedad.

Enfermedad de Kawasaki en un lactante de dos meses / Kawasaki disease in a two months old infant

La enfermedad de Kawasaki (EK) es un síndrome vasculítico multisistémico febril agudo, autolimitado, de etiología incierta. Se manifiesta frecuentemente en niños menores de cinco años de edad, siendo poco común en menores de tres meses. El diagnóstico se establece a partir de un cuadro clínico compatible, asociado a alteraciones sugestivas en los exámenes complementarios. El tratamiento consiste en la administración de gammaglobulina hiperinmune y ácido acetilsalicílico dentro de los primeros diez días del inicio de la sintomatología. Se presenta una paciente de dos meses de edad que cumple todos los criterios diagnósticos de la enfermedad. El tratamiento se realiza en forma precoz, siendo su evolución favorable, sin secuelas cardiovasculares hasta el momento actual. Si bien esta enfermedad es poco frecuente, se destaca la importancia de pensar en ella, aún en lactantes pequeños, dado que la instauración temprana del tratamiento puede disminuir la incidencia de aneurismas coronarios.