Antibiotic use in infants at risk of early-onset sepsis: results from a unicentric retrospective cohort study.

BACKGROUND: Antibiotic use for early-onset sepsis represents a high percentage of antibiotic consumption in the neonatal setting. Measures to assess infants at risk of early-onset sepsis are needed to optimize antibiotic use. Our primary objective was to assess the impact of a departmental guideline on antibiotic use among term infants with suspected EOS not confirmed, in our neonatal unit. METHODS: Retrospective cohort study, to compare antibiotic use in term infants during a baseline period of January to December 2018, and a postintervention period from October 2019, to September 2020, respectively. The primary outcome was antibiotic use measured by days of therapy, the antibiotic spectrum index, the antibiotic use rate, and the length of therapy. RESULTS: We included 71 infants in the baseline period and 66 infants in the postintervention period. Compared to those in the baseline period, there was a significant reduction in overall antibiotic measures in the postintervention period, (P < 0.001). The total days of therapy/1000 patient-days decreased from 63/1000 patient-days during the baseline period to 25.8/1000 patient-days in the postintervention period, representing a relative reduction of 59%. The antibiotic use rate decreased by more than half of the infants, from 3.2% during the baseline period to 1.3% in the postintervention period. CONCLUSIONS: The use of a departmental guideline to assess infants at risk of early-onset sepsis based on their clinical condition and prompt discontinuation of antibiotics, is a simple and low-cost measure that contributed to an important decrease in antibiotic use.

Uncommon short- and long-term cardiological side effects of thoracic radiation: a report of two cases.

Radiotherapy is an essential treatment of more than 50% of oncohematological patients. Pericardial disorders and valvular heart disease are two common radiotherapy complications. Acute pericarditis is infrequent and usually underdiagnosed. Therefore, diagnostic suspicion and early treatment are mandatory to avoid the evolution to constrictive pericarditis. The prevalence of radiation-induced valvular heart disease is common in patients with a history of Hodgkin's lymphoma and breast cancer. It has distinctive characteristics from other etiologies and, thus, different therapeutic approaches. We present two cases of unusual complications of radiotherapy; the first one in the acute setting and the second one during the follow-up in the chronic phase. A multidisciplinary and individualized approach with specific considerations is decisive in the management of these patients.

El cuerpo trans*: territorio de poder, lugar de resistencia al poder heteronormativo / The trans* body: territory of power, place of resistance to the heteronormative system

Este artículo reflexiona sobre el cuerpo trans* como territorio de poder que hace resistencia al poder hegemónico, cuyo orden busca "normalizar" los cuerpos de acuerdo con lo estipulado socialmente bajo el "deber ser" del género. Para ello se realiza un abordaje teórico sobre el cuerpo, desde posturas como las de Foucault y Butler que lo conciben como entidad que en sí misma es poder. Con base en los referentes teóricos presentados, se expresan los argumentos que permiten entender los cuerpos trans* como territorios de subversión frente al orden establecido sobre estos. Se concluye que las personas trans, si bien se resisten a la heterosexualidad obligatoria, posiblemente no sea de forma estructural y radical, sino desde dentro del orden social, generando ciertas fisuras en sus prácticas y performances que presentan ante el sistema, develando una presencia que excede sus linealidades

This article reflects on the trans* body as a territory of power, which resists the hegemonic power, whose order seeks to "normalize" the bodies according to what is socially stipulated under the "duty to be" of gender. For this, a theoretical approach is made to the body, from positions such as those of Foucault and Butler that conceive it as an entity that in itself is (is) power. Based on the theoretical references presented, the arguments that allow us to understand trans* bodies as territories of subversion against the order established on them are expressed. It is concluded that trans people, although they resist compulsory heterosexuality, may not be structurally and radically, but from within the social order, generating certain fissures in their practices and performances that they present to the system, revealing a presence that exceeds their linearities

Tumor Necrosis Factor Inhibitor Dose Reduction for Axial Spondyloarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: The present study was undertaken to investigate the effectiveness and safety of dose reduction of tumor necrosis factor inhibitor (TNFi) therapy in the treatment of axial spondyloarthritis (SpA) compared to usual care. METHODS: We searched the Cochrane Central Register of Controlled Trials, Embase, Medline, and trial registries. We screened, extracted data, and assessed risk of bias in duplicate. Data were pooled using random-effects models; subgroup analyses were performed for type of TNFi, prior TNFi exposure, and follow-up duration. Outcomes of interest were Assessment of SpondyloArthritis international Society (ASAS) response and remission criteria, disease activity, relapse, and safety. RESULTS: We included 6 randomized trials with 747 participants (442 with ankylosing spondylitis and 305 with nonradiographic axial SpA). Compared to the standard dose, there were fewer events with the reduced dose for the ASAS criteria for 40% improvement (risk ratio [RR] 0.62 [95% confidence interval (95% CI) 0.49, 0.78]) and for ASAS partial remission (RR 0.17 [95% CI 0.06, 0.46]). There was a mean increase in the Bath Ankylosing Spondylitis Disease Activity Index score (mean difference [MD] 0.35 [95% CI 0.10, 0.60]) and no difference in C-reactive protein levels (MD 0.16 [95% CI -0.76, 1.07]) with the reduced dose. There were more disease flares/relapses (RR 1.73 [95% CI 1.32, 2.27]) with the reduced dose. There were no differences in infection rates (incidence rate ratio [IRR] 0.98 [95% CI 0.76, 1.25]) or injection/infusion reactions (IRR 0.71 [95% CI 0.42, 1.19]). CONCLUSION: Patients with axial SpA may experience little to no clinical benefit from reduction of TNFi therapy. Maintaining the standard dose probably improves the sustained effect on disease activity and helps to prevent disease flare.

Caracterización de neoplasias mamarias mediante espectroscopia de impedancia eléctrica: modelo canino / Characterization of mammary neoplasia by electrical impedance spectroscopy: canine model

Introducción: La espectroscopia de impedancia eléctrica (EIE) es una técnica fácil de usar y de bajo costo que se puede utilizar para analizar tejidos biológicos en condiciones normales o patológicas. El objetivo de este trabajo fue caracterizar neoplasias de glándula mamaria benignas y malignas aplicando la técnica EIE en muestras extraídas de 45 caninos hembras (Canis lupus familiaris). Métodos: Se utilizó un medidor de impedancia eléctrica, Hioki 3532-50, para determinar los parámetros bioeléctricos: resistencia de la matriz extracelular (R), resistencia de la matriz intracelular (S), frecuencia característica (Fc) y capacitancia de membrana (Cm) en un rango de frecuencias entre 42 Hz y 5 MHz y se analizaron estadísticamente mediante la prueba no paramétrica U de Mann-Whitney (Wilcoxon) de dos colas. La precisión diagnóstica de la EIE se efectuó a través de curvas características de operación del receptor (COR) y tablas de doble entrada, con la histopatología como referencia. Resultados: Se encontraron diferencias estadísticamente significativas entre el tejido mamario sano y las neoplasias benignas para los parámetros R, Fc y Cm, p-value < 0,05. Entre tejido mamario sano y neoplasias mamarias malignas se encontraron diferencias estadísticamente significativas para R y Fc con un p-value < 0,05. La comparación entre lesiones tumorales benignas y malignas no presentó diferencias estadísticamente significativas, p-value > 0,05, para ninguna de las variables incluidas en este estudio. Conclusiones: De los parámetros analizados por EIE, la resistencia de la matriz extracelular es la que mejor permite diferenciar entre tejidos mamarios normales y neoplásicos. La EIE es una herramienta diagnóstica potencial que puede ser utilizada en la detección de cáncer mamario, con una precisión diagnóstica cercana al 80%.

Introduction: Electrical Impedance Spectroscopy (EIS) it is an easy to use and low-cost technique that can be used to analyze biological tissues in normal or pathological condition. The goal of this work was to characterize benign and malign mammary gland neoplasms applying the EIS technique in 45 female dogs (Canis lupus familiaris). Methods: An impedance meter Hioki 3532-50 was used to determine bioelectric parameters, extracellular matrix resistance (R), intracellular matrix resistance (S), characteristic frequency (Cf), and membrane capacitance (Mc), which were obtained in a 42 Hz and 5 MHz frequencies range. Were statistically analyzed with the non-parametric test of two-tailed MannWhitney (Wilcoxon). The diagnostic precision of the test was performed using receiver operating characteristics (ROC) and two-way tables using histopathology results as reference. Results: Significant differences between healthy mammary tissue and benign neoplasms were found for variables R, Cf and Mc (p < 0.05). There were statistically major differences between the healthy mammary tissue and malign mammary tumors groups for R and Cf (p < 0.05). The comparison between malign and benign tumor lesions did not show a statistically significant difference, p-value > 0.05, for any of the variables included in this study. Conclusion: Among all parameters analyzed for EIS, the extracellular matrix resistance R is the one that best allows differentiating between healthy and neoplastic mammary tissues. EIS is a diagnostic tool that can be used for breast cancer detection with a diagnostic precision close to 801%.

The kd/kd mouse is a model of collapsing glomerulopathy.

Collapsing glomerulopathy (CG) is associated with disorders that markedly perturb the phenotype of podocytes. The kd/kd mouse has been studied for immune and genetic causes of microcystic tubulointerstitial nephritis with little attention to its glomerular lesion. Because histologic examination revealed classic morphologic features of CG, the question arises whether podocytes in kd/kd mice exhibit additional phenotypic criteria for CG. Utilizing Tg26 mice as a positive control, immunohistochemical profiling of the podocyte phenotype was conducted simultaneously on both models. Similar to Tg26 kidneys, podocytes in kd/kd kidneys showed de novo cyclin D1, Ki-67, and desmin expression with loss of synaptopodin and WT-1 expression. Electron micrographs showed collapsed capillaries, extensive foot process effacement, and dysmorphic mitochondria in podocytes. These results indicate that the kd/kd mouse is a model of CG and raise the possibility that human equivalents of the kd susceptibility gene may exist in patients with CG.

The N-terminal sequence directs import of mitochondrial alanine aminotransferase into mitochondria.

Herein, we report cloning and subcellular localization of two alanine aminotransferase (ALT) isozymes, cALT and mALT, from liver of gilthead sea bream (Sparus aurata). CHO cells transfected with constructs expressing cALT or mALT as C- or N-terminal fusion with the enhanced green fluorescent protein (EGFP) showed that cALT is cytosolic, whereas mALT localized to mitochondria. Fusion of EGFP to mALT N-terminus or removal of amino acids 1-83 of mALT avoided import into mitochondria, supporting evidence that the mALT N-terminus contains a mitochondrial targeting signal. The amino acid sequence of mALT is the first reported for a mitochondrial ALT in animals.