Pattern of Primary Resistance of Helicobacter pylori to Clarithromycin among Pediatric Patients from North-Eastern Romania.

BACKGROUND: Helicobacter pylori antibiotic resistance has increased worldwide and affects the effectiveness of current therapies. The recommended first-line empiric treatment should be tailored to the local clarithromycin resistance rate. This study aimed to determine the pediatric patient profile and rate of clarithromycin resistance for patients diagnosed with Helicobacter pylori by gastric biopsy. METHODS: We studied 84 positive gastric samples for Helicobacter pylori. Positive results were confirmed by a rapid urease test and histopathological examination, with the type of gastritis established according to the Sydney System. Gastric biopsy samples were stored in RNA saver. Clarithromycin resistance was determined by a real-time polymerase chain reaction-based molecular assay after RNA-DNA extraction. RESULTS: Of the 84 biopsy samples analyzed, 35 (41.6%) were resistant to clarithromycin. Clarithromycin resistance was found mainly in girls (80%) with a mean age of 15 years (range 6-17 years). The history of prior exposure to clarithromycin was 91.6%. The concordance between the histopathological examination and the PCR test was 100%. CONCLUSIONS: One in 2.4 children infected with Helicobacter pylori had a strain resistant to clarithromycin. This resistant strain may be a reason for treatment failure in Romanian children, yet this is uninvestigated. The high rate of bacterial resistance to this antibiotic among children indicates the need for susceptibility testing before therapy.

Comparación entre el análisis automático y manual de 301 poligrafías respiratorias domiciliarias con ApneaLink / Comparison between automatic and manual scoring of 301 home respiratory polygraphs with ApneaLink device

Resumen Introducción: El síndrome de apnea obstructiva del sueño (SAOS) se asocia a aumento de morbimortalidad cardiovascular y metabólica, y a mala calidad de vida. Su diagnóstico y tratamiento eficaz mejora la salud individual y pública. Objetivo: evaluar concordancia entre análisis automático versus manual del dispositivo ApneaLink para diagnosticar y clasificar SAOS en pacientes con sospecha clínica. Material y Método: Evaluación retrospectiva de 301 poligrafías respiratorias del HOSCAR. Se mide correlación, acuerdo general y concordancia entre parámetros obtenidos manual y automáticamente usando coeficiente de Pearson, coeficiente de correlación intraclase y gráfico de Bland y Altman. Resultados: En 11,3% de casos el análisis automático interpreto erróneamente la señal de flujo. No hubo diferencias significativas entre índices de apnea-hipopnea automático (AHIa 18,9 ± 17,5) y manual (AHIm 20,8 ± 19,4) r + 0,97 (95% CI: 0,9571 a 0,9728; p < 0,0001) y tampoco entre la saturación mínima de oxígeno automática (82,1 ± 7,6) y manual (83,1 ± 6,8) r + 0,85 (95% CI: 0,8108 a 0,8766; p < 0,0001). No hubo buena correlación entre análisis automático y manual en clasificación de apneas centrales, r + 0,51 (95% CI: 0,4238 a 0,5942; p < 0,0001). Hubo subestimación de gravedad de SAOS por análisis automático: en 11% de casos. Conclusión: El diagnóstico entregado automáticamente por ApneaLink podría aceptarse sin confirmación manual adicional solamente en casos clasificados como severos. Para AHI menores se requeriría confirmación mediante análisis manual de experto.

Abstract Introduction: Obstructive sleep apnea syndrome (OSAS) is associated with increased cardiovascular and metabolic morbidity and mortality, and poor quality of life. Its effective diagnosis and treatment improve individual and public health. Aim: To evaluate concordance between automatic versus manual analysis of the ApneaLink device to diagnose and classify OSAS in patients with clinical suspicion. Material and Method: Retrospective evaluation of 301 respiratory polygraphs from HOSCAR. Correlation, general agreement and concordance between parameters obtained manually and automatically are measured using Pearson's coefficient, intraclass correlation coefficient, and Bland and Altman graph. Results: In 11.3% of cases, the automatic analysis misinterpreted the flow signal. There were no significant differences between automatic (AHIa 18.9 ± 17.5) and manual (AHIm 20.8 ± 19.4) apnea-hypopnea indices r + 0.97 (95% CI:0.9571 to 0.9728, p < 0.0001) and nor between automatic (82.1 ± 7.6) and manual (83.1 ± 6.8) minimum oxygen saturation r + 0.85 (95% CI: 0.8108 to 0.8766, p < 0.0001). There was no good correlation between automatic and manual analysis in the classification of central apneas, r + 0.51(95% CI:0.4238 to 0.5942, p < 0.0001). There was an underestimation of the severity of OSAS by automatic analysis in 11% of cases. Conclusion: The diagnosis delivered automatically by ApneaLink could be accepted without additional manual confirmation only in cases classified as severe. For minors AHI, confirmation through manual expert analysis would be required.

Automated Specification-Based Testing of REST APIs.

Nowadays, REpresentational State Transfer Application Programming Interfaces (REST APIs) are widely used in web applications, hence a plethora of test cases are developed to validate the APIs calls. We propose a solution that automates the generation of test cases for REST APIs based on their specifications. In our approach, apart from the automatic generation of test cases, we provide an option for the user to influence the test case generation process. By adding user interaction, we aim to augment the automatic generation of APIs test cases with human testing expertise and specific context. We use the latest version of OpenAPI 3.x and a wide range of coverage metrics to analyze the functionality and performance of the generated test cases, and non-functional metrics to analyze the performance of the APIs. The experiments proved the effectiveness and practicability of our method.

Riesgos anestésicos en los pacientes con apnea obstructiva del sueño / Obstructive sleep apnea anesthesic risk factors

Anesthesia and airway management in patients with obstructive sleep apnea (OSA) presents difficulties regarding the ventilation mask, intubation and ventilation after extubation. Approximately 10% to 20% of surgical patients have high probability of OSA and 81% of them have not been previously diagnosed. Early identification of these patients and the implementation of strategies to reduce perioperative respiratory depression, improves the perioperative care and reduces the risk of adverse outcomes in patients with confirmed or suspected OSA who receive sedation or anesthesia for diagnostic or therapeutic procedures under the care of an anesthesiologist. The available literature is reviewed in terms of complications and recommendations for the perioperative management of patients at risk of OSA with or without previous diagnosis.

La anestesia y manipulación de vía aérea en pacientes con síndrome de apnea obstructiva del sueño (SAHOS) presenta dificultades con respecto a la máscara de ventilación, intubación y ventilación posterior a extubación. Aproximadamente 10% a 20% de los pacientes quirúrgicos presentan alta probabilidad para SAHOS y 81% de ellos no han sido previamente diagnosticados. La identificación temprana de estos pacientes y la implementación de estrategias para disminuir la depresión respiratoria perioperatoria, mejora el cuidado perioperatorio y reduce el riesgo de complicaciones en pacientes con sospecha de SAHOS o SAHOS definido, quienes se someterán a sedación o anestesia para procedimientos diagnósticos o terapéuticos. Se revisa la literatura disponible en cuanto a complicaciones y recomendaciones para el manejo perioperatorio del paciente en riesgo de SAHOS con o sin diagnóstico previo.

Efficiency of the Ocluch©MAD in the treatment of patients with OSAS and its association with craniofacial morphology.

OBJECTIVE: This study uses polysomnography and the Epworth sleepiness scale to assess the efficiency of the Ocluch©MAD in patients with Obstructive sleep apnea-hypopnea syndrome (OSAS), on overall respiratory disturbance indices (RDI), supine respiratory disturbance index (SRDI), minimum oxygen saturation, microarousals, CT90 (or ID90), sleep efficacy and snoring. These data are associated with skeletal class and facial biotype in order to establish predictive parameters for its effectiveness according to craniofacial morphology. METHODS: 22 adult patients (between 38 and 60 years of age) of both sexes (7 women, 15 men) diagnosed with OSAS in the Hospital de Carabineros de Chile (HOSCAR) Neurology Unit were recruited and given the Ocluch© MAD in the hospital's dental clinic, for its use during a three-month period. Patients were assess at the beginning and in the end of this period. RESULTS: 87.5% of patients with mild OSAS achieved the success criterion and normalization; 71.5% of patients with moderate OSAS achieved the success criterion and 33.3% achieved normalization; 85.7% of patients with severe OSAS achieved the success criterion and 57.1% achieved normalization. All class I and mesofacial patients achieved normalization, but class II patients had the greatest proportional improvement. CONCLUSIONS: The Ocluch MAD is an efficient low-cost alternative that should be considered among the therapeutic arsenal for a multidisciplinary approach to treating this disease.