Local Antimicrobial Resistance Trends in Pediatric Urinary Tract Infection: The Importance of Local Surveillance of a Global Problem.

Introduction Urinary tract infections (UTIs) are one of the most common pediatric bacterial infections and consequently a major reason for antibiotic treatment. Despite being a global problem, antimicrobial resistance is often geographically heterogeneous. Thus, it is fundamental to know local epidemiology and practice frequent surveillance of each hospital's antibiograms. The aims of this study are to determine the local antimicrobial resistance profile in pediatric UTIs, to understand its evolution over 14 years, and finally, to infer if the currently instituted antibiotic empirical therapy remains effective. Materials and methods A retrospective observational study was performed through the analysis of urine cultures and respective antibiograms of children diagnosed with UTI from 2017 to 2019 in Centro Hospitalar Universitário do Algarve (Faro's unit, Portugal), followed by a comparison of the obtained data with the results of a similar study performed between 2003 and 2005. Results A total of 784 urine cultures were selected. Escherichia coli was the most frequent microorganism (n = 561; 71.56%), followed by Proteus mirabilis (n = 117; 14.92%) and Klebsiella pneumoniae (n = 40; 5.10%). The most commonly prescribed antibiotic was cefuroxime axetil (66.28%). Escherichia coli had an increase in resistance to amoxicillin-clavulanate of 6.16% to 34.76% and cefuroxime axetil of 0.73% to 4.46%. Proteus mirabilis had an increase in resistance to amoxicillin-clavulanate of 1.64% to 11.11%. Klebsiella pneumoniae had an increase in resistance to cefuroxime axetil (0%-27.50%) and nitrofurantoin (0%-47.50%). The three microorganisms showed a decrease in trimethoprim-sulfamethoxazole resistance profiles, as well as low resistance profiles to fosfomycin. In fifty cases in which antibiotic empirical therapy was instituted, the isolated microorganism revealed in vitro resistance; 37 of these cases had a good evolution, maintaining the antibiotic empirical therapy. Discussion Local surveillance of antimicrobial resistance allows monitoring of the resistance trends and adequacy of empirical antibiotic therapy. This study's local resistance profile was distinct from other regions of the country and the world. Continuous local surveillance also potentiates the dissemination of the results to the concerned healthcare providers and the initiation of timely responsive measures, containing the increase in antimicrobial resistance. As Escherichia coli was the commonest isolated microorganism, its antimicrobial profile should dictate antibiotic empirical therapy. This study supports that in vitro is not equivalent to in vivo resistance. Conclusion There was a significant increase in antimicrobial resistance profiles, especially to amoxicillin-clavulanate. Cefuroxime axetil remains the recommended antibiotic for empirical therapy in this hospital, although fosfomycin should be considered as an alternative in non-complicated cystitis in adolescent females. This study reinforces the importance of continuous local resistance surveillance as a preventive measure against the global increase in antimicrobial resistance.

Conceptualization of patient-centered care in Latin America: A scoping review.

INTRODUCTION: Patient-centered care (PCC) has been declared as a desirable goal for health care in Latin American countries, but a coherent definition of what exactly PCC entails for clinical practice is missing. This article's aim was to identify how PCC is conceptualized in Latin American countries. METHODS: Scientific databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Scielo, Scopus, Web of Science) and webpages of the ministries of health were searched, and experts were contacted for suggestions of literature. References were included if they contained one of a range of a priori defined keywords related to PCC in the title, were published between 2006 and 2021, and were carried out in or concerned Latin America. Definitions of PCC were extracted from the included articles and analyzed using deductive and inductive coding. Deductive coding was based on the integrative model of patient-centeredness, which unites the definitions of PCC in the international literature (mainly North America and Europe) and proposes 16 dimensions describing PCC. RESULTS: Thirty-two articles were included in the analysis and about half of them were from Brazil. Numerous similarities were found between the integrative model of patient-centeredness and the definitions of PCC given in the selected literature. The dimensions of the integrative model of patient-centeredness that were least and most prominent in the literature were physical support and patient information, respectively. A differentiation between PCC and family-centered care (FCC) was observed. Definitions of PCC and FCC as well as their cited references were diverse. CONCLUSION: A considerable overlap between the conceptualization of PCC in Latin America and the integrative model of patient-centeredness has been identified. However, there are substantial differences between countries in Latin America regarding the emphasis of research on PCC versus FCC and diverse conceptualizations of PCC and FCC exist. PATIENT CONTRIBUTION: This scoping review takes the patient's perspective based on the integrative model of patient-centeredness. Due to the study being a review, no patients, neither caregivers, nor members of the public, were involved.

What is needed to effectively communicate risk during a health crisis? A qualitative study with international experts based on the COVID-19 pandemic.

OBJECTIVE: To identify a framework for risk communication during health crises by using the current pandemic as a case study. DESIGN: A qualitative study based on individual interviews. SETTING: Different countries with diverse levels of perceived success on risk communication during the COVID-19 health crisis. PARTICIPANTS: International experts with experience in health crisis management or risk communication. ANALYSIS: A thematic analysis was performed supported by Atlas.ti. RESULTS: Four men and six women took part in the study (three from Europe, two from Latin America, two from North America, one from Asia and two from Oceania). Three major themes emerged from the data: (1) institutionalising the communication strategy; (2) defining the problem that needs to be faced; (3) developing an effective communication strategy. CONCLUSION: Risk communication during a health crisis requires preparation of governments and of health teams in order to produce and deliver effective messages as well as to help communities to make informed and healthy decisions. This is particularly relevant for slow disasters, such as COVID-19, as the strategy must innovate to avoid information fatigue of the audience. The findings of this article could inform guidelines to best equip countries for a clear communication strategy for future crises. PROSPERO REGISTRATION NUMBER: CRD42021234443.

Construcción y validación de una herramienta de auto instrucción para el Buen Trato en el encuentro clínico

Introducción: El Buen Trato es una forma de relación entre profesionales y usuarios del sistema de salud, basada en un profundo respeto y valoración de la dignidad de la persona. Objetivo: Describir el proceso de diseño y validación de la Herramienta de auto instrucción para el Buen Trato en el encuentro clínico. Método: Estudio de métodos mixtos basado en el análisis de contenido propuesto por Kyngas sobre una muestra de docentes clínicos y estudiantes de pregrado, revisión sistemática de la literatura científica y el consenso y opinión de expertos nacionales en educación en salud. Los datos se obtuvieron mediante grupos focales y encuestas. Resultados: Se construyó una Herramienta de autoevaluación del Buen Trato (HBT) durante el encuentro/atención clínica formada por tres instrumentos: a) Pauta de Autoevaluación; b) Lista de acciones relacionadas con las dimensiones del Buen Trato en el encuentro clínico y c) Pauta para la elaboración de un Plan Personal de mejora y seguimiento. Conclusiones: Los resultados muestran que el Buen Trato requiere profesionales responsables de su quehacer, que hayan alcanzado las competencias para brindar una atención de salud respetuosa. La HBT puede entenderse como una propuesta de mejoramiento continuo en la formación clínica de estudiantes y profesionales de la salud.

Introduction: Respectful care is a relationship between professionals and patients based on deep respect and assessment of the person's dignity. Aim: Describe the design and validation process of the auto-instruction tool for Respectful Care in healthcare. Method: A mixed methods study based on the content analysis proposed by Kyngäs was conducted with a sample of clinical teachers and undergraduate students, a systematic review ofscientific literature, and the consensus and opinion of national experts in health education. The data were obtained through focus groups and surveys. Results: A Respectful Care self-instruction tool was built by three instruments: a) assessment guideline; b) a List of actions related to the dimensions of respectful care and health care, and c) a Modelfor elaborating a personal improvement and monitoring plan. Conclusions: The results of this study show that Respectful care requires professionals responsible for their work who have achieved competencies to provide respectful health care. In that sense, HBT can be understood as a proposalfor continuous improvement in the clinical training of students and health professionals.

[Developing a Self-Instruction Tool for Respectful Care in Healthcare: Design and Validation Process]. / Construcción y validación de una herramienta de auto instrucción para el Buen Trato en el encuentro clínico.

INTRODUCTION: Respectful care is a relationship between professionals and patients based on deep respect and assessment of the person's dignity. AIM: Describe the design and validation process of the auto-instruction tool for Respectful Care in healthcare. METHOD: A mixed methods study based on the content analysis proposed by Kyngäs was conducted with a sample of clinical teachers and undergraduate students, a systematic review ofscientific literature, and the consensus and opinion of national experts in health education. The data were obtained through focus groups and surveys. RESULTS: A Respectful Care self-instruction tool was built by three instruments: a) assessment guideline; b) a List of actions related to the dimensions of respectful care and health care, and c) a Modelfor elaborating a personal improvement and monitoring plan. CONCLUSIONS: The results of this study show that Respectful care requires professionals responsible for their work who have achieved competencies to provide respectful health care. In that sense, HBT can be understood as a proposalfor continuous improvement in the clinical training of students and health professionals.

El Buen Trato en el encuentro clínico de enfermería: características y atributos / Respectful Care in clinical nursing care: characteristics and attributes

Objetivo principal: describir características, atributos y acciones específicas del cuidado de enfermería respetuoso del Buen Trato. Metodología: estudio de métodos mixtos basado en el análisis de contenido de Kyngäs sobre una muestra de enfermeras y estudiantes de enfermería. Se realizaron grupos focales y encuestas. Resultados principales: se identificaron cuatro dimensiones: (a) significado del Buen Trato en la atención de Enfermería, (b) conductas que reflejan una atención de enfermería que respeta el Buen Trato, (c) conductas que vulneran el Buen Trato y (d) dificultades de los estudiantes para otorgar cuidado respetuoso. Conclusión principal: El Buen Trato se basa en una relación enfermera-usuario construida sobre el respeto y reconocimiento de la dignidad de las personas. El proceso de enseñanza/aprendizaje orientado al Buen Trato en enfermería requiere que integrar conocimientos teóricos, prácticos y actitudinales, que permita a los profesionales contar con las competencias necesarias para brindar cuidado respetuoso.(AU)

Objective: to describe the characteristics and attributes and the specific actions of a respectful nursing care. Methods: Method: a mixed methods study based on the content analysis by Kyngäs was conducted with a sample of nurses and nursing students. The data was obtained through focus groups and surveys. Results: four dimensions are identified: (a) meaning of Respectful Care in Nursing care, (b) behaviors that reflect a Respectful nursing Care, (c) behaviors that violate Respectful Care and (d) difficulties of the students to include the Respectful Care in their practice. Conclusions: A Respectful Care is based on the nurse-patient relationship where patients are treated with respect for their dignity. The teaching/learning process with focus on Respectful Care in nursing requires to integrate theoretical, practical and attitudinal knowledge, which allows professionals to have the necessary skills to provide respectful care.(AU)

Experimental and genetic evidence for the impact of CD5 and CD6 expression and variation in inflammatory bowel disease.

Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) resulting from the interaction of multiple environmental, genetic and immunological factors. CD5 and CD6 are paralogs encoding lymphocyte co-receptors involved in fine-tuning intracellular signals delivered upon antigen-specific recognition, microbial pattern recognition and cell adhesion. While CD5 and CD6 expression and variation is known to influence some immune-mediated inflammatory disorders, their role in IBD remains unclear. To this end, Cd5- and Cd6-deficient mice were subjected to dextran sulfate sodium (DSS)-induced colitis, the most widely used experimental animal model of IBD. The two mouse lines showed opposite results regarding body weight loss and disease activity index (DAI) changes following DSS-induced colitis, thus supporting Cd5 and Cd6 expression involvement in the pathophysiology of this experimental IBD model. Furthermore, DNA samples from IBD patients of the ENEIDA registry were used to test association of CD5 (rs2241002 and rs2229177) and CD6 (rs17824933, rs11230563, and rs12360861) single nucleotide polymorphisms with susceptibility and clinical parameters of CD (n=1352) and UC (n=1013). Generalized linear regression analyses showed association of CD5 variation with CD ileal location (rs2241002CC) and requirement of biological therapies (rs2241002C-rs2229177T haplotype), and with poor UC prognosis (rs2241002T-rs2229177T haplotype). Regarding CD6, association was observed with CD ileal location (rs17824933G) and poor prognosis (rs12360861G), and with left-sided or extensive UC, and absence of ankylosing spondylitis in IBD (rs17824933G). The present experimental and genetic evidence support a role for CD5 and CD6 expression and variation in IBD's clinical manifestations and therapeutic requirements, providing insight into its pathophysiology and broadening the relevance of both immunomodulatory receptors in immune-mediated disorders.

CD6 deficiency impairs early immune response to bacterial sepsis.

CD6 is a lymphocyte-specific scavenger receptor expressed on adaptive (T) and innate (B1a, NK) immune cells, which is involved in both fine-tuning of lymphocyte activation/differentiation and recognition of bacterial-associated molecular patterns (i.e., lipopolysaccharide). However, evidence on CD6's role in the physiological response to bacterial infection was missing. Our results show that induction of monobacterial and polymicrobial sepsis in Cd6 -/- mice results in lower survival rates and increased bacterial loads and pro-inflammatory cytokine levels. Steady state analyses of Cd6 -/- mice show decreased levels of natural polyreactive antibodies, concomitant with decreased cell counts of spleen B1a and marginal zone B cells. Adoptive transfer of wild-type B cells and mouse serum, as well as a polyreactive monoclonal antibody improve Cd6 -/- mouse survival rates post-sepsis. These findings support a nonredundant role for CD6 in the early response against bacterial infection, through homeostatic expansion and functionality of innate-related immune cells.

Innate immune response to peritoneal bacterial infection.

Spontaneous and secondary peritoneal infections, mostly of bacterial origin, easily spread to cause severe sepsis. Cellular and humoral elements of the innate immune system are constitutively present in peritoneal cavity and omentum, and play an important role in peritonitis progression and resolution. This review will focus on the description of the anatomic characteristics of the peritoneal cavity and the composition and function of such innate immune elements under both steady-state and bacterial infection conditions. Potential innate immune-based therapeutic interventions in bacterial peritonitis alternative or adjunctive to classical antibiotic therapy will be briefly discussed.

Contribution of Evolutionary Selected Immune Gene Polymorphism to Immune-Related Disorders: The Case of Lymphocyte Scavenger Receptors CD5 and CD6.

Pathogens are one of the main selective pressures that ancestral humans had to adapt to. Components of the immune response system have been preferential targets of natural selection in response to such pathogen-driven pressure. In turn, there is compelling evidence showing that positively selected immune gene variants conferring increased resistance to past or present infectious agents are today associated with increased risk for autoimmune or inflammatory disorders but decreased risk of cancer, the other side of the same coin. CD5 and CD6 are lymphocytic scavenger receptors at the interphase of the innate and adaptive immune responses since they are involved in both: (i) microbial-associated pattern recognition; and (ii) modulation of intracellular signals mediated by the clonotypic antigen-specific receptor present in T and B cells (TCR and BCR, respectively). Here, we review available information on CD5 and CD6 as targets of natural selection as well as on the role of CD5 and CD6 variation in autoimmunity and cancer.

Native Chilean Berries Preservation and In Vitro Studies of a Polyphenol Highly Antioxidant Extract from Maqui as a Potential Agent against Inflammatory Diseases.

The best conservation method for native Chilean berries has been investigated in combination with an implemented large-scale extract of maqui berry, rich in total polyphenols and anthocyanin to be tested in intestinal epithelial and immune cells. The methanolic extract was obtained from lyophilized and analyzed maqui berries using Folin-Ciocalteu to quantify the total polyphenol content, as well as 2,2-diphenyl-1-picrylhydrazyl (DPPH), ferric reducing antioxidant power (FRAP), and oxygen radical absorbance capacity (ORAC) to measure the antioxidant capacity. Determination of maqui's anthocyanins profile was performed by ultra-high-performance liquid chromatography (UHPLC-MS/MS). Viability, cytotoxicity, and percent oxidation in epithelial colon cells (HT-29) and macrophages cells (RAW 264.7) were evaluated. In conclusion, preservation studies confirmed that the maqui properties and composition in fresh or frozen conditions are preserved and a more efficient and convenient extraction methodology was achieved. In vitro studies of epithelial cells have shown that this extract has a powerful antioxidant strength exhibiting a dose-dependent behavior. When lipopolysaccharide (LPS)-macrophages were activated, noncytotoxic effects were observed, and a relationship between oxidative stress and inflammation response was demonstrated. The maqui extract along with 5-aminosalicylic acid (5-ASA) have a synergistic effect. All of the compiled data pointed out to the use of this extract as a potential nutraceutical agent with physiological benefits for the treatment of inflammatory bowel disease (IBD).

Soluble CD5 and CD6: Lymphocytic Class I Scavenger Receptors as Immunotherapeutic Agents.

CD5 and CD6 are closely related signal-transducing class I scavenger receptors mainly expressed on lymphocytes. Both receptors are involved in the modulation of the activation and differentiation cell processes triggered by clonotypic antigen-specific receptors present on T and B cells (TCR and BCR, respectively). To serve such a relevant immunomodulatory function, the extracellular region of CD5 and CD6 interacts with soluble and/or cell-bound endogenous counterreceptors but also microbial-associated molecular patterns (MAMPs). Evidence from genetically-modified mouse models indicates that the absence or blockade of CD5- and CD6-mediated signals results in dysregulated immune responses, which may be deleterious or advantageous in some pathological conditions, such as infection, cancer or autoimmunity. Bench to bedside translation from transgenic data is constrained by ethical concerns which can be overcome by exogenous administration of soluble proteins acting as decoy receptors and leading to transient "functional knockdown". This review gathers information currently available on the therapeutic efficacy of soluble CD5 and CD6 receptor infusion in different experimental models of disease. The existing proof-of-concept warrants the interest of soluble CD5 and CD6 as safe and efficient immunotherapeutic agents in diverse and relevant pathological conditions.