Early ultrasound-guided drainage of tubo-ovarian abscesses versus conservative treatment: a retrospective cross-sectional study.

OBJECTIVE: To compare the short and long-term benefits (the length of hospital stay, surgical complications, and early clinical improvement) of adding early ultrasound-guided drainage to broad-spectrum antibiotic treatment. METHODOLOGY: Patients undergoing tubo-ovarian abscess treatment between January 2017 and June 2022 in a tertiary hospital were retrospectively evaluated. Of the patients studied, 50 subjects were treated with antibiotics alone and 63 underwent guided drainage. Twenty-one individuals underwent early drainage within 72 hours of admission, and 42 underwent guided drainage after this period. RESULTS: There was no statistical difference in the length of hospital stay between the groups simultaneously, averaging 6.4 days for the controls, 5.1 days for the early drainage group, and 9.6 days for the late drainage group (p = 0.290). In the multiple linear regression with the length of hospital stay outcome and adjusting for potential confounding factors, there was an average reduction of 2.9 days in the hospital stay (p = 0.04) for the early drainage group (< 72 hours) compared to the controls. Early clinical improvement and an expected drop in CRP were more frequent in patients who underwent drainage. Length of hospital stay increases with abscess diameter: 0.4 [(95% CI 0.1 - 0.7) (p = 0.05)] days per centimeter, regardless of other variables. CONCLUSIONS: Ultrasound-guided drainage of tubo-ovarian abscesses associated with antibiotic therapy is an effective treatment, with few complications, and may lead to clinical improvement especially when performed early.

Human gut microbiota analysis of cystic fibrosis infants using metaproteomics.

We report a metaproteomic analysis of the gut microbiota of eight infants with cystic fibrosis, during the first year of life. This is the first study in this disease that uses metaproteomics to analyze stool samples from patients at such a young age.

[What indicators of primary care activity are offered in the Spanish National Health System? Comparison between regionals governments health departments]. / ¿Qué indicadores de actividad de atención primaria se ofrecen en el Sistema Nacional de Salud? Comparación entre consejerías de salud.

The identification and evaluation of specific health care activity indicators of primary care and family medicine of the regional health ministries is proposed, analyzing their experiences. A descriptive observational study of healthcare information on institutional websites and its availability, accessibility, and quality, offered between 2015-2020 has been developed. A sample of 19 websites has been compiled. The information is freely accessible, aggregated at the regional/area level, updated (2018) and in "pdf" format. Only Catalonia and Valencia discern by sex and age. Most used indicators: assigned cards (health coverage), attendance and healthcare pressure. Average indicators per community: 6. The current experiences in indicators and activity data of primary care and family medicine at the level of the Spanish National Health System are shown. Catalonia and Madrid have stood out in offering quality of care and health outcomes. The constructive debate focuses on offering a coordinated proposal of information on quality and health outcomes, accessible, relevant, understandable, and updated, learning from current best practices.

[Pharmacological treatment in uncertainty times: Hydroxychloroquine/chloroquine use in the COVID-19 treatment]. / Tratamiento farmacológico en tiempos de incertidumbre: uso de la hidroxicloroquina/cloroquina en el tratamiento de COVID-19.

BACKGROUND AND OBJECTIVES: In this moments, of extreme gravity in which we find ourselves, and in the uncertainty face about the most effective treatment against COVID-19 disease and with the aim of find the evidence that support the chloroquine/hydroxychloroquine use recommendation to treat COVID-19 disease, a systematic review of published studies and RCT studies publishes until April 28, 2020 was carried out. MATERIAL AND METHODS: A systematic search was carried out in PubMed with the keywords COVID-19 and their synonyms and hydroxychloroquine/chloroquine. The data selection and extraction was elaborated by two researchers, independently. The results were discussed with a Primary Care physicians clinical group and the results were synthesized using GRADE methodology. RESULTS: A good quality systematic review was found that includes articles with a high risk of bias. And 8 EC launched that will produce results beyond May 2020. CONCLUSIONS: Although the conclusions of the systematic review generate a low confidence in the results, and the clinical variables that show benefit are intermediate variables, the side effects are acceptable and could be minimized with the use of QT lengthening risk tools, so it is could make a weak recommendation in favor of the use of chloroquine/hydroxychloroquine in patients with mild-moderate stage COVID-19.

Avaliação on-farm dos níveis de energia na dieta sobre a produção e a composição físico-química de leite de cabras / [On farm evaluation of the energy levels in the diet on the production and physical-chemical composition of dairy goats]

Objetivou-se, com este estudo, avaliar o efeito de dietas com diferentes níveis de energia no consumo de nutrientes, na produção e na composição do leite, no peso corporal e na relação benefício:custo de uma produção de cabras leiteiras. Foram utilizadas nove cabras, distribuídas em quadrado latino triplo 3 x 3. O ensaio teve duração de 60 dias, divididos em três períodos de 20 dias. Avaliaram-se rações completas contendo três níveis de energia: 65%, 70% e 75% de NDT. Os consumos de matéria seca, proteína bruta e matéria mineral foram superiores (P<0,05) nas dietas com maiores níveis de energia em comparação à dieta com 65% de NDT. A produção de leite foi semelhante (P>0,05) nas cabras recebendo dietas contendo 70% e 75% de NDT, todavia foi superior (P<0,05) à produção de leite das cabras recebendo dieta com 65% de NDT. A dieta com 75% de NDT possibilitou maior (P<0,05) peso corporal final, quando comparada com as dietas contendo 65% e 70% de NDT. Não foi observada diferença (P>0,05) para os parâmetros físico-químicos de gordura, lactose, proteína bruta, extrato seco desengordurado, densidade, sais e condutividade do leite. Portanto, cabras alimentadas com níveis de energia entre 70% e 75% de NDT na dieta total aumentam a produção de leite, porém 75% de NDT na dieta proporciona melhor relação benefício:custo, havendo, para cada R$ 1,00 no custo investido na alimentação, R$ 1,52 de retorno financeiro.(AU)

The objective of this study was to evaluate the effect of diets with different energy levels on nutrient intake, milk production and composition, body weight and benefit:cost ratio of a dairy goat production. Nine goats were distributed in a triple 3 x 3 latin square design. The experiment lasted for 60 days, divided into three 20-day periods. Complete rations containing three energy levels were evaluated: 65%, 70% and 75% of TDN. The dry matter intake, crude protein and mineral matter consumption were higher (P <0.05) in the diets with higher levels of energy compared to the diet with 65% of TDN. Milk production was similar (P> 0.05) in goats receiving diets containing 70% and 75% TDN, but these diets produced more milk (P<0.05) than the diet with 65% of TDN. The diet with 75% of TDN allowed a higher (P<0.05) final body weight (P<0.05) when compared to diets containing 65% and 70% TDN. There was no difference (P> 0.05) in the physical-chemical parameters of fat, lactose, crude protein, defatted dry extract, density, salts and conductivity of the milk. Therefore, goats fed with diets of 70% and 75% of TDN in the total diet increased milk production. However, the diet with 75% of TDN provides a better benefit:cost ratio, as for every $ 1.00 in the cost invested, there was $ 1.52 of financial return.(AU)

Use of a mobile application for self-management of pancreatic enzyme replacement therapy is associated with improved gastro-intestinal related quality of life in children with Cystic Fibrosis.

BACKGROUND: Most patients with cystic fibrosis (CF) suffer from pancreatic insufficiency (PI), leading to fat malabsorption, malnutrition, abdominal discomfort and impaired growth. Pancreatic enzyme replacement therapy (PERT) is effective, but evidence based guidelines for dose adjustment are lacking. A mobile app for self-management of PERT was developed in the context of the HORIZON 2020 project MyCyFAPP. It contains an algorithm to calculate individual PERT-doses for optimal fat digestion, based on in vitro and in vivo studies carried out in the same project. In addition, the app includes a symptoms diary, educational material, and it is linked to a web tool allowing health care professionals to evaluate patient's data and provide feedback. METHODS: A 6-month open label prospective multicenter interventional clinical trial was performed to assess effects of using the app on gastro-intestinal related quality of life (GI QOL), measured by the CF-PedsQL-GI (shortened, CF specific version of the Pediatric Quality of Life Inventory, Gastrointestinal Symptoms Module). RESULTS: One hundred and seventy-one patients with CF and PI between 2 and 18 years were recruited at 6 European CF centers. Self-reported CF-PedsQL-GI improved significantly from month 0 (M0) (84.3, 76.4-90.3) to month 6 (M6) (89.4, 80.35-93.5) (p< 0.0001). Similar improvements were reported by parents. Lower baseline CF-PedsQL-GI was associated with a greater improvement at M6 (p < 0.001). CONCLUSIONS: The results suggest that the MyCyFAPP may improve GI QOL for children with CF. This tool may help patients to improve self-management of PERT, especially those with considerable GI symptoms.

Noninvasive assessments of skin glycated proteins by fluorescence and Raman techniques in diabetics and nondiabetics.

Diabetes is a complex metabolic disease and has chronic complications. It has been considered a serious public health problem. The aim of the current study was to evaluate skin glycated proteins through fluorescence and Raman techniques. One hundred subjects were invited to participate in the study. Six volunteers did not attend due to exclusion criteria or a change of mind about participating. Therefore, 94 volunteers were grouped according to age range (20-80 years), health condition (nondiabetic, with insulin resistance [IR] and/or diabetic) and Fitzpatrick skin type (I-VI). The fluorescence spectrometer and the portable Raman spectroscopy system were used to measure glycated proteins from the skin. There was elevated skin autofluorescence in healthy middle-aged and elderly subjects, as well as in patients with IR and/or diabetes. Regarding Raman spectroscopy, changes in the skin hydration state, degradation of type I collagen and greater glycation were related for diabetes and chronological aging. Weak and positive correlation between the skin autofluorescence and the Raman peaks ratio (855/876) related to the glycated proteins was also found. Raman spectroscopy shows several bands for spectral analyses, complementing the fluorescence data. Therefore, this study contributes to understanding of the optical of human skin for noninvasive diabetes screening.

Mathematical Models for Predicting Development of Orius majusculus (Heteroptera: Anthocoridae) and Its Applicability to Biological Control.

Complete development of Orius majusculus Reuter (Heteroptera: Anthocoridae) at nine constant temperatures, between 12 and 34°C, was evaluated under laboratory conditions. The maximum developmental period of 90.75 d occurred at 12°C, whereas the minimum of 11.34 d occurred at 30°C. From 30 to 34°C, the developmental period increased to 13.50 d. Between 21 and 33°C the survival rate was more than 80%. The optimal temperature when considering developmental rate and survival was between 24 and 30°C. At constant temperatures, four models were developed, one of which was linear and three nonlinear (Logan type III, Lactin, and Brière). All models were validated under field conditions and diel temperature variations. The values of the adjusted determination coefficients of the linear (>0.77) and nonlinear models (>0.93) were high. The thermal requirement for complete development, from egg to adult, was 284.5 degree-days (DD). In all nonlinear models, elevated levels of accuracy (≥90.31%) in field validation were also obtained, especially in the Brière model. With the results obtained herein, the optimization of O. majusculus mass rearing, its ideal use, and field management in biological control strategies can be improved.

Herschel survey and modelling of externally-illuminated photoevaporating protoplanetary disks.

CONTEXT: Protoplanetary disks undergo substantial mass-loss by photoevaporation, a mechanism which is crucial to their dynamical evolution. However, the processes regulating the gas energetics have not been well constrained by observations so far. AIMS: We aim at studying the processes involved in disk photoevaporation when it is driven by far-UV photons (i.e. 6 < E < 13.6 eV). METHODS: We present a unique Herschel survey and new ALMA observations of four externally-illuminated photoevaporating disks (a.k.a. proplyds). For the analysis of these data, we developed a 1D model of the photodissociation region (PDR) of a proplyd, based on the Meudon PDR code and we computed the far infrared line emission. RESULTS: With this model, we successfully reproduce most of the observations and derive key physical parameters, i.e. densities at the disk surface of about 106 cm-3 and local gas temperatures of about 1000 K. Our modelling suggests that all studied disks are found in a transitional regime resulting from the interplay between several heating and cooling processes that we identify. These differ from those dominating in classical PDRs i.e. grain photo-electric effect and cooling by [OI] and [CII] FIR lines. This specific energetic regime is associated to an equilibrium dynamical point of the photoevaporation flow: the mass-loss rate is self-regulated to keep the envelope column density at a value that maintains the temperature at the disk surface around 1000 K. From the physical parameters derived from our best-fit models, we estimate mass-loss rates - of the order of 10-7 M⊙/yr - that are in agreement with earlier spectroscopic observation of ionised gas tracers. This holds only if we assume photoevaporation in the supercritical regime where the evaporation flow is launched from the disk surface at sound speed. CONCLUSIONS: We have identified the energetic regime regulating FUV-photoevaporation in proplyds. This regime could be implemented into models of the dynamical evolution of protoplanetary disks.

Chitosan as an effective inhibitor of multidrug resistant Acinetobacter baumannii.

Over the last two decades worldwide levels of antibiotic resistance have risen leading to the appearance of multidrug resistant microorganisms. Acinetobacter baumannii is a known skin pathogen which has emerged as a major cause of nosocomial outbreaks due to its capacity to colonize indwelling medical devices and natural antibiotic resistance. With chitosan being an effective antimicrobial agent against antibiotic resistant microorganisms, the aim of this work was to access its potential as an alternative to traditional antimicrobials in the management of A. baumannii growth. What the results showed was that both chitosan MW's tested were active upon A. baumannii's planktonic and sessile growth. For planktonic growth MICs and MBCs were obtained at relatively low concentrations (0.5-2mg/mL) while for sessile growth chitosan proved to be an effective inhibitor of A. baumannii's adhesion and biofilm formation. Considering these results chitosan shows a high potential for control of A. baumannii infections.

Ventilator-associated Pneumonia in Neonatal Intensive Care Unit Due to Chryseobacterium indologenes.

Ventilator-associated pneumonia represents one of the most common nosocomial infections in neonatal intensive care units, increasing morbidity and mortality and associated costs. The authors report the case of a neonatal patient with ventilator-associated pneumonia secondary to Chryseobacterium indologenes and a review of the literature. The most effective empiric treatment for C. indologenes infection remains unclear due to limited data in the literature, and therefore, therapy should be adjusted in accordance with the result of the susceptibility profile.

Endoscopic ultrasonography and rectal duplication cyst in an adult.

Rectal duplication cysts account for 4% of all duplications of the alimentary tract. Presentation in adulthood is rare. An asymptomatic 54-year-old man was referred for endoscopic colorectal cancer screening. A bulging mass covered by normal mucosa was identified in the rectum. Endoscopic ultrasonography (EUS) with fine needle aspiration (FNA) was made for a diagnosis of rectal duplication cyst. The patient was operated and the diagnosis was confirmed. The diagnosis of the rectal duplication cyst is a challenge. EUS may have a singular role when identifying a muscular layer, because this is the only absolutely necessary criterion for the diagnosis. FNA by EUS may eventually identify colorectal and/or heterotypic epithelium that are the other diagnostic criteria of the duplication cyst.

Chitosan nanoparticles as alternative anti-staphylococci agents: Bactericidal, antibiofilm and antiadhesive effects.

Chitosan is a biocompatible, bioactive, non-toxic polymer that due to these characteristics has been widely used as a carrier for targeted delivery of bioactive molecules. In recent years, and considering that chitosan has a strong antimicrobial potential, the scientific community's focus has shifted onto the possible antimicrobial activity of chitosan nanoparticles. With this in mind, the aim of this work was to produce low molecular weight chitosan nanoparticles, through the ionic gelation method and characterize their potential biological activity against three staphylococci (MSSA, MRSA and MRSE) in planktonic and sessile environments. The chitosan nanoparticles produced had an average size of 244±12nm, an average charge of 17.3±1.4mV and had a MIC of 1.25mg/mL for all tested microorganisms. Bactericidal activity was only registered for MSSA and MRSA with the time-inhibition curves showing bactericidal activity within 1h. Assays regarding chitosan nanoparticles' impact upon sessile populations showed that they were effective in preventing MRSE adhesion and highly effective in reducing MRSA and MSSA biofilm formation.

Maternal syphilis and accomplishing sexual partner treatment: still a huge gap.

Congenital syphilis (CS) is a preventable epidemic disease for which control is hindered by socioeconomic and health system issues. Inadequately treated maternal syphilis (MaS) commonly has serious adverse obstetric outcomes. This study - which is a cross-sectional study in a Brazilian large urban public Mother and Child hospital, making use of secondary data - evaluated the occurrence of treatment of sexual partners (SP) among women with MaS. The results showed that 771 MaS cases were identified from 2007 to 2014. No information on SP treatment was available in 570 (73.9%) cases. Of the 201 cases presenting information, 25 (12.4%) SP were treated. Out of 164 women having six or more prenatal visits, 25 (15.2%) SP received treatment. Data analyzed biennially have shown a growing trend of cases without collected information, ranging from 27.2% in 2007-2008 to 87.5% in 2013-2014. No linear trend in proportions of treated SP (maximum 7.4% SP treated) was found. Thus, in this study, it has been concluded that the proportion of SP adequately treated was consistently low, and the quality of information deteriorated during the studied period. Prenatal care per se, as provided, was not effective in delivering adequate treatment of SP. Creative integrated services with SP active participation are greatly needed if CS is to be controlled.

Variability in the frequency of rheumatology consultations in patients with rheumatoid arthritis in Spain.

The aim of this work was to assess the variability in the use of health-care resources, based on the number of visits to rheumatology departments by rheumatoid arthritis patients, in Spain, and its association with patient, physician and center characteristics. The sample consisted of patient records of men and women (aged 16 or older), with a clinical diagnosis of RA, who met the American Rheumatism Association 1987 revised criteria and who had been treated in a rheumatology department at a Spanish hospital with at least one visit to a rheumatologist during the two years preceding the date of the study. To analyze which variables were independently associated with the number of consultations, those with a statistically significant result in the bivariate analysis, or which were clinically relevant or deemed confounders, were used in the construction of a linear regression model. The records of 1188 RA patients were studied. The linear regression model explained the 26.67 % of the variability in the number of visits. The number of csDMARDs prescribed, the administration of biological therapy, corticoid prescription, the presence of nursing consultation, mean time to first visit in the department and attended population showed a positive significant association, while the presence of telephone consultation, distance from the hospital to the patient´s residence (≥20 km) and drug monitoring by rheumatology department + primary care physician or by other specialists were negatively associated with the number of consultations. We observed a high variability in the number of visits, which remains partially unexplained even after taking into account individual, physician and center characteristics.

Characteristics of bacterial acute diarrhea among women.

OBJECTIVE: To describe the clinical and microbiological characteristics of women presenting with acute gastroenteritis due to infection with Salmonella spp. or Shigella spp. METHODS: A cross-sectional retrospective study was conducted using data for patients with specimens positive for Shigella spp. and Salmonella spp. attending two major women's hospitals in Porto Alegre, Brazil, between January 2003 and July 2014. Women were included if they had symptoms compatible with bacterial acute diarrhea. Isolates were evaluated to determine antimicrobial susceptibility and patient clinical profile. RESULTS: Among 45 eligible patients, Salmonella spp. was identified in 32 (71%) and Shigella spp. in 13 (29%). The highest antimicrobial sensitivity rates were observed for ciprofloxacin and ceftriaxone (n=44, 98% for both) whereas the greatest resistance rate was seen for ampicillin (n=20, 44%). Seven (16%) of the women were pregnant. CONCLUSION: Ciprofloxacin, ceftriaxone, and sulfamethoxazole/trimethoprim are suitable choices for the treatment of bacterial acute diarrhea. However, the maternal and fetal safety profile of prescribed medications should be considered when treating pregnant patients.

Optimizing Nesidiocoris tenuis (Hemiptera: Miridae) as a biological control agent: mathematical models for predicting its development as a function of temperature.

For optimal application of Nesidiocoris tenuis as a biological control agent, adequate field management and programmed mass rearing are essential. Mathematical models are useful tools for predicting the temperature-dependent developmental rate of the predator. In this study, the linear model and nonlinear models Logan type III, Lactin and Brière were estimated at constant temperatures and validated at alternating temperatures and under field conditions. N. tenuis achieved complete development from egg to adult at constant temperatures between 15 and 35°C with high survivorship (>80%) in the range 18-32°C. The total developmental time decreased from a maximum at 15°C (76.74 d) to a minimum at 33°C (12.67 d) and after that, increased to 35°C (13.98 d). Linear and nonlinear developmental models all had high accuracy (R a 2 >0.86). The maximum developmental rate was obtained between 31.9°C (Logan type III and Brière model for N1) and 35.6°C (for the egg stage in the Brière model). Optimal survival and the highest developmental rate fell within the range 27-30°C. The field validation revealed that the Logan type III and Lactin models offered the best predictions (95.0 and 94.5%, respectively). The data obtained on developmental time and mortality at different temperatures are useful for mass rearing this predator, and the developmental models are valuable for using N. tenuis as a biological control agent.

[The risk and its communication to patients for decision-making in healthcare]. / El riesgo y su comunicación a los pacientes para la toma de decisiones en salud.

Informing the patients before starting diagnostic and therapeutic procedures is advisable in order to establish a trusting and caring relationship. In this article, we analyze factors that determine the risk perception by the patients, as well as elements which facilitate a good information process by health professionals.

Bias in clinical epidemiological study designs.

Systematic error, or bias, is error that occurs in each measurement made and which has a direction, i.e., the measured value is always either greater or smaller than the true value. The presence of systematic error directly affects the internal validity of the study, and indirectly affects the external validity of the results obtained. In general, such error can be classified as selection bias, classification bias or confounding bias. It is essential to deal with possible bias in the research design phase, since only confounding bias can be controlled in the phase corresponding to analysis of the results.

Synthesis of stable isotope labelled internal standards for drug-drug interaction (DDI) studies.

The syntheses of stable isotope labelled internal standards of important CYP-isoform selective probes, like testosterone 1, diclofenac 3, midazolam 5, and dextromethorphan 7, as well as their corresponding hydroxylated metabolites 6ß-hydroxytestosterone 2, 4'-hydroxydiclofenac 4, 1'-hydroxymidazolam 6 and dextrorphan 8 are reported. Microwave-enhanced H/D-exchange reactions applying either acid, base, or homogeneous and heterogeneous transition metal catalysis, or combinations thereof proved to be highly efficient for direct deuterium labelling of the above mentioned probes. Compared to conventional stepwise synthetic approaches, the combination of H/D exchange and biotransformation provides the potential for considerable time- and cost savings, in particular for the synthesis of the stable isotope labelled internal standards of 4'-hydroxydiclofenac 4 and 1'-hydroxymidazolam 6.