Implementation of Bedaquiline, Pretomanid, and Linezolid in the United States: Experience Using a Novel All-Oral Treatment Regimen for Treatment of Rifampin-Resistant or Rifampin-Intolerant Tuberculosis Disease.

BACKGROUND: Rifampin-resistant tuberculosis is a leading cause of morbidity worldwide; only one-third of persons start treatment, and outcomes are often inadequate. Several trials demonstrate 90% efficacy using an all-oral, 6-month regimen of bedaquiline, pretomanid, and linezolid (BPaL), but significant toxicity occurred using 1200-mg linezolid. After US Food and Drug Administration approval in 2019, some US clinicians rapidly implemented BPaL using an initial 600-mg linezolid dose adjusted by serum drug concentrations and clinical monitoring. METHODS: Data from US patients treated with BPaL between 14 October 2019 and 30 April 2022 were compiled and analyzed by the BPaL Implementation Group (BIG), including baseline examination and laboratory, electrocardiographic, and clinical monitoring throughout treatment and follow-up. Linezolid dosing and clinical management was provider driven, and most patients had linezolid adjusted by therapeutic drug monitoring. RESULTS: Of 70 patients starting BPaL, 2 changed to rifampin-based therapy, 68 (97.1%) completed BPaL, and 2 of the 68 (2.9%) experienced relapse after completion. Using an initial 600-mg linezolid dose daily adjusted by therapeutic drug monitoring and careful clinical and laboratory monitoring for adverse effects, supportive care, and expert consultation throughout BPaL treatment, 3 patients (4.4%) with hematologic toxicity and 4 (5.9%) with neurotoxicity required a change in linezolid dose or frequency. The median BPaL duration was 6 months. CONCLUSIONS: BPaL has transformed treatment for rifampin-resistant or intolerant tuberculosis. In this cohort, effective treatment required less than half the duration recommended in 2019 US guidelines for drug-resistant tuberculosis. Use of individualized linezolid dosing and monitoring likely enhanced safety and treatment completion. The BIG cohort demonstrates that early implementation of new tuberculosis treatments in the United States is feasible.

Autodisplay of an avidin with biotin-binding activity on the surface of Escherichia coli.

OBJECTIVES: To display a recombinant avidin fused to the autotransporter ShdA to bind biotinylated molecules on the surface of Escherichia coli. RESULTS: Two chimeric protein constructs containing avidin fused to the autotransporter ShdA were expressed on the surface of Escherichia coli DH5α. One fusion protein contained 476 amino acids of the ShdA α and ß domains, whereas the second consisted of a 314 amino acid from α and truncated ß domains. Protein production was verified by SDS-PAGE using an antibody to the molecular FLAG-tag. The surface display of the avidin-shdA fusion protein was confirmed by confocal microscopy and flow cytometry analysis, and the biotin-binding activity was evaluated by fluorescence microscopy and flow cytometry using biotin-4-fluorescein and biotinylated-ovalbumin (OVA). CONCLUSIONS: Expression of a recombinant avidin with biotin-binding activity on the surface of E. coli was achieved using the autotransporter ShdA. This system is an alternative to bind biotinylated molecules to E. coli.

Assessment of the use of ethanol instead of MTBE as an oxygenated compound in Mexican regular gasoline: combustion behavior and emissions.

The energy reforms implemented in Mexico promote the use of ethanol in gasoline but exclude the country's ozone nonattainment areas oxygenated with methyl-tert-butyl ether (MTBE) in view that further scientific studies are required. To address a potential implementation scenario in areas of ozone high VOC-sensitive regimes, the impact on performance and emissions characteristics between the regular MTBE fuel available and a formulated gasoline containing 10% v/v ethanol having similar Reid vapor pressure (RVP) were compared in a single cylinder spark-ignited engine and a set of tier I vehicles. Included in the assessment were the "criteria" pollutants (THC, CO, and NOx), toxic compounds, and speciated hydrocarbons in order to calculate the ozone-forming potential (OFP). The change in combustion speed of ethanol fuel vs. regular gasoline seems to be small and depends mainly on base gasoline formulation. Vehicle dynamometer testing showed no statistically significant differences in the average THC, CO, and NOx results when comparing both fuels. Statistically significant differences were seen in total speciated hydrocarbons, total carbonyls emitted, the increases in acetaldehyde emissions, and the decreases in OFP with E10. The results show roughly 20% increase in evaporative emissions when E10 is used, but the OFP of the emissions is lower than that of the Metropolitan Area of Mexico City fuel (MAMC). The increase in the oxygen content using ethanol fuel seems to have no deleterious effect on the vintage of vehicles tested. Taking into consideration that the evaporative emissions standard in Mexico is less stringent than that in other countries, the substitution of the actual regular gasoline for ethanol fuels should uphold the least volatile AA class in areas with ozone problems.

Implications of an inpatient warfarin dosing nomogram on safety outcomes post-discharge.

Many hospitals have implemented warfarin dosing nomograms to improve patient safety. To our knowledge, no study has assessed the impact inpatient warfarin initiation has in both medical and surgical patients, on safety outcomes post discharge. To evaluate the impact of a suggested institutional nomogram for the initiation of warfarin, the primary endpoint was the incidence of bleeding throughout follow up. Secondary endpoints included the composite of INR changes ≥0.5/day and INR >4. Patients were followed for a period of 2 weeks post-discharge. The composite endpoint was evaluated for an effect on reaching therapeutic INR, time to reach therapeutic INR, and bleeding events throughout follow up. A single center retrospective study comparing the safety of adherence vs. non-adherence to a warfarin nomogram. A total of 206 patients were included, 73 patients in the nomogram adherence vs. 133 in the nonadherence arm. There was no difference in the proportion of patients who bled throughout the follow up period, adherence 9.6% vs. nonadherence to the nomogram 13.5%, p = 0.407. There was however a statistical difference in the mean total number of bleeding events, 0.096 (7/73) in the adherence vs. 0.158 (21/133) in the non-adherence arm, p = 0.022. There was also no difference in the composite endpoint, 19.2% in the adherence vs. 28.6% in the non-adherence arm p = 0.180. A positive correlation between the inpatient composite and risk of bleeding throughout follow up was noted. The findings of this study support adherence to the nomogram as opposed to non-adherence.

Long-term effects of discharges of produced water the marine environment from petroleum-related activities at Sonda de Campeche, Gulf of México.

Produced water from offshore oil platforms is a major source of oil and related chemicals into the sea. The large volume and high salinity of produced water could pose severe environmental impacts upon inadequate disposal. This study is based on direct field sampling of effluents released into the ocean in the years 2003 and 2013 at the Sonda de Campeche located in the southern part of the Gulf of Mexico. Metals and hydrocarbons were characterized in water, sediments, and fish tissues at the discharge site and compared with those obtained at two reference sites. Chemicals that exceeded risk-based concentrations in the discharge included the metals As, Pb, Cd, and Cr, and a variety of compounds polycyclic aromatic hydrocarbon (PAHs), including naphthalene, fluorenes, and low molecular weight PAHs. The values of low to high molecular weight polycyclic aromatic hydrocarbon (PAHs), and carbon preference index indicate that hydrocarbons in sediments of the discharge zone are originated from the produced water and combustion sources. Fish tissues at the discharge zone and reference site are contaminated with PAHs, dominated by 2- and 3-rings; 4-ring accounted for less than 1% of total PAHs (TPAHs) in 2003, but increased to 7% in 2013. Results suggest that, from 2003 to 2013, discharges of produced water have had a non-negligible impact on ecosystems at a regional level, so the possibility of subtle, cumulative effects from operational discharges should not be ignored.

Transvaginal organ extraction: potential for broad clinical application.

BACKGROUND: Natural orifice transluminal endoscopic surgery procedures have evolved over the past few years. A transvaginal approach is a promising alternative for intraperitoneal procedures. Our objective was to evaluate the safety and feasibility of transvaginal organ extraction. METHODS: This institutional review board-approved protocol involved retrospective review of an ongoing prospective study. Female subjects who presented to our hospital for elective cholecystectomy, appendectomy, or sleeve gastrectomy were offered participation in the study. Eligible patients met the following criteria: age between 18 and 75, diagnosis of gallbladder disease, acute appendicitis, or morbid obesity who desired surgical treatment. A hybrid transvaginal natural orifice approach was used in this series. RESULTS: Thirty-four women underwent transvaginal organ extraction between September 2007 and January 2012. The mean age was 40 ± 12.1 years (range 23-63 years). The mean body mass index was 27 ± 6.4 kg/m(2) (range 16-43 kg/m(2)). All patients had an American Society of Anesthesiologists classification of two or below. The mean operative time for cholecystectomy, appendectomy, and sleeve gastrectomy was 90, 71, and 135 min, respectively. There were no conversions to open operation and no intraoperative complications. The mean hospital stay was 2 days for all cases. Patients were followed for a mean of 24 months (range 1-61 months). There were two pregnancies and two successful vaginal deliveries. Six patients (18 %) had minor complaints of spotting or heavy menses in the immediate postoperative period that resolved with conservative measures. There were no abdominal wall complications. There were no long-term complications and no mortalities. CONCLUSIONS: This initial experience suggests that this surgical approach is safe, does not increase length of stay, and has no long-term vaginal complications. Given this attractive profile, a transvaginal approach may prove to be a superior mode of organ extraction, although randomized studies and long-term follow-up are needed.

The contribution of evaporative emissions from gasoline vehicles to the volatile organic compound inventory in Mexico City.

The strategy for decreasing volatile organic compound emissions in Mexico has been focused much more on tailpipe emissions than on evaporative emissions, so there is very little information on the contribution of evaporative emissions to the total volatile organic compound inventory. We examined the magnitudes of exhaust and evaporative volatile organic compound emissions, and the species emitted, in a representative fleet of light-duty gasoline vehicles in the Metropolitan Area of Mexico City. The US "FTP-75" test protocol was used to estimate volatile organic compound emissions associated with diurnal evaporative losses, and when the engine is started and a journey begins. The amount and nature of the volatile organic compounds emitted under these conditions have not previously been accounted in the official inventory of the area. Evaporative emissions from light-duty vehicles in the Metropolitan Area of Mexico City were estimated to be 39 % of the total annual amount of hydrocarbons emitted. Vehicles built before 1992 (16 % of the fleet) were found to be responsible for 43 % of the total hydrocarbon emissions from exhausts and 31 % of the evaporative emissions of organic compounds. The relatively high amounts of volatile organic compounds emitted from older vehicles found in this study show that strong emission controls need to be implemented in order to decrease the contribution of evaporative emissions of this fraction of the fleet.

Application of the positive matrix factorization approach to identify heavy metal sources in sediments. A case study on the Mexican Pacific Coast.

During the last two decades, sediments collected in different sources of water bodies of the Tehuantepec Basin, located in the southeast of the Mexican Pacific Coast, showed that concentrations of heavy metals may pose a risk to the environment and human health. The extractable organic matter, geoaccumulation index, and enrichment factors were quantified for arsenic, cadmium, copper, chromium, nickel, lead, vanadium, zinc, and the fine-grained sediment fraction. The non-parametric SiZer method was applied to assess the statistical significance of the reconstructed metal variation along time. This inference method appears to be particularly natural and well suited to temperature and other environmental reconstructions. In this approach, a collection of smooth of the reconstructed metal concentrations is considered simultaneously, and inferences about the significance of the metal trends can be made with respect to time. Hence, the database represents a consolidated set of available and validated water and sediment data of an urban industrialized area, which is very useful as case study site. The positive matrix factorization approach was used in identification and source apportionment of the anthropogenic heavy metals in the sediments. Regionally, metals and organic matter are depleted relative to crustal abundance in a range of 45-55 %, while there is an inorganic enrichment from lithogenous/anthropogenic sources of around 40 %. Only extractable organic matter, Pb, As, and Cd can be related with non-crustal sources, suggesting that additional input cannot be explained by local runoff or erosion processes.

Combined transposition of internal obturator and superficial gluteal muscles for perineal hernia treatment in dogs: 17 cases (2017-2020).

OBJECTIVES: To report the results of the combined transposition of the internal obturator muscle and superficial gluteal muscle for perineal hernia treatment in dogs. MATERIALS AND METHODS: Retrospective case series of dogs treated with this technique from November 2017 to May 2020, including pre- and post-operative clinical findings, outcome and complications. RESULTS: Seventeen dogs were included in the study. Twelve dogs were presented with unilateral perineal hernia and five dogs with bilateral perineal hernias. Mean duration of clinical signs before presentation was 9 months. All perineal hernias were successfully repaired using a transposition of the internal obturator muscle to cover the ventral aspect of the perineal hernia and the superficial gluteal muscle to cover the dorsal aspect of the hernia with minimal tension. All dogs regained normal defecation within 24 hours post-surgery. Average follow-up time was 16 months. No recurrence of clinical signs or rectal deviation was observed. Five dogs developed a superficial minor partial necrosis of the T-shaped incision and two had surgical site infections. CLINICAL SIGNIFICANCE: Perineal herniorrhaphy using a combined transposition of the internal obturator and the superficial gluteal muscles is feasible and offered excellent results in this cohort of dogs. It may be considered as a technique for repairing chronic and extensive unilateral and bilateral perineal hernias.

The percentage of CD39+ monocytes is higher in pregnant COVID-19+ patients than in nonpregnant COVID-19+ patients.

Current medical guidelines consider pregnant women with COVID-19 to be a high-risk group. Since physiological gestation downregulates the immunological response to maintain "maternal-fetal tolerance", SARS-CoV-2 infection may constitute a potentially threatening condition to both the mother and the fetus. To establish the immune profile in pregnant COVID-19+ patients, a cross-sectional study was conducted. Pregnant women with COVID-19 (P-COVID-19+; n = 15) were analyzed and compared with nonpregnant women with COVID-19 (NP-COVID-19+; n = 15) or those with physiological pregnancy (P-COVID-19-; n = 13). Serological cytokine and chemokine concentrations, leucocyte immunophenotypes, and mononuclear leucocyte responses to polyclonal stimuli were analyzed in all groups. Higher concentrations of serological TNF-α, IL-6, MIP1b and IL-4 were observed within the P-COVID-19+ group, while cytokines and chemokines secreted by peripheral leucocytes in response to LPS, IL-6 or PMA-ionomicin were similar among the groups. Immunophenotype analysis showed a lower percentage of HLA-DR+ monocytes in P-COVID-19+ than in P-COVID-19- and a higher percentage of CD39+ monocytes in P-COVID-19+ than in NP-COVID-19+. After whole blood polyclonal stimulation, similar percentages of T cells and TNF+ monocytes between groups were observed. Our results suggest that P-COVID-19+ elicits a strong inflammatory response similar to NP-COVID19+ but also displays an anti-inflammatory response that controls the ATP/adenosine balance and prevents hyperinflammatory damage in COVID-19.

Secondary rearrangements and hypermutation generate sufficient B cell diversity to mount protective antiviral immunoglobulin responses.

Variable (V) region gene replacement was recently implicated in B cell repertoire diversification, but the contribution of this mechanism to antibody responses is still unknown. To investigate the role of V gene replacements in the generation of antigen-specific antibodies, we analyzed antiviral immunoglobulin responses of "quasimonoclonal" (QM) mice. The B cells of QM mice are genetically committed to exclusively express the anti-(4-hydroxy-3-nitrophenyl) acetyl specificity. However, approximately 20% of the peripheral B cells of QM mice undergo secondary rearrangements and thereby potentially acquire new specificities. QM mice infected with vesicular stomatitis virus (VSV), lymphocytic choriomeningitis virus, or poliovirus mounted virus-specific neutralizing antibody responses. In general, kinetics of the antiviral immunoglobulin responses were delayed in QM mice; however, titers similar to control animals were eventually produced that were sufficient to protect against VSV-induced lethal disease. VSV neutralizing single-chain Fv fragments isolated from phage display libraries constructed from QM mice showed VH gene replacements and extensive hypermutation. Thus, our data demonstrate that secondary rearrangements and hypermutation can generate sufficient B cell diversity in QM mice to mount protective antiviral antibody responses, suggesting that these mechanisms might also contribute to the diversification of the B cell repertoire of normal mice.

Weighing the evidence of ecological risk from PAHs contamination in the estuarine environment of Salina Cruz Bay, México.

Results of bulk-phase chemical measurements, toxicological tests combined with bioaccumulation measures in fishes, were used to evaluate the toxicity of the 16 USEPA priority polycyclic aromatic hydrocarbons from the sediment collected from eight stations of the Ventosa Estuarine System, located close to the main center of processing oil in the Mexican Pacific coast. Levels of the sum of polycyclic aromatic hydrocarbons varied from 22 to 6,850 microg kg(-1) dry weight. Based on sediment quality guidelines, the compounds with high environmental priority were acenaphtylene, acenaphtene, and phenanthrene. Acute toxicity tests with Vibrio fischeri and Daphnia magna as well as chronic toxicity with Panagrellus redivivus were performed. The quantification of hepatic ethoxyresorufin O-deethylase activity was used to assess the induction of the mixed function oxygenase system of brown trout. However, because it is often difficult to blend the results from such very different assays into a unified decision about the potential for impacts, a weight-of-evidence (WOE) approach to sediment quality investigations was followed. These assays provided measurement endpoints that could be used to develop an overall evaluation of the potential for environmental impacts from the oil processing operations. WOE provides a valuable tool for assessing the results of environmental investigations because it provides a framework for considering the strengths and weaknesses of environmental measurements, an approach for addressing uncertainty in the measurements, and documentation of the evaluation and its assumptions.

Management of abdominal distension in the preterm infant with noninvasive ventilation: Comparison of cenit versus 2x1 technique for the utilization of feeding tube.

BACKGROUND: Preterm infants are fed by orogastric / nasogastric tube until they reach maturation and coordination of sucking, swallowing and respiration at approximately 32-34 weeks of corrected age. While being on non-invasive ventilation (NIV), they frequently present abdominal distension. Currently at our institution two techniques are used for the management of abdominal distension in preterm infants fed by bolus via orogastric tube: cenit and 2 x 1.The aim of this study was to compare the proportion of preterm infants presenting NIV-associated abdominal distension with each of these techniques. STUDY DESIGN: We conducted a randomized clinical trial including infants of <  36.6 weeks of gestation and <  1500 g of birth weight who were admitted to our NICU during the period of April 1, 2016 to April 1, 2018 and received NIV. The presence of abdominal distension >  2 cm was the primary outcome. Secondary outcomes were presence of reflux, regurgitation, oxygen saturation during feeding and days to reach full feedings. Feeding tube drainage, stool characteristics and the use of prokinetics were confounding variables. RESULTS: A total of 97 patients were included. Forty-six in the cenit group and 51 in the 2 x 1 group. There was no difference in the proportion of infants with abdominal distension >  2 cm between groups. Oxygen saturation during feeding at volume of 150 ml/kg/day was higher in the cenit group with statistical significance. CONCLUSION: The use of cenit or 2 x 1 technique in preterm infants with NIV did not improve abdominal distension or other indicators of feeding tolerance.

[Recommendations on cardiopulmonary resuscitation in patients with suspected or confirmed SARS-CoV-2 infection (COVID-19). Executive summary]. / Recomendaciones sobre reanimación cardiopulmonar en pacientes con sospecha o infección confirmada por SARS-CoV-2 (COVID-19). Resumen ejecutivo.

The SARS-CoV-2 pandemic has created new scenarios that require modifications to the usual cardiopulmonary resuscitation protocols. The current clinical guidelines on the management of cardiorespiratory arrest do not include recommendations for situations that apply to this context. Therefore, the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), in collaboration with the Spanish Group of Pediatric and Neonatal CPR and with the Teaching Life Support in Primary Care program of the Spanish Society of Family and Community Medicine (SEMFyC), have written these recommendations, which are divided into 5 parts that address the main aspects for each healthcare setting. This article consists of an executive summary of them.

Systematic review of the management of canine osteoarthritis.

This review assesses the evidence for the efficacy of therapies used in the management of osteoarthritis in dogs on the basis of papers published in peer-reviewed journals in English between 1985 and July 2007. Sixty-eight papers were identified and evaluated. They considered four alternative therapies, one use of functional food, two intra-articular agents, six nutraceutical agents, 21 pharmacological agents, two physical therapies, three surgical techniques and two combinations of weight control. There was a high level of comfort (strong evidence) for the efficacy of carprofen, firocoxib and meloxicam, and a moderate level of comfort for the efficacy of etodolac in modifying the signs of osteoarthritis. There was a moderate level of comfort for the efficacy of glycosaminoglycan polysulphate, licofelone, elk velvet antler and a functional food containing green-lipped mussel for the modification of the structures involved in the disease. There was weak or no evidence in support of the use of doxycycline, electrostimulated acupuncture, extracorporeal shockwave therapy, gold wire acupuncture, hyaluronan, pentosan polysulphate, P54FP (extract of turmeric), tiaprofenic acid or tibial plateau levelling osteotomy.

Assessment of benthic changes during 20 years of monitoring the Mexican Salina Cruz Bay.

In this work a non-parametric multivariate analysis was used to assess the impact of metals and organic compounds in the macro infaunal component of the mollusks benthic community using surface sediment data from several monitoring programs collected over 20 years in Salina Cruz Bay, Mexico. The data for benthic mollusks community characteristics (richness, abundance and diversity) were linked to multivariate environmental patterns, using the Alternating Conditional Expectations method to correlate the biological measurements of the mollusk community with the physicochemical properties of water and sediments. Mollusks community variation is related to environmental characteristics as well as lead content. Surface deposit feeders are increasing their relative density, while subsurface deposit feeders are decreasing with respect to time, these last are expected to be more related with sediment and more affected then by its quality. However gastropods with predatory carnivore as well as chemosymbiotic deposit feeder bivalves have maintained their relative densities along time.

TB or not TB? Challenges in diagnosing and treating maternal and neonatal tuberculosis.

We present the case of a pregnant woman who died from disseminated tuberculosis (TB), and the difficulties encountered in diagnosing TB disease in her newborn. We discuss the burden of maternal and neonatal TB and the need for a different approach, one that is not solely based on bacteriologic evidence which, in most cases, tends to be inconclusive. We also explore the difficulties physicians and national TB programs face in managing and developing effective policies for these two highly vulnerable and neglected populations. There is an urgent need for a more realistic approach to neonatal and infant TB diagnosis.

Complications following tarsal arthrodesis using bone plate fixation in dogs.

OBJECTIVES: To report the complications encountered following tarsal arthrodesis surgery with bone plate fixation and describe the previously unreported complication of plantar necrosis. METHODS: Medical records of 40 dogs that had been treated by tarsal arthrodesis with bone plate fixation were reviewed to determine the major and minor complications and the associated risk factors. RESULTS: The major complication rate was 32.5 per cent and the minor complication rate was 42.5 per cent. Pantarsal arthrodeses had a higher major complication rate than partial tarsal arthrodeses. Plantar necrosis was the most common major complication and occurred in 15 per cent of cases. Plantar necrosis occurred more frequently when a bone plate was applied to the medial aspect of the hock, and only occurred in cases where tarsometatarsal joint arthrodesis was performed. CLINICAL SIGNIFICANCE: Plantar necrosis is a catastrophic complication that may be associated with injury to the dorsal pedal artery or perforating metatarsal artery. Application of a bone plate to the medial aspect of the hock should be performed with care during tarsal arthrodesis, particularly where the tarsometatarsal joint is debrided of cartilage. Strict attention to surgical technique and proper postoperative coaptation is critical to reduce the potential for complications with tarsal arthrodesis.

[New methods in training of paediatric emergencies: medical simulation applied to paediatrics]. / Nuevas metodologías en el entrenamiento de emergencias pediátricas: simulación médica aplicada a pediatría.

Patient safety constitutes one of the main objectives in health care. Among other recommendations, such as the creation of training centres and the development of patient safety programmes, of great importance is the creation of training programmes for work teams using medical simulation. Medical simulation is defined as "a situation or environment created to allow persons to experience a representation of a real event for the purpose of practice, learning, evaluation or to understand systems or human actions". In this way, abilities can be acquired in serious and uncommon situations with no risk of harm to the patient. This study revises the origins of medical simulation and the different types of simulation are classified. The main simulators currently used in Pediatrics are presented, and the design of a simulation course applied to the training of pediatric emergencies is described, detailing all its different phases. In the first non face-to-face stage, a new concept in medical training known as e-learning is applied. In the second phase, clinical cases are carried out using robotic simulation; this is followed by a debriefing session, which is a key element for acquiring abilities and skills. Lastly, the follow-up phase allows the student to connect with the teachers to consolidate the concepts acquired during the in-person phase. In this model, the aim is to improve scientific-technical abilities in addition to a series of related abilities such as controlling crisis situations, correct leadership of work teams, distribution of tasks, communication among the team members, etc., all of these within the present concept of excellence in care and medical professionalism.

Single dose of propofol causing propofol infusion syndrome in a newborn.

Propofol infusion syndrome (PRIS) is a rare syndrome originally described in critically ill children undergoing long-term (> 48 h) propofol infusion at high doses (> 4 mg/kg/h). Severe metabolic acidosis, rhabdomyolysis, renal failure and fatal cardiac failure are the features. Herein, we present a case of a newborn who developed PRIS after a single bolus dose of propofol at 3.2 mg/kg/do, developing rhabdomyolysis and severe metabolic acidosis, with a successful outcome after medical therapy.