Management of vancomycin-resistant Enterococci and daptomycin-resistant Enterococci infections in liver transplant recipients in a single academic center.

INTRODUCTION: Vancomycin-resistant Enterococci (VRE) infections cause significant morbidity and mortality in liver transplant (LT) recipients. Management is challenging, especially in the setting of daptomycin resistance (DR). METHODS: Single-center retrospective review of patients who underwent LT between January 1, 2020, and December 31, 2022, and developed VRE infections. Descriptive statistics were used and Kaplan-Meier curves estimated freedom from treatment failure and survival. RESULTS: Forty-two patients (median age 58; 64% female; 67% white) were included. Alcohol-related cirrhosis (48%) and metabolic dysfunction-associated steatohepatitis (31%) were the most common indications for LT, and most were from deceased donors (86%). VRE infection occurred at a median of 21 days after LT, and 16% had known prior VRE colonization. Common infection sites were blood (45%, n = 19), intraabdominal (36%, n = 15), and urine (36%, n = 15). Most were initially treated with daptomycin alone (64%) or in combination with other agents (21%); 7% received linezolid alone. Twelve (29%) developed breakthrough infections during treatment and 11 (26%) had recurrent infections after discontinuation of treatment. All-cause mortality was 36% (n = 15) at a median of 90 days after VRE infection diagnosis and was nearly twice as high in patients with DR (63%). CONCLUSION: VRE infection in LT recipients relapsed or recurred in over 25%. Mortality was high, especially in cases with DR. More data is needed to establish an optimal treatment approach, particularly for relapse and DR.

On legal guardianship: An exploratory assessment of knowledge, attitudes and practices of resident physicians.

BACKGROUND: Clinicians encounter patients under legal guardianship. We aimed to assess the knowledge, attitudes and practices (KAP) on legal guardianship in residents. METHODS: A KAP pilot survey about legal guardianship was developed by an interdisciplinary medicine-law-public health team and was distributed via institutional email to internal medicine, psychiatry, and neurology residents in a single academic institution. RESULTS: Of the 172 invited residents, 105 (61%) responded and 102 surveys were included in the final analysis. Most respondents (58% women; internal medicine 73%, neurology 15%, psychiatry 12%) had attended 42 medical schools from 16 countries and had heard about guardianship (88%), but only 23% reported having received training on guardianship during medical school or residency. The vast majority (97%) understood the intended benefit of guardianship, but only 22.5% reported knowing that guardianship removed an individual's decision-making rights. Nearly half (47%) of respondents reported never having asked for documentation to prove that an individual was a patient's guardian, and only 15% expected to see a court order as proof of guardianship status. CONCLUSIONS: Although most residents intuitively understood the intended benefit of guardianship, they did not understand its full implications for clinical practice. Training interventions are warranted.

Nocardia pseudobrasiliensis Co-infection in SARS-CoV-2 Patients.

During the SARS-CoV-2 pandemic, few cases of Nocar-dia spp. co-infection have been reported during or after a COVID-19 infection. Nocardia spp. are gram-positive aerobic actinomycetes that stain partially acid-fast, can infect immunocompromised patients, and may cause dis-seminated disease. We report the case of a 52-year-old immunocompromised man who had Nocardia pseudobrasiliensis pneumonia develop after a SARS-CoV-2 in-fection. We also summarize the literature for no-cardiosis and SARS-CoV-2 co-infections. Nocardia spp. infection should remain a part of the differential diagnosis for pneumonia in immunocompromised hosts, regardless of other co-infections. Sulfonamide/carbapenem combina-tions are used as empiric therapy for nocardiosis; species identification and susceptibility testing are required to se-lect the optimal treatment for each patient.

Gender representation in rheumatology journals: an assessment of editors, editorial boards, and authors.

Diversity is widely recognized as a driver of excellence and innovation. In recent years, women have become an increasingly significant part of the rheumatology workforce. We aimed to assess the gender representation of the leading rheumatology journals' editors and to explore whether editors' gender correlates with the gender of the first and last authors of published articles. We conducted a cross-sectional study and extracted editorial members of rheumatology journals in quartiles 1 to 3 (Clarivate Analytics) from each journal's website. We categorized editorial positions according to the level of influence in manuscript acceptance decision-making (levels I to III). The gender of editors and of the first and last authors in all 2019 original articles published in a sample of 15 rheumatology journals was assigned using a combination of digital gallery and manual searches. There were 2242 editors' names retrieved from 43 journals, 24 (26%) of the 94 editors at level I, 139 (36%) of 385 editors at level II, and 469 (27%) of 1763 at level III were female. The imbalance between journals was heterogeneous. Females were the first authors in 1342 (48%) and the last authors in 969 (35%) of the 2797 published articles. However, we found no significant correlation between editors' and authors' gender. Our data showed uneven gender representation on the editorial boards of most rheumatology journals, but we did not find any apparent vertical segregation or influence on publishing by gender. Our findings suggest that a generational transition may be occurring among authors.

Complications of Endoscopic Retrograde Cholangiopancreatography in Patients With Previous Bariatric Surgery: A National Inpatient Sample Analysis, 2007-2013.

BACKGROUND: Bariatric surgery (BS) has been proven to be effective in the treatment of obesity and weight-related diseases, but the anatomic changes after BS make endoscopic retrograde cholangiopancreatography (ERCP) technically challenging. This study aims to assess the safety and clinical outcomes of ERCP in patients with previous BS. MATERIALS AND METHODS: The National Inpatient Sample from 2007 to 2013 was queried for hospitalizations of adults over 18 years of age with procedure diagnoses of ERCP. Those with prior BS were selected as cases and those without BS as controls. Case-control matching at a ratio of 1 case to 2 controls was performed based on sex, age, race, comorbidities, and obesity. The primary outcomes were inpatient mortality and ERCP-related complications. Multivariate regression analysis was used to identify independent risk factors associated to the primary outcomes. RESULTS: A total of 1,068,862 weighted hospitalizations with ERCP procedure codes were identified. Of these, 6689 with BS were selected as cases, and 13,246 were matched as controls. The reason for hospital admission was most often biliary stone disease (60.7% vs. 55.5%), followed by malignancy (3.5% vs. 12.1%) and cholangitis (7.7% vs. 4.5%) with and without BS, P<0.05. The BS group had lower rates of post-ERCP pancreatitis (0.1% vs. 1.3%), cholecystitis (0.1% vs. 0.3%), bleeding (1.0% vs. 1.4%), and inpatient mortality (0.2% vs. 0.5%), but had higher rates of cholangitis (5.0% vs. 3.7%) and systemic infections (6.2% vs. 4.8%), all P<0.05. CONCLUSIONS: BS group had lower post-ERCP pancreatitis, cholecystitis and bleeding while had more cholangitis, and systemic infection compared with those without BS. Also, BS was independently associated with reduced inpatient mortality after adjusted for age, race, and comorbidity.

[Performance of medical schools in Mexico: results from the Examen Nacional para Aspirantes a Residencias Médicas]. / Desempeño de las escuelas de medicina en México: resultados del Examen Nacional para Aspirantes a Residencias Médicas.

OBJECTIVE: To assess the performance of medical schools (FEM) by analyzing the results of their applicants in the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). MATERIALS AND METHODS: Five performance criteria, two official and three created on purpose, were calculated from the ENARM-2016 and -2017 official databases to assess FEM performance. RESULTS: In 2016 and 2017, applicants registered from 112 and 115 FEM, respectively. Depending on the performance criteria, the FEM in the first place obtained 5 to 20 points more than the one placed second, and 23 to 98 points more than the FEM in the last place. Approximately 25% applicants were classified as "knowledge-deficient," and about 80% of these originated from less than one third of the FEM. CONCLUSIONS: The ENARM results provide information on the performance of the FEM. Approximately one of every four applicants obtained scores lower than the approval threshold of any specialty.

OBJECTIVE: Evaluar el desempeño de las facultades y escuelas de medicina (FEM) utilizando como subrogado los resultados del Examen Nacional para Aspirantes a Residencias Médicas (ENARM). MATERIALS AND METHODS: Se analizaron las bases de datos oficiales del ENARM 2016 y 2017, empleando cinco criterios de desempeño (CD) por cada FEM: dos oficiales y tres creados exprofeso. RESULTS: En 2016 y 2017 se registraron sustentantes de 112 y 115 FEM, respectivamente. Dependiendo del CD, la FEM que quedó clasificada en el primer lugar obtuvo entre 5 y 20 puntos más que la del segundo lugar, y entre 23 y 98 puntos más que la FEM ubicada en el último lugar. Aproximadamente 25% de los sustentantes fueron calificados como "deficientes en conocimientos" y aproximadamente 80% de éstos provenían de menos de un tercio de las FEM. CONCLUSIONS: El ENARM arroja información sobre el desempeño de las FEM. Aproximadamente uno de cada cuatro sustentantes obtuvo puntajes menores al aprobatorio en cualquier especialidad.

Flaws in the design of the Examen Nacional para Aspirantes a Residencias Médicas produce inequity.

OBJECTIVE: To assess the assumption of 'equity' of Mexico's resident-selection assessment tool, the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). MATERIALS AND METHODS: Official ENARM-2016 and -2017 databases were analyzed. Differences in the absolute number of correct answers (multivariable linear regression) and the number of applicants reaching their specialty minimum score (SMS) per test day (odds ratio [OR]) were calculated. Applicants affected by test-day inequity were estimated. RESULTS: There were 36 114 applicants in 2016, and 38 380 in 2017. In 2016, day-2 applicants had significantly higher scores and more reached the SMS than on days 1-3-4 (OR 1.55), and 5 (OR 3.8); 3 565 non-passing applicants were affected by inequity (equivalent to 44.64% of those selected). In 2017, day-1 and -2 applicants had significantly higher scores and more reached the SMS than on days 3-4 (OR 1.85), and 5 (OR 4.04); 3,155 non-passing applicants were affected by inequity (37.2% of those selected). CONCLUSIONS: Analysis of official ENARM databases does not support the official attribution of equity, suggesting the test should be redesigned.

OBJETIVO: Evaluar el atributo de "equidad" asignado al Examen Nacional para Aspirantes a Residencias Médicas (ENARM). MATERIAL Y MÉTODOS: Se analizaron las bases de datos oficiales del ENARM 2016 y 2017. Se compararon las diferencias inter-día de respuestas correctas (regresión linear multivariable) y de sustentantes que alcanzaron el puntaje mínimo de su especialidad (PME) (razón de momios [RM]). Se estimó a los afectados por la inequidad. RESULTADOS: Hubo 36 114 sustentantes en 2016 y 38 380 en 2017.Los días 2 (ENARM-2016) y 1-2 (ENARM-2017) registraronpuntajes significativamente más altos, y más sustentantes alcanzaron el PME que en los días 1-3-4 (RM .55) y 5 (RM 3.8) en 2016, y los días 3-4 (RM 1.85) y 5 (RM 4.04) en 2017. Se estimó que cuatro de cada diez sustentantes que aprobaron el ENARM no lo hubieran hecho si el examen fuera equitativo. CONCLUSIONES: Los resultados sugieren que el atributo de equidad del ENARM está en duda.

Análisis bibliométrico de las revistas médicas del Sistema de Clasificación de Revistas Mexicanas de Ciencia y Tecnología.

INTRODUCTION: CONACYT's Mexican Science and Technology Journals Classification System (SCRMCYT) includes the area of medicine and health sciences (M&HS). OBJECTIVE: A bibliometric analysis of M&HS journals listed in SCRMCYT in 2018 was performed. METHOD: Twelve characteristics related to indexation in the Web of Science Core Collection (WoSCC), Scopus, and PubMed databases were analyzed. Indexed journals were analyzed on whether they had recent indexed publications (2017 and 2018). Indexed journals' 50 most-cited articles in WoSCC and Scopus were analyzed. RESULTS: Of the 35 M&HS journals included in the 2018 SCRMCYT list, 31 (89 %) were indexed in Scopus (22 with indexed publications in 2017; 18 in 2018), 17 (49 %) in PubMed (10 with indexed publications in 2017 and 2018), and 12 (34 %) in WoSCC (12 with indexed publications in 2017; 8 in 2018). The 50 most-cited articles had been published only in 4 journals indexed in WoSCC and 5 in Scopus; 60 % were review articles. CONCLUSIONS: Approximately half the 2018 SCRMCYT M&HS journals lack publications indexed in 2018; this suggests that national and international relevance of these journals can be improved.

INTRODUCCIÓN: El Sistema de Clasificación de Revistas Mexicanas de Ciencia y Tecnología (SCRMCYT) del Conacyt incluye el área de medicina y ciencias de la salud (MyCS). OBJETIVO: Se realizó un análisis bibliométrico de las revistas del MyCS del listado SCRMCYT-2018. MÉTODO: Se analizaron 12 características relacionadas con la indización en las bases de datos Web of Science Core Collection (WoSCC), Scopus y PubMed. Se analizó si la revista indizada tenía publicaciones indizadas recientes (años 2017 y 2018). Se analizaron los 50 artículos más citados de las revistas indizadas en Scopus y WoSCC. RESULTADOS: De 35 revistas de MyCS incluidas en el SCRMCYT-2018, 31 (89 %) estaban indizadas en Scopus (22 con indización vigente en 2017 y 18 en 2018), 17 (49 %) en PubMed (10 vigentes en 2017 y 2018) y 12 (34 %) en WoSCC (12 vigentes en 2017 y ocho en 2018). Los 50 artículos más citados provenían de solo cuatro revistas indizadas en WoSCC y de cinco en Scopus; 60 % eran artículos de revisión. CONCLUSIONES: Aproximadamente la mitad de las revistas de MyCS del SCRMCYT-2018 carecen de indización vigente en 2018, por lo que la relevancia nacional e internacional de estas revistas puede mejorar.

The Use of Reporting Guidelines in Rheumatology: A Cross-Sectional Study of Over 850 Manuscripts Published in 5 Major Rheumatology Journals.

OBJECTIVE: To assess whether 16 of the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network-related reporting guidelines were used in rheumatology publications. METHODS: This was a cross-sectional study of research articles published in 5 high-performance rheumatology-focused journals in 2019. All articles were (1) manually reviewed to assess whether the use of a reporting guideline could be advisable, and (2) searched for the names and acronyms (eg, CONSORT [Consolidated Standards of Reporting Trials], STROBE [Strengthening the Reporting of Observational Studies in Epidemiology]) of 16 reporting guidelines. To calculate the "advisable use rate," the number of articles for which a guideline was used was divided by the number of articles for which the guideline was advised. Descriptive statistics were used. RESULTS: We reviewed 895 manuscripts across the 5 journals. The use of a guideline was deemed advisable for 693 (77%) articles. Reporting guidelines were used in 50 articles, representing 5.6% of total articles and 7.2% (95% CI 5-9) of articles for which guidelines were advised. The advisable use rate boundaries within which a guideline was applied by the journals were 0.03 to 0.10 for any guideline, 0 to 0.26 for CONSORT, 0.01 to 0.07 for STROBE, 0 to 0.8 for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and 0 to 0.14 for Animal Research: Reporting of In Vivo Experiments (ARRIVE). No identifiable trends in the variables studied were observed across the 5 journals. CONCLUSION: The limited use of reporting guidelines appears counterintuitive, considering that guidelines are promoted by journals and are intended to help authors report relevant information. Whether this finding is attributable to issues with the diffusion, awareness, acceptance, or perceived usefulness of the guidelines remains to be clarified.

Gender balance in infectious diseases and hospital epidemiology journals.

Objective: Diversity is recognized as a driver of excellence and innovation. Women represent a significant part of the infectious diseases (ID) and hospital epidemiology (HE) workforce. We aimed to assess gender representation among editors of top ID and HE journals and explore potential correlations with the gender of first and last authors in published articles. Methods: Using Scimago Journal & Country Rank, we identified 40 ID and 4 HE high-ranking journals. Editorial members were categorized by decision-making influence (levels I-III). We retrieved names of first and corresponding authors from 12 ID-focused journals' 2019 research articles. Gender assignment for editors, first authors, and last authors utilized digital galleries and manual searches. Results: Among 2,797 editors from 44 journals, 33% were women. Female representation varied across editorial levels: 26% at level I, 36% at level II, and 31% at level III. Gender balance disparities existed among journals. Female first authors accounted for 50%, and female last authors accounted for 36% of the 2,725 published articles. We found weak but significant correlations between the editors' gender and the gender of the first and last authors. Conclusion: Gender representation among ID and HE journal editors displayed unevenness, but no overt vertical segregation was observed. A generational transition among authors may be underway. Our findings suggest that a generational transition may be occurring among authors.