How Far Are We From Achieving Delabeling of False Penicillin/ß-Lactam Allergy Alerts? A Population Problem.

BACKGROUND: Interest in finding efficient ways to remove penicillin allergy alerts has grown as a result of awareness of the considerable excess of false-negative diagnoses in patients with penicillin allergy labels (90%-95%), the poorer course with non-ß-lactam antibiotics, the increase in bacterial resistance, and the fact that these problems can affect up to 20% of the population in some countries. The strategies proposed have generated many publications in countries where the number of allergists to conduct such studies is low. In many cases where delabeling is performed, the risk of ß-lactam allergy is low, and a single penicillin challenge is sufficient to delabel the alert. However, other less "ultrarapid" strategies can be used to administer a ß-lactam during an admission for infection and thus postpone delabeling until traditional drug allergy consultations. However, the definitive withdrawal of ß-lactam alerts is threatened by nonremoval of alerts in electronic health records and by the reactivation or nonsynchronization of alerts between electronic systems at different levels of care. Allergy departments need to reflect on how to implement practices that enable rapid and efficient delabeling of drug allergy alerts, especially in patients with major comorbidities.

[Facing fever in the pediatric patient: Checklist as a tool for parents]. / Checklist como herramienta para los padres ante la fiebre en el paciente pediátrico.

INTRODUCTION: In Western Europe, 20%-40% of children with fever request health care. Most of them present trivial viral infections, however, it is essential in pediatrics to distinguish patients who present a severe infection. This process begins with the recognition of the seriousness and the subsequent search for medical attention by the parents. METHODOLOGY: Analytical and cross-sectional observational study. One hundred patients were selected in two health centers. Sociodemographic data were collected, together with the responses to a checklist containing the signs and symptoms to request health care in case of fever. Subsequently, the checklist was filled out by the pediatrician. RESULTS: The mean age of the patients was 5.41 years. 50% consulted in the first 48h of fever evolution. In 42%, the response to all the items on the checklist was exactly the same between the companion and the pediatrician. There were no significant differences according to variables: first episode of fever (P=.262), age of the patient (P=.859), having a sibling (P=.880), family relationship of the companion (P=.648) or educational level of the companion (P=.828). CONCLUSIONS: Medical consultations for fever in pediatrics are carried out very early. A high percentage do not present alarm signs when they consult. There is a need to expand training on the alarm signs of fever in all parents, regardless of the number of children, age or educational level. The checklist as a tool for home assessment of fever has received high marks for its usefulness.

[Models of public care for the population with acquired brain injury in Spain: a study of the situation by Spanish autonomous communities]. / Modelos de atención pública a la población con daño cerebral adquirido en España: un estudio de la situación por comunidades autónomas.

INTRODUCTION: Rehabilitation after Acquired Brain Injury (ABI) is a dynamic, progressive process aimed at functional improvement of the affected person and their family. There is an international consensus on how the model that guides this process should be; however, in our country there are numerous territorial discrepancies regarding its application. Therefore, the objective of this work is to analyze and update the knowledge about the practices developed in the field of rehabilitation and the regulations available in each autonomous community. SUBJECTS AND METHODS: 62 participants (71.7% women), including both direct care professionals and public administration positions from the 17 Spanish Autonomous Communities and the autonomous cities of Ceuta and Melilla. A questionnaire composed of 31 questions on the functioning of rehabilitation throughout the three phases of care that often follow ABI was developed. This questionnaire was applied to these professionals in each of the Autonomous Communities, through semi-structured interviews. RESULTS: The results show the great territorial inequality existing in the functioning of rehabilitation during the recovery process of a person with ABI and the significant deficiencies of specific resources, specialized professionals such as neuropsychologists and necessary aspects such as socio-sanitary coordination. CONCLUSIONS: It is necessary to develop state regulations that guarantee the minimum basic aspects of the rehabilitation process in the DCA, in its different phases and in all the Autonomous Communities.

TITLE: Modelos de atención pública a la población con daño cerebral adquirido en España: un estudio de la situación por comunidades autónomas.Introducción. La rehabilitación tras el daño cerebral adquirido (DCA) es un proceso dinámico, progresivo y orientado a la mejora funcional de la persona afectada y de su núcleo familiar. Existe un consenso internacional sobre cómo debe ser el modelo que guíe dicho proceso; sin embargo, en nuestro país, se producen numerosas discrepancias territoriales en lo que respecta a su aplicación. Por ello, el objetivo del presente trabajo es analizar y actualizar el conocimiento sobre las prácticas desarrolladas en materia de rehabilitación y la normativa disponible en cada comunidad autónoma. Sujetos y métodos. Los participantes fueron 62 personas (71,7% mujeres), entre las cuales se encontraban tanto profesionales de atención directa como cargos de la administración pública de las 17 comunidades autónomas españolas y de las ciudades autónomas de Ceuta y Melilla. Se elaboró un cuestionario compuesto de 31 preguntas sobre el funcionamiento de la rehabilitación a lo largo de las tres fases asistenciales que suceden al DCA y que fue respondido por dichos profesionales en cada una de las comunidades autónomas a través de entrevistas semiestructuradas. La información obtenida se sintetizó por medio de análisis descriptivos. Resultados. Los resultados ponen de manifiesto la gran desigualdad territorial existente en el funcionamiento de la rehabilitación durante el proceso de recuperación tras un DCA y las carencias significativas de recursos específicos, profesionales especializados, como los neuropsicólogos, y aspectos necesarios, como la coordinación sociosanitaria. Conclusiones. Resulta necesario elaborar una normativa estatal que garantice los aspectos básicos mínimos sobre el proceso rehabilitador en el DCA, en sus distintas fases y en todas las comunidades autónomas.

A Specialized Therapeutic Approach to Chronic Urticaria Refractory to H1-Antihistamines Improves Disease Burden: The Spanish AWARE Experience.

OBJECTIVE: During its first year, the AWARE study assessed disease activity, patient quality of life (QOL), and treatment patterns in chronic urticaria (CU) refractory to H1-antihistamines (H1-AH) in clinical practice. METHODS: We performed an observational, prospective (24 months), international, multicenter study. The inclusion criteria were age ≥18 years and H1-AH-refractory CU (>2 months). At each visit, patients completed questionnaires to assess disease burden (Urticaria Control Test [UCT]), disease activity (7 day-Urticaria Activity Score [UAS7]), and QOL (Dermatology Life Quality index [DLQI], Chronic Urticaria Quality of Life Questionnaire [CU-Q2oL], and Angioedema Quality of Life Questionnaire [AE-QoL]). We present data for Spain. RESULTS: The study population comprised 270 evaluable patients (73.3% female, mean [SD] age, 48.9 [14.7] years). At baseline, 89.3% were prescribed a CU treatment. After 1 year, first- and second-line treatments became less frequent and third-line treatments became more frequent. At baseline, 47.0% of patients experienced angioedema; at 1 year, this percentage had fallen to 11.8%. The mean (SD) AE-QoL score decreased from 45.2 (28.7) to 24.0 (25.8). The mean (SD) UCT score decreased from 7.0 (4.5) to 12.1 (4.1). According to UAS7, 38.2% of patients reported absence of wheals and itch in the previous 7 days at 1 year compared with 8.3% at baseline. The mean (SD) DLQI score decreased from 8.0 (7.4) to 2.8 (4.6). At the 1-year visit, the percentage of patients reporting a high or very high impact on QOL fell from 29.9% to 9.6%. CONCLUSION: H1-AH-refractory CU in Spain is characterized by absence of control of symptoms and a considerable impact on QOL. Continuous follow-up of CU patients and third-line therapies reduce disease burden and improve patients' QOL.

Incidence of Fatal Anaphylaxis: A Systematic Review of Observational Studies.

BACKGROUND: Fatal anaphylaxis is very rare, with an incidence ranging from 0.5 to 1 deaths per million person-years. OBJECTIVE: Based on a systematic review, we aimed to explain differences in the reported incidence of fatal anaphylaxis based on the methodological and demographic factors addressed in the various studies. METHODS: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for relevant retrospective and prospective cohort studies and registry studies that had assessed the anaphylaxis mortality rate for the population of a country or for an administrative region. The research strategy was based on combining the term "anaphylaxis" with "death", "study design", and "main outcomes" (incidence). RESULTS: A total of 46 studies met the study criteria and included 16,541 deaths. The range of the anaphylaxis mortality rate for all causes of anaphylaxis was 0.002-2.51 deaths per million person-years. Fatal anaphylaxis due to food (range 0.002-0.29) was rarer than deaths due to drugs (range 0.004-0.56) or Hymenoptera venom (range 0.02-0.61). The frequency of deaths due to anaphylaxis by drugs increased during the study period (IRR per year, 1.02; 95%CI, 1.00-1.04). We detected considerable heterogeneity in almost all of the meta-analyses carried out. CONCLUSION: The incidence of fatal anaphylaxis is very low and differs according to the various subgroups analyzed. The studies were very heterogeneous. Fatal anaphylaxis due to food seems to be less common than fatal anaphylaxis due to drugs or Hymenoptera venom.

Experimental demonstration of superresolution of partially coherent light sources using parity sorting: erratum.

The authors include references that appeared on arXiv during the preparation of their paper [Opt. Express29, 22034 (2021)10.1364/OE.427734].

Experimental demonstration of superresolution of partially coherent light sources using parity sorting.

Analyses based on quantum metrology have shown that the ability to localize the positions of two incoherent point sources can be significantly enhanced over direct imaging through the use of mode sorting. Here we theoretically and experimentally investigate the effect of partial coherence on the sub-diffraction limit localization of two sources based on parity sorting. With the prior information of a negative and real-valued degree of coherence, higher Fisher information is obtained than that for the incoherent case. Our results pave the way to clarifying the role of coherence in quantum-limited metrology.

Association Between Severity of Anaphylaxis and Co-occurrence of Respiratory Diseases: A Systematic Review and Meta-analysis of Observational Studies.

BACKGROUND AND OBJECTIVE: Asthma is very prevalent in all grades of severity of anaphylaxis. Asthma and chronic obstructive pulmonary disease (COPD) have been associated with the severity of anaphylaxis. Objective: We carried out a systematic review and meta-analysis to assess the influence of respiratory diseases on the severity of anaphylaxis. METHODS: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for observational studies. The target studies were those that compared the severity of anaphylaxis between patients who had or did not have respiratory diseases. RESULTS: A total of 13 studies assessed the severity of anaphylaxis in respiratory disease. Respiratory disease increased the severity of anaphylaxis (OR, 1.87; 95%CI, 1.30-2.70), as did asthma (OR, 1.89; 95%CI, 1.26-2.83). For the meta-analysis of all studies (adjusted and nonadjusted), COPD increased the severity of anaphylaxis (OR, 2.47; 95%CI, 1.46-4.18). In the case of asthma studies, only 1 study assessed the influence of severity of asthma on severity of anaphylaxis. CONCLUSIONS: Evidence showing that respiratory disease increases the severity of anaphylaxis is low to moderate, although studies do not usually assess the importance of severity of asthma.

Platonic Gaussian beams: wave and ray treatment.

A class of self-similar beams, the Platonic Gaussian beams, is introduced by using the vertices of the Platonic solids in a Majorana representation. Different orientations of the solids correspond to beams with different profiles connected through astigmatic transformations. The rotational symmetries of the Platonic solids translate into invariance to specific optical transformations. While these beams can be considered as "the least ray-like" for their given total order, a ray-based description still offers insight into their distribution and their transformation properties.

Modal Majorana Sphere and Hidden Symmetries of Structured-Gaussian Beams.

Structured-Gaussian beams are shown to be fully and uniquely represented by a collection of points (or a constellation) on the surface of the modal Majorana sphere, providing a complete generalization of the modal Poincaré sphere to higher-order modes. The symmetries of this Majorana constellation translate into invariances to astigmatic transformations, giving way to continuous or quantized geometric phases. The experimental amenability of this system is shown by verifying the existence of both these symmetries and geometric phases.

Aborto infeccioso por Neospora spp. em equino ˗ relato de caso / [Neospora spp infectious abortion in the horse ˗ case report]

O abortamento na espécie equina é responsável por grandes perdas econômicas e, entre as possíveis causas, está a neosporose, uma enfermidade que nem sempre é investigada como provável diagnóstico. Assim, o objetivo deste trabalho foi relatar um caso de aborto equino aos 129 dias de gestação, resultante da infecção por Neospora spp.. Amostras sanguíneas da égua e do feto abortado foram enviadas para um laboratório especializado. À necrópsia, constatou-se edema gelatinoso e hemorrágico em subcutâneo, fígado ictérico e friável com autólise de alguns órgãos, como baço, rins e glândulas adrenais. Fragmentos dos órgãos coletados na necrópsia foram submetidos à histopatologia e à pesquisa de agentes infecciosos, em que se identificou hepatite e epicardite não purulentas e onfalite purulenta, bem como exame positivo para Neospora spp. pela técnica de reação em cadeia da polimerase (PCR) convencional e Nested. O soro sanguíneo obtido da égua foi submetido à pesquisa de Neospora spp. pela técnica de imunofluorescência indireta, de herpesvírus por soroneutralização em cultura de células e de Leptospira sp. por PCR, todas com resultados negativos. Dessa forma, é importante considerar a neosporose como diagnóstico diferencial em casos de abortamento e natimortalidade, uma vez que a presença de cães nas propriedades é extremamente comum, representando uma importante fonte de infecção.(AU)

Abortion in the equine species is responsible for major economic losses, and among the possible causes is neosporosis, a disease that is not always investigated as a probable diagnosis. Thus, the objective of this study was to report an abortion at 129 days of gestation resulting from Neospora spp. Blood samples from the mare and the aborted fetus were sent to a specialized laboratory. Under necropsy, gelatinous and hemorrhagic edema was detected in subcutaneous tissue, friable and jaundiced liver with autolysis in spleen, kidneys and adrenal glands. Fragments of the organs collected at necropsy were submitted to histopathology and infectious agent tests, which identified non-purulent hepatitis and epicarditis and purulent omphalitis. Also, a positive result for Neospora spp. by the conventional and nested Polymerase Chain Reaction (PCR) technique. Blood serum obtained from the mare was subjected to analyses to Neospora spp. by indirect immunofluorescence technique, herpesvirus by serum neutralization in cell culture and Leptospira sp. by PCR, all with negative results. Thus, it is important to consider neosporosis as a differential diagnosis in cases of abortion and stillbirth, since the presence of dogs in the properties is extremely common and represent an important source of infection.(AU)

Lack of correlation between left ventricular outflow tract velocity time integral and stroke volume index in mechanically ventilated patients.

OBJECTIVE: To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients. DESIGN: A prospective, descriptive, multicenter study was performed. SETTING: Five intensive care units from university hospitals. PATIENTS: Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included. INTERVENTIONS: LVOT VTI was measured by pulsatile Doppler echocardiography. Calculations of SVI were performed through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO®) thermodilution methods. MAIN VARIABLES: The relation between LVOT VTI and SVI was tested by linear regression analysis. RESULTS: One hundred and fifty-six paired measurements were compared. Mean LVOT VTI was 20.83±4.86cm and mean SVI was 41.55±9.55mL/m2. Pearson correlation index for these variables was r=0.644, p<0.001; ICC was 0.52 (CI 95% 0.4-0.63). When maximum LVOT VTI was correlated with SVI, Pearson correlation index was r=0.62, p<0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI. CONCLUSIONS: LVOT VTI could be a complementary hemodynamic evaluation in selected patients, but does not eliminate the need for invasive monitoring at the present time. The weak correlation between LVOT VTI and invasive monitoring deserves additional assessment to identify the factors affecting this disagreement.

Approximate confidence intervals for the likelihood ratios of a binary diagnostic test in the presence of partial disease verification.

The classic parameters used to assess the accuracy of a binary diagnostic test (BDT) are sensitivity and specificity. Other parameters used to describe the performance of a BDT are likelihood ratios (LRs). The LRs depend on the sensitivity and the specificity of the diagnostic test, and they reflect how much greater the probability of a positive or negative diagnostic test result for individuals with the disease than that for the individuals without the disease. In this study, several confidence intervals are studied for the LRs of a BDT in the presence of missing data. Two confidence intervals were studied through the method of maximum likelihood and seven confidence intervals were studied by applying the multiple imputation by chained equations method. A program in R software has been written that allows us to solve the estimation problem posed. The results obtained have been applied to the two real examples.

Measuring Geometric Phase without Interferometry.

A simple noninterferometric approach for probing the geometric phase of a structured Gaussian beam is proposed. Both the Gouy and Pancharatnam-Berry phases can be determined from the intensity distribution following a mode transformation if a part of the beam is covered at the initial plane. Moreover, the trajectories described by the centroid of the resulting intensity distributions following these transformations resemble those of ray optics, revealing an optical analogue of Ehrenfest's theorem associated with changes in the geometric phase.

Although it induces synchronized ovulation, hCG reduces the fertility of Santa Ines ewes submitted to TAI / Embora induza a ovulação sincronizada, hCG reduz a fertilidade de ovelhas Santa Inês submetidas à IATF

The aim of this study was to evaluate hCG treatment on ovarian response and on pregnancy rate using a 9-day oestrus synchronization protocol in Santa Ines ewes. On a random oestrus cycle day, ewes received an intravaginal progesterone device (Primer-PR®, Tecnopec, Brazil). Nine days later (Day 9), 30µg of d-cloprostenol (Prolise®, Syntex, Argentina) and 250IU of eCG (Folligon®, Intervet, Brazil) were administered and the progesterone device was removed. This moment, the ewes were randomly assigned on two groups: Control Group and hCG Group. In the hCG Group, the ewes received 500IU of hCG (Vetecor®, Hertape-Calier, Spain) 24h after device removal. In the Control Group, the ewes did not receive any ovulation inductor. Control and hCG Groups ewes were inseminated 60h and 48h after device removal, respectively. There was no difference between the groups regarding the first ovulatory follicle diameter and the second ovulatory follicle. hCG Group ewes had shorter interval between device removal and ovulation (Control: 79.9±15.4h and hCG: 54.7±4.9h; P=0.001) and more synchronized ovulations. However, the treatment with hCG decreased the pregnancy rate after TAI (P=0,009). In conclusion, hCG administration improves ovulatory synchronisation, but causes a decrease in the pregnancy rate.(AU)

Avaliou-se o tratamento com hCG na resposta ovariana e na taxa de prenhez utilizando protocolo de sincronização do estro de nove dias em ovelhas Santa Inês. As ovelhas receberam um dispositivo intravaginal de progesterona em fase aleatória do ciclo (dia zero= D0). No momento da remoção do dispositivo (D9), as fêmeas receberam 30µg de d-cloprostenol (Prolise®, Syntex, Argentina) e 250UI de eCG (Folligon®, Intervet, Brasil). Nesse momento, as ovelhas foram aleatoriamente distribuídas em dois grupos de tratamento: controle sem indução de ovulação e tratamento com 500UI hCG para indução de ovulação. As ovelhas dos grupos controle e hCG foram inseminadas 60h e 48h após a remoção do dispositivo, respectivamente. Não houve diferença entre os grupos para o diâmetro do primeiro e do segundo folículo pré-ovulatório. As avelhas do grupo hCG apresentaram menor intervalo entre a remoção do dispositivo e a ovulação (grupo controle: 79.9±15.4h e grupo hCG: 54.7±4.9h; P=0.001) e maior sincronização das ovulações. No entanto, o tratamento com hCG diminuiu a taxa de prenhez após a IATF (P=0,009). Conclui-se que, apesar de a administração de hCG aumentar a sincronização da ovulação, reduz a taxa de prenhez.(AU)

Dimensionality and internal structure of the Colombian version of the INICO-FEAPS quality of life scale.

BACKGROUND AND OBJECTIVE: Measuring quality of life (QoL) in people with intellectual disabilities (IDs) can help organisations and practitioners to implement evidence-based practices and develop person-centred planning and individualised supports. There is no reliable and valid instrument for assessing QoL in people with ID in Colombia. We investigated the internal structure of the Colombian version of the INICO-FEAPS scale and tested whether the scale identified the eight interrelated domains of the QoL conceptual framework originally described by. METHOD: Data were collected from 602 adults with moderate levels of ID and respective proxies, who completed the self-report and the report by other scales, respectively. Five measurement models were tested through confirmatory factor analysis. RESULTS: The eight correlated dimension model showed the best fit to the data. Reliability and convergent validity of the indicators were satisfactory in both versions of the scale (self-report and proxy report). CONCLUSIONS: This study contributes to research on QoL measurement by providing the first empirical evidence regarding the dimensionality, internal structure and psychometric properties of the Colombian version of the INICO-FEAPS scale. Moreover, the study presents the first adaptation of a specific QoL scale for people with ID in Colombia, which may in the future be useful for implementing evidence-based practices and developing person-centred support plans.