In Vivo Effectiveness of Several Antimicrobial Locks To Eradicate Intravascular Catheter Coagulase-Negative Staphylococci Biofilms.

Tunneled central venous catheter (TCVC) related infection remains a challenge in the care of hemodialysis patients. We aimed to determine the best antimicrobial lock therapy (ALT) to eradicate coagulase-negative staphylococci (CoNS) biofilms. We studied the colonization status of the catheter every 30 days by quantitative blood cultures (QBC) drawn through all catheter lumens. Those patients with a significant culture (i.e.,100 to 1,000 CFU/mL) of a CoNS were classified as patients with a high risk of developing catheter-related bloodstream infections (CRBSI). They were assigned to receive daptomycin, vancomycin, teicoplanin lock solution, or the standard of care (SoC) (i.e., heparin lock). The primary endpoint was to compare eradication ability (i.e., negative QBC for 30 days after ending ALT) rates between different locks and the SoC. A second objective was to analyze the correlation between ALT exposure and isolation of CoNS with antimicrobial resistance. Daptomycin lock was associated with a significant higher eradication success than with the SoC: 85% versus 30% (relative risk [RR] = 14, 95% confidence interval [CI] = 2.4 - 82.7); followed by teicoplanin locks with a 83.3% success (RR = 11.7; 95% CI = 2 - 70.2). We observed CoNs isolates with a higher teicoplanin MIC in patients with repeated teicoplanin locks exposure (coefficient = 0.3; 95% CI = 0.11 - 0.47). However, teicoplanin MICs decreased in patients treated with vancomycin locks (coefficient = -0.56; 95% CI = -0.85 - -0.02). Methicillin-resistance decreased with accumulative ALT (RR = 0.82; 95% CI = 0.69 - 0.98). In this study, daptomycin locks achieve the highest eradication rate of CoNS from hemodialysis catheters in vivo.

Flexible ureteroscopy in extreme elderly patients (80 years of age and older) is feasible and safe.

PURPOSE: To compare the safety and efficacy of RIRS in patients ≥ 80 years to a younger population. METHODS: We retrospectively compared the data from patients ≥ 80 years of age undergoing RIRS with the data of a group of patients from 18 and < 80 years. Perioperative outcomes, complications and emergency department visits were compared between two groups. RESULTS: A total of 173 patients were included in the study. Mean age was 44 (27-79) and 81 years-old (80-94), for younger and elderly group, respectively. Elderly patients had higher ASA scores (≥ 3) (28.6% vs 75.8%; p = 0.0001) and Charlson comorbidity index (1.99 vs 7.86; p = 0.0001), more diabetes (p = 0.006) and respiratory comorbidities (p = 0.002). No statistical difference was found between two groups in stone size (p = 0.614) and number (p = 0.152). Operative time (74.48 vs 102.96 min; p = 0.0001) and duration of hospitalisation (1.7 vs 2.9 days; p = 0.001) were longer for the elderly. Intraoperative complication rate did not show differences between the two groups (p = 0.166). Postoperative complications rates were similar between the cohorts (7.7% vs 9.5%; p = 0.682). The success rates were 67.5% in the younger group and 71.4% in the elderly group (p = 0.584). No difference was seen in stone recurrence (p = 0.73). A higher rate of visits to the emergency department was found in younger cohort (23.6% vs 11.6%; p = 0.046), mostly duo to stent-related symptoms. CONCLUSIONS: Despite the higher rate of comorbidity in the elderly group, RIRS was a safe procedure with similar complication rate and outcomes at an expense of higher operative time and hospital stay.

Evidence of microplastics in water and commercial fish from a high-altitude mountain lake (Lake Titicaca).

Microplastic pollution is a widespread environmental concern. Like other anthropogenic pollutants, microplastics can reach aquatic ecosystems through rivers and interact with the aquatic biota. For instance, Lake Titicaca (between Bolivia and Peru), one of the great ancient lakes in South America (3,809 m a.s.l.), shows a pollution problem, particularly in the southern shallow basin (Lago Menor) in Bolivia. Nevertheless, our knowledge of the presence of microplastics and their interaction with the biota of Lake Titicaca is limited. Therefore, this study evaluated the presence of microplastics in the stomach content of the four fish species targeted by local fisheries in Lago Menor of Lake Titicaca (Orestias luteus, Orestias agassizii, Trichomycterus dispar, and Odonthestes bonariensis; N = 1,283), and looked for relationships with trophic guilds or fishing areas. Additionally, surface water was analyzed to evaluate the presence of microplastics in the water. The evaluation of microplastics was carried out by visual observations. We observed that the frequency of microplastic ingestion was low in all species (<5%). Conversely, microplastic was present in the water, with the highest quantity at the southern part of Lago Menor (103 ± 20 particles per L), without differences in the microplastic number between sites. Most microplastics counted in stomach contents were fibers, whereas water samples mainly contained fragments. Our results point to microplastic pollution in Lago Menor of Lake Titicaca. However, we could not determine the pollution rate due to considerable methodological limitations. Further research will be needed to robustly detect microplastics in Lake Titicaca and their impact on the fish species in the lake.

Pre-Emptive Antimicrobial Locks Decrease Long-Term Catheter-Related Bloodstream Infections in Hemodialysis Patients.

This study aimed to prove that pre-emptive antimicrobial locks in patients at risk of bacteremia decrease infection. We performed a non-randomized prospective pilot study of hemodialysis patients with tunneled central venous catheters. We drew quantitative blood cultures monthly to detect colonization. Patients with a critical catheter colonization by coagulase-negative staphylococci (defined as counts of 100−999 CFU/mL) were at high risk of developing a catheter-related bloodstream infection. We recommended antimicrobial lock for this set of patients. The nephrologist in charge of the patient decided whether to follow the recommendation or not (i.e., standard of care). We compared bloodstream infection rates between patients treated with antimicrobial lock therapy versus patients treated with the standard of care (i.e., heparin). We enrolled 149 patients and diagnosed 86 episodes of critical catheter colonization by coagulase-negative staphylococci. Patients treated with antimicrobial lock had a relative risk of bloodstream infection of 0.19 when compared with heparin lock (CI 95%, 0.11−0.33, p < 0.001) within three months of treatment. We avoided one catheter-related bloodstream infection for every ten catheter-critical colonizations treated with antimicrobial lock [number needed to treat 10, 95% CI, 5.26−100, p = 0.046]. In conclusion, pre-emptive antimicrobial locks decrease bloodstream infection rates in hemodialysis patients with critical catheter colonization.

Chronic Diseases among Agricultural Workers in a Rural Area of Puerto Rico.

Occupational and environmental exposures in the agricultural industry have been associated with several illnesses and poor health outcomes. Information regarding the characteristics and health status of the labor force working in the agricultural sector in Puerto Rico is limited. The overall objective of this study was to increase the available information on agricultural workers health and needs by ascertaining the potential differences in characteristics and health status of farmworkers when compared to the general population in rural Puerto Rico This cross-sectional study used the collection and analysis of medical records of agricultural workers and non-agricultural workers in Hospital General Castañer, located in Lares, Puerto Rico. The research period was five years, from 2012 to 2016. This research described agricultural workers' demographic and socioeconomic profile and evaluated relationships between one or more demographic variables and farmer's health. Agricultural workers presented alower prevalence of hypertensive disease (69.4%) and ahigher prevalence of cerebrovascular disease (3.4%) when compared to non-agricultural workers. In other words, agricultural workers were 21% less likely to have hypertensive disease as compared to non-agricultural workers. Results for agricultural workers showed that 4.0% of the workers were diagnosed with arthritis, and 48.8% had suffered at least one type of dorsopathy. The results from this research provide useful information for developing an appropriate framework to address Puerto Rican agricultural worker's health while promoting the agricultural industry development on the island. Finally, this study provided insight into the prevalence and demographic characteristics of agriculture workers in acentral region of Puerto Rico. Further efforts are needed to better define the agricultural workers and farming communities in Puerto Rico that may be exposed to related hazards.

Cognitive versus behavioral ADHD phenotype: what is it all about?

The ADHD PASS assessment is discussed. 100 combined and 50 inattentive ADHD patients with DSM IV - TR criteria, no comorbidity, and no previous treatment were enrolled. Those with SNAP-IV> or =2.5/1.8 (teacher/parents) [n=96] were randomly assigned to 1 of 3 treatment groups: Concerta, humanistic psychology, and Concerta+psychology. Those with SNAP-IV<2.5/1.8 [n=54] to 1 of 2 groups: Concerta and Concerta+psychology. All of them [n=150] we administered the SNAP-IV and cognitive DN:CAS battery at baseline and 6 and 12 months later. Cluster analysis and paired Student t-test were applied. The cluster analysis produced three cognitive profiles: one [n=96] with planning dysfunction and SNAP-IV> or =2.5/1.8, the majority [n=76] combined ADHD; another [n=38] with successive processing dysfunction and SNAP-IV<2.5/1.8, the majority [n=28] inattentive ADHD; and another [n=16] without cognitive dysfunction and with SNAP-IV<2.5/1.8, [n=8] combined and [n=8] inattentive. Only planning ameliorated at 12 months assessment. It was better in group 3 (p<0.1) than in group 1 (p<0.5), than in group 2 (p<0.4/0.3). Remission was parallel to planning improvement, group 3>group 1> group 2. PASS assessment in ADHD may be relevant.

Macrolide and fluoroquinolone resistance in Mycoplasma genitalium in two Swedish counties, 2011-2015.

Mycoplasma genitalium, causing non-gonococcal non-chlamydial urethritis and associated with cervicitis, has developed antimicrobial resistance (AMR) to both the macrolide azithromycin (first-line treatment) and the fluoroquinolone moxifloxacin (second-line treatment). Our aim was to estimate the prevalence of resistance, based on genetic AMR determinants, to these antimicrobials in the M. genitalium population in two Swedish counties, Örebro and Halland, 2011-2015. In total, 672 M. genitalium positive urogenital samples were sequenced for 23S rRNA and parC gene mutations associated with macrolide and fluoroquinolone resistance, respectively. Of the samples, 18.6% and 3.2% in Örebro and 15.2% and 2.7% in Halland contained mutations associated with macrolide and fluoroquinolone resistance, respectively. The predominating resistance-associated mutations in the 23S rRNA gene was A2059G (n = 39) in Örebro and A2058G (n = 13) and A2059G (n = 13) in Halland. The most prevalent possible resistance-associated ParC amino acid alterations were S83I (n = 4) in Örebro and S83N (n = 2) in Halland. Resistance-associated mutations to both macrolides and fluoroquinolones were found in 0.7% of samples. Our findings emphasize the need for routine AMR testing, at a minimum for macrolide resistance, of all M. genitalium-positive samples and regular national and international surveillance of AMR in M. genitalium, to ensure effective patient management and rational antimicrobial use.

Prevalence of macrolide and fluoroquinolone resistance-mediating mutations in Mycoplasma genitalium in five cities in Russia and Estonia.

BACKGROUND AND OBJECTIVE: Resistance in the sexually transmitted bacterium Mycoplasma genitalium to all recommended therapeutic antimicrobials have rapidly emerged. However, to date, internationally reported resistance surveillance data for M. genitalium strains circulating in Eastern Europe are entirely lacking. The aim of this study was to estimate the prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium in four cities in Russia and one in Estonia, 2013-2016. MATERIALS AND METHODS: Consecutive urogenital samples found positive for M. genitalium during diagnostic testing were retrospectively analyzed for resistance-associated mutations in the 23S rRNA and parC genes using pyrosequencing and conventional Sanger sequencing, respectively. RESULTS: In total, 867 M. genitalium positive samples from 2013-2016 were analyzed. Macrolide resistance-associated mutations were detected in 4.6% of the samples from Russia (0.7-6.8% in different cities) and in 10% of the samples from Estonia. The mutations A2059G and A2058G were highly predominating in both Russia and Estonia, accounting together for 90.9% of the cases positive for nucleotide substitutions in the 23S rRNA gene. The rates of possible fluoroquinolone resistance-associated mutations were 6.2% in Russia (2.5-7.6% in different cities) and 5% in Estonia. The mutations S83I and S83N were the most frequent ones in Russia (24.4% each), whereas D87N highly predominated in Estonia (83.3% of all fluoroquinolone resistance-associated mutations). Approximately 1% of the samples in both countries harbored both macrolide and possible fluoroquinolone resistance-associated mutations, with A2058G and S83I being the most frequent combination (37.5%). CONCLUSIONS: The prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium was 4.6% and 6.2%, respectively, in Russia, and 10% and 5%, respectively, in Estonia. Despite the relatively low rates of macrolide and fluoroquinolone resistance in these countries, antimicrobial resistance surveillance and testing for resistance-associated mutations in M. genitalium positive cases would be valuable.

Body Mass Index in Pregnancy Does Not Affect Peroxisome Proliferator-activated Receptor Gamma Promoter Region (-359 to -260) Methylation in the Neonate.

BACKGROUND: Obesity in pregnancy can contribute to epigenetic changes. AIM: To assess whether body mass index (BMI) in pregnancy is associated with changes in the methylation of the peroxisome proliferator-activated receptor γ (PPAR) promoter region (-359 to - 260) in maternal and neonatal leukocytes. SUBJECTS AND METHODS: In this matched, cohort study 41 pregnant women were allocated into two groups: (a) Normal weight (n = 21) and (b) overweight (n = 20). DNA was extracted from maternal and neonatal leukocytes (4000-10,000 cells) in MagNA Pure (Roche) using MagNA Pure LC DNA Isolation Kit 1 (Roche, Germany). Treatment of DNA (2 µg) was performed with sodium bisulfite (EZ DNA Methylation-Direct™ Kit; Zymo Research). Real-time quantitative polymerase chain reaction (qPCR) was performed in a LightCycler 2.0 (Roche) using the SYBR(®) Advantage(®) qPCR Premix Kit (Clontech). The primers used for PPARγ coactivator (PPARG) M3 were 5'- aagacggtttggtcgatc-3' (forward), and5'- cgaaaaaaaatccgaaatttaa-3' (reverse) and those for PPARG unmethylated were: 5'-gggaagatggtttggttgatt-3' (forward) and 5'- ttccaaaaaaaaatccaaaatttaa-3' (reverse). Intergroup differences were calculated using the Mann-Whitney U-test, and intragroup differences, with the Wilcoxon test (IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp.). RESULTS: Significant differences were found in BMI, pregestational weight, and postdelivery weight between groups but not in the methylation status of the PPARγ promoter region (-359 to - 260). CONCLUSION: The PPARγ promoter region (-359 to - 260) in peripheral leukocytes is unlikely to get an obesity-induced methylation in pregnancy.

[Ahmed drainage device implant. Our experience between 1995 and 2003]. / Implante de válvula de Ahmed. Nuestra experiencia 1995-2003.

PURPOSE: To evaluate the indications, results and complications of the Ahmed drainage device implanted between January 1995 and December 2003. MATERIALS AND METHODS: A retrospective study of 70 eyes in 65 patients. We analysed: the indications for surgery; the preoperative intraocular pressure (IOP), the postoperative IOP at 1 and 3 months, 1, 2 and 3 years after surgery; and the short and long term postoperative complications. We defined an absolute success as an IOP between 5 and 21 mmHg without glaucoma medications, relative success the same IOP levels whilst taking glaucoma medications and failure as an IOP of less than 5 and more than 22 mmHg. RESULTS: The most frequent indications for use of the drainage device were: neovascular glaucoma (45.7%), no response to other glaucoma surgery (20%), aphakic glaucoma (10%) and traumatic glaucoma (8.5%). Mean preoperative IOP was 39 mmHg. Mean postoperative IOP was: 19.7 mmHg (1 month), 21.6 mmHg (3 months), 19.6 mmHg (1 year), 18 mmHg (2 years) and 18.6 mmHg (3 years). The most frequent early complications were athalamia and hiphema. The most frequent late complications were tube or body valve extrusion and fibrotic reaction around the valve. CONCLUSIONS: Both the indications and success rates are similar to those previously reported. Visual acuity assessment is not of value in this group of patients because of their multiple associated ophthalmic pathologies.

Selective inactivation of NADPH oxidase 2 causes regression of vascularization and the size and stability of atherosclerotic plaques.

BACKGROUND: A variety of NADPH oxidase (Nox) isoforms including Noxs 1, 2, 4 and 5 catalyze the formation of reactive oxygen species (ROS) in the vascular wall. The Nox2 isoform complex has arguably received the greatest attention in the progression of atherogenesis in animal models. Thus, in the current study we postulated that specific Nox2 oxidase inhibition could reverse or attenuate atherosclerosis in mice fed a high-fat diet. METHODS: We evaluated the effect of isoform-selective Nox2 assembly inhibitor on the progression and vascularization of atheromatous plaques. Apolipoprotein E-deficient mice (ApoE-/-) were fed a high fat diet for two months and treated over 15 days with Nox2ds-tat or control sequence (scrambled); 10 mg/kg/day, i.p. Mice were sacrificed and superoxide production in arterial tissue was detected by cytochrome C reduction assay and dihydroethidium staining. Plaque development was evaluated and the angiogenic markers VEGF, HIF1-α and visfatin were quantified by real time qRT-PCR. MMP-9 protein release and gelatinolytic activity was determined as a marker for vascularization. RESULTS: Nox2ds-tat inhibited Nox-derived superoxide determined by cytochrome C in carotid arteries (2.3 ± 0.1 vs 1.7 ± 0.1 O2(•-) nmol/min*mg protein; P < 0.01) and caused a significant regression in atherosclerotic plaques in aorta (66 ± 6 µm(2) vs 37 ± 1 µm(2); scrmb vs. Nox2ds-tat; P < 0.001). Increased VEGF, HIF-1α, MMP-9 and visfatin expression in arterial tissue in response to high-fat diet were significantly attenuated by Nox2ds-tat which in turn impaired both MMP-9 protein expression and activity. CONCLUSION: Given these results, it is quite evident that selective Nox inhibitors can reverse vascular pathology arising with atherosclerosis.

Comparison of dynamic and integrated light-scattering techniques in the study of the interaction of Candida rugosa lipase with DPPC liposomes.

Dynamic light-scattering (DLS) and wide angle integrated light-scattering (WAILS) spectroscopies were evaluated in the study of binding of Candida rugosa lipase (CRL) with 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) liposomes. The use of cumulants analysis on DLS data allowed for the determination of general lipase-liposome-binding trends. Particle intensity distributions obtained from DLS data by a discrete inversion method revealed the different populations created upon lipase-liposome interactions. Using a discrete inversion technique on WAILS data, not only these populations could be differentiated but also accurate number distributions were obtained in short periods of time. Both DLS and WAILS are excellent tools for the study of lipase binding to lipid vesicles; however, care must be exercised in the analysis of the experimental data whenever particle size distributions are multimodal. The selection of the light scattering technique will depend on the information required.

[Not Available]. / Influences des entraîneurs Ga(2)O(3) et NaF sur la volatilisation et l'excitation du vanadium dans la methode de Scribner-Mullin.

A study has been made of the effect of NaF and Ga(2)O(3) as entrainers, on the spectral line intensities of vanadium, and on the sensitivity and detection limits by the Scribner-Mullin method. The two entrainers have different effects on the volatilization of vanadium. By radiotracer methods with (48)V, the degree of volatilization was found to be 37% with NaF and 0.9% with Ga(2)O(3). Use of NaF greatly increases the sensitivity, lowering the detection limit by a factor of about 50, without affecting the precision. The physicochemical conditions in the plasma do not seem to influence the line intensities with either entrainer.

Posterior fossa subdural hematoma.

One case of traumatic posterior fossa subdural hematoma (PFSH) is described. This location represent 1% of the subdural hematomas. Computerized Tomography (CT) was used in the diagnosis and follow-up of the hematoma. The etiology and physiopathology of this process are discussed.

Hydatid cyst: unusual cause of unilateral exophthalmos.

Intraorbital hydatid cysts are encountered unusually on neurosurgical services. Recently, 3 patients with intraorbital hydatid cysts have been studied by the Neurosurgical Service of C. S. "La Paz." In two of them, a computed tomography (CT) scan was performed; we think that these are the first cases of this type to be studied with CT scans. In each case, the CT scan showed a circular mass with a density similar to that of the eye. Frequency, localization, symptomatology, and neuroradiological aspects of intraorbital hydatid cysts are described. The different surgical approaches also are discussed.

Medical vs. Surgical treatment of ectopic pregnancy. The University of New Mexico's six-year experience.

OBJECTIVE: To review and compare the treatments for ectopic pregnancy in a university setting serving an indigent population. STUDY DESIGN: Charts assigned an ICD-9 code for ectopic pregnancy from January 1, 1993, through December 31, 1998, were reviewed for presenting symptoms, hCG levels, ultrasound findings, treatment modality and need for subsequent treatment. RESULTS: Of 401 patients treated for ectopic pregnancy, 7 were managed expectantly. One hundred nineteen (30%) patients received methotrexate. Seventy percent (83/119) of these ectopic pregnancies resolved with a single dose and an additional 11 after a second dose, for a 79% overall success rate. Twenty-five patients (21%) failed methotrexate therapy and required surgical treatment, and 11 (9%) pregnancies were ruptured. Primary treatment was surgical in 275 (69%) patients: 172 (63%) underwent laparoscopy and 103 (37%) laparotomy. Primary laparoscopic treatment was successful in 90%. Success rates were significantly lower for medical therapy as compared to laparoscopic treatment (79% vs. 90%, odds ratio 2.2, 95% confidence interval 1.1, 4.3; P = .02). No discriminating predictors of successful treatment with methotrexate were identified. CONCLUSION: The success rate of methotrexate therapy for ectopic pregnancy was lower than that of surgical management in a university setting serving an indigent population.

Infusion of anti-CD10 monoclonal antibody (J5) following ablative chemotherapy in a patient with refractory pre-B acute lymphoblastic leukemia.

The case of a 9-year old girl with end-stage refractory pre-B CD10/CALLA positive acute lymphoblastic leukaemia is described. The patient was treated with high doses of cytarabine followed by intravenous anti-CD10 monoclonal antibody (J5) in an effort to prevent the recovery of the leukemic CD10 positive clone following the bone marrow hypoplasia resulting from the chemotherapy. The number of CD10 positive cells dissapeared both in the peripheral blood as well as in the bone marrow, but when granulocytic recovery ensued, the patient died from respiratory infection. No evidence of antigenic modulation of the CD10 antigen was observed in the blast cells.

Tempol attenuates atherosclerosis associated with metabolic syndrome via decreased vascular inflammation and NADPH-2 oxidase expression.

Oxidative stress is an important factor in the generation of vascular injury in atherosclerosis. Chronic administration of fructose in rodents is able to facilitate oxidative damage. In the present study we evaluated the role of Tempol, a superoxide dismutase mimetic, on the effect of high fructose intake in apolipoprotein E-deficient (ApoE-KO) mice. Rodents were fed with fructose overload (FF, 10% w/v) for 8 weeks and treated with Tempol 1 mg/kg/day the latest 4 weeks. Tempol revert the pro-oxidant effects caused by FF, diminished lipid peroxidation and impaired vascular NADPH oxidase system through the downregulation of p47phox expression in the vascular wall. Tempol inhibited the expression of vascular adhesion molecule 1 (VCAM-1) in aorta and reduced the development of atheroma plaques. Our results indicate that tempol attenuates oxidative stress by interfering with the correct assembly of Nox2 oxidase complex in the vascular wall and is able to reduce atherosclerosis. Thus tempol represents a potential therapeutic target for preventing risk factors associated with metabolic syndrome.