Preputial lymphangioma in a stallion: First report.

This short communication describes a case of a 30-year-old stallion with a mass on the base of the penis causing paraphimosis. The patient was submitted to anti-inflammatory and diuretic therapy with no signs of improvement, so 16 days after the lesion was detected, the animal was euthanized. Necropsy was performed, and histopathological assessment of the lesion was conducted. The mass was composed primarily of channels and cavernous structures, lined by elongated cells of vascular origin, located in the preputium. The lesion was diagnosed as a preputial lymphangioma. To the authors' best knowledge, the anatomical location of this neoplasm (which is rare in veterinary medicine) has not been previously reported.

Pyrolysis Temperature vs. Application Rate of Biochar Amendments: Impacts on Soil Microbiota and Metribuzin Degradation.

Biochar-amended soils influence the degradation of herbicides depending on the pyrolysis temperature, application rate, and feedstock used. The objective of this study was to evaluate the influence of sugarcane straw biochar (BC) produced at different pyrolysis temperatures (350 °C, 550 °C, and 750 °C) and application rates in soil (0, 0.1, 0.5, 1, 1.5, 5, and 10% w/w) on metribuzin degradation and soil microbiota. Detection analysis of metribuzin in the soil to find time for 50% and 90% metribuzin degradation (DT50 and DT90) was performed using high-performance liquid chromatography (HPLC). Soil microbiota was analyzed by respiration rate (C-CO2), microbial biomass carbon (MBC), and metabolic quotient (qCO2). BC350 °C-amended soil at 10% increased the DT50 of metribuzin from 7.35 days to 17.32 days compared to the unamended soil. Lower application rates (0.1% to 1.5%) of BC550 °C and BC750 °C decreased the DT50 of metribuzin to ~4.05 and ~5.41 days, respectively. BC350 °C-amended soil at high application rates (5% and 10%) provided high C-CO2, low MBC fixation, and high qCO2. The addition of low application rates (0.1% to 1.5%) of sugarcane straw biochar produced at high temperatures (BC550 °C and BC750 °C) resulted in increased metribuzin degradation and may influence the residual effect of the herbicide and weed control efficiency.

Mononitrate Isosorbide as an Adjunctive Therapy in Schizophrenia: A Randomized Controlled Crossover Trial.

BACKGROUND: Schizophrenia is a complex disabling mental disorder, and many patients present poor response to available treatments. Accumulating evidence about the role of the glutamate/nitric oxide pathway in mediating the positive and negative symptoms of schizophrenia suggests potential benefits of drugs that modulate this system. The aim of this study was to test the efficacy of isosorbide mononitrate (ISMN) as an adjunctive therapy for symptomatic outpatients with schizophrenia. METHODS: This was a 2-month randomized, double-blind, placebo-controlled trial with 24 schizophrenia patients. Participants were treated with ISMN 50 mg for 1 month and placebo for another month in a crossover design. The Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale, Global Assessment of Functioning, and MATRICS Cognitive Consensual Battery were used for symptom assessment and arterial spin labeling was used to assess brain activation patterns. RESULTS: We found significant differences in the total, general, and positive subscales of the PANSS, Global Assessment of Functioning scores, and Clinical Global Impression scores during treatment with ISMN relative to placebo. No treatment effects were found comparing scores in the MATRICS Cognitive Consensual Battery and the negative subscale of the PANSS between the active and placebo conditions. A post hoc analysis of neuroimaging data showed reduced activity in the thalamus in subgroup of patients with severe psychopathology. CONCLUSIONS: Schizophrenia patients with persistent symptoms showed significant improvement after 4 weeks of treatment with ISMN 50 mg/d compared with placebo. Isosorbide mononitrate added beneficial effects to antipsychotic treatment in terms of positive symptoms and functioning.

Health-related quality of life of thyroid cancer patients undergoing radioiodine therapy: a cohort real-world study in a reference public cancer hospital in Brazil.

PURPOSE: The purpose of this study was to access changes in health-related quality of life (HRQoL) caused by radioiodine therapy (RAI) in thyroid cancer patients. METHODS: Prospective cohort study at Brazilian National Cancer Institute with patients enrolled between March 2015 and June 2017. RAI was performed by administration of 1.11 to 9.25 GBq of Na131I. EORTC QLQ-C30 v3 and EORTC QLQ-H&N35 questionnaires were applied to determine HRQoL at baseline, 1 week and 3 months after RAI. HRQoL during follow-up was evaluated by calculation of score absolute changes in each domain. Descriptive analysis was performed by measures of central tendency and dispersion. Changes in HRQoL were evaluated by paired t-test. The association between social demographic and clinical data and HRQoL was assessed by univariate linear regression for significantly changed domains, and p < 0.05 was considered significant. RESULTS: An improvement on global HRQoL and social Function post-therapy (p = 0.002 and p < 0.001) and on role (p = 0.038), emotional (p < 0.001), and cognitive function (p = 0.016) during RAI were observed. Nausea and vomiting (p < 0,001), pain (p < 0.001), sensitivity problems (p < 0.001), problems with social contact (p < 0.001), dry mouth (p = 0.007), and sticky saliva (p = 0.001) increased during RAI. Females were more sensible to changes in nausea and vomiting, and patients < 55 years experienced higher changes in sense during RAI. CONCLUSIONS: Although RAI might affect HRQoL negatively, patients experienced an improvement on global HRQoL and symptoms reduction post-therapy.

Temperament and performance of Nellore bulls classified for residual feed intake in a feedlot system.

This study aimed to evaluate the performance in feedlot and temperament of Nellore bulls classified by residual feed intake. The residual feed intake was calculated as the difference between the observed and predicted dry matter intake. Bulls classified as low residual feed intake had lower dry matter intake (kg day-1) and dry matter intake (g kg-1 d-1) of body weight, and were more efficient in feed conversion ratio than those classified as medium and high. The average daily gain didn't differ among residual feed intake classes and was 1.69 kg day-1, 1.82 kg day-1 and 1.71 kg day-1 for bulls classified as low, medium, or high, respectively. The residual feed intake was positively associated with dry matter intake, feed conversion ratio and subcutaneous fat thickness. The subcutaneous fat thickness was lower in bulls classified as low residual feed intake than in those with medium and high. No differences were observed in flight speed and reactivity score among residual feed intake classes. Overall, we concluded that bulls classified as low residual feed intake consumed less dry matter than high, with no differences in average daily gain, temperamentand had better feed efficiency, albeit their subcutaneous fat thickness was lower.

Flow cytometry assessment of graft-infiltrating lymphocytes can accurately identify acute rejection in kidney transplants.

BACKGROUND: Previously, we have reported that flow cytometry analysis of fine-needle aspirates can accurately predict rejection in kidney transplants treated with cyclosporine-azathioprine-prednisolone. In this study, we examined this technique's accuracy using current immunosuppression. METHODS: Kidney transplant recipients were treated with calcineurin inhibitors, mycophenolate mofetil, and prednisolone: 92 remained rejection-free - Group I - and 37 developed acute rejection - Group II. An allograft aspiration specimen and peripheral blood were collected from Group I on post-transplant day 7 and from Group II on the day of clinical rejection. RESULTS: Significant changes were seen in both aspiration and peripheral blood samples in several T cell subsets when comparing Groups I and II. A sensitivity of 94.6%, specificity of 85%, and AUC = 0.966 were observed through combining CD8DR with CD3CD69 values from aspiration specimen; the corresponding AUC in peripheral blood was 0.847. Irreversible rejections displayed a significantly higher activation score (p = 0.024). CONCLUSIONS: Flow cytometry analysis of aspiration specimen achieved high diagnostic performance in renal transplants through studying CD8DR and CD3CD69 under current immunosuppressive therapy. Peripheral blood analysis, although not significant, showed the same trend. The activation score anticipated the irreversibility of rejection. The data suggest this test, through an easily tolerated technique, merits further diagnostic use.

Bacterial diversity in semen from stallions in three European countries evaluated by 16S sequencing.

The microbiome plays a significant role in shaping the health and functioning of the systems it inhabits. The seminal microbiome of stallions has implications for the health of the reproductive tract, sperm quality during preservation and antibiotic use in semen extenders. Diverse bacteria are present on the external genital tract and a mix of commensal microorganisms populates various parts of the reproductive tract, influencing the seminal bacterial content. Other sources of bacteria include the environment, semen collection equipment, and personnel. The bacterial load can adversely affect sperm quality and fertility, particularly in artificial insemination, where semen is extended and stored before use. Antibiotics are frequently used to inhibit bacterial growth, but their effectiveness varies depending on the bacterial strains present. The aim of this study was to assess the bacterial diversity in semen from 37 healthy stallions across three European nations (Germany, Portugal, and Sweden) using 16S sequencing. Semen samples were collected from individual stallions at three AI centers; DNA extraction, sequencing, and bioinformatic analysis were performed. Differences in bacterial diversity among the stallions were seen; although bacterial phyla were shared across the regions, differences were observed at the genus level. Climate, husbandry practices, and individual variability likely contribute to these differences. These findings underscore the importance of tailoring antibiotic strategies for semen preservation based on regional bacterial profiles. The study presents a comprehensive approach to understanding the intricacies of the stallion seminal microbiome and its potential implications for reproductive technologies and animal health.

A comparative study on the quality of in vivo labeled red blood cell radionuclide ventriculography images employing different freeze-dried reagents.

Radionuclide ventriculography or Multi Gated Acquisition (MUGA) employing [ 99m Tc]Technetium red blood cell (RBC) labeling is considered the gold standard for cardiotoxicity assessments in cancer patients undergoing chemotherapy. This in-vivo RBC labeling technique involves the reduction of [ 99m Tc]Technetium by the stannous chloride present in freeze-dried reagent kits, with the pyrophosphate kit (PYP) being the most employed for this purpose. The literature, however, describes diethylenetriaminepentaacetic acid (DTPA) as an alternative to PYP, although a lack of comparative data from MUGA images between both reagents is noted. A retrospective cross-sectional observational study was conducted at the Brazilian National Cancer Institute Nuclear Medicine Service concerning 80 randomized MUGA images, 20 obtained employing DTPA between 2020 and 2023 and 60 obtained employing PYP between 2017 and 2020, applying the mean count per pixel (ct/pixel) and heart background (C/F) ratios as quality image indicators. Although the heart ct/pixel ratio was statistically lower in the DTPA images compared with PYP ( P  = 0.02), the C/F ratio was statistically similar when comparing both radiopharmaceuticals ( P  = 0.697). A semi-quantitative analysis of MUGA images obtained with DTPA and PYP indicates similar image quality, supporting the use of DTPA as an alternative to PYP without compromising diagnostic interpretations.

A case of equine multicentric lymphoma: Clinical, microscopical, and molecular findings.

Background: Although relatively uncommon, lymphoma is the most prevalent haematopoietic neoplasia in horses, and multicentric lymphoma remains the most common presentation of the disease. The pathogenesis of equine lymphoma is still poorly understood and the diagnosis is usually confirmed at an advanced stage of the disease, compromising the prognosis. This study investigated the clinical, pathological, and molecular features of a case of equine multicentric lymphoma. Case Description: An apparently healthy 5-year-old crossbreed mare hospitalized at the Centre of Animal Reproduction of Vairão, Portugal, suddenly presented clinical signs of supraorbital oedema and mandibular lymph node enlargement, developing fever, facial oedema, and generalized lymphadenopathy. The mare ended up dying twenty-four days after the first clinical signs due to multisystem organ failure. Haematological and biochemical analyses, necropsy, and microscopic and molecular evaluation of affected tissues were performed. At necropsy, the main findings were multiple multinodular lesions, distributed along the serous surface of oropharynx, trachea, pericardium, gastrointestinal tract, and mesentery. Microscopically, these consisted of solid proliferations of neoplastic round cells that exhibited immunopositivity for CD3 (T cells). Based on these findings, a medium-grade multicentric T-cell lymphoma was diagnosed. Conclusion: There is still very little research regarding the molecular characterization of lymphoma in horses. As an entity itself is quite heterogeneous, it is important to describe the interspecies particularities to understand its development and behaviour.

The impact of long-term storage conditions on the development of experimental dentinal microcracks.

This study evaluated the impact of long-term storage conditions (medium and time) on the development of experimental dentinal microcracks through micro-computed tomography. Sixty freshly extracted premolars were stored in formalin, water, or dry conditions (n = 20) and scanned after 72 h, 30 days, 6 months and 3 years of extraction. The effect of the storage medium and time on the occurrence of dentinal defects was statistically evaluated. A total of 211 000 images were screened revealing the existence of 11 519 slices with dentinal defects. Dry conditions significantly contributed to the development of new defects in all time points. During the 3-year follow-up period, no new defects were detected in the teeth that were stored in water and, in a single tooth, in the formalin group, after 6 months of storage.

Host metabolomic responses in recurrent P. vivax malaria.

Malaria is the leading parasitic disease worldwide, with P. vivax being a major challenge for its control. Several studies have indicated metabolomics as a promising tool for combating the disease. The study evaluated plasma metabolomic profiles of patients with recurrent and non-recurrent P. vivax malaria in the Brazilian Amazon. Metabolites extracted from the plasma of P. vivax-infected patients were subjected to LC-MS analysis. Untargeted metabolomics was applied to investigate the metabolic profile of the plasma in the two groups. Overall, 51 recurrent and 59 non-recurrent patients were included in the study. Longitudinal metabolomic analysis revealed 52 and 37 significant metabolite features from the recurrent and non-recurrent participants, respectively. Recurrence was associated with disturbances in eicosanoid metabolism. Comparison between groups suggest alterations in vitamin B6 (pyridoxine) metabolism, tyrosine metabolism, 3-oxo-10-octadecatrienoate ß-oxidation, and alkaloid biosynthesis II. Integrative network analysis revealed enrichment of other metabolic pathways for the recurrent phenotype, including the butanoate metabolism, aspartate and asparagine metabolism, and N-glycan biosynthesis. The metabolites and metabolic pathways predicted in our study suggest potential biomarkers of recurrence and provide insights into targets for antimalarial development against P. vivax.

Synthesis and anti-Trypanosoma cruzi activity of naphthoquinone-containing triazoles: electrochemical studies on the effects of the quinoidal moiety.

In our continued search for novel trypanocidal compounds, twenty-six derivatives of para- and ortho-naphthoquinones coupled to 1,2,3-triazoles were synthesized. These compounds were evaluated against the infective bloodstream form of Trypanosoma cruzi, the etiological agent of Chagas disease. Compounds 17-24, 28-30 and 36-38 are described herein for the first time. Three of these novel compounds (28-30) were found to be more potent than the standard drug benznidazole, with IC50/24h values between 6.8 and 80.8µM. Analysis of the toxicity to heart muscle cells led to LC50/24h of <125, 63.1 and 281.6µM for 28, 29 and 30, respectively. Displaying a selectivity index of 34.3, compound 30 will be further evaluated in vivo. The electrochemical properties of selected compounds were evaluated in an attempt to find correlations with trypanocidal activity, and it was observed that more electrophilic quinones were generally more potent.

Case report: Long term follow-up of a large unilateral epididymal cyst in a stallion used for teaching: Is this condition associated with infertility?

A 30-year-old Lusitano stallion presented with an enlarged right epididymis. The ultrasound scan revealed a cyst-like formation and the histopathological examination was compatible with epididymal cyst located at the body/tail transition, epididymal spermatocele and sperm granuloma and epididymitis. However, these conditions did not seem to affect the animal's reproductive performance, nor did the semen parameters analyzed over the 8 years after the diagnosis show significant changes. Nevertheless, since the ejaculate contains mostly sperm cells from the tail of the epididymis, where fertile spermatozoa are stored until ejaculated, a deep knowledge of the different conditions that can affect this organ is of the utmost importance.

Incidental versus symptomatic nonfunctioning pituitary adenomas: Are they different?

BACKGROUND: Nonfunctioning pituitary adenomas (NFPAs) constitute one of the most common tumours in the sellar region and are often discovered only when associated with compressive symptoms. With the frequent use of brain imaging, there has been an increase in the prevalence of incidentally discovered NFPAs. AIM: We aim to determine the prevalence of incidental diagnosis with NPAs observed over a decade and compare the analytical, clinical and treatment differences between those who were diagnosed either incidentally or symptomatically. We also intend to evaluate the pathology differences between both groups. METHODS: We retrospectively analysed patients aged ≥18 years with an apparent NFPA, defined as a pituitary lesion compatible with pituitary adenoma which is not associated with the clinical or biochemical evidence of a hormone-secreting tumour. Inclusion criteria included normal prolactin level for lesions <9 mm or a prolactin level <100 ng/mL for lesions ≥10 mm in maximal tumour diameter. RESULTS: We included 119 patients [53.8% males; mean age: 56.8 years (SD = 16.7)]. Diagnosis was incidental in 47.1% of patients, and many patients had unappreciated signs and symptoms of pituitary disease. In the symptomatic and incidental groups, 66.7% and 41.1% of patients had hypopituitarism, respectively (p = .005). Only 20.4% of patients incidentally diagnosed had microadenoma (p = .060). Hypopituitarism was present in 18.8% of those patients with microadenomas. Most tumours were macroadenomas (87.4%). Half of those patients diagnosed incidentally were submitted to surgery, compared with 75.8% of those who were diagnosed symptomatically (p = .004). CONCLUSIONS: Nonfunctioning pituitary adenomas are commonly diagnosed incidentally, with many manifesting symptoms on examination. NFPAs incidentally diagnosed are more commonly macroadenomas and less frequently associated with hypopituitarism than symptomatic. Accordingly, if there was a greater level of knowledge and more suspicion about these pathologies, it might be possible to discover them earlier.

Impact of inbreeding and genetic parameter estimates for seminal traits in Lusitano horses.

The objectives of this study were to establish baseline information for seminal traits in Lusitano stallions, to assess the impact of inbreeding, interval between collections and age on semen quality during the breeding and non-breeding seasons, and to estimate the corresponding genetic parameters. A total of 2129 ejaculates by 146 Lusitano stallions used for artificial insemination, obtained from four equine reproduction centers distributed throughout Portugal, over a period of 14 years (2008-2021), were included in the study. The seminal traits analyzed, and the corresponding means and standard deviations, were gel-free volume (56.95 ± 28.76 mL), concentration (186.48 ± 104.68 × 106), motility (64.1 ± 16.9%), total number of spermatozoa (TNS) (9.271 ± 4.956 × 109) and total number of motile spermatozoa per ejaculate (TNMS) (5.897 ± 3.587 × 109). These results are in the normal range of values described for other breeds. In the stallions analyzed, the mean value for the inbreeding coefficient was 7.93 ± 5.29%, and for age it was 12.70 ± 6.83 years. A significant decline in sperm concentration, motility, TNS, and TNMS was observed as inbreeding increased. The season also influenced sperm concentration, motility, TNS and TNMS, with the highest values observed during the breeding season. When considering the impact of age on Lusitano seminal parameters, results showed a nonlinear relationship, with a positive effect until 18 years of age for volume, motility, TNS and TNMS and a negative effect after this age, with a slow decrease. However, age had a markedly negative effect on sperm concentration. The interval between semen collections only affected (P < 0.05) sperm motility, with a regression coefficient of +1.89 ± 2.17% per additional day. Genetic parameters were estimated with an Animal Model, and the estimated heritability (repeatability) was 0.27 (0.35) for volume, 0.02 (0.38) for sperm concentration, 0.24 (0.44) for motility, 0.29 (0.39) for TNS and 0.41 (0.41) for TNMS. These results suggest that it is possible to improve semen quality by selection and that the properties of semen produced by a stallion tend to remain consistent throughout its lifetime. Furthermore, the impact of inbreeding should be taken into consideration when selecting Lusitano stallions for fertility.

Exploring the Efficacy of 6 Preparation Systems for Achieving Minimal Root Canal Transportation: A Micro-CT Investigation.

INTRODUCTION: This study aimed to assess the canal transportation with 6 preparation systems. METHODS: Sixty curved mesial roots of mandibular molars were scanned, and their root canals (n = 20 per group) were prepared with XP-endo Shaper, BioRace, ProTaper Next, Twisted File Adaptive, Reciproc, or Reciproc Blue systems. After preparation, a new scan was conducted, and transportation was determined by comparing the geometric center of the canal in 13,542 cross-sectional slices. The transport direction frequencies were recorded, and linear transport were compared using a Univariate GLM model and Tukey honestly significant difference tests (α = 5 %). RESULTS: Transportation was affected by the preparation system and root third (P < .05), with no significant effect observed for the root canal (P > .05). The Twisted File Adaptive had the highest transport (P < .05), and the lowest transports were observed with XP-endo Shaper, ProTaper Next, and BioRace (P < .05). Reciproc Blue and Reciproc showed intermediate results (P < .05). The apical and coronal third exhibited the lowest and highest transportation, respectively (P < .05). A significant interaction was observed between the preparation system and root third (P < .05). In the coronal third, transportation was mostly toward the disto-inside direction, whereas in the middle and apical thirds, transportation was predominantly toward the mesio-outside direction. CONCLUSIONS: XP-endo Shaper had the lowest mean linear transportation followed by the ProTaper Next, BioRace, Reciproc Blue, and Reciproc systems. The Twisted File Adaptive system had the worst performance. The direction of transportation was generally toward the inner aspect of the canal at the coronal third and toward the outer aspect of the curve at the middle and apical thirds.

Methylprednisolone therapy induces differential metabolic trajectories in severe COVID-19 patients.

IMPORTANCE: The SARS-CoV-2 virus infection in humans induces significant inflammatory and systemic reactions and complications of which corticosteroids like methylprednisolone have been recommended as treatment. Our understanding of the metabolic and metabolomic pathway dysregulations while using intravenous corticosteroids in COVID-19 is limited. This study will help enlighten the metabolic and metabolomic pathway dysregulations underlying high daily doses of intravenous methylprednisolone in COVID-19 patients compared to those receiving placebo. The information on key metabolites and pathways identified in this study together with the crosstalk with the inflammation and biochemistry components may be used, in the future, to leverage the use of methylprednisolone in any future pandemics from the coronavirus family.

Towards effective clinical decision support systems: A systematic review.

BACKGROUND: Clinical Decision Support Systems (CDSS) are used to assist the decision-making process in the healthcare field. Developing an effective CDSS is an arduous task that can take advantage from prior assessment of the most promising theories, techniques and methods used at the present time. OBJECTIVE: To identify the features of Clinical Decision Support Systems and provide an analysis of their effectiveness. Thus, two research questions were formulated: RQ1-What are the most common trend characteristics in a CDSS? RQ2-What is the maturity level of the CDSS based on the decision-making theory proposed by Simon? METHODS: AIS e-library, Decision Support Systems journal, Nature, PlosOne and PubMed were selected as information sources to conduct this systematic literature review. Studies from 2000 to 2020 were chosen covering search terms in CDSS, selected according to defined eligibility criteria. The data were extracted and managed in a worksheet, based on the defined criteria. PRISMA statements were used to report the systematic review. RESULTS: The outcomes showed that rule-based module was the most used approach regarding knowledge management and representation. The most common technological feature adopted by the CDSS were the recommendations and suggestions. 19,23% of studies adopt the type of system as a web-based application, and 51,92% are standalone CDSS. Temporal evolution was also possible to visualize. This study contributed to the development of a Maturity Staging Model, where it was possible to verify that most CDSS do not exceed level 2 of maturity. CONCLUSION: The trend characteristics addressed in the revised CDSS were identified, compared to the four predefined groups. A maturity stage model was developed based on Simon's decision-making theory, allowing to assess the level of maturity of the most common features of the CDSS. With the application of the model, it was noticed that the phases of choice and implementation are underrepresented. This constitutes the main gap in the development of an effective CDSS.

Triazole-functionalized hydrochar-stabilized Pd nanocatalyst for ullmann coupling.

Biomass valorization is essential, particularly in emerging countries. Here, hydrochar from arabica coffee straw was functionalized with a triazole group (HD-TRz) for use as a support of palladium nanoparticles (PdNPs-HD-TRz) applied in the Ullmann coupling reaction for the first time. It provided remarkably excellent selectivities, conversions at a temperature as low as 45 °C and catalyst recyclability, surpassing previous literature performances. Hydrochar was obtained by one-pot reaction via hydrothermal synthesis, using NaOH solution as activating agent and functionalized with a 1,3-triazole group by CuAAC "click" reaction. The PdNPs were prepared via reduction of hydrochar-bound Pd(II) using NaBH4. Hydrochar functionalization was monitored by infrared spectroscopy, and X-ray diffraction (XRD) allowed to observe carbon and palladium planes in hydrochar and PdNPs HD-TRz structures. The PdNPs presented a spherical shape with 2.1 ± 0.1 nm size, homogeneously distributed in the carbon coverslips. The HD-TRz-supported PdNPs were used as a catalyst in the Ullmann reaction of iodobenzene, using ethanol as solvent with 100% of conversion and 91% selectivity at 45 °C. The material was reused, presenting 100% of conversion and selectivities of 92, 84 and 73% for the 1st, 2nd and 3rd cycle, respectively. The scope of the reaction was expanded to other molecules showing the potential of this and other triazole-hydrochar-supported nanocatalysts.

Outbreak of KPC-producing Klebsiella pneumoniae at a Portuguese university hospital: Epidemiological characterization and containment measures.

Background: KPC-producing K pneumoniae (KPC-Kp) is a public health problem with important clinical and epidemiological implications. We describe an outbreak of KPC-Kp at vascular surgery and neurosurgery wards in a central hospital in Porto, Portugal. Methods: A case of KPC-Kp was considered to be a patient positive for KPC-Kp with strong epidemiological plausibility of having acquired this microorganism in the affected wards and/or with genetic relationship ≥92% between KPC-Kp isolates. Active surveillance cultures (ASCs) and real-time polymerase chain reaction were used for the detection of carbapenemase genes through rectal swab in a selected population. Molecular analysis was performed using pulsed-field gel electrophoresis at the National Reference Laboratory. Patient risk factors were collected from the electronic medical record system. Information regarding outbreak containment strategy was collected from the Infection Control Unit records. Results: Of the 16 cases, 11 (69%) were identified through active screening, representing 1.4% of the total 766 ASCs collected. The most frequent risk factors identified were previous admission (63%), antibiotic exposure in the past 6 months (50%), and immunodepression (44%). The length of stay until KPC-Kp detection was high (0-121 days, mean 35.6), as was the total length of stay (5-173 days, mean 56.6). Three patients (19%) were infected by KPC-Kp, 2 of whom died. One previously colonized patient died later because of KPC-Kp infection. Conclusions: Multifactorial strategy based on contact precautions (with patient and healthcare professional cohorts) and ASC, as well as Antibiotic Stewardship Program reinforcement, allowed to contain this KPC-Kp outbreak.