Evaluation of ceftazidime/avibactam for serious infections due to multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa.

OBJECTIVES: The steady progress in resistance of Pseudomonas aeruginosa (PA) has led to difficulties in treating infections due to multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains. Ceftazidime/avibactam (CAZ/AVI) has in vitro activity against many of these strains, however clinical experience with CAZ/AVI is limited. This study aimed to evaluate the characteristics and outcomes of eight patients with infections due to MDR- or XDR-PA treated with CAZ/AVI, including four strains resistant to ceftolozane/tazobactam. METHODS: This was a retrospective descriptive study of patients admitted to a teaching hospital between January 2016 and May 2017 who received CAZ/AVI as initial or continuation therapy for infection due to MDR- and XDR-PA. RESULTS: The sources of infection were hospital-acquired lower respiratory tract infection in five patients (62.5%) and osteomyelitis, meningitis and catheter-related bacteraemia in one patient each. Clinical cure was achieved in 4 patients (50.0%). The 30-day and 90-day mortality rates were 12.5% and 37.5%, respectively. One patient (12.5%) developed encephalopathy that improved with discontinuation of the drug. CONCLUSIONS: CAZ/AVI may be a valuable option for serious infections due to resistant PA.

Effect of magnesium oxide (MgO) addition in diets for lactating holstein cows / Efecto de la adición de óxido de magnesio (MgO) en dietas para vacas holstein en lactación

It was evaluated the effect of magnesium oxide (MgO) addition in diets for Holstein cows on milk production and quality. Nineteen Holstein cows in second third of lactation were assigned to two treatments (T), with 9 and 10 animals. Both treatments were similar for days in lactation and milk yield. Cows were assigned at random to two treatments (T) groups: T1 received 0.2% and T2 received 0.4% of MgO. The MgO (alkalinizing agent) was mixed with a commercial concentrate and offered in feed bunk with total diet, which consisted of 9 kg/d of concentrate plus alfalfa hay fed ad libitum. Total diet was offered three times a day (0600; 1200 and 1700 h). The experimental period was of 30 d, with other 30 for adaptation. Milk production (kg/d) and milk quality (fat, protein, and total solids) were evaluated. Data were analyzed using the statistical package SAS through of a randomized block design. Animals on T2 (0.40% MgO) produced 2.85 kg/d more milk (P<0.50) than those on T1 (0.20% MgO). The fat, protein and total solids content in milk were higher (P<0.05) in T1 than in T2. It is concluded that the addition of 0.4% MgO in diets for lactating dairy cows resulted in milk production increased, although there was a small reduction in milk quality, compared with 0.2% MgO supplementation.

Se evaluó el efecto de adición de óxido de magnesio (MgO) en dietas para vacas Holstein sobre la producción y calidad de la leche. Diecinueve vacas Holstein en el segundo tercio de lactancia fueron asignadas a dos tratamientos (T), con 9 y 10 animales. Ambos tratamientos fueron similares para días de lactancia y producción de leche. Las vacas fueron asignadas al azar a dos grupos o tratamientos (T): T1 recibió 0,2%, y T2 recibió 0,4% de MgO. El MgO (agente alcalinizante) se mezcló con un concentrado comercial y se ofreció en el comedero junto con la dieta total, la cual consistió de 9 kg/d del concentrado mas heno de alfalfa ad libitum. La dieta total se ofreció 3 veces al día (06000, 1200 and 1700 h). El periodo experimental fue de 30 d, con otros 30 d de adaptación. Se evaluó la producción de leche (kg/d) y la calidad de la leche (grasa, proteína, y sólidos totales). Los datos se analizaron por medio del paquete estadístico SAS en un diseño de bloques al azar. Los animales en T2 (0,4% MgO) produjeron más leche (2,5 kg/d; P<0,05) que aquellos en T1 (0,20% MgO). El contenido de grasa, proteína, y sólidos totales en leche fue más alto (P<0,05) en T1 que en T2. Se concluye que la adición de 0,40% de MgO en dietas para vacas lactantes incrementa la producción de leche, sin embargo puede haber una pequeña reducción en la calidad de la leche, comparado con la suplementación de 0,20% de MgO.

Apendicitis aguda horas de evolución y diagnóstico histopatológico: Hospital Patrocinio Peñuela Ruíz: período 1999-2000 / Appendicitis sharp hours of evolution and diagnose histopathological: Hospital Patrocinio Peñuela Ruíz: period 1999-2000

Se estudiaron 149 casos de pacientes operados con diagnóstico histológico de apendicitis aguda, en el HPPR durante el período 1999-2000. El objetivo del mismo fue determinar la existencia o no de una correlación entre las horas de evolución y el diagnóstico histopatológico. Se recolectaron los siguientes datos de las historias clínicas: horas de evolución del dolor abdominal y diagnóstico histológico. Se clasificaron los pacientes en cuatro grupos según el tiempo de evolución del dolor (12 horas o menos, 12 a 24 horas, 24 a 48 horas). La mayor parte de los pacientes (47 por ciento) consultaron entre las 24 y 48 horas de iniciado el dolor. Para los cuatro grupos el hallazgo histológico más frecuente fue apendicitis flegmonosa y hemorrágica (46,51 por ciento, 65,51 por ciento, 55,32 por ciento y 40 por ciento respectivamente). Se concluye que no hay relación directa entre las horas de evolución del dolor y la fase histológica.

Late complications following treatment for severe aplastic anemia (SAA) with high-dose cyclophosphamide (Cy): follow-up of a randomized trial.

High-dose cyclophosphamide (Cy) has been promoted as curative therapy for severe aplastic anemia (SAA). However, our randomized trial comparing antithymocyte globulin (ATG) and Cy was terminated early because of excess morbidity/early mortality in the Cy arm. We now report analysis of secondary endpoints at a median of 38 months. Relapse occurred in 6 (46%) of 13 responders in the ATG arm versus 2 (25%) of 8 in the Cy arm (P =.38). Five (31%) of 16 patients in the ATG arm and 4 (27%) of 15 patients in the Cy arm had evidence of paroxysmal nocturnal hemoglobinuria (PNH) at diagnosis, with no substantial change in the overall percentage of glycophosphatidyl inositol (GPI)-anchored protein-deficient neutrophils over extended follow-up in individual patients in either arm. Bone marrow cytogenetic abnormalities have been observed among surviving patients in both arms (2 of 14 ATG versus 1 of 12 Cy, P =.70). High-dose Cy does not prevent relapse or clonal evolution in SAA.