Planetary influences on the solar cycle: A nonlinear dynamics approach.

We explore the effect of some simple perturbations on three nonlinear models proposed to describe large-scale solar behavior via the solar dynamo theory: the Lorenz and Rikitake systems and a Van der Pol-Duffing oscillator. Planetary magnetic fields affecting the solar dynamo activity have been simulated by using harmonic perturbations. These perturbations introduce cycle intermittency and amplitude irregularities revealed by the frequency spectra of the nonlinear signals. Furthermore, we have found that the perturbative intensity acts as an order parameter in the correlations between the system and the external forcing. Our findings suggest a promising avenue to study the sunspot activity by using nonlinear dynamics methods.

Reproductive outcomes of anestrous goats supplemented with spineless Opuntia megacantha Salm-Dyck protein-enriched cladodes and exposed to the male effect.

The possible influence of the "male effect" upon reproductive outcomes of adult anestrous goats under marginal rangeland conditions and supplemented with protein-enriched Opuntia megacantha Salm-Dyck was evaluated. Reproductive variables included: estrus percentage (EST, %), estrus latency (ESL, hours), ovulation percentage (OP, %), ovulation rate (OR, units), average largest follicle at ovulation (LFO, mm), largest corpus luteum (LCL, mm), embryo number (EBN, units), and embryo implantation percentage (EIP, %). During early May, anestrous mix-breed adult goats (Criollo x Alpine-Saanen-Nubian; n = 38, 26° N) were randomly distributed to (1) Control (CC; n = 12), (2), Non-enriched Opuntia (NEO; n = 14), and (3) Protein-enriched Opuntia (PEO; n = 12). Neither LW (P > 0.05) nor BCS (P > 0.05) or any of the evaluated ovarian variables differed (P > 0.05) among treatments; EST = 89.66%, ESL = 53.66 h, OP = 70.33%, OR = 1.07 units, LFO = 4.5 mm, LCL = 9.6 mm, EBN = 0.94 embryos, and EIP = 48.66%. Irrespective of nutritional supplementation regime, all goats denoted an increased response to the male effect just in the middle of the anestrous season and managed under marginal grazing conditions during the dry season (May to June; 26° N). The use of the male effect successfully invoked neurophysiological pathways to re-activate ovarian follicular and luteal pathways during the natural anestrous season in the female goat. Yet, such successful physiological scenario was not equally exerted to promote an increased embryo implantation rate; this issue claims further consideration. Therefore, it is essential to align not only the peri-conceptional but also the peri-implantation stages to the best suited environmental conditions in the rangeland, in order to increase both reproductive and economic efficiency while promoting sustainability in those rangeland-based marginal goat production systems.

Asymptomatic bacteriuria in preadolescent girls.

BACKGROUND: The detection of asymptomatic bacteriuria in preadolescent girls may be important due to its effects on subsequent pregnancies. OBJECTIVE: To describe the prevalence of asymptomatic bacteriuria in preadolescent girls and the value of the nitrite test for screening. MATERIAL AND METHODS: Cross-sectional study in girls aged 9 to 13 years. Bacteriuria was defined as the growth of > 100,000 CFU/mL in 2 consecutive urine specimens. RESULTS: Three hundred and twenty seven girls were included. Asymptomatic bacteriuria was found in 7 girls, so the prevalence was 2.1% (95% CI, 1 to 4.4%). Escherichia coli was the isolated agent in all the cases. Focused interrogatory found history of urinary symptoms in 6 girls. The utility values of the nitrite test were: sensitivity, 1; specificity, 0.9; positive likelihood ratio, 10; and negative predictive value, 1. CONCLUSIONS: The prevalence of asymptomatic bacteriuria in preadolescent girls in this Mexican study is similar to the one reported internationally; it is reasonable to consider its early detection to avoid its effects on future pregnancies. Nitrite test seems to be good for screening.

Melanoma cells with acquired resistance to vemurafenib have decreased autophagic flux and display enhanced ability to transfer resistance.

Over the last years, the incidence of melanoma, the deadliest form of skin cancer, has risen significantly. Nearly half of the melanoma patients exhibit the BRAFV600E mutation. Although the use of BRAF and MEK inhibitors (BRAFi and MEKi) showed an impressive success rate in melanoma patients, durability of response remains an issue because tumor quickly becomes resistant. Here, we generated and characterized Lu1205 and A375 melanoma cells resistant to vemurafenib (BRAFi). Resistant cells (Lu1205R and A375R) exhibit higher IC50 (5-6 fold increase) and phospho-ERK levels and 2-3 times reduced apoptosis than their sensitive parents (Lu1205S and A375S). Moreover, resistant cells are 2-3 times bigger, display a more elongated morphology and have a modulation of migration capacity. Interestingly, pharmacological inhibition of sphingosine kinases, that prevents sphingosine-1-phosphate production, reduces migration of Lu1205R cells by 50 %. In addition, although Lu1205R cells showed increased basal levels of the autophagy markers LC3II and p62, they have decreased autophagosome degradation and autophagy flux. Remarkably, expression of Rab27A and Rab27B, which are involved in the release of extracellular vesicles are dramatically augmented in resistant cells (i.e. 5-7 fold increase). Indeed, conditioned media obtained from Lu1205R cells increased the resistance to vemurafenib of sensitive cells. Hence, these results support that resistance to vemurafenib modulates migration and the autophagic flux and may be transferred to nearby sensitive melanoma cells by factors that are released to the extracellular milieu by resistant cells.

The Effect of Month of Harvesting and Temperature-Humidity Index on the Number and Quality of Oocytes and In Vitro Embryo Production in Holstein Cows and Heifers.

The aim of this study was to evaluate the effect of the month of oocyte harvesting and the temperature-humidity index on oocyte number and quality harvested from Holstein cows and heifers, oocyte developmental competence, and total embryos produced in an area of intense ambient temperature for most of the year. A total of 5064 multiparous lactating cows and 2988 nulliparous heifers were used as oocyte donors and distributed across the months of the year. Overall, total oocytes per collection did not differ (p > 0.05) between cows (16.6 ± 2.7) and heifers (15.1 ± 1.8), but oocyte developmental competence was lower (p < 0.05) in cows (21.3 ± 5.4) than heifers (25.5 ± 4.0). For cows, the total number of oocytes harvested was two-fold higher (p < 0.05) in November than in May. For heifers, the total number of oocytes harvested was highest in April (17.19 ± 0.53) and lowest in May (10.94 ± 0.32; p < 0.05). For cows, total embryos were highest in November (2.58 ± 0.42) and lowest in August (1.28 ± 0.10; p < 0.05). Thus, taken together, these results indicate that severe heat stress impaired the number and quality of oocytes harvested from donor Holstein multiparous cows and heifers, oocyte developmental competence, and total embryos produced in this area of intense ambient temperature for most of the year.

Efficiency of hCG for Inducing Resumption of Ovarian Cyclicity and Synchronized Ovulations during the Seasonal Anestrous in Sheep.

This research aimed to evaluate whether the administration of hCG at the time of removal of a progesterone device may be effective at inducing estrus and ovulations in sheep during the natural seasonal anestrous, by comparing reproductive outputs (induction and duration of estrus, follicle development, ovulation, ovulation rate, and pregnancy rates) in ewes treated with eCG or only saline solution at the time of CIDR removal. Whereas results demonstrated no response in the control non-treated group, the largest rate of narrowly synchronized estrus signs and ovulations occurred in the eCG-group. The administration of hCG was effective at inducing estrus, promote follicular growth and a delayed yet significant ovulation (>84%) on day 10 after CIDR removal; moreover, an increased embryonic implantation rate was also observed. Moreover, if the hCG ewes remain exposed to active males for some days, said strategy could be adopted, aiming to induce pregnancies by natural mating in a short period of time.

Salvaging diabetic foot through debridement, pressure alleviation, metabolic control, and antibiotics.

There is a fatalist perception of diabetic foot because the argument of "small-vessel disease" prevails. This is the report of a cohort study of patients facing a formal recommendation for major foot amputation to assess how many can be saved with a conventional treatment, defined as debridement, pressure alleviation, metabolic control, and antibiotics. The primary efficacy measurement was the salvage of the limb at the follow-up visit between 25 and 35 days after the first consultation. The secondary efficacy measurement was the subsequent epithelization of the ulcerative lesions, following patients for up to 270 days. The cohort consisted of 105 type 2 diabetic patients; 87 (83%) had severe lesions. A total of 71 patients (68%) required hospitalization. By the intention-to-treat analysis, 89 patients (85%) avoided major amputation. A total of 88 patients were evaluated for complete epithelization, reaching median success by day 120. Overall, 51 patients (49%) underwent minor amputations. It was concluded that there is a high rate of unnecessary major foot amputations, because a diabetic foot can be salvaged across the continuum of severity when patients receive care in a multidisciplinary wound clinic.

[Analysis of nosocomial pediatric bacteremias at a general hospital between 1990 and 2006. The impact of attending the intravascular therapy]. / Análisis de las bacteriemias nosocomiales pediátricas en un hospital general entre 1990 y 2006. Impacto de la atención a la terapia intravascular.

INTRODUCTION: The administration of parenteral infusates is a frequent intervention that is considered innocuous; moreover, the risk of this procedure which offers a direct access to the bloodstream is minimized. OBJECTIVE: To evaluate the epidemiology of nosocomial pediatric bacteremias after implementing a control program. METHODS: Analysis of pediatric bacteremias was made in 3 periods: 1) 1990-1992, prior to establishing strategies to avoid contamination of parenteral infusions; 2) 1996, the phase after establishing these strategies; and 3) 2005-2006, the recent situation in the hospital. RESULTS: The proportion of gram-negative rods isolated in blood cultures dropped from 82.9 to 35.1% (p = 0.004) during the 17-year study period. There was no significant difference in the proportion of gram-negative rods isolated from intravascular catheters. The proportion of contaminated parenteral infusions dropped from 22.2% to 0.4% (p < 0.001). DISCUSSION: The strategies established to avoid the contamination of parenteral infusions were associated with a reduction in the proportion of gram-negative rods in blood cultures, although the proportion is still higher than that in developed countries, probably related to catheter contamination. We suggest establishing similar strategies in other hospitals from developing countries.

Mandibular and temporomandibular morphologic characteristics of patients with suspected unilateral condylar hyperplasia: a CT study.

INTRODUCTION: Facial asymmetry associated with unilateral condylar hyperplasia (UCH) is a complicated clinical condition. OBJECTIVE: The objective of this study was to describe morphological characteristics of the mandible and the temporomandibular joint in patients with facial asymmetry, using computed tomography and 3D reconstruction. METHODS: A retrospective observational study was performed with patients displaying facial asymmetry evaluated by single photon emission computed tomography (SPECT)/CT analysis, for suspected UCH, between 2015 and 2018. The following variables were compared between the affected side (producing the asymmetry) and the contralateral side (side to where the jaw is deflected): condylar length, condylar medial and lateral pole length, mandibular ramus length, intra-articular spaces, articular eminence height and position of the posterior wall of the glenoid fossa. RESULTS: Forty-three patients (21 women, mean age: 20.7 ± 7.25 years) with facial asymmetry were included, 19 patients presented right side deviation and 24 patients had left side deviation. Condylar length, lateral pole length, the sum of maximum values and articular eminence height were greater in the affected side (p< 0.05). A positive correlation was found between the position of the posterior wall of the glenoid fossa and the articular eminence height in the affected side (r = 0.442). CONCLUSIONS: In patients with suspected UCH, evaluated through CT, craniofacial measurements showed significantly larger condylar length and the condylar sum of maximum values in the affected side. A positive correlation was found between the increased dimensions of the articular eminence and the more posterior position of the glenoid fossa in the affected side.

The Effect of P4 + eCG Estrus Induction Protocol during the Deep and the Transition Anestrous Period on the Reproductive Performance of Crossbred Dairy Goats.

Seasonal reproduction restricts the offering of goat commodities across the year. Therefore, it is crucial to improve diverse strategies to induce the reproductive response in goats during the anestrus stage. The effectiveness of a short P4 + eCG-based estrus induction protocol during both the deep anestrous (March) or the reproductive transition period (June) upon the reproductive performance of crossbred dairy goats was assessed. Adult, anestrous, 24-30-month- old dairy crossbred (Saanen-Alpine-Nubian × Criollo) goats (n = 123) from two commercial herds and 10 sexually active goat bucks were used. Before the trials, the anestrous status of goats was confirmed. Then, goats were randomly allocated into two different experiments. In Exp. 1, we tested the effect of different doses (D) of intramuscular progesterone (P4; 10 or 20 mg + eCG (100 UI)) and type of breeding (TB), natural mating (NM), or artificial insemination (AI), on two commercial goat herds (H1 & H2), in March (deep anestrous). In Exp. 2, we evaluated the effect of D (P4; 10 or 20 mg + 100 UI eCG) in goats subjected to NM, and either during deep anestrous (March; M) or transitional anestrous (June; J), in two commercial herds. After breeding, conception and pregnancy were diagnosed with ultrasound scanning. The response variables were estrus induction (EI; %), estrus latency (EL; h), ovulation (OVP; %), ovulation rate (OR; units), fertility (FERT; %), and pregnancy (PREG; %). No differences (p > 0.05) in live weight (LW) and body condition score (BCS) occurred between herds in both trials. In Exp. 1, EI, EL, OVP, OR, FERT, and PREG were affected (p < 0.05) by the H-TB-D interaction, whereas in H1 + P4-20 combination had the highest (p < 0.05) EI, EL, and OVP values. Irrespective of TB, H1 had the largest (p < 0.05) OR, independently of TB or D. Also, the lowest (p < 0.05) OVP occurred in the AI + P4-10 group, while the AI had the lowest (p < 0.05) FERT, irrespective of D. FERT and PREG were two-fold higher (p < 0.05) in NM compared with AI. In Exp. 2, EI, EL, OVP, OR, FERT, and PREG were affected (p < 0.05) by the H-M-D interaction. In general, H2 + P4-10 had the lowest (p < 0.05) reproductive outcomes in March, whereas H1 had the largest (p < 0.05) values in either month. No differences (p > 0.05) between P4 doses occurred for EI, OVP, OR, FERT, and PREG. Yet, the largest (p < 0.05) EL occurred with P4-20 in June. No correlations (p > 0.05) occurred between LW and all the reproductive variables. BCS was positively correlated (p < 0.05) with EI (0.34), OVP (0.44), OR (0.58), and PREG (0.20). Also, positive correlations (p < 0.05) occurred between EI with EL (0.83), OVP (0.80), OR (0.64), and PREG (0.56); EL with OVP (0.58), OR (0.44), and PREG (0.42); OVP with OR (0.79) and PREG (0.70), as well as OR and PREG (0.63). Results of these studies confirm a multidimensional response regarding the effectiveness of P4 + eCG for estrus induction in goats mainly modulated by a specific time within the anestrous season, or even by specific management or a particular environment at the herd level (H1), although quite remarkably independent of the animal's LW or BCS at herd level. Moreover, the best reproductive outcomes occurred with NM in June. The most reproductive variables were similar using either 10 or 20 mg P4 + 100 IU eCG, giving the possibility to lessen the scale in the use of exogenous hormones while obtaining acceptable out of season reproductive response.

The Opuntia Effect Improves Dam-Kid Metabolic Markers, Augments Colostrum Quality and Enhances Kid-To-Dam Behavioral Interactions in Crossbred Goats and their Offspring under Semiarid-Rangeland Conditions.

The possible effect of protein-enriched Opuntia cladode supplementation during the pre- and post-partum stages (-25 days to +15 days; day 0 = kidding) upon dam-kid metabolic status, colostrum-milk quality, and some behavioral kid-to-dam interaction in goats managed under rangeland extensive conditions was evaluated. Multiparous crossbred goats (n = 30), homogeneous regarding live weight (LW; 55.9 ± 1.03 kg) and body condition score (BCS; 2.5 ± 0.2 units), were randomly assigned to (1) protein-enriched Opuntia (PEO; n = 10; 29.8% crude protein (CP), 2.2 Mcal ME kg-1), (2) non-enriched Opuntia (NEO; n = 10; 6.4% CP, 2.1 Mcal ME kg-1), and (3) control (CON; n = 10, non-supplemented). The PEO and NEO goats were individually supplemented with Opuntia cladodes (250 g day-1; 09:00-10:00 a.m.; 25 days pre- and 15 days post-partum); then, all groups grazed in a marginal rangeland (10:00 a.m. to 06:00 p.m.). LW, BCS, and blood samples to quantify serum glucose (GLU) levels were collected weekly from day -25 up to day +15 in both dams (pre- and post-partum) and kids (post-partum). At 4h and 8h post-partum, kid-to-dam behavioral tests were performed; approaches (APRO, units), animal-to-animal contact (ACONT, s), latency-to-contact (LCONT, s), and high (HPB) and low (LPB) bleats were registered. The response variables LW (58.2 ± 3.5 kg), GLU from does (66.4 ± 3.3 mg/dL), colostrum fat (12.3 ± 1.15%), non-fatty solids (20.9 ± 2.1%), density (64.4 ± 7.0%), and protein (8.1 ± 0.8%), as well as milk density (31.2 ± 1.7%) and protein (3.9 ± 0.3%), favored the PEO group. Moreover, the dam-to-kid 4 h LPB (34.5 ± 4.6 frequency), as well as kid-to-dam 8 h LCONT-own (100 ± 35.5 s) and LPB (25.2 ± 6.9 frequency) also favored the PEO group. To conclude, peripartum supplementation with protein-enriched Opuntia cladodes emerged as a key alternative to enhance the dam-kid metabolic status, to improve colostrum quality and some milk components (density and protein), as well as to expand the kid-to-dam bond in goat production systems under marginal extensive conditions.

Does Size Matters? Relationships among Social Dominance and Some Morphometric Traits upon Out-of-Season Reproductive Outcomes in Anestrus Dairy Goats Treated with P4 + eCG.

The possible role of the social rank (R) (i.e., low-LSR, middle-MSR, or high-HSR) in anestrus goats exposed to a P4 + eCG (D) (i.e., 100 or 350 IU) estrus induction protocol (EIP) was evaluated. Goats (Alpine-Saanen-Nubian × Criollo; n = 70; 25° North) managed under stall-fed conditions were all ultrasound evaluated to confirm anestrous status, while the social rank was determined 30 d prior to the EIP. The response variables included estrus induction (EI, %), duration of estrus (DUR, h), ovulation rate (OR, n), live weight (LW, kg), thoracic perimeter (TP, cm), thoracic diameter (TD, cm), body length (BL, cm), height at withers (HW, cm), beard length (BEA, cm), compactness index (COM, cm), and anamorphosis index (ANA, cm), as affected by R, D, and the R × D interaction were evaluated, while the correlation coefficients among reproductive and morphometric variables were quantified. An R × D interaction (p < 0.05) affected the response variables EI, DUR, and OR. While the largest (p < 0.05) EI% occurred in the HSR goats, irrespective of eCG (i.e., 100 or 350 IU), both the shortest estrus duration (DUR, h) and the lowest ovulation rate (OR, n) occurred in the LSR + D100 combination, with no differences among HSR and MSR either with D100 or D350. Regarding the LW and morphometric response variables, (i.e., LW, TP, TD, BL, HW, BEA, COM, and ANA) all of them favored either the HSR and MSR groups, with the lowest phenotypic values occurring in the LSR-goats. The EI% was observed to be positively correlated (p < 0.05) with DUR (0.71), LW (0.28), TP (0.31), TD (0.34), BL (0.33), HW (0.35), COM (0.23), and ANA (0.23). While DUR was correlated (p < 0.05) with TP (0.26) and ANA (0.24), OR demonstrated no-correlation (p > 0.05) with any response variable, either reproductive or morphometric. As expected, LW had high correlation coefficients (p < 0.01) with TP (0.86), TD (0.88), BL (0.82), HW (0.75), BEA (0.51), COM (0.97), and ANA (0.75). In general, the morphometric variables as a whole demonstrated important correlation coefficients among them (p < 0.01), ranging from 0.38 up to 0.84. To estimate the importance of the morphometric differences between social rank upon estrus induction, a principal component (PC) analysis was performed based on the correlation matrix derived from the corporal measurements. The PC1 and PC2 explained 70.3% and 17.6% of the morphometric variation, respectively. The PC1 was a measure of the goat size (i.e., small, medium, large) and its association with estrus occurrence was evaluated using a logistic regression model; the bigger the goat, the increased probability of being in estrus, by up to five times compared to small goats. Our results confirm that the higher social ranked, larger goats amalgamated some fundamental factors to be successful: aggressiveness, primacy to food access, augmented live weight, and corporal size; all of these were able to modulate out-of-season reproductive success in crossbred dairy goats subjected to an estrus induction protocol and managed under stall-fed conditions in Northern Mexico.

Does chlorhexidine mouthwash reduce the rate of oral colonization bygram-negative bacteria in patients with chemotherapy? Aplacebo-controlled trial.

The presence of gram-negative bacteria in the oral cavity is an undesirable occurrence in patients undergoing chemotherapy. Our aim was to investigate the antibacterial effect of 0.12% chlorhexidine mouthwash in chemotherapypatients with a randomized, double-blind, placebo-controlled trial. There were no significant differences between oral colonization rates; there may be local factors that interfere with chlorhexidine activity.

Leg length discrepancy after total hip arthroplasty: comparison of 3 intraoperative measurement methods.

INTRODUCTION: Total hip arthroplasty (THA) is 1 of the most successful and frequent orthopaedic procedures around the world. Leg length discrepancy is reported in 1% to 60% of cases and is 1 of the most frequent causes of patient dissatisfaction and a common reason for litigation. The aim of this study was to compare leg length discrepancies following THA using 3 different intraoperative measuring methods. MATERIAL AND METHODS: We present a prospective cohort study of 454 hips undergoing THA for osteoarthritis between January 2009 and August 2016. We compared postoperative leg length discrepancy using 1 of the following 3 measurement methods: (1A) direct intraoperative comparison of the legs; (1B) measurement with a compass-like device with supra-acetabular fixation, involving length and offset; (1C, D) an intraoperative device that measures the trochanteric/joint ratio. RESULTS: Leg length discrepancy >5 mm was present in 26% of the total study population. Direct intraoperative leg-to-leg assessment resulted in the greatest proportion of leg length discrepancy >5 mm (31%), followed by the compass group (27%) and the least discrepancy was observed in the trochanteric/joint ratio group (15%). The trochanteric/joint ratio assessment method resulted in the greatest reduction in discrepancy when compared to the other methods: discrepancies of 5-10 mm fell by 48% (relative risk [RR] 0.40 CI [confidence interval [CI] 95%, 0.22-0.74), and discrepancies of ≥10 mm fell by 59% (RR 0.52; CI 95%, 0.32-0.84). CONCLUSIONS: We conclude that the use of an intraoperative measurement device can reduce the leg length discrepancy, with best results when using the trochanteric/joint ratio device.

[Chlorination and bacterial contamination. Hospitals with troubled waters]. / Cloración y contaminación bacteriana. Aguas turbulentas en los hospitales.

OBJECTIVE: To know the quality of the water from hospitals and the risks that poor chlorination implies. METHODS: We analyzed 90 water specimens from 15 hospitals (9 from the private and 6 from the public sector). Specimens were obtained from three areas (hospitalization ward, operating room, and kitchen) in two visits. RESULTS: By microbiologic analysis, we found 30 (33.3%) contaminated specimens. By chemical analysis, we found only 49 (54.5%) specimens with adequate chlorination (> or = 1 mg/L). Of the 30 contaminated specimens, only 7 (23.3%) had adequate chlorination. On the other hand, of the 60 specimens without contamination, 42 (79%) had adequate chlorination (chi2 = 17.561, p < 0.001). The significant difference was sustained when the criterion for appropriate chlorination was established at > or = 0.5 mg/L. CONCLUSIONS: Hospitals require guidelines for water chlorination and testing to maintain it at > or = 0.5 mg/L in every point of use.

Chlorhexidine avoids skin bacteria recolonization more than triclosan.

BACKGROUND: We do not know whether differences exist between the residual effect of 2% chlorhexidine in 70% isopropyl alcohol when compared with 1% triclosan in 70% isopropyl alcohol. METHODS: Using an analytic, longitudinal, controlled, and comparative experimental trial, with blinded measurements, we recruited healthy, adult volunteers from the University of Guanajuato who completed a stabilization phase of skin microbiota and had no history of skin allergies. Four 25-cm2 areas of the inner surface of the forearms were designated for study: unscrubbed control for establishing baseline bacterial counts, scrubbed control with tridistilled water, scrubbed with chlorhexidine, and scrubbed with triclosan. Quantitative cultures were taken of all the areas at 0, 3, and 24 hours, using agar plates with neutralizing agents. RESULTS: A total of 135 healthy volunteers were tested. At 24 hours, the unscrubbed control counts were 288 CFU/cm2, whereas the scrubbed control counts were 96 CFU/cm2; 24 CFU/cm2 for chlorhexidine and 96 CFU/cm2 for triclosan (Kruskal-Wallis χ2H = 64.27; P <.001). CONCLUSIONS: Chlorhexidine is the best antiseptic option when a prolonged antiseptic effect is needed; for instance, when implanting medical devices or performing surgical procedures.

Nosocomial bacteremia in neonates related to poor standards of care.

BACKGROUND: In developing countries, intravenous liquids are mixed and administered by nurses, sometimes under suboptimal infection control conditions. We hypothesized that outbreaks of infusate-associated neonatal bacteremias are common, and we evaluated whether they can be detected by vigilant microbiologic surveillance of infusates. METHODS: We studied intravenous infusates administered to neonates in a Mexican hospital where mixtures of infusates were prepared in hospital wards. The study was performed in 3 stages: stage 1, initial culturing of in-use infusates under basal conditions; stage 2, prospective culturing during a cluster of clinical sepsis; and stage 3, final culturing once the outbreak was controlled. RESULTS: In stage 1, 68 infusates were sterile, and 1 was contaminated with Staphylococcus aureus (1.45%), from 23 patients. In stage 2, of 182 infusates from 39 patients, 51 infusates (28%) were contaminated with Gram-negative rods. On the first day of stage 2, 11 of 15 infusates were contaminated with the same strain of Klebsiella pneumoniae, which continued to appear for 26 days. Another 4 strains of Gram-negative rods were also isolated during stage 2. The association between contaminated infusate and death was significant (odds ratio, 9.4; 95% confidence interval, 2-44.3; P < 0.001). Mixtures made by nurses were more likely contaminated than commercial preparations (odds ratio, 3.1; 95% confidence interval, 1.1-8.5; P = 0.037). In stage 3, there were 42 sterile infusates from 22 patients. CONCLUSIONS: Our study suggests that poor standards of care common in hospitals from developing countries sometimes result in outbreaks of sepsis and death for newborn patients.

Mandibular and temporomandibular morphologic characteristics of patients with suspected unilateral condylar hyperplasia: a CT study

ABSTRACT Introduction: Facial asymmetry associated with unilateral condylar hyperplasia (UCH) is a complicated clinical condition. Objective: The objective of this study was to describe morphological characteristics of the mandible and the temporomandibular joint in patients with facial asymmetry, using computed tomography and 3D reconstruction. Methods: A retrospective observational study was performed with patients displaying facial asymmetry evaluated by single photon emission computed tomography (SPECT)/CT analysis, for suspected UCH, between 2015 and 2018. The following variables were compared between the affected side (producing the asymmetry) and the contralateral side (side to where the jaw is deflected): condylar length, condylar medial and lateral pole length, mandibular ramus length, intra-articular spaces, articular eminence height and position of the posterior wall of the glenoid fossa. Results: Forty-three patients (21 women, mean age: 20.7 ± 7.25 years) with facial asymmetry were included, 19 patients presented right side deviation and 24 patients had left side deviation. Condylar length, lateral pole length, the sum of maximum values and articular eminence height were greater in the affected side (p< 0.05). A positive correlation was found between the position of the posterior wall of the glenoid fossa and the articular eminence height in the affected side (r = 0.442). Conclusions: In patients with suspected UCH, evaluated through CT, craniofacial measurements showed significantly larger condylar length and the condylar sum of maximum values in the affected side. A positive correlation was found between the increased dimensions of the articular eminence and the more posterior position of the glenoid fossa in the affected side.

RESUMO Introdução: A assimetria facial associada à hiperplasia condilar unilateral (HCU) é uma condição clínica complexa. Objetivo: O objetivo desse estudo foi descrever as características morfológicas da mandíbula e da articulação temporomandibular de pacientes com assimetria facial, usando tomografia computadorizada e reconstruções tridimensionais. Métodos: Esse estudo observacional retrospectivo foi realizado em pacientes com assimetria facial e suspeita de HCU, avaliados por meio da análise de tomografia computadorizada de emissão de fóton único (SPECT)/TC, entre os anos de 2015 e 2018. As seguintes variáveis foram comparadas entre o lado afetado (responsável pela assimetria) e o lado contralateral (lado para onde a arcada estava desviada): comprimento condilar, comprimento dos polos medial e lateral do côndilo, comprimento do ramo mandibular, espaços intra-articulares, altura da eminência articular e posição da parede posterior da fossa glenoide. Resultados: A amostra constituiu-se de 43 pacientes (21 mulheres, idade média: 20,7 ? 7,25 anos) com assimetria facial, da qual 19 pacientes apresentavam desvio do lado direito e 24, do lado esquerdo. O comprimento condilar, o comprimento do polo lateral, a soma dos valores máximos e a altura da eminência articular foram maiores no lado afetado (p< 0,05). Foi encontrada uma correlação positiva entre a posição da parede posterior da fossa glenoide e a altura da eminência articular no lado afetado (r = 0,442). Conclusão: Em pacientes com suspeita de HCU, avaliados por meio de TC, as medidas craniofaciais mostraram um comprimento condilar e a soma dos valores condilares máximos significativamente maiores no lado afetado. Foi encontrada uma correlação positiva entre as dimensões aumentadas da eminência articular e a posição mais posterior da fossa glenoide no lado afetado.

Nosocomial pediatric bacteremia: the role of intravenous set contamination in developing countries.

OBJECTIVE: To assess the rate of bacterial contamination of intravenous administration sets at their rubber injection ports and matching infusates. DESIGN: Cultures of injection ports and infusate during 26 visits to 4 hospitals. SETTING: Four public general pediatric hospitals in Mexico City with substandard care practices. PATIENTS: Hospitalized pediatric patients receiving intravenous solutions. RESULTS: Overall, 176 of 251 injection ports were contaminated (70.1%; 95% confidence interval [CI95], 64.5% to 75.8%), 35 (13.9%; CI95, 9.7% to 18.2%) with gram-negative rods, primarily of the tribe Klebsielleae. Cultures of infusates were positive in 17 cases (6.8%, CI95, 3.7% to 9.9%), 5 of which grew gram-negative rods (2%; CI95, 0.6% to 4.6%). In 3 cases (1.2%), the same species with gram-negative rods was found in the infusates and on the injection ports. During one visit, 8 clustered cases of injection port contamination with a clonal Enterobacter cloacae were found; this agent was also found in the blood culture, intravenous fluid, and parenteral nutrition of one patient. Inadequate chlorination of tap water, a potential risk factor, was recorded during 22 visits (84.6%). CONCLUSION: These data suggest that external contamination of the intravenous administration set could play a role in infusate contamination.

[Antibiotic-resistant fecal Escherichia coli in healthy children. Induced by the use of antibiotics?]. / Escherichia coli fecal resistente a antibióticos en niños sanos. Inducción por uso de antibióticos?

OBJECTIVE: To determine the rate of antibiotic resistance of fecal E. coli from healthy children and to infer if it is acquired environmentally or induced by antibiotic use. MATERIAL AND METHODS: Cross sectional study in children from schools and day care centers in Leon, Mexico. Prior antibiotic use (60 days) was questioned to the parents. A single fecal sample was cultured and an isolated colony suggestive of E. coli was submitted to biochemical identification and testing of disk susceptibility to 12 antibiotics. RESULTS: Four hundred fifty-six isolates were studied from children of 10 institutions, with ages ranging from 3 to 72 months (mean, 42.41). Use of antibiotics was referred in 242 children (53.07%). The antibiotics more commonly used were trimethoprim/sulfa, ampicillin, and penicillin (34, 20.5, and 18%). The highest rate of resistance was found for tetracycline, ampicillin, and trimethoprim/sulfa (64.4, 52.63, and 46.05%). The resistance to ciprofloxacin, amikacin, gentamicin, and ceftriaxone was less than 5%. Resistance to five or more antimicrobials was found in 93 isolates (20.39%); this rate was higher in isolates from children who received antibiotics (59/242, 24.38% vs. 34/214, 15.89%) (p = .025; OR 1.71, IC 95% 1.04-2.81). CONCLUSIONS: The study suggests that saprophyte bacteria acquires resistance through both, use of antibiotics and from the environment. These results support the concept that antimicrobial resistance must be considered as a public health problem.