Stream food webs in tropical mountains rely on allochthonous carbon regardless of land use.

The relative importance of allochthonous and autochthonous carbon (C) as sources of energy for tropical stream food webs remains an open question. Allochthonous C might be the main energy source for small and shaded forest streams, while autochthonous C is more likely to fuel food webs draining land uses with less dense vegetation. We studied food webs in cloud forest streams draining watersheds with forests, coffee plantations, and pastures. Our goal was to assess the effects of those land uses on the C source and structure of stream food webs. The study took place in tropical montane streams in La Antigua Watershed, in eastern Mexico. We selected three streams per land use and sampled biofilm and leaf litter as the main food resources, and macroinvertebrates and aquatic vertebrates from different trophic guilds. Samples were analyzed for δ13C and δ15N isotopes. Using a Bayesian mixing model, we estimated the proportional assimilation of autochthonous and allochthonous carbon by each guild. We found that consumers were mostly using allochthonous C in all streams, regardless of watershed land use. Our findings indicate that montane cloud forest streams are dominated by allochthony even in watersheds dominated by pastures. Abundant precipitation in this life zone might facilitate the movement of allochthonous C into streams. While food webs of streams from coffee plantations and pastures also rely on allochthonous resources, other impacts do result in important changes in stream functioning.

Associated factors, inequalities, and spatial distribution of the use of modern contraceptive methods among women of reproductive age in Peru: a population-based cross-sectional study.

BACKGROUND: The use of contraceptive methods in Peru has remarkably increased in recent decades. Nevertheless, despite the completeness and accessibility of family planning methods, modern contraceptive methods utilization in Peru remains below the South American average. Thus, this study aimed to elucidate the factors associated with modern contraceptive use, as well as the presence of inequalities and the spatial distribution in Peruvian women aged 15-49 years in 2019. METHODS: A secondary data analysis was conducted using information from the 2019 Peruvian Demographic and Health Survey. We performed descriptive statistics, bivariate analysis, and Poisson multiple regression. Inequalities were estimated through concentration curves and Erreygers' normalized concentration index. Spatial analysis included choropleth map, Global Moran's I, Kriging interpolation and Getis-Ord-Gi* statistic. RESULTS: The prevalence of modern contraceptive use was 39.3% among Peruvian women of reproductive age. Modern contraceptive use was directly associated with youth (aPR 1.39), women having their first sexual intercourse before the age of 18 (aPR 1.41), and being married but not together (aPR 1.87). In addition, speaking Quechua or Aymara (aPR 0.87) and having no children (aPR 0.59) were inversely associated with utilization of modern contraceptives. We found the presence of inequalities in the use of contraceptive methods (pro-rich distribution), although the magnitude was low. Spatial analysis unveiled the presence of a clustered distribution pattern (Moran's Index = 0,009); however, there was inter-departmental and intra-departmental heterogeneity in the predicted prevalence of the use of modern contraceptives. In addition, significant hot and cold spots were found in Peru. CONCLUSION: Two out of five Peruvian women of reproductive age used modern contraceptives. It was associated with younger women's age, younger age at first sexual intercourse, being married or cohabitant, among others. No substantial inequality was found in modern contraceptive use. The prevalence was heterogeneous at the intra- and inter-departmental level. Those departments located in the south, south-east, and north-east had the lowest prevalence. Therefore, nonfinancial barriers must be tackled through multi- and cross-sectoral efforts and continue to universally provide modern contraceptives.

Lateral extraarticular tenodesis improves stability in non-anatomic ACL reconstructed knees: in vivo kinematic analysis.

PURPOSE: To carry out an in vivo kinematic analysis to determine whether adding a lateral extraarticular tenodesis (LET) for those patients with subjective instability and objective residual laxity after a transtibial (TT) anterior cruciate ligament reconstruction (ACLR) reduces anteroposterior and rotational laxity and to evaluate the 2-year follow-up clinical outcomes to analyze whether biomechanical changes determine clinical improvement or not. METHODS: A total of 19 patients with residual knee instability after TT ACLR who underwent a modified Lemaire LET were prospectively evaluated for at least 2-year follow-up. Preoperative, intraoperative, and 6 and 24-month postoperative kinematic analyses were carried out using the KiRA accelerometer and KT1000 arthrometer to look for residual anterolateral rotational instability and residual anteroposterior instability. Functional outcomes were measured with the single-leg vertical jump test and the single-leg hop test. Clinical outcomes were evaluated using the IKDC 2000, Lysholm, and Tegner scores. RESULTS: A significant reduction in anterolateral rotational instability was detected with the patient under anesthesia (from 3 ± 1.2 to 1.1 ± 1.1 m/s2; p < 0.05) as well as with the patient awake (from 2.1 ± 0.8 to 0.7 ± 1.4 m/s2; p < 0.05). A significant reduction in anteroposterior instability was only present under anesthesia (from 3.4 ± 1.9 to 2.1 ± 1.1 mm; p < 0.05), while no difference was present without anesthesia (from 2.3 ± 1.1 to 1.6 ± 1 mm; n.s.). Postoperative analysis of knee laxity did not show any significant variation from the first to the last follow-up. Both the single-leg vertical jump test and single-leg hop test improved significantly at the last follow-up (both p < 0.05). The mean values of both the IKDC and Tegner scores showed an improvement (p < 0.05 and p < 0.05, respectively), whereas that was not the case with the Lysholm score (n.s.). CONCLUSIONS: The modified Lemaire LET can improve the kinematics of a non-anatomic ACL reconstructed knee with residual subjective and objective instability. These kinematic changes were able to lead to an improvement in subjective stability as well as the function of the knee in a small cohort of recreationally active patients. At 2-year follow-up, the kinematic changes as well as the level of activity of the patients and the IKDC score show their improvement sustained. LEVEL OF EVIDENCE: Level IV.

Falsas creencias sobre el consumo de tabaco. Mentiras peligrosas / False beliefs on use of tobacco. Dangerous lies

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Características antropométricas, fisiológicas y funcionales en jugadores profesionales de rugby seven / Anthropometric, physiological and functional characteristics in professional rugby seven players

El desarrollo de cualidades específicas en jugadores de rugby seven optimiza su desempeño. El objetivo de este trabajo es la caracterización de las cualidades antropométricas, fisiológicas y funcionales en jugadores profesionales de ese deporte mediante un estudio transversal en catorce seleccionados nacionales de rugby seven. Se rescataron datos demográficos, tácticos, antropométricos (índice de masa corporal (IMC) y composición corporal), fisiológicos (consumo de oxígeno ­VO2­) y funcionales (Running-based Anaerobic Sprint Test (RAST) y saltos verticales (Squat Jump (SJ) y Counter Movement Jump ­CMJ­).Se comparó a los atletas según posición de juego (forwards y backs) con prueba de Mann-Whitney y Fisher y se buscaron asociaciones entre variables demográficas y resultados funcionales con regresión lineal simple y ANOVA (significancia: p<0.05).La media de edad fue 23.5 años (22-29), y la del IMC 26.6 kg/m2 (23.4-33.3), mayor en forwards (p=0.005). El porcentaje de masa grasa corporal fue 17.5% (15.7-21.9), sin diferencias por posición.El VO2 fue mayor en backs (p=0.035). La prueba de saltabilidad no tuvo diferencias en potencia relativa (p=0.807), la potencia máxima mostró una tendencia mayor en forwards (p=0.086).Se evidenció que por cada año de edad la velocidad VO2 máxima disminuyó en 0.14 m/s (p=0.05). Por cada punto de IMC, la velocidad VO2 máxima disminuyó en 0.2 m/s (p=0.007), y el VO2 máximo disminuyó en 1.21 ml/kg/min (p=0.001).Consumir tabaco mostró una tendencia a aumentar en 4 w/kg el índice de fatiga (p=0.094), 21.4% eran fumadores.Una mayor edad e IMC se asocian con peor desempeño funcional en atletas de rugby seven. Los forwards presentaron mayor IMC y menor VO2.Tipo de estudio: Estudio transversal. Nivel de evidencia: III

Developing specific abilities in Rugby Seven players optimizes their game performance.Characterize anthropometric, physiological and functional qualities of Rugby Seven professional athletes.Cross-sectional study, fourteen rugby seven athletes of the national team were recruited. Demographic, tactical and anthropometric data (body mass index (BMI) and composition) were obtained. The following outcomes were evaluated: physiological parameters (oxygen consumption ­VO2­) and functional parameters (Running-based Anaerobic Sprint Test, vertical jumps (Single Squat Jump-Counter Movement Jump ­CMJ­).Athletes were grouped according to their game position (forwards and backs) for comparison (Mann-Whitney and Fisher's test).A simple linear regression and ANOVA were used to establish association between demographic variables and functional outcomes (significance: p<0.05; suggestion: p<0.1).Median age was 23.5 years (22-29), and median BMI was 26.6 kg/m2 (23.4-33.3), higher in forwards (p=0.005). KERR fat was 17.5% (15.7-21.9), without difference according to game position.Maximum oxygen consumption (VO2 max) was 54.8 ml/kg/min (48.2-61), higher in backs (p=0.035). Jumping tests showed no difference in the relative power (p=0.807), muscular peak power showed a tendency to be higher in forwards (p=0.086).For each year of age increased, the VO2 max speed decreased in 0.14 m/s (p=0.05). For each BMI point increased, the VO2 max speed decreased in 0.2 m/s (p=0.007), and the VO2 max decreased in 1.21 ml/kg/min (p=0.001). Smoking showed a tendency to increase the fatigue index in 4 w/kg (p=0.094); 21.4% were smokers.Older age and BMI are associated with poorer functional performance in these athletes. Forwards show higher percentage of BMI and lower VO2. Type of study: Cross-sectional study. Level of evidence: III

Miedo a volar: Componentes y formas de afrontamiento de un grupo de patagones que viven en aislamiento relativo / Fear of flying: Components and forms of coping with a group of Patagonians living in relative isolation

Resumen El presente estudio trata del temor a volar, las expectativas de peligro y las estrategias de afrontamiento que las personas dicen utilizar al momento de volar en avión. Un total de 287 participantes, habitantes de una zona aislada geográficamente, que utilizan habitualmente el avión, fueron medidos en las variables ya señaladas. El muestreo fue no probabilístico accidental y el diseño utilizado fue no experimental transversal correlacional. Los principales resultados indican que las personas dicen temer principalmente a situaciones que provocan en ellos la pérdida del control emocional aunque sus estrategias de afrontamiento más comunes suelen estar orientadas a la resolución de problemas. Estas estrategias, orientadas a recuperar simbólicamente el control psicológico, no apuntan al afrontamiento de las emociones. También se describen algunas diferencias en el uso de estas estrategias según género. Se discuten estos resultados en términos de su sincronía con los estudios previos y sus potenciales implicancias para los actuales programas terapéuticos de intervención de dicho problema.

Abstract This study is about the fear of flight, the danger expectations and the coping strategies that people say to use when flying on an airplane. A total of 287 participants, people from a graphically isolated zone that usually use planes, were measured according to the already mentioned variables. The sampling was not accidental probabilistic and the designed used was not experimental transversal correlational. The principal results indicate that people say to be afraid principally of situations that cause in them the loss of the emotional control, although, their most common coping strategies use to be oriented to affront anxiety. This strategy, aimed to regain the psychological control symbolically, does not point to the emotions coping. Also, some differences in the use of these strategies according to gender are described. These results are discussed regarding its timing with previous studies and their potential implications for current therapeutic intervention programs for this problem.

Oxygen saturation and lactate concentration gradient from the right atrium to the pulmonary artery in the immediate postoperative following cardiac surgery with extracorporeal circulation. / Gradiente de saturação de oxigênio e concentração de lactato entre átrio direito e artéria pulmonar no pós-operatório imediato de cirurgia cardíaca com circulação extracorpórea.

OBJECTIVE: This prospective study aimed to characterize the changes in blood lactate concentration and blood oxygen saturation in patients during the immediate postoperative period of cardiac surgery with extracorporeal circulation. METHODS: Blood samples were collected from 35 patients in a rapid and random order from the arterial line and from the proximal and distal port of a pulmonary artery catheter. RESULTS: The results showed no statistically significant differences between the blood oxygen saturation in the right atrium (72% ± 0.11%) and the blood oxygen saturation in the pulmonary artery (71% ± 0.08%). The blood lactate concentration in the right atrium was 1.7mmol/L ± 0.5mmol/L, and the blood lactate concentration in the pulmonary artery was 1.6mmol/L ± 0.5mmol/L (p < 0.0005). CONCLUSION: The difference between the blood lactate concentration in the right atrium and the blood lactate concentration in the pulmonary artery might be a consequence of the low blood lactate concentration in the blood from the coronary sinus, as it constitutes an important substrate for the myocardium during this period. The lack of differences between the blood oxygen saturation in the right atrium and the percentage of blood oxygen saturation in the pulmonary artery suggests a lower oxygen extraction by the myocardium given a lower oxygen consumption.

OBJETIVO: Caracterizar as modificações na concentração sanguínea do lactato e da saturação de oxigênio em pacientes no pós-operatório imediato de cirurgia cardíaca com circulação extracorpórea. MÉTODOS: Foram coletadas amostras de sangue de 35 pacientes, de forma rápida e aleatória, do acesso arterial e das portas proximal e distal de um cateter pulmonar. RESULTADOS: Não foram verificadas diferenças estatisticamente significantes entre saturação de oxigênio no átrio direito (72% ± 0,11%) e na artéria pulmonar (71% ± 0,08%). A concentração sanguínea de lactato no átrio direito foi de 1,7mmol/L ± 0,5mmol/L, enquanto na artéria pulmonar esta concentração foi de 1,6mmol/L ± 0,5mmol/L (p < 0,0005). CONCLUSÃO: A diferença entre as concentrações sanguíneas de lactato no átrio direito e na artéria pulmonar pode ser consequência da baixa concentração de lactato no sangue do seio coronário, já que o lactato é um importante substrato para o miocárdio durante este período. A ausência de diferenças entre saturação sanguínea de oxigênio no átrio direito e na artéria pulmonar sugere extração de oxigênio mais baixa pelo miocárdio, em razão do menor consumo de oxigênio.

Gradiente de saturação de oxigênio e concentração de lactato entre átrio direito e artéria pulmonar no pós-operatório imediato de cirurgia cardíaca com circulação extracorpórea / Oxygen saturation and lactate concentration gradient from the right atrium to the pulmonary artery in the immediate postoperative following cardiac surgery with extracorporeal circulation

RESUMO Objetivo: Caracterizar as modificações na concentração sanguínea do lactato e da saturação de oxigênio em pacientes no pós-operatório imediato de cirurgia cardíaca com circulação extracorpórea. Métodos: Foram coletadas amostras de sangue de 35 pacientes, de forma rápida e aleatória, do acesso arterial e das portas proximal e distal de um cateter pulmonar. Resultados: Não foram verificadas diferenças estatisticamente significantes entre saturação de oxigênio no átrio direito (72% ± 0,11%) e na artéria pulmonar (71% ± 0,08%). A concentração sanguínea de lactato no átrio direito foi de 1,7mmol/L ± 0,5mmol/L, enquanto na artéria pulmonar esta concentração foi de 1,6mmol/L ± 0,5mmol/L (p < 0,0005). Conclusão: A diferença entre as concentrações sanguíneas de lactato no átrio direito e na artéria pulmonar pode ser consequência da baixa concentração de lactato no sangue do seio coronário, já que o lactato é um importante substrato para o miocárdio durante este período. A ausência de diferenças entre saturação sanguínea de oxigênio no átrio direito e na artéria pulmonar sugere extração de oxigênio mais baixa pelo miocárdio, em razão do menor consumo de oxigênio.

ABSTRACT Objective: This prospective study aimed to characterize the changes in blood lactate concentration and blood oxygen saturation in patients during the immediate postoperative period of cardiac surgery with extracorporeal circulation. Methods: Blood samples were collected from 35 patients in a rapid and random order from the arterial line and from the proximal and distal port of a pulmonary artery catheter. Results: The results showed no statistically significant differences between the blood oxygen saturation in the right atrium (72% ± 0.11%) and the blood oxygen saturation in the pulmonary artery (71% ± 0.08%). The blood lactate concentration in the right atrium was 1.7mmol/L ± 0.5mmol/L, and the blood lactate concentration in the pulmonary artery was 1.6mmol/L ± 0.5mmol/L (p < 0.0005). Conclusion: The difference between the blood lactate concentration in the right atrium and the blood lactate concentration in the pulmonary artery might be a consequence of the low blood lactate concentration in the blood from the coronary sinus, as it constitutes an important substrate for the myocardium during this period. The lack of differences between the blood oxygen saturation in the right atrium and the percentage of blood oxygen saturation in the pulmonary artery suggests a lower oxygen extraction by the myocardium given a lower oxygen consumption.

Targeting local vascular and systemic consequences of inflammation on vascular and cardiac valve calcification.

INTRODUCTION: Cardiac valve calcification and vascular calcification (VC) are associated with cardiovascular mortality in the general population and in patients with chronic kidney disease (CKD). CKD, diabetes mellitus, and atherosclerosis are among the causes of systemic inflammation that are associated with VC. AREAS COVERED: This review collates clinical and experimental evidence that inflammation accelerates VC progression. Specifically, we review the actions of key pro-inflammatory cytokines and inflammation-related transcription factors on VC, and the role played by senescence. Inflammatory cytokines, such as the TNF superfamily and IL-6 superfamily, and inflammation-related transcription factor NF-κB promote calcification in cultured vascular smooth muscle cells, valvular interstitial cells, or experimental animal models through direct effects, but also indirectly by decreasing circulating Fetuin A or Klotho levels. EXPERT OPINION: Experimental evidence suggests a causal link between inflammation and VC that would change the clinical approach to prevention and treatment of VC. However, the molecular basis remains unclear and little is known about VC in humans treated with drugs targeting inflammatory cytokines. The effect of biologicals targeting TNF-α, RANKL, IL-6, and other inflammatory mediators on VC, in addition to the impact of dietary phosphate in patients with chronic systemic inflammation, requires study.

Analysis of pelagic species decline in the upper San Francisco Estuary using multivariate autoregressive modeling (MAR).

Four species of pelagic fish of particular management concern in the upper San Francisco Estuary, California, USA, have declined precipitously since ca. 2002: delta smelt (Hypomesus transpacificus), longfin smelt (Spirinchus thaleichthys), striped bass (Morone saxatilis), and threadfin shad (Dorosoma petenense). The estuary has been monitored since the late 1960s with extensive collection of data on the fishes, their pelagic prey, phytoplankton biomass, invasive species, and physical factors. We used multivariate autoregressive (MAR) modeling to discern the main factors responsible for the declines. An expert-elicited model was built to describe the system. Fifty-four relationships were built into the model, only one of which was of uncertain direction a priori. Twenty-eight of the proposed relationships were strongly supported by or consistent with the data, while 26 were close to zero (not supported by the data but not contrary to expectations). The position of the 2 per thousand isohaline (a measure of the physical response of the estuary to freshwater flow) and increased water clarity over the period of analyses were two factors affecting multiple declining taxa (including fishes and the fishes' main zooplankton prey): Our results were relatively robust with respect to the form of stock-recruitment model used and to inclusion of subsidiary covariates but may be enhanced by using detailed state-space models that describe more fully the life-history dynamics of the declining species.

Solitary osteochondroma long-term follow-up.

A series of 113 osteochondromas were treated in our institution with a long-term follow-up. A retrospective study of the cases of solitary osteochondroma diagnosed and treated in our center from 1970 to 2002 was done. A diagnosis for clinical findings in 73% of the patients was made. The most frequent location was the distal femur. Six patients had a recurrence and in two patients the lesions became malignant and chondrosarcoma developed. Relapse of the exostosis is rare, occurring in an estimated 2% of the resections. The growth of an osteochondroma and/or the presence of pain in older patients suggest possible malignancy.

[Flouroquinolone activity in clinical isolates of Streptococcus pneumoniae with different susceptibility to penicilline: an epidemiological study in five cities of Mexico]. / Actividad de las fluoroquinolonas en aislamientos clínicos de Streptococcus pneumoniae con diferente susceptibilidad a la penicilina: estudio epidemiológico en cinco ciudades de la República Mexicana.

OBJECTIVE: Determine the susceptibility to five fluoroquinolones and cross-resistance of pneumococcusclinical isolates with different penicillin susceptibilities gathered in a community-based study. DESIGN: Cross-sectional survey. MATERIALS: Two hundred and thirty one (231) isolates were obtained from respiratory secretions or blood specimens from 231 patients with acquired acute respiratory infection or bacteremia. OUTCOME MEASURES: In vitro susceptibility to penicillin (PEN), ciprofloxacin (CIP), levofloxacin (LEV), gatifioxacin (GAT), moxifloxacin (MOX) and gemifioxacin (GEM) was determined with minimal inhibitory concentration (MIC) using the E test. RESULTS: 42% of the isolates showed decreased susceptibility to PEN. The lowest antibiotic concentration that inhibited 90% of the isolates was 3 microg/ml (for CIP), 1 microg/ml (for LEV), 0.25 microg/ml (for GAT), 0.125 microg/ml (for MOX) and 0.032 microg/ml (for GEM). Median MIC for LEV, GAT, MOX and GEM increased with decreasing susceptibility to CIP. Susceptibility to CIP was similar between penicillin-susceptible and penicillin-resistant pneumococci. CONCLUSION: Third and fourth generation fluoroquinolones showed very high inhibitory activity, higher than that for CIP, for both penicillin-susceptible and penicillin-resistant pneumococci. We noted cross-resistance among fluoroquinolones.

Actividad de las fluoroquinolonas en aislamientos clínicos de Streptococcus pneumoniae con diferente susceptibilidad a la penicilina: Estudio epidemiológico en cinco ciudades de la República Mexicana / Flouroquinolone activity in clinical isolates of Streptococcus pneumoniae with different susceptibility to penicilline: An epidemiological study in five cities of Mexico

Objetivo: Determinar el grado de sensibilidad a cinco fluoroquinolonas, y la resistencia cruzada, en aislados clínicos de neumococo con diferente susceptibilidad a la penicilina Diseño: Estudio transversal Lugar: Los aislamientos de Streptococcus pneumoniae (Sp) se obtuvieron en cinco centros de atención médica y en un laboratorio de referencia de cinco ciudades de la República Mexicana, durante febrero de 1999 a mayo del 2000. Material: 231 aislamientos de Sp obtenidos de muestras de secreción de la vía aérea o sangre, de 231 pacientes con infección respiratoria aguda o bacteriemia adquiridas en la comunidad. Mediciones: Se midió la susceptibilidad in vitro a penicilina (PEN), ciprofloxacina (CIP), levofloxacina (LEV), gatifloxacina (GAT), moxifloxacina (MOX) y gemifloxacina (GEM) mediante la determinación de la concentración mínima inhibitoria (CMI) con la prueba E. Resultados: 42% de los aislamientos mostraron susceptibilidad disminuida a la PEN. La mínima concentración del antibiótico que logró inhibir al 90% de los aislamientos fue de 3 µg/ml (para la CIP), 1 Hg/ml (para la LEV), 0.25ng/ml (para la GAT), 0.125 µg/ml (para la MOX) y 0.032 µg/ml (para la GEM). La mediana de la CMI para la LEV (GAT, MOX y GEM) se incrementó proporcionalmente a la disminución de la sensibilidad del neumococo a la CIP. La susceptibilidad a la CIP fue semejante entre los aislamientos sensibles y resistentes a la PEN. Conclusión: las fluoroquinolonas de tercera y cuarta generación mostraron tener buena actividad inhibitoria del neumococo, incluyendo a las cepas resistentes a la PEN, siendo mayor que la de CIP. Se documentó resistencia cruzada entre las fluoroquinolonas.

Objective: Determine the susceptibility to five fluoroquinolones and cross resistance of pneumococcus clinical isolates with different penicillin susceptibilities gathered in a community based study . Design: Cross sectional survey. Materials: Two hundred and thirty one (231) isolates were obtained from respiratory secretions or blood specimensfrom 231 patients with acquired acute respiratory infection or bacteremia. Outcome measures: In vitro susceptibility to penicillin (PEN), ciprofloxacin (CIP), levofloxacin (LEV), gatifloxacin (GAT), moxifloxacin (MOX) and gemifloxacin (GEM) was determined with minimal inhibitory concentration (MIC) using the E test. Results: 42% of the isolates showed decreased susceptibility to PEN. The lowest antibiotic concentration that inhibited 90% of the isolates was 3 Hg/ml (for CIP), 1 µg/ml (forLEV), 0.25 µg/ml (for GAT), 0.125 µg/ml (for MOX) and 0.032 µg/ml (for GEM). Median MIC for LEV, GAT, MOX and GEM increased with decreasing susceptibility to CIP. Susceptibility to CIP was similar between penicillin susceptible and penicillin resistant pneumococci. Conclusion: Third and fourth generation fluoroquinolones showed very high inhibitory activity, higher than that for CIP, for both penicillin susceptible and penicillin resistant pneumococci. We noted cross resistance among fluoroquinolones.