Detection of OXA-181 Carbapenemase in Shigella flexneri.

We report the detection of OXA-181 carbapenemase in an azithromycin-resistant Shigella spp. bacteria in an immunocompromised patient. The emergence of OXA-181 in Shigella spp. bacteria raises concerns about the global dissemination of carbapenem resistance in Enterobacterales and its implications for the treatment of infections caused by Shigella bacteria.

Japanese scoring systems to predict resistance to intravenous immunoglobulin in Kawasaki disease were unreliable for Caucasian Israeli children.

AIM: This study assessed the validity of using established Japanese risk scoring methods to predict intravenous immunoglobulin (IVIG) resistance to Kawasaki disease in Israeli children. METHODS: We reviewed the medical records of 282 patients (70% male) with Kawasaki disease from six Israeli medical centres between 2004 and 2013. Their mean age was 2.5 years. The risk scores were calculated using the Kobayashi, Sano and Egami scoring methods and analysed to determine whether a higher risk score predicted IVIG resistance in this population. Factors that predicted a lack of response to the initial IVIG dose were identified. RESULTS: We found that 18% did not respond to the first IVIG dose. The three scoring methods were unable to reliably predict IVIG resistance, with sensitivities of 23%-32% and specificities of 67%-87%. Calculating a predictive score that was specific for this population was also unsuccessful. The factors that predicted a lacked of response to the first IVIG dose included low albumin, elevated total bilirubin and ethnicity. CONCLUSION: The established risk scoring methods created for Japanese populations with Kawasaki disease were not suitable for predicting IVIG resistance in Caucasian Israeli children, and we were unable to create a specific scoring method that was able to do this.

Virtual reality for pain and anxiety management in children.

Question Pain and anxiety are common in children who need procedures such as administering vaccines or drawing blood. Recent reports have described the use of virtual reality (VR) as a method of distraction during such procedures. How does VR work in reducing pain and anxiety in pediatric patients and what are the potential uses for it? Answer Recent studies explored using VR with pediatric patients undergoing procedures ranging from vaccinations and intravenous injections to laceration repair and dressing changes for burn wounds. Interacting with immersive VR might divert attention, leading to a slower response to incoming pain signals. Preliminary results have shown that VR is effective, either alone or in combination with standard care, in reducing the pain and anxiety patients experience compared with standard care or other distraction methods.

La réalité virtuelle pour la prise en charge de la douleur et de l'anxiété chez l'enfant.

Question La douleur et l'anxiété sont courantes chez les enfants qui doivent subir une intervention comme l'administration d'un vaccin ou un prélèvement sanguin. De récents rapports ont décrit le recours à la réalité virtuelle comme méthode de distraction durant de telles interventions. Comment la réalité virtuelle fonctionne-t-elle pour réduire la douleur et l'anxiété chez les patients pédiatriques et quelles sont ses utilisations potentielles? Réponse De récentes études se sont penchées sur l'utilisation de la réalité virtuelle chez des patients pédiatriques devant subir des interventions comme des vaccins, des injections intraveineuses, ou encore la réparation de lacérations ou le changement de pansements recouvrant des brûlures. L'interaction avec une réalité virtuelle immersive peut détourner l'attention, ce qui provoque une réaction plus lente aux signaux de douleur émergents. Des résultats préliminaires ont fait valoir que la réalité virtuelle était efficace, à elle seule ou combinée avec les soins habituels, pour réduire la douleur et l'anxiété que ressentent les patients, par rapport aux soins standards ou aux autres méthodes de distraction.

p-NO2-Bn-H4neunpa and H4neunpa-Trastuzumab: Bifunctional Chelator for Radiometalpharmaceuticals and 111In Immuno-Single Photon Emission Computed Tomography Imaging.

Potentially nonadentate (N5O4) bifunctional chelator p-SCN-Bn-H4neunpa and its immunoconjugate H4neunpa-trastuzumab for 111In radiolabeling are synthesized. The ability of p-SCN-Bn-H4neunpa and H4neunpa-trastuzumab to quantitatively radiolabel 111InCl3 at an ambient temperature within 15 or 30 min, respectively, is presented. Thermodynamic stability determination with In3+, Bi3+, and La3+ resulted in high conditional stability constant (pM) values. In vitro human serum stability assays have demonstrated both 111In complexes to have high stability over 5 days. Mouse biodistribution of [111In][In(p-NO2-Bn-neunpa)]-, compared to that of [111In][In(p-NH2-Bn-CHX-A″-diethylenetriamine pentaacetic acid (DTPA))]2-, at 1, 4, and 24 h shows fast clearance of both complexes from the mice within 24 h. In a second mouse biodistribution study, the immunoconjugates 111In-neunpa-trastuzumab and 111In-CHX-A″-DTPA-trastuzumab demonstrate a similar distribution profile but with slightly lower tumor uptake of 111In-neunpa-trastuzumab compared to that of 111In-CHX-A″-DTPA-trastuzumab. These results were also confirmed by immuno-single photon emission computed tomography (immuno-SPECT) imaging in vivo. These initial investigations reveal the acyclic bifunctional chelator p-SCN-Bn-H4neunpa to be a promising chelator for 111In (and other radiometals) with high in vitro stability and also show H4neunpa-trastuzumab to be an excellent 111In chelator with promising biodistribution in mice.

Brief resolved unexplained event: New diagnosis in infants.

QUESTION: For many years, the term apparent life-threatening event (ALTE) was associated with sudden infant death syndrome, and parents who described an acute event in their infants were sent to the hospital for admission. I understand that for infants new terminology is recommended. What is the current approach to a near-death experience of an infant? ANSWER: A recent clinical practice guideline revised the name and definition of an ALTE to a brief resolved unexplained event (BRUE). The diagnosis of BRUE in infants younger than 1 year of age is made when infants experience 1 of the following BRUE symptoms: a brief episode (ie, less than 1 minute and usually less than 20 to 30 seconds) that is entirely resolved (infant is at baseline), which remains unexplained after the history and physical examination are completed, and includes an event characterized by cyanosis or pallor; absent, decreased, or irregular breathing; hypertonia or hypotonia; or altered responsiveness. Low-risk infants should not be admitted to the hospital and overtesting is discouraged.

Bref incident résolu inexpliqué: Nouveau diagnostic chez les nourrissons.

QUESTION: Pendant de nombreuses années, l'acronyme ALTE (apparent life-threatening event ou malaise grave du nourrisson) était associé au syndrome de mort subite du nourrisson. Les parents qui décrivaient un malaise aigu chez leur nourrisson étaient envoyés à l'hôpital pour le faire admettre. J'ai appris qu'une nouvelle terminologie est recommandée pour les nourrissons. Quelle est l'approche actuelle pour une expérience proche de la mort chez un nourrisson? RÉPONSE: Dans un guide de pratique clinique récent, on a révisé le nom d'un ALTE pour le remplacer par BRUE (brief resolved unexplained event ou bref incident résolu inexpliqué), de même que sa définition. Un diagnostic de BRUE chez les nourrissons de moins de 1 an est posé lorsque l'enfant présente 1 des symptômes suivants du BRUE : un bref épisode (c.-à-d. moins de 1 minute et habituellement de 20 à 30 secondes) qui s'est complètement réglé (l'état du nourrisson est revenu à la normale), qui demeure inexpliqué après l'anamnèse et l'examen physique, et peut comporter un incident caractérisé par une cyanose ou une pâleur; une respiration absente, diminuée ou irrégulière; une hypertonie ou une hypotonie; ou une réceptivité altérée. Les nourrissons à faible risque ne devraient pas être hospitalisés et les tests excessifs sont découragés.

Fusobacterium infections in children.

QUESTION: A 2-year-old patient in my practice with acute otitis media that has progressed to mastoiditis with a high fever returns with positive culture results for Fusobacterium What should I do next? ANSWER: Fusobacterium is a genus of anaerobic bacteria. Although Fusobacterium infections are rare, they can become severe if not treated promptly. Appropriate treatment is combination antibiotic therapy consisting of a ß-lactam (penicillin, cephalosporin) and an anaerobic antimicrobial agent (metronidazole, clindamycin). At times surgical involvement is required for mastoiditis such as drainage of abscesses or insertion of a ventilation tube. Delayed treatment of an infection caused by Fusobacterium can lead to serious complications, including Lemierre syndrome. Children should be seen in a hospital for close monitoring.

Electronic cigarettes and adolescents.

Question I see in my office an increased number of adolescents who use electronic cigarettes (e-cigarettes). Should I encourage adolescents to choose e-cigarettes over regular cigarettes if they decide to smoke? Are e-cigarettes less harmful and a potential smoking cessation method for adolescents? Answer While e-cigarettes do not have carcinogenic tobacco, most contain nicotine, which not only leads to addiction, but can also impair brain development and cognitive function in youth. Recent studies have also shown that adolescents who use e-cigarettes are more likely to begin smoking tobacco cigarettes. It is therefore essential that physicians explain to adolescents the risks and health concerns e-cigarettes present, and implement measures to prevent or cease e-cigarette use.

Muscle cells challenged with saturated fatty acids mount an autonomous inflammatory response that activates macrophages.

Obesity is associated with chronic low-grade inflammation. Within adipose tissue of mice fed a high fat diet, resident and infiltrating macrophages assume a pro-inflammatory phenotype characterized by the production of cytokines which in turn impact on the surrounding tissue. However, inflammation is not restricted to adipose tissue and high fat-feeding is responsible for a significant increase in pro-inflammatory cytokine expression in muscle. Although skeletal muscle is the major disposer of dietary glucose and a major determinant of glycemia, the origin and consequence of muscle inflammation in the development of insulin resistance are poorly understood.We used a cell culture approach to investigate the vectorial crosstalk between muscle cells and macrophages upon exposure to physiological, low levels of saturated and unsaturated fatty acids. Inflammatory pathway activation and cytokine expression were analyzed in L6 muscle cells expressing myc-tagged GLUT4 (L6GLUT4myc) exposed to 0.2 mM palmitate or palmitoleate. Conditioned media thereof, free of fatty acids, were then tested for their ability to activate RAW264.7 macrophages.Palmitate -but not palmitoleate- induced IL-6, TNFα and CCL2 expression in muscle cells, through activation of the NF-κB pathway. Palmitate (0.2 mM) alone did not induce insulin resistance in muscle cells, yet conditioned media from palmitate-challenged muscle cells selectively activated macrophages towards a pro-inflammatory phenotype.These results demonstrate that low concentrations of palmitate activate autonomous inflammation in muscle cells to release factors that turn macrophages pro-inflammatory. We hypothesize that saturated fat-induced, low-grade muscle cell inflammation may trigger resident skeletal muscle macrophage polarization, possibly contributing to insulin resistance in vivo.