Reducing Antibiotic Duration for Uncomplicated UTI in the Pediatric Emergency Department.

BACKGROUND: Short-duration (3-5 days) antibiotic treatment of uncomplicated urinary tract infection (uUTI) in children >24 months of age is equivalent to longer-duration antibiotic treatment, with added benefits of antibiotic stewardship. At our pediatric emergency department (ED), 13% of 5- to 18-year-old patients discharged with uUTI received ≤5 days of antibiotics. We aimed to increase short-duration prescriptions in patients with uUTI from 13% to >50% over 12 months. METHODS: This quality improvement project was conducted from January 2021 to August 2022. Complicated UTI was excluded. Interventions included education, practice feedback, and electronic health record changes. The outcome measure, the proportion of children treated with a short antibiotic duration, was studied by using p-charts. Antibiotic days saved were calculated. Revisits with UTI within 14 days of confirmed uUTI treated with short-duration antibiotics (balancing measure) were analyzed by using Fisher's exact test. RESULTS: In 1292 (n = 363 baseline, 929 post-intervention) eligible patients treated for uUTI, shorter antibiotic duration increased from 13% to 91%. We met our 50% aim within 2 months, with continued improvement leading to an additional centerline shift. Consequently, 2619 antibiotic days were saved. Two of 334 (0.6%) patients returned (P = NS) within 14 days of the index visit with a culture-positive uUTI. CONCLUSIONS: By using education, feedback, and electronic health record changes, we decreased antibiotic duration in children discharged from the ED for uUTI without a significant increase in return visits with UTI. These interventions can be expanded to wider age groups and other outpatient settings.

Global Tonga tsunami explained by a fast-moving atmospheric source.

Volcanoes can produce tsunamis by means of earthquakes, caldera and flank collapses, pyroclastic flows or underwater explosions1-4. These mechanisms rarely displace enough water to trigger transoceanic tsunamis. Violent volcanic explosions, however, can cause global tsunamis1,5 by triggering acoustic-gravity waves6-8 that excite the atmosphere-ocean interface. The colossal eruption of the Hunga Tonga-Hunga Ha'apai volcano and ensuing tsunami is the first global volcano-triggered tsunami recorded by modern, worldwide dense instrumentation, thus providing a unique opportunity to investigate the role of air-water-coupling processes in tsunami generation and propagation. Here we use sea-level, atmospheric and satellite data from across the globe, along with numerical and analytical models, to demonstrate that this tsunami was driven by a constantly moving source in which the acoustic-gravity waves radiating from the eruption excite the ocean and transfer energy into it by means of resonance. A direct correlation between the tsunami and the acoustic-gravity waves' arrival times confirms that these phenomena are closely linked. Our models also show that the unusually fast travel times and long duration of the tsunami, as well as its global reach, are consistent with an air-water-coupled source. This coupling mechanism has clear hazard implications, as it leads to higher waves along land masses that rise abruptly from long stretches of deep ocean waters.

Molecular phylogenetic relationships reveal contrasting evolutionary patterns in Gorgoniidae (Octocorallia) in the Eastern Pacific.

The description and delimitation of species in an evolutionary framework is essential for understanding patterns of biodiversity and distribution, and in the assessment of conservation strategies for natural resources. This study seeks to clarify the evolutionary history and genetic variation within and between closely related octocoral species that are fundamental to benthic marine ecosystems for harbouring a high diversity of associated fauna. For our study system, we focused on members of the Gorgoniidae family in the Eastern Pacific, particularly of the Ecuadorian littoral, a less studied marine ecosystem. According to our results, the diagnosis of the genus Pacifigorgia is here amended to include species previously considered in the genus Leptogorgia. The genera Leptogorgia and Eugorgia are included within a single clade, and neither are recovered as monophyletic. In this case, according to the priority rule of the International Code of Zoological Nomenclature (ICZN), our proposal is to include the species considered in these two genera in Leptogorgia. In addition, we found evidence of interesting speciation patterns: morphological differentiation with no apparent genetic differentiation (in Pacifigorgia), and inconsistencies between mitochondrial and nuclear data that suggest a hybridisation phenomenon (in Leptogorgia). In the first case, recent radiation, ancient hybridisation, sympatric speciation, and in the second, reticulate evolution may have contributed to the evolutionary history of the studied taxa. Therefore, incongruences observed between morphological and molecular evidences in these octocorals, and in corals in general, may reveal the types of events/patterns that have influenced their evolution.

Note: development of ESS Bilbao's proton ion source: Ion Source Hydrogen positive.

The Ion Source Hydrogen positive is a 2.7 GHz off-resonance microwave discharge ion source. It uses four coils to generate an axial magnetic field in the plasma chamber around 0.1 T that exceeds the ECR resonance field. A new magnetic system was designed as a combination of the four coils and soft iron in order to increase the reliability of the source. The description of the simulations of the magnetic field and the comparison with the magnetic measurements are presented. Moreover, results of the initial commissioning of the source for extraction voltage until 50 kV will be reported.

Computerised vaccination register for the Murcia region, Spain, 1991 to 2011.

We describe the Murcia regional vaccination register in Spain, which was set up in 1991, detailing its main features, advantages and limitations. We also report on some recent special actions carried out that led to an improvement in vaccination coverage against measles, rubella and mumps (MMR): by using the vaccination register, we were able to identify and vaccinate persons aged under 20 years in a measles outbreak in 2010 in the town of Jumilla who were not adequately vaccinated for their age with MMR vaccine. From spring 2012, use of our register will enable us to identify susceptible individuals in our region under 40 years of age who have received fewer than two doses of MMR vaccine and call them for the appropriate vaccination. We also set out our experience in the use of barcodes to identify individuals and collect vaccine data: our data show that the barcodes help to improve data quality and completeness. Finally, we identify certain challenges in search of greater standardisation for systems and encoding that is necessary to enable an easy exchange of data between different registers.

[Plain-film radiography in the study of spinal pain]. / La radiografía simple en el estudio del dolor de la columna vertebral.

The introduction of tomographic imaging techniques, fundamentally computed tomography and magnetic resonance imaging, has led to a gradual decrease in the indications for plain-film radiography, resulting in fewer patients studied and fewer projections for each patient. Consequently, plain-film studies of the spine have received less attention and radiologists are less familiar with the typical findings in normal and pathologic conditions of the spine. Nevertheless, plain-film radiography continues to be widely used in both primary and specialized care. Thus, radiologists still need to be aware of the normal radiologic anatomy of the spine and of the radiologic manifestations of the diverse pathological processes that can affect the spinal column and that can cause pain. The aim of this article is to review the manifestations on plain-film radiography of a wide variety of diseases that can cause back pain, including congenital, traumatic, degenerative, tumor-related, inflammatory, and infectious diseases and processes.

The effect of the sixth sulfur ligand in the catalytic mechanism of periplasmic nitrate reductase.

The catalytic mechanism of nitrate reduction by periplasmic nitrate reductases has been investigated using theoretical and computational means. We have found that the nitrate molecule binds to the active site with the Mo ion in the +6 oxidation state. Electron transfer to the active site occurs only in the proton-electron transfer stage, where the Mo(V) species plays an important role in catalysis. The presence of the sulfur atom in the molybdenum coordination sphere creates a pseudo-dithiolene ligand that protects it from any direct attack from the solvent. Upon the nitrate binding there is a conformational rearrangement of this ring that allows the direct contact of the nitrate with Mo(VI) ion. This rearrangement is stabilized by the conserved methionines Met141 and Met308. The reduction of nitrate into nitrite occurs in the second step of the mechanism where the two dimethyl-dithiolene ligands have a key role in spreading the excess of negative charge near the Mo atom to make it available for the chemical reaction. The reaction involves the oxidation of the sulfur atoms and not of the molybdenum as previously suggested. The mechanism involves a molybdenum and sulfur-based redox chemistry instead of the currently accepted redox chemistry based only on the Mo ion. The second part of the mechanism involves two protonation steps that are promoted by the presence of Mo(V) species. Mo(VI) intermediates might also be present in this stage depending on the availability of protons and electrons. Once the water molecule is generated only the Mo(VI) species allow water molecule dissociation, and, the concomitant enzymatic turnover.

Estudio clínico para evaluar el efecto de dos cremas humectantes con protector solar en la piel de pacientes que utilizan tretinoína0, 025% para el tratamiento del fotodaño / Clinical study to evaluate the effect of two facial moisturizer test products

Introducción: La exposición a la radiación ultravioleta (RUV) produce un deterioro en la piel denominado fotodaño, que puede mejorarse con la aplicaciónde tretinoína. Este tratamiento, sin embargo, puede causar efectos colaterales.El objetivo es comparar las diferencias en la eficacia, tolerancia y preferencias al utilizar tretinoína al 0,025%, junto con dos productos hidratantes diferentes.Materiales y métodos: Estudio abierto, prospectivo, doble ciego, randomizado. Cincuenta y siete mujeres de 35 a 55 años, con daño solar, se aplicaronen el período de pre-condicionamiento, una crema humectante en cada hemicara: una con niacinamida y otra sólo con componentes hidratantes.Luego, se agregó tretinoína tópica al 0,025%. Se evaluó fotodaño, tolerancia y preferencias.Resultados: En el período de precondicionamiento no se hallaron diferencias significativas en la tolerancia. La pérdida trans epidérmica de agua(PTEA) fue significativamente peor para el humectante B. La textura de la piel mejoró significativamente para ambos humectantes. En el período detratamiento la tolerancia disminuyó más para el humectante B en las semanas 2 y 4, mejorando al final del estudio. Los parámetros relacionados confoto daño mejoraron, más para el humectante A.La PTEA aumentó en las semanas 2 y 4, más para el humectante B; para luego disminuir.Comentario: La tretinoína tópica es bien tolerada, cuando se la utiliza en combinación con cremas humectantes. La niacinamida agrega beneficios ala acción hidratante de un producto, ya que cumple un rol en la prevención de efectos adversos y en la potenciación de los efectos beneficiosos delretinoide (AU)

Introduction: Ultraviolet radiation exposure cause a deleterious effect in the skin called photodamage. Tretinoin application can improve this damage,however it can also cause adverse effects. The objective of this paper is to compare the differences in tolerance and patient preference when usingtretinoin 0.025% along with two different moisturizers.Material and methods: It was and open, prospective, randomized, double blinded study. Fifty sevenwomen, 35 to 55 year old with photodamagedskin, applied during a preconditioning period a different moisturizer in each side of the face. One of them contained niacinamide and the other onlyhydrating components. After 15 days topical tretinoin 0,025% was added. Efficacy, tolerance and preferences were evaluated.Results: We didn’t find significative differences in tolerance during the preconditioning period. Transepidermal water loss (TEWL) was significativelyworse for moisturizer B. Skin texture improved for both used products. During the treatment period, tolerance was worse for moisturizer B in weeks 2 and 4. There was a more important improvement in photodamage related items for moisturizer A. TEWL were high for both products in weeks 2 and4, diminishing afterwards. This elevation was higher for moisturizer B.Comment: topical tretinoin is well tolerated when used in combination with moisturizer creams. Niacinamide adds benefits because it helps preventingadverse events and promote desirable anti age effects of the retinoid (AU)

Bacterial nitrate reductases: Molecular and biological aspects of nitrate reduction.

Nitrogen is a vital component in living organisms as it participates in the making of essential biomolecules such as proteins, nucleic acids, etc. In the biosphere, nitrogen cycles between the oxidation states +V and -III producing many species that constitute the biogeochemical cycle of nitrogen. All reductive branches of this cycle involve the conversion of nitrate to nitrite, which is catalyzed by the enzyme nitrate reductase. The characterization of nitrate reductases from prokaryotic organisms has allowed us to gain considerable information on the molecular basis of nitrate reduction. Prokaryotic nitrate reductases are mononuclear Mo-containing enzymes sub-grouped as respiratory nitrate reductases, periplasmic nitrate reductases and assimilatory nitrate reductases. We review here the biological and molecular properties of these three enzymes along with their gene organization and expression, which are necessary to understand the biological processes involved in nitrate reduction.

[Study of the sentinel node in breast cancer using lymphoscintigraphy and a fast method for cytokeratin]. / Estudio del ganglio centinela en el cáncer de mama mediante linfogammagrafía y citoqueratina por congelación.

INTRODUCTION: Histopathological examination of the axillary sentinel node (SN) is becoming a routine procedure in the surgical phase of infiltrating ductal carcinoma of the breast (IDC). The SN exam may yield false negative cases mainly due to identification failure of the SN but some of the false negative cases may be the result of the pathological examination procedure applied. MATERIAL AND METHODS: Sixty two (62) cases of clinically staged N0 IDC of the breast by TNM nomenclature were assigned to breast surgery along with conventional axillary node dissection. The identification technique included lymphoscintigraphy and intraoperative gamma-detecting probe after peritumoral injection of 99mTc-labeled colloids.The histological study of SN was performed with paired 4 microm slices and staining with hematoxylin-eosin and with a fast method of cytokeratins for freezing. RESULTS: In only two of the 62 patients, it was not possible to identify the SN. Eighteen of the remaining 60 had SN involvement by metastasis, having no metastases in the other nodes of the axillary dissection in 6 of them. Ten of those were micrometastasis (size of metastasis= or <0.2 cm). In two out of these last 10 cases, diagnosis of the micrometastasis was only possible using slices stained with CK. There were no false negative results. CONCLUSIONS: The lymphoscintigraphy, after peritumoral injection of small volumes and low dose of the tracer, makes it possible to obtain excellent results in the intraoperative detection of the SN in breast cancer. The study of this SN with a fast method for CK decreases the number of false negative results of the technique.

Estudio del ganglio centinela en el cáncer de mama mediante linfogammagrafía y citoqueratina por congelación / Study of the sentinel node in breast cancer using lymphoscintigraphy and a fast method for cytokeratin

Introducción: El estudio histológico del ganglio centinela axilar (GC) está estableciéndose como un procedimiento habitual en la cirugía del carcinoma infiltrante de mama. Los falsos negativos descritos son imputables tanto a la identificación del verdadero ganglio centinela como al protocolo aplicado para el estudio de dicho ganglio. Material y métodos: Estudiamos 62 enfermas de carcinoma infiltrante de mama, clínicamente N0 (TNM), subsidiarias de exéresis tumoral y vaciamiento axilar. En todas se practicó linfogammagrafía y detección intraoperatoria tras la administración peritumoral de 99mTc-nanocoloide de albúmina. El estudio histológico del GC se efectuó realizando pares de cortes de 4 y tinción mediante hematoxilina-eosina (H/E) y técnica rápida de citoqueratinas (CK) por congelación. Resultados: Del total de 62 enfermas, en dos no fue posible detectar el GC. De las 60 restantes, 18 presentaban metástasis en el GC, sin observarse afectación de otros ganglios en 6 de ellas. Diez de estas enfermas mostraron la presencia de micrometástasis exclusivamente (depósito tumoral 2 mm).En dos de estos diez últimos casos, el diagnóstico de las micrometástasis sólo fue posible a partir de los cortes teñidos con CK. No se obtuvo ningún resultado falso negativo. Conclusiones: La linfogammagrafía, previa inyección peritumoral de volúmenes pequeños y dosis bajas del radiotrazador, permite obtener excelentes resultados en la localización intraoperatoria del GC en el cáncer de mama. Su posterior estudio mediante CK rápida permite disminuir el número de falsos negativos de la técnica (AU)

Analysis of factors influencing vaccine uptake: perspective from Spain.

Although each of the 17 Autonomous Regions in Spain has their own vaccination policies, factors influencing vaccine uptake do not differ considerably among them. Knowledge of vaccine preventable diseases, awareness that the diseases prevented by vaccinations are serious or very serious, awareness that vaccinations are not generally associated with serious adverse events, cost-free status and satisfaction with our computerised immunization registry, are the elements which influence vaccine uptake in our country.

Age and outcome after severe head injury.

The authors analyzed the relationship between patient age and the final outcome in a series of 810 patients aged 14 years or older who were consecutively admitted between 1987 and 1996 after suffering a severe closed head injury. The most relevant clinico-radiological variables were prospectively collected in a Data Bank. Stratified and logistic regression analyses were performed in order to assess the influence of age on adverse outcome and the interaction between patient age and other prognostic indicators. Our results reaffirm that the adverse outcome rate increases steadily with age in severe head injured patients and that age effect on outcome is independent of other prognostic variables. The odds of having an adverse outcome increases significantly over 35 years of age being 10 times higher in patients older than 65 years as compared to those aged 15-25 years (reference age group). The adverse influence of an advanced age on the final outcome has not yet been satisfactorily explained but an older brain may have an impaired ability to recover after a pathological insult as compared to a younger one.

Solubilization and fractionation of paired helical filaments.

Paired helical filaments isolated from brains of two different patients with Alzheimer's disease were extensively treated with the ionic detergent, sodium dodecyl sulphate. Filaments were solubilized at different extents, depending on the brain examined, thus suggesting the existence of two types of paired helical filaments: sodium dodecyl sulphate-soluble and insoluble filaments. In the first case, the number of structures resembling paired helical filaments greatly decreased after the detergent treatment, as observed by electron microscopy. Simultaneously, a decrease in the amount of sedimentable protein was also observed upon centrifugation of the sodium dodecyl sulfate-treated paired helical filaments. A sodium dodecyl sulphate-soluble fraction was isolated as a supernatant after low-speed centrifugation of the sodium dodecyl sulphate-treated paired helical filaments. The addition of the non-ionic detergent Nonidet-P40 to this fraction resulted in the formation of paired helical filament-like structures. When the sodium dodecyl sulphate-soluble fraction was further fractionated by high-speed centrifugation, three subfractions were observed: a supernatant, a pellet and a thin layer between these two subfractions. No paired helical filaments were observed in any of these subfractions, even after addition of Nonidet P-40. However, when they were mixed back together, the treatment with Nonidet P-40 resulted in the visualization of paired helical filament-like structures. These results suggest that at least two different components are needed for the reconstitution of paired helical filaments as determined by electron microscopy. The method described here may allow the study of the components involved in the formation of paired helical filaments and the identification of possible factors capable of blocking this process.

Effect of high mobility group proteins 14 and 17 on the structural and transcriptional properties of acetylated complete and H2A.H2B-deficient nucleosomal cores.

Acetylation of H2A.H2B-deficient nucleosomal cores, like that of the complete particles, causes a substantial increase in the efficiency of the particles as in vitro transcription templates. Binding of the high mobility group proteins 14 and 17 (HMG 14/17) to chemically acetylated nucleosomal particles, both complete nucleosomal cores and those lacking one of the two H2A.H2B dimers, is accompanied by a small structural stabilization. The affinity of HMG 14/17 for the nucleosomal cores is not affected by acetylation of the particles. With acetylated complete and H2A.H2B-deficient cores, the binding of HMG 14/17 does not cause any significant change in the levels of RNA synthesis, which is compatible with the presence of these proteins in transcriptionally active nucleosomes.

Interaction of RNA polymerase II with acetylated nucleosomal core particles.

Chemical acetylation of nucleosomal cores is accompanied by an increase in their efficiency as in vitro transcription templates. Low amounts of acetic anhydride cause preferential modification of the amino-terminal tails of core histones. Modification of these domains, which causes moderate structural effects, is apparently correlated with the observed stimulation of RNA synthesis. In contrast, extensive modification of the globular regions of core histones, which is accompanied by a large structural relaxation of the particle, causes little additional effect on transcription. Acetylation of the amino-terminal domains of histones might stimulate transcription by changing the interaction of the histone tails with components of the transcriptional machinery.

Dicarboxylic acid anhydrides as dissociating agents of protein-containing structures.

Dissociation of protein-containing structures by modification of protein amino groups with dicarboxylic acid anhydrides is a mild procedure which, in some cases, offers advantages over treatment with alternative dissociating agents, such as urea, guanidine hydrochloride, detergents, high ionic strength, and extremes of pH. In addition to dissociating multimeric proteins and protein aggregates, dicarboxylic acid anhydrides are effective dissociating agents for membrane-bound proteins and nucleoprotein particles. With most dicarboxylic acid anhydrides reviewed, the introduced reagent residues can be eliminated under moderate acid conditions, which allows the purification of unmodified individual components, and the use of diassembly-reconstitution systems valuable for investigating the structural and functional roles played by the individual components of complex particles. Each reagent can be suitable for a particular purpose, depending on the required specificity of the modification and stability of the modified groups. The stability of the acylated amino groups ranges from the very stable succinylated amino groups to the very labile acylation obtained with dimethylmaleic anhydride. Between these extremes, the stability of the modified amino groups decreases stepwise in the following order: maleic, exo-cis-3,6-endoxo-delta 4-tetrahydrophthalic, citraconic, and 3,4,5,6-tetrahydrophthalic anhydride. With respect to the selectivity of the produced modification, little or no modification of hydroxyamino acid and cysteine residues has been observed with dimethylmaleic, exo-cis-3,6-endoxo-delta 4-tetrahydrophthalic, and 3,4,5,6-tetrahydrophthalic anhydrides. With the other reagents, the extent of modification of hydroxyamino acid residues increases in the order citraconic, maleic and succinic anhydride. Citraconic and maleic anhydrides can produce irreversible modification of cysteine residues, the reactivity of sulfhydryl groups being higher with maleic anhydride.

Structural and transcriptional properties of different nucleosomal particles containing high mobility group proteins 14 and 17 (HMG 14/17).

Binding of high mobility group (HMG) proteins 14 and 17 (HMG 14/17) to complete nucleosomal cores and to cores lacking one H2A.H2B dimer, the amino-terminal tails of histones, or both one H2A.H2B dimer and the amino-terminal ends of histones is accompanied by an overall stabilization of the particles as determined by thermal denaturation, circular dichroism and DNase I digestion. In spite of the structural stabilization brought about by HMG 14/17, the presence of these proteins causes little effect on the efficiency of the different nucleosomal particles as transcription templates for RNA polymerase II. The nucleosomal particles lacking one H2A.H2B dimer and containing two bound HMG 14/17 molecules are efficient in vitro transcription templates, which allow transcription of the whole length of the DNA present in the particle. These results are consistent with HMG 14/17 being present in active chromatin.

Reconstitution of rat liver 60S ribosomal subunits following disassembly by dimethylmaleic anhydride.

Modification of 60S ribosomal subunits from rat liver with dimethylmaleic anhydride (60 mumols/ml) is accompanied by release of 35% of the protein. The acidic ribosomal proteins, as well as 9 basic proteins, are selectively liberated from the ribosomal subunits. Reconstitution of the protein-deficient particles with the corresponding split proteins is accompanied by substantial recovery of the original polyphenylalanine synthetic activity. The described reconstitution procedure can be used to investigate the roles played by the released proteins and the functional similarities of proteins from different sources. Hybrid reconstitution of residual ribosomal particles from rat liver or yeast with the corresponding heterologous split proteins produces subunits which have incorporated heterologous proteins but are inactive in polyphenylalanine synthesis.