Using natural language processing to explore characteristics and management of patients with axial spondyloarthritis and psoriatic arthritis treated under real-world conditions in Spain: SpAINET study.

Background: Spondyloarthritis (SpA) is a group of related but phenotypically distinct inflammatory disorders that include axial SpA (axSpA) and psoriatic arthritis (PsA). Information on the characteristics and management of these patients in the real world remains scarce. Objectives: To explore the characteristics and management [disease activity assessment and treatment with secukinumab (SEC) or other biologic disease-modifying antirheumatic drugs (bDMARDs)] of axSpA and PsA patients using natural language processing (NLP) in Electronic Health Records (EHRs). Design: National, multicenter, observational, and retrospective study. Methods: We analyzed free-text and structured clinical information from EHR at three hospitals. All adult patients with axSpA, PsA or non-classified SpA from 2018 to 2021 with minimum follow-up of three months were included when starting SEC or other bDMARDs. Clinical variables were extracted using EHRead® technology based on Systemized Nomenclature of Medicine-Clinical Terms (SNOMED CT) terminology. Results: Out of 887,735 patients, 758 were included, of which 328 had axSpA [58.5% male; mean (SD) age of 50.7 (12.7) years], 365 PsA [54.8% female, 53.9 (12.4) years], and 65 non-classified SpA. Mean (SD) time since diagnosis was 36.8 (61.0) and 24.1 (35.2) months for axSpA and PsA, respectively. Only 116 axSpA patients (35.3%) had available Ankylosing Spondylitis Disease Activity Score (ASDAS) or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at bDMARD onset, of which 61 presented active disease. Disease Activity in PSoriatic Arthritis (DAPSA) or Disease Assessment Score - 28 joints (DAS-28) values at bDMARD onset were available for only 61 PsA (16.7%) patients, with 23 of them having active disease. The number of patients with available tender joint count or swollen joint count assessment was 68 (20.7%) and 59 (18%) for axSpA, and 115 (31.5%) and 119 (32.6%) for PsA, respectively. SEC was used in 63 (19.2%) axSpA patients and in 63 (17.3%) PsA patients. Conclusion: Using NLP, the study showed that around one-third of axSpA and one-sixth of PsA patients have disease activity assessments with ASDAS/BASDAI or DAPSA/DAS-28, respectively, highlighting an area of improvement in these patients' management.

Investigating axial spondyloarthritis and psoriatic arthritis patients using natural language processing We conducted a study in Spain to better understand patients with specific rheumatic conditions known as axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). To analyze their characteristics, we used a computer technology called EHRead, which uses Natural Language Processing (NLP) to analyze free text from electronic health records. Out of a large group of patients, we focused on 758 individuals who had axSpA or PsA. Most of the axSpA patients were men, and they were around 51 years old on average. For the PsA patients, most were women, and their average age was about 54 years. We analyzed outcomes and treatments of these patients. Our findings showed that we can describe and assess a cohort of patients from real world using NLP. Besides, only about one-third of axSpA patients and one-sixth of PsA patients had their respective outcomes completely assessed, which indicates that there is potential room for improvement in the management of axSpA and PsA. The most promising feature in our study is the use of NLP, an artificial intelligence technology that helps us understand information in medical records written in free text. This can help us explore the characteristics of patients and their management in the real world, bringing an opportunity to enhance the care of patients with axSpA and PsA.

Recovery course of persistent posterior subretinal fluid after successful repair of rhegmatogenous retinal detachment.

PURPOSE: To investigate best corrected visual acuity (BCVA), subretinal fluid (SRF) absorption time or ellipsoid zone (EZ) restoration time and various variables in patients with persistent SRF after successful primary repair of rhegmatogenous retinal detachment (RRD). METHODS: This retrospective multicenter study allowed independent analysis of the healing pattern by two observers based on composite of serial cross-sectional macular optical coherence tomography (OCT) scans. Univariate and multivariate analyses were implemented. RESULTS: One hundred and three cases had persistent SRF after pars plana vitrectomy, scleral buckling, or pneumatic retinopexy. By univariate analysis, SRF resolution time correlated positively with the number of retinal breaks (p < 0.001) and with increased myopia (p = 0.011). Using multivariate analysis, final BCVA (log MAR) correlated positively with age, duration of RRD, initial BCVA (OR = 3.28; [95%CI = 1.44-7.47]; p = 0.015), and SRF resolution time (OR = 0.46 [95%CI 0.21-1.05]; p = 0.049). EZ restoration time was longer with increasing number of retinal tears (OR = 0.67; [95%CI 0.29-1.52]; p = 0.030), worse final BCVA, and presence of macula-off RRD (OR = 0.26; [95%CI 0.08-0.88]; p = 0.056). SRF resolution time correlated marginally with prone position. CONCLUSIONS: Residual posterior SRF is more common in eyes with multiple breaks or in myopic eyes. Final BCVA is better in younger subjects and in eyes with shorter duration of RRD. Persistent SRF is a self-limited disorder with a mean resolution of 11.2 months with good visual prognosis improving from a mean baseline logMAR of 1.08 to 0.25 at one year.

The Potential of Surveillance Data for Dengue Risk Mapping: An Evaluation of Different Approaches in Cuba.

To better guide dengue prevention and control efforts, the use of routinely collected data to develop risk maps is proposed. For this purpose, dengue experts identified indicators representative of entomological, epidemiological and demographic risks, hereafter called components, by using surveillance data aggregated at the level of Consejos Populares (CPs) in two municipalities of Cuba (Santiago de Cuba and Cienfuegos) in the period of 2010-2015. Two vulnerability models (one with equally weighted components and one with data-derived weights using Principal Component Analysis), and three incidence-based risk models were built to construct risk maps. The correlation between the two vulnerability models was high (tau > 0.89). The single-component and multicomponent incidence-based models were also highly correlated (tau ≥ 0.9). However, the agreement between the vulnerability- and the incidence-based risk maps was below 0.6 in the setting with a prolonged history of dengue transmission. This may suggest that an incidence-based approach does not fully reflect the complexity of vulnerability for future transmission. The small difference between single- and multicomponent incidence maps indicates that in a setting with a narrow availability of data, simpler models can be used. Nevertheless, the generalized linear mixed multicomponent model provides information of covariate-adjusted and spatially smoothed relative risks of disease transmission, which can be important for the prospective evaluation of an intervention strategy. In conclusion, caution is needed when interpreting risk maps, as the results vary depending on the importance given to the components involved in disease transmission. The multicomponent vulnerability mapping needs to be prospectively validated based on an intervention trial targeting high-risk areas.

Fibromyxoid Nephrogenic Adenoma: A Series of 43 Cases Reassessing Predisposing Conditions, Clinical Presentation, and Morphology.

Nephrogenic adenoma is a benign epithelial lesion of the genitourinary tract that arises from the reimplantation and proliferation of shed renal tubular cells in areas of urothelial injury and denudation. Fibromyxoid nephrogenic adenoma is a rare variant that consists of compressed spindle-shaped renal epithelial cells in a fibromyxoid background. Only 14 observations of this variant are reported in the literature. We performed a retrospective analysis of fibromyxoid nephrogenic adenomas from 3 large reference centers. We identified 43 lesions in 6 women and 36 men (2 in 1 man) with a median age of 72 years (range, 31 to 94 y). Median lesion size was 0.7 cm (range, 0.2 to 5 cm). Nephrogenic adenomas were in the bladder (n=15), prostate/prostatic urethra (n=14), kidney (n=7), ureter (n=3), penile urethra (n=3), and urethral diverticulum (n=1). One of the kidney lesions developed in an end-stage kidney and radiologically mimicked cancer. Of 37 patients with information, 36 had predisposing conditions including prior biopsy, transurethral resection of bladder tumor, resection, Foley catheter, BCG treatment, urinary stones, (chemo)radiation, or diverticulum. Only 4/37 (10.8%) had a history of prior irradiation. Fifteen lesions had pure fibromyxoid morphology and 28 were admixed classic and fibromyxoid patterns. Three nephrogenic adenomas involved prostatic stroma, 3 renal sinus fat, 2 muscularis propria (1 bladder, 1 renal pelvis), 1 perinephric fat, and 1 corpus spongiosum. Ten fibromyxoid nephrogenic adenomas were intermixed with urothelial carcinoma, 1 with prostate adenocarcinoma, and 1 with malignant melanoma. By immunohistochemistry, PAX8 was positive in all the examined lesions (n=31). Napsin A was negative in all examined fibromyxoid nephrogenic adenomas (n=30). Twenty of them had classic nephrogenic adenoma component which was positive for napsin A. Similar to classic nephrogenic adenoma, fibromyxoid nephrogenic adenoma can occur anywhere along the urinary tract and is associated with a prior history that causes urothelial injury. In nearly a quarter of the cases, fibromyxoid nephrogenic adenoma extended beyond the lamina propria. Unlike previously suggested, fibromyxoid nephrogenic adenoma is not specifically related to prior radiation therapy. Awareness of this variant is important to avoid misdiagnosis and overtreatment.

Post-mortem COVID-19 Positive Testing: Institute of Forensic Sciences Experience.

OBJECTIVE: The main objective was to present the experience of the Institute of Forensic Sciences of Puerto Rico in facing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19. It has been found that some COVID-19 positive cases may continue to show post-mortem positive results for up to 49 days. METHODS: The in vitro technique of ID NOW COVID-19 was used in the analysis to evaluate the presence of SARS-Cov-2 in postmortem forensic cases. This isothermal method allows to amplify and identify the presence of the RNA-dependent RNA polymerase viral segment. Information on demographics, comorbidities, and the manner and cause of death was collected. RESULTS: A total of 612 subjects were sampled, of which 41 (6.7%) tested positive for COVID-19;14 (34.1%) of those subjects remained positive for more than 7 days Postmortem. Of the 41 positive cases, only 3 (7.3%) had been diagnosed with COVID-19 before their demise. The most common comorbidities were hypertension (36%), obesity (29%), and mental health conditions (50%). CONCLUSION: Results from postmortem COVID-19 testing revealed that some cadavers remain COVID-19 positive for a longer period than expected. Despite this, based on the information collected from the cases that were tested more than once, there is no direct correlation between the cause of death and persistent COVID-19 positivity. We recommend that additional investigations be carried out, in which investigations viral load and the maximum time of the infectious phase are specifically evaluated.

La educación virtual y su impacto en el aprendizaje como modalidad de enseñanza clínica en enfermería durante la pandemia de covid-19, en la universidad de panamá. documento tipo ensayo argumentativo / Virtual education and its impact on learning as a clinical teaching modality in nursing during the covid-19 pandemic, at the university of panama. document type argumentative essay / Educação virtual e seu impacto na aprendizagem como modalidade de ensino clínico em enfermagem durante a pandemia covid-19, na universidade de panamá. documento do tipo ensaio argumentativo

El presente artículo, es un ensayo, que permite hacer una reflexión sobre los elementos que integraron la formación de los estudiantes de enfermería durante la pandemia COVID 19, cuando de un día a otro se tuvo que transformar la educación y asumir cambios radicales, como dejar de ir a las aulas de manera presencial, para recibir la formación que permitiera el logro de las metas del perfil profesional de enfermería, a través de un medio digital remoto, como fue una pantalla de computador, tableta o celular. El año 2020 será sin duda, recordado por el impacto que generó en la metodología de enseñanza procedimental en Enfermería. Como docentes universitarios enfrentamos el reto de la formación de profesionales de enfermería, con la práctica de destrezas, desde la distancia, en modalidad sincrónica. La educación virtual permitió la incorporación de los elementos de aprendizaje de manera activa generando la información para la construcción del conocimiento en el saber, el ser y en el hacer como parte de las competencias que debían adquirir los estudiantes. Se enfrentaron retos como el de abordar el consumo de data, con un impacto económico sobre todo en el periodo de crisis económica.

Abstract This article is an essay that allows a reflection on the elements that made up the training of nursing students during the COVID 19 pandemic, when education had to be transformed, from one day to the next, and radical changes taken: namely, from not having in-person classes to receive the training, that would allow achieving the goals of the professional profile of nursing, to teaching with a remote digital medium, like a computer monitor, tablet or cell phone. The year 2020 will be remembered undoubtedly for the impact it generated on the procedural teaching methodology in Nursing. As university teachers, we face the challenge of training nursing professionals, through the practice of skills, from a distance, in a synchronous mode. Virtual education allowed the incorporation of learning elements in an active way generating information for the construction of knowledge in knowing, being, and doing as part of the skills that students should acquire. Challenges, such as dealing with data consumption with an economic impact, were especially faced during the economic crisis.

Resumo: Este artigo é um ensaio, que nos permite refletir sobre os elementos que integraram a formação dos alunos de enfermagem durante a pandemia COVID 19, quando de um dia para o outro a educação teve que ser transformada e mudanças radicais tiveram que ser assumidas, como parar de ir às salas de aula pessoalmente para receber a formação que permitiria o cumprimento das metas do perfil profissional de enfermagem, através de um meio digital remoto, como um computador, tablet ou celular. O ano de 2020 será, sem dúvida, lembrado pelo impacto que gerou na metodologia do ensino processual em Enfermagem. Como professores universitários enfrentamos o desafio de formar profissionais de enfermagem, com a prática de habilidades, à distância, na modalidade síncrona. A educação virtual permitiu a incorporação de elementos de aprendizagem de forma ativa gerando informações para a construção do conhecimento baseado no ser, no saber e no fazer como parte das habilidades que os alunos tinham que adquirir. Desafios foram enfrentados, como a abordagem do consumo de data, com impacto econômico especialmente no período de crise econômica.

Recovery course of foveal microstructure in the nonsurgical resolution of full-thickness macular hole.

PURPOSE: To analyze the recovery course of foveal microstructures in eyes with nonsurgical healing of full-thickness macular hole (FTMH). METHODS: By serial OCT scans, the temporal healing sequences were analyzed in ocular trauma, vitreomacular traction (VMT), cystoid macular edema (CME), and the remaining group. We evaluated correlations between the final best-corrected spectacle visual acuity and reconstruction time of external limiting membrane (ELM), and inner segment/outer segment (IS/OS). RESULTS: The healing (mean±standard deviation in months) most involved fusion at the level of the outer nuclear layer (ONL) (6.3±10.5) followed by restoration of ELM (9.1±13.8), and lastly, by IS/OS regeneration (13.1±19.5). In severe blunt ocular trauma, healing was fast and involved subretinal zipper glue-like reapposition with resulting outer retinal atrophy. Best spectacle-corrected visual acuity correlated with normalization of the clivus (p=0.012), faster ELM (p=0.006), and IS/OS reconstitution (p=0.024). Recurrence of FTMH occurred when the healing was halted (3 eyes) or was aberrant by lamellar hole epiretinal proliferation (LHEP) (3 eyes) or by the persistence of VMT (1 eye). CONCLUSION: Recovery sequences proceeded from the ONL to the deeper layers with BCVA correlating absolutely and temporally with the restoration of outer retinal layer integrity.

Astigmatism correction with toric implantable collamer lens in low and high astigmatism groups.

PURPOSE: To analyze the target induced astigmatism (TIA), surgically induced astigmatism (SIA), difference vector (DV), and correction index (CI) in the correction of astigmatism with phakic lenses, and its influence on visual acuity, and to analyze the safety and efficacy indexes of the correction of high and low power astigmatism with toric phakic lenses. DESIGN: Retrospective comparative study. METHODS: The medical records of patients that were operated on at the research center during the period were analyzed. Results were divided into Low Astigmatism Group - LAG (33 eyes) and High Astigmatism Group - HAG (93 eyes) according to the implanted toric ICL lens power. Preoperative refraction and resultant postoperative refraction were analyzed by vector analysis. Visual acuity pre and postop, with and without optical correction, were compared. RESULTS: A total of 126 eyes were studied. The average preop refraction was -5.02 D sphere with -2.61 D cylinder. The average ICL lens power implanted was -8.31 D sphere +2.77 D cylinder. Refractive remaining was -0.01 ± 0.11 D sphere -0.15 ± 0.28 D cylinder. The arithmetic average angle of error in the astigmatism correction was 1.08°. The resultant cylinder was -0.03 ± 0.12 D and -0.19 ± 0.30 D in the low and high astigmatism groups, respectively, with a mean UDVA -0.01 ± 0.10 and 0.01 ± 0.16 and CDVA -0.03 ± 0.08 and -0.01 ± 0.17 for each group. The safety and efficacy indexes for the low astigmatism group were 1.09 ± 0.16 and 1.05 ± 0.17, respectively, with 1.11 ± 0.17 and 1.06 ± 0.16 for the high astigmatism group. CONCLUSIONS: The correction of astigmatism by the implantation of toric phakic lenses of the posterior chamber is safe and effective, independently of the amount of cylinder corrected.

Work Environment, Mental Health, and Eating Behavior in Mexican Nurses.

Nursing staff in public hospitals face highly demanding working conditions, which are related to mental health and eating problems. The current study aimed to identify the most frequent work characteristics associated with mental health problems and eating behavior in nursing staff. A cross-sectional study was performed on a random sample of 190 nurses at a specialized hospital in Mexico City. Work characteristics, mental health problems (stress, depression, and anxiety), emotional eating, and loss-of-control eating were measured using standardized scales. Associations among relevant work variables and mental health and eating behavior were assessed using logistic regression models adjusted for sociodemographic characteristics. High prevalence of stress (28%), depression (35%), anxiety (33%), emotional eating (27%), and loss-of-control eating (38%) were found. These mental health problems have been associated with variables related to work overload, little appreciation of work, and exposure to the suffering and death of patients. [Journal of Psychosocial Nursing and Mental Health Services, 60(1), 31-37.].

Domestic work, occupational stress and depression in nurses at a public hospital in Mexico City

AIM: To identify the effect of the domestic on the depression of nurses in a public hospital in Mexico City. BACKGROUND: Domestic work performed mainly by women coupled with the demands of work is associated with the possibility of developing mental disorders, especially depression. INTRODUCTION: Working conditions have an impact on the physical and mental health of nurses. Participation in domestic activities adds to wear and tear on workers. METHODS: The research had a cross-sectional design with a random sample of 329 nurses from a third-level hospital in Mexico City. Occupational stress and domestic work were evaluated with nursing Stress Scale questionnaires and the Individual Worker Health Survey (PROESSAT). The DASS-21 subscale was used for depression. The associations were analyzed using logistic regression models. RESULTS: The probability of suffering from depression was 7 times higher for women engaged in domestic work. Experiencing death, lack of support and having an additional job increased their association. DISCUSSION: The work-family conflict, as well as lack of support, is associated with depressive symptoms in nurses. CONCLUSION: There is a need to implement strategic programs that provide nurses with tools to deal with work-family conflict reconciliation. It is necessary to offer more favorable working conditions in the practice of nursing.

Resistencia antimicrobiana en pacientes con Infección del Tracto Urinario / Antimicrobial resistance in patients with Urinary Tract Infection / Resistência antimicrobiana em pacientes coma infecção do trato urinário

RESUMEN El alarmante incremento de la resistencia bacteriana a los antibióticos, en pacientes con infección del tracto urinario, es uno de los mayores problemas actuales de la salud pública mundial; siendo la Escherichia coli, principal patógeno en esta infección, resistente a la mayoría de los antibióticos. Con el objetivo de determinar el patrón microbiológico de resistencia antimicrobiana de los gérmenes más frecuentemente aislados en urocultivos positivos, en el laboratorio de microbiología del Hospital Provincial Docente Celia Sánchez Manduley, Manzanillo, durante el año 2018, se realizó un estudio observacional, descriptivo de corte transversal a todos los urocultivos realizados a los pacientes con la orden de estudio bacteriológico, en la institución y período de tiempo declarados. Se evaluaron las variables: positividad del cultivo, gérmenes aislados, resistencia antimicrobiana de los microorganismos aislados en general y de la Escherichia coli en particular. Los datos fueron analizados utilizando la estadística descriptiva. Se analizaron 2482 urocultivos, 714 fueron positivos; como germen predominó Escherichia coli en 58.12% de los casos. El total de gérmenes aislados mostró resistencia a: cefotaxima (46.08 %), ciprofloxacino (44.67 %), ácido nalidíxico (44.11 %), cotrimoxazol (42.99 %) y ceftazidima (42.85 %).Para el caso de la Escherichia coli se mantuvo el mismo patrón de resistencia con valores discretamente superiores. La menor resistencia de estos microorganismos fue para la nitrofurantoina, alrededor de un1.44 %. Se determinó el patrón microbiológico de resistencia antimicrobiana de los gérmenes más frecuentes aislados en los urocultivos positivos de este estudio.

ABSTRACT The alarming increase in bacterial resistance to antibiotics in patients with urinary tract infection is one of the biggest current problems in world public health; being Escherichia coli, the main pathogen in this infection, resistant to most antibiotics. With the aim of determining the microbiological pattern of antimicrobial resistance of the germs most frequently isolated in positive urine cultures, in the microbiology laboratory of the Celia Sánchez Manduley Provincial Teaching Hospital, Manzanillo, during 2018, an observational, descriptive cut-off study was carried out. cross-sectional to all urine cultures performed on patients with the order of bacteriological study, in the institution and period of time declared. The variables were evaluated: positivity of the culture, isolated germs, antimicrobial resistance of isolated microorganisms in general and Escherichia coli in particular. The data were analyzed using descriptive statistics. 2482 urine cultures were analyzed, 714 were positive; As a germ, Escherichia coli predominated in 58.12% of the cases. The total of isolated germs showed resistance to: cefotaxime (46.08%), ciprofloxacin (44.67%), nalidixic acid (44.11%), cotrimoxazole (42.99%) and ceftazidime (42.85%). In the case of Escherichia coli, the same resistance pattern was maintained with slightly higher values. The lowest resistance of these microorganisms was for nitrofurantoin, around 1.44%. The microbiological pattern of antimicrobial resistance of the most frequent germs isolated in the positive urine cultures of this study was determined.

RESUMO O alarmante aumento da resistência bacteriana aos antibióticos em pacientes com infecção do trato urinário é um dos maiores problemas atuais de saúde pública mundial; sendo Escherichia coli, o principal patógeno dessa infecção, resistente à maioria dos antibióticos. Como objetivo de determinar o padrão microbiológico de resistência antimicrobiana dos germes mais freqüentemente isolados em uroculturas positivas, no laboratório de microbiologia do Hospital Universitário Provincial Celia Sánchez Manduley, Manzanillo, durante 2018, foi realizado um estudo observacional descritivo de corte. out. transversal a todas as culturas de urina realizadas em pacientes com a ordem de estudo bacteriológico, na instituição e período de tempo declarado. Foram avaliadas as variáveis: positividade da cultura, germes isolados, resistência antimicrobiana dos microrganismos isolados em geral e Escherichia coli em particular. Os dados foram analisados ​​por meio de estatística descritiva. 2.482 culturas de urina foram analisadas, 714 foram positivas; Como germe, a Escherichia coli predominou em 58,12% dos casos. O total de germes isolados apresentou resistência a: cefotaxima (46,08%), ciprofloxacina (44,67%), ácido nalidíxico (44,11%), cotrimoxazol (42,99%) e ceftazidima (42,85%). No caso da Escherichia coli, o mesmo padrão de resistência foi mantido com valores ligeiramente superiores. A menor resistência desses microrganismos foi para a nitrofurantoína, em torno de 1,44%. Foi determinado o padrão microbiológico de resistência antimicrobiana dos germes mais frequentes isolados unas uroculturas positivas deste estudo.

Antimicrobial resistance in patients with Urinary Tract Infection / Resistencia antimicrobiana en pacientes con Infección del Tracto Urinario

The alarming increase in bacterial resistance to antibiotics in patients with urinary tract infection is one of the biggest current problems in world public health; being Escherichia coli, the main pathogen in this infection, resistant to most antibiotics. With the aim of determining the microbiological pattern of antimicrobial resistance of the germs most frequently isolated in positive urine cultures, in the microbiology laboratory of the Celia Sánchez Manduley Provincial Teaching Hospital, Manzanillo, during 2018, an observational, descriptive cut-off study was carried out, cross-sectional to all urine cultures performed on patients with the order of bacteriological study, in the institution and period of time declared. The variables were evaluated: positivity of the culture, isolated germs, antimicrobial resistance of isolated microorganisms in general and Escherichia coli in particular. The data were analyzed using descriptive statistics. 2482 urine cultures were analyzed, 714 were positive; As a germ, Escherichia coli predominated in 58.12 percent of the cases. The total of isolated germs showed resistance to: cefotaxime (46.08 percent), ciprofloxacin (44.67 percent), nalidixic acid (44.11 percent), cotrimoxazole (42.99 percent) and ceftazidime (42.85 percent). In the case of Escherichia coli, the same resistance pattern was maintained with slightly higher values. The lowest resistance of these microorganisms was for nitrofurantoin, around 1.44 percent. The microbiological pattern of antimicrobial resistance of the most frequent germs isolated in the positive urine cultures of this study was determined(AU)

El alarmante incremento de la resistencia bacteriana a los antibióticos, en pacientes con infección del tracto urinario, es uno de los mayores problemas actuales de la salud pública mundial; siendo la Escherichia coli, principal patógeno en esta infección, resistente a la mayoría de los antibióticos. Con el objetivo de determinar el patrón microbiológico de resistencia antimicrobiana de los gérmenes más frecuentemente aislados en urocultivos positivos, en el laboratorio de microbiología del Hospital Provincial Docente Celia Sánchez Manduley, Manzanillo, durante el año 2018, se realizó un estudio observacional, descriptivo de corte transversal a todos los urocultivos realizados a los pacientes con la orden de estudio bacteriológico, en la institución y período de tiempo declarados. Se evaluaron las variables: positividad del cultivo, gérmenes aislados, resistencia antimicrobiana de los microorganismos aislados en general y de la Escherichia coli en particular. Los datos fueron analizados utilizando la estadística descriptiva. Se analizaron 2482 urocultivos, 714 fueron positivos; como germen predominó Escherichia coli en 58.12 por ciento de los casos. El total de gérmenes aislados mostró resistencia a: cefotaxima (46.08 por ciento), ciprofloxacino (44.67 por ciento), ácido nalidíxico (44.11 por ciento), cotrimoxazol (42.99 por ciento) y ceftazidima (42.85 por ciento). Para el caso de la Escherichia coli se mantuvo el mismo patrón de resistencia con valores discretamente superiores. La menor resistencia de estos microorganismos fue para la nitrofurantoina, alrededor de un 1.44 por ciento. Se determinó el patrón microbiológico de resistencia antimicrobiana de los gérmenes más frecuentes aislados en los urocultivos positivos de este estudio(EU)

Identification and Isolation of Two Different Subpopulations Within African Swine Fever Virus Arm/07 Stock.

No efficient vaccines exist against African swine fever virus (ASFV), which causes a serious disease in wild boars and domestic pigs that produces great industrial and ecological concerns worldwide. An extensive genetic characterization of the original ASFV stocks used to produce live attenuated vaccine (LAV) prototypes is needed for vaccine biosecurity and control. Here, we sequenced for the first time the Arm/07 stock which was obtained from an infected pig during the Armenia outbreak in 2007, using an improved viral dsDNA purification method together with high coverage analysis. There was unexpected viral heterogeneity within the stock, with two genetically distinct ASFV subpopulations. The first, represented by the Arm/07/CBM/c2 clone, displayed high sequence identity to the updated genotype II Georgia 2007/1, whereas the second (exemplified by clone Arm/07/CBM/c4) displayed a hemadsorbing phenotype and grouped within genotype I based on a central region conserved among all members of this group. Intriguingly, Arm/07/CBM/c4 contained a unique EP402R sequence, produced by a single mutation in the N-terminal region. Importantly, Arm/07/CBM/c4 showed in vitro features of attenuated strains regarding innate immune response pathway. Both Arm/07/CBM/c2 and c4 represent well-characterized viral clones, useful for different molecular and virus-host interaction studies, including virulence studies and vaccine development.

American Thyroid Association Sonographic Risk and Afirma Gene Expression Classifier Alone and in Combination for the Diagnosis of Thyroid Nodules with Bethesda Category III Cytology.

Background: The Afirma gene expression classifier (GEC) has been used to aid in the diagnosis and management of thyroid nodules having Bethesda category III fine-needle aspiration cytologic diagnosis (B3 nodules). The American Thyroid Association sonographic risk stratification system for thyroid nodules (ATA-US) may stratify B3 nodules and aid in the decision to order a molecular test. The aim of this study was to assess the association between ATA-US and GEC as well as to determine their individual and combined diagnostic performances when applied to B3 nodules. Methods: A retrospective single-center study included B3 nodules that had undergone evaluation by GEC. Each ultrasound was reviewed by three radiologists, and nodules were classified using the 2015 ATA sonographic risk categories. Nodules were determined to be benign or malignant based on surgical pathology or minimum 11 months of follow-up. Positive predictive values (PPV) and negative predictive values (NPV) were calculated for GEC, ATA-US, and GEC across all ATA-US categories. Results: One hundred twenty-six B3 nodules with GEC results were included and deemed benign or malignant based on final pathology or follow-up. Prevalence of malignancy was 32%. The rate of malignancy was similar in the ATA-US high suspicion (HS) and intermediate suspicion (IS) categories at 42% and 38%, respectively; and lower in nodules with low suspicion sonography (LS) and very low suspicion sonography (VLS) at 23% and 11%, respectively. The PPV and NPV of ATA-US was calculated by designating HS or IS sonography as a "positive" test and the lower risk categories as "negative." ATA-US had a PPV of 40% and NPV of 79%. The GEC PPV was 40% and NPV was 83%. The PPV of GEC was 50% in nodules with HS or IS ATA-US and lower at 28% and 20%, respectively, in LS and VLS nodules. The NPV of GEC was 80% in HS, 77% in IS, 84% in LS, and 100% in VLS sonography categories. Conclusions: In B3 nodules, ATA-US and GEC have similar diagnostic performance. The PPV of GEC varies across ATA-US categories, while the NPV remains similar. These data support the need for future prospective studies.

Fecal Contamination of Drinking Water Was Associated with Diarrheal Pathogen Carriage among Children Younger than 5 Years in Three Peruvian Rural Communities.

Drinking water contamination is a frequent problem in developing countries and could be associated with bacterial pathogen carriage in feces. We evaluated the association between the risk of drinking water and bacterial carrier status in children younger than 5 years in a cross-sectional study conducted in 199 households from three Peruvian rural communities. Fecal samples from children were screened for pathogenic Aeromonas, Campylobacter, and Vibrio species, as well as for Enterobacteriaceae, including pathogenic Escherichia coli. The drinking water risk was determined using E. coli as an indicator of contamination. Nineteen (9.5%) children were colonized with pathogens and classified as carriers, all without diarrhea symptoms. Of 199 drinking water samples, 38 (19.1%) were classified as very high risk because of high fecal contamination (> 100 E. coli/100 mL). Shared-use water sources, daily washing of containers, and washing using only water were associated with higher prevalence of bacterial carriage, whereas there was no association between households reporting boiling and chlorination of water and carrier status. The prevalence of carriage in children exposed to very high-risk water was 2.82 (95% CI: 1.21-6.59) times the prevalence of those who consumed less contaminated water, adjusted by the water source and daily washing. Our results suggest that household drinking water plays an important role in the generation of carriers with diarrheal pathogens. Our findings also highlight the importance of interventions to ensure the safety of drinking water. Further studies are needed to validate the observed association and determine its significance with respect to diarrhea in the community.

Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) joint consensus statement for MR imaging of placenta accreta spectrum disorders.

OBJECTIVES: This study was conducted in order to establish the joint Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) guidelines on placenta accreta spectrum (PAS) disorders and propose strategies to standardize image acquisition, interpretation, and reporting for this condition with MRI. METHODS: The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to questions regarding the details of patient preparation, MRI protocol, image interpretation, and reporting were collected, analyzed, and classified as "recommended" versus "not recommended" (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts). RESULTS: Consensus regarding image acquisition, interpretation, and reporting was determined using the RAND-UCLA Appropriateness Method. The use of a tailored MRI protocol and standardized report was recommended. CONCLUSIONS: A standardized imaging protocol and reporting system ensures recognition of the salient features of PAS disorders. These consensus recommendations should be used as a guide for the evaluation of PAS disorders with MRI. KEY POINTS: • MRI is a powerful adjunct to ultrasound and provides valuable information on the topography and depth of placental invasion. • Consensus statement proposed a common lexicon to allow for uniformity in MRI acquisition, interpretation, and reporting of PAS disorders. • Seven MRI features, namely intraplacental dark T2 bands, uterine/placental bulge, loss of low T2 retroplacental line, myometrial thinning/disruption, bladder wall interruption, focal exophytic placental mass, and abnormal vasculature of the placental bed, reached consensus and are categorized as "recommended" for diagnosing PAS disorders.