How Far Are We From Achieving Delabeling of False Penicillin/ß-Lactam Allergy Alerts? A Population Problem.

BACKGROUND: Interest in finding efficient ways to remove penicillin allergy alerts has grown as a result of awareness of the considerable excess of false-negative diagnoses in patients with penicillin allergy labels (90%-95%), the poorer course with non-ß-lactam antibiotics, the increase in bacterial resistance, and the fact that these problems can affect up to 20% of the population in some countries. The strategies proposed have generated many publications in countries where the number of allergists to conduct such studies is low. In many cases where delabeling is performed, the risk of ß-lactam allergy is low, and a single penicillin challenge is sufficient to delabel the alert. However, other less "ultrarapid" strategies can be used to administer a ß-lactam during an admission for infection and thus postpone delabeling until traditional drug allergy consultations. However, the definitive withdrawal of ß-lactam alerts is threatened by nonremoval of alerts in electronic health records and by the reactivation or nonsynchronization of alerts between electronic systems at different levels of care. Allergy departments need to reflect on how to implement practices that enable rapid and efficient delabeling of drug allergy alerts, especially in patients with major comorbidities.

Incidence of adverse drug reactions in COVID-19 hospitalised patients through the minimum basic data set / Incidencia de reacciones adversas a medicamentos en pacientes hospitalizados por COVID-19 a través del conjunto mínimo básico de datos

Background: At the beginning of the COVID-19 pandemic many drugs were used with an uncertain benefit/risk profile that needed to be evaluated. The goal of this study was to analyse the incidence of adverse drug reactions (ADRs) and describe the drugs used in COVID-19 hospitalised patients at the beginning of the COVID-19 pandemic through the minimum basic data set (MBDS). Methods: Retrospective observational study that included hospitalised patients with COVID-19 at our centre between March and May 2020 who had ADRs coded in discharge/death medical reports according to the International Classification of Diseases (ICD-10). Those patients with ADRs ascribed to COVID therapy were selected and the causal relationship was evaluated using the Naranjo algorithm. Descriptive statistical analysis was used. Results: We identified 141 ADRs in 110 cases of hospitalisation due to COVID-19 that entailed an incidence of 9.66% (141/1459), CI95% 8.25-11.29. From the ADRs analysed, 60.3% (85/141) were ascribed to COVID therapy. Lopinavir/ritonavir represented 38.8% (33/85) of ADRs, glucocorticoids 23.5% (20/85) and hydroxychloroquine 9.4% (8/85). Out of the ADRs, 31.8% (27/85) were gastrointestinal disorders (probable lopinavir/ritonavir), 27.0% (23/85) blood glucose disorders (probable glucocorticoid) and 17.6% (15/85) hypertransaminasaemia (probable azithromycin, possible lopinavir/ritonavir, possible hydroxychloroquine, possible interferon). Regarding intensity, 64.7% (55/85) were mild cases, 29.4% (25/85) moderate and 5.9% (5/85) severe. The percentage of ADRs that did not require intervention were 24.7% (21/85), 32.9% (28/85) required pharmacological treatment, 40.0% (34/85) suspension of the drug, 1.2% (1/85) close monitoring and 1.2% (1/85) dose reduction. Conclusions: The incidence of ADR in COVID population that required admission at the beginning of the pandemic seems to be higher than in the general population. The MBDS proves to be a useful tool to trace ADRs. (AU)

Introducción: La llegada de la pandemia de COVID-19 supuso la utilización de muchos fármacos con un perfil de riesgo/beneficio incierto que debe ser evaluado. El objetivo de este estudio fue analizar la incidencia de reacciones adversas a medicamentos (RAM) y describir los medicamentos utilizados en pacientes hospitalizados por COVID-19 al comienzo de la pandemia a través del conjunto mínimo básico de datos (CMBD). Materiales y métodos: Estudio observacional retrospectivo que incluyó pacientes hospitalizados por COVID-19 en nuestro centro entre marzo y mayo de 2020 que presentaban RAM codificadas en los informes médicos de alta/exitus según la Clasificación Internacional de Enfermedades (CIE-10). Se seleccionaron los pacientes con RAM atribuidas a la terapia COVID-19 y se evaluó la relación causal mediante el algoritmo de Naranjo. Se realizó un análisis estadístico descriptivo. Resultados: Identificamos 141 RAM en 110 casos de hospitalización por COVID-19 lo que supone una incidencia del 9,66% (141/1459), IC95% 8,25-11,29. De las RAM analizadas el 60,3% (85/141) se atribuyeron a la terapia COVID. Lopinavir/ritonavir representó el 38,8% (33/85) de las RAM, los glucocorticoides el 23,5% (20/85) y la hidroxicloroquina el 9,4% (8/85). De todas las RAM, el 31,8% (27/85) fueron trastornos gastrointestinales (probable lopinavir /ritonavir), el 27,0% (23/85) trastornos de la glucemia (probable glucocorticoide) y el 17,6% (15/85) hipertransaminasemia (probable azitromicina, posible lopinavir /ritonavir, posible hidroxicloroquina, posible interferón). En cuanto a la intensidad, el 64,7% (55/85) de las RAM fueron casos leves, el 29,4% (25/85) moderados y el 5,9% (5/85) graves. El porcentaje de RAM que no requirió intervención fue 24,7% (21/85), 32,9% (28/85) requirió tratamiento farmacológico, 40,0% (34/85) suspensión del fármaco, 1,2% (1/85) seguimiento estrecho y 1,2% (1/85) reducción de dosis... (AU)

Homeostasis and food craving in obesity: a functional MRI study.

OBJECTIVES: Food intake in obesity has been found to be reward-based and less contingent on homeostatic needs. Accordingly, previous studies investigating neural processing of food cues observed aberrant processing in reward- and control-related brain regions in obesity. To further investigate the relation between homeostasis and food intake, this study investigated the influence of glucose metabolism on the neuronal response during the regulation of food craving in participants with obesity. METHODS: Twenty-five normal-weight and 25 women with obesity were examined on two occasions after receiving either water or glucose directly into the stomach using a nasogastric tube. Participants were blinded to the type of infusion and were required to refrain from eating for 16 h before each visit. An event-related fMRI paradigm was used to investigate the effect of intestinal glucose load on the neuronal response during the regulation of food craving. RESULTS: A 2 × 2 mixed-model ANOVA revealed that craving regulation was associated with increased activation in fronto-parietal regions in participants with obesity when compared to healthy controls. However, this effect was observed independently from homeostatic satiety. A regression analysis revealed that the reduction of food craving was related to increased activation in the lingual gyrus in individuals with obesity following the infusion of water. CONCLUSIONS: In participants with obesity, the neuronal response during the regulation of food craving is associated with increased neural cognitive top-down control and increased visual food processing. Since this observation was independent from satiety status, our results indicate a reduced influence of homeostasis on neural processing during food craving in obesity. This study was registered on clinicaltrials.org: NCT03075371.

Spherically shaped micro-structured antireflective surfaces.

An antireflecting micro-structured interface, working in the resonance domain, and made from a bi-periodic array of semi-spherical hollowing-out in a silicon substrate is presented. Its parameters such as sphere radius and position of sphere centers from the surface are optimized numerically. A simple and robust process is described allowing such kind of antireflective surfaces to be fabricated for the infrared range. Spectral and angular reflectance measurement demonstrates the efficiency of the antireflective micro-structured interface which can easily be adapted for the visible range and for photovoltaic applications by a simple homothetic modification of the micro-structure typical dimensions.

Enhanced antireflecting properties of micro-structured top-flat pyramids.

This paper aims at modeling bi-periodic micro-structured silicon surfaces exhibiting broadband antireflection properties in the infrared range using Rigorous Coupled-Wave Analysis (RCWA). These structures of pyramidal shape, which typical dimensions are smaller than the wavelength, are not in the Effective Medium Theory (EMT) validity domain. The influence of various opto-geometrical parameters such as period, depth, shape of the pattern is examined. The antireflective properties of such bi-periodic patterned surfaces are then discussed using the photonic crystal theory and photonic band diagrams description. Correlations between the density of Bloch modes, their localizations with respect to the incident medium light line and the surface reflectance are presented.

Effect of feeding glyphosate-tolerant (roundup-ready events GA21 or nk603) corn compared with reference hybrids on feedlot steer performance and carcass characteristics.

Three experiments were conducted to compare the feeding value of genetically enhanced corn (Roundup Ready corn events GA21 and nk603) with nontransgenic hybrids. The four treatments included two separate reference hybrids (REF), the near-isogenic control hybrid (CON), and the genetically enhanced corn (RR), resulting in two preplanned comparisons of CON vs. RR and RR vs. the average of REF. In Exp. 1 (RR event GA21), 175 steers (BW = 427 kg) were fed in 25 pens with seven pens per corn hybrid, except CON, which contained four pens due to limited quantities of that hybrid. In Exp. 2 (RR event nk603), 196 steers (BW = 420 kg) were fed in 28 pens with seven pens per corn. In Exp. 3 (RR event nk603), 200 steers were fed in 20 pens, with a similar treatment design to Exp. 2 and five pens per corn. All experiments were conducted as completely randomized designs and utilized corn produced at University of Illinois (Exp. 1 and 2) and University of Nebraska (Exp. 3) research farms under identity-preserved protocols. In all experiments, DMI, ADG, and feed efficiency were similar (P > 0.30) between RR and REF. In Exp. 1 and Exp. 2, RR was not different (P > 0.25) than CON for growth performance. In Exp. 3, RR was not different from CON for ADG and DMI (P > 0.15) or for feed efficiency (P = 0.08). No differences were observed between RR and CON or RR and REF for carcass weight, longissimus dorsi area, and marbling scores in any of the experiments. Subtle differences were observed between RR and either CON or REF for fat depth in each experiment; however, cattle fed RR were not consistently greater and varied from either the CON or the REF (but not both contrasts) within an experiment. Based on these results, insertion of glyphosate-tolerant genes had no significant effect on nutritive quality of corn. Performance and carcass characteristics were not influenced, which suggests that Roundup Ready corn is similar to conventional, nontransgenic corn when fed to finishing feedlot cattle.

Postnatal development and the differential expression of presynaptic terminal-associated proteins in the developing retina of the Brazilian opossum, Monodelphis domestica.

In the present study we have characterized the postnatal (PN) development of the retina in the Brazilian opossum, Monodelphis domestica. Monodelphis, a small, pouchless marsupial, undergoes a protracted period of postnatal development. Using bromodeoxyuridine immunohistochemistry, we have investigated postnatal neurogenesis of the retina. In addition, we have examined the differentiation of the retina by using antibodies directed against the presynaptic terminal-associated proteins synaptotagmin, Rab3A, synaptophysin and synaptosomal-associated protein-25 (SNAP-25), and have characterized their spatial and temporal distribution during postnatal development. This study is the first systematic comparison of the developmental expression of multiple presynaptic terminal-associated proteins in relation to retinal neurogenesis and differentiation. At birth (1PN), the Monodelphis retina was relatively undifferentiated morphologically and birthdating analysis revealed mitotically active cells throughout the retina. The 8PN retina was organized into two cellular layers: an outer region of mitotically active neuroepithelial cells and an inner region of postmitotic cells. The inner plexiform layer formed between 5PN and 10PN, and exhibited unique patterns of immunoreactivity with the antibodies used in this analysis. By 25PN the retina was well laminated, and synaptotagmin-, Rab3A-, synaptophysin- and SNAP-25-like immunoreactivities exhibited distinct and specific patterns within the plexiform layers, although they had not yet achieved their mature, adult patterns. These results indicate that each of these proteins exhibits developmentally regulated changes in its cellular localization, and therefore may play important roles during morphogenesis and synaptogenesis of the vertebrate retina.

Estudo microbiológico e citológico do trato genital de éguas / Microbiological and cytological study of the genital tract of mares

Estudou-se a flora microbiana de 810 amostras de "swabs" colhidos do trato genital de éguas de diferentes raças, com idades entre seis e 13 anos, durante o período de estro, e a citologia de esfregaços de secreçäo endometrial e a sensibilidade dos microrganismos isolados, frente a diferentes drogas antimicrobianas. Dos cultivos bacterianos realizados, 445 (54,9 por cento) foram isolados um ou mais microrganismos. Os mais frequente foram: Streptococcus sp (S. zooepidemicus 24,9 por cento, S. equisimilis 6,1 por cento, S. faecalis 5,6 por cento e S. equi 4,0 por cento), Staphylococcus sp (S. aureus 13,9 por cento, S. epidermidis 6,5 por cento e S. intermedius 3,1 por cento), Escherichia coli (E. coli näo hemolítica 8,5 por cento e E. coli beta hemolítica 3,8 por cento), Rhodococcus equi 7,4 por cento, Klebsiella pneumoniae 3,8 por cento, Candida albicans 3,4 por cento, Acinetobacter calcoaceticus 2,5 por cento, Pseudomonas aeruginosa 2,2 por cento, Proteus mirabilis 1,8 por cento, Alcaligines faecalis 1,6 por cento, Nocardia asteroides 0,7 por cento e Pasteurella hemolytica 0,4 por cento. A associaçäo entre os resultados obtidos nos exames microbiológicos e citológicos revelou x2 = 280,128 (P<0,001) e coeficiente de associaçäo significativa Psi = 0,59, concluindo-se que existe associaçäo significativa entre os dois tipos de exames. Segundo os antibiogramas, as drogas que melhor agiram sobre a maioria dos microrganismos foram cloranfenicol e gentamicina

[Cervical limits and contour forms as a function of material technology]. / Les limites cervicales et les formes de contour en fonction de la technologie et des matériaux utilisés.

The objectives of tooth preparation for porcelain crowns are emphasized in this article. The forms of contour described by Gonon, LE Huche, Poggioli and Leibowitch are reviewed in the first part. In the second part, the profile of the cervical limits and their evolution are described, according to the materials used. The importance of the marginal fit, in relation to microleakage and esthetics, is related in the third part.

[The trapped popliteal artery syndrome. About one bilateral case (author's transl)]. / Le syndrome de l'artère poplitée piégée. A propos d'un cas bilatéral.

The authors report on a new case of trapped popliteal artery syndrome. It was bilateral and revealed on one side by acute thrombotic ischemia, leading on this occasion to discovery of the opposite trap. They insist on the extremely easy diagnosis based on a dynamic examination of the limb. The distal pulses must be felt in intermediary position, then after tensing of the gastrocnemia by dorsiflexion of the foot and hyper extension of the knee. Blood velocity measurement by Doppler probes and bifemoralangiography, both dynamic, must precede imperative surgery.