Pesticide exposure, birth size, and gestational age in the ISA birth cohort, Costa Rica.

Purpose: To examine associations of prenatal biomarkers of pesticide exposure with birth size measures and length of gestation among newborns from the Infants' Environmental Health (ISA) birth cohort, Costa Rica. Methods: We included 386 singleton liveborn newborns with data on birth size measures, length of gestation, and maternal urinary biomarkers of chlorpyrifos, synthetic pyrethroids, mancozeb, pyrimethanil, and 2, 4-D during pregnancy. We associated biomarkers of exposure with birth outcomes using multivariate linear regression and generalized additive models. Results: Concentrations were highest for ethylene thiourea (ETU, metabolite of mancozeb), median = 3.40; p10-90 = 1.90-6.79 µg/L, followed by 3,5,6-trichloro-2-pyridinol (TCP, metabolite of chlorpyrifos) p50 = 1.76 p10-90 = 0.97-4.36 µg/L, and lowest for 2,4-D (p50 = 0.33 p10-90 = 0.18-1.07 µg/L). Among term newborns (≥37 weeks), higher prenatal TCP was associated with lower birth weight and smaller head circumference (e.g., ß per 10-fold-increase) during the second half of pregnancy = -129.6 (95% confidence interval [CI] = -255.8, -3.5) grams, and -0.61 (95% CI = -1.05, -0.17) centimeters, respectively. Also, among term newborns, prenatal 2,4-D was associated with lower birth weight (ß per 10-fold-increase = -125.1; 95% CI = -228.8, -21.5), smaller head circumference (ß = -0.41; 95% CI = -0.78, -0.03), and, during the second half of pregnancy, with shorter body length (ß = -0.58; 95% CI = -1.09, -0.07). Furthermore, ETU was nonlinearly associated with head circumference during the second half of pregnancy. Biomarkers of pyrethroids and pyrimethanil were not associated with birth size, and none of the biomarkers explained the length of gestation. Conclusions: Prenatal exposure to chlorpyrifos and 2,4-D, and, possibly, mancozeb/ETU, may impair fetal growth.

Assessment of Culture Systems to Produce Bacterial Cellulose with a Kombucha Consortium.

Bacterial cellulose (BC) is an emerging material for high-end applications due to its biocompatibility and physicochemical characteristics. However, the scale-up production of this material is still expensive, with the culture medium constituting one-third of the total cost. Herein, four different media (yeast nitrogen base, YNB; Murashige and Skoog, MSO; black tea; and NPK fertilizer solution) were compared while using sucrose as an additional carbon source. The yields of BC were best for YNB and fertilizer with 0.37 and 0.34 gBC/gC respectively. These two were then compared using glucose as a carbon source, with improvements in the production of 29% for the fertilizer, while only an 8% increase for YNB was seen; however, as the carbon concentration increased with a fixed N concentration, the yield was lower but the rate of production of BC increased. The obtained BC films were sanitized and showed low molecular weight and all the expected cellulose characteristic FT-IR bands while SEM showed nanofibers around 0.1 µm. Compared to traditional methods for lab-scale production, the use of the fertilizer and the consortium represent benefits compared to traditional lab-scale BC culture methods such as a competitive cost (two times lower) while posing resilience and tolerance to stress conditions given that it is produced by microbial communities and not with a single strain. Additionally, the low molecular weight of the films could be of interest for certain coating formulations.

In vitro activity of ceftazidime-avibactam against gram-negative bacteria in patients with bacteremia and skin and soft-tissue infections in Colombia 2019-2021.

OBJECTIVES: Ceftazidime-avibactam (CAZ-AVI) is an option for infections caused by MDR gram-negative bacilli. In this study, we aimed to analyze the in vitro antimicrobial activity of CAZ-AVI and other antimicrobial agents against gram-negative bacilli that were collected in Colombia between 2019 and 2021 from patients with bacteremia and skin and soft-tissue infections (SSTIs). METHODS: A total of 600 Enterobacterales and 259 P. aeruginosa strains were analyzed. The phenotypic resistance of isolates, particularly non-susceptibility to meropenem, multidrug-resistant (MDR) isolates, and difficult-to-treat (DTR) P. aeruginosa, was evaluated according to CLSI breakpoints. RESULTS: Enterobacterales had the most susceptibility to CAZ-AVI (96.5 %) and tigecycline (95 %). Tigecycline and CAZ-AVI were the antimicrobial agents with the most in vitro activity against carbapenem-resistant Enterobacterales (CRE). CAZ-AVI was the antimicrobial treatment with the most activity against P. aeruginosa. CONCLUSIONS: Tigecycline and CAZ-AVI were the antimicrobial agents with the most activity against CRE and MDR Enterobacterales. For P. aeruginosa, CAZ-AVI was the antimicrobial treatment with the most in vitro activity.

Prediction of steel plate-based damper for improving the behavior of concentrically braced frames based on RSM and ML approaches for sustainable structures.

The stiffness (K) and slenderness factor (λ) of a steel plate-based damper has been studied on the basis of elastic-inelastic-plastic buckling (EIP) modes and flexural/shear/flexural-shear failure mechanisms (FSF-S), which has been designed for the improvement of the behavior of concentrically braced frames. Steel plate-based dampers offer significant benefits in terms of mode shapes and failure mechanisms, contributing to improved dynamic performance, enhanced structural resilience, and increased safety of civil engineering structures. Their effectiveness in mitigating dynamic loads makes them a valuable tool for engineers designing structures to withstand extreme environmental conditions and seismic events. This study was undertaken by using the learning abilities of the response surface methodology (RSM), artificial neural network (ANN) and the evolutionary polynomial regression (EPR). Steel plate dampers are special structural designs used to withstand the effect of special loading conditions especially seismic effects. Its design based on the prediction of its stiffness (K) and slenderness factor (λ) cannot be overlooked in the present-day artificial intelligence technology. In this research work, thirty-three entries based on the steel plate damper geometrical properties were recorded and deployed for the intelligent forecast of the fundamental properties (λ and K). Design ratios of the steel plate damper properties were considered and models behavior was recorded. From the outcome of the model, it can be observed that even though the EPR and ANN in that order outclassed the other techniques, the RSM produced model minimization and maximization features of the desirability levels, color factor scales and 3D surface observation, which shows the real model behaviors. Overall, the EPR with R2 of 0.999 and 1.000 for the λ and K, respectively showed to be the decisive model but the RSM has features that can be beneficial to the structural design of the studied steel plate damper for a more robust and sustainable construction. With these performances recorded in this exercise, the techniques have shown their potential to be applied in the prediction of steel damper stiffness with optimized characteristic features to withstand structural stresses.

Conjunctival ultraviolet autofluorescence as a biomarker of outdoor exposure in myopia: a systematic review and meta-analysis.

Outdoor exposure is considered the primary modifiable risk factor in preventing the development of myopia. This effect is thought to be attributed to the light-induced synthesis and release of dopamine in the retina. However, until recent years, there was no objective quantifiable method available to measure the association between time spent outdoors and myopia. It is only recently that the conjunctival ultraviolet autofluorescence (CUVAF) area, serving as a biomarker for sun exposure, has begun to be utilized in numerous studies. To provide a comprehensive summary of the relevant evidence pertaining to the association between the CUVAF area and myopia across different geographic regions and age groups, a systematic review and meta-analysis were conducted. The search encompassed multiple databases, including MEDLINE, SCIENCE DIRECT, GOOGLE SCHOLAR, WEB OF SCIENCE, and SCOPUS, and utilized specific search terms such as "conjunctival ultraviolet autofluorescence", "CUVAF", "UVAF", "objective marker of ocular sun exposure", "myopia", "degenerative myopia", and "high myopia". The bibliographic research included papers published between the years 2006 and 2022. A total of 4051 records were initially identified, and after duplicates were removed, 49 articles underwent full-text review. Nine articles were included in the systematic review. These studies covered myopia and outdoor exposure across different regions (Australia, Europe and India) with a total population of 3615 individuals. They found that myopes generally had smaller CUVAF areas compared to non-myopes. The meta-analysis confirmed this, revealing statistically smaller CUVAF areas in myopic patients, with a mean difference of - 3.30 mm2 (95% CI - 5.53; - 1.06). Additionally, some studies showed a positive correlation between more outdoor exposure and larger CUVAF areas. In terms of outdoor exposure time, myopic patients reported less time outdoors than non-myopic individuals, with a mean difference of - 3.38 h/week (95% CI - 4.66; - 2.09). Overall, these findings highlight the connection between outdoor exposure, CUVAF area and myopia, with regional variations playing a significant role. The results of this meta-analysis validate CUVAF as a quantitative method to objectively measure outdoor exposure in relation with myopia development.

In vitro activity of ceftazidime-avibactam against Gram-negative strains in Chile 2015-2021.

OBJECTIVES: Ceftazidime-avibactam (CAZ-AVI) combines ceftazidime and a reversible ß-lactamase inhibitor that has shown activity against multidrug-resistant (MDR) Enterobacterales and P. aeruginosa. Using data from the Antimicrobial Testing Leadership and Surveillance program (ATLAS), this study examined the in vitro antimicrobial activity of CAZ-AVI and other antibiotics against Gram-negative bacteria collected from Chilean hospitals between 2015 and 2021. METHODS: Clinical isolates of Enterobacterales and P. aeruginosa were collected from three medical centres in Chile. Blood, abdominal fluid, urine, soft tissues, and respiratory tract samples were obtained from infected patients. Minimum inhibitory concentrations using the broth microdilution method were determined for susceptibility testing, and the Clinical and Laboratory Standards Institute (CLSI) breakpoints were used for interpreting the results. Extended-spectrum ß-lactamases (ESBL) and carbapenemase genes were also detected through polymerase chain reaction. RESULTS: A total of 2600 Enterobacterales and 836 P. aeruginosa were analysed. CAZ-AVI was the antibiotic with the highest in vitro activity against Enterobacterales (99.72%). The incidence of carbapenem-resistant Enterobacterales (CRE) was 1.5% (n = 39), and the antibiotics with the best in vitro activity were tigecycline (92.31%), CAZ-AVI (88.57%), and amikacin (79.49%). CAZ-AVI was the antibiotic with the best activity against ESBL-producing Enterobacterales (99.34%) and MDR Enterobacterales (99.31%). For KPC-producing Enterobacterales, susceptibility to amikacin was 100%, whereas susceptibility to CAZ-AVI was 91.67%. Regarding MDR and difficult-to-treat resistance P. aeruginosa, 44.83% and 38.99% were susceptible to CAZ-AVI, respectively. CONCLUSION: CAZ-AVI shows excellent in vitro activity against Enterobacterales in general, CRE, ESBL-producing Enterobacterales, and KPC-producing Enterobacterales. CAZ-AVI is also an option against MDR P. aeruginosa.

A cross-sectional analysis of medical conditions and environmental factors associated with fractional exhaled nitric oxide (FeNO) in women and children from the ISA birth cohort, Costa Rica.

BACKGROUND: Fractional exhaled nitric oxide (FeNO) is a marker of airway inflammation. Elevated FeNO has been associated with environmental exposures, however, studies from tropical countries are limited. Using data from the Infants' Environmental Health Study (ISA) birth cohort, we evaluated medical conditions and environmental exposures' association with elevated FeNO. METHODS: We performed a cross-sectional analysis of 277 women and 293 8-year old children who participated in the 8-year post-partum visit in 2019. We measured FeNO and collected information on medical conditions and environmental exposures including smoke from waste burning, work in banana plantations, and home pesticide use. We defined elevated FeNO as >25 ppb for women and >20 ppb for children. To evaluate factors associated with elevated FeNO, we used logistic regression models adjusted for obesity in women and unadjusted in children. RESULTS: Overall elevated FeNO was common (20% of women, 13% of children). Rhinitis diagnosis was significantly associated with elevated FeNO in both women (odds ratio (OR): 3.67 95% Confidence Interval (CI): 1.81,7.35) and children (OR: 8.18 95%CI: 3.15, 21.22); wheeze was associated with elevated FeNO in women (OR: 4.50 95% CI: 2.25, 8.99). Environmental exposures were associated with elevated FeNO, but not significantly. Waste burning was associated with elevated FeNO in both women (OR: 1.58 95%CI 0.68, 4.15) and children (OR: 2.49 95%CI:0.82, 10.79). Para-occupational pesticide exposures were associated with elevated FeNO in women and children. For women, having a partner working in agriculture was associated with elevated FeNO (OR: 1.61 95%CI:0.77, 3.58) and for children, maternal work in agriculture was associated with elevated FeNO. (OR 2.08 95%CI 0.86, 4.67) CONCLUSION: Rhinitis and wheeze were associated with elevated FeNO in this rural, agricultural population. Smoke from waste burning as well as para-occupational pesticide exposure may contribute to elevated FeNO in rural communities.

Respiratory and allergic outcomes among 5-year-old children exposed to pesticides.

BACKGROUND: Little is known about the effects of pesticides on children's respiratory and allergic outcomes. We evaluated associations of prenatal and current pesticide exposures with respiratory and allergic outcomes in children from the Infants' Environmental Health Study in Costa Rica. METHODS: Among 5-year-old children (n=303), we measured prenatal and current specific gravity-corrected urinary metabolite concentrations of insecticides (chlorpyrifos, pyrethroids), fungicides (mancozeb, pyrimethanil, thiabendazole) and 2,4-D. We collected information from caregivers on respiratory (ever doctor-diagnosed asthma and lower respiratory tract infections (LRTI), wheeze and cough during last 12 months) and allergic (nasal allergies, itchy rash, ever eczema) outcomes. We fitted separate multivariable logistic regression models for high (≥75th percentile (P75)) vs low (

Incertidumbre en cuidadores en asociación con la carga de síntomas de pacientes terminales / Uncertainty in caregivers in association with symptom burden of terminally ill patients / Incerteza nos cuidadores em associação com a carga de sintomas de pacientes terminais

Objetivo: Determinar el nivel de incertidumbre del cuidador familiar (CF) de la persona hos-pitalizada en fase terminal y su asociación con carga de síntomas y funcionalidad del paciente. Materiales y método: Estudio observacional de tipo corte transversal, donde se identificó la prevalencia de incertidumbre en el CF de pacientes hospitalizados en fase terminal usando la escala de incertidumbre. Adicionalmente, se evaluó la carga de síntomas mediante escala Edmonton del paciente terminal hospitalizado en una institución de salud de alta complejidad. Resultados: La muestra incluyó información de 69 CF y pacientes terminales hospitalizados. El 85,51% de los cuidadores tuvo un nivel de incertidumbre medio. Se observó un nivel es-tadísticamente significativo de incertidumbre menor en el CF, a mayor intensidad de dolor del paciente (p=0,04), al igual que en náuseas (p=0,0004), depresión (p=0,03) y ansiedad (p=0,025) según carga de síntomas. Discusión: La vivencia del cuidador de un paciente terminal, refle-jada en la incertidumbre frente a la enfermedad de este, se relaciona principalmente con la de-pendencia funcional del enfermo, debido probablemente al impacto que su falta de suficiencia puede generar en las rutinas diarias del cuidador familiar, lo cual, puede alterar completamente la dinámica familiar y generar sobrecarga, estrés, ansiedad y trastornos en la comunicación. Conclusión: La mayoría de CF de pacientes terminales son mujeres en edad productiva, con carga familiar, y con nivel de incertidumbre medio alto frente a la enfermedad del paciente. La incertidumbre del cuidador familiar es diferente según los síntomas que presenta el paciente.

Objective: To determine the level of uncertainty of the family caregiver (FC) of the terminally hospitalised person and its association with symptom burden and patient functionality. Mate-rials and methods: Observational cross-sectional study, in which the prevalence of uncertain-ty in the FC of terminally ill hospitalised patients was identified using the uncertainty scale. In addition, the symptom burden was assessed using the Edmonton scale in terminally ill patients hospitalised in a highly complex health institution. Results: The sample included information from 69 CF and terminally ill hospitalised patients. 85.51% of caregivers had a medium level of uncertainty. A statistically significant lower level of uncertainty was observed in the CF, the greater the intensity of the patient's pain (p=0.04), as well as in nausea (p=0.0004), de-pression (p=0.03) and anxiety (p=0.025) according to symptom burden. Discussion: The ex-perience of the caregiver of a terminally ill patient, reflected in the uncertainty of the patient's illness, is mainly related to the functional dependence of the patient, probably due to the impact that their lack of sufficiency can have on the daily routines of the family caregiver, which can completely alter the family dynamics and generate overload, stress, anxiety and communica-tion disorders. Conclusion: The majority of FC of terminally ill patients are women of produc-tive age, with a family burden, and with a medium-high level of uncertainty about the patient's illness. The uncertainty of the family caregiver is different according to the patient's symptoms

Objetivo: Determinar o nível de incerteza do cuidador familiar (CF) da pessoa hospitalizada em estado terminal e sua associação com a carga de sintomas e a funcionalidade do paciente. Mate-riais e métodos: Estudo observacional de corte transversal, no qual a prevalência de incerteza no CF de pacientes terminais hospitalizados foi identificada usando a escala de incerteza. Além dis-so, a carga de sintomas de pacientes terminais hospitalizados em uma instituição de saúde de alta complexidade foi avaliada usando a escala de Edmonton. Resultados: A amostra incluiu infor-mações de 69 pacientes com FC e pacientes terminais hospitalizados. 85,51% dos cuidadores tin-ham um nível médio de incerteza. Foi observado um nível de incerteza estatisticamente significa-tivo menor na FC quanto maior a intensidade da dor do paciente (p=0,04), bem como na náusea (p=0,0004), depressão (p=0,03) e ansiedade (p=0,025) de acordo com a carga de sintomas. Dis-cussão: A experiência do cuidador de um paciente terminal, refletida na incerteza da doença do paciente, está relacionada principalmente à dependência funcional do paciente, provavelmente devido ao impacto que sua falta de suficiência pode ter nas rotinas diárias do cuidador familiar, o que pode alterar completamente a dinâmica familiar e gerar sobrecarga, estresse, ansiedade e distúrbios de comunicação. Conclusão: A maioria dos CF de pacientes terminais são mulheres em idade produtiva, com ônus familiar e com um nível médio-alto de incerteza sobre a doença do paciente. A incerteza do cuidador familiar é diferente de acordo com os sintomas do paciente.

Stability of DL-Glyceraldehyde under Simulated Hydrothermal Conditions: Synthesis of Sugar-like Compounds in an Iron(III)-Oxide-Hydroxide-Rich Environment under Acidic Conditions.

Researchers have suggested that the condensation of low-molecular-weight aldehydes under basic conditions (e.g., pH > 11) is the prebiotic reaction responsible for the abiotic formation of carbohydrates. It has also been suggested that surface hydrothermal systems were ubiquitous during the early Archean period. Therefore, the catalysis of prebiotic carbohydrate synthesis by metallic oxide minerals under acidic conditions in these environments seems considerably more probable than the more widely hypothesized reaction routes. This study investigates the stability of DL-glyceraldehyde and its reaction products under the simulated conditions of an Archean surface hydrothermal system. The Hveradalur geothermal area in Iceland was selected as an analog of such a system. HPLC-ESIMS, UV−Vis spectroscopy, Raman spectroscopy and XPS spectroscopy were used to analyze the reaction products. In hot (323 K) and acidic (pH 2) solutions under the presence of suspended iron(III) oxide hydroxide powder, DL-glyceraldehyde readily decomposes into low-molecular-weight compounds and transforms into sugar-like molecules via condensation reactions.

Efficacy and Safety of Vagus Nerve Stimulation on Upper Limb Motor Recovery After Stroke. A Systematic Review and Meta-Analysis.

Background: Upper limb motor impairment is one of the main complications of stroke, affecting quality of life both for the patient and their family. The aim of this systematic review was to summarize the scientific evidence on the safety and efficacy of Vagus Nerve Stimulation (VNS) on upper limb motor recovery after stroke. Methods: A systematic review and meta-analysis of studies that have evaluated the efficacy or safety of VNS in stroke patients was performed. The primary outcome was upper limb motor recovery. A search of articles published on MEDLINE, CENTRAL, EBSCO and LILACS up to December 2021 was performed, and a meta-analysis was developed to calculate the overall effects. Results: Eight studies evaluating VNS effects on motor function in stroke patients were included, of which 4 used implanted and 4 transcutaneous VNS. It was demonstrated that VNS, together with physical rehabilitation, increased upper limb motor function on average 7.06 points (95%CI 4.96; 9.16) as assessed by the Fugl-Meyer scale. Likewise, this improvement was significantly greater when compared to a control intervention (mean difference 2.48, 95%CI 0.98; 3.98). No deaths or serious adverse events related to the intervention were reported. The most frequent adverse events were dysphonia, dysphagia, nausea, skin redness, dysgeusia and pain related to device implantation. Conclusion: VNS, together with physical rehabilitation, improves upper limb motor function in stroke patients. Additionally, VNS is a safe intervention.

Pyrimethanil and chlorpyrifos air concentrations and pregnant women's urinary metabolites in the Infants' Environmental Health Study (ISA), Costa Rica.

BACKGROUND: Only few studies have compared environmental pesticide air concentrations with specific urinary metabolites to evaluate pathways of exposure. Therefore, we compared pyrimethanil and chlorpyrifos concentrations in air with urinary 4-hydroxypyrimethanil (OHP, metabolite of pyrimethanil) and 3,5,6-trichloro-2-pyridinol (TCPy, metabolite of chlorpyrifos) among pregnant women from the Infant's Environmental Health Study (ISA) in Matina County, Costa Rica. METHODS: During pregnancy, we obtained repeat urinary samples from 448 women enrolled in the ISA study. We extrapolated pyrimethanil and chlorpyrifos concentrations measured with passive air samplers (PAS) (n = 48, from 12 schools), across space and time using a Bayesian spatiotemporal model. We subsequently compared these concentrationswith urinary OHP and TCPy in 915 samples from 448 women, usingseparatemixed models andconsidering several covariables. RESULTS: A 10% increase in air pyrimethanil (ng/m3) was associated with a 5.7% (95% confidence interval (CI 4.6, 6.8) increase in OHP (µg/L). Women living further from banana plantations had lower OHP: -0.7% (95% CI -1.2, -0.3) for each 10% increase in distance (meters) as well as women who ate rice and beans ≥15 times a week -23% (95% CI -38, -4). In addition, each 1 ng/m3 increase in chlorpyrifos in air was associated with a 1.5% (95% CI 0.2, 2.8) increase in TCPy (µg/L), and women working in agriculture tended to have increased TCPy (21%, 95% CI -2, 49). CONCLUSION: The Bayesian spatiotemporal models were useful to estimate pyrimethanil and chlorpyrifos air concentrations across space and time. Our results suggest inhalation of pyrimethanil and chlorpyrifos is a pathway of environmental exposure. PAS seems a useful technique to monitor environmental current-use pesticide exposures. For future studies, we recommend increasing the number of locations of environmental air measurements, obtaining all air and urine measurements during the same month, and, ideally, including dermal exposure estimates as well.

In vitro activity of ceftazidime-avibactam against Gram-negative strains in patients with complicated urinary tract infection and complicated intra-abdominal infection in Colombia 2014-2018.

Ceftazidime/avibactam (CAZ/AVI) has excellent in vitro activity against enterobacterales and Pseudomonas aeruginosa. The study aimed to analyze the in vitro antimicrobial activity of CAZ/AVI and other antibiotics against isolates of enterobacterales and P. aeruginosa from patients with complicated urinary tract infection (cUTI) and complicated intra-abdominal infection (cIAI) in Colombian hospitals between 2014 and 2018, using the Antimicrobial Testing Leadership and Surveillance (ATLAS) database. Enterobacterales and P. aeruginosa samples were obtained from patients with cUTI and cIAI. Susceptibility was determined using The Clinical and Laboratory Standards Institute (CLSI) breakpoints. Meropenem-non-susceptible isolates were screened for extended-spectrum ß-lactamase (ESBL) production. Isolates that were positive for ESBL activity were examined by Multiplex Polymerase Chain Reaction (Multiplex PCR) to detect genotypic resistance. A total of 565 Enterobacterales and 95 P. aeruginosa from patients with cUTI and 345 Enterobacterales and 65 P. aeruginosa from patients with cIAI were isolated. In vitro activity showed susceptibility to CAZ/AVI greater than 99% for Enterobacterales and in lower percentages for P. aeruginosa in cUTI (78.46%) and cIAI (83.33%). CAZ/AVI showed good in vitro activity against multidrug-resistant (MDR) Enterobacterales and P. aeruginosa in patients with cUTI and cIAI.

Multisystemic Inflammatory Syndrome in Children From the South of Colombia: One Year of Experience.

Background: Multisystemic inflammatory syndrome in children (MIS-C) is one of the most severe presentations of COVID-19 infection in pediatrics. Currently, we have few studies that describe the characteristics of this condition in Colombian children. Objective: To describe the clinical and epidemiological characteristics of children hospitalized with MIS-C in Neiva, Colombia. Methods: Observational follow-up study of a cohort of children with MIS-C for 12 months (May 15, 2020, to May 30, 2021) in two hospitals in the city of Neiva. Epidemiological data, clinical characteristics, laboratory characteristics, cardiological evaluation, treatment, and clinical outcomes were analyzed. Results: We included 34 patients who met the diagnosis of MIS-C. The median age was 68 months. Some type of nutritional issue was observed by 43.75% of those under 5 years of age and by 27.78% of those over 5 years of age. Gastrointestinal symptoms were the most frequent, with vomiting, diarrhea, and abdominal pain being the most frequent by 79, 70, and 67%, respectively. By 77% of the patients, a history of SARS-COV-2 infection was documented through IgG. In the echocardiogram, 35.4% of the patients had systolic dysfunction, followed by coronary involvement by 35%. Conclusion: This study describes a series of cases of children with MIS-C in Colombia. Gastrointestinal manifestations were predominant. Mortality was high in comparison to other countries but similar to that reported in Colombia. This fact was associated with relevant pathological background. More training is required for physicians in order to have a better understanding of the disease so as to have an early diagnosis and timely treatment.

In vitro activity of ceftazidime/avibactam against Gram-negative strains in Colombia 2014-2018.

OBJECTIVES: Ceftazidime/avibactam (CAZ/AVI) has shown in vitro activity against multidrug-resistant (MDR) Gram-negative bacteria, especially Enterobacterales and carbapenem-resistant Pseudomonas aeruginosa. However, in vitro activity of CAZ/AVI against Gram-negative bacteria in Colombian hospitals is still unknown. The study aimed to analyse the in vitro antimicrobial activity of CAZ/AVI against Gram-negative bacteria collected from hospitals in Colombia using the Antimicrobial Testing Leadership and Surveillance (ATLAS) database. METHODS: Enterobacterales and P. aeruginosa samples were obtained from four hospitals in Colombia between 2014 and 2018. Samples of blood, abdominal fluid, urine, soft tissues, and respiratory tract were collected from adult and paediatric patients. The 2020 Clinical and Laboratory Standards Institute (CLSI) breakpoints were used for the interpretation of susceptibility. Meropenem-non-susceptible Enterobacterales and P. aeruginosa isolates were screened for extended-spectrum ß-lactamase (ESBL) production. Isolates that were positive for ESBL activity were examined by PCR for detecting genotypic resistance. RESULTS: A total of 2005 Enterobacterales were isolated; 29.28% were not susceptible to levofloxacin, 29.14% to aztreonam, and 25.19% to cefepime. The CAZ/AVI was the antibiotic with the best susceptibility against carbapenem-resistant Enterobacterales (CRE) (94.64%), non-metallo-ß-lactamase(MBL)-producing Enterobacterales (98.06%), and MDR Enterobacterales (98.36%). For carbapenem-resistant P. aeruginosa, in vitro activity of CAZ/AVI was 59.26%, and 50% for non-MBL-producing P. aeruginosa. CONCLUSION: CAZ/AVI shows excellent in vitro activity against MDR Enterobacterales and CRE. For MDR P. aeruginosa and carbapenem-resistant P. aeruginosa, in vitro activity of CAZ/AVI was lower compared to the activity against Enterobacterales, but CAZ/AVI was the antibiotic with the best activity.

Exposure to common-use pesticides, manganese, lead, and thyroid function among pregnant women from the Infants' Environmental Health (ISA) study, Costa Rica.

BACKGROUND: Pesticides and metals may disrupt thyroid function, which is key to fetal brain development. OBJECTIVES: To evaluate if current-use pesticide exposures, lead and excess manganese alter free thyroxine (FT4), free triiodothyronine (FT3), and thyroid stimulating hormone (TSH) concentrations in pregnant women from the Infants' Environmental Health Study (ISA). METHODS: At enrollment, we determined women's (n = 400) specific-gravity corrected urinary pesticide (µg/L) metabolite concentrations of mancozeb (ethylene thiourea (ETU)), pyrimethanil, thiabendazole, chlorpyrifos, synthetic pyrethroids, and 2,4-D. We also measured manganese hair (MnH) (µg/g) and blood (MnB) (µg/L), and blood lead (PbB) (µg/L) concentrations. To detect an immediate and late effect on thyroid homeostasis, we determined TSH, FT4 and FT3 in serum obtained at the same visit (n = 400), and about ten weeks afterwards (n = 245). We assessed associations between exposures and outcomes with linear regression and general additive models, Bayesian multivariate linear regression, and Bayesian kernel machine regression. RESULTS: About 80%, 94%, and 100% of the women had TSH, FT4, and FT3 within clinical reference ranges, respectively. Women with higher urinary ETU, and pyrimethanil-metabolites, had lower FT4: ß = -0.79 (95%CI = -1.51, -0.08) and ß = -0.29 (95%CI = -0.62, -0.03), respectively, for each tenfold increase in exposure. MnB was positively associated with FT4 (ß = 0.04 (95%CI = 0.00, 0.07 per 1 µg/L increase), and women with high urinary pyrethroid-metabolite concentrations had decreased TSH (non-linear effects). For the late-effect analysis, metabolites of pyrethroids and chlorpyrifos, as well as MnH, and PbB were associated decreased TSH, or increased FT4 and/or FT3. DISCUSSION: Mancozeb (ETU) and pyrimethanil may inhibit FT4 secretion (hypothyroidism-like effect), while chlorpyrifos, pyrethroids, MnB, MnH, PbB and Mn showed hyperthyroidism-like effects. Some effects on thyroid homeostasis seemed to be immediate (mancozeb (ETU), pyrimethanil, MnB), others delayed (chlorpyrifos, MnH, PbB), or both (pyrethroids), possibly reflecting different mechanisms of action.

Aligning recycling behaviors and the recycling system - Towards a full cycle of materials and behavioral methods.

In a transdisciplinary project with the Municipality of Trelew (Argentina), we assessed barriers to households disposing of separated waste, developed supportive behavioral interventions, tested the interventions in a randomized controlled trial, and supported the Municipality in upscaling the most successful and cost-effective intervention to a total of 20,000 households. The interventions were designed to address the three main barriers to waste separation detected through a baseline study: a lack of knowledge on how separation works; the additional hassle it represents; and the self-regulation challenge it poses. The interventions consisted of envelopes containing simplifying information, empathetic messages, a magnetic calendar acting as a reminder, or a combination thereof. The interventions roughly halved the prevalence of bags containing unusable mixed waste two weeks after the intervention. This impact was still present after six months. We did not find evidence for an additional effect of empathetic messages or the reminder. Based on these results, the simplified information intervention was rolled out. The results provide evidence of the high potential of using the full range of behavioral methods to increase sustainable behaviors, particularly in the context of limited options to adapt the waste management system as such.

In vitro activity of ceftazidime-avibactam against Gram-negative strains in patients with complicated urinary tract infection and complicated intra-abdominal infection in Colombia 2014-2018

ABSTRACT Ceftazidime/avibactam (CAZ/AVI) has excellent in vitro activity against enterobacterales and Pseudomonas aeruginosa. The study aimed to analyze the in vitro antimicrobial activity of CAZ/AVI and other antibiotics against isolates of enterobacterales and P. aeruginosa from patients with complicated urinary tract infection (cUTI) and complicated intra-abdominal infection (cIAI) in Colombian hospitals between 2014 and 2018, using the Antimicrobial Testing Leadership and Surveillance (ATLAS) database. Enterobacterales and P. aeruginosa samples were obtained from patients with cUTI and cIAI. Susceptibility was determined using The Clinical and Laboratory Standards Institute (CLSI) breakpoints. Meropenem-non-susceptible isolates were screened for extended-spectrum b-lactamase (ESBL) production. Isolates that were positive for ESBL activity were examined by Multiplex Polymerase Chain Reaction (Multiplex PCR) to detect genotypic resistance. A total of 565 Enterobacterales and 95 P. aeruginosa from patients with cUTI and 345 Enterobacterales and 65 P. aeruginosa from patients with cIAI were isolated. In vitro activity showed susceptibility to CAZ/AVI greater than 99% for Enterobacterales and in lower percentages for P. aeruginosa in cUTI (78.46%) and cIAI (83.33%). CAZ/AVI showed good in vitro activity against multidrug-resistant (MDR) Enterobacterales and P. aeruginosa in patients with cUTI and cIAI.

Extended axial irradiances: Barker rings.

For extending focal depth we employ a set of transparent concentric rings, which are coded with the Barker sequences of length L. At the neighborhood of the paraxial focal plane, these transparent masks generate an axial uniform distribution, which is modulated with sinusoidal variations. For imaging applications, one can extend focal depth if the Barker length is congruent to unity modulo 4. And, for optical trapping, a bottle neck irradiance distribution is generated if the Barker length is congruent to three modulo 4.