Beyond antibiotic prescribing rates: first-line antibiotic selection, prescription duration, and associated factors for respiratory encounters in urgent care

Abstract Objective: Assess urgent care (UC) clinician prescribing practices and factors associated with first-line antibiotic selection and recommended duration of therapy for sinusitis, acute otitis media (AOM), and pharyngitis. Design: Retrospective cohort study. Participants: All respiratory UC encounters and clinicians in the Intermountain Health (IH) network, July 1st, 2019–June 30th, 2020. Methods: Descriptive statistics were used to characterize first-line antibiotic selection rates and the duration of antibiotic prescriptions during pharyngitis, sinusitis, and AOM UC encounters. Patient and clinician characteristics were evaluated. System-specific guidelines recommended 5–10 days of penicillin, amoxicillin, or amoxicillin-clavulanate as first-line. Alternative therapies were recommended for penicillin allergy. Generalized estimating equation modeling was used to assess predictors of first-line antibiotic selection, prescription duration, and first-line antibiotic prescriptions for an appropriate duration. Results: Among encounters in which an antibiotic was prescribed, the rate of first-line antibiotic selection was 75%, the recommended duration was 70%, and the rate of first-line antibiotic selection for the recommended duration was 53%. AOM was associated with the highest rate of first-line prescriptions (83%); sinusitis the lowest (69%). Pharyngitis was associated with the highest rate of prescriptions for the recommended duration (91%); AOM the lowest (51%). Penicillin allergy was the strongest predictor of non–first-line selection (OR = 0.02, 95% CI [0.02, 0.02]) and was also associated with extended duration prescriptions (OR = 0.87 [0.80, 0.95]). Conclusions: First-line antibiotic selection and duration for respiratory UC encounters varied by diagnosis and patient characteristics. These areas can serve as a focus for ongoing stewardship efforts

Response of Bortezomib Chemotherapy in Hepatic Amyloidosis

Amyloidosis is a rare disorder with a wide spectrum of presentations and anomalies. It is subdivided into 2 broad categories based on protein deposition; primary and secondary amyloidosis. It can present as a single-organ involvement or as a diffuse infiltrative multi-organ process. Isolated hepatic amyloidosis presentation is a rare phenomenon that develops due to insoluble amyloid deposition in liver. Its clinical presentation is usually vague and ranges from mild hepatomegaly with elevated liver enzymes to acute liver failure and hepatic rupture. Currently, there are scarce data available regarding treatment options for biopsy-proven hepatic amyloidosis. In this review article, we present an interesting case of hepatic amyloidosis and its poor outcome to new molecular targeted chemotherapy. Furthermore, we aim to review current and future diagnostic tools for early detection and advancements in targeted chemotherapeutics options available for hepatic amyloidosis

Beyond antibiotic prescribing rates: first-line antibiotic selection, prescription duration, and associated factors for respiratory encounters in urgent care

OBJECTIVE: Assess urgent care (UC) clinician prescribing practices and factors associated with first-line antibiotic selection and recommended duration of therapy for sinusitis, acute otitis media (AOM), and pharyngitis. DESIGN: Retrospective cohort study. PARTICIPANTS: All respiratory UC encounters and clinicians in the Intermountain Health (IH) network, July 1st, 2019-June 30th, 2020. METHODS: Descriptive statistics were used to characterize first-line antibiotic selection rates and the duration of antibiotic prescriptions during pharyngitis, sinusitis, and AOM UC encounters. Patient and clinician characteristics were evaluated. System-specific guidelines recommended 5-10 days of penicillin, amoxicillin, or amoxicillin-clavulanate as first-line. Alternative therapies were recommended for penicillin allergy. Generalized estimating equation modeling was used to assess predictors of first-line antibiotic selection, prescription duration, and first-line antibiotic prescriptions for an appropriate duration. RESULTS: Among encounters in which an antibiotic was prescribed, the rate of first-line antibiotic selection was 75%, the recommended duration was 70%, and the rate of first-line antibiotic selection for the recommended duration was 53%. AOM was associated with the highest rate of first-line prescriptions (83%); sinusitis the lowest (69%). Pharyngitis was associated with the highest rate of prescriptions for the recommended duration (91%); AOM the lowest (51%). Penicillin allergy was the strongest predictor of non-first-line selection (OR = 0.02, 95% CI [0.02, 0.02]) and was also associated with extended duration prescriptions (OR = 0.87 [0.80, 0.95]). CONCLUSIONS: First-line antibiotic selection and duration for respiratory UC encounters varied by diagnosis and patient characteristics. These areas can serve as a focus for ongoing stewardship efforts

Multimodal imaging reveals the spatiotemporal dynamics of recollection.

Functional MRI research suggests that different frontal and parietal cortical regions support strategic processes that are engaged at different stages of recollection, from pre-retrieval processing of a cue to post-retrieval maintenance and evaluation of recollected information. Whereas some of these regions respond in a domain-general way, other regions are sensitive to the type of information being recollected. However, the low temporal resolution of fMRI cannot distinguish component processes at the time-scale at which recollection occurs. We therefore combined fMRI with the excellent temporal resolution of source localised EEG/MEG to investigate the spatiotemporal neural dynamics of recollection. fMRI and EEG/MEG data were collected from the same participants in two sessions while they retrieved different types of episodic information. This multimodal imaging approach revealed striking consistency between the regions identified with fMRI and EEG/MEG, providing novel evidence of how these brain areas interact over time to support source recollection. For domain-general recollection, results from both modalities converged in showing the strongest activations in medial parietal cortex, which according to EEG/MEG was reliable at a late retrieval stage. Domain-specific source recollection increased fMRI and EEG/MEG activation in the left lateral prefrontal cortex, which EEG/MEG indicated also to be recruited during a post-recollection stage. The findings suggest that although medial parietal and left lateral prefrontal regions mediate functionally different retrieval processes, they are both engaged at a late stage of episodic retrieval

Efeito do raleio e do anelamento do tronco no crescimento, produção e qualidade da ameixeira japonesa Effect of thinning and of trunk girdling on growth, production and quality of japanese plums

Na produção de ameixas (Prunus salicina Lindley) para consumo in natura, o tamanho do fruto é um dos aspectos mais valorizados. O raleio de frutos é tradicionalmente utilizado para obter, entre outros efeitos, a melhoria do tamanho dos frutos remanescentes. Uma antiga prática, que está recebendo renovada atenção, é o anelamento, que em muitas situações pode aumentar o tamanho dos frutos e antecipar a colheita. Este trabalho avaliou os efeitos do raleio manual de frutos em intensidades de 0, 25, 50 e 75%, associado ou não ao anelamento do tronco (4 mm de largura), sobre o crescimento, a produção e a qualidade da ameixeira cv. Amarelinha. O experimento foi conduzido na Estação Experimental Agronômica da Universidade Federal do Rio Grande do Sul (EEA/UFRGS) no ciclo 1995/96. O raleio foi realizado em 16/10/95, 36 dias após a plena floração, e o anelamento, sete dias após o raleio. O raleio reduziu a produção proporcionalmente à intensidade de raleio aplicada. O anelamento antecipou a colheita, diminuiu a firmeza e a acidez titulável, e aumentou a relação sólidos solúveis totais/acidez titulável dos frutos; mas diminuiu o vigor e o crescimento das plantas. Nenhum dos tratamentos alterou significativamente o peso médio dos frutos.<br>In the production of plums (Prunus salicina Lindley) for in natura consumption the fruit size is a very important feature. Fruit thinning is traditionally used to increase fruit size. Girdling is a practice which is deserving renewed attention, since in many situations is useful to improve fruit size and to advance harvest. This study seeks to evaluate the effect of manual fruit thinning at intensities of 0, 25, 50, and 75% associated or not to trunk girdling (4 mm wide) on the growth, production and quality of plum cv. Amarelinha. The experiment was carried out at the Universidade Federal do Rio Grande do Sul Experimental Research Station (Southern Brazil), during the growth season of 1995-96 (August - June). Thinning was applied on October 16, 1995, 36 days after full bloom, and girdling seven days after thinning. Thinning decreased total fruit yield proportionally to the applied intensity. Trunk girdling anticipated harvesting, decreased fruit firmness, titratable acidity and increased the ratio total soluble solids: titratable acidity of fruits, but decreased the vigour and vegetative growth of the trees. None of treatments affected significantly the mean fruit weight

TSC22D4 is a molecular output of hepatic wasting metabolism

In mammals, proper storage and distribution of lipids in and between tissues is essential for the maintenance of energy homeostasis. Here, we show that tumour growth triggers hepatic metabolic dysfunction as part of the cancer cachectic phenotype, particularly by reduced hepatic very-low-density-lipoprotein (VLDL) secretion and hypobetalipoproteinemia. As a molecular cachexia output pathway, hepatic levels of the transcription factor transforming growth factor beta 1-stimulated clone (TSC) 22 D4 were increased in cancer cachexia. Mimicking high cachectic levels of TSC22D4 in healthy livers led to the inhibition of hepatic VLDL release and lipogenic genes, and diminished systemic VLDL levels under both normal and high fat dietary conditions. Liver-specific ablation of TSC22D4 triggered hypertriglyceridemia through the induction of hepatic VLDL secretion. Furthermore, hepatic TSC22D4 expression levels were correlated with the degree of body weight loss and VLDL hypo-secretion in cancer cachexia, and TSC22D4 deficiency rescued tumour cell-induced metabolic dysfunction in hepatocytes. Therefore, hepatic TSC22D4 activity may represent a molecular rationale for peripheral energy deprivation in subjects with metabolic wasting diseases, including cancer cachexi