Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network.

OBJECTIVE: To gain an understanding of the variation in available resources and clinical practices between neonatal units (NNUs) in the low-income and middle-income country (LMIC) setting to inform the design of an observational study on the burden of unit-level antimicrobial resistance (AMR). DESIGN: A web-based survey using a REDCap database was circulated to NNUs participating in the Neonatal AMR research network. The survey included questions about NNU funding structure, size, admission rates, access to supportive therapies, empirical antimicrobial guidelines and period prevalence of neonatal blood culture isolates and their resistance patterns. SETTING: 39 NNUs from 12 countries. PATIENTS: Any neonate admitted to one of the participating NNUs. INTERVENTIONS: This was an observational cohort study. RESULTS: The number of live births per unit ranged from 513 to 27 700 over the 12-month study period, with the number of neonatal cots ranging from 12 to 110. The proportion of preterm admissions <32 weeks ranged from 0% to 19%, and the majority of units (26/39, 66%) use Essential Medicines List 'Access' antimicrobials as their first-line treatment in neonatal sepsis. Cephalosporin resistance rates in Gram-negative isolates ranged from 26% to 84%, and carbapenem resistance rates ranged from 0% to 81%. Glycopeptide resistance rates among Gram-positive isolates ranged from 0% to 45%. CONCLUSION: AMR is already a significant issue in NNUs worldwide. The apparent burden of AMR in a given NNU in the LMIC setting can be influenced by a range of factors which will vary substantially between NNUs. These variations must be considered when designing interventions to improve neonatal mortality globally

Formation of Pb(III) Intermediates in the Electrochemically Controlled Pb(II)/PbO 2

The formation of lead dioxide PbO(2), an important corrosion product in drinking water distribution systems with lead-bearing plumbing materials, has been hypothesized to involve Pb(III) intermediates, but their nature and formation mechanisms remain unexplored. This study employed the electrochemical (EC) method of rotating ring disk electrode (RRDE) and quantum chemical (QC) simulations to examine the generation of intermediates produced during the oxidation of Pb(II) to PbO(2). RRDE data demonstrate that PbO(2) deposition and reduction involves at least two intermediates. One of them is a soluble Pb(III) species that undergoes further transformations to yield immobilized PbO(2) nanoparticles. The formation of this intermediate in EC system is mediated by hydroxyl radicals (OH(•)), as was evidenced by the suppression of intermediates formation in the presence of the OH(•) scavenger para-chlorobenzoic acid. QC simulations confirmed that the oxidation of Pb(II) by OH(•) proceeds via Pb(III) species. These results show that Pb(III) intermediates play an important role in the reactions determining transitions between Pb(II) and Pb(IV) species and could impact lead release in drinking water

Seamless congestion control over wired and wireless IEEE 802.11 networks

We present a new approach for seamless congestion control over heterogeneous networks containing wired and wireless IEEE 802.11 links. The approach uses ECN (Explicit Congestion Notification) as a common signalling mechanism for conveying congestion information from both wired and wireless links. Two additional novel aspects of the approach are that ECN marking for a wireless link, due to the way resources are shared, is performed for both the uplink and the downlink based on measurements of the aggregate traffic in both directions, and the marking mechanism dynamically adapts to varying traffic and load conditions. Simulation results demonstrate that our approach achieves higher fairness compared to drop-tail queueing, and can effectively control the average packet delay over the wireless link. Document type: Part of book or chapter of boo

Breastfeeding during the novel coronavirus (COVID-19) pandemic: guidelines and challenges

COVID-19 pandemic has raised questions on pregnant women and newborns’ management. Guidelines, issued by most international agencies and national bodies, recommend rooming-in and direct breastfeeding. In the early days of this pandemic, breastfeeding practices have been challenged by fear among both parents and healthcare workers occasionally resulting in mother-newborn separation. We herein review current breastfeeding guidelines and discuss remaining questions and challenges. As we are facing the second wave of this pandemic, more information is gathered, especially regarding possible virus transmissibility through breastfeeding, enabling more definite instructions about breastfeeding practices. © 2020 Informa UK Limited, trading as Taylor &amp; Francis Group

Association Between Uric Acid and Worsening Peripheral Microangiopathy in Systemic Sclerosis

Objective: The key element in the pathogenesis of systemic sclerosis (SSc) is microcirculatory changes in several vascular beds. Uric acid is associated with endothelial dysfunction and therefore, microvascular damage. The aim of this study was to examine the association between uric acid (UA) and peripheral microvascular involvement in patients with SSc.Methods: We included consecutive, consenting patients with SSc. Serum UA, urea and creatinine were measured, and glomerular filtration rate (GFR) was calculated with CKD-EPI. All participants underwent nailfold video-capillaroscopy (NVC) to evaluate the microcirculation.Results: A total of 64 patients (95.3% women) were included in the study. UA levels were significantly associated with the number of avascular areas (r = 0.290; p = 0.020), whereas no correlation was shown for the GFR (r = -0.065; p = 0.609). A significant trend of UA in the three capillaroscopic patterns was shown (3.90 +/- 1.52 vs. 4.15 +/- 0.98 vs. 5.38 +/- 2.26; for early, active, and late patterns respectively, p = 0.028). Multivariate analysis showed that male gender (beta = 3.049; 95% CI = 0.997-5.101) and UA (beta = 0.352; 95% CI = 0.117-0.588) were independently associated with the number of avascular areas.Conclusion: These data suggest that UA levels are significantly associated with the capillaroscopic patterns, reflecting a progressive microvasculopathy

Getting to know endometriosis‐related infertility better: A review on how endometriosis affects oocyte quality and embryo development

Endometriosis‐related infertility describes a case of deteriorated fecundity when endometriosis is diagnosed. Numerous mechanisms have been proposed in an effort to delineate the multifaceted pathophysiology that induces impairment of reproductive dynamics in patients with endometriosis. In this critical analysis, authors present the plethora of molecular events that are entailed and elaborate on how they potentially impair the oocyte’s and embryo’s competence in patients with endometriosis. Reactive oxygen species, dysregulation of the immune system and cellular architectural disruption constitute the crucial mechanisms that detrimentally affect oocyte and embryo developmental potential. The molecular level impairment of the reproductive tissue is discussed, since differentiation, proliferation and apoptosis constitute focal regulatory cellular functions that appear severely compromised in cases of endometriosis. Mapping the precise molecular mechanisms entailed in endometriosis‐related infertility may help delineate the complex nature of the disorder and bring us a step closer to a more personalized approach in understanding, diagnosing and managing endometriosis‐related infertility. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

The current evidence regarding covid‐19 and pregnancy: Where are we now and where should we head to next?

Despite the volume of publications dedicated to unraveling the biological characteristics and clinical manifestations of SARS‐CoV‐2, available data on pregnant patients are limited. In the current review of literature, we present an overview on the developmental course, complications, and adverse effects of COVID‐19 on pregnancy. A comprehensive review of the literature was per-formed in PubMed/Medline, Embase, and Cochrane Central databases up to June 2021. This article collectively presents what has been so far reported on the identified critical aspects, namely complications during pregnancy, delivery challenges, neonatal health care, potential routes of viral transmission, including vertical transmission or breastfeeding, along with the risks involved in the vaccination strategy during pregnancy. Despite the fact that we are still largely navigating un-charted territory, the observed publication explosion in the field is unprecedented. The overwhelm-ing need for data is undoubtable, and this serves as the driver for the plethora of publications wit-nessed. Nonetheless, the quality of data sourced is variable. In the midst of the frenzy for reporting on SARS‐CoV‐2 data, monitoring this informational overload is where we should head to next, con-sidering that poor quality research may in fact hamper our attempts to prevail against this unpar-alleled pandemic outbreak. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

The current evidence regarding covid‐19 and pregnancy: Where are we now and where should we head to next?

Despite the volume of publications dedicated to unraveling the biological characteristics and clinical manifestations of SARS‐CoV‐2, available data on pregnant patients are limited. In the current review of literature, we present an overview on the developmental course, complications, and adverse effects of COVID‐19 on pregnancy. A comprehensive review of the literature was per-formed in PubMed/Medline, Embase, and Cochrane Central databases up to June 2021. This article collectively presents what has been so far reported on the identified critical aspects, namely complications during pregnancy, delivery challenges, neonatal health care, potential routes of viral transmission, including vertical transmission or breastfeeding, along with the risks involved in the vaccination strategy during pregnancy. Despite the fact that we are still largely navigating un-charted territory, the observed publication explosion in the field is unprecedented. The overwhelm-ing need for data is undoubtable, and this serves as the driver for the plethora of publications wit-nessed. Nonetheless, the quality of data sourced is variable. In the midst of the frenzy for reporting on SARS‐CoV‐2 data, monitoring this informational overload is where we should head to next, con-sidering that poor quality research may in fact hamper our attempts to prevail against this unpar-alleled pandemic outbreak. © 2021 by the authors. Licensee MDPI, Basel, Switzerland