Clinical evaluation of guidelines and therapeutic approaches in multi drug-resistant urinary tract infections

Antibiotic resistance represents a real health emergency worldwide, mostly due to the lack of new antibiotics active against multidrug-resistant Enterobacteriaceae. Considering the global epidemiological situation in several infections, including urinary tract infections (UTIs), some antibiotics, such as fluoroquinolones and trimethoprim/sulphamethoxazole, can no longer be used for empiric treatment due to high resistance rates. However, some old antibiotics maintain high microbiological activity against UTI pathogens: according to many recent guidelines, fosfomycin trometamol, nitrofurantoin and pivmecillinam are recommended for the first-line treatment of uncomplicated UTIs. This article provides an overview of the therapeutic management of UTIs, especially uncomplicated and recurrent cystitis, as well as complicated UTIs such as catheter-related UTIs, and UTIs in males, post-menopausal women and diabetic patients, based on the main international guidelines

New antibiotic development: barriers and opportunities

Antibiotic resistance represents a serious threat to public health worldwide, leading to increased healthcare costs, prolonged hospital stays, treatment failures and deaths. To address the emergency of multidrug-resistance, the major international societies of infectious diseases and public health have developed strategies and guidelines to reduce unnecessary antimicrobial use as well as to incite the development of new antibiotics targeting multidrug-resistant pathogens. Even though pharmaceutical companies have been developing new antibiotics since 2010, the global situation is still worrisome. Indeed, the currently available data regarding new antibiotics are limited to microbiological activity and pharmacokinetic profile and their use for the treatment of life-threatening infections (i.e., sepsis) is often off-label. The aim of this article is to present the antibiotic molecules recently commercialized and with which clinicians will deal quite often in next years. We describe ceftolozane/tazobactam, ceftazidime/avibactam, eravacycline, plazomicin, dalbavancin, oritavancin and tedizolid in terms of mechanism of action, antimicrobial spectrum, trials behind the approval and possible indications for the future. In last few years, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) approved many new antibiotic molecules but, unfortunately, they lack in biological innovation and in wide clinical indications. These agents show appealing properties for off-label use, as we propose in the article, but caution is still needed considering that high-quality clinical data are limited

The Pros and Cons of Prophylactic Central Compartment Lymph Node Dissection for Papillary Thyroid Carcinoma

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78140/1/thy.2009.1578.pd

Mitral valve prolapse syndrome: The effect of adrenergic stimulation

Previous studies demonstrating increased adrenergic tone in symptomatic patients with mitral valve prolapse prompted a study of the response of symptomatic patients with mitral valve prolapse to adrenergic stimulation. Sixteen such patients had plasma catecholamines and 24 hour urinary epinephrine plus norepinephrine values that were greater than those of control subjects (473.3 ± 92.8 pg/ml versus 292 ± 15 and 44.7 ± 2.3 μg/g creatinine versus 29.8 ± 2.3; p < 0.01 and < 0.001, respectively). Twenty-four hour urinary sodium was lower in the patient group than in the control group (75 ± 7.4 versus 141 ±11 mEq; p < 0.01), with an inverse relation between urinary sodium and norephinephrine in the patient group (r = - 0.78) but not in the control group.Isoproterenol infusions, 0.5, 1.0 and 2.0 μg/min for 6 minutes, produced a dose-related, greater increase in heart rate in the mitral valve prolapse group than in the control group (16.1 ± 2.3 versus 10 ± 2; 31.8 ± 3.5 versus 19.6 ± 3; 48 ± 4.1 versus 27 ± 3; p< 0.01 with 0.5, 1.0 and 2.0 μg, respectively). The greater increase in heart rate resulted in a significantly shorter diastolic time in the patient group than in the control group (26.4 ± 2 s/min versus 30.6 ± 2; 27 ± 1.5 versus 30.6 ± 2; 26.6 ± 2 versus 30.9 ± 2; p < 0.01 with 0.5, 1.0 and 2.0 μg, respectively). The QT interval was 25 ms shorter than electromechanical systole (QS2) in the normal group and 26.5 ms shorter than QS2in the mitral valve prolapse group at rest; during isoproterenol infusion QT-QS2values were different in the mitral valve prolapse and control groups (3.3 ± 3 versus -7.0 ± 3; 31.9 ± 2.8 versus 10 ± 4; 52 ± 9.2 versus 29 ± 8; p < 0.01 with 0.5, 1.0 and 2.0 μg/min, respectively). Isoproterenol infusion also reproduced symptoms on a dose-related basis in 14 patients with mitral valve prolapse but not in control subjects (excluding palpitation).Symptomatic patients with mitral valve prolapse and high rest values of catecholamines were hypersensitive to isoproterenol infusion, suggesting that some of the symptoms are catecholamine-related or mediated

Método óptico para la detección omnidireccional de bordes

Se propone un método óptico omnidireccional para la extracción de bordes a tiempo real. El método consiste en el diseño de un filtro complejo que es implementado en un procesador óptico con arquitectura de Vander Lugt. Se enfatiza la invariancia a rotaciones de la técnica, así como su equivalencia con el detector de bordes de Canny. Se llevaron a cabo simulaciones numéricas para comparar la implementación propuesta con algunos de los detectores y resaltadores de bordes más frecuentemente utilizados. Finalmente, se presentan resultados experimentales que muestran el excelente desempeño del método propuestoA method for omnidireccional real-time optical edge extraction is proposed. The method consists on the design of a complex filter that is implemented in a Vander Lugt like optical processor. It is emphasized the rotation invariance of the technique, as its equivalence with the Canny edge detector. Numerical simulations have been performed to compare the proposed implementation with some frequently used edge detectors and enhancers. Experimental results are presented to show the very good performance of the method.Fil: Mazzaferri, J. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales (UBA-FCEyN). Departamento de Física. Buenos Aires. ArgentinaFil: Ledesma, S.. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales (UBA-FCEyN). Departamento de Física. Buenos Aires. Argentin

Preventing corneal calcification associated with xylazine for longitudinal optical coherence tomography in young rodents

PURPOSE. Spectral-domain optical coherence tomography (SD-OCT) is widely used in clinical ophthalmology and recently gained popularity in laboratory research involving small rodents. Its noninvasive nature allows repeated measurements, thereby decreasing the number of animals required. However, when used at a conventional dosage, xylazine (an a2- adrenoceptor) can cause irreversible corneal calcification, especially among young rodents. In the present study, we test whether corneal calcification associated with xylazine is mediated by the a2-adrenoceptor. METHODS. Our study tested Sprague-Dawley rats, Long-Evans rats, and CD-1 mice (postnatal day [P]14). Retinal images were captured by SD-OCT. Quantitative PCR (qPCR) was used to study gene expression, whereas receptor localization was examined by immunofluorescent staining followed by confocal microscopy. Calcium deposits were detected via von Kossa staining. RESULTS. When used at dosages appropriate for adult animals, ketamine-xylazine anesthetics led to a high rate of respiratory failure, increased apoptotic activity in the corneal epithelium, and irreversible corneal calcification in P14 rat pups. Meanwhile, OCT image quality decreased drastically as a result of corneal calcification among animals recovering from anesthesia. a2-Adrenoceptor subtypes were highly expressed on P14, in line with rodents’ age-specific sensitivity to xylazine. Clonidine, a potent a2-adrenoceptor agonist, dosedependently induced corneal calcification, which could be prevented by an a2-adrenoceptor antagonist. CONCLUSIONS. These data suggest that a2-adrenoceptors contribute to corneal calcification in young rodents. Therefore, we developed a suitable OCT imaging protocol for this cohort, including a carefully tailored ketamine-xylazine dosage (60 mg/kg and 2.5 kg/mg, respectively)

“Quiet at Night”: Reduced overnight vital sign monitoring linked to both safety and improvements in patients’ perception of hospital sleep quality

Obtaining middle of the night vital signs is disruptive to sleep and not founded on evidence-based medicine. We sought to investigate the perception of quality of sleep and overall satisfaction during a hospital stay between an intervention group where overnight night vital signs were not obtained and a standard of care group where overnight vital signs were obtained every four hours. We also monitored for adverse events in the intervention and standard group. Low-risk observational stay patients with a planned cardiac procedure were eligible for this study. After consent, patients were randomized to the intervention or standard group. Participants were provided a questionnaire on the day following their overnight stay to assess their perception of quality of sleep and satisfaction with their hospital stay. Charts were reviewed to assess for any adverse outcomes. During the study period, 39 patients were enrolled in the standard group and 41 in the intervention group. All patients were discharged the following day as planned and no adverse events occurred overnight. More patients in the standard group rated good/excellent sleep at home, and more patients in the intervention group rated good/excellent sleep in the hospital. There was a trend toward less disruptive sleep between home and hospital for the intervention group (p = 0.096). There was no difference found in the overall satisfaction of hospital stay response between the intervention and standard groups (p = 0.999). Fewer patients in the intervention group had worse sleep in the hospital as compared to home, significant at p \u3c 0.10. We also found there was no escalation of care despite not obtaining vitals throughout the night in our intervention group. With this proof of concept now safely implemented, it is our intention to implement further studies to broaden our inclusion criteria and population to encourage a restful and healing environment through the entire healthcare stay

Photon counting statistics using a digital oscilloscope

We present a photon counting experiment designed for an undergraduate physics laboratory. The statistics of the number of photons of a pseudo thermal light source is studied in two limiting cases: well above and well below the coherence time, giving Poisson and Bose-Einstein distributions, respectively. We show that using a digital oscilloscope the experiment can be done in a reasonable time, without need of counting boards. The use of the oscilloscope has the additional advantage of allowing the storage of the data for further processing. Hence, using the same set of data, the analysis of the statistics of the occurrence of n photons as a function of the time windows adds important evidence to determine accurately the nature of the light source. The stochastic nature of the detection phenomena adds an additional value to this type of experiments, since the student is forced to a thorough visit through data processing and statistics