Diabetic Foot Infection: Causative Pathogens and Empiric Antibiotherapy Considerations-The Experience of a Tertiary Center

Most moderate-to-severe diabetic foot infections (DFIs) require hospitalization with urgent surgical approach and administration of empiric antibiotherapy. To ensure optimal antibiotic coverage, regular microbiological background updates are imperative. The purpose is to characterize the microbiological profile and the antibiotic sensitivity pattern of the DFI causative pathogens isolated within a specialized DFI unit of a tertiary hospital, in order to establish evidence-based policies regarding empirical antibiotic use. A cross-sectional study was conducted. Microbiological cultures and corresponding antibiotic sensitivity tests collected from moderate-to-severe DFIs as a first approach to the hospitalized patient were retrieved and analyzed during a 12-month period. Two groups were analyzed: inpatients that had been previously followed at the diabetic foot clinic of the hospital and inpatients without a previous contact with the hospital services. A total of 125 isolates obtained from 87 patients were deemed for analysis. Globally, a predominance of Gram-positive bacteria was observed (60%). Staphylococcus aureus was the most common pathogen. The global ratio of methicillin-sensitive S aureus to methicillin-resistant S aureus (MRSA) was 1.3:1, with similar findings in both groups. According to the antibiotic sensitivity test results, and within the recommended empiric antibiotic regimens for DFI, piperacillin/tazobactam seems to be the most suitable option. Gram-positive bacteria prevail as the main isolates in DFIs. Screening for MRSA-specific risk factors is mandatory. When going for a first empiric therapy, piperacillin/tazobactam is recommended in this institution, and an anti-MRSA agent should be added early, if necessary. We encourage continuous monitoring for the bacterial prevalence in Portuguese diabetic foot centers as it is paramount for the decision making regarding DFI protocols.info:eu-repo/semantics/publishedVersio

Endovascular treatment versus medical care alone for ischaemic stroke: systematic review and meta-analysis

Objectives: To evaluate the efficacy and safety of endovascular treatment, particularly adjunctive intra-arterial mechanical thrombectomy, in patients with ischaemic stroke. / Design: Systematic review and meta-analysis. / Data sources: Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, SciELO, LILACS, and clinical trial registries from inception to December 2015. Reference lists were crosschecked. / Eligibility criteria for selecting studies: Randomised controlled trials in adults aged 18 or more with ischaemic stroke comparing endovascular treatment, including thrombectomy, with medical care alone, including intravenous recombinant tissue plasminogen activator (rt-PA). Trial endpoints were functional outcome (modified Rankin scale scores of ≤2) and mortality at 90 days after onset of symptoms. No language or time restrictions applied. / Results: 10 randomised controlled trials (n=2925) were included. In pooled analysis endovascular treatment, including thrombectomy, was associated with a higher proportion of patients experiencing good (modified Rankin scale scores ≤2) and excellent (scores ≤1) outcomes 90 days after stroke, without differences in mortality or rates for symptomatic intracranial haemorrhage, compared with patients randomised to medical care alone, including intravenous rt-PA. Heterogeneity was high among studies. The more recent studies (seven randomised controlled trials, published or presented in 2015) proved better suited to evaluate the effect of adjunctive intra-arterial mechanical thrombectomy on its index disease owing to more accurate patient selection, intravenous rt-PA being administered at a higher rate and earlier, and the use of more efficient thrombectomy devices. In most of these studies, more than 86% of the patients were treated with stent retrievers, and rates of recanalisation were higher (>58%) than previously reported. Subgroup analysis of these seven studies yielded a risk ratio of 1.56 (95% confidence interval 1.38 to 1.75) for good functional outcomes and 0.86 (0.69 to 1.06) for mortality, without heterogeneity among the results of the studies. All trials were open label. Risk of bias was moderate across studies. The full results of two trials are yet to be published. / Conclusions: Moderate to high quality evidence suggests that compared with medical care alone in a selected group of patients endovascular thrombectomy as add-on to intravenous thrombolysis performed within six to eight hours after large vessel ischaemic stroke in the anterior circulation provides beneficial functional outcomes, without increased detrimental effects. / Systematic review registration: PROSPERO CRD42015019340

Ulcerated Papules and nodules in an infant

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Are uranium-contaminated soil and irrigation water a risk for human vegetable consumers? A study case with Solanum tuberosum L., Phaseolus vulgaris L. and Lactuca sativa L.

The knowledge of uranium concentration, in the products entering the human diet is of extreme importance because of their chemical hazard to health. Controlled field experiments with potatoes, beans and lettuce (Solanum tuberosum L., Phaseolus vulgaris L. and Lactuca sativa L.) were carried out in a contaminated soil used by local farmers located near a closed Portuguese uranium mine (Cunha Baixa, Mangualde). The soil with high average uranium levels (64–252 mg/kg) was divided in two plots, and irrigated with non-contaminated and uranium-contaminated water (\20 and [900 lg/L). Uranium maximum average concentration in the edible vegetables parts (mg/kg fresh weight) ranged in the following order: lettuce (234 lg/kg)[green bean (30 lg/kg)[potatoes without peel (4 lg/kg). Although uranium in soil, irrigation water and vegetables was high, the assessment of the health risk based on hazard quotient indicates that consumption of these vegetables does not represent potential adverse (no carcinogenic) effects for a local inhabitant during lifetime

Evolutionary Computation on Road Safety

This study examines the psychological research that focuses on road safety in Smart Cities as proposed by the Vulnerable Road Users (VRUs) sphere. It takes into account qualities such as VRUs’ personal information, their habits, environmental measurements and things data. With the goal of seeing VRUs as active and proactive actors with differentiated feelings and behaviours, we are committed to integrating the social factors that characterize each VRU into our social machinery. As a result, we will focus on the development of a VRU Social Machine to assess VRUs’ behaviour in order to improve road safety. The formal background will be to use Logic Programming to define its architecture based on a Deep Learning approach to Knowledge Representation and Reasoning, complemented with an Evolutionary approach to Computing

An innovative thermal protective clothing system for firefighters

Nowadays, despite the evolution of personal protective equipment (PPE), the number of firefighters injured and burned during fire extinguishing operations is still very high, leading in some cases to loss of life. Therefore, the research and development of new solutions to minimize firefighters' heat load and skin burns, with consecutive improvements of commercial firefighters' suits, is of extreme importance. The integration of phase change materials (PCMs) in a protective clothing system has been used to significantly reduce the incoming heat flux from the fire environment. This study consists in the development of a protective clothing system composed by a vest, specially designed to protect the torso (back, chest and abdomen) with a layer of PCM pouches, to be worn over a fire-resistant jacket - selection and design based on numerical models' predictions. Therefore, several mockups were made, varying the number of PCM pouches and their distribution in the vest, allowing the creation of air ducts to increase the breathability of the vest. The most promising solutions are being evaluated in a real controlled environment, at a Portuguese National School of Firefighters (ENB) simulation site, using a fire manikin and thermocouples to monitor vest temperature during heat and flame exposure, and consequently to verify PCMs influence in heat protection. Results regarding the development of a PCM vest will be presented, focusing on the integration of PCM pouches and the thermal performance of the most promising solutions

Intravenous immunoglobulin and Sjögren Syndrome

A síndrome de Sjögren (SS) é uma patologia auto-imune com incidência e prevalência importantes, manifestações clínicas variadas e critérios diagnósticos bem definidos. Áreas como os seus mecanismos fisiopatológicos e novas estratégias terapêuticas têm merecido atenção crescente. A imunoglobulina intravenosa (IgIV) está indicada para o tratamento de várias entidades nosológicas, sendo crescente a investigação acerca dos seus mecanismos de acção, nomeadamente sobre a actividade imunitária. O seu espectro de indicações terapêuticas continua altamente controverso mas tem vindo a expandir-se, sobretudo no âmbito da auto-imunidade. Existem apenas alguns casos descritos de utilização da IgIV no tratamento da SS, principalmente quando se apresenta com manifestações neurológicas. Apresentamos uma revisão da indicação do uso da IgIV na SS, fazendo uma análise dos resultados de relatos de casos da sua utilização, entretanto publicados. A IgIV parece ser uma opção terapêutica a ter em conta na SS. Segundo o que se sabe, à data, será uma opção terapêutica, de segunda linha, para os casos com manifestações extraglandulares graves refractários à terapêutica convencional

Smart firefighters PPE: Impact of phase change materials

Considering the high level of heat and flame exposure firefighters encounter while performing their work activities, personal protective equipment (PPE) is of the utmost importance to enhance their safety. Phase change materials (PCMs) are known as advanced materials able to absorb high amounts of thermal energy, with the potential to increase the thermal performance of protective clothing. In this work, a PCM-vest was developed for the first time, and its thermal performance was evaluated. A three-stage approach was followed: (1) at a small scale in the laboratory, the effect of different encapsulated PCMs on a multilayer assembly performance was evaluated; (2) in the laboratory, the essential requirements of heat and flame tests were assessed; and (3) in a simulated urban fire, the thermal performance of three different PCM-vests (different textiles and designs) was studied. As the main conclusions, the PCMs significantly affected the heating rate of the multilayer assembly, particularly when a PCM with higher latent heat was used. In some cases, the heat transfer index (HTI) doubled by comparison with the sample without PCMs. As a drawback and as expected, the cooling time was increased. The PCM-vest sample ensured the requirements of the heat and flame tests. Through this study, the positive impact of using PCMs to enhance the heat protection of conventional PPE can be highlighted

Study of complexation capacity and its relationship with some environmental variables in five reservoirs of the Tiete river system

The copper and cadmium complexation properties in natural sediment suspensions of reservoirs of the Tiete River were studied using the solid membrane copper and cadmium ion-selective electrodes. The complexation and the average conditional stability constants were determined under equilibrium conditions at pH=6.00 +/- 0.05 in a medium of 1.0 mol L-1 sodium nitrate, using the Scatchard method. The copper and cadmium electrodes presented Nernstian behavior from 1 X 10(-6) to 1 x 10(-1) mol L-1 of total metal concentration. Scatchard graphs suggest two classes of binding sites for both metals. A multivariate study was done to correlate the reservoirs and the variables: complexation properties, size, total organic carbon, volatile acid sulfide, E-H and pH.3071505151

Effect of Cr(V) on reproductive organ morphology and sperm parameters: An experimental study in mice

BACKGROUND: Cr(V) species are formed during the intracellular reduction of Cr(VI), a ubiquitous environmental pollutant. In this study, the acute toxicity of a physiologically stable Cr(V) compound, [Cr(V)-BT](2- )(BT = bis(hydroxyethyl)aminotris(hydroxymethyl)methane) was investigated in the male reproductive system of sexually mature 60-day-old male ICR-CD1 mice. METHODS: Eight-week-old animals were subcutaneously injected daily with a dose of ca 8 μmol of Cr/mouse, during 5 days. The control group was injected with 0.5 mL of BT buffer. Testis and epididymis morphology was evaluated using light and transmission electron microscopy. Epididymal sperm counts, motility and acrosome integrity were also assayed using standard methods. RESULTS: Seminiferous epithelium abnormalities were detected in the Cr(V)-BT experimental group, including intraepithelial vacuolation, and remarkable degeneration of Sertoli cells, spermatocytes and spermatids. The premature release of germ cells into the tubular lumen was also evident. Histological evaluation of epididymal compartments revealed apparently normal features. However, the epididymal epithelium presented vacuolation. [Cr(V)-BT](2- )induced a reduction in sperm acrosome integrity. However, sperm motility and density were not significantly affected. CONCLUSION: This in vivo study using a Cr(V) compound, provides evidence for the potential reproductive hazards caused on male reproductive system by species containing chromium in intermediate oxidation states