In Vitro Susceptibility to Ceftazidime/Avibactam and Comparators in Clinical Isolates of Enterobacterales from Five Latin American Countries

Background: High rates of resistance to third-generation cephalosporins and carbapenems in Enterobacterales have been reported in Latin America. Ceftazidime/avibactam (CZA) is the combination of a third-generation cephalosporin and a non-β-lactam β-lactamase inhibitor, which hasshown activity against isolates producing class A, C and D β-lactamases. Herein, we evaluated the activity of CZA and comparators against clinical isolates of Enterobacterales in Latin America. Methods: The activity of CZA and comparators was evaluated against clinical isolates of Enterobacterales from Argentina, Brazil, Chile, Colombia and Mexico that were collected between January 2016 andOctober 2017. One specific phenotypic subset was evaluated. A carbapenem non-susceptible (CNS) phenotype was defined as any isolate displaying a minimum inhibitory concentration (MIC) ≥1 mg/L for ertapenem. Results: CZA was active against 95.8% of all isolates and 77.5% of CNS isolates. Fosfomycin (FOS) and tigecycline (TGC) were the second most active antibiotics with 93.4% ofEnterobacterales being susceptible. Conclusions: The results of this study underline the potential therapeutic role of CZA in Latin AmericaFil: Appel, Tobias Manuel. Universidad El Bosque; ColombiaFil: Mojica, Maria Fernanda. Universidad El Bosque; ColombiaFil: De La Cadena, Elsa. Universidad El Bosque; ColombiaFil: Pallares, Cristian. Universidad El Bosque; ColombiaFil: Radice, Marcela Alejandra. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Microbiología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Castañeda Méndez, Paulo. Hospital Médica Sur; MéxicoFil: Jaime-Villalón, Diego. Hospital San Angel; MéxicoFil: Gales, Ana. Universidade de Sao Paulo; BrasilFil: Munita, Jose. No especifíca;Fil: Villegas, Maria. Universidad El Bosque; Colombi

Safety of Oral Bisphosphonates in Moderate-to-Severe Chronic Kidney Disease: A Binational Cohort Analysis

Bisphosphonates are the first-line treatment for preventing fractures in osteoporosis patients. However, their use is contraindicated or to be used with caution in chronic kidney disease (CKD) patients, primarily because of a lack of information about their safety and effectiveness. We aimed to investigate the safety of oral bisphosphonates in patients with moderate to severe CKD, using primary-care electronic records from two cohorts, CPRD GOLD (1997-2016) and SIDIAP (2007-2015) in the UK and Catalonia, respectively. Both databases were linked to hospital records. SIDIAP was also linked to end-stage renal disease registry data. Patients with CKD stages 3b to 5, based on two or more estimated glomerular filtration rate measurements less than 45 mL/min/1.73 m2 , aged 40 years or older were identified. New bisphosphonate users were propensity score-matched with up to five non-users to minimize confounding within this population. Our primary outcome was CKD stage worsening (estimated glomerular filtration rate [eGFR] decline or renal replacement therapy). Secondary outcomes were acute kidney injury, gastrointestinal bleeding/ulcers, and severe hypocalcemia. Hazard ratios (HRs) were estimated using Cox regression and Fine and Gray sub-HRs were calculated for competing risks. We matched 2447 bisphosphonate users with 8931 non-users from CPRD and 1399 users with 6547 non-users from SIDIAP. Bisphosphonate use was associated with greater risk of CKD progression in CPRD (sub-HR [95% CI]: 1.14 [1.04, 1.26]) and SIDIAP (sub-HR: 1.15 [1.04, 1.27]). No risk differences were found for acute kidney injury, gastrointestinal bleeding/ulcers, or hypocalcemia. Hence, we can conclude a modest (15%) increased risk of CKD progression was identified in association with bisphosphonate use. No other safety concerns were identified. Our findings should be considered before prescribing bisphosphonates to patients with moderate to severe CKD. © 2020 American Society for Bone and Mineral Research (ASBMR)

Metodología de identificación de peligros en la protección contra caídas

Las tareas de trabajo en alturas son consideradas de alto riesgo debido al potencial de perdida de vidas que pueden generar, mediante las estadísticas de accidentalidad son de un porcentaje considerable; es la actividad que genera mayor accidentes graves y mortales en la industria Colombiana, observando en el sector de la construcción el mayor porcentaje de accidentalidad de este tipo, por lo anterior nace la necesidad de crear estrategia de control que contribuyan a la identificación de peligros. La presente monografía se encuentra basada en documentos bibliográficos (fuentes verídicas) de donde se recolectó información, la cual va en una rejilla organizada por autor, año, objetivo, método, resultado y conclusión como método de evaluación semiestructurado, así se analiza la información y se escoge la metodología control total de perdidas, la cual es la herramienta que ayudará al desarrollo de medias preventivas y así disminuir la ocurrencia de accidentes en el momento que se desarrolle trabajo de alturas en los diferentes sectores económicos.PregradoProfesional en Salud Ocupaciona

Numerical simulations of the flow and aerosol dispersion in a violent expiratory event

This paper presents and discusses the results of the “2022 International Computational Fluid Dynamics Challenge on violent expiratory events” aimed at assessing the ability of different computational codes and turbulence models to reproduce the flow generated by a rapid prototypical exhalation and the dispersion of the aerosol cloud it produces. Given a common flow configuration, a total of 7 research teams from different countries have performed a total of 11 numerical simulations of the flow dispersion by solving the Unsteady Reynolds Averaged Navier–Stokes (URANS) or using the Large-Eddy Simulations (LES) or hybrid (URANS-LES) techniques. The results of each team have been compared with each other and assessed against a Direct Numerical Simulation (DNS) of the exact same flow. The DNS results are used as reference solution to determine the deviation of each modeling approach. The dispersion of both evaporative and non-evaporative particle clouds has been considered in 12 simulations using URANS and LES. Most of the models predict reasonably well the shape and the horizontal and vertical ranges of the buoyant thermal cloud generated by the warm exhalation into an initially quiescent colder ambient. However, the vertical turbulent mixing is generally underpredicted, especially by the URANS-based simulations, independently of the specific turbulence model used (and only to a lesser extent by LES). In comparison to DNS, both approaches are found to overpredict the horizontal range covered by the small particle cloud that tends to remain afloat within the thermal cloud well after the flow injection has ceased

Oral bisphosphonate use and all-cause mortality in patients with moderate-severe (grade 3B-5D) chronic kidney disease: a population-based cohort study

Oral bisphosphonates (oBPs) have been associated with reduced fractures and mortality. However, their risks and benefits are unclear in patients with moderate–severe CKD. This study examined the association between oBPs and all-cause mortality in G3B-5D CKD. This is a population-based cohort study including all subjects with an estimated glomerular filtration rate (eGFR) &lt;45/mL/min/1.73 m 2 (G3B: eGFR &lt;45/mL/min/1.73 m 2 G4: eGFR 15–29/mL/min/1.73 m 2 G5: eGFR &lt;15/mL/min/1.73 m 2 G5D: hemodialysis) aged 40+ years from the UK Clinical Practice Research Datalink (CPRD) and the Catalan Information System for Research in Primary Care (SIDIAP). Previous and current users of other anti-osteoporosis drugs were excluded. oBP use was modeled as a time-varying exposure to avoid immortal time bias. Treatment episodes in oBP users were created by concatenating prescriptions until patients switched or stopped therapy or were censored or died. A washout period of 180 days was added to (date of last prescription +180 days). Propensity scores (PSs) were calculated using prespecified predictors of mortality including age, gender, baseline eGFR, socioeconomic status, comorbidities, previous fracture, co-medications, and number of hospital admissions in the previous year. Cox models were used for PS adjustment before and after PS trimming (the first and last quintiles). In the CPRD, of 19,351 oBP users and 210,954 non-oBP users, 5234 (27%) and 85,105 (40%) deaths were recorded over 45,690 and 915,867 person-years of follow-up, respectively. oBP users had 8% lower mortality risk compared to non-oBP users (hazard ratio [HR] 0.92; 95% CI, 0.89 to 0.95). Following PS trimming, this became nonsignificant (HR 0.98; 95% CI, 0.94 to 1.04). In the SIDIAP, of 4146 oBP users and 86,127 non-oBP users, 1330 (32%) and 36,513 (42%) died, respectively. oBPs were not associated with mortality in PS adjustment and trimming (HR 1.04; 95% CI, 0.99 to 1.1 and HR 0.95; 95% CI, 0.89 to 1.01). In this observational, patient-based cohort study, oBPs were not associated with increased mortality among patients with moderate–severe CKD. However, further studies are needed on other effects of oBPs in CKD patients.</p

Use of failure-to-rescue after emergency surgery as a dynamic indicator of hospital resilience during the COVID-19 pandemic. A multicenter retrospective propensity score-matched cohort study

10.1016/j.ijsu.2022.106890INTERNATIONAL JOURNAL OF SURGERY106complete