Management of infections due to KPC-producing Klebsiella pneumoniae

The emergence of the Klebsiella pneumoniae carbapenemases in K. pneumoniae and other Gram-negative bacteria, usually on a background of multidrug resistance, has led to difficult therapeutic choices. Among available antibiotics, tigecycline and the polymyxins are the most frequently active against these organisms in vitro. Optimal therapy of infections due to these bacteria may involve maximization of antibiotic dose as well as their use in combination

Is spinal tuberculosis contagious?

SummaryWhile pulmonary Mycobacterium tuberculosis infections are recognized for their public health implications, less is known about the infectiousness of extrapulmonary tuberculosis, specifically, spinal tuberculosis or Pott's disease. We present a case of spinal tuberculosis with concomitant active pulmonary tuberculosis in the absence of chest radiographic abnormalities or symptoms, and review the literature regarding infectiousness of concomitant spinal and pulmonary tuberculosis

Effective Detection of the 2009 H1N1 Influenza Pandemic in U.S. Veterans Affairs Medical Centers Using a National Electronic Biosurveillance System

The 2008-09 influenza season was the time in which the Department of Veterans Affairs (VA) utilized an electronic biosurveillance system for tracking and monitoring of influenza trends. The system, known as ESSENCE or Electronic Surveillance System for the Early Notification of Community-based Epidemics, was monitored for the influenza season as well as for a rise in influenza cases at the start of the H1N1 2009 influenza pandemic. We also describe trends noted in influenza-like illness (ILI) outpatient encounter data in VA medical centers during the 2008-09 influenza season, before and after the recognition of pandemic H1N1 2009 influenza virus.We determined prevalence of ILI coded visits using VA's ESSENCE for 2008-09 seasonal influenza (Sept. 28, 2008-April 25, 2009 corresponding to CDC 2008-2009 flu season weeks 40-16) and the early period of pandemic H1N1 2009 (April 26, 2009-July 31, 2009 corresponding to CDC 2008-2009 flu season weeks 17-30). Differences in diagnostic ICD-9-CM code frequencies were analyzed using Chi-square and odds ratios. There were 649,574 ILI encounters captured representing 633,893 patients. The prevalence of VA ILI visits mirrored the CDC's Outpatient ILI Surveillance Network (ILINet) data with peaks in late December, early February, and late April/early May, mirroring the ILINet data; however, the peaks seen in the VA were smaller. Of 31 ILI codes, 6 decreased and 11 increased significantly during the early period of pandemic H1N1 2009. The ILI codes that significantly increased were more likely to be symptom codes. Although influenza with respiratory manifestation (487.1) was the most common code used among 150 confirmed pandemic H1N1 2009 cases, overall it significantly decreased since the start of the pandemic.VA ESSENCE effectively detected and tracked changing ILI trends during pandemic H1N1 2009 and represents an important temporal alerting system for monitoring health events in VA facilities

Acute cardiac injury events ≤30 days after laboratory-confirmed influenza virus infection among U.S. veterans, 2010–2012

<div><p>The Rnd family of proteins, Rnd1, Rnd2 and Rnd3, are atypical Rho family GTPases, which bind to but do not hydrolyse GTP. They interact with plexins, which are receptors for semaphorins, and are hypothesised to regulate plexin signalling. We recently showed that each Rnd protein has a distinct profile of interaction with three plexins, Plexin-B1, Plexin-B2 and Plexin-B3, in mammalian cells, although it is unclear which region(s) of these plexins contribute to this specificity. Here we characterise the binary interactions of the Rnd proteins with the Rho-binding domain (RBD) of Plexin-B1 and Plexin-B2 using biophysical approaches. Isothermal titration calorimetry (ITC) experiments for each of the Rnd proteins with Plexin-B1-RBD and Plexin-B2-RBD showed similar association constants for all six interactions, although Rnd1 displayed a small preference for Plexin-B1-RBD and Rnd3 for Plexin-B2-RBD. Furthermore, mutagenic analysis of Rnd3 suggested similarities in its interaction with both Plexin-B1-RBD and Plexin-B2-RBD. These results suggest that Rnd proteins do not have a clear-cut specificity for different Plexin-B-RBDs, possibly implying the contribution of additional regions of Plexin-B proteins in conferring functional substrate selection.</p></div

Uso terapêutico de tecidos e órgãos humanos para transplantes: eventos adversos e ações de biovigilância

Objetivo: Identificar evidências na literatura sobre eventos adversos e ações de biovigilância no processo de doação e uso terapêutico de tecidos e órgãos humanos para transplante. Método: Revisão integrativa, utilizando as bases de dados LILACS, MEDLINE e Embase. Critérios de inclusão: estudos primários em inglês, espanhol e português, publicados entre 2015 a 2021, acerca da biovigilância na doação e transplante, riscos e eventos adversos. Resultados: Analisados 10 artigos, identificando a ocorrência de eventos adversos referentes ao processo de doação e transplante e estratégias de biovigilância para reduzir riscos e aumentar a segurança. Conclusão: Riscos e eventos adversos podem ocorrer no processo de doação e transplante. Observaram-se estratégias, para mitigar os riscos e a ocorrência/recorrência de eventos adversos, propiciando maior qualidade assistencial e segurança ao paciente. O enfermeiro tem papel fundamental no que concerne à biovigilância, estando presente em todas as fases do processo de doação e transplante

Diferencias sociodemográficas, clínicas y de tratamiento entre ancianos con enfermedades cardiovasculares del SUS y de convenios / particulares

OBJETIVO: Avaliar as características sociodemográficas, clínicas e a prevalência de medicamentos utilizados por idosos com doenças cardiovasculares abordando a diferença entre usuários do sistema único de saúde (SUS) e de convênios/particulares durante a internação hospitalar. MÉTODOS: Pesquisa transversal, retrospectiva, sendo conduzida em um hospital de grande porte de Porto Alegre, mediante revisão de prontuários dos pacientes internados nas unidades de internação coronariana no período compreendido entre janeiro e dezembro de 2015. A amostra foi constituída da avaliação de 152 prontuários, a coleta foi realizada através de um instrumento específico semiestruturado. RESULTADOS: Total de 68 pacientes idosos pertenciam ao grupo de usuários do SUS. Os demais 84 prontuários eram usuários de diversos grupos de Convênios/Particulares. Em relação ao estilo de vida mostrou-se que o tabagismo foi representativo. Quanto aos medicamentos presentes no RENAME, o AAS (94,1% vs 90,4%) e o Maleato de Enalapril (73,5% VS 50,6%) foram, respectivamente, os mais citados pelos pacientes do SUS e convênios/particulares. Já o medicamento Atorvastatina Cálcica, fora do RENAME, foi prescrita em 73,8% dos investigados do grupo SUS e 88,5% de convênios/particulares. CONCLUSÕES: Conclui-se que os pacientes do grupo convênios/particulares utilizam um número maior de medicamentos diferenciados que estão fora do relatório Nacional de Medicamentos Essenciais, do que os do grupo SUS. O grupo SUS se destaca por serem mais hipertensos e tabagistas e consequentemente realizam mais internações com patologias mais graves quando comparados ao outro grupo. Esses dados comparativos salientam a importância de ações que visem equilibrar as diferenças existentes entre as modalidades de planos de saúde atendidas no Brasil.OBJECTIVE: To evaluate the sociodemographic, clinical characteristics and prevalence of medications used by elderly patients with cardiovascular diseases, addressing the difference between users of the single health care system (SUS) and private/covenant during hospitalization. Methods: A retrospective cross-sectional study was carried out in a large hospital in Porto Alegre, by reviewing medical records of patients hospitalized at the coronary care units in the period from January to December 2015. The sample consisted of the evaluation of 152 medical records, the collection was performed through a specific semi-structured instrument. RESULTS: A total of 68 elderly patients belonged to the SUS user group. The other 84 medical records were users of several Covenants / Individuals groups. Regarding lifestyle, it was shown that smoking was representative. The presence of a significant association Regarding the clinical profile, all patients in both groups were hospitalized in coronary care units. CONCLUSIONS: It is concluded that the patients in the private / covenants group use a greater number of drugs outside the National Essential Medicines report than those in the SUS group. The SUS group stands out for being more hypertensive and smokers and as a result, they perform more hospitalizations with more severe pathologies when compared to the other group. These comparative data highlight the importance of actions that aim to balance the differences between the modalities of health plans served in Brazil.OBJETIVOS: Evaluar las características sociodemográficas, clínicas y la prevalencia de medicamentos utilizados por ancianos con enfermedades cardiovasculares abordando la diferencia entre usuarios del sistema único de salud (SUS) y de convenios / particulares durante la internación hospitalaria. MÉTODOS: Investigación transversal, retrospectiva, siendo conducida en un hospital de gran porte de Porto Alegre, mediante revisión de prontuarios de los pacientes internados en las unidades de internación coronaria en el período comprendido entre enero y diciembre de 2015. La muestra fue constituida de la evaluación de 152 prontuarios, la recolección fue realizada a través de un instrumento específico semi-estructurado. RESULTADOS: Total de 68 pacientes ancianos pertenecían al grupo de usuarios del SUS. Los demás 84 prontuarios eran usuarios de diversos grupos de Convenios / Particulares. En relación al estilo de vida se mostró que el tabaquismo fue representativo. En cuanto a los medicamentos presentes en RENAME, el AAS (94,1% vs 90,4%) y el Maleato de Enalapril (73,5% VS 50,6%) fueron, respectivamente, los más citados por los pacientes del SUS y convenios / los individuos. El medicamento Atorvastatina Cálcica, fuera del RENAME, fue prescrita en el 73,8% de los investigados del grupo SUS y el 88,5% de convenios / particulares. CONCLUSIONES: Se concluye que los pacientes del grupo convenios / particulares utilizan un número mayor de medicamentos diferenciados que están fuera del informe Nacional de Medicamentos Esenciales, que los del grupo SUS. El grupo SUS se destaca por ser más hipertensos y tabaquistas y consecuentemente realizan más internaciones con patologías más graves cuando comparadas al otro grupo. Estos datos comparativos subrayan la importancia de acciones que busquen equilibrar las diferencias existentes entre las modalidades de planes de salud atendidas en Brasil

Weighing the Giants - I. Weak-lensing masses for 51 massive galaxy clusters: project overview, data analysis methods and cluster images

This is the first in a series of papers in which we measure accurate weak-lensing masses for 51 of the most X-ray luminous galaxy clusters known at redshifts 0.15<z<0.7, in order to calibrate X-ray and other mass proxies for cosmological cluster experiments. The primary aim is to improve the absolute mass calibration of cluster observables, currently the dominant systematic uncertainty for cluster count experiments. Key elements of this work are the rigorous quantification of systematic uncertainties, high-quality data reduction and photometric calibration, and the "blind" nature of the analysis to avoid confirmation bias. Our target clusters are drawn from RASS X-ray catalogs, and provide a versatile calibration sample for many aspects of cluster cosmology. We have acquired wide-field, high-quality imaging using the Subaru and CFHT telescopes for all 51 clusters, in at least three bands per cluster. For a subset of 27 clusters, we have data in at least five bands, allowing accurate photo-z estimates of lensed galaxies. In this paper, we describe the cluster sample and observations, and detail the processing of the SuprimeCam data to yield high-quality images suitable for robust weak-lensing shape measurements and precision photometry. For each cluster, we present wide-field color optical images and maps of the weak-lensing mass distribution, the optical light distribution, and the X-ray emission, providing insights into the large-scale structure in which the clusters are embedded. We measure the offsets between X-ray centroids and Brightest Cluster Galaxies in the clusters, finding these to be small in general, with a median of 20kpc. For offsets <100kpc, weak-lensing mass measurements centered on the BCGs agree well with values determined relative to the X-ray centroids; miscentering is therefore not a significant source of systematic uncertainty for our mass measurements. [abridged]Comment: 26 pages, 19 figures (Appendix C not included). Accepted after minor revisio

FATORES RELACIONADOS ÀS HOSPITALIZAÇÕES POR DIABETES NO BRASIL: ANÁLISE SECUNDÁRIA DA PESQUISA NACIONAL DE SAÚDE

Objetivo: Evidenciar os fatores relacionados às hospitalizações por Diabetes, a partir dos dados da Pesquisa Nacional de Saúde (PNS) realizada em 2013. Métodos: Análise secundária de dados clínicos, hábitos de vida e sociodemográficos de diabéticos identificados na PNS com e sem histórico de hospitalização pela doença. Resultados: Foram analisados 3.182 participantes com 7,5% de hospitalizações, que foram mais frequentes em homens, com baixa escolaridade, com Plano de Saúde, má autopercepção de saúde, realizando consulta médica regular, em uso de insulina, necessitando controle glicêmico domiciliar e avaliação regular dos pés (p&lt;0,05). Menor frequência de hospitalização foi observada nos que receberam recomendação para prática de atividade física regular (p&lt;0,05). Na análise ajustada, as maiores chances de hospitalização foram: ser homem e ter baixa escolaridade, ter má autopercepção de saúde, usar insulina e receber orientações para uma alimentação saudável (p&lt;0,001). Conclusão: Gênero, escolaridade, autopercepção e estilo de vida foram associados com maior frequência de hospitalização por Diabetes

Single-subject analyses of magnetoencephalographic evoked responses to the acoustic properties of affective non-verbal vocalizations

Magneto-encephalography (MEG) was used to examine the cerebral response to affective non-verbal vocalizations (ANVs) at the single-subject level. Stimuli consisted of nonverbal affect bursts from the Montreal Affective Voices morphed to parametrically vary acoustical structure and perceived emotional properties. Scalp magnetic fields were recorded in three participants while they performed a 3-alternative forced choice emotion categorization task (Anger, Fear, Pleasure). Each participant performed more than 6000 trials to allow single-subject level statistical analyses using a new toolbox which implements the general linear model (GLM) on stimulus-specific responses (LIMO-EEG). For each participant we estimated ‘simple’ models (including just one affective regressor (Arousal or Valence)) as well as ‘combined’ models (including acoustical regressors). Results from the ‘simple’ models revealed in every participant the significant early effects (as early as ~100 ms after onset) of Valence and Arousal already reported at the group-level in previous work. However, the ‘combined’ models showed that few effects of Arousal remained after removing the acoustically-explained variance, whereas significant effects of Valence remained especially at late stages. This study demonstrates (i) that single-subject analyses replicate the results observed at early stages by group-level studies and (ii) the feasibility of GLM-based analysis of MEG data. It also suggests that early modulation of MEG amplitude by affective stimuli partly reflects their acoustical properties

Convalescent plasma for COVID-19 in hospitalised patients : an open-label, randomised clinical trial

Background: The effects of convalescent plasma (CP) therapy in hospitalised patients with coronavirus disease 2019 (COVID-19) remain uncertain. This study investigates the effect of CP on clinical improvement in these patients. Methods: This is an investigator-initiated, randomised, parallel arm, open-label, superiority clinical trial. Patients were randomly (1:1) assigned to two infusions of CP plus standard of care (SOC) or SOC alone. The primary outcome was the proportion of patients with clinical improvement 28 days after enrolment. Results: A total of 160 (80 in each arm) patients (66.3% critically ill, 33.7% severely ill) completed the trial. The median (interquartile range (IQR)) age was 60.5 (48–68) years; 58.1% were male and the median (IQR) time from symptom onset to randomisation was 10 (8–12) days. Neutralising antibody titres >1:80 were present in 133 (83.1%) patients at baseline. The proportion of patients with clinical improvement on day 28 was 61.3% in the CP+SOC group and 65.0% in the SOC group (difference −3.7%, 95% CI −18.8–11.3%). The results were similar in the severe and critically ill subgroups. There was no significant difference between CP+SOC and SOC groups in pre-specified secondary outcomes, including 28-day mortality, days alive and free of respiratory support and duration of invasive ventilatory support. Inflammatory and other laboratory marker values on days 3, 7 and 14 were similar between groups. Conclusions: CP+SOC did not result in a higher proportion of clinical improvement on day 28 in hospitalised patients with COVID-19 compared to SOC alone