Oral fosfomycin for the treatment of lower urinary tract infections among kidney transplant recipients—Results of a Spanish multicenter cohort

Preliminary results of this study were presented at the 29th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), held in Amsterdam, The Netherlands, from 13 to 16 April, 2019 (oral communication O‐0699).Oral fosfomycin may constitute an alternative for the treatment of lower urinary tract infections (UTIs) in kidney transplant recipients (KTRs), particularly in view of recent safety concerns with fluroquinolones. Specific data on the efficacy and safety of fosfomycin in KTR are scarce. We performed a retrospective study in 14 Spanish hospitals including KTRs treated with oral fosfomycin (calcium and trometamol salts) for posttransplant cystitis between January 2005 and December 2017. A total of 133 KTRs developed 143 episodes of cystitis. Most episodes (131 [91.6%]) were produced by gram‐negative bacilli (GNB), and 78 (54.5%) were categorized as multidrug resistant (including extended‐spectrum β‐lactamase‐producing Enterobacteriaceae [14%] or carbapenem‐resistant GNB [3.5%]). A median daily dose of 1.5 g of fosfomycin (interquartile range [IQR]: 1.5‐2) was administered for a median of 7 days (IQR: 3‐10). Clinical cure (remission of UTI‐attributable symptoms at the end of therapy) was achieved in 83.9% (120/143) episodes. Among those episodes with follow‐up urine culture, microbiological cure at month 1 was achieved in 70.2% (59/84) episodes. Percutaneous nephrostomy was associated with a lower probability of clinical cure (adjusted odds ratio: 10.50; 95% confidence interval: 0.98‐112.29; P = 0.052). In conclusion, fosfomycin is an effective orally available alternative for treating cystitis among KTRs.This study was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016)—cofinanced by the European Development Regional Fund “A way to achieve Europe”; the Group for Study of Infection in Transplantation and the Immunocompromised Host (GESITRA‐IC) of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC); and the Spanish Network for Research in Renal Diseases (REDInREN RD16/0009). MFR holds a research contract “Miguel Servet” (CP 18/00073) from the Spanish Ministry of Science, Innovation and Universities, Instituto de Salud Carlos III

Efficacy and Safety of Oral Fosfomycin for Asymptomatic Bacteriuria in Kidney Transplant Recipients: Results from a Spanish Multicenter Cohort

Current guidelines recommend against systematic screening for or treating asymptomatic bacteriuria (AB) among kidney transplant (KT) recipients, although the evidence regarding episodes occurring early after transplantation or in the presence of anatomical abnormalities is inconclusive. Oral fosfomycin may constitute a good option for the treatment of posttransplant AB, particularly due to the emergence of multidrug-resistant (MDR) uropathogens. Available clinical evidence supporting its use in this specific setting, however, remains scarce. We performed a retrospective study in 14 Spanish institutions from January 2005 to December 2017. Overall, 137 episodes of AB diagnosed in 133 KT recipients treated with oral fosfomycin (calcium and trometamol salts) with a test-of-cure urine culture within the first 30 days were included. Median time from transplantation to diagnosis was 3.1 months (interquartile range [IQR], 1.1 to 10.5). Most episodes (96.4% [132/137]) were caused by Gram-negative bacteria (GNB), and 56.9% (78/137) were categorized as MDR (extended‐spectrum β‐lactamase‐producing Enterobacterales [20.4%] and carbapenem‐resistant GNB [2.9%]). Rate of microbiological failure at month 1 was 40.1% (95% confidence interval [CI], 31.9% to 48.9%) for the whole cohort and 42.3% (95% CI, 31.2% to 54.0%) for episodes due to MDR pathogens. Previous urinary tract infection (odds ratio [OR], 2.42; 95% CI, 1.11 to 5.29; P value = 0.027) and use of fosfomycin as salvage therapy (OR, 8.31; 95% CI, 1.67 to 41.35; P value = 0.010) were predictors of microbiological failure. No severe treatment-related adverse events were detected. Oral fosfomycin appears to be a suitable and safe alternative for the treatment (if indicated) of AB after KT, including those episodes due to MDR uropathogens.This study was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III (ISCIII), Subdirección General de Redes y Centros de Investigación Cooperativa, Ministry of Science and Innovation, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), and Spanish Network for Research in Renal Diseases (REDInREN RD16/0009) and cofinanced by the European Development Regional Fund entitled A way to achieve Europe. M.F.-R. holds a research contract (Miguel Servet, CP18/00073), from the Spanish Ministry of Science and Innovation, ISCIII.Peer reviewe

Relatório Diagnóstico sobre o ensino superior e a ciência pós-covid-19 na Ibero-América : perspectivas e desafios 2022

O principal impacto no ensino a partir da declaração da pandemia foi a transição urgente e não planejada para modalidades de ensino remoto de emergência. A pandemia chegou e surpreendeu os países e instituições de ensino superior com capacidades diferentes para o desenvolvimento do ensino remoto de emergência e isso se refletiu nos resultados desiguais e nos desafios que tiveram que superar. Inicialmente apresentada como breve, a suspensão da presencialidade em muitos países da região ultrapassou 40 semanas e é o período sem aulas presenciais mais longo do mundo. A primeira reação das instituições foi criar comitês de crise para lidar com a emergência e garantir a continuidade do ensino de forma remota. A pandemia da covid-19 obrigou asinstituições universitárias a empreenderem esforços institucionais, acadêmicos,tecnológicos, etc., que não estavam em suas agendas e para os quais, em muitos casos,não houve preparação prévia. Esses esforços não foram apresentados de forma equilibrada no panorama regional. Embora as universidades da região já utilizassem plataformas virtuais de apoio ao ensino e à aprendizagem antes da pandemia, a maioria não eram propostas institucionais, mas sim iniciativas individuais. Esta foi a base para a continuidade da aprendizagem durante a emergência, e como a suspensão da presencialidade durou mais tempo, as instituições foram fortalecendo as propostas pedagógicas remotas de emergência no nível institucional, incorporando ferramentas e capacitação de professores. No nível institucional, para favorecer a continuidade da aprendizagem, as universidades não propuseram uma metodologia única, deixando para o pessoal docente a decisão sobre o uso das salas de aulas virtuais. Nelas, foram ministradas a maioria das aulas on-line sincronizadas, pelo menos em um primeiro momento. Embora os esforços das IES para oferecer apoio à comunidade universitária para garantir a continuidade da aprendizagem nas melhores condições possíveis sejam evidentes, havia limitações tecnológicas, tanto em termos de conectividade quanto de equipamentos, que nem sempre puderam ser cobertas. Também foram evidenciadas limitações pedagógicas, apesar do empenho para desenvolver competências básicas nos professores, visando facilitar o uso das possibilidades da educação a distância; e, por último, limitações socioemocionais, com esforços institucionais para reduzir a ansiedade e o stress gerados pelo isolamento e a desconexão social. A função de P&D universitária produziu um duplo movimento: por um lado, parou o planejamento e as ações em desenvolvimento até o surgimento da pandemia e, por outro, teve que disponibilizar e redirecionar recursos para produzir conhecimento sobre o SARS-CoV-2 e a covid-19, bem como para produzir recursos tecnológicos e auxiliar o sistema de saúde na prevenção do contágio, e no atendimento aos doentes e aos efeitos psicossociais da pandemia. As ações dos atores universitários para a contenção epidemiológica quanto à produção tecnológica e de conhecimento, são muito relevantes. Em alguns casos, surgiram de iniciativas institucionais nas IES com um histórico de capacidade de intervenção sociocomunitária e de articulação com o setor produtivo. Nesse sentido, as decisões políticas implementadas e os resultados obtidos foram, em maior ou menor grau, produto da articulação dos setores científicos e governamentais. No campo das IES, foram realizados muitos estudos e pesquisas sobre a SARS-CoV-2, a covid-19, a pandemia e seus efeitos em diferentes campos disciplinares. Em muitos casos, os esforços institucionais foram orientados para a produção e disponibilidade de recursos tecnológicos ou dispositivos de apoio social, especialmente para lidar com os efeitos dos processos do confinamento e luto pessoal. As pesquisas que não estão ligadas à covid-19 ou que não puderam ser mantidas foram adiadas em muitos países e podem enfrentar severas restrições para sua continuidade. Este risco é maior nas universidades dos países mais pobres que dependem de agências doadoras para o financiamento

Informe diagnóstico sobre la educación superior y la ciencia post COVID-19 en Iberoamérica : perspectivas y desafíos de futuro 2022

El principal efecto en la enseñanza a partir de la declaración de la pandemia fue la transición urgente y sin planificación previa a modalidades de enseñanza remota de emergencia. La desigual capacidad para el desarrollo de enseñanza remota de emergencia con que la pandemia sorprendió a países e instituciones del nivel superior, tiene su correlato en los desiguales resultados y los desafíos que tuvieron que superar. La supresión de la presencialidad, que se presentó inicialmente como breve, en muchos países de la región, superó las 40 semanas y se trata del cierre más prolongado a nivel mundial. La primera reacción de las instituciones fue la conformación de comités de crisis para hacer frente a la emergencia y garantizar la continuidad de la enseñanza de manera remota. La pandemia COVID-19 obligó a que las instituciones universitarias llevaran adelante una serie de esfuerzos institucionales, académicos, tecnológicos, etc., que no estaban en sus agendas y para los cuales, en muchos casos, no había preparación previa. Estos esfuerzos no se presentaron de manera equilibrada en el panorama regional. Si bien las universidades de la región utilizaban plataformas virtuales de apoyo a la enseñanza desde antes de la pandemia, estas no eran en su mayoría propuestas institucionales, sino iniciativas individuales. Esta fue la base de la continuidad pedagógica durante la emergencia y a medida que el cierre de la presencialidad se prolongó, las instituciones fueron fortaleciendo las propuestas pedagógicas remotas de emergencia a nivel institucional, incorporando herramientas e instancias de formación docente. Para favorecer la continuidad pedagógica, las universidades a nivel institucional no propusieron una única metodología, dejando estas decisiones de uso de las aulas virtuales al profesorado, desde donde se dictaron mayoritariamente clases sincrónicas virtualizadas, al menos en una primera instancia. Si bien se evidencian los esfuerzos de las IES para ofrecer soporte a la comunidad universitaria con el objetivo de garantizar la continuidad pedagógica en las mejores condiciones, existen limitaciones de orden tecnológico, ya sea de conectividad o equipamiento, que no siempre han podido ser cubiertos. También se evidenciaron limitaciones de orden pedagógico, pese a los esfuerzos destinados a desarrollar las competencias básicas en los docentes para facilitar el aprovechamiento de las posibilidades de la educación a distancia; y, finalmente, de orden socioemocional, con esfuerzos institucionales tendientes a reducir la ansiedad y el estrés que el aislamiento y la desconexión social generaron

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Prospective individual patient data meta-analysis of two randomized trials on convalescent plasma for COVID-19 outpatients

Data on convalescent plasma (CP) treatment in COVID-19 outpatients are scarce. We aimed to assess whether CP administered during the first week of symptoms reduced the disease progression or risk of hospitalization of outpatients. Two multicenter, double-blind randomized trials (NCT04621123, NCT04589949) were merged with data pooling starting when = 50 years and symptomatic for <= 7days were included. The intervention consisted of 200-300mL of CP with a predefined minimum level of antibodies. Primary endpoints were a 5-point disease severity scale and a composite of hospitalization or death by 28 days. Amongst the 797 patients included, 390 received CP and 392 placebo; they had a median age of 58 years, 1 comorbidity, 5 days symptoms and 93% had negative IgG antibody-test. Seventy-four patients were hospitalized, 6 required mechanical ventilation and 3 died. The odds ratio (OR) of CP for improved disease severity scale was 0.936 (credible interval (CI) 0.667-1.311); OR for hospitalization or death was 0.919 (CI 0.592-1.416). CP effect on hospital admission or death was largest in patients with <= 5 days of symptoms (OR 0.658, 95%CI 0.394-1.085). CP did not decrease the time to full symptom resolution

Connections : safe spaces for women and youth in Latin America and The Caribbean

RESUMEN: Este libro se puede leer en muchos niveles. Uno de ellos puede no ser muy obvio para aquellos que están acostumbrados a leer sobre violencia e inseguridad en América Latina. Es el nivel que le da a este libro un estatus de originalidad y una contribución que va más allá de la región: el ser una forma de conocimiento destinada no solo a interpretar el mundo, sino a cambiarlo […], visibiliza la importancia de un proceso de investigación ajustado al tipo de conocimiento que produce. Aquí se conectan el proceso y el resultado, lo que debería propiciar un debate más amplio con respecto a cómo y qué sabemos de la naturaleza de la violencia y la agencia social para reducirla […]. Esta visión es particularmente relevante en contextos donde el Estado reproduce la violencia, con terribles impactos, en especial en periferias excluidas. […] El proceso de investigación abordado en este libro transgredió muchas fronteras. Hubo fronteras entre países, barreras lingüísticas, fronteras en torno a la educación, el conocimiento y la experiencia, y entre etnias, géneros y generaciones. […] este proceso reunió a académicos, activistas y líderes comunitarios de cinco países de América Latina y uno del Caribe, incluyendo comunidades indígenas en México y Guatemala […]. La violencia está en el tiempo y en el espacio y se reproduce entre las generaciones en diversos espacios de socialización. Este proceso de investigación que trasciende las fronteras, plantea una discusión que atraviesa los diferentes casos sobre cómo los déficits y las desigualdades materiales, las violencias estatales en nombre de la ‘seguridad’, las especificidades culturales, de género y generacionales de la experiencia y la comprensión de la violencia, así como las diversas formas de criminalidad, se cruzan y se reproducen a través del tiempo y el espacio. Jenny Pearce, investigadora y profesora en el Latin American and Caribbean Centre (LACC) de la London School of Economics and Political ScienceABSTRACT: This book can be read on many levels. One level may not be so obvious to those who are used to reading about violence and insecurity in Latin America. It is the level which gives this book a claim to true originality and a contribution beyond the region. This contribution is to form of scholarship aimed not only to interpret the world but to change it […], this text visibilizes the significance of the research process to the kind of knowledge that is produced. It connects process and outcome, and this should start a wider debate about how as well as what we know about the nature of violence and the social agency to reduce it […]. This is particularly relevant in contexts where the State reproduces violence, with terrible impacts on the margins. The research process discussed in this book transgressed many boundaries. There were intercountry borders, linguistic barriers, boundaries around education, knowledge and experience and between ethnicities, genders and generations. […] the research process brought together scholars and community activists and actors from five Latin American and one Caribbean country. And within Latin America there were indigenous communities in Mexico and Guatemala who participated […]. Violence is located in time and space. It is reproduced inter-generationally through varied socialisation spaces. The boundary crossing research process, raises cross case discussion about how material deficits and inequalities, state violences in the name of ‘security’, cultural, gender and generational specificities of experience and understanding of violence, and varied forms of criminality, intersect and reproduce through time and space. Professor Jenny Pearce. Latin American and Caribbean Centre (LACC), London School of Economics and Political Scienc

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

DEVELOPMENT OF AN EVALUATION TOOL TO MEASURE THE DEGREE OF ASSOCIATIVITY BETWEEN THE VARIABLES MIGRATION FROM IPV4 TO IPV6 AND INFRASTRUCTURE OF THE TECHNOLOGICAL UNIVERSITIES OF THE STATE OF MORELOS

The migration of IPv4 to IPv6 has become a necessity due to the exhaustion of IPv4 addresses, since the IANA in 2011, delivered the last block of IP addresses, is the domain within the area of the Technologies of The information, which is imperative migration from IPv4 to IPv6, however, the questions are Are the public universities ready to perform this migration?, Is the network infrastructure available to carry out this migration? For this reason, the University of Technology Emiliano Zapata of the State of Morelos, carried out the present investigation, whose objective was the development and validation of an instrument to measure the degree of associativity between the migration of IPv4 to IPv6 with the network infrastructure of the Universities of the State of Morelos. The instrument consisted of 37 items, in 6 dimensions, was used the methodology of scale creation in the social sciences, was validated by a sample of sixty teachers and experts in the area of networks and telecommunications, which were Randomly selected, they evaluated each of the items of the instrument, the information was examined through a correlation analysis using the coebach "α" of Cronbach and the "r" coefficient of Pearson, according to the results it is concluded that The instrument, values obtained from the Cronbach coefficient "α" was 0.970 and a Pearson coefficient of 0.942, based on the results we conclude that the instrument has a high level of reliability to measure the degree of associativity between IPv4 migration To IPv6 and the network infrastructure that the Technological Universities of the State of Morelos have