Catheter-associated urinary tract infections: patient characteristics, treatment, and clinical outcomes in one South Texas acute care hospital

Background: Catheter-associated urinary tract infections (CA-UTIs) account for 40 percent of nosocomial infections worldwide. Their elimination is at the forefront of quality improvement in one South Texas acute care hospital. Methods: Over a period of 6 months, five CA-UTIs occurred in one South Texas acute care hospital. These cases were identified via regular surveillance by Infection Prevention staff and the Laboratory Department of the hospital. This research reviews patient age, sex, length of stay, bacteria contracted, appropriate antibiotic use, patient characteristics, and overall outcomes. Results: Between the months of July and December 2021, 5 CAUTIs were contracted. Patients ranged in age from 44 to 71 years old with a mean age of 68.8 years old; 2 were male and 3 were female; the average length of stay ranged from 19 to 59 days with an average stay of 32.2 days. All patients had severe illness on presentation and multiple comorbidities. Organisms isolated included klebsiella oxytoca, carbapenem-resistant Enterobacteriaceae, extended-spectrum beta-lactamase E. coli and klebsiella pneumoniae. Susceptibility studies were conducted on all 5 patients. Antibiotics used include piperacillin-tazobactam, ceftriaxone, levofloxacin, and meropenem. CAUTIs resolved in 4 patients; two of them were discharged to skilled nursing facilities, one was discharged home, and one died due to complications from COVID-19. Conclusions: Among these cases, factors such as local rates of COVID-19 cases (the cases happened when hospital census was unusually high), extended length of stay, use of mechanical ventilation, Foley catheter placement in the Emergency Department, severe illness, and comorbid health conditions should be considered when assessing risk of CA-UTI and treatment outcome. While antibiotics that were prescribed appropriately corresponded with sensitivity studies, sustainability of infection prevention processes for the prevention of CA-UTIs is difficult to sustain during periods of crisis as exemplified in this project

Impact of Academic Golden Weekend Initiative on Academic Success for an Internal Medicine Clerkship

Background: COVID-19 precautions led to a change in the number of protected weekends for the UTRGV Internal Medicine Clerkship, going from 2 protected weekends to none. The aim of Academic Golden Weekends during a fully inpatient clerkship has been to maximize the student experience by providing enough time to balance all the necessary components of the student experience. Starting April 26, 2021, all cohorts completing their Internal Medicine Clerkship as third-year medical students had 3 protected weekends. Methods: Two surveys were created to compare the pre-intervention and post-intervention cohorts. The surveys focused on student satisfaction regarding the time they had for self-study, accomplishing clerkship requirements, and overall well-being. Furthermore, IM Clerkship NBME grade and clerkship final grade data have been retrieved and deidentified, later analyzed by a blinded party to assess the impact of the Academic Golden Weekend Initiative on academic performance. Results: Prior survey analysis has shown that prior to the implementation of Academic Golden Weekends, students had a higher rate of dissatisfaction regarding time available for self-study, accomplishing clerkship requirements, and self-care. The leading cause for overall dissatisfaction was lack of protected weekends.100% of students in the post-intervention cohort reported feeling that Academic Golden Weekends had a positive impact on their academic performance and self-care and reported increased levels f satisfaction across all categories. However, the preliminary analysis of the impact that this initiative had on academic performance, did not show a significant improvement on average NBME, and clerkship grades. Conclusions: While the Academic Golden Weekends initiative has led to improved student satisfaction for academic performance and self-care, the limited data collected thus far does not reveal a significant improvement in academic performance in terms of NBME and clerkship grades. Once more data is gathered these variables will be re-analyzed for statistical differences

MRNA-1273 COVID-19 Vaccine Leading To Anti-LGI1 Limbic Encephalitis Flare

Introduction: Here, we discuss a patient with a past medical history of Anti-LGI1 limbic encephalitis that presented with seizure-like activity approximately three weeks after the administration of the mRNA-1273 COVID-19 vaccine. Case Description: A 75-year-old male with a history of Anti-LGI1 limbic encephalitis presented to our hospital with bilateral, truncal myoclonus and lateral nystagmus. EEG showed periodic lateralized epileptiform discharges. Brain MRI was unremarkable. The lumbar puncture was not suggestive of meningoencephalitis and the patient was diagnosed with a clinical relapse of Anti-LG1 limbic encephalitis, started on IVIG, methylprednisolone, azathioprine, and antiseizure medications. After the absence of seizure activity was documented, he was discharged with instructions to follow up with neurology and advised to withhold the second dose of the COVID-19 vaccine. Discussion: Our patient was previously diagnosed with Anti-LGI1 in 2011and had been clinically stable without seizures since 2016. His relapse could have been triggered by an immunological response to the COVID-19 vaccine. Although vaccine administration does not pose a more prominent danger than natural SARS-CoV-2 infection, the temporal association raises the possibility of the vaccine as a trigger for the patient’s autoimmune limbic encephalitis relapse. Unfortunately, little is known about how to predict, prevent or ameliorate these events in certain immunologically predisposed individuals or if the temporal association reported here represents an adverse event of the mRNA-1273 COVID-19 vaccine. Ongoing reporting and further research are warranted to evaluate if this association can be confirmed, and if so, understand if there is a plausible underlying immunological mechanism

Does Circular Economy Affect Financial Performance? The Mediating Role of Sustainable Sup-ply Chain Management in the Automotive Industry

The implementation of stricter sustainable policies and the tightening of environmental laws are forcing manufacturing companies, particularly those that make up the automotive industry, to make changes and improvements involving Circular Economy (CE) practices. However, CE practices do not always lead to an improvement in firm performance. This study analyzes the effects of the implementation of CE practices on the financial performance (FIP) of manufacturing companies in the automotive industry of Mexico, considering the mediating effect exerted by sustainable supply chain management (SSCM). The proposed model is validated through PLS-SEM using a sample of 460 companies. The results show that the FIP is strengthened through the implementation of the CE and that this effect is mediated by the commitment of the company to promote a better SSCM. This study contributes to the CE and SSCM theories by providing evidence about the positive effect that the implementation of these activities has on the performance of the automotive industry and how a SSCM equally exerts a direct and indirect effect on this. In the same way, managers can use this study and its results to make their operations more efficient and to demonstrate the effects of sustainability on the financial performance of the company

Coccidioides immitis presenting with acute hydropneumothorax in an immunocompetent patient from South Texas

Coccidioidomycosis is a disease caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii that predominates in dry climates and it is endemic in Southern California and Arizona. Coccidioides is also found in parts of West Texas and a long the Rio Grande River, however, incidence tends to decrease in areas close to the Gulf of Mexico due to increased humidity. Coccidioidomycosis is more commonly a subclinical and self-limited disease in up to sixty percent of cases. Acute pneumonia (Valley fever), extra thoracic disseminated infection and complications occur more frequently in immunocompromised hosts. We present a case of severe coccidiomycosis in an immunocompetent host who lived in central California for two months, 2 years prior to manifesting severe respiratory compromise. Clinicians should be able to recognize differential diagnoses for cavitary-like lung lesions, paying close attention to social history and CDC epidemiology data

Social distancing and testing as optimal strategies against the spread of COVID-19 in the Rio Grande Valley of Texas

At the beginning of August 2020, the Rio Grande Valley (RGV) of Texas experienced a rapid increase of coronavirus disease 2019 (abbreviated as COVID-19) cases and deaths. This study aims to determine the optimal levels of effective social distancing and testing to slow the virus spread at the outset of the pandemic. We use an age-stratified eight compartment epidemiological model to depict COVID-19 transmission in the community and within households. With a simulated 120-day outbreak period data we obtain a post 180-days period optimal control strategy solution. Our results show that easing social distancing between adults by the end of the 180-day period requires very strict testing a month later and then daily testing rates of 5% followed by isolation of positive cases. Relaxing social distancing rates in adults from 50% to 25% requires both children and seniors to maintain social distancing rates of 50% for nearly the entire period while maintaining maximum testing rates of children and seniors for 150 of the 180 days considered in this model. Children have higher contact rates which leads to transmission based on our model, emphasizing the need for caution when considering school reopenings

Efficacy of different routes of acetaminophen administration for postoperative pain in children:a systematic review and network meta-analysis

Purpose: Acetaminophen is the most common drug used to treat acute pain in the pediatric population, given its wide safety margin, low cost, and multiple routes for administration. We sought to determine the most efficacious route of acetaminophen administration for postoperative acute pain relief in the pediatric surgical population. Methods: We conducted a systematic review of randomized controlled trials (RCTs) that included children aged between 30 days and 17 yr who underwent any type of surgical procedure and that evaluated the analgesic efficacy of different routes of administration of acetaminophen for the treatment of postoperative pain. We searched MEDLINE, CENTRAL, Embase, CINAHL, LILACs, and Google Scholar databases for trials published from inception to 16 April 2023. We assessed the risk of bias in the included studies using the Cochrane Risk of Bias 1.0 tool. We performed a frequentist network meta-analysis using a random-effects model. Our primary outcome was postoperative pain using validated pain scales. Results: We screened 2,344 studies and included 14 trials with 829 participants in the analysis. We conducted a network meta-analysis for the period from zero to two hours, including six trials with 496 participants. There was no evidence of differences between intravenous vs rectal routes of administration of acetaminophen (difference in means, −0.28; 95% confidence interval [CI], −0.62 to 0.06; very low certainty of the evidence) and intravenous vs oral acetaminophen (difference in means, −0.60; 95% CI, −1.20 to 0.01; low certainty of the evidence). For the comparison of oral vs rectal routes, we found evidence favouring the oral route (difference in means, −0.88; 95% CI, −1.44 to −0.31; low certainty of the evidence). Few trials reported secondary outcomes of interest; when comparing the oral and rectal routes in the incidence of nausea and vomiting, there was no evidence of differences (relative risk, 1.20; 95% CI, 0.81 to 1.78). Conclusion: The available evidence on the effect of the administration route of acetaminophen on postoperative pain in children is very uncertain. The outcomes of postoperative pain control and postoperative vomiting may differ very little between the oral and rectal route. Better designed and executed RCTs are required to address this important clinical question. Study registration: PROSPERO (CRD42021286495); first submitted 19 November 2021.</p

Efficacy of different routes of acetaminophen administration for postoperative pain in children:a systematic review and network meta-analysis

Purpose: Acetaminophen is the most common drug used to treat acute pain in the pediatric population, given its wide safety margin, low cost, and multiple routes for administration. We sought to determine the most efficacious route of acetaminophen administration for postoperative acute pain relief in the pediatric surgical population. Methods: We conducted a systematic review of randomized controlled trials (RCTs) that included children aged between 30 days and 17 yr who underwent any type of surgical procedure and that evaluated the analgesic efficacy of different routes of administration of acetaminophen for the treatment of postoperative pain. We searched MEDLINE, CENTRAL, Embase, CINAHL, LILACs, and Google Scholar databases for trials published from inception to 16 April 2023. We assessed the risk of bias in the included studies using the Cochrane Risk of Bias 1.0 tool. We performed a frequentist network meta-analysis using a random-effects model. Our primary outcome was postoperative pain using validated pain scales. Results: We screened 2,344 studies and included 14 trials with 829 participants in the analysis. We conducted a network meta-analysis for the period from zero to two hours, including six trials with 496 participants. There was no evidence of differences between intravenous vs rectal routes of administration of acetaminophen (difference in means, −0.28; 95% confidence interval [CI], −0.62 to 0.06; very low certainty of the evidence) and intravenous vs oral acetaminophen (difference in means, −0.60; 95% CI, −1.20 to 0.01; low certainty of the evidence). For the comparison of oral vs rectal routes, we found evidence favouring the oral route (difference in means, −0.88; 95% CI, −1.44 to −0.31; low certainty of the evidence). Few trials reported secondary outcomes of interest; when comparing the oral and rectal routes in the incidence of nausea and vomiting, there was no evidence of differences (relative risk, 1.20; 95% CI, 0.81 to 1.78). Conclusion: The available evidence on the effect of the administration route of acetaminophen on postoperative pain in children is very uncertain. The outcomes of postoperative pain control and postoperative vomiting may differ very little between the oral and rectal route. Better designed and executed RCTs are required to address this important clinical question. Study registration: PROSPERO (CRD42021286495); first submitted 19 November 2021.</p

Sampling related individuals within ponds biases estimates of population structure in a pond‐breeding amphibian

Effective conservation and management of pond‐breeding amphibians depends on the accurate estimation of population structure, demographic parameters, and the influence of landscape features on breeding‐site connectivity. Population‐level studies of pond‐breeding amphibians typically sample larval life stages because they are easily captured and can be sampled nondestructively. These studies often identify high levels of relatedness between individuals from the same pond, which can be exacerbated by sampling the larval stage. Yet, the effect of these related individuals on population genetic studies using genomic data is not yet fully understood. Here, we assess the effect of within‐pond relatedness on population and landscape genetic analyses by focusing on the barred tiger salamanders (Ambystoma mavortium) from the Nebraska Sandhills. Utilizing genome‐wide SNPs generated using a double‐digest RADseq approach, we conducted standard population and landscape genetic analyses using datasets with and without siblings. We found that reduced sample sizes influenced parameter estimates more than the inclusion of siblings, but that withinpond relatedness led to the inference of spurious population structure when analyses depended on allele frequencies. Our landscape genetic analyses also supported different models across datasets depending on the spatial resolution analyzed. We recommend that future studies not only test for relatedness among larval samples but also remove siblings before conducting population or landscape genetic analyses. We also recommend alternative sampling strategies to reduce sampling siblings before sequencing takes place. Biases introduced by unknowingly including siblings can have significant implications for population and landscape genetic analyses, and in turn, for species conservation strategies and outcomes

Bactrim, Spironolactone and Lisinopril. Stay Away! A Dangerous Cocktail for Hyperkalemia

Introduction: Hyperkalemia is a potentially life-threatening complication of several medications, particularly in situations of polypharmacy. Trimethoprim/sulfamethoxazole (TMP-SMX) is a first line antibiotic for outpatient treatment of MRSA for skin and soft tissue infections that can enhance the hyperkalemic effects of spironolactone and Angiotensin receptor inhibitors (ACEI). Case Presentation: A 53-year-old female with history of HTN, stage 3 CKD, CHF, hypercholesterolemia and DM II, chronic left foot ulcer presented to our local hospital with generalized malaise, severe lower extremity weakness and heaviness of 2 days duration. She normally uses a walker but has had increasing difficulty standing from a seated position. Her medications included: spironolactone, carvedilol, lisinopril, amlodipine, aspirin, atorvastatin, and insulin and had been started on TMP-SMX for the management of an infected chronic ulcer. Physical exam was significant for a blood pressure of 182/87 mm Hg, BMI of 52, lethargy, dry oral mucous membranes, and nonsignificant musculoskeletal examination. The laboratory results revealed significantly elevated potassium levels at 8.6 mmol/L; GFR of 31 and creatinine: 1.79 mg/dL. EKG revealed tall, peaked T-waves with widened QRS complexes in the precordial leads and a right BBB. TMP-SMX, spironolactone and lisinopril were discontinued, and the patient was started on a hyperkalemia treatment protocol. The patient improved rapidly over the next 3 days with resolution of the ECG changes, improved muscle strength and the potassium level was back to normal limits by the time of discharge. Conclusion: Clinicians and pharmacists should be aware of the enhanced hyperkalemic effects of TMP-SMX, spironolactone and lisinopril and should avoid this combination