Comparative performance of vulvovaginal swab sampling versus endocervical sampling for the detection of Chlamydia, Gonorrhea, Mycoplasma genitalium, and Trichomoniasis: A cross-sectional study in Spain

INTRODUCTION

The global increase in sexual transmitted infections (STI) makes it necessary to seek public health strategies that facilitate rapid and minimally invasive diagnosis. The objective was to evaluate the concordance between vaginal and endocervical samples for STI diagnosis.

MATERIALS AND METHODS

A retrospective cross-sectional study was carried out on vaginal and endocervical samples from women attended in our reference area with symptoms suggestive of vulvovaginitis or for STI screening during the study period.

RESULTS

A total of 130 paired samples were analyzed; fifty-seven and 59 samples were positive for vaginal and endocervical specimens (Kappa index of 0.969 (Standard error = 0.022). The sensitivity of the vaginal samples was 96.5% (IC95%: 87.2-99.4), with a specificity of 100% (IC95%: 93.0-100).

DISCUSSION

The introduction of STI screening in vaginal samples in our environment can facilitate rapid and effective diagnosis and allow early treatment of STI. Additionally, it facilitates sample collection and diagnosis in the community setting, essential for optimal screening.

Detection of intrathecal IgG antibody for varicella and measles diagnosis by evaluation and comparison of a commercial IgG chemiluminescent immunoassay with two ELISAs

OBJECTIVES

Analyse alternative methods of intrathecal antibody detection by comparing chemiluminescent immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA) techniques to determine if CLIA can replace ELISA in the diagnosis of CNS infections.

METHODS

A panel of 280 paired samples-cerebrospinal fluid (CSF) and serum-with known antibody reactivities (Varicella, n = 60; Measles, n = 120) and negative samples (n = 100) were used to evaluate the performance of six serological test kits (Enzygnost, VirClia®, and Serion ELISA (Measles and Variella).

RESULTS

For Measles virus IgG, the VirClia® IgG monotest revealed 97% and 94% positive and negative agreement to the Enzygnost as reference test, respectively. In contrast, Serion ELISA kits yielded values of 18% and 90%. For the Varicella Zoster virus (VZV) IgG, the VirClia® IgG monotest showed 97% and 90% positive and negative agreement compared to Enzygnost. The Serion ELISA kits showed values of 55% and 86%, respectively. ROC analysis revealed that the areas under the curve for Measles and VZV IgGs were 0.7 and 0.852, respectively, using the Serion kit, and 0.963 and 0.955, for Vircell S.L CLIA technique. VirClia® monotest values were calculated using an antibody index cut-off of 1.3.

CONCLUSION

The findings indicate that CLIA testing can improve antibody detection in CSF samples, aiding the diagnosis of infectious neurological impairments.

Measurement of the 2νββ Decay Rate and Spectral Shape of ^{100}Mo from the CUPID-Mo Experiment

Neutrinoless double beta decay (0νββ) is a yet unobserved nuclear process that would demonstrate Lepton number violation, a clear evidence of beyond standard model physics. The process two neutrino double beta decay (2νββ) is allowed by the standard model and has been measured in numerous experiments. In this Letter, we report a measurement of 2νββ decay half-life of ^{100}Mo to the ground state of ^{100}Ru of [7.07±0.02(stat)±0.11(syst)]×10^{18}  yr by the CUPID-Mo experiment. With a relative precision of ±1.6% this is the most precise measurement to date of a 2νββ decay rate in ^{100}Mo. In addition, we constrain higher-order corrections to the spectral shape, which provides complementary nuclear structure information. We report a novel measurement of the shape factor ξ_{3,1}=0.45±0.03(stat)±0.05(syst) based on a constraint on the ratio of higher-order terms from theory, which can be reliably calculated. This is compared to theoretical predictions for different nuclear models. We also extract the first value for the effective axial vector coupling constant obtained from a spectral shape study of 2νββ decay.

Reduced neutralizing antibody response to SARS-CoV-2 vaccine booster dose in people living with HIV with severe immunosuppression

OBJECTIVE

To assess the immunogenicity of SARS-CoV-2 vaccines among PLWH with severe immunosuppression, after a booster dose.

METHODS

Case-control study nested in a prospective cohort of PLWH. All patients with CD4 cell count <200 cells/mm³ who had received additional dose of mRNA COVID-19 vaccine, after a standard immunization scheme were included.

CONTROL GROUP

patients age- and sex-matched, with CD4 ≥200 cells/mm3, in the ratio of 2:1. Antibody response to a booster dose (anti-S levels 33.8 ≥BAU/mL) and neutralizing activity against SARS-CoV-2 B.1, B.1.617.2, and Omicron BA.1, BA.2 and BA.5 strains were assessed after the booster shot.

RESULTS

54 PLWH were included, 18 with CD4 counts <200 cells/mm³ . 51 (94%) showed response to a booster dose. Response was less frequent in PLWH with CD4 <200 cells/mm³ than in those with CD4 counts ≥200 cells/mm³ [15 (83%) vs. 36 (100%), p=0.033]. In the multivariate analysis, CD4 counts ≥200 cells/mm³ [IRR=18.1 (CI 95% 16.8-19.5), p<0.001] was associated with a higher probability of showing antibody response. Neutralization activity against SARS-CoV-2 B.1, B.1.617, BA.1 and BA.2 strains was significantly inferior among individuals with CD4 counts <200 cells/mm³ .

CONCLUSIONS

Among PLWH with CD4 counts<200 cells/mm³ , the immune response elicited by mRNA additional vaccine dose is reduced. This article is protected by copyright. All rights reserved.

In vitro neutralizing activity of BNT162b2 mRNA-induced antibodies against full B.1.351 SARS-CoV-2 variant

SARS-CoV-2 variation represents a serious challenge to current COVID-19 vaccines. Recent reports suggest that B.1.351 and other variants may escape the neutralization activity of the antibodies generated by current vaccines. Ninety-nine healthcare workers undertaking BNT162b2 mRNA vaccination were sampled at baseline, on the day of the second dose, and 14 days after the latter. Neutralization activity against SARS-CoV-2 B.1, B.1.1.7 and B.1.351 was investigated using a Vero-E6 model. Eleven of the study participants had prior infection with SARS-CoV-2. Neutralization titers against the B.1 and the B.1.1.7 variants were not statistically different and were significantly higher than titers against the B.1.351 variant across pre-exposed and non-pre-exposed vaccinated individuals (p < .01). While all vaccinated individuals presented neutralizing antibodies against B.1 and B 1.1.7 after the second dose, 14% were negative against B.1.351 and 76% had low titers (1/201/80). Pre-exposed vaccinated individuals showed higher titers than non-pre-exposed after the first (median titers of 1/387 versus 1/28, respectively) and the second doses (1/995 versus 1/703, respectively). As high as 72% of the pre-exposed vaccines presented titers >1/80 after a single dose, while only 11% of non-exposed vaccinated individuals had titers >1/80. BNT162b2 mRNA-induced antibodies show a lower in vitro neutralizing activity against B.1.351 variant compared to neutralization against B.1.1.7 or B.1 variants. Interestingly, for individuals pre-exposed to SARS-CoV-2, one dose of BNT162b2 mRNA may be adequate to produce neutralizing antibodies against B.1.1.7 and B.1, while two doses of BNT162b2 mRNA provide optimal neutralizing antibody response against B.1.351 too.

New Limit for Neutrinoless Double-Beta Decay of ^{100}Mo from the CUPID-Mo Experiment

The CUPID-Mo experiment at the Laboratoire Souterrain de Modane (France) is a demonstrator for CUPID, the next-generation ton-scale bolometric 0νββ experiment. It consists of a 4.2 kg array of 20 enriched Li_{2}^{100}MoO_{4} scintillating bolometers to search for the lepton-number-violating process of 0νββ decay in ^{100}Mo. With more than one year of operation (^{100}Mo exposure of 1.17  kg×yr for physics data), no event in the region of interest and, hence, no evidence for 0νββ is observed. We report a new limit on the half-life of 0νββ decay in ^{100}Mo of T_{1/2}>1.5×10^{24}  yr at 90% C.I. The limit corresponds to an effective Majorana neutrino mass ⟨m_{ββ}⟩<(0.31-0.54)  eV, dependent on the nuclear matrix element in the light Majorana neutrino exchange interpretation.

Predictors of atrial fibrillation in patients with cryptogenic stroke and fifteen-days electrocardiographic monitoring. Preliminary results of the DECRYPTORING study

Funding Acknowledgements

Type of funding sources: None.

onbehalf

DECRYPTORING study

Introduction

Cryptogenic stroke (CS) represents up to 30% of all stroke types.  In one third of CS, atrial fibrillation (AF) is identified as the underlying cause. Predictors of AF in the setting of CS have been described, however these findings were based on retrospective studies and with maximum ECG monitoring of 72 hours. To overcome these limitations, we designed the prospective Decryptoring study whose objective is to create a comprehensive predictive model for AF in patients with CS.

Methods

From April 2019, 41 consecutive patients with a CS and age &gt; 60 years were included. On admission, a transthoracic echocardiogram with 3D volume and left atrial (LA) strain was performed. All patients were monitored with a 15-day ECG-Holter after discharge. Patients were classified according to AF detection.

Results

AF was detected in 9 patients (22%). Patients with AF were older (75.9 ± 8 vs. 81.9 ± 4.3 years, p = 0.041). There was no difference in T-troponin levels. NTproBNP was higher in the group with AF (350 ± 586 pg / ml vs. 1084 ± 1416 pg / ml, p = 0.018). Regarding LA strain, patients with AF presented reservoir LA strain (25.5 ± 8.2% vs 17.4 ± 4.3%; p = 0.006) and conduct LA strain (12 ± 5.2% vs 7.2 ± 1.5%; p = 0.01) lower than patients without AF. There were no differences in contraction LA strain or other echocardiographic variables. The risk of developing AF was higher in patients with NTproBNP&gt; 165 pg / ml (OR 11.3 [95% CI 1.2-102.9] p = 0.031), LA reservoir strain &lt;19.1% (OR 7.7 [IC 95 % 1.5-40.0] p = 0.016) and LA conduct strain &lt;9.1% (OR 7.8 [95% CI 1.3-45.0] p = 0.022) (Table).

Conclusions

This prospective study, demonstrates that high NTproBNP, low reservoir LA strain and low conduct LA strain are associated with underlying AF in patients with cryptogenic stroke.

No AF (n = 32) AF (n = 9) P value Age (years) 75.9 ± 8 81.9 ± 4.3 p = 0.041 NTPROBNP (pg/ml) 350 ± 586 1084 ± 1416 P = 0.018 LA indexed diastolic volume (ml/m2) 30 ± 11.8 33.8 ± 9.8 P = 0.35 LA EF (%) 45 ± 16.7 45 ± 12.8 P = 1 Reservoir LA strain (%) 25.5± 8.2 17.4± 4.3 P = 0.006 Conduct LA strain (%) 12 ± 5.2 7.2 ± 1.5 P = 0.01 Contraction LA strain (%) 13.5 ±5.3 10.2± 3.9 P = 0.10 NTPROBNP &gt; 165 pg/ml 12 (41%) 8 (89%) OR 11.3 [IC 95% 1.2-102.9]; p = 0.031 Reservoir LA strain &lt;19.1% 6 (20%) 6 (67%) OR 7.7 [IC 95% 1.5-40.0]; p = 0.016 Conduct LA strain &lt;9.1% 9 (31%) 7 (78%) OR 7.8 [IC 95% 1.3-45.1]; p = 0.022

Cutaneous habronemosis in horses: First molecular characterization of Habronema muscae in Israel

Draschia megastoma, Habronema microstoma, and Habronema muscae are the etiological agents of cutaneous habronemosis, commonly known as summer sores, an inflammatory cutaneous and ocular parasitic disease of horses and other equids transmitted by flies. Here, we describe a cluster of cutaneous habronemosis in five horses that showed single or multiple typical cutaneous ulcerative wounds located on the face, lower forelegs or hindquarters in Israel with the presence of typical "sulphur granules." All affected animals were confirmed by histopathological and/or molecular methods to be infected by H. muscae. This constitutes the first report of cutaneous habronemosis in Israel in which the causative nematode, H. muscae, was identified by molecular means. Cutaneous habronemosis should be considered as a differential diagnosis in equids with cutaneous ulcerative lesions during the summer months, especially when affected animals are refractive to antibiotic treatment alone.

The potential role of dietary advanced glycation endproducts in the development of chronic non-infectious diseases: a narrative review

Increasing clinical and experimental evidence accumulated during the past few decades supports an important role for dietary advanced glycation endproducts (AGE) in the pathogenesis of many chronic non-infectious diseases, such as type 2 diabetes, CVD and others, that are reaching epidemic proportions in the Western world. Although AGE are compounds widely recognised as generated in excess in the body in diabetic patients, the potential importance of exogenous AGE, mostly of dietary origin, has been largely ignored in the general nutrition audience. In the present review we aim to describe dietary AGE, their mechanisms of formation and absorption into the body as well as their main mechanisms of action. We will present in detail current evidence of their potential role in the development of several chronic non-infectious clinical conditions, some general suggestions on how to restrict them in the diet and evidence regarding the potential benefits of lowering their consumption.

Troglostrongylus brevior is the dominant lungworm infecting feral cats in Jerusalem

Feline lungworms infect the respiratory tract of wild and domestic cats, causing infection often associated with clinical disease. Until recently, Aelurostrongylus abstrusus has been considered the most relevant species of lungworm, while Troglostrongylus brevior was considered of less significance. Fecal samples of feral cats from Jerusalem, Israel, collected over a year, were examined for first stage lungworm larvae (L1) using the Baermann method. Positive samples were morphologically identified, and their species identity was molecularly confirmed. Forty of 400 (10.0%) cats were lungworm-positive, of which 38/40 (95.0%) shed Troglostrongylus brevior and 6/40 (15.0%) shed Aelurostrongylus abstrusus. Four cats (10.0%) had mixed infections with both lungworm species. L1 shedding was associated with clinical respiratory signs in 11 (19.0%) T. brevior shedding cats of a total of 58 cats manifesting respiratory signs, while 23/342 (6.7%) cats without respiratory signs were L1-positive (p = 0.006). Non-respiratory clinical signs were also found to be more prevalent in L1 shedders (p = 0.012). A young kitten ≤ 4 weeks of age shed T. brevior L1 larvae. DNA sequences of both lungworm species using the ribosomal internal transcribed spacer 2 (ITS2) locus were > 99% similar to other sequences deposited in GenBank, suggesting that T. brevior and A. abstrusus ITS2 sequences are both highly conserved. In conclusion, L1 shedding in feral cats from Jerusalem were mostly caused by T. brevior with only a small proportion involving A. abstrusus, different from many studies from other geographical regions.

Systematic review of failure of nonoperative management in complicated sigmoid diverticulitis with abscess

PURPOSE

The aim of this systematic review was to determine the rates of failure following nonoperative management for acute sigmoid diverticulitis complicated by abscess.

METHODS

Pubmed and Medline were systematically searched by two independent researchers. Studies reporting outcomes of nonoperative management of diverticulitis with abscess revealed on CT scan were included. The endpoint of the study was failure of nonoperative management which included relapse and recurrence. Relapse was defined as development of additional complications such as peritonitis or obstruction that required urgent surgery during index admission or readmission within 30 days. Recurrence was defined as development of symptoms after an asymptomatic period of 30-90 days following nonoperative management. Nonoperative management included nil per os, intravenous fluids and antibiotics, CT-guided percutaneous drainage, and/or total parenteral nutrition.

RESULTS

Twenty-four of 844 studies yielded by literature search totaling 12,601 patients were eligible for inclusion. Pooled relapse rate was 18.9%. The pooled rate of recurrence of acute diverticulitis was found to be 25.5%. 60.9% of recurrences were complicated diverticulitis. Failure rate appeared to be significantly increased in patients undergoing percutaneous drainage for distant abscess as compared with pericolic abscess (51% vs. 18%; p = 0.0001).

CONCLUSION

The rate of failure of nonoperative management was 44.4%. The rate of relapse at 30 days following nonoperative management was at 18.9%. Distant abscesses were associated with significantly increased rates of relapse compared with pericolic abscesses. The rate of recurrence following nonoperative management was 25.5% at the mean follow-up of 38 months.

Epigenetic control of the EWS‑FLI1 promoter in Ewing's sarcoma

Ewing sarcoma (ES) is a primary bone marrow tumor that very rarely develops in extra-osseous tissues, such as lung. The hallmark of ES tumors is a translocation between chromosomes 11 and 22, resulting in a fusion protein, commonly referred to as EWS-FLI1. The epigenetic profile (histone acetylation and methylation enrichment of the promoter region) that may regulate the expression of the aberrant transcription factor EWS-FLI1, remains poorly studied and understood. Knowledge of epigenetic patterns associated with covalent histone modification and expression of enzymes associated with this process, can contribute to the understanding of the molecular basis of the disease, as well as to the identification of possible molecular targets involved in expression of the EWS-FLI1 gene, so that therapeutic strategies may be improved in the future. In the present study, the transcriptional activation and repression of the EWS-FLI1 fusion gene in ES was accompanied by selective deposition of histone markers on its promoter. The EWS-FLI1 fusion gene was evaluated in two patients with ES using conventional cytogenetic, fluorescence in situ hybridization and nested PCR assays, which revealed that the aberrant expression of the EWS-FLI1 gene is accompanied by enrichment of H3K4Me3, H3K9ac and H3K27ac at the promoter region.

P845 Deep vein thrombosis, pulmonary embolism and patent foramen ovale: a lethal mix

A 50-year-old woman without remarkable medical history was admitted at the Emergency Department for acute dyspnoea. The patient had been recently submitted to C5-C6 microdiscectomy. She was tachypneic and oxygen saturation was 88%. CT angiography showed bilateral pulmonary embolism (PE) (Figure 1A, yellow arrowheads) with signs of right ventricle overload. Bilateral deep vein thrombosis was also confirmed. The patient was admitted at the Intensive Care Unit, clinically stable. Few hours later, she presented sudden hemodynamic and respiratory deterioration, requiring invasive mechanical ventilation and vasopressors. Due to recent cervical surgery, systemic fibrinolysis was ruled out. Decision for percutaneous thrombectomy and inferior vena cava filter placement was made. Nevertheless, percutaneous thrombectomy was unsuccessful due to the impossibility to catheterize pulmonary artery. Contrast injection demonstrated that the guiding catheter was located in the left atrium (Figure 1B), suggesting a patent foramen ovale (PFO). Transoesophageal echocardiogram confirmed the presence of a 5x6 mm PFO with right-to-left shunt (Figures 1C – yellow arrows, and 1D). In addition, a 4 cm mobile mass attached to the aortic valve and protruding throughout the left ventricle outflow tract was visualized, suggesting paradoxical embolism (Figure 1E – white arrows). Accordingly, open surgical approach with pulmonary thrombectomy, PFO closure and removal of the left-sided thrombus was decided. Unfortunately, despite careful cannulation, thrombus was not found when aortic valve was inspected. Worst suspicions were confirmed, when the patient presented non-reactive mydriatic pupils. A brain CT showed signs of an extensive bihemisferic ischemic stroke (Figure 1F) presumably related to cerebral embolization of aortic thrombus. The patient finally died. Autopsy study was not consented.

PFO has been associated with paradoxical embolisms and risk of stroke in PE. This case strikingly illustrates that treatment of these patients may be challenging in spite of an adequate diagnosis and management.

Abstract P845 Figure.

RID: Evaluation of the Possible Inhibiting Effect of the Proinflammatory Signaling Induced by TNF-α through NF-κβ and AP-1 in Two Cell Lines of Breast Cancer

Receptor internalization and degradation (RID), is a transmembrane protein coded within the E3 region expression cassette of adenoviruses. RID downregulates the cell surface expression of epidermal growth factor receptor (EGFR), tumor necrosis factor receptor (TNFR), and apoptosis antigen 1 (FAS), causing a reduction of the effects of their respective ligands. In addition, RID inhibits apoptosis by decreasing the secretion of TNF-related apoptosis-inducing ligand (TRAIL) by normal tissue cells. In this article, we report that RID inhibited chemokine expression in human breast cancer cell line MDA-MB-231 but showed no effect in cell line MCF7. These dissimilar results may be due to the different molecular and functional properties of both cell lines. Therefore, it is necessary to replicate this study in other breast cancer cell models.

P1332 Breaking the dichotomy of myocardial infarction and stress cardiomyopathy

INTRODUCTION

An 83-year-old woman with a past medical history of hypertension, dyslipidaemia and recent diagnosis of disseminated breast cancer was admitted at Emergency department for acute heart failure. She complained about short chest pain episodes on previous days, the ECG showed new T negative waves on precordial leads and high sensitive troponin serum levels were modestly increased (TropT 1200ng/l). Echocardiographic assessment documented moderate left ventricular dysfunction (LVEF 40%) with apical and midventricular dyskinesia associated with hypercontractility off basal segments.

The following day the patient underwent a coronary angiography that showed an occlusion in the distal segment of a large obtuse marginal branch (Panel A) with no other significant stenosis in the remaining vessels. Ventriculography showed a typical apical ballooning pattern (Panel B). Despite the occluded coronary artery was reaching the apex, the myocardial wall motion abnormalities extended beyond the ischemic territory. Therefore, a cardiac magnetic resonance (CMR) was performed a few days later in order to clarify the diagnosis.

CMR confirmed the mid LVEF dysfunction with apical dyskinesia and the T2 weighted spin echo images showed myocardial oedema in all the apical segments (Panel C). Remarkably, a subedocardial late gadolinium enhancement (LGE) restricted to the apical segment of the inferolateral wall was detected, being consistent with the ischaemic territory of the occluded obtuse marginal branch (Panel D). These findings supported the concomitant diagnosis of an apical stress cardiomyopathy and an acute inferolateral myocardial infarction. The patient was successfully discharged one week later with a normal LVEF and no signs of congestion.

DISCUSSION

Apical ballooning in the scenario of an acute coronary syndrome may be secondary to both an acute coronary artery occlusion or to stress cardiomyopathy. Cardiac MR has a key role to resolve the differential diagnosis of these two aetiologies, since ischemia typically produces a subendocardial late gadolinium enhancement pattern and stress cardiomyopathy shows an apical oedema without coronary stenosis or extending beyond a localized ischemic territory. Our case is astonishing because in the clinical practice these two diagnoses frequently excludes each other, but as demonstrated in our case, the differential diagnosis between myocardial infarction and stress cardiomyopathy is not a proper dichotomy.

Abstract P1332 Figure

Detection of Intraspinal Spirocerca lupi in Canine Cerebrospinal Fluid by Polymerase Chain Reaction

Aberrant migration of Spirocerca lupi into the spinal cord is an important cause of severe progressive neurological dysfunction in dogs. Although early diagnosis is essential to prevent deterioration, ante-mortem diagnosis of this condition remains challenging. The aim of this study was to evaluate the detection of the 18S ribosomal DNA (rDNA) S. lupi gene in the cerebrospinal fluid (CSF) of presumptively-affected dogs using polymerase chain reaction (PCR). Dogs with a non-compressive spinal cord lesion, pleocytosis with presence of eosinophils in the CSF and a characteristic clinical presentation were included. CSF samples from eight dogs were available for the study, of which seven were definitively diagnosed with intraspinal spirocercosis by PCR of either the CSF samples (6/7) or tissue samples obtained at necropsy examination (3/7), or both (2/7). Of these seven positive cases, only one dog had a negative CSF PCR, indicating a sensitivity of 86% for detecting nematode DNA in the CSF of infected dogs using this PCR protocol. The nematode DNA sequences obtained from the CSF of six dogs and the spinal cord tissue of three dogs were 98-100% identical to the publicly available sequences of S. lupi, confirming the diagnosis. These findings indicate that PCR targeting the 18S rDNA of S. lupi in CSF is useful for the ante-mortem diagnosis of canine intraspinal spirocercosis.

Meta-analysis of routine calcium/vitamin D3 supplementation versus serum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy

BACKGROUND

The aim was to assess the effectiveness of routine administration of calcium +/- vitamin D3 compared with a serum calcium level-based strategy to prevent symptomatic hypocalcaemia after thyroidectomy.

METHODS

RCTs comparing routine supplementation of calcium +/- vitamin D3 with treatment based on serum calcium levels measured after total thyroidectomy, published between 1980 and 2017, were identified in MEDLINE, Embase, LILACS and Google Scholar databases. Risk of bias was evaluated using the Cochrane Collaboration tool. Risk differences were calculated by random-effects meta-analysis. Meta-regression and cumulative meta-analysis were used to explore the best therapeutic approach.

RESULTS

Fifteen studies with 3037 patients were included, and seven treatment comparisons were made. Routine supplementation with calcium + vitamin D3 offered a lower risk of symptomatic (risk difference (RD) -0·25, 95 per cent c.i. -0·32 to -0·18) and biochemical (RD -0·24, -0·31 to -0·17) hypocalcaemia than treatment based on measurement of calcium levels. The number needed to treat was 4 (95 per cent c.i. 3 to 6) for symptomatic hypocalcaemia. No publication bias was found; although heterogeneity was high for some comparisons, sensitivity analysis did not change the main results.

CONCLUSION

Routine postoperative administration of calcium + vitamin D3 is effective in decreasing the rate of symptomatic and biochemical hypocalcaemia.

Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study

OBJECTIVE

To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures.

METHODS

Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated.

RESULTS

396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations.

CONCLUSIONS

Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost.

Rates, predictors and mortality of community-onset bloodstream infections due to Pseudomonas aeruginosa: systematic review and meta-analysis

BACKGROUND

Pseudomonas aeruginosa is mostly a nosocomial pathogen affecting predisposed patients. However, community-onset bloodstream infections (CO-BSI) caused by this organism are not exceptional.

OBJECTIVES

To assess the predisposing factors for CO-BSI due to P. aeruginosa (CO-BSI-PA) and the impact in mortality of inappropriate empirical antimicrobial therapy.

DATA SOURCE

A systematic literature search was performed in the Medline, Embase, Cochrane Library, Scopus and Web of Science databases. Study eligibility criteria and participants: Articles published between 1 January 2002 and 31 January 2018 reporting at least of 20 adult patients with CO-BSI due to P. aeruginosa were considered.

INTERVENTION

Empiric antimicrobial therapy for CO-BSI-PA.

METHODS

A systematic review and a meta-analysis were conducted for risk factors and to evaluate if inappropriate empiric antimicrobial therapy increased mortality in CO-BSI-PA using a Mantel-Haenszel effects model.

RESULTS

Twelve studies assessing data of 1120 patients were included in the systematic review. Solid tumour (33.1%), haematologic malignancy (26.4%), neutropenia (31.7%) and previous antibiotic use (44.8%) were the most prevalent predisposing factors. Septic shock was present in 42.3% of cases, and 30-day crude mortality was 33.8%. Mortality in meta-analysis (four studies) was associated with septic shock at presentation (odds ratio, 22.31; 95% confidence interval, 3.52-141.35; p 0.001) and with inappropriate empiric antibiotic therapy (odds ratio, 1.83; 95% confidence interval, 1.12-2.98l p 0.02).

CONCLUSIONS

CO-BSI-PA mostly occurred in patients with predisposing factors and had a 30-day mortality comparable to hospital-acquired cases. Inappropriate empirical antibiotic therapy was associated with increased mortality. Appropriate identification of patients at risk for CO-BSI-PA is needed for empirical treatment decisions.

Hospitalizations for asthma exacerbation in Chilean children: A multicenter observational study

BACKGROUND

Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this.

OBJECTIVE

Describe clinical characteristics of children hospitalized for asthma exacerbation.

METHODS

Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist.

RESULTS

396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist.

CONCLUSIONS

Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children.

Relationship between peripheral arterial occlusive disease (PAOD) and chronic Chlamydophila (Chlamydia) pneumoniae infection

We carried out a meta-analysis of observational case-control studies published before May 2004 to assess the degree of association between Chlamydophila pneumoniae (Cp) infection and PAOD. A search of the Medline database was performed using atherosclerosis and "Chlamyd* pneumoniae" as keywords. Strict criteria were applied for the selection of case studies, which had to be studies of Cp seroprevalence or of Cp detection in patients versus controls. Forty-three published studies that met these criteria were selected. An association between PAOD and Cp was revealed by immunohistochemical analysis (OR=15.4, 95%CI=5.0–46.9) and nested PCR studies of arterial biopsies (OR=4.3, 95%CI=1.8–10), by PCR study of non-arterial samples (OR=2.9, 95%CI=1.2–7.0), by other direct-detection tests (OR=16.7, 95%CI=7.0–39.8), and by ELISA and MIF tests to detect high IgG (OR=2, 95%CI=1.1–3.5 and OR=1.7, 95%CI=1.0–2.9, respectively) and IgA (OR=1.9, 95%CI=1.1–3.4 and OR=1.5, 95%CI=1.1–2.0, respectively) titers. No significant association was found in simple PCR studies of arterial biopsies, MIF tests to detect low IgG titers or IgM, or ELISA studies to detect IgM. According to this review, the association between Cp infection and PAOD depends on the analytical method adopted. Establishing a relationship between Cp and PAOD will require a case-control study with an adequate number of cases and samples that uses a combination of direct and indirect techniques to identify the presence of the bacterium in different types of sample from the same subjects, correlating the results with the activity of the disease.

Pathogenicity and Virulence of Soilborne Oomycetes on Phaseolus vulgaris

Dry bean (Phaseolus vulgaris L.) is a globally important leguminous food crop. Yields can be reduced by high incidence of soilborne oomycetes that cause seedling disease. Breeders have attempted to develop Pythium root rot-resistant bean varieties; however, relationships between dry bean and most soilborne oomycete species remain uncharacterized. Oomycete species (n = 28), including Pythium spp. and Phytopythium spp., were tested in a growth chamber seedling assay at 20°C and an in vitro seed assay at 20°C and 26°C to evaluate their pathogenicity and virulence on 'Red Hawk' dark red kidney bean and 'Zorro' black bean. Root size or disease severity was significantly impacted by 14 oomycete species, though results varied by bean variety, temperature, and assay. Of these 14 pathogenic oomycete species, 11 species exhibited significant differences in DSI due to temperature on at least one bean variety. Pythium aphanidermatum, P. myriotylum, P. ultimum, P. ultimum var. sporangiiferium, and P. ultimum var. ultimum were the most virulent species in both assays, causing seed rot and pre-emergence damping-off of dry bean. Oomycete species were clustered into three groups based on symptom development: seed rot pathogens, root rot pathogens, or nonpathogens. Intraspecific variability in virulence was observed for eight of the 14 pathogenic oomycete species. Improved understanding of Pythium and Phytopythium interactions with dry bean may enable breeders and pathologists to more effectively evaluate strategies for oomycete seedling disease management.

Nuclear Force Imprints Revealed on the Elastic Scattering of Protons with ^{10}C

How does nature hold together protons and neutrons to form the wide variety of complex nuclei in the Universe? Describing many-nucleon systems from the fundamental theory of quantum chromodynamics has been the greatest challenge in answering this question. The chiral effective field theory description of the nuclear force now makes this possible but requires certain parameters that are not uniquely determined. Defining the nuclear force needs identification of observables sensitive to the different parametrizations. From a measurement of proton elastic scattering on ^{10}C at TRIUMF and ab initio nuclear reaction calculations, we show that the shape and magnitude of the measured differential cross section is strongly sensitive to the nuclear force prescription.

Role of assessing liver fibrosis in management of chronic hepatitis C virus infection

Fibrosis progression is common in hepatitis C. Both host and viral factors influence its natural history. Liver fibrosis is a key predictive factor for advanced disease including endpoints such as liver failure, cirrhosis and hepatocellular carcinoma (HCC). METAVIR fibrosis stages F3-F4 have been considered as the threshold for antiviral therapy. However, this aspect is controversial after the advent of new direct-acting antivirals (DAAs) because they show an excellent efficacy and safety profile. Moreover, in the DAA era, fibrosis stage seems not to be a predictive factor of a sustained virological response (SVR). Viral eradication decreases liver damage by improving the inflammation, as well as by regressing fibrosis irrespective of the treatment regimen. Non-invasive methods are useful in the assessment of liver fibrosis, replacing liver biopsy in clinical practice; but their usefulness for monitoring fibrosis after SVR needs to be demonstrated. Fibrosis regression has been demonstrated after the eradication of hepatitis C virus infection and is associated with a lower risk of hepatic cirrhosis and liver cancer. However, patients showing advanced fibrosis and cirrhosis must be followed-up after SVR, as risks of portal hypertension and HCC remain.

Direct Measurement of the Astrophysical ^{38}K(p,γ)^{39}Ca Reaction and Its Influence on the Production of Nuclides toward the End Point of Nova Nucleosynthesis

We have performed the first direct measurement of the ^{38}K(p,γ)^{39}Ca reaction using a beam of radioactive ^{38}K. A proposed ℓ=0 resonance in the ^{38}K+p system has been identified at 679(2) keV with an associated strength of 120_{-30}^{+50}  meV. Upper limits of 1.16 (3.5) and 8.6 (26) meV at the 68% (95%) confidence level were also established for two further expected ℓ=0 resonances at 386 and 515 keV, respectively. The present results have reduced uncertainties in the ^{38}K(p,γ)^{39}Ca reaction rate at temperatures of 0.4 GK by more than 2 orders of magnitude and indicate that Ar and Ca may be ejected in observable quantities by oxygen-neon novae. However, based on the newly evaluated rate, the ^{38}K(p,γ)^{39}Ca path is unlikely to be responsible for the production of Ar and Ca in significantly enhanced quantities relative to solar abundances.

Study of the performance of imidazolium-derived cations as structure directing agents in the synthesis of zeolites in fluoride media

Three imidazolium cations based on the imidazolium ring, 1,2,3-triethylimidazolium (123TEI), 1,2,3-triethyl-4-methylimidazolium (123TE4MI), and 2-ethyl-1,3-dimethyl (2E13DMI), were employed as structure directing agents (SDA) in the synthesis of pure silica zeolites.

Inverse Kinematic Study of the (26g)Al(d,p)(27)Al Reaction and Implications for Destruction of (26)Al in Wolf-Rayet and Asymptotic Giant Branch Stars

In Wolf-Rayet and asymptotic giant branch (AGB) stars, the (26g)Al(p,γ)(27)Si reaction is expected to govern the destruction of the cosmic γ-ray emitting nucleus (26)Al. The rate of this reaction, however, is highly uncertain due to the unknown properties of key resonances in the temperature regime of hydrogen burning. We present a high-resolution inverse kinematic study of the (26g)Al(d,p)(27)Al reaction as a method for constraining the strengths of key astrophysical resonances in the (26g)Al(p,γ)(27)Si reaction. In particular, the results indicate that the resonance at E(r)=127  keV in (27)Si determines the entire (26g)Al(p,γ)(27)Si reaction rate over almost the complete temperature range of Wolf-Rayet stars and AGB stars.