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Introduction: The optimal treatment for extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae bloodstream infections has yet to be defined. Retrospective studies have shown conflicting results, with most data suggesting the non-inferiority of beta-lactam-beta-lactamase inhibitor combinations compared with carbapenems. However, the recently published MERINO trial failed to demonstrate the non-inferiority of piperacillin-tazobactam to meropenem. The potential implications of the MERINO trial are profound, as widespread adoption of carbapenem treatment will have detrimental effects on antimicrobial stewardship in areas endemic for ESBL and carbapenem-resistant bacteria. Therefore, we believe that it is justified to re-examine the comparison in a second randomised controlled trial prior to changing clinical practice., Methods and Analysis: PeterPen is a multicentre, investigator-initiated, open-label, randomised controlled non-inferiority trial, comparing piperacillin-tazobactam with meropenem for third-generation cephalosporin-resistant Escherichia coli and Klebsiella bloodstream infections. The study is currently being conducted in six centres in Israel and one in Canada with other centres from Israel, Italy and Canada expected to join. The two primary outcomes are all-cause mortality at day 30 from enrolment and treatment failure at day seven (death, fever above 38°C in the last 48 hours, continuous symptoms, increasing Sequential Organ Failure Assessment Score or persistent blood cultures with the index pathogen). A sample size of 1084 patients was calculated for the mortality endpoint assuming a 12.5% mortality rate in the control group with a 5% non-inferiority margin and assuming 100% follow-up for this outcome., Ethics and Dissemination: The study is approved by local and national ethics committees as required. Results will be published, and trial data will be made available., Trial Registration Numbers: ClinicalTrials.gov Registry (NCT03671967); Israeli Ministry of Health Trials Registry (MOH_2018-12-25_004857)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Daily smoking adolescents are a public health problem as they are more likely to become adult smokers and to develop smoking-related health problems later on in their lives., Methods: The study is part of the four-yearly, cross-national Health Behaviour in School-aged Children study, a school-based survey on a nationally representative sample using a standardised methodology. Data of 4 survey periods are available (1990-2002). Gender-specific daily smoking trends among 14-15 year olds are examined using logistic regressions. Sex ratios are calculated for each survey period and country. Interaction effects between period and gender are examined., Results: Daily smoking prevalence in boys in 2002 ranges from 5.5% in Sweden to 20.0% in Latvia. Among girls, the daily smoking prevalence in 2002 ranges from 8.9% in Poland to 24.7% in Austria. Three daily smoking trend groups are identified: countries with a declining or stagnating trend, countries with an increasing trend followed by a decreasing trend, and countries with an increasing trend. These trend groups show a geographical pattern, but are not linked to smoking prevalence. Over the 4 surveys, the sex ratio has changed in Belgium, Switzerland, and Latvia., Conclusion: Among adolescents in Europe, three groups of countries in a different stage of the smoking epidemic curve can be identified, with girls being in an earlier stage than boys. In 2002, large differences in smoking prevalence between the countries have been observed. This predicts a high mortality due to smoking over 20-30 years for some countries, if no policy interventions are taken.

On November 2002, 305 cases of atypical pneumonia appeared in southern China. In February 2003, cases were reported in Hong Kong and from there the disease spread to many other countries, mainly, China, Hong Kong, Singapore, Vietnam and Toronto in Canada. The syndrome was defined as Severe Acute Respiratory Syndrome SARS), and a person is suspected of having SARS if he/she became ill after November 1 2002, has a fever exceeding 38 degrees C, has symptoms of a respiratory disease and was in a risk area or in close contact with a SARS patient within ten days prior the appearance of symptoms. The World Health Organization has received reports of 4,836 cases, of which 293 persons have died. Most were family members or medical staff treating the patient, persons who came into close and prolonged contact with the patient. The estimated incubation period is two days to one week. Symptoms of the disease include fever, shortness of breath and cough. Ten percent of patients afflicted with SARS require artificial breathing. The mortality rate is 6-7%. A novel coronavirus is associated with this outbreak, and the evidence indicates that this virus has an etiologic role in SARS. Infection is transmitted from person to person through direct or close contact with airborne droplets or personal objects of an infected person. Patients must be isolated and treated by contact and airborne isolation. Treatment consists of support care and artificial respiration when required. The use of anti-viral medications has not yet proven effective.