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Antibiotic misuse is associated with emergence of resistance and high expenditures. Fluoroquinolones (FQ) and carbapenems (CP) are drugs with considerable potential of resistance development and its disseminated use is a concern. We undertook a prospective clinical audit to evaluate prescriptions of FQ and CP in a multistep process. Each prescription was unfolded in the following steps: indication for antimicrobial therapy; adequacy of initial prescription, dosage and route; previous cultures; and parenteral--oral transition. There was no antibiotics indication in 8.9% of FQ and 1.5% of CP group (p = 0.07). In CP 25.8% of initial schemes were inappropriate (21% in FQ). Lack of switch to oral therapy comprised 25% of monthly costs of FQ. Inadequacy in initial choice accounted for 13.6% of CP expenses. We concluded that, in spite of infection control restrictive policies, inappropriateness of antibiotic usage is worrisome. Clinical audit in a multistep approach may identify possible flaws in this process. [ABSTRACT FROM AUTHOR]

For the development of efficient management and conservation strategies for wild rodent species, understanding the aspects related to their reproduction, including the interaction of this physiological function with the environment, is essential. This study aimed to evaluate the impacts of weather changes derived from a semiarid region's dry and rainy seasons on the epididymal sperm characteristics of red-rumped agouti (Dasyprocta leporina), a histricognath rodent, still little studied, which inhabits the Brazilian Caatinga. The sperm from the epididymal cauda of 14 agoutis were collected, seven individuals per season (dry and rainy). Samples were evaluated for kinetic parameters, membrane structural and functional integrity, mitochondrial activity, morphology, and morphometry. The environmental variables were measured: maximum air temperature, relative humidity, wind speed, solar radiation, and the total rainfall for dry and rainy seasons were, respectively, 36.2 and 34.1 °C, 66.8 and 80.1%, 4.0 and 1.9 m/s, 527.3 and 441.8 W/m 2 , and 0.2 and 517.7 mm. There were strong correlations between some sperm parameters and environmental variables, mainly those related to the acquisition of sperm mobility. Sperm concentration and the number of sperm collected were higher in the dry (1028.7 sperm/mL × 10⁶ and 1361.2 × 10 6 sperm) than in the rainy season (758.9 sperm × 10⁶/mL and 714.6 sperm × 10 6 ). During the rainy season, there were fewer sperm defects, higher sperm metrics, and higher membrane structural integrity with mitochondrial activity. Regarding motility patterns, the increases during the rainy season stand out in total and progressive motility, VAP, VSL, VCL, and subpopulations of rapid sperm. In summary, our results suggest that the adverse climatic conditions of the dry season in the semiarid region, mainly high solar radiation and temperature, considerably impair the epididymal sperm quality of red-rumped agoutis. On the contrary, the largest amount of sperm was obtained during this season, probably due to compensatory and adaptive mechanisms of the species to enable its reproduction throughout the year., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

A 55-year-old man submitted to emergency surgery due to cardiac perforation by stabbing. One month later, he presented with chest pain, and a transthoracic echocardiogram revealed moderate-severe mitral regurgitation. After 6 months, a new transthoracic echocardiogram showed a left ventricular pseudoaneurysm, being later submitted to pseudoaneurysm exclusion and mitral valvuloplasty., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

The objectives of the study were to (1) describe the kinematic parameters of spermatozoa (2) compare methods of evaluating sperm viability (3) validate assays of functionality and integrity of the sperm membrane and (4) evaluate possible changes between spermatozoa from the epididymis and the vas deferens of the greater rhea. Semen samples were recovered from 7 adult individuals. Sperm motility was characterized by adjusting the set-up for Computer-assisted semen analysis (CASA) to that new species. For sperm viability evaluation, smears of bromophenol blue and eosin-nigrosine dyes were used. Five solutions of different osmolarities were then tested for the hypoosmotic swelling test (HOST). The combination of fluorescent probes (propidium iodide - IP and Hoechst 33342) was also used to assess plasma membrane integrity. Data were presented as mean ± SEM. Rhea spermatozoa from the vas deferens had an overall motility of 14.6 ± 2.5%. The bromophenol blue staining technique revealed that 64.6 ± 5.2% sperm were viable, while that proportion was 72.1 ± 2.5% using eosin-nigrosine. An average of 77.6 ± 4.8% of spermatozoa reacted to the HOST with distilled water at 0 mOsm/l. Fluorescent probes indicated that 65.3 ± 2.6% of spermatozoa had intact membranes. Interestingly, no statistical differences were observed between the parameters analyzed in the epididymal spermatozoa and the vas deferens. These new assays set reference values that can now be used to further exploration of sperm handling conditions and freezing protocols in rheas., Competing Interests: Conflict of interest: The authors have no conflict of interest to declare.

Background: This study aims to provide an academic medical overview of the framework and key outcomes of two mammography quality certification programs in Brazil., Methods: These programs assess radiation dose and phantom image quality in mammography units through a postal system. Each unit that passes this initial assessment is required to submit a sample of copies of five complete examinations. The quality of the patient images and reports is then reviewed by radiologists and medical physicist experts. Additionally, the number of mammography units and mammography coverage in the target population, were assessed., Results: During the study period, 1007 units applied to the certification programs, and 934 (92.8%) successfully passed the assessment of radiation dose and phantom image quality. Out of these, 556 (59.5%) also passed the review of clinical image quality and reports, earning certification. The main issues related to mammogram and report quality were associated with the performance of radiographers (in terms of positioning) and radiologists (in terms of interpretation). On average, there are more than two mammography units/10,000 women in the target group. The screening mammography coverage in this group is 26.3% for women relying exclusively on the public healthcare and 58.1% for women with private healthcare plans., Conclusion: This study demonstrates the suitability of the framework adopted by national mammography quality certification programs in a middle-income country. These programs are carried out by relatively small workforce and at reasonable costs, utilizing postal resources to cover the large number of existing mammographic units and the vast distances within the country., Policy Statement: All mammography services in Brazil must adhere to the quality requirements for examinations and reference values for radiation dose to women established by the Ministry of Health. This ensures standardized conditions for early detection of breast cancer and minimizes the risk associated with x-rays., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

This study is aimed at evaluating the effect of different extenders on the cryopreservation of semen from Africanized honeybees (A. mellifera). Semen from honeybee drones from 10 different colonies was obtained by endophallus exposure technique and immediately evaluated for motility, viability using fluorescent probes, functional membrane integrity using the water test, and morphology. Samples from each colony were divided in three aliquots and subjected to a dilution ratio of 12:1 (diluent: semen) using Tris, Tris + egg yolk (Tris+EY), and Collins extender. Samples were cryopreserved and stored in liquid nitrogen for one week and then rewarmed and reevaluated. Immediate dilution provoked no significant effect on sperm motility and functional membrane integrity, regardless of the extender used; however, the greatest values (P < 0.05) for normal sperm morphology were found at the use of isolate Tris (69.3 ± 1.9%). After thawing, there were no significant differences among extenders with relation to the preservation of sperm motility, viability, and functional membrane integrity, but the Tris extender provided the highest post-thawing values (P < 0.05) for sperm normal morphology (49.2 ± 4.9%) while the Collins extender provoked the highest amounts (P < 0.05) of curled tail defects (67.5 ± 3.2%). Moreover, the Tris was the only extender at preserving the proportion of normal sperm after thawing similar to what was verified for fresh samples. In summary, we suggest the use of a Tris-based extender for the cryopreservation of Africanized honeybee semen., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

The search for assisted reproduction techniques applied to the conservation and even the genetic improvement of wild species is becoming increasingly common. Regarding conservation of male gametes from wild animals, although current advances are focused on cryopreservation, the development of protocols for sperm refrigeration seems to be underrated, despite its various advantages and applications. Therefore, this review aims to highlight the importance of short-term conservation of sperm from wild mammals, report the development of state-of-the-art refrigeration protocols for both ejaculated and epididymal sperm, and evaluate the challenges and prospects of their application.

Resistance to chemotherapy poses a major challenge for cancer treatment. Reactivating a stem cell program resembling that seen in embryonic development can lead cancer cells to acquire a stem-cell phenotype characterized by expression of stemness genes, pluripotency, high self-renewal ability, and tumor-initiating capability. These cancer stem cells (CSCs) are usually resistant to anticancer drugs and are likely involved in treatment failure in many cancer types. Ewing sarcoma (ES) is a pediatric cancer type typically resulting from a typical genetic alteration affecting bone or soft tissues. Despite advances in treatment, survival prognostic remains poor for patients with refractory or recurrent disease. Here, we review the increasing evidence indicating that ES tumors contain a CSC subpopulation expressing stem cell genes, including BM1, OCT3/4, NANOG, and SOX2, that plays a role in resistance to drug treatment, and current experimental strategies that successfully counteract chemoresistance mediated by CSCs in ES., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Vaccines are the most effective strategy to control the spread of coronavirus disease-2019 (COVID-19). Data on COVID-19 among healthcare workers (HCW) pre- and postvaccination are limited. This study aims to evaluate the clinical characteristics and outcomes of HCW with COVID-19 pre- and postvaccination. Retrospective cohort study. All HCWs with suspected COVID-19 were included. Demographic data, occupation, symptoms, work in COVID-19 area, and vaccination status were collected. There were 22 267 HCW visits for suspected COVID-19; 7879 (35.4%) tested positive, and 14 388 (64.6%) tested negative. Fever, cough, fatigue, and dyspnea were positive predictors of COVID-19, and sore throat, headache, coryza, work in a COVID-19 area, and COVID-19 vaccination were negative predictors. Of the total number of visits, 41.2% were from vaccinated HCW and 58.8% were from unvaccinated HCW. Among HCWs with COVID-19, 84 (1.1%) required hospitalization, 11 (0.1%) in an intensive care unit (ICU), with three (0.04%) deaths. Six hospitalizations occurred in vaccinated HCWs, being of short duration, with no need for ICU admission and no deaths. SARS-CoV-2 infection prevalence was high among HCW, and vaccinated HCW had fewer hospitalizations, need for ICU, and deaths. Therefore, vaccines may attenuate COVID-19 severity, and efforts must be concentrated to ensure adequate vaccination for HCW., (© 2022 Wiley Periodicals LLC.)

Losartan (LST) is a potent and selective angiotensin II (Ang II) type 1 (AT1) receptor antagonist widely used in the treatment of hypertension. The formation of Ang II is catalyzed by the angiotensin I-converting enzyme (ACE) through proteolytic cleavage of angiotensin I (Ang I), which is involved in the control of blood pressure. Despite the vast literature on the relationship of losartan with the renin-angiotensin system (RAS), the actions of losartan on the sACE enzyme are so far poorly understood. In view of this, we investigated how losartan can interact with the sACE enzyme to block its activity and intracellular signaling. After performing docking assays following quantum biochemistry calculations using losartan and sACE crystallographic data, we report that their interaction results reveal a new mechanism of action with important implications for understanding its effects on hypertension., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Research in higher education institutions is present in all courses, and academic instruction in research methodology is vital, with educational technologies being an essential component of this process. With the Covid-19 pandemic, there were changes in teaching, learning, and in performing scientific research in undergraduate courses. Among the technologies, the Mendeley reference management tool has become increasingly helpful in these contexts. Therefore, this manuscript is an account of workshop experiences for the use of the Mendeley tool in the teaching of Research Methodology and Scientific Methodology offered in the distance education modality in undergraduate courses at the Universidade do Contestado, Brazil. After basic instruction on Mendeley, students participating in the workshops were guided to apply the tool using Bardin's content analysis technique. This technique is usually laborious and seldom involved in literature reviews by undergraduate students; Mendeley technology makes it more accessible. From experiences with the 2020 and 2021 workshops, during the COVID-19 pandemic, it is suggested that the content analysis method combined with the Mendeley technology can help students present better literature reviews, especially for final graduation projects such as course completion monographs., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Elsevier Inc. All rights reserved.)

This exploratory study investigates the impact of a military mission on Portuguese families, specifically on children. Although most research seeks the negative consequences of this lived experience, through the "Deployment Risk and Resilience Model" the present study intends to explore if this period can also be an opportunity for military's children to grow and become more resilient. Aiming to express freely their lived and felt stories about the phenomenon under study, semi-structured interviews were conducted with 22 children of the service members of the Portuguese Army, aged between 8 and 21 years old. The results of the thematic analysis indicated that the most critical moments of the mission were the notification period, the last days before the departure of the service member, and the deployment. The preparation of activities for the service members' absence in the pre-deployment and the increase of tasks to be carried out, during the deployment, were the most referenced changes. In the post-deployment, children perceived a rapid readjustment of the family system. Despite the military's children's difficulties in readjusting during the mission, they reported that the feelings of closeness to the nuclear family, increased responsibility, and personal growth were positive results experienced. It would be interesting to extend similar studies within family systems, as in other branches of the armed forces. As practical implications, the findings of our pioneering study may significantly contribute to the construction of programs and/or actions that promote a possible growth in the personal resilience of the children of Portuguese service members, and not only the recovery of the state prior to the mission., Competing Interests: The authors have declared that no conflicting interests exist.

The year 2020 was atypical due to the pandemic caused by the SARS-CoV-2 virus (COVID-19), providing a unique opportunity to understand changes in air quality due to the reduction in urban activity. Therefore, the aim of the present study was to perform an integrated evaluation on the influence of the effects of the 2020 pandemic on air quality in the city of Fortaleza, investigating levels of PM 2.5 , PM 10 , NO 2 , NO, SO 2 , CO, and O 3 , corresponding health risks, as well as the influence of meteorological variables and urban activity. In all phases analyzed, significant reductions were found in NO x , NO, NO 2 , and CO. A considerable reduction in PM 2.5 and PM 10 was found in the early phases, with an increase in the later phases. These findings are explained by the nearly 50% reduction in vehicular traffic and the consequent reduction in fossil fuel emissions, mainly in the partial lockdown and total lockdown periods, as well as reductions in commercial (stores/shops) and industrial activities. The variation in O 3 was initially non-significant, followed by a considerable increase in the last three phases analyzed; this increase was influenced by changes in temperature and the incidence of sunlight. SO 2 concentrations increased in the period studied, demonstrating that the vehicular fleet, local commerce, and other activities are not the predominant sources of this compound. Estimated health risks were reduced by half during the lockdown period, especially for non-smokers, followed by a drastic increase in the last three phases. The planetary boundary layer was positively correlated with O 3 and PM 10 and negatively correlated with NO x , NO 2 , and NO, indicating its influence on the distribution of pollutants in the lower atmosphere and, consequently, air quality., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

We reviewed 20 years of levels, sources, and environmental risks related to the main petroleum hydrocarbons in the northeast region of Brazil. The aim of this study was to conduct a systematic review to serve as a comprehensive baseline for future monitoring programmes related to the oil spill disaster in 2019/2020. Most contamination levels of both PAHs and AHs were classified as low, except those in specific areas influenced by human activities, such as ports, highly urbanised mangroves, or rivers of medium-sized cities with inadequate liquid and solid waste treatment. Most hydrocarbons were linked to natural sources and burning processes, except in regions of extraction activities and petrochemical facilities as well as highly urbanised areas, where degraded petroleum and oil hydrocarbons predominated. Only 2.5% of the samples exceeded threshold effect levels for ∑ 16-PAHs and no samples exceeded probable effect levels. When regional threshold levels were used, however, the probable effect for the ∑ 16-PAHs measured was high, ranging from 5.8 to 6.1%. The few studies reporting biological responses showed that hydrocarbons from anthropogenic sources can induce adverse effects on marine organisms even at low to moderate levels. As the region has recently received a considerable quantity of crude oil, studies should be prioritised for a more precise assessment of the impact of this oil spill., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Anabolic androgenic steroid (AAS) abuse leads to myocardial toxicity. Human studies are conflicting about the myocardial fibrosis in AAS users. We evaluated cardiac tissue characterization, left ventricle (LV) function, and cardiac structure by cardiovascular magnetic resonance (CMR). Twenty strength-trained AAS users (AASU) aged 29±5 yr, 20 strength-trained AAS nonusers (AASNU), and 7 sedentary controls (SC) were enrolled. Native T1 mapping, late-gadolinium enhancement (LGE), extracellular volume (ECV), and myocardial strain were evaluated. AASU showed lower Native T1 values than AASNU (888±162 vs. 1020±179 ms p=0.047). Focal myocardial fibrosis was found in 2 AASU. AASU showed lower LV radial strain (30±8 vs. 38±6%, p<0.01), LV circumferential strain (-17±3 vs. -20±2%, p<0.01), and LV global longitudinal strain (-17±3 vs. -20±3%, p<0.01) than AASNU by CMR. By echocardiography, AASU demonstrated lower 4-chamber longitudinal strain than AASNU (-15±g3 vs. -18±2%, p=0.03). ECV was similar among AASU, AASNU, and SC (28±10 vs. 28±7 vs. 30±7%, p=0.93). AASU had higher LV mass index than AASNU and SC (85±14 vs. 64±8 vs. 58±5 g/m 2 , respectively, p<0.01). AAS abuse may be linked to decreased myocardial native T1 values, impaired myocardial contractility, and focal fibrosis. These alterations may be associated with maladaptive cardiac hypertrophy in young AAS users., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Healthcare-associated infections (HAIs) are among the most common adverse events in hospitals. We used artificial intelligence (AI) algorithms for infection surveillance in a cohort study. The model correctly detected 67 out of 73 patients with HAIs. The final model used a multilayer perceptron neural network achieving an area under receiver operating curve (AUROC) of 90.27%; specificity of 78.86%; sensitivity of 88.57%. Respiratory infections had the best results (AUROC ≥93.47%). The AI algorithm could identify most HAIs. AI is a feasible method for HAI surveillance, has the potential to save time, promote accurate hospital-wide surveillance, and improve infection prevention performance., (© 2021 The Authors.)

Wide-ranging connectivity patterns of common bottlenose dolphins ( Tursiops truncatus ) are generally poorly known worldwide and more so within the oceanic archipelagos of Macaronesia in the North East (NE) Atlantic. This study aimed to identify long-range movements between the archipelagos of Macaronesia that lie between 500 and 1,500 km apart, and between Madeira archipelago and the Portuguese continental shelf, through the compilation and comparison of bottlenose dolphin's photo-identification catalogues from different regions: one from Madeira ( n  = 363 individuals), two from different areas in the Azores ( n  = 495 and 176), and four from different islands of the Canary Islands ( n  = 182, 110, 142 and 281), summing up 1791 photographs. An additional comparison was made between the Madeira catalogue and one catalogue from Sagres, on the southwest tip of the Iberian Peninsula ( n  = 359). Results showed 26 individual matches, mostly between Madeira and the Canary Islands ( n  = 23), and between Azores and Madeira ( n  = 3). No matches were found between the Canary Islands and the Azores, nor between Madeira and Sagres. There were no individuals identified in all three archipelagos. The minimum time recorded between sightings in two different archipelagos (≈ 460 km apart) was 62 days. Association patterns revealed that the individuals moving between archipelagos were connected to resident, migrant and transient individuals in Madeira. The higher number of individuals that were re-sighted between Madeira and the Canary Islands can be explained by the relative proximity of these two archipelagos. This study shows the first inter-archipelago movements of bottlenose dolphins in the Macaronesia region, emphasizing the high mobility of this species and supporting the high gene flow described for oceanic dolphins inhabiting the North Atlantic. The dynamics of these long-range movements strongly denotes the need to review marine protected areas established for this species in each archipelago, calling for joint resolutions from three autonomous regions belonging to two EU countries., Competing Interests: Sara Magalhães is employed by Mar Ilimitado, Rui Peres dos Santos is employed by Futurismo and Fabian Ritter is employed by M.E.E.R. e.V., (©2021 Dinis et al.)

Chagas disease is a neglected tropical disease caused by the protozoan parasite Trypanosoma cruzi , with approximately 6-7 million people infected worldwide, becoming a public health problem in tropical countries, thus generating an increasing demand for the development of more effective drugs, due to the low efficiency of the existing drugs. Aiming at the development of a new antichagasic pharmacological tool, the density functional theory was used to calculate the reactivity descriptors of amentoflavone, a biflavonoid with proven anti-trypanosomal activity in vitro, as well as to perform a study of interactions with the enzyme cruzain, an enzyme key in the evolutionary process of T-cruzi . Structural properties (in solvents with different values of dielectric constant), the infrared spectrum, the frontier orbitals, Fukui analysis, thermodynamic properties were the parameters calculated from DFT method with the monomeric structure of the apigenin used for comparison. Furthermore, molecular docking studies were performed to assess the potential use of this biflavonoid as a pharmacological antichagasic tool. The frontier orbitals (HOMO-LUMO) study to find the band gap of compound has been extended to calculate electron affinity, ionization energy, electronegativity electrophilicity index, chemical potential, global chemical hardness and global chemical softness to study the chemical behaviour of compound. The optimized structure was subjected to molecular Docking to characterize the interaction between amentoflavone and cruzain enzyme, a classic pharmacological target for substances with anti-gas activity, where significant interactions were observed with amino acid residues from each one's catalytic sites enzyme. These results suggest that amentoflavone has the potential to interfere with the enzymatic activity of cruzain, thus being an indicative of being a promising antichagasic agent., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors. Published by Elsevier Ltd.)

Failure to adjust doses may contribute to adverse events. We evaluated the effectiveness of providing the estimated glomerular filtration rate on appropriateness of dosing for antimicrobials. The approach increased appropriateness of dosing from 33.9% to 41.4% (P < .001). Nudging prescription behavior can boost strategies for adequate antimicrobial prescription.

Purpose: Surface treatments may significantly affect physical-chemical properties and surface biologic responses. This study aimed to investigate the influence of alterations in the physical-chemical properties of pure titanium with different surface topographies on biocompatibility and early microbiologic response., Materials and Methods: Titanium disks were exposed to five different surface treatments created through acid etching and anodizing methods. Surface morphology, 2D and 3D roughness, wettability, biocompatibility, and cell viability were evaluated. Osteoblast adhesion and bacterial adhesion tests were also executed. Data were statistically analyzed using analysis of variance followed by Tukey test, roughness (P < .05), and bacterial proliferation (P < .05)., Results: Five different surface morphologies were developed; double acid etching was shown to be significantly rougher than the others. The 2D roughness measurements were shown to be less consistent than the 3D measurements. All surfaces presented biocompatibility to allow cell behavior and differentiation. Osteoblasts presented better evolution in terms of adhesion and behavior in the nanomorphologies. High roughness significantly increased bacterial adhesion., Conclusion: Surface treatments may critically alter titanium properties and morphology. Therefore, roughness measurements with a wide area should be used in their evaluation. Nanotextured surfaces show a positive effect on bone cells and antibacterial response; their application is suggested when considering surface texturization for biomedical implants.

In this study we propose the use of text mining and machine learning methods to predict and detect Surgical Site Infections (SSIs) using textual descriptions of surgeries and post-operative patients' records, mined from the database of a high complexity University hospital. SSIs are among the most common adverse events experienced by hospitalized patients; preventing such events is fundamental to ensure patients' safety. Knowledge on SSI occurrence rates may also be useful in preventing future episodes. We analyzed 15,479 surgery descriptions and post-operative records testing different preprocessing strategies and the following machine learning algorithms: Linear SVC, Logistic Regression, Multinomial Naive Bayes, Nearest Centroid, Random Forest, Stochastic Gradient Descent, and Support Vector Classification (SVC). For prediction purposes, the best result was obtained using the Stochastic Gradient Descent method (79.7% ROC-AUC); for detection, Logistic Regression yielded the best performance (80.6% ROC-AUC)., Competing Interests: The authors have declared that no competing interests exist.

Studies with a comprehensive analysis of the epidemiology of acute kidney injury (AKI) in intensive care units (ICUs) are still limited in developing countries. The aim of this study is to identify the incidence and risk factors of AKI in critically ill patients from a Brazilian ICU. We performed a retrospective analysis of the records of patients admitted to a single-centre adult ICU in Brazil between 1 January 2011 and 31 December 2016. The KDIGO criteria were used to define AKI. Univariate and multivariate data analyses were carried out. We included 1,500 patients. The incidence of AKI was 40.5%, and the AKI dialysis rate was 13%. The predictors of AKI at ICU admission included hypertension [odds ratio (OR) = 1.44, p 0.017], high serum creatinine concentration [OR = 3.54; p < 0.001], low serum albumin concentration [OR = 1.42, p 0.015], high APACHE II score [OR = 2.10; p < 0.001] and high SAPS 3 [OR = 1.75; p < 0.001]. The incidence of AKI was high, and we identified the predictors of AKI among critically ill Brazilian patients. The results of this study may contribute to the implementation of targeted therapies.

Chagas disease is caused by Trypanosoma cruzi and affects about 7 million people worldwide. Benznidazole and nifurtimox have low efficacy and high toxicity. The present study was designed to identify the trypanocidal effect of (-)-α-Bisabolol (BIS) and investigate its mechanism. Epimastigotes and trypomastigotes were cultured with BIS and the viable cells were counted. BIS antiamastigote effect was evaluated using infected LLC-MK2 cells. MTT assay was performed to evaluate BIS cytotoxicity. Growth recovery was assessed to evaluate BIS effect after short times of exposure. BIS mechanism was investigated through flow cytometry, with 7-AAD and Annexin V-PE. DCFH-DA, rhodamine 123 (Rho123) and acridine orange (AO). Finally, enzymatic and computational assays were performed to identify BIS interaction with T. cruzi GAPDH (tcGAPDH). BIS showed an inhibitory effect on epimastigotes after all tested periods, as well on trypomastigotes. It caused cytotoxicity on LLC-MK2 cells at higher concentrations, with selectivity index (SeI) = 26.5. After treatment, infected cells showed a decrease in infected cells, the number of amastigotes per infected cell and the survival index (SuI). Growth recovery demonstrated that BIS effect causes rapid death of T. cruzi. Flow cytometry showed that BIS biological effect is associated with apoptosis induction, increase in cytoplasmic ROS and mitochondrial transmembrane potential, while reservosome swelling was observed at a late stage. Also, BIS action mechanism may be associated to tcGAPDH inhibition. Altogether, the results demonstrate that BIS causes cell death in Trypanosoma cruzi Y strain forms, with the involvement of apoptosis and oxidative stress and enzymatic inhibition., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Acute Kidney Injury (AKI) is associated with high morbidity and mortality. Ischemia and reperfusion (I/R) are events that lead to AKI through hypoxia, reactive oxygen species (ROS) production, oxidative stress and apoptosis. We aimed to evaluate the mechanism of nephroprotection mediated by Bisabolol in human tubular kidney cells after injury by I/R in vitro. HK2 cells were exposed to I/R and treated with Bisabolol. Cell viability was accessed by MTT assay. Cells were submitted to flow cytometry to evaluate necrotic/apoptotic cells, reactive oxygen species production and mitochondrial transmembrane depolarization. TBARS and GSH were used as parameters of redox balance. Also, KIM-1 supernatant levels were measured. In order to identify an interaction between bisabolol and NOX4, molecular docking and enzymatic assays were performed. Expression of isoform NOX4 on treated cells was examined by western-blot. Finally, cells were visualized by scanning electron microscopy. Bisabolol improved cell viability and prevented cell death by apoptosis, indicated also by the decreased levels of KIM-1. It was observed a decrease on reactive oxygen species production and mitochondrial depolarization, with antioxidant regulation by increased GSH and decreased lipid peroxidation. It was also demonstrated that bisabolol treatment can inhibit NOX4. Finally, SEM images showed that bisabolol reduced I/R-induced cell damage. Bisabolol treatment protects HK2 cells against oxidative damage occasioned by I/R. This effect is related to inhibition of apoptosis, decrease on KIM-1 release, reactive oxygen species accumulation and mitochondrial dysfunction. Bisabolol inhibited NOX4 activity in the tubular cells, impairing reactive oxygen species synthesis., (Copyright © 2019. Published by Elsevier B.V.)

The chronic wound in legs due to vascular abnormalities occurs in 1% to 2% of the adult population. The current treatments are unsatisfactory, and new approaches should be studied. We report in this article a case of a 52-year-old man with a chronic venous wound at the tibia, which has been conventionally treated for nine years. With six weeks of treatment with the autologous fibrin membrane, we were able to identify scar tissue and vascularization, which are characteristic of a healing process.

Iron (Fe) is an essential element to plants, but can be harmful if accumulated to toxic concentrations. Fe toxicity can be a major nutritional disorder in rice ( Oryza sativa ) when cultivated under waterlogged conditions, as a result of excessive Fe solubilization of in the soil. However, little is known about the basis of Fe toxicity and tolerance at both physiological and molecular level. To identify mechanisms and potential candidate genes for Fe tolerance in rice, we comparatively analyzed the effects of excess Fe on two cultivars with distinct tolerance to Fe toxicity, EPAGRI 108 (tolerant) and BR-IRGA 409 (susceptible). After excess Fe treatment, BR-IRGA 409 plants showed reduced biomass and photosynthetic parameters, compared to EPAGRI 108. EPAGRI 108 plants accumulated lower amounts of Fe in both shoots and roots compared to BR-IRGA 409. We conducted transcriptomic analyses of roots from susceptible and tolerant plants under control and excess Fe conditions. We found 423 up-regulated and 92 down-regulated genes in the susceptible cultivar, and 42 up-regulated and 305 down-regulated genes in the tolerant one. We observed striking differences in root gene expression profiles following exposure to excess Fe: the two cultivars showed no genes regulated in the same way (up or down in both), and 264 genes were oppositely regulated in both cultivars. Plants from the susceptible cultivar showed down-regulation of known Fe uptake-related genes, indicating that plants are actively decreasing Fe acquisition. On the other hand, plants from the tolerant cultivar showed up-regulation of genes involved in root cell wall biosynthesis and lignification. We confirmed that the tolerant cultivar has increased lignification in the outer layers of the cortex and in the vascular bundle compared to the susceptible cultivar, suggesting that the capacity to avoid excessive Fe uptake could rely in root cell wall remodeling. Moreover, we showed that increased lignin concentrations in roots might be linked to Fe tolerance in other rice cultivars, suggesting that a similar mechanism might operate in multiple genotypes. Our results indicate that changes in root cell wall and Fe permeability might be related to Fe toxicity tolerance in rice natural variation.

Introduction: Telemedicine technologies are increasingly being incorporated into infectious disease practice. We aimed to demonstrate the impact of antimicrobial stewardship through telemedicine on bacterial resistance rates., Methods: We conducted a quasi-experimental study in a 220-bed hospital in southern Brazil. An antimicrobial stewardship program incorporating the use of telemedicine was implemented. Resistance and antimicrobial consumption rates were determined and analysed using a segmented regression model., Results: After the intervention, the rate of appropriate antimicrobial prescription increased from 51.4% at baseline to 81.4%. Significant reductions in the consumption of fluoroquinolones (level change, β = -0.80; P < 0.01; trend change, β = -0.01; P = 0.98), first-generation cephalosporins (level change, β = -0.91; P < 0.01; trend change, β = +0.01; P = 0.96), vancomycin (level change, β = -0.47; P = 0.04; trend change, β = +0.17; P = 0.66) and polymyxins (level change, β = -0.15; P = 0.56; trend change, β = -1.75; P < 0.01) were identified. There was an increase in the consumption of amoxicillin + clavulanate (level change, β = +0.84; P < 0.01; trend change, β = +0.14; P = 0.41) and cefuroxime (level change, β = +0.21; P = 0.17; trend change, β = +0.66; P = 0.02). A significant decrease in the rate of carbapenem-resistant Acinetobacter spp. isolation (level change, β = +0.66; P = 0.01; trend change, β = -1.26; P < 0.01) was observed., Conclusions: Telemedicine, which provides a tool for decision support and immediate access to experienced specialists, can promote better antibiotic selection and reductions in bacterial resistance.

Chagas disease is a public health problem, affecting about 7 million people worldwide. Benznidazole (BZN) is the main treatment option, but it has limited effectiveness and can cause severe adverse effects. Drug delivery through nanoparticles has attracted the interest of the scientific community aiming to improve therapeutic options. The aim of this study was to evaluate the cytotoxicity of benznidazole-loaded calcium carbonate nanoparticles (BZN@CaCO3) on Trypanosoma cruzi strain Y. It was observed that BZN@CaCO3 was able to reduce the viability of epimastigote, trypomastigote and amastigote forms of T. cruzi with greater potency when compared with BZN. The amount of BZN necessary to obtain the same effect was up to 25 times smaller when loaded with CaCO3 nanoparticles. Also, it was observed that BZN@CaCO3 enhanced the selectivity index. Furthermore, the cell-death mechanism induced by both BZN and BZN@CaCO3 was evaluated, indicating that both substances caused necrosis and changed mitochondrial membrane potential.

Introduction and Aim: Myotonic dystrophy type 1 (DM1) is a multisystem disease in which cardiac involvement is common. The aim of this study was to identify early changes in left atrial (LA) mechanics and left ventricular (LV) systolic function in patients with myotonic dystrophy type 1 using three-dimensional (3D) speckle tracking echocardiography (3D-STE)., Methods: This observational study included 25 patients with DM1 and 25 healthy volunteers. We assessed LA and LV global strain parameters using 3D-STE., Results: Patients with DM1 showed significantly lower longitudinal LA strain (22.85%±5.06 vs. 26.82%±5.15; p=0.008 in univariate analysis and p=0.026 in multivariate analysis) and global LV longitudinal strain (-13.55%±1.82 vs. -16.11%±1.33; p<0.001 in univariate analysis and p<0.001 in multivariate analysis), which was not observed with LA area tracking (p=0.412) or LV global circumferential strain (p=0.879), global radial strain (p=0.058), area tracking (p=0.092) or twist (p=0.992)., Conclusion: LA and LV global longitudinal strain is significantly decreased in patients with DM1, which may be an early marker of subclinical dysfunction in these patients., (Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Key Message: Cold-tolerance in rice may be related to increased cellulose deposition in the cell wall, membrane fatty acids unsaturation and differential expression of several newly identified genes. Low temperature exposure during early vegetative stages limits rice plant's growth and development. Most genes previously related to cold tolerance in rice are from the japonica subspecies. To help clarify the mechanisms that regulate cold tolerance in young indica rice plants, comparative transcriptome analysis of 6 h cold-treated (10 °C) leaves from two genotypes, cold-tolerant (CT) and cold-sensitive (CS), was performed. Differentially expressed genes were identified: 831 and 357 sequences more expressed in the tolerant and in the sensitive genotype, respectively. The genes with higher expression in the CT genotype were used in systems biology analyses to identify protein-protein interaction (PPI) networks and nodes (proteins) that are hubs and bottlenecks in the PPI. From the genes more expressed in the tolerant plants, 60% were reported as affected by cold in previous transcriptome experiments and 27% are located within QTLs related to cold tolerance during the vegetative stage. Novel cold-responsive genes were identified. Quantitative RT-PCR confirmed the high-quality of RNAseq libraries. Several genes related to cell wall assembly or reinforcement are cold-induced or constitutively highly expressed in the tolerant genotype. Cold-tolerant plants have increased cellulose deposition under cold. Genes related to lipid metabolism are more expressed in the tolerant genotype, which has higher membrane fatty acids unsaturation, with increasing levels of linoleic acid under cold. The CT genotype seems to have higher photosynthetic efficiency and antioxidant capacity, as well as more effective ethylene, Ca 2+ and hormone signaling than the CS. These genes could be useful in future biotechnological approaches aiming to increase cold tolerance in rice.

Objective: To present the current recommendations for breast cancer screening in Brazil, as devised by the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Breast Disease Society, and the Brazilian Federation of Gynecological and Obstetrical Associations., Materials and Methods: We analyzed scientific studies available in the Medline and Lilacs databases. In the absence of evidence, the recommendations reflected the consensus of a panel of experts., Recommendations: Annual mammography screening is recommended for women 40-74 years of age. Among women ≥ 75 years of age, annual mammography screening should be reserved for those with an expected survival > 7 years. Complementary ultrasound should be considered for women with dense breasts. Complementary magnetic resonance imaging is recommended for women at high risk. When available, an advanced form of mammography known as tomosynthesis can be considered as a means of screening for breast cancer.

Predicting the individual response to chemotherapy is a crucial challenge in cancer treatment. DNA damage caused by antitumor therapies evokes different repair mechanisms responses, such as Nucleotide Excision Repair (NER), whose components are being studied as prognosis biomarkers and target therapies. However, few reports have addressed DNA damages in pediatric Acute Lymphoid Leukemia (ALL). Hence, we conducted an observational follow-up study with pediatric patients to assess DNA damage (by Comet Assay) and gene expression from NER pathway during chemotherapy induction. Bone marrow samples from diagnosis, 15th(D15) and 35th (D35) days of the treatment were collected from 28 patients with ALL. There was no increase in damage index. However, there was a reduction of cells with low damages on D35 compared with diagnosis. NER pathway expression remained the same, however, in a single patient, a significant decrease was observed, maybe due to silencing or downregulation of repair pathways. DNA damage levels and repair may influence the clinical outcome, being involved in drug resistance and risk of relapse. In pediatric ALL, we analyzed for the first time DNA damage and repair behavior in BM samples. Monitoring patient's outcomes will help to access the implication of our findings in survival and relapse rates., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Brain-derived neurotrophic factor (BDNF) and its receptor, tropomyosin-related receptor kinase B (TrkB) are involved in the maturation of B lymphocytes in the bone marrow (BM), promote cell differentiation in B-cell malignancies, and are associated with poor prognosis in adults with acute leukemia (AL). However, the role of BDNF in pediatric AL remains poorly understood., Objective: We carried out a cohort observational study to evaluate BDNF levels in BM or peripheral blood (PB) samples from children with AL., Methods: BM or PB samples were collected from 57 children and adolescents with acute lymphoid leukemia (ALL), 14 children and adolescents with acute myeloid leukemia (AML), and 44 healthy individuals (HI) of the same age range., Results: BDNF levels at diagnosis in AL patients were significantly lower when compared to HI. Samples from patients in complete remission from disease had higher levels of BDNF compared to those obtained from patients with malignant cells. Moreover, BDNF levels at diagnosis in patients who died were significantly lower compared to those found in survivors., Conclusions: These findings provide the first evidence for a possible role of BDNF as a marker of active disease and poor prognosis in pediatric AL.

Objective: To study the relationship between the serum levels of alkaline phosphatase (AP) and lactate dehydrogenase (LDH), and the percentage of tumor necrosis (TN) in patients with Ewing´s Sarcoma (ES) . , Methods: This is a case series with retrospective evaluation of patients with diagnosis of ES divided into 2 groups: Group 1, patients whose serum levels of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were obtained in the staging phase before preoperative chemotherapy (CT), and Group 2, patients whose values were measured after completion of the preoperative CT. The percentage of tumor necrosis (TN) of surgical specimens extracted in surgery was also evaluated . , Results: Eighty four medical records from 1995 to 2015 were included. Both AP as LDH decreased in the patients studied, the pre CT value being higher than the post CT value. The average decrease of LHD was 272.95 U/L and AP was 10.17 U/L. The average tumor necrosis was 65.12 %. There was no statistical correlation between serums levels and the tumor necrosis percentage . , Conclusion: The serum levels values of AP and LDH are not predictors for chemotherapy-induced necrosis in patients with ES. Level of Evidence IV, Case Series. , Competing Interests: All the authors declare that there is no potential conflict of interest referring to this article.

Ewing sarcoma (ES) is a highly aggressive pediatric cancer that may arise from neuronal precursors. Neurotrophins stimulate neuronal devlopment and plasticity. Here, we found that neurotrophins nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), as well as their receptors (TrkA and TrkB, respectively) are expressed in ES tumors. Treatment with TrkA (GW-441756) or TrkB (Ana-12) selective inhibitors decreased ES cell proliferation, and the effect was increased when the two inhibitors were combined. ES cells treated with a pan-Trk inhibitor, K252a, showed changes in morphology, reduced levels of β-III tubulin, and decreased mRNA expression of NGF, BDNF, TrkA and TrkB. Furthermore, combining K252a with subeffective doses of cytotoxic chemotherapeutic drugs resulted in a decrease in ES cell proliferation and colony formation, even in chemoresistant cells. These results indicate that Trk inhibition may be an emerging approach for the treatment of ES., Competing Interests: The authors declare no conflicts of interest.

Background: There are no data on surgical site infection (SSI) rates stratified by surgical procedures (SPs) in Brazil, and our objective was to report such rates., Methods: From January 2005 to December 2010 we conducted a surveillance study on SSIs in four hospital members of the International Nosocomial Infection Control Consortium (INICC) in four Brazilian cities. We applied the U.S. Centers for Disease Control and Prevention's National Healthcare Safety Network's (CDC-NHSN's) surveillance methods. Surgical procedures were classified into following types following International Classification of Diseases (ICD-9) criteria., Results: We recorded 349 SSIs, associated to 61,863 SPs (0.6%; [CI], 0.5-0.6). SSI rates per type of SP were compared with INICC and CDC-NHSN reports, respectively: 2.9% for cardiac surgery (vs. 5.6%, p = 0.001 vs. 1.3%, p = 0.001); 0.4% for cesarean section (vs. 0.7%, p = 0.001 vs. 1.8%, p = 0.001); 5.4% for craniotomy (vs. 4.4% p = 0.447 vs. 2.6% p = 0.005) and 1.1% for vaginal hysterectomy (vs. 2.0% p = 0.102 vs. 0.9% p = 0.499.), Conclusions: Our SSI rates were greater in two of the four analyzed types of SPs compared with CDC-NHSN, but similar to most INICC rates. These findings on the epidemiology of SSI in Brazil will enable us to introduce targeted interventions for infection control.

Background. Polymorphism of the accessory gene regulator group II (agr) in methicillin-resistant Staphylococcus aureus (MRSA) is predictive of vancomycin failure therapy. Nevertheless, the impact of group II agr expression on mortality of patients with severe MRSA infections is not well established. Objective. The goal of our study was to evaluate the association between agr polymorphism and all-cause in-hospital mortality among critically ill patients receiving vancomycin for nosocomial MRSA bacteremia. Methods. All patients with documented bacteremia by MRSA requiring treatment in the ICU between May 2009 and November 2011 were included in the study. Cox proportional hazards regression was performed to evaluate whether agr polymorphism was associated with all-cause in-hospital mortality. Covariates included age, APACHE II score, initial C-reactive protein plasma levels, initial serum creatinine levels, vancomycin minimum inhibitory concentration, vancomycin serum levels, and time to effective antibiotic administration. Results. The prevalence of group I and group II agr expression was 52.4% and 47.6%, respectively. Bacteremia by MRSA group III or group IV agr was not documented in our patients. The mean APACHE II of the study population was 24.3 (standard deviation 8.5). The overall cohort mortality was 66.6% (14 patients). After multivariate analysis, initial plasma C-reactive protein levels (P = 0.01), initial serum creatinine levels (P = 0.008), and expression of group II agr (P = 0.006) were positively associated with all-cause in-hospital mortality. Patients with bacteremia by MRSA with group II agr expression had their risk of death increased by 12.6 times when compared with those with bacteremia by MRSA with group I agr expression. Conclusion. Group II agr polymorphism is associated with an increase in mortality in critically ill patients with bacteremia by MRSA treated with vancomycin.

Objective: this article reports on the experience of using the interpretive phenomenological framework of Patricia Benner in a Brazilian context. Benner's interpretive phenomenology, based on existential and interpretative philosophy, aims to understand human experiences in the particular worlds of research participants. Data were collected through interviews with nine nurses in November and December 2014., Results: data analysis process according to Benner's framework consisted of: transcription, coding, thematic analysis, and search for paradigmatic cases and examples. Therefore, the prior knowledge of the researcher is an important part of the study, consisting in manners of the research conduction., Conclusion: The use of this methodological framework entailed a great challenge for the researcher, however, it also enabled a unique opportunity to illuminate important existential phenomena related to the daily lives of research participants.

Effects of vibratory stimulation on motor performance have been widely investigated. Many theories have been applied, in order to evaluate its influence on individuals; however, very few studies have researched vibratory stimulation-induced cortical behavior. The aim of the present study is to investigate behavioral changes, such as reaction time and index finger movements, as well as electrophysiological changes, using beta band absolute power, in subjects submitted to vibratory stimulation. For this study, 30 healthy subjects were randomly selected and divided into two groups, experimental and control, and were submitted to a right index finger task, before and after vibratory stimulation, which was applied to the right upper limb, while their standard cerebral activity was recorded through electroencephalogram. No significant difference was found among behavioral variables. On the other hand, beta band absolute power significantly increased in the experimental group for the C3, C4 and P4 derivations, while it decreased at P3. The results suggest that electrophysiological changes were induced by vibratory stimulation, while reaction time and task-related movements were not affected by it., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: The present study aimed to evaluate whether patient education level interferes in the percentage of pain relief or increase using visual analogue scale (VAS) and subjective pain perception., Patients and Methods: Ninety-five patients presenting acute shoulder pain due to enthesitis were evaluated. They were asked to quantify the pain using VAS before steroid articular infiltration. One week later, patients reevaluated the pain using VAS and orally stated the percentage of perceived pain increase or relief. The information gathered was then compared among three patient educational levels (elementary, high school, and university)., Results: Percentages of improvement stated orally and utilizing VAS presented no statistically significant differences among the three educational status levels (p = 0.804)., Conclusion: Patient educational status caused no impact in the results of acute pain self-assessment with VAS and oral evaluation.

[Purpose] Stretching using proprioceptive neuromuscular facilitation involve physiological reflex mechanisms through submaximal contraction of agonists which activate Golgi organ, promoting the relaxation reflex. The aim of this study was to evaluate the effects of proprioceptive neuromuscular facilitation alone and with prior application of cryotherapy and thermotherapy on hamstring stretching. [Subjects and Methods] The sample comprised of 32 young subjects with hamstring retraction of the right limb. The subjects were randomly allocated to four groups: the control, flexibility PNF, flexibility PNF associated with cryotherapy, flexibility PNF in association with ultrasound therapy. [Results] After 12 stretching sessions, experimental groups showed significant improvements compared to the control group. Moreover, we did not find any significant differences among the experimental groups indicating PNF stretching alone elicits similar results to PNF stretching with prior administration of cryotherapy or thermotherapy. [Conclusion] PNF without other therapy may be a more practical and less expensive choice for clinical care.

Background: The Gram stain can be used to direct initial empiric antimicrobial therapy when complete culture is not available. This rapid test could prevent the initiation of inappropriate therapy and adverse outcomes. However, several studies have attempted to determine the value of the Gram stain in the diagnosis and therapy of bacterial infection in different populations of patients with ventilator-associated pneumonia (VAP) with conflicting results. The objective of this study is to evaluate the accuracy of the Gram stain in predicting the existence of Staphylococcus aureus infections from cultures of patients suspected of having VAP., Methods: This prospective single-center open cohort study enrolled 399 patients from December 2005 to December 2010. Patients suspected of having VAP by ATS IDSA criteria were included. Respiratory secretion samples were collected by tracheal aspirate (TA) for standard bacterioscopic analysis by Gram stain and culture., Results: Respiratory secretion samples collected by tracheal aspirates of 392 patients were analyzed by Gram stain and culture. When Gram-positive cocci were arranged in clusters, the sensitivity was 68.4%, specificity 97.8%, positive predictive value 88.1% and negative predictive value 92.8% for predicting the presence of Staphylococcus aureus in culture (p < 0.001)., Conclusions: A tracheal aspirate Gram stain can be used to rule out the presence of Staphylococcus aureus in patients with a clinical diagnosis of VAP with a 92.8% Negative Predictive Value. Therefore, 7.2% of patients with Staphylococcus aureus would not be protected by an empiric treatment that limits antimicrobial coverage to Staphylococcus aureus only when Gram positive cocci in clusters are identified.

Background. The epidemiology of Clostridium difficile infection has changed over time. Therefore, it is essential to monitor the characteristics of patients at risk of infection and factors associated with poor prognosis. Objective. To evaluate factors associated with C. difficile infection and with poor prognosis in those with documented C. difficile colitis. Methods. A retrospective case-control study of 75 patients with documented C. difficile colitis and 75 controls with hospital-acquired diarrhea of other causes. Stepwise multiple logistic regression was used to identify factors associated with C. difficile infection among patients with hospital-acquired diarrhea. Results. Previous antibiotic treatment (odds ratio (OR), 13.3; 95% confidence interval (CI), 1.40-126.90), abdominal distension (OR, 3.85; 95% CI, 1.35-10.98), and fecal leukocytes (OR, 8.79; 95% CI, 1.41-54.61) are considered as predictors of C. difficile colitis; anorexia was negatively associated with C. difficile infection (OR, 0.15; 95% CI, 0.03-0.66). Enteral tube feeding was independently associated with a composite outcome that included in-hospital mortality, intensive care unit admission, and treatment failure (OR, 3.75; 95%CI, 1.24-11.29). Conclusions. Previous antibiotic use and presence of fecal leukocytes in patients with hospital-acquired diarrhea are associated with C. difficile colitis and enteral tube support with complications associated with C. difficile colitis.

Background: The current study sought to compare 28-day mortality rates in cancer patients with febrile neutropenia (FN) and gastrointestinal (GI) symptoms who underwent monotherapy using an antibiotic with antipseudomonal and anti-anaerobic activity (piperacillin-tazobactam or a carbapenem) and a group treated with a combination of cefepime-metronidazole., Findings: We performed a prospective cohort study in a single tertiary hospital from October 2009 to August 2011. All consecutive adult cancer patients admitted with FN secondary to intensive chemotherapy and GI symptoms (abdominal pain, diarrhea or perianal pain) were evaluated. Kaplan-Meier curves were used for calculating time-dependent occurrence of death. In total, 37 patients with FN and GI symptoms were evaluated (15 in monotherapy arm and 22 in the combination therapy arm). Treatment with combination cefepime and metronidazole resulted in a lower 28-day mortality rate compared with piperacillin-tazobactam or carbapenem monotherapy (0% versus 40%; log-rank P=0.002)., Conclusions: Results of the present study suggest a significant reduction in mortality in cancer patients with FN and GI symptoms treated with combination cefepime-metronidazole therapy compared with monotherapy using agents with antipseudomonal and anti-anaerobic activity. Further randomized trials are warranted to confirm the superior results using combination therapy in patients with FN and GI symptoms.