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Objetivo: Identificar interacciones medicamentosas de los anticonvulsivantes de primera línea con antipsicóticos y/o antidepresivos y su impacto en el paciente con epilepsia en el Hospital de San José, Bogotá, que asistieron a la consulta externa desde el 1 de junio del 2015 hasta el 30 de abril del 2016. Materiales y métodos: Estudio descriptivo para identificar las interacciones medicamentosas en pacientes con epilepsia. Se incluyó a 26 pacientes ≥ 18 años con los criterios de la International League Against Epilepsy en terapia con antiepilépticos de primera línea asociados a medicamentos antipsicóticos y/o antidepresivos; se excluyó a embarazadas y aquellos con alteración hepática y renal. El análisis descriptivo se realizó por medio de frecuencias absolutas y relativas para las variables cualitativas, y para las cuantitativas medianas y rangos intercuartílicos. Resultados: La mediana de edad fue 49 años (RIC: 33-57), 14 (53,8%) eran mujeres. Antecedentes relevantes: hipoxia perinatal y traumatismo craneoencefálico en 5 (19,2%). La monoterapia anticonvulsivante más frecuente fue carbamazepina en 8 casos (30,8%). Dos que recibían carbamazepina presentaron leucopenia. Ninguno tuvo elevación de enzimas hepáticas. Los niveles séricos de los anticonvulsivantes en la mayoría se hallaron dentro del rango terapéutico. Discusión y conclusiones: Se describieron múltiples combinaciones de anticonvulsivantes con antipsicóticos y/o antidepresivos sin documentar toxicidad hepática, ni alteraciones hematológicas graves que indiquen cambio de terapia; la mayoría de los niveles séricos de anticonvulsivantes estaban dentro del rango terapéutico.

The article is devoted to the study of the development of physical culture and sports in Russia. Today, the formation of a professional worldview in the field ofphysical culture and sports is an important component of the state, social and economic policy of the state. In the current program of development of physical culture and sport noted that one of the main functions ofphysical culture and sport is to contribute to the formation ofa professional Outlook in the field of healthy lifestyles, as well as in the education of youth and the younger generation. The priority direction of our state's policy is primarily aimed at improving the health of the nation through the promotion of mass physical culture classes.

The article is devoted to the study of the problems of continuous professional physical education in the internal affairs bodies and is dictated by the importance ofphysical readiness, which at first glance does not cause visible doubts, as an important component of the overall combat readiness of employees. This fact fundamentally characterizes the role ofphysical training, which acts as one of the main subjects of service and combat training, as well as being an effective pedagogical tool and energy basis for training and education. The analysis of the obtained results allows us to define a single concept of the development of the system of continuous professional physical education in the internal affairs bodies, the essence of which is reduced to the need for the gradual formation of the foundations ofpedagogical skills in accordance with the multi-level structure of legal education.

Neuroimaging studies of autism spectrum disorder (ASD) have been predominantly unimodal. While many fMRI studies have reported atypical activity patterns for diverse tasks, the MEG literature in ASD remains comparatively small. Our group recently reported atypically increased event-related theta power in individuals with ASD during lexicosemantic processing. The current multimodal study examined the relationship between fMRI BOLD signal and anatomically-constrained MEG (aMEG) theta power. Thirty-three adolescents with ASD and 23 typically developing (TD) peers took part in both fMRI and MEG scans, during which they distinguished between standard words (SW), animal words (AW), and pseudowords (PW). Regions-of-interest (ROIs) were derived based on task effects detected in BOLD signal and aMEG theta power. BOLD signal and theta power were extracted for each ROI and word condition. Compared to TD participants, increased theta power in the ASD group was found across several time windows and regions including left fusiform and inferior frontal, as well as right angular and anterior cingulate gyri, whereas BOLD signal was significantly increased in the ASD group only in right anterior cingulate gyrus. No significant correlations were observed between BOLD signal and theta power. Findings suggest that the common interpretation of increases in BOLD signal and theta power as ‘activation’ require careful differentiation, as these reflect largely distinct aspects of regional brain activity. Some group differences in dynamic neural processing detected with aMEG that are likely relevant for lexical processing may be obscured by the hemodynamic signal source and low temporal resolution of fMRI.

The purpose of the article is to make a review of the studies dealing with the order of company market entry as a success factor for new products. On the one hand, the interest in the review is driven by the need to develop and launch successful new products and, on the other, the high likelihood for product failure was confirmed by a lot of studies. Furthermore, research in the last years has considered the order of company market entry a factor that determines the market performance of company new products. As a result of the review, a classification is proposed of the studies on the order of company market entry including three areas: consequences of company market entry; pre-entry conditions; characteristics of the economic environment influencing the first two areas. The main conclusion formulated in the article is that, overall, the studies on the order of market entry support the relation between entry timing and company performance with the order of market being a question of matching company resources and capabilities, and environment requirements. The methods of analysis and synthesis as well as induction and deduction are used in the article.

Abstract Campomanesia xanthocarpa, a plant belonging to the Myrtaceae family, is popularly known as gabiroba. Leaves of gabiroba has been popularly used to treat various diseases, including inflammatory, renal, and digestive, among others. Additionally, studies have shown an effect to reduce blood cholesterol levels. The aim of this study was to evaluate the antihyperglycemic and hypolipidemic effects of Campomanesia xanthocarpa seed extract in hyperglycemic rats. The results showed that 400 mg/kg of seed extract was able to decrease blood glucose levels and to increase the muscular and hepatic glycogen content as well as to inhibit the sucrase and maltase activity. At doses of 200 mg/kg and 800 mg/kg, the activity of these enzymes was also reduced. In the lipid profile 400 mg/kg produced a decrease in total and LDL cholesterol serum levels; and with 200 mg/kg there was an increase in HDL cholesterol levels. The extract did not present hepatic and renal toxic effects at the different doses tested. The results suggest that the treatment with Campomanesia xanthocarpa seeds extract is useful in reducing glycemia, total cholesterol and LDL levels with potential adjuvant therapeutic in the treatment of diabetes and hypercholesterolemia, however, additional pharmacological and toxicological studies are still required.

Previously, numerical evidence was presented of a self-intersecting Bezier curve having the unknot for its control polygon. This numerical demonstration resolved open questions in scientic visualization, but did not provide a formal proof of self-intersection. An example with a formal existence proof is given, even while the exact self-intersection point remains undetermined.

Purpose: To treat delayed present (more than 24h) and Gustilo type III fractures in a better way than external fixation which before was a routine in our hospital. Methods: We have applied advanced trauma life support control (ATLS). After proper debridement of the wound, irrigation with saline and antibiotic cover, we reduced the fracture with the Sign IM nail, which is a solid nail without internal dead space, and then we added antibiotic loaded cement with 3g of Amikacin and 4g of Vancomycin. Results: Out of 38 delayed present fractures, we have observed serous discharge in 3 cases which have been controlled by changing the antibiotic loaded cement. While the other cases remained uninfected. Conclusion: The best way to deal with infection is to prevent it, while other factors as obesity, diabetes, and other co-morbidities increase the risk of infection. In our method, we also provided local high concentration of antibiotic with the use of cement loaded antibiotic, and the control of dead space with bone defect and tissue loss. If we do not put cement or other solid material, then blood will definitely take space and that would be a media for infection.

Purpose: In this study, we reported a rare paediatric closed medial malleolus fracture non-union (the fracture did not involve the growth plate). Methods: The fracture was initially treated with Plaster-of-Paris cast for 6 weeks followed by physiotherapy. The fracture position and union were assessed regularly with X-rays. Open reduction and internal fixation with cannulated screw was performed. Intraoperatively, there were only minimal soft tissues in the fracture gap and they were cleared prior to fixation. Further regular X-rays suggested fracture position was maintained but lack of callus formation. The patients remained symptomatic. A few months following the operation, the non-invasive ultrasound bone stimulator treatment was arranged for six months in view of the non-union. On completion of the treatment, she remained painful on weight-bearing. Subsequently radiological investigations confirmed fracture non-union. Further open reduction internal fixation with autologous bone-grafting was performed. Results: The fracture was finally united a few months following the autologous bone-grafting procedure and the patient’s symptoms resolved. The fracture was also confirmed to be united radiologically. Conclusion: In this study, we reported one of these rare closed symptomatic medial malleolus non-union without growth plate involved. While following multiple treatment modalities (both conservative & invasive), fracture union was finally achieved. The union occurred over more than a year period.

The compact linear accelerator for research and applications (CLARA) is an ultrabright electron beam test facility being developed at STFC Daresbury Laboratory. The ultimate aim of CLARA is to test advanced free electron laser (FEL) schemes that can later be implemented on existing and future short-wavelength FELs. In addition, CLARA is a unique facility to provide a high-quality electron beam to test novel concepts and ideas in a wide range of disciplines and to function as a technology demonstrator for a future United Kingdom x-ray FEL facility. CLARA is being built in three phases; the first phase, or front end (FE), comprises an S-band rf photoinjector, a linac, and an S-bend merging with the existing versatile electron linear accelerator beam line; the second phase will complete the acceleration to full beam energy of 250 MeV and also incorporate a separate beam line for use of electrons at 250 MeV; and the third phase will include the FEL section. The CLARA FE was commissioned during 2018, and the facility was later made available for user experiments. Significant advancements have been made in developing high-level software and a simulation framework for start-to-end simulations. The high-level software has been successfully used for unmanned rf conditioning and for characterization of the electron beam. This paper describes the design of the CLARA FE, performance of technical systems, high-level software developments, preliminary results of measured beam parameters, and plans for improvements and upgrades.

We present a 46-year-old psychiatric patient presenting with a lingual abscess. This paper covers the epidemiology, clinical features, diagnosis, and differential diagnosis with a view to assisting emergency physicians in the timely recognition and management of this rare but potentially life-threatening condition.

La presente investigación tiene como objetivo comprender los discursos que subyacen en la producción-constitución de subjetividad de un grupo de estudiantes indígenas de la Universidad del Quindío. Son tenidos en cuenta autores como Foucault, para el tema de discursos y prácticas de sí, Dussel para entender el proceso de colonización, Castro para referirse al tema de colonialidad y decolonialidad, Escobar sobre globalización. La categoría de subjetividad abordada desde la perspectiva de Castro, así como Maldonado para hablar de colonialidad del ser. Se usó un enfoque cualitativo con el método de la hermenéutica pluritópica, la cual entiende la diferencia de lo múltiple y hace um diálogo intercultural, usando técnicas como lo son la entrevista a profundidad y talleres de expresión gráfica. El análisis de la información arroja datos en cuanto a las secuelas de la globalización sobre las subjetividades, el papel de agencias socializadoras como la iglesia y la escuela para replicar le pensamiento occidental y la lucha y resistencia por el rescate de lo propio y la identidad pese a los processos del desarrollo y la modernidad.

Dengue is the most common arboviral disease in the world. Traditionally, it has affected more adults, but the incidence in children has increased in recent years. Colombia is no stranger to this change; therefore, we aimed to find the differences in signs, symptoms, and clinical, hematological, and hemogram characteristics between children under 12 years old and individuals aged 12 years and older in an endemic region of Colombia in 2020-2022. The analyses were conducted with baseline data, corresponding to a cross-sectional design. Multiple correspondence analysis was used for general, dermatological, and clinical symptom profiles. Discriminant analysis was used for laboratory profiles. Multiple correspondence analysis was applied to nominal categorical data, employing Euclidean distances to analyze age groups. Discriminant analysis was applied to a training sample and validated on a test sample. The overall agreement of the model's discrimination, sensitivity, specificity, and fit indicators was calculated. The results indicated that individuals under 12 years exhibited distinct dermatological and clinical features, including rash, pruritus, hypotension, lymphocyte count, and platelet count, compared with those aged 12 years and older. In contrast, those 12 years and older were profiled for general and clinical symptoms such as pain (back pain, retro-orbital pain, headache), dizziness, chills, hematuria, tachypnea, and elevated/high hematocrit, hemoglobin, and basophil values. These findings are crucial to understanding the high incidence in children; they also facilitate rapid understanding of the disease in clinical care settings and differentiate it from other febrile outbreaks. This will affect disease control, particularly in severe cases, and reduce mortality.

Immunoglobulin heavy chain variable ( IGHV ) region mutations, TP53 mutation, fluorescence in situ hybridization (FISH), and cytogenetic analysis are the most important prognostic biomarkers used in chronic lymphocytic leukemia (CLL) patients in our daily practice. In real-life environment, there are scarce studies that analyze the correlation of these factors with outcome, mainly referred to time to first treatment (TTFT) and overall survival (OS). This study aimed to typify IGHV mutation status, family usage, FISH aberrations, and complex karyotype (CK) and to analyze the prognostic impact in TTFT and OS in retrospective study of 375 CLL patients from a Spanish cohort. We found unmutated CLL (U-CLL) was associated with more aggressive disease, shorter TTFT (48 vs. 133 months, p  < 0.0001), and shorter OS (112 vs. 246 months, p  < 0.0001) than the mutated CLL. IGHV3 was the most frequently used IGHV family (46%), followed by IGHV1 (30%) and IGHV4 (16%). IGHV5-51 and IGHV1-69 subfamilies were associated with poor prognosis, while IGHV4 and IGHV2 showed the best outcomes. The prevalence of CK was 15% and was significantly associated with U-CLL. In the multivariable analysis, IGHV2 gene usage and del13q were associated with longer TTFT, while VH1-02, +12, del11q, del17p, and U-CLL with shorter TTFT. Moreover, VH1-69 usage, del11q, del17p, and U-CLL were significantly associated with shorter OS. A comprehensive analysis of genetic prognostic factors provides a more precise information on the outcome of CLL patients. In addition to FISH cytogenetic aberrations, IGHV and TP53 mutations, IGHV gene families, and CK information could help clinicians in the decision-making process., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)

This study compared weekly training-load (TL), training-monotony (TM), and training-strain (TS) in 80 professional football players (28.1 ± 3.2 yrs, 78.0 ± 5.9 kg, and 182.0 ± 4.8 cm), considering two lengths (6 and 7 days between matches), two types of periodization strategies (placing the compensatory session in MD+1 [P1] or MD+2 [P2] post-match-day) and two players' status, starters, and non-starters. Using Global Positioning Technology, the monitored variables were: Player Load (PL), Total Distance (TD), distances at various speeds (>21 [HSR], >24 [VHSR], and > 27 [SPR] km·h -1 ), number of accelerations (>2 m·s -2 , ACC), and decelerations (<-2 m·s -2 , DEC). Kruskal-Wallis and Mann-Whitney non-parametric statistical tests were used for loading strategy differences. In both lengths and periodization strategies of the micro-cycles, non-starters trained more than starters. There were differences in the quantity (TL) and distribution (TM and TS) demand considering the micro-cycle's length and periodization strategy. In MD+1 (P1), non-starters accumulated higher TL, showing moderate to large Cohen's d magnitudes in HSR, VHSR, SPR, PL, and TD. For starters, training in MD+2 (P2) resulted in higher values ( p  < 0.05) of TL, TM and TS. The coaching staff needs to anticipate TL, TM, and TS by considering players' status, periodization strategy, and the number of training sessions between matches.

Leptospirosis represents a public health problem in Colombia. However, the underreporting of the disease is an unfortunate reality, with a clear trend towards a decrease in cases since 2019, when the guidelines for its confirmatory diagnosis changed with the requirement of two paired samples. The purpose of this review is to highlight the importance of leptospirosis. While the access to rapid diagnosis is available at practically all levels of care for dengue and malaria, leptospirosis-a doubly neglected disease-deserves recognition as a serious public health problem in Colombia. In this manner, it is proposed that molecular tests are a viable diagnostic alternative that can improve the targeted treatment of the patient and the timeliness of data and case reporting to SIVIGILA, and reduce the underreporting of the disease. Taking advantage of the strengthened technological infrastructure derived from the SARS-CoV-2 pandemic for molecular diagnosis in Colombia, with a network of 227 laboratories distributed throughout the national territory, with an installed capacity for PCR testing, it is proposed that molecular diagnosis can be used as an alternative for early diagnosis. This would allow case confirmation through the public health network in Colombia, and, together with the microagglutination (MAT) technique, the epidemiological surveillance of this disease in this country would be strengthened.

The pathogenesis of the severity of chikungunya infection is not yet fully understood., Objective: To assess the role of the cytokines/chemokines and system of complement in the evolution of chikungunya infection., Methods: In both acute and chronic phases, we measured the serum levels of 12 cytokines/chemokines and two complement mediators: mannose-binding lectin (MBL) and C3a, in 83 patients with chikungunya infection and ten healthy controls., Results: During the acute phase, 75.9% of the patients developed musculoskeletal disorders, and in 37.7% of them, these disorders persisted until the chronic phase. In general, patients had higher levels of cytokines than healthy controls, with significant differences for IFN-γ, IL-6, IL-8, IL-10, and MIP-1. Most cytokines exhibited a downward trend during the chronic phase. However, only IL-10, and MIP-1 levels were significantly lower in the chronic phase. Additionally, these levels never decreased to concentrations found in healthy controls. Moreover, MBL levels were significantly higher in the acute phase compared with the chronic phase. C3a levels were significantly higher in patients with musculoskeletal disorder compared with patients without it, in both acute-phase 118.2 (66.5-252.9), and chronic phase 68.5 (64.4-71.3), P < 0.001. Interestingly, C3a levels were significantly higher when patients had a severe disease version. Besides, in the acute phase, C3a levels were higher in patients that suffer arthritis as opposed to when they suffer arthralgia, 194.3 (69.5-282.2), and 70.9 (62.4-198.8), P = 0.013, respectively., Conclusions: Our results showed an immunological response that persisted until the chronic phase and the role of the complement system in the severity of the disease., Competing Interests: None., (AJCEI Copyright © 2022.)

Vaccine-associated hypermetabolic lymphadenopathy (VAHL) has been reported as a common post-vaccination side effect, especially with mRNA-based COVID-19 vaccines. Most VAHL cases present normal or enlarged regional lymph nodes close to the injection site, usually with mild-moderate FDG (18 F-Fluorodeoxyglucose) uptake on FDG positron emission tomography (PET)/CT. Here, we describe the case of a 33-year-old woman with past history of Classic Hodgkin Lymphoma (CHL) who underwent follow-up FDG PET/CT 3 days (d) after the first dose of the adenovirus-vectored Oxford-AstraZeneca COVID-19 vaccine. FDG PET/CT showed unexpected small hypermetabolic cervical and abdominal lymph nodes in the same location as at the onset of the disease, suggesting radiological relapse. Considering temporal relationship and other cases of VAHL, a new image was performed 2 months later, which revealed decreased lymph nodes and normalization of FDG uptake. This case illustrates that the possibility of a false-positive should always be considered by physicians in this new context, even when hypermetabolic lymph nodes appear far from the vaccination site.

Polyethylene terephthalate (PET) is the plastic packaging material most widely used to produce bottles intended for contact with food and beverages. However, PET is not inert, and therefore, some chemical compounds present in PET could migrate to food or beverages in contact, leading to safety issues. To evaluate the safety of PET samples, the identification of potential migrants is required. In this work, eight PET samples obtained from the Ecuadorian market at different phases of processing were studied using a well-known methodology based on a solvent extraction followed by gas chromatography-mass spectrometry analysis and overall migration test. Several chemical compounds were identified and categorized as lubricants (carboxylic acids with chain length of C12 to C18), plasticizers (triethyl phosphate, diethyl phthalate), thermal degradation products (p-xylene, benzaldehyde, benzoic acid), antioxidant degradation products (from Irgafos 168 and Irganox), and recycling indicator compounds (limonene, benzophenone, alkanes, and aldehydes). Additionally, overall migration experiments were performed in PET bottles, resulting in values lower than the overall migration limit (10 mg/dm 2 ); however, the presence of some compounds identified in the samples could be related to contamination during manufacturing or to the use of recycled PET-contaminated flakes. In this context, the results obtained in this study could be of great significance to the safety evaluation of PET samples in Ecuador and would allow analyzing the PET recycling processes and avoiding contamination by PET flakes from nonfood containers.

Background: COVID-19 related in-hospital venous thromboembolism (VTE) incidence is high but data reported vary significantly. Some studies show that up to half of the events are diagnosed early after admission., Objectives: To study symptomatic VTE incidence in acute COVID-19 hospitalized patients and to describe timing of VTE diagnosis., Methods: Multicenter cohort of 5966 patients hospitalized with acute COVID-19. Multicenter Registry of 844 hospitalized patients with acute COVID-19 and associated acute VTE., Results: By the time of cohort data collection, 68 patients (1.14%) were still hospitalized, 19.8% had died, and 5.4% required ICU. During a median follow-up of 6 days (IQR, 4-12), 183 patients (3.07%; 95% CI, 2.64-3.55) presented a symptomatic VTE event. The cumulative incidences of VTE at 7, 14 and 21 days in wards [2.3% (95% CI, 1.9-2.7), 3.6% (95% CI, 3.0-4.3), and 4.3% (95% CI, 3.5-5.1)] were similar to the ones reported in ICU [2.2% (95% CI, 1.0-4.4), 2.9% (95% CI, 1.5-5.3), and 4.1% (95% CI, 2.2-6.8)], but at 30 and 60 days were higher in ICU [6.9% (95% CI, 4.2-10.5), and 12.8% (95% CI, 8.1-18.5)] than in wards. Eighty-eight VTE events (48%) were diagnosed early, within 48 h of admission. VTE was not associated with death (HR, 0.79; 95% CI, 0.55-1.12)., Conclusions: Incidence of symptomatic VTE in our COVID-19 cohort is consistent with that of other real-life studies recently published. Early VTE events are, along with COVID-19, the reason for admission rather than an in-hospital complication., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: The COVID-19 outbreak has affected almost all hospital departments, including transfusion services. However, the demand for transfusions in a general hospital designated to deal with COVID-19 patients has not been analysed before., Study Design and Methods: A retrospective study was conducted to evaluate blood transfusion practices from 15 March to 14 April 2020 at Hospital Universitario Infanta Leonor (Madrid, Spain). During this month, with few exceptions, the hospital became a 'COVID-19' centre. In addition, transfusion rates during this time frame and the same period over the last 4 years were compared., Results: From 15 March to 14 April 2020, only 254 blood components were transfused, resulting in a 49·3% reduction over the previous year. Interestingly, in critically ill patients, the red blood cell (RBC) transfusion/bed ratio significantly decreased during this period (0·92) compared to the same ratio over the past 4 years (2·70) (P = 0·02). Of note, 106 blood components (95 RBC; 11 platelet concentrates) were transfused to only 36 out of 1348 COVID-19 patients (2·7%). The main reason for RBC transfusion in COVID-19 patients was a previous underlying disease (44%) followed by bleeding (25%) and inflammatory anaemia (25%)., Conclusion: This is the first study to report a decrease in blood transfusions during the COVID-19 pandemic in a general hospital and especially in the intensive care unit. The results of this study suggest that COVID-19 does not generally induce transfusion requiring anaemia, being the main causes for transfusion in these patients underlying conditions or bleeding., (© 2020 International Society of Blood Transfusion.)

We report the case of a 38-year-old woman who initially consulted for an undifferentiated fever. Although her clinical condition evolved with signs and symptoms compatible with dengue with alarm signs and that the anti-dengue IgM detection in a single sample indicated it was a probable case that could have happened during the previous three months, the patient kept consulting due to little improvement. On the tenth day after the onset of symptoms, she presented with painful polyarticular symmetric edema, as well as hyperpigmented lesions in the nasolabial fold. Chikungunya diagnosis was confirmed by the presence of IgM antibodies. In endemic countries for dengue and chikungunya, the possibility of co-infection exists, but it may go unnoticed. On the other hand, the co-infection may worsen the clinical course of these diseases. Therefore, physicians should evaluate the clinical and laboratory characteristics of both infections to be able to diagnose the coinfection for adequate management and to minimize complications.

In recent years, new prognostic indexes (PIs) for chronic lymphocytic leukemia (CLL), which include clinical, biological, and genetic variables, have been validated, highlighting the MD Anderson Cancer Center prognostic index (MDACC PI), the CLL-international prognostic index (CLL-IPI), and the Barcelona-Brno biomarkers only prognostic model. The aim of this study is to compare the utility of these PIs in a cohort of Spanish patients. A retrospective analysis of 696 unselected CLL patients newly diagnosed and previously untreated from different Spanish institutions was performed. The MDACC PI, the CLL-IPI, and the biomarkers only PI were applied to these patients, and a comparison of the three PIs was performed. With a median follow-up time of 46 months, 394 patients were alive and 187 had received treatment. The median overall survival (OS) was 173 months and the median time to first therapy (TTFT) was 32 months. Significant differences were obtained in OS and TTFT for all subgroups when applying these PIs, with the CLL-IPI being the one with the higher c -index (0.676 for OS and 0.757 for TTFT). The three PIs were able to discriminate patients in different prognostic subgroups. In our cohort, the CLL-IPI showed higher power in predicting TTFT and OS.

The recent Zika virus (ZIKV) outbreak demonstrates that cost-effective clinical diagnostics are urgently needed to detect and distinguish viral infections to improve patient care. Unlike dengue virus (DENV), ZIKV infections during pregnancy correlate with severe birth defects, including microcephaly and neurological disorders. Because ZIKV and DENV are related flaviviruses, their homologous proteins and nucleic acids can cause cross-reactions and false-positive results in molecular, antigenic, and serologic diagnostics. We report the characterization of monoclonal antibody pairs that have been translated into rapid immunochromatography tests to specifically detect the viral nonstructural 1 (NS1) protein antigen and distinguish the four DENV serotypes (DENV1-4) and ZIKV without cross-reaction. To complement visual test analysis and remove user subjectivity in reading test results, we used image processing and data analysis for data capture and test result quantification. Using a 30-μl serum sample, the sensitivity and specificity values of the DENV1-4 tests and the pan-DENV test, which detects all four dengue serotypes, ranged from 0.76 to 1.00. Sensitivity/specificity for the ZIKV rapid test was 0.81/0.86, respectively, using a 150-μl serum input. Serum ZIKV NS1 protein concentrations were about 10-fold lower than corresponding DENV NS1 concentrations in infected patients; moreover, ZIKV NS1 protein was not detected in polymerase chain reaction-positive patient urine samples. Our rapid immunochromatography approach and reagents have immediate application in differential clinical diagnosis of acute ZIKV and DENV cases, and the platform can be applied toward developing rapid antigen diagnostics for emerging viruses., (Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Introduction: Quibdó, a municipality in Chocó, has poor public services and weather and social conditions that favor dengue transmission. However, there are few studies about this problem in this district., Objective: To determine the frequency of dengue infection in patients with acute febrile syndrome and to compare clinical features among dengue infected patients with other febrile diseases., Materials and Methods: A cross-sectional study was conducted from January, 2008, to March, 2010. The study population comprised patients with febrile syndrome of seven or fewer days of evolution, recruited from hospitals in the town. Dengue diagnosis was made in serum samples by detection of IgM antibodies, NS1 antigen, reverse transcription polymerase chain reaction, and virus isolation. Clinical and laboratory information from the patients was obtained., Results: During the study period, 469 patients with acute febrile syndrome were recruited, of whom 98.3% were Afro-descendant. Dengue fever was found in 28.4% of the cases. Four dengue serotypes were identified with DENV-1 predominance. The ages ranged from zero to 76 years. From all patients, 70.7% of cases were classified as dengue without warning signs. Nausea, vomiting, abdominal pain, cough, nasal congestion and sore throat were significantly more frequent in patients with another febrile disease., Conclusions: Active surveillance of the acute febrile syndrome allowed for the detection of undiagnosed cases of dengue; the observed frequency of this infection suggests that the study area has a high risk of dengue infection.

A one-day point prevalence study to investigate the patterns of antibiotic use was undertaken in 43 latin American (LA) intensive care units. Of 510 patients admitted, 231 received antibiotic treatment on the day of the study (45%); in 125 cases (54%) due to nosocomial-acquired infections. The most frequent infection reported was nosocomial pneumonia (43%). Only in 122 patients (53%) were cultures performed before starting antibiotic treatment. 33% of the isolated microorganisms were enterobacteriaceae (40% extended-spectrum beta-lactamase-producing), 23% methicillin-resistant Staphylococcus aureus and 17% carbapenems-resistant non-fermentative Gram-negatives. The antibiotics most frequently prescribed were carbapenems (99/231, 43%); alone (60/99, 60%) or in combination with vancomycin (39/99, 40%). "Restricted" antibiotics (carbapenems, vancomycin, piperacillin-tazobactam, broad-spectrum cephalosporins, tigecycline, polymixins and linezolid) were most frequently indicated in severely ill patients (APACHE II score at admission >15, p=0.0007 and, SOFA score at the beginning of the antibiotic treatment >3, p=0.0000). Only 36% of antibiotic treatments were cultured-directed.Our findings help explain the high rates of multidrug-resistant pathogens in LA settings (i.e. ESBL-producing Gram-negatives) and the severity of the registered patients illnesses.