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Background Levofloxacin prophylaxis (LVXp) is often used for patients with underlying leukemia and severe neutropenia to reduce the risk of fever and bacteremia. This study evaluated trends in viridans group streptococci (VGS) antibiotic susceptibilities over time and clinical outcomes of children with VGS bloodstream infections (BSIs) during institutional adoption of LVXp. Methods VGS blood culture isolates between 1/1/2010 and 12/31/2021 with susceptibility testing reported were included. Available isolates were re-identified to the species level and additional susceptibility testing was performed. Demographic and clinical data were abstracted from medical records. Results A total of 264 VGS BSI isolates were identified in immunocompromised (IC, n = 125) and non-immunocompromised subjects, (non-IC, n = 139). IC subjects had lower rates of VGS isolates susceptible (S) to LVX and higher minimum inhibitory concentration (MICs) to LVX (p = 0.004) and ciprofloxacin (p = 0.0005) compared with non-IC subjects. No other evaluated antibiotic had increased MICs in either group. Fifteen of 19 (74%) LVX not susceptible (NS) isolates occurred in IC subjects, 13 represented breakthrough infections. IC subjects had higher rates of VGS-related shock (p = 0.012), need for pressor support (p = 0.039), and longer duration of hospitalization than non-IC subjects (p < 0.001). Clinical outcomes were comparable between subjects with LVX S and NS VGS BSI isolates. Conclusions VGS with reduced susceptibility to LVX emerged during institutional adoption of LVXp in high-risk children with immunocompromising conditions, but did not result in significant differences in clinical outcomes. Ongoing surveillance and susceptibility testing are critical in weighing the utility of LVXp against emerging antimicrobial resistance in this high-risk population. [ABSTRACT FROM AUTHOR]

Aim: To evaluate whether renal length z‐scores predict renal dysfunction in children with a solitary functioning kidney (SFK). Methods: In a single‐centre retrospective cohort of children with SFK, we correlated body mass index z‐scores, extracellular volume and lean body mass to renal length z‐scores. We grouped these z‐scores to other markers of renal dysfunction (proteinuria, hypertension, extracellular volume and abnormal estimated glomerular function rate [eGFR]) and analysed renal length z‐score with multivariate analysis, receiver‐operated characteristics (ROC) plots and Youden's index to determine an appropriate cut‐off. Results: 111 children had a median follow‐up 5.08 years, eGFR 80.8 mL/min/1.73 m2, and age at last follow‐up 7.4 (3.8‐13.4 years). The median renal length z‐scores of those without any renal dysfunction (n = 37, 25.1%) were greater (+3.66, interquartile range 3.02‐4.47) than those with renal dysfunction (median 3.11, interquartile range 1.76‐4.11, P =.0107, Mann‐Whitney test). Using a cut‐off of z‐score of >+1.911, the odds ratio for having no renal dysfunction was 0.07 (95% CI 0.002‐0.459, P =.0010). However, accuracy of the renal length z‐score was poor (ROC curve 0.6488). Conclusion: In this cohort of children with SKF, using the renal length z‐score as a biomarker of renal dysfunction at 7 years of age is not recommended. [ABSTRACT FROM AUTHOR]

This paper examines visitor satisfaction in the context of heritage tourism in two tourist-historic heritage destinations: Seville and York. The study investigates the direct and indirect relationships between quality of experience, perceived value and emotions on satisfaction. The results show that the quality of experience positively and directly influences satisfaction through the cognitive variable perceived value and the affective variable emotions. The indirect effect of quality of experience through emotions on satisfaction was greater compared with the indirect effective through perceived value. Therefore, this study draws attention to the importance of quality of experience and emotions on visitor satisfaction. Given that heritage tourism has the potential to elicit emotional and experiential responses by visitors, these findings have significant management implications for heritage destination managers when considering the heritage visitor experience. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to investigate the mediating role of experience quality between the dimensions of authenticity and satisfaction in the context of cultural-heritage tourism. This paper investigates the direct influences of these variables on satisfaction and the indirect influences of two dimensions of authenticity on satisfaction through quality of experience. This study is a pioneer in analysing the influence of each of the two dimensions of authenticity on satisfaction via quality of experience in a cultural-heritage context. A questionnaire survey administered to 205 visitors in the City of York, United Kingdom, was analysed using the structural equation modelling technique. The findings confirmed the direct and indirect influence of the variable authenticity in its double perspective (objective and existential authenticity) on satisfaction. The findings also identified the mediating role of quality of experience on authenticity and satisfaction. It is therefore recommended that cultural tourism attractions should be offered that provide visitors with a high quality authentic and personal experience in order to enhance visitor satisfaction. [ABSTRACT FROM AUTHOR]

Objective Pancreatic Scintigraphy With Interleukin-2 Radiolabeled With 99MTc (99MTc-Il-2) Is A Technique Used To Image Chronic Inflammatory-Mediated Disorders. We Used This Method To Detect A Signal Consistent With The Presence Of Insulitis In Patients With Autoimmune Diabetes. Positive And Negative Controls (Patients With Pancreatic Carcinoma And Type 2 Diabetes, Respectively) Also Were Studied. Research Design And Methods We Examined 25 Patients With Autoimmune Diabetes (16 With Recently Diagnosed Type 1 Diabetes, 9 With Latent Autoimmune Diabetes In Adults [Lada]), 6 With Type 2 Diabetes, And 7 With Pancreatic Carcinoma (The Latter Two Groups Were Used As Negative And Positive Controls, Respectively). All Patients Underwent 99MTc-Il-2 Scintigraphy And Contrast-Enhanced Mri Of The Pancreas. To Validate Positive Controls, Samples Were Taken From Patients With Pancreatic Carcinoma During Surgery For Histological And Immunohistochemical Investigations. Results Pancreatic Accumulation Of 99MTc-Il-2 Was Detected In Patients With Autoimmune Diabetes (61% Positive) And, Notably, In 6 Of 9 Patients With Lada; Semiquantita-Tive Evaluation Of Pancreatic Uptake Of 99MTc-Il-2 Showed Higher Values In Patients With Autoimmune Diabetes (Both Childhood And Lada) And Pancreatic Carcinoma Than In Those With Type 2 Diabetes (4.45 ± 1.99, ± 4.79 1.1, And 4.54 ± 1.62 Vs. 2.81 ± 0.63; P = 0.06, P = 0.01, And P = 0.04, Respectively). In Patients With Pancreatic Carcinoma, Pancreatic Interleukin-2 Receptor Expression Correlated With Pancreatic ±Tc-Il-2 Uptake (R = 0.8; P = 0.01). In Patients With Lada, ±Tc-Il-2 Uptake Inversely Correlated With Duration Of Disease (R = 0.7; P = 0.03). Conclusions Autoimmune Diabetes In Adults Is Associated With Increased Pancreatic ±Tc-Il-2 Uptake, Indicating The Presence Of Insulitis, Particularly Within 1 Year Of The Beginning Of Insulin Therapy, Similar To Type 1 Diabetes At Diagnosis. [ABSTRACT FROM AUTHOR]

Severe skin reactions include Stevens-Johnson Syndrome, toxic epidermal necrolysis and Drug reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, which are uncommon in the pediatric population (incidence 1/1000- 10 000 children), but they have bad prognosis. Drug-sensitive Syndrome with eosinophilia and systemic symptoms consists in rash, hematological abnormalities, lymphadenopathy and organ involvement. We report the case of a 12-year-old male patient who developed this pathology after initiating anticonvulsant therapy with carbamazepine. We consider that it is important to be aware of this disease and to include it among the differential diagnoses in patients with similar conditions because this syndrome is life-threatening., (Sociedad Argentina de Pediatría.)