Search

Background: The incidence of catheter-related bloodstream infections (CRBSIs) has fallen over the last decade, especially in intensive care units (ICUs).Aim: To assess the existence of concomitant trends in outcomes and to analyse the current risk factors for mortality.Methods: A multicentre retrospective cohort study was conducted at 24 Catalan hospitals participating in the Surveillance of healthcare-associated infections in Catalonia (VINCat). All hospital-acquired CRBSI episodes diagnosed from January 2010 to December 2019 were included. A common protocol including epidemiological, clinical, and microbiological data was prospectively completed. Mortality at 30 days after bacteraemia onset was analysed using the Cox regression model.Findings: Over the study period, 4795 episodes of CRBSI were diagnosed. Among them, 75% were acquired in conventional wards and central venous catheters were the most frequently involved (61%). The 30-day mortality rate was 13.8%, presenting a significant downward trend over the study period: from 17.9% in 2010 to 10.6% in 2019 (hazard ratio (HR): 0.95; 95% confidence interval (CI): 0.92-0.98). The multivariate analysis identified age (HR: 1.03; 95% CI: 1.02-1.04), femoral catheter (1.78; 1.33-2.38), medical ward acquisition (2.07; 1.62-2.65), ICU acquisition (3.45; 2.7-4.41), S. aureus (1.59; 1.27-1.99) and Candida sp. (2.19; 1.64-2.94) as risk factors for mortality, whereas the mortality rate associated with episodes originating in peripheral catheters was significantly lower (0.69; 0.54-0.88).Conclusion: Mortality associated with CRBSI has fallen in recent years but remains high. Intervention programmes should focus especially on ICUs and medical wards, where incidence and mortality rates are highest. [ABSTRACT FROM AUTHOR]

Post-transplant diabetes mellitus (PTDM) is a frequent complication after kidney transplantation (KT). This systematic review investigated the effect of different immunosuppressive regimens on the risk of PTDM. We performed a systematic literature search in MEDLINE and CENTRAL for randomized controlled trials (RCTs) that included KT recipients with any immunosuppression and reported PTDM outcomes up to 1 October 2023. The analysis included 125 RCTs. We found no differences in PTDM risk within induction therapies. In de novo KT, there was an increased risk of developing PTDM with tacrolimus versus cyclosporin (RR 1.71, 95%CI [1.38-2.11]). No differences were observed between tacrolimus+mammalian target of rapamycin inhibitor (mTORi) and tacrolimus+MMF/MPA, but there was a tendency towards a higher risk of PTDM in the cyclosporin+mTORi group (RR 1.42, 95%CI [0.99-2.04]). Conversion from cyclosporin to an mTORi increased PTDM risk (RR 1.89, 95%CI [1.18-3.03]). De novo belatacept compared with a calcineurin inhibitor resulted in 50% lower risk of PTDM (RR 0.50, 95%CI [0.32-0.79]). Steroid avoidance resulted in 31% lower PTDM risk (RR 0.69, 95%CI [0.57-0.83]), whereas steroid withdrawal resulted in no differences. Immunosuppression should be decided on an individual basis, carefully weighing the risk of future PTDM and rejection. • Post-transplant diabetes mellitus (PTDM) is a frequent complication after kidney transplantation, with an incidence of 20-30%. • PTDM increases the risk of cardiovascular disease, one of the main causes of death with a functioning graft. • Immunosuppression therapy can accelerate pre-existing pancreatic beta cell damage, being a major risk factor for PTDM. • This is the largest meta-analysis evaluating the effect of the different immunosuppression strategies on PTDM in kidney transplant recipients. • Belatacept and steroid avoidance showed a reduction in PTDM incidence. • Immunosuppression should be decided on an individual basis, carefully weighing the risk of future PTDM and rejection. [ABSTRACT FROM AUTHOR]

Objectives: To determine the health status, exercise capacity, and health related quality of life (HRQoL) of COVID-19 associated acute respiratory distress syndrome (ARDS) survivors, 8 months after diagnosis.Methods: All eligible patients were interviewed and underwent a physical examination, chest X-ray, and 6 min walk test (6MWT). Scales to evaluate post-traumatic stress disorder, depression, anxiety, and HRQoL were applied.Results: Of 1295 patients, 365 suffered ARDS and 166 survived to hospital discharge. Five died after discharge and 48 were lost to follow-up. Of the 113 remaining patients, 81% had persistent symptoms. More than 50% of patients completed less than 80% of the theoretical distance on the 6MWT, 50% had an abnormal X-ray and 93% of patients developed psychiatric disorders. Mean SF-36 scores were worse than in the general population. After multivariate regression analysis, female sex, non-Caucasian race, and Charlson index>2 were independent risk factors for a worse mental health component summary score on the SF-36, and age was associated with a better prognosis. Female sex and chronic obstructive pulmonary disease were independently associated with a worse physical component summary score.Conclusion: COVID-19 associated ARDS survivors have long-term consequences in health status, exercise capacity, and HRQoL. Strategies addressed to prevent these sequelae are needed. [ABSTRACT FROM AUTHOR]

Study Objective: We performed a long-term follow-up to quantify the impairment of sexual quality of life (SQL) and health-related QL (HRQL) in sexually active women after laparoscopic excision of deep infiltrating endometriosis (DIE).Design: Prospective case-control study.Setting: Hospital Clinic of Barcelona.Patients: A total of 193 patients (after dropout and exclusions) were divided into 2 groups: one hundred twenty-nine premenopausal women with DIE (DIE group) and 64 healthy women who underwent tubal ligation (C group).Interventions: All patients underwent laparoscopic surgery: laparoscopic endometriosis surgery in the DIE group and laparoscopic tubal ligation in the C group. All women were followed for at least 36 months, and they completed the Medical Outcomes Study 36-item short form questionnaire to assess their HRQL and 3 self-administered questionnaires that evaluate different aspects of SQL: the generic Sexual Quality of Life-Female questionnaire, the Female Sexual Distress Scale to evaluate "sexually related distress," and the Brief Profile of Female Sexual Function to screen hypoactive sexual desire disorder. The patients with DIE as well as the controls completed the 4 questionnaires before surgery, and the patients with DIE also completed the questionnaires at 6 and 36 months after surgery.Measurements and Main Results: A comparison of the patients and controls before surgery showed a statistically significant impairment in SQL and HRQL among the patients with DIE. A statistically significant improvement in SQL and HRQL was observed in the DIE group 6 months after surgery, with scores being similar to those of the C group. An evaluation 36 months after surgery showed that SQL and HRQL were better than presurgical SQL and HRQL in the DIE group, with a slight reduction compared with the 6-month evaluation.Conclusion: SQL and HRQL improved in patients with DIE undergoing complete laparoscopic endometriosis resection and were comparable to those of healthy women at 6 months after surgery, showing a slight reduction at 36 months of follow-up. [ABSTRACT FROM AUTHOR]

The proto-Andean and Early Andean evolution of the southwestern Gondwana margin comprises three stages that differ in their magmatic evolution and deformational style: the Gondwana cycle (~330–280 Ma), the Pre-Andean stage (~280–210 Ma) and the Early Andean Cycle (210–100 Ma). These stages have been traditionally interpreted as the upper crustal response to changes in the tectonic setting which include: Cordilleran-style continental arc (Gondwana cycle), orogenic collapse and possibly slab break-off that led to continental rifting and extensive crustal melting (Pre-Andean stage), and subsequent subduction re-initiation in oceanic arc-style context (Early Andean cycle). The petrological and geochemical characteristics of Carboniferous to Jurassic igneous rocks from this region however do not support the described model. Elemental and Sr-Nd-Pb isotopic data of 86 samples, along with a compilation of ~1230 samples from the literature suggest that subduction was the most likely process by which the magmatic record was generated. Sub-alkaline affinities, LILE enrichment over HFSE, Nb Ta troughs, porphyritic textures and hornblende- and biotite-bearing lithologies are present in all studied units, whereas isotopes suggest that magma sources are a mixture of depleted mantle and variable contribution from the continental crust. Even though the aforementioned features are common to all igneous rocks, some changes point to a decline in the contribution of crustal/lithospheric sources to the magmatism with time. Thus, SiO 2 , La N /Yb N and 87Sr/86Sr initial exhibit a systematic decrease from ~285 to 150 Ma, whereas the εNd initial parameter increases in the same period. These changes were accompanied by the shift from dominant compressional (Carboniferous-Early Permian) to transtentional (Middle Permian-Jurassic) stresses in the upper crust, suggesting that the margin went from advancing to retreating due to Pangea reorganization and break-up. Following a potential flat slab event, slab roll-back may have induced extension in the upper crust and lithospheric loss as a consequence of delamination or thermal erosion. Unlabelled Image • Elemental and isotopic data from 86 Andean rocks (Carboniferous to Jurassic) are contrasted to a database of 1237 samples. • Geochemistry of the samples suggests that Carboniferous to Jurassic magmatism in the Andean region is subduction-related. • Crustal thinning and increase of mantle contribution to magmas are explained by lithospheric delamination/thermal erosion. [ABSTRACT FROM AUTHOR]

Copyright of European Review of Applied Psychology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Graphical abstract Sixteen compounds from endemic plants of Peru were isolated and characterized. Their insecticidal and antifungal activities were tested. Highlights • Sixteen compounds were obtained from Senecio subcandidus. • Their structures were elucidated by extensive 1D and 2D NMR spectra. • The molecular structure of 5 and 7 were confirmed by X-ray diffraction. • Their insecticidal and antifungal activities were tested. Abstract Sixteen compounds incluiding four benzofurans (1–4) , three benzoic acid derivatives (6–8), one eremophilane (9), four diterpenes (10–13) and four pyrrolizidine alkaloids (14–17) were isolated from Senecio subcandidus, S. klugii and S. ayapatensis from Perú. Compounds 1–4 and 6–9 have not been previously reported as natural products. Their molecular structures were determined by NMR spectroscopic analysis, comparison with published NMR data and chemical transformations. The X-ray analysis of acetylated derivative 5 and compound 7 were also performed. Their insecticidal and antifungal activities were tested. [ABSTRACT FROM AUTHOR]

Abstract Objective The objective of this study was to examine the intra- and intertester reliability, concurrent criterion-related validity, and responsiveness to treatment of the "figure-of-four" position. Methods A total of 52 asymptomatic male soccer players participated in this study. The intraclass correlation coefficient (2, 1) was used to determine intra- and intertester reliability of the figure-of-four position. Pearson product moment correlation coefficients examining the association between the figure-of-four position and goniometric measurements of hip extension and external rotation were used to establish concurrent validity. To evaluate responsiveness to treatment, the figure-of-four position was assessed by a blinded examiner before and immediately after the application of a stretching technique or control intervention. Results Excellent reliability (intraclass correlation coefficient > 0.75) was obtained for both intra- and intertester reliability of the figure-of-four position. Overall, the figure-of-four position and goniometric measurements of both hip extension and external rotation were significantly correlated. However, no significant treatment effects were observed for the figure-of-four position. Conclusion The results of this study demonstrated that the figure-of-four position is a reliable and valid way to obtain information on tightness of anterior hip joint structures in male soccer players. However, responsiveness to treatment of the figure-of-four position should be questioned. [ABSTRACT FROM AUTHOR]

The objective of this study was the characterization of nematicidal activity and valorization of hydrolate obtained as a byproduct of the semi industrial vapor-pressure essential oil extraction of a domesticated Artemisia absinthium population (Teruel, Spain), in comparison with a population (Sierra Nevada, Spain) undergoing the domestication process. Hydrolates from three crops of these two populations showed strong in vitro nematicidal effects against the root knot nematode Meloidogyne javanica and similar chemical profiles. The hydrolate of the A. absinthium population from Teruel strongly suppressed nematode egg hatching (>95%) after 5 days of incubation. In vivo tests on tomato seedlings showed a significant reduction in the of root penetration rate of M. javanica J2 treated with a hydrolate sublethal concentration (33%). In pot experiments, the hydrolate of A. absinthium tested on tomato plants significantly affected the nematode population, the infection frequency and the reproduction rate. The extraction of the organic fraction of the hydrolate gave a nematicidal extract and an inactive aqueous residue. The chemical profile of the active organic extract showed the presence of ( 5Z )-2,6-dimethylocta-5,7-diene-2,3-diol, previously described in the hydrodistilled essential oil of this A. absinthium population, among other compounds. This study demonstrates that the organic fraction of the A. absinthium hydrolate is a potential root-nematode control agent. Therefore, the hydrolate byproduct of the semi industrial vapor-pressure essential oil extraction could be a source of new nematicidal products. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate a range of selected physical measures for their relative contributions and extent to which they may explain the performance of the Timed "Up and Go" test (TUG) in a sample of healthy older adults. The participants where 194 adults aged 65 and older with no cognitive impairment and independent in their daily activities from local senior centres and a geriatric nursing home in Valencia, Spain. Age, body mass index (BMI), TUG, Berg balance scale (BBS), One-leg stand test (OLS). grip strength, chair stand test (STS-5), knee extension strength and rectus femoris cross-sectional area (CSA) where measured. Moderate to high significant associations were found between the TUG performance and BBS and knee extension strength (r = -.561 and -.397). A step-wise multiple regression analysis showed that the BBS was a significant and independent predictor (AdjR² = .373) for the TUG performance. The TUG is highly correlated with the BBS score and knee extension strength, measures that represent common performance tasks in everyday life. The BBS was demonstrated to be the most significant factor explaining the TUG performance. The TUG is demonstrated to be a useful tool for predicting changes in functional balance measured with the BBS. The mobility decline may be better explained as the sum of deficits across multiple domains rather than as a single entity. Clinicians would benefit of those findings by a better understanding of the physical measures, in addition to designing more accurate interventions focusing on the enhancement of mobility. [ABSTRACT FROM AUTHOR]

Risk of sudden cardiac death (SCD) increases with age, and several studies have examined the impact of different drugs on cardiovascular function. However, few studies have integrated epidemiological drug consumption data and genetic background in the context of cardiac death. We performed a retrospective population-based study in forensic sudden death cases from a 9-year period in Catalonia. The young cohort included 924 cases 18–50 years old, 566 of which had a cardiac cause of death. Complete autopsy, toxicological, and histopathological studies were performed. Molecular autopsy using next-generation sequencing was performed in nearly 400 cardiac cases. Cases related with fatal acute intoxication were excluded. Drug consumption prevalence was similar between forensic cases of cardiac and non-cardiac origin (62.5% versus 69.5%), with the exception of alcohol, which was more prevalent in the cardiac group than in the non-cardiac group (23.3% versus 17.1%). Individuals in the toxicology-positive group were carriers of more rare genetic variants and were significantly younger than the toxicology-negative group. Psychopharmacological drugs were identified in 22.3% of cardiac cases, and molecular autopsy identified an association between antiepileptic drugs or caffeine and pathogenic or likely pathogenic variants in arrhythmogenic genes. Specific substances could therefore play an essential role as triggers of SCD in genetically predisposed young people. • Post mortem cases with positive toxicological findings were carriers of more rare genetic variants and were significantly younger than negative. • Psychopharmacological drugs were identified in 22.3% of cases of sudden cardiac death. • Molecular autopsy identified an association between antiepileptic drugs or caffeine and pathogenic or likely pathogenic variants in arrhythmogenic genes. • Specific substances could play an essential role as triggers of SCD in genetically predisposed young people. [ABSTRACT FROM AUTHOR]

Unexpected cardiac deaths are a current challenge to healthcare systems. In adults, coronary artery disease and acquired cardiomyopathies are the most frequent causes of sudden cardiac death while in younger than 35 years old, the main cause is represented by non-ischemic diseases, usually inherited. Nowadays, around 10%−15% of unexpected deaths remain without a definite cause of decease after a complete autopsy, then classified as deaths potentially due to an inherited arrhythmia. Discrete abnormalities in some of the heart measures have been considered as potential predictors or risk factors for sudden cardiac death. However, role of non-benign genetic variants in these scattered heart alterations remains to be clarified, especially if variants are classified of ambiguous role. Clinicians usually only take into consideration pathogenic variants for decision-making. It is yet unclear what the role of VUS genetic variants in modifying the anatomical parameters of the heart. We hypothesize that some heart measures might be influenced by polygenic components as some variants may individually confer minor risk but may actually produce additive effects when combined with others. Our aim was to investigate whether carrying non-benign rare variants in genes related to inherited arrhythmias may contribute to scattered cardiac alterations in anatomical normal hearts. The study is composed by 761 samples collected from autopsies of SD suffered by adults from 18 to 50 years of age who occurred in Catalonia (Spain) in a 9-year period. Complete medico-legal autopsy was performed to determine the cause of death. Molecular autopsy was performed as part of our forensic protocol, including genes associated with inherited diseases.To evaluate the effect of genetic rare variants into hearts measures we performed a linear regression model and data were presented as regression. This study showed, for the first time, that rare variants, regardless of significance (pathogenic, probably pathogenic or uncertain significance), may contribute to interventricular septum width in the structurally normal heart. While the cohort is based on sudden death cases, further studies and case-control studies will be necessary to conclude that the genetic determinants of septal thickness contributes to sudden cardiac death. We conclude that non-benign rare variants contribute to modify scattered septum width in structural normal hearts, being a potential risk factor of arrhythmia in genetic harbors. These evidence support the current recommendation in forensic protocols of including histologic analysis of septum when inherited arrhythmogenic disease is suspicious cause of decease. [Display omitted] • 60% of sudden cardiac death (SCD) cases with structurally normal hearts carry non-benign rare variants in SCD related genes. • Non-benign rare variants in genes encoding structural myocyte proteins contribute to a significant thickened septum. • Septum thickness increase is correlated with a tendency of an increase in total heart weight. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of this study was to assess the effects of a low-load training program for the deep cervical flexors (DCFs) on pain, disability, and pressure pain threshold (PPT) over cervical myofascial trigger points (MTrPs) in patients with chronic neck pain. Methods: Thirty patients with chronic idiopathic neck pain participated in a 6-week program of specific training for the DCF, which consisted of active craniocervical flexion performed twice per day (10-20 minutes) for the duration of the trial. Perceived pain and disability (Neck Disability Index, 0-50) and PPT over MTrPs of the upper trapezius, levator scapulae, and splenius capitis muscles were measured at the beginning and end of the training period. Results: After completion of training, there was a significant reduction in Neck Disability Index values (before, 18.2 ± 12.1; after, 13.5 ± 10.6; P < .01). However, no significant changes in PPT were observed over the MTrPs. Conclusion: Patients performing DCF training for 6 weeks demonstrated reductions in pain and disability but did not show changes in pressure pain sensitivity over MTrPs in the splenius capitis, levator scapulae, or upper trapezius muscles. [Copyright &y& Elsevier]

Purpose: The present study was undertaken to evaluate mucoceles in the oral cavity of pediatric patients, including the clinical characteristics, treatment, and progress of the lesions. Patients and Methods: A retrospective study was performed from the medical records of patients (0-14 years old) treated for oral mucoceles between 1998 and 2008 in a reference children''s hospital. All subjects with mucoceles on lips, mouth, buccal mucosa, and palate were included. The following data were recorded: age, gender, history of trauma, location, size, progression, time before diagnosis, treatment, histologic type, follow-up time, and recurrence. Results: A total of 89 patients (mean age, 6.1 years) participated in this study. There were 89 mucoceles: 4 were congenital; 79.8% were located on the lower lip; and 69% were larger than 5 mm in diameter. Average progression time was 5.7 months (range, 1-24 months). It was observed that older patients developed more mucoceles on the tongue and lips and younger patients developed more mucoceles on the buccal mucosa and palate. The lesions of 39 subjects resolved spontaneously; 50 were removed but 4 reappeared afterward. Histologically, all lesions were extravasation mucoceles. Conclusion: Mucoceles were more commonly located on the lower lip; 43.8% resolved spontaneously and 8% of the surgically removed mucoceles reappeared. [Copyright &y& Elsevier]

Summary: Objective: To address the minimum duration of pulmonary rehabilitation necessary for patients with chronic obstructive pulmonary disease (COPD) to achieve a plateau in Health-Related Quality of Life (HRQL) and exercise tolerance. Methods: COPD patients with a dyspnea rating of at least 2 on the Medical Research Council scale participated in an outpatient rehabilitation program of 3 weekly sessions for 12 weeks. Measurements included HRQL and exercise tolerance 2 weeks before the program started and every 2 weeks thereafter. Patients were considered to have reached a plateau if they showed no improvement beyond 20% of the minimal important difference between 2 consecutive evaluations on HRQL score or walk tests. Results: Twenty-eight patients participated. The number of patients achieving stability after 8 weeks, showing continued improvement after 8 weeks, and demonstrating an erratic pattern of change was as follows: for physical function 16 (56%), 10 (37%) and 2 (7%) patients; for emotional function 22 (79%), 5 (18%) and 1 (4%); and for 6-min walk test 21 (75%), 5 (18%) and 2 (7%). More severe patients demonstrated a greater likelihood (76%) of achieving stability in physical function at 12 weeks than did less severe patients (27%; p on difference=0.003). The likelihood of stability at 12 weeks in emotional function and the 6-min walk test did not differ by severity. Conclusions: A program of 3 weekly 3-h sessions of outpatient pulmonary rehabilitation program should last at least 8 weeks in order to achieve optimal HRQL and exercise tolerance for most patients. [Copyright &y& Elsevier]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose Ion channels are expressed both in the heart and in the brain, being advocated as responsible for sudden unexpected death in epilepsy but few pathogenic mutations have been identified. We aim to identify a novel gen associated with channelopathies and epilepsy in a family. Methods We assessed a family showing epilepsy concomitant with LQTS. Index case showed prolonged QT interval. His father suffers of LQT and epilepsy. We performed a direct sequencing analysis of KCNQ1 , KCNH2 , KCNE1 , KCNE2 and SCN5A genes. Results We identified a non-synonymous heterozygous missense pathogenic mutation (p.L273F) in exon 6 of the KCNQ1 gene. All clinically affected relatives carried the same mutation. Conclusion We report, for a first time, a KCNQ1 mutation in a family suffering of both phenotypes, suggesting that KCNQ1 genetic variations may confer susceptibility for recurrent seizure activity increasing the risk or lead to sudden death. [ABSTRACT FROM AUTHOR]

Simulations are the first approach to test ITS applications due to the difficulties involved in deploying real test scenarios. In addition to the use of detailed network simulators, realistic vehicular movements are key to guarantee reliable results. SUMO is one of the tools most used to generate synthetic traces of vehicles for this objective. In this paper, a qualitative review of the five traffic demand generation tools of SUMO: DUArouter, JTRrouter, DFrouter, OD2trips, and MArouter, is presented. We include the advantages and limitations of each of these tools to simulate vehicles' mobility in real scenarios. Moreover, we compare the vehicular traces obtained with these tools using real input data and a carefully debugged map of the financial district of Quito by using well-known graph metrics for network analysis. We found that despite that the tools used the same input, the value of some metrics of the ad-hoc communication network can differ up to one magnitude order. [ABSTRACT FROM AUTHOR]

• Copy Number Variants cause arrhythmogenic diseases leading to sudden cardiac death. • Copy Number Variants explain up to 13% of arrhythmogenic cases. • Genetic interpretation of Copy Number Variants is the main current challenge. • Clinical translation of Copy Number Variants should be done with caution. Over the last ten years, analysis of copy number variants has increasingly been applied to the study of arrhythmogenic pathologies associated with sudden death, mainly due to significant advances in the field of massive genetic sequencing. Nevertheless, few published reports have focused on the prevalence of copy number variants associated with sudden cardiac death. As a result, the frequency of these genetic alterations in arrhythmogenic diseases as well as their genetic interpretation and clinical translation has not been established. This review summarizes the current available data concerning copy number variants in sudden cardiac death-related diseases. [ABSTRACT FROM AUTHOR]

Abstract: A 58-year-old man presented to the hospital with fever and headache after amoxicillin intake. Physical examination, laboratory, and a cranial CT scan were unremarkable. Cerebrospinal fluid (CSF) testing revealed lymphocytic pleocytosis. After discontinuation of amoxicillin and symptomatic care, the patient quickly improved. Interestingly, he had had two prior episodes of aseptic meningitis that were probably also related to the administration of amoxicillin. Aseptic meningitis can be caused by multiple non-infectious conditions including drugs, malignancy, and autoimmune diseases. We report a case associated with amoxicillin that meets the criteria of drug-induced aseptic meningitis. Considering the wide utilization of amoxicillin, healthcare providers should be aware of it as a possible cause of drug-induced aseptic meningitis. [Copyright &y& Elsevier]

Background & Aims Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin increases the risk of upper gastrointestinal bleeding (UGIB). Guidelines suggest avoiding certain drug combinations, yet little is known about the magnitude of their interactions. We estimated the risk of UGIB during concomitant use of nonselective (ns)NSAIDs, cyclooxygenase -2 selective inhibitors (COX-2 inhibitors), and low-dose aspirin with other drugs. Methods We performed a case series analysis of data from 114,835 patients with UGIB (930,888 person-years of follow-up) identified from 7 population-based health care databases (approximately 20 million subjects). Each patient served as his or her own control. Drug exposure was determined based on prescriptions of nsNSAIDs, COX-2 inhibitors, or low-dose aspirin, alone and in combination with other drugs that affect the risk of UGIB. We measured relative risk (incidence rate ratio [IRR] during drug exposure vs nonexposure) and excess risk due to concomitant drug exposure (relative excess risk due to interaction [RERI]). Results Monotherapy with nsNSAIDs increased the risk of diagnosis of UGIB (IRR, 4.3) to a greater extent than monotherapy with COX-2 inhibitors (IRR, 2.9) or low-dose aspirin (IRR, 3.1). Combination therapy generally increased the risk of UGIB; concomitant nsNSAID and corticosteroid therapies increased the IRR to the greatest extent (12.8) and also produced the greatest excess risk (RERI, 5.5). Concomitant use of nsNSAIDs and aldosterone antagonists produced an IRR for UGIB of 11.0 (RERI, 4.5). Excess risk from concomitant use of nsNSAIDs with selective serotonin reuptake inhibitors (SSRIs) was 1.6, whereas that from use of COX-2 inhibitors with SSRIs was 1.9 and that for use of low-dose aspirin with SSRIs was 0.5. Excess risk of concomitant use of nsNSAIDs with anticoagulants was 2.4, of COX-2 inhibitors with anticoagulants was 0.1, and of low-dose aspirin with anticoagulants was 1.9. Conclusions Based on a case series analysis, concomitant use of nsNSAIDs, COX-2 inhibitors, or low-dose aspirin with SSRIs significantly increases the risk of UGIB. Concomitant use of nsNSAIDs or low-dose aspirin, but not COX-2 inhibitors, with corticosteroids, aldosterone antagonists, or anticoagulants produces significant excess risk of UGIB. [ABSTRACT FROM AUTHOR]

Background: Cerebral vasoreactivity in obstructive sleep apnea syndrome is altered. Continuous positive airway pressure is effective in the reduction of the occurrence of apneas. We studied whether this treatment also improves cerebral vasoreactivity. Methods: The breath-holding maneuver was performed and assessed by apnea test with transcranial Doppler in the basilar artery. After 2 years of continuous positive airway pressure treatment, the test was repeated. Results: There is an improvement in the apnea test after continuous positive airway pressure. There are increases in the pulsatility index, diastolic blood pressure, and basal heart rate. The improvement in the apnea test depends on the body mass index of the patient. Conclusions: Cerebral vasoreactivity as measured by the apnea test improves after 2 years of continuous positive airway pressure. This improvement depends of the body mass index of the patient. [Copyright &y& Elsevier]