bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the Feasibility and Acceptability of the Lifestyle Enhancement for ADHD Program
Authors: Ola Cindy , Gonzalez Erin , Tran Nguyen , Sasser Tyler , Kuhn Michelle , LaCount Patrick A , Stein Mark A , Mendoza Jason A , Tandon Pooja S 
Published: March 2021

Abstract

Objective
To evaluate the feasibility and acceptability of the Lifestyle Enhancement for Attention Deficit Hyperactivity Disorder (ADHD) Program (LEAP), a novel parent behavior management training program that promotes physical activity (PA) and positive health behaviors and is enhanced with mobile health technology (Garmin) and a social media (Facebook) curriculum for parents of children with ADHD.

Methods
The study included parents of children ages 5–10 years diagnosed with ADHD who did not engage in the recommended &gt;60 min/day of moderate to vigorous PA based on parent report at baseline. Parents participated in the 8-week LEAP group and joined a private Facebook group. Children and one parent wore wrist-worn Garmin activity trackers daily. Parents completed the Treatment Adherence Inventory, Client Satisfaction Questionnaire, and participated in a structured focus group about their experiences with various aspects of the program.

Results
Of 31 children enrolled, 51.5% had ADHD combined presentation, 36.3% with ADHD, predominately inattentive presentation, and 12.1% had unspecified ADHD (age 5–10; M = 7.6; 48.4% female). Parents attended an average of 86% of group sessions. On average, parents wore their Garmins for 5.1 days/week (average step count 7,092 steps/day) and children for 6.0 days/week (average step count 9,823 steps/day). Overall, parents and children were adherent to intervention components and acceptability of the program was high.

Conclusions
Findings indicate that the LEAP program is an acceptable and feasible intervention model for promoting PA among parents and their children with ADHD. Implications for improving ADHD symptoms and enhancing evidence-based parent training programs are discussed.
#9: Frequency and Antimicrobial Susceptibility of Gram-Negative Organisms Causing Bloodstream Infections in Pediatric Patients from United States (US) Medical Centers (2014–2018)
Authors: Sader H S , Castanheira M , Streit J M , Carvalhaes C G , Mendes R E 
Published: March 2021

Abstract

Background
Ceftazidime–avibactam is US FDA approved for the treatment of pneumonia and complicated intra-abdominal and urinary tract infections in adults, and it is in late-stage clinical development for the treatment of pediatric patients.

Methods
Organisms were consecutively collected from pediatric patients (≤17 years old) with bloodstream infections in 33 US medical centers in 2014–2018. Enterobacterales, P. aeruginosa, and H. influenzae isolates (n = 976) were susceptibility (S) tested against ceftazidime–avibactam and comparators by reference broth microdilution methods; 42.9% of isolates tested were from patients &lt;1 year old, and 70.7% from patients ≤5 years old. Isolates with an ESBL–phenotype were screened for β-lactamase genes.

Results
Overall, 40.1% of organisms were Gram-negative bacteria (GNB), 57.0% Gram-positives, and 2.8% Candida spp. The five most common GNB were E. coli (32.4% of GNB), K. pneumoniae (17.3%), E. cloacae (9.8%), P. aeruginosa (9.2%), and S. marcescens (5.5%; Table). Enterobacterales, P. aeruginosa, and H. influenzae isolates combined represented 89% of GNB and all isolates (100.0%) were susceptible to ceftazidime–avibactam. Among Enterobacterales (n = 845; MIC50/90, 0.12/0.25 mg/L), the highest ceftazidime–avibactam MIC value was only 4 mg/L and 99.2% of isolates were inhibited at ≤1 mg/L. Enterobacterales susceptibility to ceftriaxone, piperacillin–tazobactam, ceftolozane–tazobactam, and meropenem were 88.2%, 93.1%, 97.5%, and 99.5%, respectively. Forty-four Enterobacterales isolates (5.2%) produced an ESBL, including CTX-M-type (n = 35 [79.5% of ESBL producers], 21 being CTX-M-15), SHV-type (12; 27.3%), and OXA-1/30 (9; 20.5%). Twelve isolates (27.3%) produced &gt;1 ESBL. No carbapenemase gene was detected. Among ESBL producers, highest ceftazidime–avibactam MIC was 2 mg/L, and susceptibility rates for ceftolozane–tazobactam and meropenem were 92.9% and 100.0%, respectively. Ceftazidime–avibactam exhibited complete activity against P. aeruginosa (MIC50/90, 2/4 mg/L; 100.0% susceptible). P. aeruginosa susceptibility rates for meropenem, piperacillin–tazobactam, and ceftolozane–tazobactam were 82.5%, 85.6%, and 100.0%, respectively; and 10.3% of isolates exhibited multidrug-resistance phenotype (not susceptible to ≥3 classes). Ceftazidime–avibactam was highly active against H. influenzae (n = 34; MIC50/90, ≤0.015/0.03 mg/L; highest MIC, 0.06 m/L).

Conclusions
Ceftazidime–avibactam exhibited potent activity against a large collection of GNB isolated from pediatric patients with bacteremia and showed complete coverage (100.0% susceptibility) against P. aeruginosa, Enterobacterales, and H. influenzae.
#39: Streptococcus anginosus Group Infections in Children: A Retrospective Cohort Study, 2015–2019
Authors: Amin O , Smith O , Berkowitz F , Lyon T , Kao C , Shane A , Yildirim Ia , Gonzalez M 
Published: March 2021

Abstract

Background
Infections attributed to the Streptococcus anginosus group (SAG), which includes Streptococcus anginosus, Streptococcus constellatus, and Streptococcus intermedius, have varying clinical presentations. SAG infections are difficult to identify initially, and members of the group may require different management strategies.

Methods
A retrospective review of SAG-positive cultures from January 2015, to September 2019, was conducted to describe the demographic, clinical, and laboratory features including the site of infection, antibiotic susceptibility, management, and clinical outcome.

Results
We identified 561 patients [median age 11.3, interquartile range (IQR) 7.1–14.9 years, male:female ratio 3:2, non-Hispanic–non-Latino 454 (81%), White 279 (49%)]. Thirty-nine (7%) had at least one underlying condition. Of these, inflammatory bowel disease 15 (39%), diabetes 7 (18%), immunodeficiency 5 (13%). SAG was found in exudate, fluid, or aspirate (537/561, 96%), blood (11/561, 2%), and tissue (11/561, 2%) samples; 388 (69%) were polymicrobial infections. The most common site of infection was intra-abdominal (175, 31%), followed by neck/odontogenic (114. 20%) and genitourinary tract (66, 12%). The median length of stay was 6 days (IQR 3–10 days) and was statistically significantly longer for patients with blood, central nervous system, and pulmonary infections compared with soft tissue and upper respiratory tract infections (P &lt; 0.001). Beta-lactams were the most commonly used antibiotics (38%), followed by clindamycin (30 %) (see Figure for antibiotic susceptibility results) and 33 (56%) patients received combination therapy. We did not observe any SAG attributed to mortality.

Conclusions
In our retrospective cohort, SAG infections were more commonly identified in males, were associated with abscess formation, and presented as polymicrobial infections. Children with underlying comorbidities are more likely to present with systemic SAG infections. SAG-associated infections can be variable in presentation site and severity and should be considered as pathogens when managing patients.
#82: Osteomyelitis with Panton-Valentine Leukocidin Producing Staphylococcus aureus Strains, Experience in a Tertiary Pediatric Hospital in Mexico City
Authors: Aguilar Nancy , Aquino Alejandra , Vázquez Guillermo , Mérida Jocelin , Isunza-Alonso Oscar , Tamez Oscar , de Colsa Agustín 
Published: March 2021

Abstract

Background
S. aureus is the most common cause of osteomyelitis in children. Panton-Valentine leucocidin (PVL) is an exotoxin produced by certain S. aureus strains, which can be detected in both methicillin-sensitive and -resistant strains of staphylococci. Pediatric osteomyelitis by PVL producing S. aureus constitute a rare, but highly critical event. They are characterized by a rapid course of marked inflammation, worsening under conservative therapy, and a high rate of recurrence. No information is available on osteomyelitis and Panton-Valentine leukocidin producing S. aureus in Mexico.

Objective
The aim of this study was to determine the molecular characterization of S. aureus strains isolated in pediatric patients with osteomyelitis and their clinical features in a tertiary hospital in Mexico City.

Methods
We conducted a prospective study of children admitted for osteomyelitis, between December 2018 and November 2019, at Instituto Nacional de Pediatría. We obtained an informed consent in children under 12 years of age and an informed assent in children over 12. The confirmation of the S. aureus isolates was performed by amplification and analysis of 16S rRNA and nuc genes. The mecA and pvl genes were detected by PCR, the clinical features were obtained at the admission.

Results
Fifty patients were included and 26 cases of osteomyelitis were diagnosed, 13 were due to staphylococcus aureus genus and 6 due to S. aureus; all of them were methicillin susceptible and two were PVL producers. Both patients had a severe initial presentation, with extensive local abscesses, and one required three surgical procedures and developed septic pulmonary embolism. The two patients received double antimicrobial treatment and required a long therapy interval.

Conclusions
Osteomyelitis with Panton-Valentine Leukocidin producing S. aureus seems to be more severe. In patients with severe osteomyelitis, it is essential to detect the PVL toxin because they require early surgical intervention and prolonged intravenous therapy. Our findings suggest that the severity of the osteomyelitis is linked with PVL production more than with methicillin resistance due to that all our isolates were methicillin susceptible.
#99: Streptococcus pyogenes Utilizes the Peptide-Based Rgg 2/3 Quorum Sensing System During Oropharyngeal Colonization
Authors: Gogos Artemis , Federle Michael J 
Published: March 2021

Abstract

Background
Streptococcus pyogenes is a human-restricted pathogen most often found in the human nasopharynx. Multiple bacterial factors have been found to contribute to persistent colonization of this niche, and many of these factors are important in mucosal immunity and vaccine development. In this work, we infected mice intranasally with transcriptional regulator mutants of the Rgg2/3 quorum sensing (QS) system—a peptide-based signaling system conserved in all sequenced isolates of S. pyogenes.

Methods
Three-week-old CD1 mice were intranasally infected with ~107 CFU of S. pyogenes strain MGAS315. Calcium alginate throat swabs were used to monitor nasopharyngeal colonization by the bacteria over time. Luciferase reporters used alongside an IVIS camera were able to show quorum sensing activity levels after inoculation into the mouse nose. Bacterial RNA was isolated from the throat of the mice and quantitative RT–PCR was performed on the samples to corroborate the luciferase reporter data. The nasal-associated lymphoid tissue (NALT) was excised and its supernatants were subjected to 32-plex murine cytokine and chemokine analysis (Millipore).

Results
Deletion of the QS system’s transcriptional activator (Δrgg2) dramatically diminished the percentage of colonized mice. Deletion of the transcriptional repressor (Δrgg3) increased the percentage of colonized mice compared with wild type. Stimulation of the QS system using synthetic pheromones prior to inoculation did not significantly increase the percentage of animals colonized, indicating that activity of the QS system is responsive to conditions of the host nasopharynx. Mice inoculated with QS-dependent luciferase reporters were subjected to in vivo imaging and showed activation within 1 hour. Bacterial RNA extracted directly from oropharyngeal swabs and evaluated by quantitative RT–PCR subsequently confirmed QS upregulation within 1 hour of inoculation. In the nasal-associated lymphoid tissue (NALT), a muted inflammatory response to the Δrgg2 bacteria suggests that their rapid elimination fails to elicit the previously characterized response to intranasal inoculation of GAS.

Conclusions
Deletion of the Rgg2 transcriptional activator of the Rgg 2/3 quorum sensing system eliminates colonization of the murine nasopharynx and changes the transcriptional profile of the bacteria in this niche. An existing small-molecule inhibitor of the Rgg2/3 system was unable to inhibit QS activation in vivo, likely due to the suboptimal achievable doses; however, results of our study indicate inhibition of QS may diminish the oropharyngeal colonization of S. pyogenes and argue for further development.
#84: Evolutionary Pressure from APOBEC Causes an Underrepresentation of TC Motifs in Human Polyomavirus
Authors: Shapiro Kate , Shapiro Maxwell , MacCarthy Thomas 
Published: March 2021

Abstract

Background
Apolipoprotein B mRNA editing enzyme, catalytic polypeptide-like (APOBEC) is a family of enzymes found in mammals that deaminate cytidine to uridine on ssDNA, facilitating a C-to-T mutation. Less commonly, APOBEC effectively mutates C-to-G as well. APOBEC has the potential to mutate the viral genome, rendering the virus nonproductive. The enzyme targets certain mutational motifs, also known as hotspots: most APOBECs deaminate at TC motifs. We hypothesize that human polyomaviruses (hPyV) have an under-representation of TC hotspots in their genomes to avoid APOBEC targeting. Specifically, we analyzed the degree of TC motif under-representation in five conserved genes of hPyV, each of which is expressed in either the early or late phase of the viral life cycle.

Methods
We utilized a statistical tool, the Cytidine Deaminase Under-representation Reporter (CDUR) that can be used to analyze sequences and determine whether these sequences have mutated under the evolutionary pressure of APOBEC based on the targeted hotspot. This tool uses a permutation test to determine whether the number of hotspots at a given coding sequence is significantly more or significantly less than expected under pseudo-random biological sequence evolution. The same analysis was used to determine whether the number of nonsynonymous mutations that might occur at those hotspots is significantly more or significantly less than expected by chance.

Results
TC motifs in early genes were more underrepresented compared with late genes in most hPyV species. Most early genes were susceptible to nonsynonymous mutations at the TC motifs. Those species which did not fit into this paradigm showed a similar degree of under-representation and susceptibility to nonsynonymous mutations at AC motifs. We also find a large over-representation of TG hotspots, but not TT hotspots.

Conclusions
hPyV may have evolved a reduced number of hotspots to subvert APOBEC and evade host immune defenses. Under-representation of TC motifs is more prevalent in early genes. Early genes include the small T and large T antigens, essential for viral proliferation. In addition, the large T antigen was particularly susceptible to mutation at TC motifs. This underscores the evolutionary pressure imposed on hPyV by APOBEC to evade host immunity. It is possible that the over-representation of TG motifs in hPyV is due to specific host DNA-repair mechanisms, but this requires further investigation.
#10: Fever and neutropenia. 10 years surveillance in a pediatric Mexican hospital
Authors: Sánchez-Medina E , Reyes-Hernández A , Severiano-Tellez A 
Published: March 2021

Abstract

Background
Fever and neutropenia, is a very common complication of chemotherapy in the treatment of cancer. It could happen in 10–50% of patients with solid tumors and more than 80% of patients with blood cancer. During leukemia treatment is very important first defense mechanisms integrity, such as skin, mucous membranes, Tlaxcala Children’s Hospital is a pediatric general hospital, located in the center of Mexico and is where the pediatric cancer patients are treated, with almost 30 new cases by year, treatment with chemotherapy and as an adverse event fever and neutropenia, which increases morbidity and mortality

Methods
We conducted an observational, descriptive, and analytic study aiming to identify fever and neutropenic events in ALL patients, their epidemiologic characteristics, antibiotic use, isolation and antibiogram, and outcome.

Results
We reviewed 124 files from ALL patients between 2007–2017, we found 204 cases, 70 (33.8%) at induction, 18.6% consolidation, reinduction 17.6%, maintenance 14.2%. Out of 204 cases, we documented 177 with fever and neutropenia, 15 events of septic shock and 12 with fever and neutropenia with an identifiable source; the first-line antibiotic for fever and neutropenia was ceftazidime/amikacin, and for septic shock cefepime with an aminoglycoside, we found 3.39%, 20%, and 0% deaths from each group. Patients with fever and neutropenia with or without identifiable source had a length-stay average of 9.8 days compared with 30 days in patients with septic shock, CRP average was 12.47 mg/dL in the patients who survived and 8.23 mg/dL in those who did not. We found a very low positivity in cultures, and in most cases, those cultures did not meet criteria for diagnosis, the most common bacteria identified were E. coli, P. aeruginosa.

Conclusions
This is the first approach to get a better knowledge about infectious complications in patients with ALL, these findings could lead to identifying opportunities to improve diagnosis and treatment which lead to reducing cost, morbidity, healthcare-associated infections.
#68: Outcomes of Establishing Infection Care and Prevention Standards in Pediatric Oncology Units in Three Hospitals on the Island of Hispaniola
Authors: Caniza M , Contreras J , Santana G , Mentor G , Gassant P , Gautier J , Homsi M , Happ B , Garcia W , Gomez W , Rodriguez-Galindo C 
Published: March 2021

Abstract

Background
Survival of children with cancer goes hand-on-hand with cancer treatment and improvement of infection care and prevention (ICP). The Hispaniola Island project aims to improve the quality of care and survival for children with cancer in 3 pediatric cancer units by implementing ICP programs in these units with the long-term plan of absorbing such programs into the structure of the hospital care delivery process. We report the 1-year outcomes of establishing ICP standards in pediatric oncology units.

Methods
We followed the general steps for health promotion when engaging with the new sites, which are: (1) planning the process; (2) conducting a situational assessment; (3) identifying objectives; (4) identifying strategies; (5) developing indicators; and (6) tracking progress.

Results
The planning process included discussions with local leadership, timeline plans for ICP interventions, data gathering, and decision-making. Three healthcare providers were identified and trained through the St. Jude Global educational programs as local ICP champions and institutional contacts. Through site visits and focus group discussions, each unit developed a team consisting of the local ICP champion and an infection preventionist to lead the local unit ICP improvement. Situational analysis revealed no surveillance in infections, suboptimal practices hand hygiene, central-line management, and mechanical ventilation. To guide improvement, the local ICP team begun collecting surveillance of ICP indicators, such as infection rates, with monthly reporting to and mentoring by the St. Jude team. Since February 2019, the 3 sites ICP teams prospectively captured 17,532 patient-days (median: 365 patient-days per month; range: 209–573), 384 central-line days (median: 15 central-line days per month; range: 0–33), identified 278 healthcare-associated infections in 159 patients; monitored hand hygiene through direct (observations) and indirect (alcohol gel consumption) methodologies and provided monthly education sessions in ICP to hospital staff, patients and their families. Early results demonstrate the utility of a dedicated ICP team using a standardized ICP reporting system to guide focused improvement of care delivery.

Conclusions
Improving ICP standards is essential for any intervention which aims to improve the survival of children with cancer. A step-wise procedure in building local teams, engaging hospital leaders, evaluating on-site resources, and introducing methods to collect infection rates and other quality indicators for healthcare delivery will provide evidence-based guidance to improve the safety of cancer care delivery. We hope that the improvement could be sustained in the longer run by incorporating the created structure and processes to the hospital system.
#29: Clinical Evaluation of Pediatric Patients with Respiratory Symptoms with Confirmed and Negative Influenza in a Third-level Pediatric Center in Mexico City
Authors: Tarrasa Giancarlo Hernán Cristerna , Mendoza Martha Ramiro , Mendoza Francisco Javier Otero , de la Garza Eduardo Arias 
Published: March 2021

Abstract

Background
Influenza virus is responsible for 3 to 5 million cases every year with an estimated mortality in children around 0.15 deaths per 100,000 population. Mexico reported in the 2018–2019 Influenza season 7,210 confirmed cases with 811 deaths (11%) with AH1N1 the most frequent type with 67% of the cases and 88% of the deaths. Clinical assessment of children with influenza is difficult because of the overlap of symptoms between other viral diseases so we evaluated the severity of respiratory symptoms in influenza-positive and -negative children to attain better clinical assessment of influenza cases.

Methods
We evaluated 846 children less than 18 years old who were screened for influenza in the emergency department at our hospital by using the WHO Influenza Like Disease (ILD) definition between epidemiological week 40 up to week 20 of the 2018–2019 influenza season. Clinical characteristics, evolution and comorbidities were assessed between positive and negative influenza test. Influenza was confirmed by RT–PCR of a nasal swab. Both χ 2 test and t-test were used for statistical analysis of both groups.

Results
Of the 846 children evaluated for ILD, 177 were positive and 669 were negative for influenza virus. 53.6% of the positive group and 52.2% of the negative group were male, mean ages were 5.25 years and 3.73 years, respectively (P &lt; 0.0001) with 55% and 73.9% less than 5 years old, respectively. 75.7% of the positive group had severe disease defined as hypoxemic pneumonia and 78.6% of the negative group. Statistically significant differences in clinical evaluation were observed regarding frequency of fever, cough, sore throat, chills, myalgias, arthralgias, malaise, conjunctivitis and sudden onset of symptoms. Also, in the positive group there was higher probability of having a positive close contact (6.8%) case than in the negative group (2.5%) (P = 0.005). Cardiopathy, immunosuppression and cancer were the most frequent comorbidities in the influenza group. Four percent of the influenza-positive group and 5% of the negative group were vaccinated. Influenza types were 55.4% AH1N1pdm09, 35% B (29% Yamagata, 22.6% Victoria, 48.4% undetermined) and 9% of AH3. Two deaths were reported in the influenza-positive group.

Conclusions
Influenza can produce a severe disease in children, especially with those with co-morbidity; therefore, careful evaluation of respiratory symptoms, contact history to ILD, and highly sensitive diagnostics will accurately diagnose influenza. Patients with severe influenza should be promptly treated with antivirals and isolated to decrease intrahospital transmission.