tbuckley/cabot-search huggingface dataset:
A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19
Authors: David R Boulware, Matthew F Pullen, Ananta S Bangdiwala, Katelyn A Pastick, Sarah M Lofgren, Elizabeth C Okafor, Caleb P Skipper, Alanna A Nascene, Melanie R Nicol, Mahsa Abassi, Nicole W Engen, Matthew P Cheng, Derek LaBar, Sylvain A Lother, Lauren J MacKenzie, Glen Drobot, Nicole Marten, Ryan Zarychanski, Lauren E Kelly, Ilan S Schwartz, Emily G McDonald, Radha Rajasingham, Todd C Lee, Kathy H Hullsiek
Journal: New England Journal of Medicine (2020)

BackgroundCoronavirus disease 2019 (Covid-19) occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For persons who are exposed, the standard of care is observation and quarantine. Whether hydroxychloroquine can prevent symptomatic infection after SARS-CoV-2 exposure is unknown.MethodsWe conducted a randomized, double-blind, placebo-controlled trial across the United States and parts of Canada testing hydroxychloroquine as postexposure prophylaxis. We enrolled adults who had household or occupational exposure to someone with confirmed Covid-19 at a distance of less than 6 ft for more than 10 minutes while wearing neither a face mask nor an eye shield (high-risk exposure) or while wearing a face mask but no eye shield (moderate-risk exposure). Within 4 days after exposure, we randomly assigned participants to receive either placebo or hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 additional days). The primary outcome was the incidence of either laboratory-confirmed Covid-19 or illness compatible with Covid-19 within 14 days.ResultsWe enrolled 821 asymptomatic participants. Overall, 87.6% of the participants (719 of 821) reported a high-risk exposure to a confirmed Covid-19 contact. The incidence of new illness compatible with Covid-19 did not differ significantly between participants receiving hydroxychloroquine (49 of 414 [11.8%]) and those receiving placebo (58 of 407 [14.3%]); the absolute difference was −2.4 percentage points (95% confidence interval, −7.0 to 2.2; P=0.35). Side effects were more common with hydroxychloroquine than with placebo (40.1% vs. 16.8%), but no serious adverse reactions were reported.ConclusionsAfter high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure. (Funded by David Baszucki and Jan Ellison Baszucki and others; ClinicalTrials.gov number, NCT04308668.) Quick Take Hydroxychloroquine as Postexposure Prophylaxis for Covid-19 1m 57s
Residential Proximity to Oil and Gas Development and Birth Outcomes in California: A Retrospective Cohort Study of 2006–2015 Births
Authors: Kathy V. Tran, Joan A. Casey, Lara J. Cushing, Rachel Morello-Frosch
Journal: Environmental Health Perspectives (2020)

Background: Studies suggest associations between oil and gas development (OGD) and adverse birth outcomes, but few epidemiological studies of oil wells or inactive wells exist, and none in California. Objective: Our study aimed to investigate the relationship between residential proximity to OGD and birth outcomes in California. Methods: We conducted a retrospective cohort study of 2,918,089 births to mothers living within 10 km of at least one production well between January 1, 2006 and December 31, 2015. We estimated exposure during pregnancy to inactive wells count (no inactive wells, 1 well, 2–5 wells, 6+ wells) and production volume from active wells in barrels of oil equivalent (BOE) (no BOE, 1–100 BOE/day, >100 BOE/day). We used generalized estimating equations to examine associations between overall and trimester-specific OGD exposures and term birth weight (tBW), low birth weight (LBW), preterm birth (PTB), and small for gestational age birth (SGA). We assessed effect modification by urban/rural community type. Results: Adjusted models showed exposure to active OGD was associated with adverse birth outcomes in rural areas; effect estimates in urban areas were close to null. In rural areas, increasing production volume was associated with stronger adverse effect estimates. High (>100 BOE/day) vs. no production throughout pregnancy was associated with increased odds of LBW [odds ratio (OR)=1.40, 95% confidence interval (CI): 1.14, 1.71] and SGA (OR=1.22, 95% CI: 1.02, 1.45), and decreased tBW (mean difference = −36 grams, 95% CI: −54, −17), but not with PTB (OR=1.03, 95% CI: 0.91, 1.18). Conclusion: Proximity to higher production OGD in California was associated with adverse birth outcomes among mothers residing in rural areas. Future studies are needed to confirm our findings in other populations and improve exposure assessment measures. https://doi.org/10.1289/EHP5842
Germline genetic mutational landscape and characteristics of men with prostate cancer (PCa): A single institution experience.
Authors: Sunil Adige, Lisa Bealin, Nicole Ventriglia, Daniel M. Geynisman, Fern Anari, Kristen Danielle Whitaker, Mary Beryl Daly, Elizabeth R. Plimack, Pooja Ghatalia, Michael J. Hall, Karen Ruth, Elias Obeid
Journal: Journal of Clinical Oncology (2020)

e13679 Background: The role of germline genetic testing (GGT) is rapidly changing for men with PCa. We describe the characteristics of men with PCa diagnosed with pathogenic (P) and likely pathogenic (LP) mutations on GGT. Methods: We conducted a retrospective single-institution study for all men with PCa who received single gene or multi-gene GGT from 1997-2019, unselected for disease stage, Gleason score, or age at diagnosis, and while most had a family history of cancer, some did not. All participants were from the Risk Assessment Program (RAP) database at FCCC and consented for research purposes at the time of GGT. Results: 160 men with PCa had GGT. 72/160 (45%) patients had no mutations. 41/160 (26%) patients had a variant of undetermined significance (VUS) (13 with 2 VUS, 1 with 3 VUS). 47/160 (29%) men were found to have a P or LP germline mutation. 26/47 (55%) with recurrent disease, and 1/47 (2%) unknown. 46 were Caucasian, and 1 was African American ( PALB2). 28/47 (60%) had Gleason Scores (GS) ≤7. 6/47 (13%) had a Prostate Specific Antigen (PSA) at diagnosis &lt; 4.0 ng/mL. 23/47 (49%) were diagnosed &lt; 60 years of age, and 8/47 (17%) at ≤ 50. 19/23 (83%) PCa cases with P/LP diagnosed below age 60 had DNA repair genes: BRCA2 (8), BRCA1 (4), CHEK2 (4), ATM (2), and PALB2 (1). 74/160 (46%) were tested after PCa NCCN genetics guidelines changed (October 2017), of which 19/74 (25%) had P/LP, and of those positive for P/LP, 6/19 (32%) had non-metastatic disease. Two patients had small cell neuroendocrine PCa ( CHEK2 and BRCA2), the remaining had adenocarcinoma PCa. Please see Table for full results. Conclusions: To our knowledge, this is the largest single-institution study reporting PCa characteristics and incidence of P/LP germline mutations. Rates of DNA-repair gene mutations were higher than previously reported, possibly reflecting our specialized cancer center’s population. While BRCA1/2 mutations were the most represented (55%), we describe PCa patients with mutations in ATM, CHEK2, NBN, PALB2, CFTR, and MUTYH, recognizing a few are not known to be linked to PCa. More than half of P/LP mutation carriers had GS ≤7. Additionally, 13% of the men with P/LP germline mutations had low PSA ( &lt; 4.0 ng/mL) at diagnosis. Our findings highlight the importance of the new guidelines and GGT importance in some men with PCa, particularly if they could benefit from a different therapeutic approach, or be influenced into cascade GGT. [Table: see text]
Abbreviated geriatric assessment (GA) in new oncology patients and its association with early death.
Authors: Michael Maranzano, Anu Radha Neerukonda, James Alfred Wallace, William Dale, Blase N. Polite, Selina Lai-ming Chow
Journal: Journal of Clinical Oncology (2020)

12035 Background: The ASCO 2018 Geriatric Oncology Guidelines support the broad application of GA to risk-stratify patients age ≥65 undergoing cancer-directed therapy. Despite this, GA has not been widely adopted due largely to perceived time and resource constraints. We administered an abbreviated GA by medical assistants (MAs) in an outpatient oncology clinic to explore its feasibility and correlation with adverse events. Methods: This is a single-institution, retrospective study of adults establishing oncology care at an academic medical center from 11/2016-4/2017. MAs completed an abbreviated GA of well-validated tests. Cognitive function was screened by the Mini-Cog (score &lt; 4) and physical function by the Five Times Sit-to-Stand Test (FTSST ≥ 15 seconds). Patient-reported Outcomes (PRO) screened for malnutrition by the Malnutrition Screening Test (MST ≥ 2), for vulnerability by Vulnerable Elders Survey (VES-13 ≥ 3) and for depression by Patient Health Questionnaire-4 (PHQ-4 &gt; 2). The first result within 3 months of the initial visit was used for analysis. ED visits, inpatient admissions and early death, defined as within the first 6 months from the initial visit, were collected from the electronic medical record. GA results and baseline characteristics were modeled for these events using univariate logistic regression. Multivariable regression was performed when univariate regression revealed at least 2 factors with p&lt; 0.1. Results: New patients 65+ years (n=304, median age 72) established care in our practice during this six-month period. Nearly all patients (n=285, 94%) completed at least one GA test. Fewer patients completed the Mini-Cog and FTSST (60% completed) compared to the PRO screenings (83-90% completed). Those with any positive GA screening test were nearly 3 times as likely to die within 6 months of their initial outpatient visit compared with those with no deficits (OR 2.95, 95% CI 1.11-9.30). Those with FTSST ≥ 15 sec or unable to complete were more likely to have an ED visit within 6 months (OR 2.40, 95%CI 1.04-5.46).No other individual screening test had a statistically significant association with adverse events. Conclusions: An abbreviated version of GA completed by MAs can be incorporated into new oncology patient visits for all older adults, and those with any abnormalities on screening tests had a higher likelihood of early death. [Table: see text]
小儿烧伤院前急救1 383例分析
Authors: 黄方涛, 童仁联
Journal: BMJ (2005)

对10年来住院治疗的1 383例小儿烧伤患者的院前急救情况进行回顾性研究,发现处置不当普遍存在,其中创面处理错误、未建立有效静脉通道和人为因素延误治疗时间者比率甚高,尤其是部分社区和乡镇医疗机构医生造成的失误屡屡发生,应引起重视。
Phase II, multicenter trial of nivolumab (Nivo) and brentuximab vedotin (BV) in patients (Pts) with untreated Hodgkin lymphoma (HL) over the age of 60 years or unable to receive standard ABVD chemotherapy: Results of a study of Academic and Community Cancer Research United (ACCRU) RU051505I.
Authors: Bruce D. Cheson, Nancy L. Bartlett, Betsy LaPlant, Hun Ju Lee, Ranjana H. Advani, Beth Christian, Catherine S. Magid Diefenbach, Tatyana Feldman, Stephen M. Ansell
Journal: Journal of Clinical Oncology (2020)

8014 Background: HL is highly curable with &gt; 90% of pts with limited and &gt; 80% with advanced stage disease experiencing long-term disease-free survival. HL typically occurs in younger pts, yet 15-35% are &gt; 60 yrs and experience a lower response rate, shorter survival, and greater toxicity. BV and checkpoint inhibitors have impressive activity in pts with relapsed and refractory HL. Thus, we initiated a phase II trial of BV-nivo in untreated pts with HL &gt;60 yrs of age or considered unsuitable for standard ABVD therapy. Methods: Inclusion criteria: previously untreated pts with classical HL &gt; 60 yrs or &lt; 60 yrs but considered unsuitable for standard chemotherapy because of a cardiac ejection fraction of &lt; 50%, diffusion capacity &lt; 80%, or creatinine clearance &gt; 30 but &lt; 60 mL/min, or refused chemotherapy; ECOG PS 0-2, ANC &gt;1500/mm 3 , platelets &gt; 100,000/mm 3 , hemoglobin &gt; 9 g/dl, bilirubin &lt;1.5 x upper limits of normal (ULN), aspartate/alanine transaminases &lt; 2.5 x ULN, amylase and/or lipase &lt; 1.5 x ULN, and serum creatinine &lt; 2.0 mg/dl. Pts received BV at 1.8 mg/kg (cap at 180 mg) and nivo 3 mg/kg every 21 days for 8 cycles. Response was assessed per the Lugano Classification. Results: The study accrued 46 pts between May 13, 2016-January 30, 2019. Median age of 71.5 yrs, 69.5% had ECOG PS 1 or 2; 64% stage III or IV; 39.1% with B symptoms; 4.3% were &lt; 60 years. Median follow-up was 21.2 months (range 2.9, 38.5), and 35 pts (76.1%) completed all 8 cycles of therapy. At the interim analysis (1 st 25 pts) ORR was 64% (52% mCR, 12% pMR) which was lower than the projected 80%. In all 46 pts, 45.7% achieved mCR and 15.2% mPR (ORR 60.9%); in evaluable pts, best ORR was 95% with 68% mCR. No clinical factors predicted response. Neither median duration of response nor median survival has been reached. Median PFS is 21.8 months (17.8, Not reached). 22 pts experienced 33 treatment delays, primarily due to BV. 22 pts experienced peripheral neuropathy (5 grade 3). Grade 4 toxicities included increased transaminases (n = 1), increased lipase and/or amylase (n = 2), pancreatitis (1). One pt died from cardiac arrest, possibly treatment-related. Conclusions: BV-nivo is active in untreated older HL pts with comorbidities. However, efficacy and response durability did not meet pre-specified criteria. Future trials based on these drugs, selecting pts most likely to benefit, may lead to a chemo-free approach for pts with HL. Clinical trial information: NCT02758717 .
Immune tolerance to colon cancer is mediated by colon dysbiosis: Human results and experimental In Vivo validation.
Authors: Emma Bergsten, Denis Mestivier, Aurelien Amiot, Nicola DeAngelis, Khashayarsha Khazaie, Iradj Sobhani
Journal: Journal of Clinical Oncology (2020)

e16062 Background: Lynch syndrome (Ly) but not Sporadic (Sp) CRC patients are responsive to immunotherapies. We have shown micorbiota from CRC patients induces precancerous colonic lesions in germ-free mice. The aim was to investigate microbiota linked compromised anti tumor immune response. Methods: We compared 1) Whole metagenomic fecal microbiotas of CRC patients [Sp, n = 53+Ly, n = 19] to controls (n = 90) or being first degree relatives of Ly patients (n = 14), respectively; 2) Tumoral to normal mucosa-adherent microbiota (16sRNA sequences); 3) Normal to tumoral tissues’ mRNA RT-PCRs of IL1b, IL4, IL6, IL8, IL17, TNFa, TGFb, FasL, Granzyme A&amp;B, Thy1; 4) CD3, CD4, CD8, Granzym, KL1, FoxP3, RORgT, MastCell, cells in tumor tissues quantified by immunohistochemistry (IHC), between subgroups. Associations between bacteria, tissue immune cell infiltrates and clinical data (3-yrs follow up or death) were established by using unsupervised Systems Biology and Bioinformatics analyses (Institut Pasteur Shaman platform and Qlucor program). Anti tumoral immune response links with bacteria were based on differences between Ly and Sp CRC patients. Tumor tolerance links with bacteria were identified using germ-free mice (n = 185) who orally received microbiota (9 Sp CRC patients vs 9 controls) with colonic mucosa examined 3 months after human fecal transfer (whole exome sequencing, methylchips, IHC for CD3, CD11b, FoxP3, RORgT, ILC3). Results: Enrichment in Peptostreptococcus, Thermodesulfovibrio and diminution in Ruminococcus, Eubacterium, Coprococcus were linked with FoxP3 and IL-17 over expressions in tumor tissues. Enrichment in Escherichia, Enterobacter, Thioalkalimicrobium, and diminution in Eubacterium, Faecalibacterium and Butyrovibrio were associated with higher FoxP3, FasL, Granzyms A&amp;B, Perforin, Thy1 mRNAs/mRNACD3. Diminution of Eubacterium, Dorea, Faecalibacterium genera and enrichment in Fusobacterium, E. Coli/Shigella were associated with higher CD3, FoxP3, GranzymA and B and FOXP3-RORgT cells in tumor tissues. Higher fecal enrichments in oral bacteria (parvimonas micra) and lack of Thermodesulfovibrio enrichment were associated with higher FoxP3-RORgt cells and short survival; in mice ILC3 and FoxP3-RORgT cells were linked with Sp CRC dysbiosis. Species linked with immunotolerance are identified. Conclusions: Fecal and tissue microbiota can impact failure of anti tumoral immune response in sporadic CRC patients by enhancing overexpression of IL-17 and reducing cytotoxic T-cell infiltration in tumors. Clinical trial information: NCT01270360 .
Next-generation sequencing (NGS) identifies a new breast cancer subtype with HER2 low-amplification status as a candidate for targeted therapy.
Authors: Guo-Chun Zhang, Ning Liao, Bo Chen, Jiali Lin, Jianguo Lai, Weikai Xiao, Chong-Yang Ren, Ling-Zhu Wen, XueRui Li, Yulei Wang, Kai Li, Li Cao, Minghan Jia, Min Li, Analyn Lizaso, Han Han-Zhang, Hao Liu, Lu Zhang, Jing Liu, Zhou Zhang
Journal: Journal of Clinical Oncology (2020)

553 Background: HER2 expression or amplification qualify patients to receive targeted therapeutics against HER2; however, traditional methods of quantifying HER2 amplification using fluorescence in situ hybridization (FISH) do not include a reliable definition for low level amplification. With the promising response rate of patients with low HER2 amplified-metastatic breast cancer to subsequent-line trastuzumab deruxtecan (DS-8201a) therapy, there is a need to improve the existing criteria to accurately identify patients with low HER2. In our study, we investigate whether HER2 amplification quantified by NGS could provide a method to stratify patients into subgroups. Methods: A total of 774 patients diagnosed with breast cancer from Guangdong Provincial People's Hospital (GDPH) who underwent targeted NGS using 520 or 33 cancer-related genes and had their HER2 status evaluated with either FISH or IHC were included in this study. HER2 status were defined as per 2018 ASCO/ACP guidelines. Results: Our results demonstrate that NGS could quantify HER2 amplification with high sensitivity and specificity, with area under the curve of 0.990 [95%CI: 0.982-0.999]. The receiver operating curve indicated an optimal cut-off of 2.62 copy number (CN) for identifying IHC/FISH HER2-negative status with 97.8% specificity. Meanwhile, the cut-off of ≥ 3.62 CN identified patients with IHC/FISH HER2-positive status with 99.8% specificity. Among the 774 patients, 65.8% (n = 509) had HER2 CN of ≤ 2.62 and were classified as HER2 non-amplified, while 25.8% (n = 199) had HER2 CN of ≥ 3.62, classified as HER2-amplified. The remaining 66 patients (8.5%) had HER2 CN between 2.62 and 3.62, and were the patients with heterogeneous IHC/FISH results, classified using NGS as HER2 low-amplified. Patients with low-amplified (49.0% vs. 38.8%, P &lt; 0.001) and amplified (50.3% vs. 38.8%, P &lt; 0.001) HER2 had significantly more number of copy number amplifications in other gene, including CDK12, RARA, and SPOP (P &lt; 0.001, P &lt; 0.001) than patients with HER2 non-amplified, indicating distinct mutation profile. Conclusions: Our results demonstrate that NGS could provide a more accurate stratification of patients based on their HER2 amplification levels. Patients with low levels of HER2 amplification has a distinct mutation profile, suggesting that NGS could serve as a robust tool to identify patients with HER2 amplification, whether high or low, who could benefit treatment with targeted agents designed against heterogeneous HER2 expression.
Individualized health education in the management of the patients with type 2 diabetes mellitus
Authors: Jiaqi Yao
Journal: BMJ (2016)

2型糖尿病，特别是新诊断2型糖尿病患者人数逐年增长。基于糖尿病并发症的高致残率、致死率，对新诊断2型糖尿病患者进行多种形式积极有效的、规范的、个体化的综合健康教育，有利于丰富患者糖尿病知识，提高治疗依从性，培养良好的自我管理习惯，从而使血糖达标，延缓糖尿病急慢性并发症的发生、发展，同时合理分配卫生资源，减少国家卫生经济的负担。
Loss of Her-2 expression after neo-adjuvant therapy with dual anti-Her-2 agents (Pertuzumab/Herceptin) with chemotherapy in locally advanced Her-2 positive breast cancer.
Authors: Niraj K. Gupta, Erica Giblin, Tara Spivey, Kristen Govert, Christopher A. Leagre, Robert H. Liebross, Kristen Schmidt, Patrick Heckman, Riessa Burnett, Rina Yadav, Rachelle Tutterrow, Nick Beaudrie, Jessic Durk, Vasu Tumati, Thomas Dugan, Robert Paul, Ian Sando, Jamie Donnelly
Journal: Journal of Clinical Oncology (2020)

e12562 Background: Conversion of Her-2 positive to negative after neoadjuvant treatments in Her-2 positive breast cancer has been reported. In most of these reports either chemotherapy alone or in combination with a single Her-2 agent (trastuzumab) was utilized. Use of dual anti-Her-2 agents (Pertzummab/Trastuzumab) along with chemotherapy as the neoadjuvant treatment regimen in Her-2 + breast cancer is a standard of care now. We looked at the loss of Her-2 expression after neo-adjuvant regimen consisting of dual anti-Her-2 agents and chemotherapy in locally advanced Her-2 + breast cancer. Methods: We reviewed the records of Her-2 positive patients with T2 or higher or lymph Node+ Her-2 + breast treated at our institution. Patients who had received neo-adjuvant chemotherapy and dual anti-Her-2 agents, pertuzumab and Trastuzumab were identified for this study. Clinical and pathologic data was collected. Her-2 expression was determined by IHC and FISH. Results: Between Dec 2014 and June 2019, 79 patients for identified. Median age was 47 yrs, range 31-83 yrs. All were females except one. Pre-treatment, 74 pts. were 3 + on IHC and 5 pts. were 2+ on IHC, but positive by FISH. Median Her-2/CEP 17 copy number ratio was 6.2, range 3.6-16.7. Sixty patients were ER positive and 19 were ER negative. Pertuzumab+ TCH was the most common regimen used, 91% of the patients. All patients underwent surgery. Forty five out of 79 patients, 56%, had a pCR. Thirty four pts with residual disease were re-assessed for Her-2 expression. 7/32 (20.5%) patients were Her-2 negative. 6/7 pts. were 0/1+ by IHC and 1 pt. was 2+ by IHC but negative by FISH. Five out of seven pts. (71.5%) converting to Her-2 negative were ER negative at diagnosis and 2/7 (28.5%) converting to Her-2 negative were ER + at diagnosis. All patients converting to Her-2 negative had received Pertuzumab+TCH. Conclusions: Loss of Her-2 expression is observed after neoadjuvant treatments with a dual anti-Her-2 regimen along with chemotherapy. Implications of this change on choosing adjuvant treatments in Her-2 + pts who have had neo-adjuvant therapy and effect on recurrence/survival outcomes needs to be explored in larger studies.
原发性肺动脉肉瘤二例
Authors: 屈正, 王春玲, 曹剑, 陈东, 李俊秋
Journal: BMJ (2011)

原发性肺动脉肉瘤是在肺动脉主干腔内息肉状生长的罕见肿瘤.临床表现与肺动脉栓塞相似,常依据术中或术后病理确诊,预后与围术期综合治疗有关[1].随着近年来我国肺动脉栓塞外科治疗病例的增多,心血管医生有必要对肺动脉肉瘤的诊治进一步认识.2001年10月和2007年2月术者外科治疗2例,报告如下。
Pathogen distribution and resistance in childhood urinary tract infection
Authors: Chao-ying Chen
Journal: BMJ (2013)

To explore the new trend of pathogens and antimicrobial resistance in children with urinary tract infection (UTI). Distribution of pathogens and their antimicrobial resistance in 85 culture-positive hospitalized children with UTI from 2008 to 2012 were analyzed. Urine culture was deemed positive with a pure growth >105/ml (single organism). Among 85 strains of bacterium, gram-negative bacilli accounted for 92.9%(with 64.7% of E coli.), gram-positive cocci 2.4% and fungi 4.7%. The resistance rates of Gram-negative bacilli to ampicillin, trimethoprim-sulfamethoxazole and ampicillin/sulbactam were 82.3%, 63.3% and 63.3% respectively. The resistance rates of E coli. to 3rd and 4th generation cephalosporin were both over 60%. And 0% and 5.5% of E coli. UTIs were resistant to imipenem and amikacin respectively. It indicated that E coli. remained a dominant pathogen in childhood UTI. The resistance patterns were grave. Every hospital should monitor the resistance patterns of urinary pathogens on a regular basis and use antibiotics with a low resistance.


Key words: 
Anti-infective agents, urinary; Child