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Microbial and Clinical Characteristics in Hepatobiliary Surgery Patients: Analyzing Risk Factors and Antibiotic Resistance

Introduction: Bactibilia frequently complicates biliary obstruction, especially in malignant cases with drainage, and is associated with antimicrobial resistance, thereby posing significant therapeutic challenges. This study characterized the microbiological and clinical profiles, antibiotic resistance patterns, and associated risk factors in patients undergoing hepatobiliary surgery in Colombia. Materials and Methods: We conducted a cross-sectional analytical study on 95 patients with positive bacterial cultures following surgery. The analysis included clinical and microbiological variables. For analytical purposes, patients were stratified into two groups: those with PBD and those without, allowing for the assessment of clinical and microbiological differences between the cohorts. We used chi-square tests, Student\'s t-tests, Mann-Whitney tests, and logistic regression. Results: Of the 95 patients, 61.05% were men, with a median age of 67 years. Preoperative exposure to endoscopic retrograde cholangiopancreatography was significantly higher in patients with biliary pancreatitis (73.47%; p=0.001). Escherichia coli exhibited high resistance to ampicillin/sulbactam (74.29%) and ciprofloxacin (59.46%), while piperacillin/tazobactam (89.74%). Resistance to meropenem was notably associated with female sex (odds ratio [OR: 9.55; 95% confidence interval [CI], 1.12-80.9; P=0.038) and longer ICU stay (OR: 1.12; 95% CI, 1.00-1.24; P=0.038). Discussion: This study reveals significant antibiotic resistance in E. coli and K. pneumoniae, especially in patients with preoperative biliary drainage. These findings highlight the importance of tailoring antibiotic prophylaxis based on preoperative cultures to effectively address antibiotic resistance in hepatobiliary surgery.

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Infectio

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B-cell Maturation Antigen-directed Therapies versus Standard Regimens in Lenalidomide-refractory Relapsed or Refractory Multiple Myeloma After 1-3 Prior Lines: A Systematic Review and Network Meta-analysis of Phase 3 Trials

The therapeutic landscape for relapsed or refractory multiple myeloma (RRMM) has evolved with the introduction of B-cell maturation antigen (BCMA)-directed agents and novel triplet combinations; however, robust comparative evidence in lenalidomide-refractory patients with early relapse remains limited. We conducted a systematic review and network meta-analysis (NMA) of phase 3 randomized controlled trials (RCTs) comparing BCMA-targeted therapies with standard regimens in adults with RRMM after 1-3 prior lines. MEDLINE, Embase, CENTRAL, and Web of Science were searched from inception through December 2025. The primary endpoint was progression-free survival (PFS), which was quantitatively synthesized using NMA; overall survival (OS), minimal residual disease (MRD) negativity, and grade ≥3 adverse events were summarized descriptively. Ten phase 3 RCTs met the inclusion criteria. Experimental regimens consistently improved PFS compared with control arms, with hazard ratios ranging from 0.31 to 0.70 across trials. Within the connected network, anti-CD38-based triplets demonstrated the most favorable PFS estimates. Although BCMA-directed therapies showed superior efficacy in direct comparisons, including deeper responses and higher MRD negativity rates, limited network connectivity precluded robust indirect comparisons across therapeutic classes. OS data were heterogeneous and frequently immature, and safety outcomes were not quantitatively synthesized. Multiple therapeutic strategies improve PFS in lenalidomide-refractory RRMM during early relapse. Anti-CD38-based triplets remain a cornerstone of care, while BCMA-directed therapies represent a promising alternative. However, structural limitations of the evidence network warrant cautious interpretation.

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Journal of Applied Hematology

Título del artículo:

Understanding sugar-sweetened beverage tax implementation globally: a 34-year, population-based observational study in 183 countries

Background: Taxes on sugar-sweetened beverages can improve public health. We aimed to characterise the extent and types of sugar-sweetened beverage taxes implemented worldwide and the national characteristics predicting implementation, such as sugar-sweetened beverage intake amounts, disease rates, or economic development. Methods: This longitudinal analysis aggregated serial global datasets (including the Global Dietary Database, Non-Communicable Diseases Risk Factor Collaboration, Global Burden of Disease study, and World Bank data) from 1990 to 2024 in 183 countries to assess sugar-sweetened beverage tax characteristics and national predictors of policy adoption. Sugar-sweetened beverage taxes for public health purposes were identified and characterised, including amounts, fiscal instruments, structures, and covered beverages. Sugar-sweetened beverage consumption, obesity and diabetes prevalence, gross domestic product (GDP), and sociodemographic index (SDI) were assessed as predictors of tax implementation using Cox proportional hazards models with time-varying covariates. Findings: From 1990 to 2024, 64 countries implemented sugar-sweetened beverage taxes, accelerating over time and covering 3·5 billion people globally. South Asia led in adoption (50% of countries; median tax rate 7·5%), followed by southeast and east Asia (47·8%; 5·0%), the Middle East and North Africa (30·0%; 17·0%), and Latin America and the Caribbean (31·3%; 7·0%). Taxes were ad valorem (ie, based on price; 45%), volume-based (44%), sugar-content-based (5%), or mixed (6%), and 13% of countries earmarked revenue for public health. Multivariable-adjusted predictors of tax implementation included diabetes prevalence (hazard ratio [HR]=1·22 [95% CI 1·05–1·43]), obesity prevalence (1·14 [1·00–1·29]), GDP per capita (HR per $10 000: 1·19 [1·06–1·34]), and SDI (0·70 [0·57–0·86]), but not sugar-sweetened beverage intake (0·77 [0·42–1·39]). Interpretation: Global adoption of sugar-sweetened beverage taxes has rapidly accelerated since 1990; however, there is important heterogeneity by region and tax structure, and the taxes are shaped by a country\'s economic capacity, social development, and health conditions. Funding: This work was supported by the National Institutes of Health (R01HL115189).

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Lancet Global Health

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Sporogenesis and ultrastructure of spores in the fern Anemia hirsuta (Anemiaceae)

Introduction: Research into the ontogeny of sporangia and sporogenesis of leptosporangiate ferns is scarce in the scientific literature. Objectives: To describe and analyze the ontogeny of sporangia, sporogenesis, micromorphology, and ultrastructure of mature spores of the fern Anemia hirsuta. Methods: Fertile fronds of A. hirsuta were processed according to standard protocols for sectioning and embedding samples in paraffin and resin. Sections in paraffin were stained with safranin-alcian blue, Toluidine Blue, and PAS/amidoblack. Sections in resin were stained with Toluidine Blue. The samples were prepared for observation under scanning electron microscopy (SEM) to yield detailed descriptions. Mature spores were analyzed by X-ray energy dispersion (XEDS). Ultrathin sections were obtained for transmission electron microscopy (TEM) observation. Results: The entire leptosporangium is formed from a basal and an apical cell derived from a single epidermal cell of the fertile pinna. The mature leptosporangia are globose, with a subapical ring and a short pedicel. During development, the tapetum is initially cellular, and then becomes plasmodial. The sporocytes undergo simultaneous meiotic division to form tetrads of spores in a tetrahedral arrangement. The exospore is formed first, with two layers, a very thin internal layer and a thick outer layer, followed by the endospore, and finally the perispore. The spores are trilete and muriform, with simple or branched siliceous microspines. The perispore associated with the muri and grooves appears to be highly organized with evident ultrastructural differences. Conclusions: The ontogeny of the sporangia and sporogenesis of A. hirsuta is similar to that previously described for leptosporangiate ferns and recorded in some related fossil species. The highly structured and organized perispore is observed. A high silica content in the microspines of the sporodermis is herein reported for the first time in this group.

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Revista De Biologia Tropical

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Recurrencia de herpes zóster en atención primaria: confusión residual no medida, era posvacuna recombinante y validez externa para América Latina

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Enfermedades Infecciosas Y Microbiologia Clinica

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The circular economy in the corporate business model

— Background research shows a positive correlation between the Circular Economy and Operational Profitability; however, current interest demonstrates the impact of the Circular Economy on the development of business models. To this end, a documentary analysis was conducted for the period between 2020 and 2025 to investigate this impact, allowing inferences to be drawn about the various changes occurring in Social Accounting, specifically regarding the Circular Economy, business models, and regulatory advancements, including International Financial Reporting Standards (IFRS). The findings confirm that companies investing in the Circular Economy demonstrate greater profitability and production efficiency, despite adverse factors such as: lack of awareness regarding its applicability, investment costs, financing, and the omission of these from reports and non-monetary results in Financial Statements through sections in IFRS. Therefore, progress in revealing this trend is slow in Latin America, especially regarding the structure of models, which remain linear rather than circular. This contrasts with the global average, where the adoption of circular models has generated significant results, such as a reduction in landfill waste through recycling, reuse, and product repair. This translates into greater profitability and improved business competitiveness for those who have implemented these practices. Finally, work must continue on developing a comprehensive accounting model that incorporates the aforementioned findings.

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Aibi Revista De Investigacion Administracion E Ingenierias

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The Need to Include COPD as Cardiovascular Risk Modifying Factor in the Framingham Risk Score, ASCVD Risk Score and PREVENT Risk Calculator: A Call Based on the 2025 GOLD Guidelines

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Revista Argentina De Cardiologia

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Prognostic Stratification in Chagas Cardiomyopathy: Precision Medicine Adapted to the Local Real-World Setting

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Revista Argentina De Cardiologia

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