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Mymensingh Medical Journal : MMJ Jul 2024In Intensive Care Units (ICUs) infection represents the most frequent complication leading to high mortality. Particularly the incidence of fungal infections, especially... (Observational Study)
Observational Study
In Intensive Care Units (ICUs) infection represents the most frequent complication leading to high mortality. Particularly the incidence of fungal infections, especially due to Candida spp., has been increasing during the last years. Over last two decades there is predominance of Non albicans Candida (NAC) infection with increased isolation of novel species and decreased susceptibility. Early identification of Candida species and determination of antifungal susceptibility pattern is essential for effective management. Therefore, the study was conducted to isolate and identify Candida species from the blood samples of the patients suspected of candidemia and assess their antifungal susceptibility pattern. This cross-sectional, descriptive type of observational study was conducted in the Department of Microbiology, Mymensingh Medical College, Bangladesh from March 2021 to February 2022. Venous blood was collected from clinically suspected patients admitted at ICU, Neonatal Intensive Care Unit (NICU), Mymensingh Medical College Hospital, Bangladesh. Primary blood culture was performed by automated method followed by sub-culture in Saboraud's Dextrose Agar (SDA) and blood agar media. Candida species were recognized by phenotypic and genotypic methods. Antifungal susceptibility testing was done by disk diffusion and broth microdilution method (BMD). Out of 125 blood specimens collected, Candida species were isolated from 39(31.0%) blood samples of which NAC species were 35(89.0%) whereas C. albicans was only 4(10.2%). Eight (8) different Candida species were identified of which C. parapsilosis was predominant 16(41.0%). Rare and emerging drug resistant species of C. ciferrii 23.0%, C. auris 7.7%, C. rugosa 10.3%, C. lusitaniae 2.6% were also isolated. Candidemia was highest in neonate 33(84.61%) with male predominance 24(61.54%). Use of broad-spectrum antibiotics, prolonged hospital stay, pre-maturity and low birth weight (LBW) were found to be important risk factors. In candidemia the highest resistance was to Fluconazole-33% and lowest to Voriconazole-5%. The study showed that NAC species were more common with emergence of rare and multidrug resistant species.
Topics: Humans; Bangladesh; Candidemia; Cross-Sectional Studies; Female; Male; Candida; Antifungal Agents; Intensive Care Units; Microbial Sensitivity Tests; Infant, Newborn; Adult; Drug Resistance, Fungal
PubMed: 38944705
DOI: No ID Found -
Journal of Pediatric Urology Jun 2024Many pediatric urology conditions affect putatively normal tissues or appear too commonly to be based solely on specific DNA mutations. Understanding epigenetic...
INTRODUCTION
Many pediatric urology conditions affect putatively normal tissues or appear too commonly to be based solely on specific DNA mutations. Understanding epigenetic mechanisms in pediatric urology, therefore, has many implications that can impact cell and tissue responses to settings, such as environmental and hormonal influences on urethral development, uropathogenic infections, obstructive stimuli, all of which originate externally or extracellularly. Indeed, the cell's response to external stimuli is often mediated epigenetically. In this commentary, we highlight work on the critical role that epigenetic machinery, such as DNA methyltransferases (DNMTs), Enhancer of Zeste Polycomb Repressive Complex 2 Subunit (EZH2), and others play in regulating gene expression and cellular functions in three urological contexts.
DESIGN
Animal and cellular constructs were used to model clinical pediatric uropathology. The hypertrophy, trabeculation, and fibrosis of the chronically obstructed bladder was explored using smooth muscle cell models employing disorganised vs. normal extracellular matrix (ECM), as well as a new animal model of chronic obstructive bladder disease (COBD) which retains its pathologic features even after bladder de-obstruction. Cell models from human and murine hypospadias or genital tubercles (GT) were used to illustrate developmental responses and epigenetic dependency of key developmental genes. Finally, using bladder urothelial and organoid culture systems, we examined activity of epigenetic machinery in response to non uropathogenic vs. uropathogenic E.coli (UPEC). DNMT and EZH2 expression and function were interrogated in these model systems.
RESULTS
Disordered ECM exerted a principal mitogenic and epigenetic role for on bladder smooth muscle both in vitro and in CODB in vivo. Key genes, e.g., BDNF and KCNB2 were under epigenetic regulation in actively evolving obstruction and COBD, though each condition showed distinct epigenetic responses. In models of hypospadias, estrogen strongly dysregulated WNT and Hox expression, which was normalized by epigenetic inhibition. Finally, DNA methylation machinery in the urothelium showed specific activation when challenged by uropathogenic E.coli. Similarly, UPEC induces hypermethylation and downregulation of the growth suppressor p16INK4A. Moreover, host cells exposed to UPEC produced secreted factors inducing epigenetic responses transmissible from one affected cell to another without ongoing bacterial presence.
DISCUSSION
Microenvironmental influences altered epigenetic activity in the three described urologic contexts. Considering that many obstructed bladders continue to display abnormal architecture and dysfunction despite relief of obstruction similar to after resection of posterior valves or BPH, the epigenetic mechanisms described highlight novel approaches for understanding the underlying smooth muscle myopathy of this crucial clinical problem. Similarly, there is evidence for an epigenetic basis of xenoestrogen on development of hypospadias, and UTI-induced pan-urothelial alteration of epigenetic marks and propensity for subsequent (recurrent) UTI. The impact of mechanical, hormonal, infectious triggers on genitourinary epigenetic machinery activity invite novel avenues for targeting epigenetic modifications associated with these non-cancer diseases in urology. This includes the use of deactivated CRISPR-based technologies for precise epigenome targeting and editing. Overall, we underscore the importance of understanding epigenetic regulation in pediatric urology for the development of innovative therapeutic and management strategies.
PubMed: 38944627
DOI: 10.1016/j.jpurol.2024.06.008 -
Journal of the Formosan Medical... Jun 2024Risk stratification for patients with a higher risk of hepatocellular carcinoma (HCC) is crucial. We aimed to investigate the role of the Fibrosis-4 (FIB-4) index in...
BACKGROUND AND AIMS
Risk stratification for patients with a higher risk of hepatocellular carcinoma (HCC) is crucial. We aimed to investigate the role of the Fibrosis-4 (FIB-4) index in predicting chronic hepatitis C (CHC)-related HCC.
METHODS
A retrospective cohort study consecutively included treatment-naive CHC patients receiving longitudinal follow-up at the National Taiwan University Hospital from 1986 to 2014. The clinical data were collected and traced for HCC development. Multivariable Cox proportional hazard regression analysis was used to investigate the predictors for HCC.
RESULTS
A total of 1285 patients in the ERADICATE-C cohort were included. The median age was 54, 56% were females, and 933 had HCV viremia. There were 33%, 38%, and 29% of patients having FIB-4 index <1.45, 1.45-3.25, and ≥3.25, respectively. After a median of 9-year follow-up, 186 patients developed HCC. Multivariable analysis revealed that older age, AFP≥20 ng/mL, cirrhosis, and a higher FIB-4 index were independent predictors for HCC. Compared with patients with FIB-4 index <1.45, those with FIB-4 1.45-3.25 had a 5.51-fold risk (95% confidence interval [CI]: 2.65-11.46), and those with FIB-4 ≥ 3.25 had 7.45-fold risk (95% CI: 3.46-16.05) of HCC. In CHC patients without viremia, FIB-4 index 1.45-3.25 and FIB-4 ≥ 3.25 increased 6.78-fold and 16.77-fold risk of HCC, respectively, compared with those with FIB-4 < 1.45.
CONCLUSION
The baseline FIB-4 index can stratify the risks of HCC in untreated CHC patients, even those without viremia. The FIB-4 index should thus be included in the management of CHC.
PubMed: 38944614
DOI: 10.1016/j.jfma.2024.06.008 -
Journal of Science and Medicine in Sport Jun 2024To compare prevalence and change scores of disordered eating (DE) in combat sport athletes by sex and explore the potential relationship between rapid weight loss (RWL)...
OBJECTIVES
To compare prevalence and change scores of disordered eating (DE) in combat sport athletes by sex and explore the potential relationship between rapid weight loss (RWL) and DE scores.
DESIGN
Prospective study based on 24 events (September 2022-2023).
METHODS
A body mass (BM) questionnaire was completed at ~1 day post-competition providing pre-competition BM data for -7 days, -24 h, and weigh-in. The Athletic Disordered Eating (ADE) online questionnaire was completed at ~7 and ~28 days post-competition, providing overall DE and four subscale scores (food and energy control, bingeing, body control, and body discontent).
RESULTS
There were 122, 132, and 89 respondents for the BM (77 % male), and ADE questionnaires at 7 (79 % male), and 28 days (74 % male). A large proportion of males' (83 %) and females' (89 %) DE scores were moderate to very high; minimal (17 % vs. 11 %), moderate (36 % vs. 32 %), high (37 % vs. 36 %), and very high (11 % vs. 21 %). Comparing DE change scores in males and females indicated deterioration (5 % vs. 0 %), improvement (3 % vs. 25 %, p = 0.013), and no difference (92 % vs. 75 %). Body discontent change score showed a significant sex difference (p = 0.014), with females improving (42 % vs. 17 %, p = 0.035) and males deteriorating (35 % vs. 4 %, p = 0.008). Correlation analyses were significant for RWL -7 days and males' food control score (R = 0.22, p = 0.031).
CONCLUSIONS
Moderate to very high DE indications were identified in 4 of every 5 combat sport competitors. A sex-specific change in body discontent is evident, and most competitors struggle with their food-body relationship post-competition, irrespective of RWL magnitude.
PubMed: 38944583
DOI: 10.1016/j.jsams.2024.06.007 -
Primary Care Diabetes Jun 2024Charcot neuroarthropathy (CN) is a complex disease of the bone and joints that can lead to serious and life-threatening complications. This study investigates...
AIMS
Charcot neuroarthropathy (CN) is a complex disease of the bone and joints that can lead to serious and life-threatening complications. This study investigates epidemiologic trends in diabetic CN in Texas and the impact of age on these values.
METHODS
A retrospective analysis was conducted using the Texas Department of State Health Services Hospital Discharge Data Public Use Data File. Using International Classification of Diseases, Ninth (ICD-9) and Tenth (ICD-10) Revision codes, we identified patients with diabetes and Charcot ankle or foot. Data extracted included diagnoses, race, and gender. Population rates were estimated using census data, calculated per 1000 population and standardized by age.
RESULTS
Overall and age-standardized rates of CN increased each year from 2006 to 2016, except for a downward trend from 2014 to 2016. Poisson regression revealed significant increases in the incidence rate ratio compared to 2006 for each year from 2008 to 2016. When age group is included, all years except 2007 show a significant increase relative to 2006, and all age groups have increased rates relative to ages 18-44. Major and minor amputations in patients with CN have increased.
CONCLUSIONS
The increasing rates of CN and amputations highlight the need for further research and standardized strategies for diagnosis and management.
PubMed: 38944563
DOI: 10.1016/j.pcd.2024.06.012 -
Thoracic Surgery Clinics Aug 2024The authors provide an overview of cultural adjustments and policy changes to support wellness in medicine. Subsequently, the data around wellness in cardiothoracic... (Review)
Review
The authors provide an overview of cultural adjustments and policy changes to support wellness in medicine. Subsequently, the data around wellness in cardiothoracic surgery, as well as policies and interventions that have been put into place to address wellness concerns in cardiothoracic surgery is discussed. The authors focus on both trainees and attendings and provide both a list of actions to address deficits in wellness management in the field, as well as resources available to promote well-being among cardiothoracic surgeons.
Topics: Humans; Thoracic Surgery; Health Promotion; Accreditation; United States; Internship and Residency; Education, Medical, Graduate
PubMed: 38944452
DOI: 10.1016/j.thorsurg.2024.04.003 -
The Journal of Nutrition Jun 2024Poor dietary quality is a risk factor for diet-related chronic disease and suboptimal nutritional patterns often begin early in the life course. While the dietary...
BACKGROUND
Poor dietary quality is a risk factor for diet-related chronic disease and suboptimal nutritional patterns often begin early in the life course. While the dietary intakes of young children, adolescents, and middle-aged and older adults are well established, much less is known about emerging adults, who represent a unique timepoint in life, as they are undergoing significant changes in food environments, autonomy, finances, and caregiver and parental involvement.
OBJECTIVE
To examine dietary quality, as assessed via the Healthy Eating Index (HEI), by demographic, socioeconomic, and health-related characteristics among U.S. emerging adults (18-23y) who participated in the 2015-2018 National Health and Nutrition Examination Survey (NHANES).
METHODS
NHANES data were collected via a household interview and 2 24-hour dietary recalls (24HR). Usual dietary intakes from the 24HRs were approximated using the multivariate National Cancer Institute Method to compute mean HEI-2015 overall and component scores (range 0-100, higher scores indicating higher dietary quality).
RESULTS
Overall dietary quality among U.S. emerging adults [HEI-2015: 50.3±1.3] was significantly lower than other U.S. adults (≥24y) [HEI-2015: 56.3±0.5; p<0.0001], with differences primarily driven by lower intakes of whole fruit, vegetables, and whole grains, and higher intakes of sodium, refined grains, and saturated fat. Few differences in HEI-2015 scores were noted across population subgroups by sex, food security, family income, and food assistance program participation, except for added sugar; intakes of added sugar were significantly higher among women, food insecure, and food assistance program participants as compared to their counterparts, respectively.
CONCLUSIONS
Dietary quality is poor among U.S. emerging adults and persists across all population subgroups, suggesting a significant need for tailored public health interventions to improve dietary quality among this population. Future research investigating to what extent emerging adults prioritize healthful behaviors and exploring other indicators for identifying nutritionally vulnerable subgroups may be impactful for identifying disparities among this life stage.
PubMed: 38944345
DOI: 10.1016/j.tjnut.2024.06.015 -
The Science of the Total Environment Jun 2024Quantifying the impacts of climate change on hydrological systems is crucial for developing adaptive strategies in water resources management. In this work, we quantify...
Quantifying the impacts of climate change on hydrological systems is crucial for developing adaptive strategies in water resources management. In this work, we quantify the future climate impacts on hydroclimatic extremes in the risk-prone, coastal, 15-m-above-sea-level Eastern Shore of Virginia (ESVA) region, utilizing the Sixth International Coupled Model Intercomparison Project (CMIP6) Assessment Report 6 (AR6) and General Circulation Models (GCMs). In addition, we incorporate historical data on demographics and disasters, land use land cover (LULC), Landsat imagery, and projected sea level rise (SLR) to better understand and highlight the correlation between hydroclimatic extremes and societal components in this region. The hydrological model Soil and Water Assessment Tool (SWAT), Standardized Precipitation Index (SPI), Normalized Difference Water Index (NDWI), and Interquartile Range (IQR) method have been used to evaluate the intensity and frequency of projected climatic extremes, in which SLR projections under different greenhouse gas emission pathways are temporally and spatially quantified. Our findings include (1) a trend towards wetter conditions is found with an increase in flood events and up to an 8.9 % rise in the severity of flood peaks compared to the 2003-2020 period; (2) current coastal high-risk regions, identified using historical data for natural disasters, demographics, and LULC, are projected to be more susceptible to future climate impacts; and (3) low-lying coastal towns and regions are identified as currently highly vulnerable to coastal and SLR-induced flooding and are projected to become even more susceptible by 2100. This is the first effort that provides valuable scientific insights into anticipated shifts in future climate patterns, essential for natural hazards prevention in ESVA. It highlights the need for authorities and decision-makers to plan and implement adaptive strategies and sustainable policies for the ESVA region and other coastal areas across the United States.
PubMed: 38944311
DOI: 10.1016/j.scitotenv.2024.174289 -
The Science of the Total Environment Jun 2024In an increasingly dry environment, it is crucial to understand how tree species use soil water and cope with drought. However, there is still a knowledge gap regarding...
In an increasingly dry environment, it is crucial to understand how tree species use soil water and cope with drought. However, there is still a knowledge gap regarding the relationships between species-specific stomatal behaviour, spatial root distribution, and root water uptake (RWU) dynamics. Our study aimed to investigate above- and below-ground aspects of water use during soil drying periods in four temperate tree species that differ in stomatal behaviour: two isohydric tracheid-bearing conifers, Scots pine and Norway spruce, and two more anisohydric deciduous species, the diffuse-porous European beech, and the ring-porous Downy oak. From 2015 to 2020, soil-tree-atmosphere-continuum parameters were measured for each species in monospecific forests where trees had no access to groundwater. The hourly time series included data on air temperature, vapor pressure deficit, soil water potential, soil hydraulic conductivity, and RWU to a depth of 2 m. Analysis of drought responses included data on stem radius, leaf water potential, estimated osmotically active compounds, and drought damage. Our study reveals an inherent coordination between stomatal regulation, fine root distribution and water uptake. Compared to conifers, the more anisohydric water use of oak and beech was associated with less strict stomatal closure, greater investment in deep roots, four times higher maximum RWU, a shift of RWU to deeper soil layers as the topsoil dried, and a more pronounced soil drying below 1 m depth. Soil hydraulic conductivity started to limit RWU when values fell below 10 to 10 cm/d, depending on the soil. As drought progressed, oak and beech may also have benefited from their leaf osmoregulatory capacity, but at the cost of xylem embolism with around 50 % loss of hydraulic conductivity when soil water potential dropped below -1.25 MPa. Consideration of species-specific water use is crucial for forest management and vegetation modelling to improve forest resilience to drought.
PubMed: 38944298
DOI: 10.1016/j.scitotenv.2024.174346 -
Diabetes Research and Clinical Practice Jun 2024Effective diabetes management remains suboptimal in low-resourced countries including Ghana. We determined the effectiveness of hospital-community link diabetes...
OBJECTIVE
Effective diabetes management remains suboptimal in low-resourced countries including Ghana. We determined the effectiveness of hospital-community link diabetes management intervention on glycaemic control and other outcomes.
METHODS
A retrospective study design, using secondary data from the Ghana-Netherlands for Health Foundation diabetes programme. The z-test was used for proportions, to compare parameters between baseline (2017) and endpoint (2022). The Friedman test was used to assess changes in blood glucose levels, and the multivariable Logistic regression to identify factors associated with blood glucose control.
RESULTS
Analyses of 251 clinical records showed decline in median blood glucose levels across six years from 8.8 mmol/L (7.2-12.9) in 2017 to 6.5 mmol/L (5.7-7.2) (p = 0.001) in 2022, recording 43 % increase in patients attaining glycaemic control in 2022 (p = 0.001). The Friedman test showed significant reduction in glucose levels (χ = 319.2, p = 0.001), with an effect size of 0.25 using the Kendall test. The logistic regression analyses revealed that patients on metformin and Glibenclamide combination were more likely to achieve glycaemic control than those on metformin monotherapy (adjusted OR = 7.30, 95 % CI 2.31-23.01, p = 0.001).
CONCLUSION
The intervention achieved significant reduction in blood glucose levels. Patients with diabetes benefit from the hospital-community link diabetes management intervention regarding glycaemic control.
PubMed: 38944249
DOI: 10.1016/j.diabres.2024.111762