Category: Nevin Manimala

Viruses. 2023 May 24;15(6):1232. doi: 10.3390/v15061232.

ABSTRACT

The first case of ASF in a domestic pig population in Serbia was confirmed in 2019 in a backyard population. Today, outbreaks in wild boar and, more importantly, in domestic pigs are still occurring, although the government measures for ASF prevention are in place. The aim of this study was to determine critical risk factors and identify the possible reasons for ASF introduction into different extensive pig farms. The study was conducted on 26 extensive pig farms with confirmed ASF outbreaks, with data collected from beginning of 2020 to the end of 2022. Collected epidemiological data were divided into 21 main categories. After identifying specific values of variables as critical for ASF transmission, we identified nine important ASF transmission indicators as those variables for which at least 2/3 of the observed farms reported values critical for ASF transmission. Among them were type of holding, distance to hunting ground, farm/yard fencing, and home slaughtering; however, the hunting activity of pig holders, swill feeding, and feeding with mowed green mass were not included. We represented the data in the form of contingency tables to study associations between pairs of variables using Fisher’s exact test. All pairs of variables in the group including type of holding, farm/yard fencing, domestic pig-wild boar contact, and hunting activity were significantly related; hunting activity of pig holders, holding pigs in backyards, unfenced yards, and domestic pig-wild boar contact were observed on the same farms. Free-range pig farming led to observed domestic pig-wild boar contact on all farms. The identified critical risk factors need to be strictly addressed to prevent the further spread of ASF to extensive farms and backyards in Serbia and elsewhere.

PMID:37376532 | DOI:10.3390/v15061232

Front Biosci (Elite Ed). 2023 May 5;15(2):11. doi: 10.31083/j.fbe1502011.

ABSTRACT

BACKGROUND: Nylon 11 is a synthetic plastic widely used in commercial products such as tubing for automobiles, offshore oilfields, and medical devices. An increasing amount of nylon and other plastic wastes have been released into various environments, posing ecological threats. The biodegradation of bundled nylon polymers has been considered impossible due to their crystalline structures.

METHODS: Nylon 11 film was created and incubated with adult mealworms. The mass, as well as structures, of nylon 11 films at pre- and post-incubation with beetles were compared. The number of nylon 11 monomer degrading bacteria in feces were determined by culture-dependent approach. The t-test was utilized to examine the statistical significance.

RESULTS: We discovered that adult mealworm (Tenebrio molitor) beetle can ingest nylon 11 when stretched thin. The microscopic observation of their feces did not identify the presence of large fragments of nylon 11. The analysis of fecal bacteria revealed that while the total number of culturable bacteria did not change significantly, the number of 11-aminoundecanoic acid-metabolizing bacteria increased by 10,000-fold.

CONCLUSIONS: Our results suggest that bundled nylon 11 polymers were fragmented into smaller pieces, including monomeric units (11-aminoundecanoic acid) by adult mealworm. The monomers seem to have supported the proliferation of gut microbial communities capable of utilizing 11-aminoundecanoic acid as a carbon and nitrogen source. Our work implies the potential use of the mealworm beetle as a means to fragment nylon polymers for remediation applications.

PMID:37369567 | DOI:10.31083/j.fbe1502011

Emerg Med J. 2023 Jun 27:emermed-2023-213142. doi: 10.1136/emermed-2023-213142. Online ahead of print.

ABSTRACT

BACKGROUND: Time-based targets are used to improve patient flow and quality of care within EDs. While previous research often highlighted the benefits of these targets, some studies found negative consequences of their implementation. We study the consequences of removing the 4-hour access standard.

METHODS: We conducted a before and after, retrospective, observational study using anonymised, routinely collected, patient-level data from a single English NHS ED between April 2018 and December 2019. The primary outcomes of interest were the proportion of admitted patients, that is, the admission rate, the length of stay in the ED and ambulance handover times. We used interrupted time series models to study and estimate the impact of removing the 4-hour access standard.

RESULTS: A total of 169 916 attendances were included in the analysis. The interrupted time series models for the average daily admission rate indicate a drop from an estimated 35% to an estimated 31% (95% CI -4.1 to -3.9). This drop is only statistically significant for Majors (Ambulant) patients (from an estimated 38.3% to an estimated 31.4%) and, particularly, for short-stay admissions (from an estimated 18.1% to an estimated 12.8%). The models also show an increase in the average daily length of stay for admitted patients from an estimated 316 min to an estimated 387 min (95% CI 33.5 to 108.9), and an increase in the average daily length of stay for discharged patients from an estimated 222 min to an estimated 262 min (95% CI 6.9 to 40.4).

CONCLUSION: Lifting the 4-hour access standard reporting was associated with a drop in short-stay admissions to the hospital. However, it was also associated with an increase in the average length of stay in the ED. Our study also suggests that the removal of the 4-hour standard does not impact all patients equally. While certain patient groups such as those Majors (Ambulant) patients with less severe issues might have benefited from the removal of the 4-hour access standard by avoiding short-stay hospital admissions, the average length of stay in the ED seemed to have increased across all groups, particularly for older and admitted patients.

PMID:37369563 | DOI:10.1136/emermed-2023-213142

BMJ Open Respir Res. 2023 Jun;10(1):e001662. doi: 10.1136/bmjresp-2023-001662.

ABSTRACT

BACKGROUND: A close relationship exists between obstructive sleep apnoea (OSA) and hypertension. However, the impact of hypertension on the prognostic significance of OSA in patients with acute coronary syndrome (ACS) remains unclear.

METHODS: This is a post hoc analysis of the OSA-ACS project, which consecutively included patients with ACS and receiving overnight sleep study from June 2015 to January 2020. OSA was defined as AHI ≥15 events/hour. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), including a composite of cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularisation or hospitalisation for unstable angina or heart failure.

RESULTS: A total of 1927 patients with ACS were finally enrolled in this study. The mean patient age was 56.4±10.5 years. Among them, 1247 (64.7%) patients had hypertension, and 1014 (52.6%) patients had OSA. During 2.9 (1.5, 3.6) years of follow-up, OSA was associated with an increased risk of MACCE among patients with hypertension (HR=1.35, 95% CI 1.04 to 1.75, p=0.02), but not in patients without hypertension (HR=1.15, 95% CI 0.79 to 1.68, p=0.47). The interaction between OSA and hypertension for MACCE was not statistically significant (interaction p=0.29). For patients with pre-existing hypertension, OSA was associated with an increased risk of MACCE only among those with grade 3 hypertension (HR 1.54, 95% CI 1.12 to 2.13, p=0.008), but not those with grade 1 or 2 hypertension.

CONCLUSIONS: OSA was associated with an increased risk of MACCE following ACS in patients with hypertension, especially in patients with pre-existing severe hypertension. These findings highlight the importance of identifying OSA in ACS patients with hypertension.

TRIAL REGISTRATION NUMBER: NCT03362385.

PMID:37369551 | DOI:10.1136/bmjresp-2023-001662

BMJ Open Diabetes Res Care. 2023 Jun;11(3):e003327. doi: 10.1136/bmjdrc-2023-003327.

ABSTRACT

INTRODUCTION: Hypoglycemia is a major limiting factor in achieving recommended glycemic targets for people with type 1 diabetes. Exposure to recurrent hypoglycemia results in blunted hormonal counter-regulatory and symptomatic responses to hypoglycemia. Limited data on metabolic adaptation to recurrent hypoglycemia are available. This study examined the acute metabolic responses to hypoglycemia and the effect of antecedent hypoglycemia on these responses in type 1 diabetes.

RESEARCH DESIGN AND METHODS: Twenty-one outpatients with type 1 diabetes with normal or impaired awareness of hypoglycemia participated in a study assessing the response to hypoglycemia on 2 consecutive days by a hyperinsulinemic glucose clamp. Participants underwent a period of normoglycemia and a period of hypoglycemia during the hyperinsulinemic glucose clamp. Plasma samples were taken during normoglycemia and at the beginning and the end of the hypoglycemic period. Metabolomic analysis of the plasma samples was conducted using comprehensive two-dimensional gas chromatography with time-of-flight mass spectrometry.

RESULTS: In total, 68 metabolites were studied. On day 1, concentrations of the branched-chain amino acids, leucine (p=3.8×10^-3) and isoleucine (p=2.2×10^-3), decreased during hypoglycemia. On day 2, during hypoglycemia, five amino acids (including leucine and isoleucine) significantly decreased, and two fatty acids (tetradecanoic and oleic acids) significantly increased (p<0.05). Although more metabolites responded to hypoglycemia on day 2, the responses of the single metabolites were not statistically significant between the 2 days.

CONCLUSIONS: In individuals with type 1 diabetes, one episode of hypoglycemia decreases leucine and isoleucine concentrations. Antecedent hypoglycemia results in the decrement of five amino acids and increases the concentrations of two fatty acids, suggesting an alteration between the two hypoglycemic episodes, which could indicate a possible adaptation. However, more studies are needed to gain a comprehensive understanding of the consequences of these alterations.

TRIAL REGISTRATION NUMBER: NCT01337362.

PMID:37369531 | DOI:10.1136/bmjdrc-2023-003327

CMAJ Open. 2023 Jun 27;11(3):E569-E578. doi: 10.9778/cmajo.20210291. Print 2023 May-Jun.

ABSTRACT

BACKGROUND: Previous research has shown that cocaine-associated deaths occur more frequently in hot weather, which has not been described for other illicit drugs or combinations of drugs. The study objective was to evaluate the relation between temperature and risk of death related to cocaine, opioids and amphetamines in British Columbia, Canada.

METHODS: We extracted data on all deaths with cocaine, opioid or amphetamine toxicity recorded as an underlying or contributing cause from BC vital statistics for 1998-2017. We used a time-stratified case-crossover design to estimate the effect of temperature on the risk of death associated with acute drug toxicity during the warmer months (May through September). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for each 10°C increase in the 2-day average maximum temperature at the residential location.

RESULTS: We included 4913 deaths in the analyses. A 10°C increase in the 2-day average maximum temperature was associated with an OR of 1.43 (95% CI 1.11-1.86) for deaths with only cocaine toxicity recorded (n = 561), an OR of 1.15 (95% CI 0.99-1.33) for deaths with opioids only (n = 1682) and an OR of 1.11 (95% CI 0.60-2.04) for deaths with amphetamines only (n = 133). There were also elevated effects when toxicity from multiple drugs was recorded. Sensitivity analyses showed differences in the ORs by sex, by climatic region, and when the location of death was used instead of the location of residence.

INTERPRETATION: Increasing temperatures were associated with higher odds of death due to drug toxicity, especially for cocaine alone and combined with other drugs. Targeted interventions are necessary to prevent death associated with toxic drug use during hot weather.

PMID:37369523 | DOI:10.9778/cmajo.20210291

In Vivo. 2023 Jul-Aug;37(4):1703-1713. doi: 10.21873/invivo.13257.

ABSTRACT

BACKGROUND/AIM: Lung percutaneous needle biopsy (PNB) under CT guidance can be performed with a single-needle or with a coaxial (CX) technique. This study evaluated the CX technique in a large cohort of patients who underwent to CT-guided lung PNB in our Institute over a period of 7 years.

PATIENTS AND METHODS: We retrospectively collected and analyzed data relative to 700 CT-guided lung PNBs performed from August 2012 to August 2019 in 700 patients (M:F=436:264; mean age=69 years, range=6-93 years) with normal coagulation and pulmonary function. PNB was considered diagnostic if at least one of the collected tissue specimens allowed for histological diagnosis. Pulmonary hemorrhage (PH) and pneumothorax (PNX) were evaluated as present or absent. Statistical analysis was made by Chi-square test of Pearson, Fisher’s exact test and Wilcoxon test.

RESULTS: The CX technique showed a high diagnostic accuracy (93.0%) and allowed the collection of a great number of appropriate tissue specimens with a single pleural puncture (≥3 specimens in 77.4% of cases). PH was the complication more frequent (55.4%), without significant clinical impact. Global PNXs incidence was high (42.9%), but the introducer allowed to aspirate the PNX with a lower percentage of chest tube placement vs. PNXs not aspirated (6.3% and 13.3%, respectively).

CONCLUSION: This large retrospective study confirmed the high diagnostic accuracy of lung PNB with the CX technique and allowed identification of significant factors to achieve a greater diagnostic power and decrease complication rates.

PMID:37369512 | DOI:10.21873/invivo.13257

In Vivo. 2023 Jul-Aug;37(4):1714-1720. doi: 10.21873/invivo.13258.

ABSTRACT

BACKGROUND/AIM: Synovial calprotectin has been demonstrated as a promising biomarker for periprosthetic joint infections (PJI) in painful total hip (THA) and knee arthroplasties (TKA). However, its diagnostic utility has not been evaluated explicitly in cases with marked loosening or migration of the implant. Concerns have already been raised in cases with metallosis and severe periprosthetic osteolysis because wear-induced inflammation may yield false positive results. The purpose of this study was to evaluate calprotectin for the diagnosis of PJI in cases that preoperatively demonstrate moderate to severe periprosthetic osteolysis or implant migration as signs for implant loosening in THA and TKA.

PATIENTS AND METHODS: Thirty-three patients were included in this prospective study between February of 2019 and November of 2021. The extent of osteolysis was classified according to Engh et al., Paprosky et al., and the modern Knee Society Radiographic Evaluation and Scoring System. Synovial white blood cell count (WBC), percentage of polymorphonuclear neutrophils (PMC), serum C-reactive protein (CRP) and synovial calprotectin using a lateral-flow-assay were tested against the European Bone and Joint Infection Society (EBJIS) definition for PJI. Statistic quality criteria were calculated and compared using a binary classification test.

RESULTS: Ten patients were classified as confirmed infections according to the EBJIS definition (7 THA and 5 TKA). The calprotectin assay yielded a sensitivity of 0.60, a specificity of 0.61, a positive predictive value of 0.40, and a negative predictive value of 0.78. The calprotectin assay resulted in nine false positive and four false negative cases. No correlation between the extent of osteolysis and false classification by means of the calprotectin assay was observed.

CONCLUSION: The diagnostic accuracy of synovial calprotectin is impaired if moderate to severe signs of implant loosening are present. If PJI is unlikely, the calprotectin LFT can be applied as a further exclusion tool as the negative predictive value remains relatively high.

PMID:37369505 | DOI:10.21873/invivo.13258

In Vivo. 2023 Jul-Aug;37(4):1450-1454. doi: 10.21873/invivo.13229.

ABSTRACT

BACKGROUND/AIM: Anastomotic leak (AL) remains one of the most troublesome complications in general surgery. The current review aimed to assess the level of C-reactive protein (CRP) in drainage fluid after entero-enteric, colonic, or colorectal anastomosis as a predictive biomarker for AL.

MATERIALS AND METHODS: Four medical databases (PUBMED-MEDLINE, Google Scholar, UpToDate, and Cochrane Library) were searched in January 2023 for prospective or retrospective studies on the role of acute-phase proteins in drainage fluid as a predictive biomarker of AL. Two independent researchers gathered and processed the data using MedCalc. The data were pooled and Student’s t-test was used to compare the data between the AL and non-AL groups.

RESULTS: Overall, four studies were included in the current review, containing 753 patients in total, for whom various types of enteric and colonic anastomoses were constructed. Overall 79 (10.49%) of patients demonstrated AL and the mean CRP level (±standard deviation) on postoperative day 3 was 167.7±77.13 mg/l. On the contrary, the non-AL group (674/753) had a statistically significantly lower mean CRP level at 83.76±20.32 mg/l. CRP values were not related to mortality. It was not possible to propose a CRP cut-off indicating an increased risk for AL as the data were insufficient.

CONCLUSION: The CRP level in drainage fluid might be a valuable biomarker for predicting the possibility of AL in general surgery. However, further and larger-scale studies are needed to establish a CRP cut-off value and this variable would possibly be different for patients with different pathologies.

PMID:37369500 | DOI:10.21873/invivo.13229

In Vivo. 2023 Jul-Aug;37(4):1455-1476. doi: 10.21873/invivo.13230.

ABSTRACT

BACKGROUND/AIM: COVID-19 has dramatically impacted non-pandemic-related care, including preventive medicine. Our objective was to quantify the alterations in the volume of screening tests for breast and cervical cancer during the COVID-19 era compared to pre-pandemic levels. Secondarily, we discussed the causes responsible for this change, presented suggestions for screening optimization and conducted a targeted search of the relevant literature for worsening of future mortality due to screening setback.

MATERIALS AND METHODS: We systematically searched Pubmed, Google Scholar and Epistemonikos for articles in English or Greek, published from March 11th, 2020, until September 14th, 2022, that illustrated quantitative variations of mammograms or Pap/HPV tests. Preprint articles, editorials and speeches were excluded. Quality of included studies was assessed via the JBI critical appraisal checklist for studies reporting prevalence data. The evidence was narratively synthesized.

RESULTS: A total of 56 articles were included, being either observational studies or reports from cancer registries. Large reductions were universally identified, peaked during the first wave but partially persisted after easing of the restrictions.

CONCLUSION: Our systematic review provides an updated record of the variations in screening volume and approaches screening neglect from a multidimensional perspective answering why it happened and how we could achieve recovery. A strong awareness campaign is proposed, in conjunction with triaging citizens more likely to benefit from screening. Cervical self-sampling is emphasized in the literature. Various studies displayed a potential increase in cancer mortality in the future based on predictive statistical models.

PMID:37369493 | DOI:10.21873/invivo.13230