Nevin Manimala

Int J Clin Pharmacol Ther. 2024 Dec 31. doi: 10.5414/CP204652. Online ahead of print.

ABSTRACT

BACKGROUND: Serratia marcescens has recently been categorized as low-risk for AmpC β-lactamase inducible production, but research on outcomes in Serratia bacteremia by antibiotic choice is limited.

OBJECTIVES: This study examined the clinical characteristics and outcomes of patients with ceftriaxone-susceptible Serratia bacteremia who received AmpC-directed β-lactam therapy vs. narrower spectrum therapies.

MATERIALS AND METHODS: Records of hospitalized adults with at least one positive blood culture for Serratia, over an 8-year period, across seven hospitals in an integrated health care system, were reviewed.

RESULTS: Of the 73 identified patients, 17 (23.3%) received carbapenem-based therapy. More than half of cases were community-acquired, with urological and intravenous drug use being the most common sources. While there was a trend toward lower mortality in carbapenem-treated patients (14.8 vs. 0%; p = 0.10), this was not statistically significant. The composite outcome of clinical failure was also not significant. However, compared to non-carbapenem-treated patients, carbapenem-treated patients had longer treatment duration (13 vs. 15 days; p = 0.02), prolonged hospital stays (5 vs. 11 days; p < 0.001), and higher infection-related readmission rates (17.6 vs. 3.6%; p = 0.04). A subset analysis of the 56 non-carbapenem treated patients found no significant difference in 30-day mortality or clinical failure between cefepime and non-cefepime-containing subgroups.

CONCLUSION: Our study found that cefepime- or carbapenem-based therapy may have limited clinical relevance in the treatment of Serratia bacteremia when the strains are initially susceptible to ceftriaxone, highlighting the importance of antibiotic stewardship to prevent emergence of multidrug resistant organisms.

PMID:39744800 | DOI:10.5414/CP204652

Emerg Med Australas. 2025 Feb;37(1):e14559. doi: 10.1111/1742-6723.14559.

ABSTRACT

OBJECTIVES: Somatic symptom and related disorders (SSRDs) are complex disorders that are commonly encountered in tertiary paediatric settings. Despite this, little is known about ED use prior to hospital admission. We aimed to describe the pattern of ED use in a cohort of children and adolescents who were subsequently admitted to hospital with SSRD and to identify factors associated with ED presentations.

METHOD: We conducted a retrospective review of the electronic medical records of 123 patients admitted with SSRD to ascertain their ED contact in the 12 months preceding their initial admission. Documentation about patient and presentation characteristics, ED management and discharge recommendations were recorded. Descriptive statistics, including Fisher’s Exact Test, were used.

RESULTS: Our patient group (65.9% female) had a median age of 14.3 years (range 7.3-18.3 years). Patient and presentation characteristics differed little by frequency of presentation to the ED; the symptom of pain was the only significant factor associated with the multiple ED presentations (P = 0.015). Documentation of a possible SSRD presentation in ED was significantly associated with the recommendation for mental health follow-up (P = 0.005), however engagement with mental healthcare at the time of a patient’s initial admission was uncommon.

CONCLUSIONS: Children and adolescents with SSRD who go on to have a hospital admission present frequently to EDs, especially in the setting of pain symptoms. Training of ED clinicians in diagnosing SSRD appears indicated, as is the development of local care pathways that may obviate the need for hospital admission in at least some patients.

PMID:39744779 | DOI:10.1111/1742-6723.14559

Emerg Med Australas. 2025 Feb;37(1):e14552. doi: 10.1111/1742-6723.14552.

ABSTRACT

OBJECTIVE: To compare the frequency of clinically significant missed injuries in clinically stable trauma patients undergoing initial whole-body computed tomography (WBCT) versus selective imaging. Secondary objectives include comparisons of radiation exposure, incidental findings, ED length of stay (LOS), hospital LOS and mortality.

METHODS: We performed a retrospective cohort study of trauma activations at a tertiary trauma centre in patients with normal vital signs from 1st January 2022 to 31st December 2022. Data were collected from the trauma registry and chart review of medical records.

RESULTS: A total of 665 patients were included with 42% (n = 277) receiving a WBCT, compared to 58% (n = 388) undergoing selective imaging. Most patients (52%) did not have any traumatic axial injuries identified. Missed injuries were identified in 0.8% (n = 3/388) of patients in the selective imaging cohort, with no adverse patient outcomes or major alteration to inpatient management. No missed injuries were identified in the WBCT group. Mortality was rare (0.9%, n = 6/665), occurring exclusively in elderly patients and mostly attributed to non-traumatic pathologies. Patients undergoing WBCT had a significantly increased likelihood of incidental findings (75% vs 35%, P < 0.001), increased radiation exposure (mean 24.67 vs 8.19 millisieverts [mSv], P < 0.001), longer ED LOS (9.86 vs 8.43 h, P = 0.012) and a higher likelihood of admission (65.3% vs 55.7%, P = 0.012).

CONCLUSIONS: Missed injuries were rare and without major complications in this clinically stable cohort. The liberal use of WBCT, despite low rates of missed injuries, morbidity and mortality, suggests over-utilisation of WBCT for ‘mechanism only’ traumas.

PMID:39744774 | DOI:10.1111/1742-6723.14552

Pharmacotherapy. 2025 Jan 2. doi: 10.1002/phar.4643. Online ahead of print.

ABSTRACT

AIMS: With the growing evidence of cardiovascular risks associated with diclofenac use, regulatory measures governing its application and sales have intensified since 2008. We evaluated the association between central regulatory actions and trends in diclofenac use in Denmark from 1999 to 2023, according to different dosage forms and routes of administration.

METHODS AND RESULTS: Data on diclofenac sales in Denmark from 1999 to 2023 were retrieved from the publicly available web database MEDSTAT, based on the Danish Register of Medicinal Products Statistics. The annual sales of various diclofenac dosage forms, including systemic (tablets, modified-release dosage forms, and suppositories) and topical (nonspecific and ophthalmic) dosage forms, were calculated and displayed by sales unit. From 1999 to 2008, sales of all systemically administered diclofenac forms increased: tablets by 51% (2000-2008), modified-release dosage forms by 40% (2003-2007), and suppositories by 44% (1999-2008). Thereafter, sales of tablets declined by 86% and modified-release dosage forms by 90% through 2023. The sales of suppositories declined somewhat lesser, by 34%, during 2008 to 2018 and then increased by 67% through 2023. Sales of nonspecific topical diclofenac increased by several thousandfold from 2005, although with brief periods of decline.

CONCLUSION: Sales of systemically administered diclofenac dosage forms, particularly tablets and modified-release drugs, declined by approximately 90% from about 2008 to 2023, indicating compliance with Danish and international regulatory actions. Conversely, sales of topically administered diclofenac increased heavily from 2005 to 2023, denoting a policy-driven shift toward these lower risk dosage forms.

PMID:39744765 | DOI:10.1002/phar.4643

Front Artif Intell. 2024 Dec 18;7:1499913. doi: 10.3389/frai.2024.1499913. eCollection 2024.

ABSTRACT

INTRODUCTION: Musical instrument recognition is a critical component of music information retrieval (MIR), aimed at identifying and classifying instruments from audio recordings. This task poses significant challenges due to the complexity and variability of musical signals.

METHODS: In this study, we employed convolutional neural networks (CNNs) to analyze the contributions of various spectrogram representations-STFT, Log-Mel, MFCC, Chroma, Spectral Contrast, and Tonnetz-to the classification of ten different musical instruments. The NSynth database was used for training and evaluation. Visual heatmap analysis and statistical metrics, including Difference Mean, KL Divergence, JS Divergence, and Earth Mover’s Distance, were utilized to assess feature importance and model interpretability.

RESULTS: Our findings highlight the strengths and limitations of each spectrogram type in capturing distinctive features of different instruments. MFCC and Log-Mel spectrograms demonstrated superior performance across most instruments, while others provided insights into specific characteristics.

DISCUSSION: This analysis provides some insights into optimizing spectrogram-based approaches for musical instrument recognition, offering guidance for future model development and improving interpretability through statistical and visual analyses.

PMID:39744740 | PMC:PMC11688478 | DOI:10.3389/frai.2024.1499913

World J Orthop. 2024 Dec 18;15(12):1191-1199. doi: 10.5312/wjo.v15.i12.1191. eCollection 2024 Dec 18.

ABSTRACT

BACKGROUND: Achilles tendon rupture is a common orthopedic injury, with an annual incidence of 11-37 per 100000 people, significantly impacting daily life. Minimally invasive surgery, increasingly favored for its reduced risks and comparable fixation strength to open surgery, addresses these challenges. Despite advantages like accelerated recovery, perioperative care poses emotional support, pain management, and rehabilitation challenges, impacting treatment efficacy and patient experience. To address these gaps, this study investigated the efficacy of a rapid rehabilitation protocol in enhancing recovery outcomes for minimally invasive Achilles tendon surgery, aiming to develop personalized, standardized care guidelines for broader implementation.

AIM: To evaluate a nursing-led rapid rehabilitation program for minimally invasive Achilles tendon repair surgery, providing evidence-based early recovery indicators.

METHODS: This study enrolled 160 patients undergoing channel-assisted minimally invasive Achilles tendon repair randomized into experimental and control groups. The experimental group received perioperative rapid rehabilitation nursing care, while the control group received standard care. The primary outcome measure was the Oswestry disability index score, with secondary outcomes including quality of life, Barthel index, patient satisfaction with nursing, incidence of complications, and rehabilitation adherence. Statistical analysis included appropriate methods to compare outcomes between groups. The study was conducted in a specific setting, utilizing a randomized controlled trial design.

RESULTS: All 160 patients completed the follow-up. The experimental group showed significantly greater improvements in key efficacy indicators: Postoperative Oswestry disability index score (8.688 vs 18.88, P < 0.0001), quality of life score (53.25 vs 38.99, P < 0.0001), and Barthel index (70.44 vs 51.63, P < 0.0001). The experimental group had a lower incidence of deep vein thrombosis (1.25% vs 10.00%, P = 0.0339) with a relative risk of 0.1250 (95% confidence interval: 0.02050-0.7421). Infection rates were lower in the experimental group (2.50% vs 11.25%, P = 0.0564). Hospital stay (5.40 days vs 7.26 days, P < 0.0001) and postoperative bed rest (3.34 days vs 5.42 days, P < 0.0001) were significantly shorter. Patient satisfaction was 100% in the experimental group vs 87.50% in the control group (P = 0.0031).

CONCLUSION: The rapid rehabilitation intervention significantly reduced pain, shortened hospital stays, and lowered complication rates, improving joint function and patient satisfaction.

PMID:39744729 | PMC:PMC11686527 | DOI:10.5312/wjo.v15.i12.1191

Front Vet Sci. 2024 Dec 18;11:1506106. doi: 10.3389/fvets.2024.1506106. eCollection 2024.

ABSTRACT

BACKGROUND: Canine gastroenteritis (CGE) is a common cause for seeking veterinary care in companion animal medicine and an area where antibiotics have been reported to be widely used. Therefore, creating relevant benchmarks for antibiotic use in CGE is important when implementing and analyzing antibiotic stewardship interventions. The aim of this paper was to describe the level and temporal trend of systemic antibiotic use for CGE in Sweden between 2020 and 2023.

MATERIALS AND METHODS: This was an observational multicenter cohort study. Retrospective data from 93,641 CGE consultations was extracted from the electronic health record and analyzed. All CGE consultations were included irrespective of age, breed, severity of disease and level of care. To evaluate the data, 100 medical records of CGE consultations were also manually reviewed using a predefined study protocol.

RESULTS: The overall level of systemic antibiotic use in Swedish dogs diagnosed with gastroenteritis was 5.7% during the study period, with aminopenicillins being the most abundantly used antibiotics (60.2%). The yearly level of antibiotic use in CGE declined from 8.1% in 2020 to 3.9% in 2023, with a statistically significant annual percentage change (APC) of -21.3% (95% CI, -22.8 to -19.7). Concurrently, the annual all-cause mortality decreased for all CGE consultations. Higher levels of antibiotic use were seen in hospitalized CGE (21.7% compared to 2.1% for non-hospitalized CGE, OR 13.1, 95% CI: 12.3-14.0, p < 0.001) and hemorrhagic diarrhetic CGE (21.0% compared to 5.5% for non-hemorrhagic diarrhetic CGE, OR 4.6, 95% CI: 4.2-4.9, p < 0.001).

CONCLUSION: This study revealed a low level and a significantly declining trend of antibiotic use in canine gastroenteritis in Sweden, implicating a high level of awareness and compliance to antibiotic guidelines among Swedish veterinarians. During the same period, the all-cause mortality rates decreased significantly for all CGE consultations, implicating that this level of antibiotic use do not compromise patient safety. Benefiting from automatic surveillance, we hereby provide important benchmarks which should encourage more prudent use of antibiotics in CGE internationally.

PMID:39744720 | PMC:PMC11688813 | DOI:10.3389/fvets.2024.1506106

Front Physiol. 2024 Dec 18;15:1498590. doi: 10.3389/fphys.2024.1498590. eCollection 2024.

ABSTRACT

OBJECTIVE: The primary aim of this study was to compare the immediate effect of contrast compression therapy with the use of Game Ready (GRT) on hyperaemic reactions in the upper limb on the application and contralateral sides, specifically in the context of mixed martial arts (MMA) athletes.

DESIGN: In this experimental, single-blind, randomized crossover study, we recruited 30 male volunteers training in MMA (mean age: 28.33 ± 3.79 years, BMI: 25.25 ± 3.06, training experience: 9.93 ± 3.83). They were randomly assigned to the experimental (n = 15) or control (sham) group (n = 15). The experimental group underwent a 10-minute Game Ready Therapy (GRT) session, while the control group GRS underwent a sham therapy session. After a 2-week break, a cross-over change of therapy in the groups was performed, ensuring a comprehensive evaluation of the contrast compression therapy’s perfusion effects in 30 participants. Main outcome measures: Hyperemic reaction was measured: rest flow (RF – [non-referent unit]); therapeutic flow (TF- [min]), i.e., the average flow recorded during GR or sham therapy: time of recovery (TR – [min]), i.e., the time for perfusion to return to the resting value after the intervention. Measurements were performed on the ipsilateral and contralateral sides.

RESULTS: The mean perfusion during therapy was significantly higher in GRT compared to GRS (24.70 ± 1.45 vs. 12.60 ± 1.37; p < 0.001; ES = 5.7 [large]; △ = 12.10 > MDC). The time from cessation of contrast therapy to the return of blood flow to resting values showed significantly higher values in GRT compared to GRS (3.07 ± 0.45 vs. 16.80 ± 0.91; p < 0.001; ES = 16.27 [large]). No statistically significant difference was noted between the mean resting perfusion value (RF) and the mean perfusion value during therapy (TF) in the contralateral limb (7.74 ± 0.89 vs. 7.66 ± 0.89; p = 0.284; ES = 0.20 [negligible]; △ = 0.09 < MDC.

CONCLUSION: This study suggests that compression contrast therapy on the ipsilateral side positively affects the intensification of the hyperaemic reaction. However, no statistically significant hyperaemic responses were observed on the contralateral side.

PMID:39744701 | PMC:PMC11688390 | DOI:10.3389/fphys.2024.1498590

Infect Dis Clin Microbiol. 2024 Dec 19;6(4):282-290. doi: 10.36519/idcm.2024.370. eCollection 2024 Dec.

ABSTRACT

OBJECTIVE: The impact of cytomegalovirus (CMV) on inflammatory bowel disease (IBD) flares remains a matter of debate. This study aimed to evaluate patients with CMV infection who presented with IBD exacerbation in terms of diagnosis and treatment and investigate the importance of CMV DNA levels in colitis development.

MATERIALS AND METHODS: Patients who were followed up with IBD and examined with clinical suspicion of CMV colitis at a university hospital between January 2016 and December 2021 were retrospectively scanned. This study included all patients who underwent colonoscopic biopsy with a preliminary diagnosis of CMV colitis and compared those with colitis detected histopathologically with those without colitis.

RESULTS: Thirty-nine patients with IBD were included in the study. No statistically significant difference was observed regarding the two groups’ demographic data, clinical findings, and outcomes. The median serum CMV DNA level in patients with CMV colitis was 104 copies/mL, which was lower than in patients without colitis (1216 copies/mL) (p=0.008). Among patients with CMV colitis, CMV DNA levels were negative or low in 16 (61.5%).

CONCLUSION: In patients with IBD, CMV colitis may not always be accompanied by CMV viremia. Therefore, negative or low serum CMV DNA levels are not sufficient to exclude CMV colitis. In case of high clinical suspicion, further examinations should be planned.

PMID:39744664 | PMC:PMC11687240 | DOI:10.36519/idcm.2024.370

Infect Dis Clin Microbiol. 2024 Dec 19;6(4):268-275. doi: 10.36519/idcm.2024.380. eCollection 2024 Dec.

ABSTRACT

OBJECTIVE: Clostridioides difficile is one of the leading causes of antibiotic-associated diarrhea. Recurrent C. difficile infection (rCDI) is significant because of prolonged hospital stays, morbidity, and additional costs. Our study aimed to examine the characteristics of C. difficile infections and investigate factors associated with recurrence.

MATERIALS AND METHODS: Adult patients with signs of acute gastroenteritis and gastrointestinal polymerase chain reaction (GI PCR) panel tests performed on stool material, and C. difficile was detected as the causative agent were included in the study. rCDI was defined as the recurrence of symptoms and re-detection of C. difficile in the GI PCR panel within eight weeks after the onset of the initial episode in patients whose symptoms improved with appropriate antimicrobial treatment. Variables in patients with and without recurrence were compared, and risk factors for recurrence were investigated.

RESULTS: A total of 59 patients with C. difficile infection (CDI) were diagnosed. The median age of patients was 75, and 57.6% were male. Forty-nine patients (83.1%) were diagnosed with the infection while hospitalized. The most commonly used treatment was metronidazole. rCDI was identified in eight patients. The presence of malignancy, hematological malignancy, development of CDI episode in the intensive care unit, and continuation of antibiotic treatment for non-C. difficile etiology after CDI diagnosis were statistically more common in the recurrence group (p<0.05). Mortality during hospitalization occurred in a total of 11 patients (18.6%).

CONCLUSION: CDI is important because of its frequent occurrence and potential for fatal outcomes. It is crucial to identify patients at risk for recurrence. In our study, the development of CDI attacks in the intensive care unit, malignancy, and continuation of antibiotic treatment for non-CDI infection after CDI diagnosis were found to be associated with recurrence. Evaluating these parameters in patient follow-up will contribute to prognostic assessment.

PMID:39744662 | PMC:PMC11687231 | DOI:10.36519/idcm.2024.380