Tag: nevin manimala

Resuscitation. 2024 Mar 22:110189. doi: 10.1016/j.resuscitation.2024.110189. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: In case of out-of-hospital cardiac arrest (OHCA) personnel of the emergency medical services (EMS) are regularly confronted with advanced directives (AD) and do-not-attempt-resuscitation (DNACPR) orders. The authors conducted a retrospective analysis of EMS operation protocols to examine the prevalence of DNACPR in case of OHCA and the influence of a presented DNACPR on CPR-duration, performed Advanced-Life-Support (ALS) measures and decision making.

MATERIALS AND METHODS: Retrospective analysis of prehospital medical documentation of all resuscitation incidents in a German county with 250,000 inhabitants from 1 January 2016 to 31 December 2022. Combined with data from the structured CPR team-feedback database patients characteristics, measures and course of the CPR were analysed. Statistic testing with significance level p<0.05.

RESULTS: In total n=1,474 CPR events were analysed. Patients with DNACPR vs. no DNACPR: n=263 (17.8%) vs. n=1,211 (82.2%). Age: 80.0±10.3 years vs. 68.0±13.9 years; p<0.001. Patients with ASA-status III/IV: n=214 (81.3%) vs. n=616 (50.9%); p<0.001. Initial layperson-CPR: n=148 (56.3%) vs. n=647 (55.7%); p=0.86. Airway management: n=185 (70.3%) vs. n=1,069 (88.3%); p<0.001. With DNACPR CPRduration initiated layperson-CPR vs. no layperson-CPR: 19:14min (10:43-25:55min) vs. 12:40min (06:35-20:03min); p<0.001.

CONCLUSION: In case of CPR EMS-personnel are often confronted with DNACPRorders. Patients are older and have more previous diseases than patients without DNACPR. Initiated layperson-CPR might lead to misinterpretation of patients will with impact on CPR-duration and unwanted measures. Awareness of this issue should be created through measures such as training programs in particular to train staff in the interpretation and legal admissibility of ADs.

PMID:38522733 | DOI:10.1016/j.resuscitation.2024.110189

J Vasc Surg Venous Lymphat Disord. 2024 Mar 22:101874. doi: 10.1016/j.jvsv.2024.101874. Online ahead of print.

ABSTRACT

OBJECTIVE: Telangiectasias, characterized by dilated venules, are frequently observed in the lower extremities. Sclerotherapy stands out as the predominant treatment for these vascular lesions. The integration of laser therapy with a mild sclerosing agent, serving as an osmotic sclerosant, presents an enhanced cosmetic treatment approach, aiming to optimize outcomes while minimizing potential adverse effects. This study sought to evaluate the feasibility, efficacy, and safety of cryo-laser and cryo-sclerotherapy (CLaCS) and compare it with injection sclerotherapy for the treatment of telangiectasia and reticular veins.

METHODS: In this randomized controlled trial, individuals expressing concerns about telangiectasia and reticular veins were recruited for aesthetic treatment. Enrolled patients were prospectively randomized according to the chosen treatment technique. Group A included patients undergoing CLaCS treatment with 70% dextrose, focusing on a single area measuring 20 cm by 20 cm. Group B comprised patients receiving polidocanol injection sclerotherapy for a single area of the same dimensions.

RESULTS: A total of 195 patients were enrolled in Group A, while Group B comprised 197 patients. Following three treatment sessions, The rates of complete lesion elimination after first, second and third treatment sessions were 64.6%, 86.2%, and 100% in Group A and 50.3%, 74.1%, and 85.3% in group B respectively. Notably, Group A exhibited a significantly higher complete elimination rate compared to Group B at the conclusion of the study (p<0.001). Furthermore, Group A demonstrated a statistically significant lower incidence of postprocedural pigmentation and other complications when compared to Group B (p<0.001). These findings underscore the enhanced efficacy and safety profile associated with the CLaCS technique utilizing 70% dextrose in comparison to injection sclerotherapy with polidocanol.

CONCLUSION: CLaCS, combining cryo-laser and cryo-sclerotherapy, demonstrated superior efficacy and safety compared to traditional polidocanol sclerotherapy for treating telangiectasia and reticular veins.

PMID:38522666 | DOI:10.1016/j.jvsv.2024.101874

Cryobiology. 2024 Mar 22:104891. doi: 10.1016/j.cryobiol.2024.104891. Online ahead of print.

ABSTRACT

Nowadays the significant role of biobanks in medical, diagnostic, industrial, and environmental research is well known. Bacterial biobanks could be used as a good resource for designing new treatments, biomedical and industrial researches, and laboratory diagnostics. To have a collection of bacteria from clinical samples and maintain their long-term viability, their preservation needs appropriate protective agents, like cryoprotectants and lyoprotectants. In this study, we collected and characterized Gram-negative and Gram-positive bacteria carrying important antibiotic resistance markers from different clinical samples of hospitalized children. Sucrose (10%), skimmed milk (10%), skimmed milk plus sodium glutamate (10% + 1%), and bovine serum albumin (BSA, 10%) were used as lyoprotectants during the freeze-drying procedure. The survival rate of the lyophilized samples was calculated by dilution plating and measuring the colony forming unit (CFU) after 3 months of storage. The culture analysis results indicated that 25 of the 27 studied bacterial genera (Dilutions 10^-3 to 10^-6), including Shigella, Methicillin-resistant S. aureus, Acinetobacter spp., Escherichia spp., Pseudomonas spp., Klebsiella spp., Enterococcus spp., were recovered in cultured fractions from all preservation conditions, while 2 genera were only detected in a single preservation condition (2/27, 7.4%). Based on the results, sucrose (10%) and skimmed milk (10%) presented the most protective features. The survival rates varied significantly according to types of the bacteria. Collectively, our results showed a diversity in the recovery of different bacterial genera after lyophilization. While statistically no significant difference was detected among the studied protective agents, sucrose (10%) and skimmed milk (10%) exhibited more effective lyoprotective properties for both Gram-positive and Gram-negative bacteria among the clinical isolates in our study.

PMID:38522663 | DOI:10.1016/j.cryobiol.2024.104891

Biosystems. 2024 Mar 22:105193. doi: 10.1016/j.biosystems.2024.105193. Online ahead of print.

ABSTRACT

We derive the classic, ubiquitous, but enigmatic Yerkes-Dodson effect of applied stress on real-world performance in a highly natural manner from fundamental assumptions on cognition and its dynamics, as constrained by the asymptotic limit theorems of information and control theories. We greatly extend the basic approach by showing how differences in an underlying probability model can affect the dynamics of decision across a broad range of cognitive enterprise. Most particularly, however, this development may help inform our understanding of the different expressions of human psychopathology. A ‘thin tailed’ underlying distribution appears to characterize expression of ‘ordinary’ situational depression/anxiety symptoms of conditions like burnout induced by toxic stress. A ‘fat tailed’ underlying distribution appears to be associated with brain structure and function abnormalities leading to serious mental illness and poor decision making where symptoms are not only emerging in the setting of severe stress but may also appear in a highly punctuated manner at relatively lower levels of stress. A simple hierarchical optimization shows how environmental ‘shadow price’ constraints can buffer or aggravate the effects of stress and arousal. Extension of the underlying theory to other patterns of pathology, like immune disorders and premature aging, seems apt. Applications to the punctuated dynamics of institutional cognition under stress also appear possible. Ultimately, the probability models studied here can be converted to new statistical tools for the analysis of observational and experimental data.

PMID:38522638 | DOI:10.1016/j.biosystems.2024.105193

Ophthalmol Retina. 2024 Mar 22:S2468-6530(24)00121-0. doi: 10.1016/j.oret.2024.03.017. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the molecular causes of Schubert-Bornschein (S-B) congenital stationary night blindness (CSNB), clinically characterize in detail, and assess genotype-phenotype correlations for retinal function and structure.

DESIGN: Retrospective, longitudinal, single center case series.

PARTICIPANTS: 122 patients with S-B CSNB attending Moorfields Eye Hospital, United Kingdom.

METHODS: All case notes, results of molecular genetic testing, and optical coherence tomography (OCT) were reviewed.

MAIN OUTCOME MEASURES: Molecular genetics, presenting complaints, rates of nystagmus, nyctalopia, photophobia, strabismus, color vision defects and spherical error of refraction (SER). Retinal thickness, outer nuclear layer thickness (ONL) and ganglion cell layer + inner plexiform layer (GCL+IPL) thickness from OCT imaging.

RESULTS: X-linked (CACNA1F and NYX) and autosomal recessive (TRPM1, GRM6, GPR179 and CABP4) genotypes were identified. The mean reported age of onset was 4.94 ± 8.99 years. Over the follow-up period, 95.9% of patients reported reduced visual acuity (VA), half had nystagmus and 64.7% reported nyctalopia. Incomplete CSNB (iCSNB) patients more frequently had nystagmus and photophobia. Nyctalopia was similar for iCSNB and complete CSNB (cCSNB). Color vision data was limited but more defects were found in iCSNB. None of these clinical differences met statistical significance. There was no significant difference between groups in VA, with a mean of 0.46 LogMAR, and remained stable over the course of follow-up. cCSNB patients, specifically those with NYX and TRPM1 variants, were more myopic. CACNA1F patients showed the largest refractive variability and the CABP4 patient was hyperopic. No significant differences were found in OCT structural analysis during the follow-up period.

CONCLUSIONS: Retinal structure in CSNB is stationary and no specific genotype – structure correlates were identified. VA appears to be relatively stable, with rare instances of progression.

PMID:38522615 | DOI:10.1016/j.oret.2024.03.017

Environ Pollut. 2024 Mar 22:123849. doi: 10.1016/j.envpol.2024.123849. Online ahead of print.

ABSTRACT

Urban streams that receive untreated domestic and hospital waste can transmit infectious diseases and spread drug residues, including antimicrobials, which can then increase the selection of antimicrobial-resistant bacteria. Here, water samples were collected from three different urban streams in the state of São Paulo, Brazil, to relate their range of Water Quality Indices (WQIs) to the diversity and composition of aquatic microbial taxa, virulence genes (virulome), and antimicrobial resistance determinants (resistome), all assessed using untargeted metagenome sequencing. There was a predominance of phyla Proteobacteria, Actinobacteria, and Bacteroidetes in all samples, and Pseudomonas was the most abundant detected genus. Virulence genes associated with motility, adherence, and secretion systems were highly abundant and mainly associated with Pseudomonas aeruginosa. Furthermore, some opportunistic pathogenic genera had negative correlations with WQI. Many clinically relevant antimicrobial resistance genes (ARGs) and efflux pump-encoding genes that confer resistance to critically important antimicrobials were detected. The highest relative abundances of ARGs were β-lactams and macrolide-lincosamide-streptogramin. No statistically supported relationship was detected between the abundance of virulome/resistome and collection type/WQI. On the other hand, total solids were a weak predictor of gene abundance patterns. These results provide insights into various microbial outcomes given urban stream quality and point to its ecological complexity. In addition, this study suggests potential consequences for human health as mediated by aquatic microbial communities responding to typical urban outputs.

PMID:38522607 | DOI:10.1016/j.envpol.2024.123849

Environ Pollut. 2024 Mar 22:123807. doi: 10.1016/j.envpol.2024.123807. Online ahead of print.

ABSTRACT

This article contributes to the scant literature exploring the determinants of methane emissions. A lot is explored considering CO₂ emissions, but fewer studies concentrate on the other most long-lived greenhouse gas (GHG), methane which contributes largely to climate change. For the empirical analysis, a large dataset is used considering 192 countries with data ranging from 1960 up to 2022 and considering a wide set of determinants (total central government debt, domestic credit to the private sector, exports of goods and services, GDP per capita, total unemployment, renewable energy consumption, urban population, Gini Index, and Voice and Accountability). Panel Quantile Regression (PQR) estimates show a non-negligible statistical effect of all the selected variables (except for the Gini Index) over the distribution’s quantiles. Moreover, the Simple Regression Tree (SRT) model allows us to observe that the losing countries, located in the poorest world regions, abundant in natural resources, are those expected to curb methane emissions. For that, public interventions like digitalization, green education, green financing, ensuring the increase in Voice and Accountability, and green jobs, would lead losers to be positioned in the winner’s rankings and would ensure an effective fight against climate change.

PMID:38522606 | DOI:10.1016/j.envpol.2024.123807

Calcif Tissue Int. 2024 Mar 24. doi: 10.1007/s00223-024-01198-0. Online ahead of print.

ABSTRACT

Peak bone mineral density (BMD) is one of the most important factors influencing the development of osteoporosis. It was predicted that a 10% increase in peak BMD will delay the onset of osteoporosis by 13 years. However, changes in peak BMD over time are unknown. This study aimed to investigate secular trends in peak BMD among young adults in the United States. Based on the National Health and Nutrition Examination Survey from 1999-2018, 3,975 males aged 19-28 years and 2370 females aged 31-40 years were our target population for estimating peak lumbar spine BMD. BMD was measured by dual-energy X-ray absorptiometry. Generalized linear models adjusted for multiple covariates were used to examine the secular trends in peak BMD in males and females, respectively. Secular trends for peak lumbar spine BMD from 1999-2000 to 2017-2018 were not statistically significant in males or females (all P_linear and P_quadratic > 0.05). Similar results were observed in race/ethnicity subgroups (all P_linear and P_quadratic > 0.05). However, in stratified analyses by obesity category, peak lumbar spine BMD in obese males and females increased from 1999-2000 to 2009-2010 and then decreased until 2017-2018, while peak lumbar spine BMD in non-obese females decreased from 1999-2000 to 2005-2006 and then increased until 2017-2018 (all P_quadratic < 0.05). Peak lumbar spine BMD was greater in obese males and females than in non-obese males and females up to 2009-2010, but not from 2011-2012 onwards. Overall, there were no significant secular trends in peak lumbar spine BMD. However, secular trends differed between obese and non-obese groups.

PMID:38522039 | DOI:10.1007/s00223-024-01198-0

Mol Nutr Food Res. 2024 Mar 24:e2300770. doi: 10.1002/mnfr.202300770. Online ahead of print.

ABSTRACT

SCOPE: Gastro-AD (GAD) is a soy flour derived product that undergoes an industrial fermentation with Lactobacillus delbrueckii R0187 and has demonstrated clinical effects in gastroesophageal reflux and peptic ulcer symptom resolution. The aim of this study is to describe and link GAD’s metabolomic profile to plausible mechanisms that manifest and explain the documented clinical outcomes.

METHODS AND RESULTS: ¹H NMR spectroscopy with multivariate statistical analysis is used to characterize the prefermented soy flour and GAD products. The acquired spectra are screened using various resources and the molecular assignments are confirmed using total correlation spectroscopy (TOCSY). Peaks corresponding to different metabolites are integrated and compared between the two products for relative changes. HPLC and GC are used to quantify some specific molecules. NMR analyses demonstrate significant changes in the composition of various assigned bioactive moieties. HPLC and GC analysis demonstrate deglycation of isoflavones after fermentation, resulting in estrogenically active secondary metabolites that have been previously shown to help to reduce inflammation.

CONCLUSION: The identification of bioactive molecules, such as genistein and SCFAs, capable of modulating anti-inflammatory signaling cascades in the stomach’s gastric and neuroendocrine tissues can explain the reported biological effects in GAD and is supported by in vivo data.

PMID:38522032 | DOI:10.1002/mnfr.202300770

Nutr Clin Pract. 2024 Mar 24. doi: 10.1002/ncp.11143. Online ahead of print.

ABSTRACT

BACKGROUND: Enteral nutrition (EN) support therapy increases the risk of abnormal blood glucose (BG). The aim of this study is to evaluate the clinical value of a real-time continuous glucose monitoring (rt-CGM) system in BG monitoring during postoperative EN support therapy in patients with esophageal cancer.

METHODS: Patients without diabetes mellitus (DM) with esophageal cancer who planned to receive postoperative EN were enrolled. With the self-monitoring of BG value as the reference BG, the accuracy of rt-CGM was evaluated by the mean absolute relative difference (MARD) value, correlation efficient, agreement analysis, and Parkes and Clarke error grid plot. Finally, paired t tests were used to compare the differences in glucose fluctuations between EN and non-EN days and slow and fast days.

RESULTS: The total MARD value of the rt-CGM system was 13.53%. There was a high correlation between interstitial glucose and fingertip capillary BG (consistency correlation efficient = 0.884 [95% confidence interval, 0.874-0.894]). Results of 15/15%, 20/20%, 30/30% agreement analysis were 58.51%, 84.71%, and 99.65%, respectively. The Parkes and Clarke error grid showed that the proportion of the A and B regions were 100% and 99.94%, respectively. The glucose fluctuations on EN days vs non-EN days and on fast days vs slow days were large, and the difference was statistically significant (P < 0.001).

CONCLUSION: The rt-CGM system achieved clinical accuracy and can be used as a new option for glucose monitoring during postoperative EN therapy. The magnitude of glucose fluctuation during EN therapy remains large, even in the postoperative population without DM.

PMID:38522023 | DOI:10.1002/ncp.11143