Tag: pubmed

J Infect Dev Ctries. 2024 Dec 30;18(12):1909-1915. doi: 10.3855/jidc.19794.

ABSTRACT

INTRODUCTION: Appropriate antibiotic use requires using the right antibiotic, at the right dose, for the right duration, and at the right time. Drug-resistant diseases cause numerous deaths globally a year, and antibiotic stewardship is a cornerstone in fighting antibiotic resistance. This study focuses on tracking the antibiotic prescribing practices in Palestine and improving future antibiotic prescribing.

METHODOLOGY: Data from prescriptions of the most commonly prescribed antibiotics was collected from the Health Department of Ramallah and Al-Bireh clinics between January 1 to March 31, 2020. The prescriptions were divided into three categories according to the diagnosis status: unwritten, unspecific, and precise diagnosis. The precise prescriptions were further divided into two categories: appropriate or inappropriate indication. Only appropriate prescriptions were candidates for the assessment of dose and duration appropriateness.

RESULTS: The percentages of the three categories of diagnosis precise, unspecific, and unwritten were 23.4%, 20.4%, and 56.2%, respectively. The percentage of appropriate prescriptions was 16.2%. Azithromycin was the most over-utilized antibiotic, followed by co-amoxiclav (amoxicillin/clavulanic acid). Amoxicillin and co-trimoxazole (trimethoprim/sulfamethoxazole) were under-prescribed. All the prescriptions indicated for urinary tract infections (UTIs) were inappropriate.

CONCLUSIONS: Most prescriptions were not candidates for analysis due to missing diagnosis. Amoxicillin, co-amoxiclav, cefuroxime, azithromycin, and ciprofloxacin were the most commonly prescribed antibiotics and were mostly indicated for pharyngitis. The duration of all sinusitis regimens was inappropriate. More rational antibiotic use in the Department of Health could be achieved by improving documentation, following updated guidelines, choosing cost-effective agents, and keeping track of local resistance patterns and antibiograms.

PMID:39832250 | DOI:10.3855/jidc.19794

J Infect Dev Ctries. 2024 Dec 30;18(12):1899-1908. doi: 10.3855/jidc.19592.

ABSTRACT

INTRODUCTION: Antimicrobial resistance remains a global threat with increasing morbidity and mortality rates. The aim of this study was to identify the antimicrobial resistance trends among ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) isolated from clinical samples at a Health Practice and Research Hospital over five years.

METHODOLOGY: Microbiological diagnosis utilized classical culture methods and automated systems. Antimicrobial susceptibility analysis was conducted using BD Phoenix, adhering to European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards.

RESULTS: A total of 15,272 clinical strains of ESKAPE pathogens were identified in this study. The most frequently isolated pathogens among ESKAPE were K. pneumoniae (3.938, 27.79%), Acinetobacter baumannii (3,013, 19.73%) and Enterococcus faecium (2,966, 19.24%). Bacterial strains were isolated predominantly from urine (3,263, 21.37%), followed by blood cultures (3,099, 20.29%). ESKAPE pathogens were most commonly found in internal intensive care units (4,758, 31.16%), followed by surgical intensive care units (4,000, 26.19%). Reduced resistance rates were observed for most antibiotics against Enterococcus faecium and Staphylococcus aureus. The vancomycin resistance rate for Enterococcus faecium was 18.48%, and the methicillin resistance rate for Staphylococcus aureus was 44.87%. A concerning trend of increasing antimicrobial resistance was noted in Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.

CONCLUSIONS: The alarming rise in antimicrobial resistance among Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae is a significant concern. The high rates of antimicrobial resistance observed in ESKAPE pathogens underscore the urgent need for improvement in antimicrobial stewardship and infection prevention and control programs.

PMID:39832249 | DOI:10.3855/jidc.19592

J Infect Dev Ctries. 2024 Dec 30;18(12):1846-1854. doi: 10.3855/jidc.19368.

ABSTRACT

INTRODUCTION: Post-COVID-19 syndrome refers to the occurrence of symptoms lasting more than 4 weeks in individuals who have recovered from COVID-19. This study aims to investigate the post-COVID-19 symptoms in healthcare professionals.

METHODOLOGY: This descriptive study included 166 healthcare professionals who had tested positive for COVID-19 via PCR at least four weeks prior and subsequently presented to the Family Medicine Clinic at Pamukkale University Training and Research Hospital. Participants` demographic data, medical history, COVID-19 history and ongoing or newly emerged complaints and symptoms were evaluated, and physical examinations were carried out and recorded on a patient information form. Blood tests were conducted, and the results were analyzed.

RESULTS: The most common post-COVID-19 symptoms and complaints observed in our study were difficulty in performing daily activities (32.5%; n = 54), fatigue (26.5%; n = 44), forgetfulness (25.9%; n = 43) and weakness (24.1%; n = 40), respectively. Smoking, alcohol use, hospitalization, the need for oxygen support and having comorbidities such as asthma, diabetes, hypertension and rheumatism were found to be associated with various post-acute symptoms. Post-acute symptoms were most frequently observed in individuals vaccinated with Sinovac (38.5%), followed by those who were unvaccinated (35.7%). Least symptoms were seen in individuals vaccinated with only Biontech (15.4%).

CONCLUSIONS: The most common post-COVID-19 symptoms observed in our study were difficulty in performing daily activities, fatigue, forgetfulness and weakness. Having comorbidities was found to be associated with various post-COVID-19 symptoms.

PMID:39832242 | DOI:10.3855/jidc.19368

J Food Sci. 2025 Jan;90(1):e70015. doi: 10.1111/1750-3841.70015.

ABSTRACT

This study aimed to investigate the potential hypoglycemic mechanism of red ginseng acidic polysaccharides (RGAP) from the perspective of fatty acid (FA) regulation. A high-glucose/high-fat diet in conjunction with streptozotocin administration was employed to establish type 2 diabetes mellitus (T2DM) rat models, and their fecal FAs were detected using the liquid chromatography-mass spectrometry (LC-MS) method. RGAP treatment alleviated the polyphagia, polydipsia, weight loss, and hyperglycemia observed in T2DM rats. FA profile was disturbed by T2DM modeling, and 11 marker FAs were selected from statistical analysis, whose intensities were reversely changed by RGAP administration. Among these marker FAs, short-chain FAs were negatively correlated with the fasting blood glucose (FBG) level, while positive correlations were observed between long-chain FA and the FBG level. Combined with the metabolite-enzyme-gene network analysis, we inferred that the mechanistic mechanism RGAP on T2DM may be associated with the regulation of FA metabolism and inflammation-related signaling pathways. This study confirmed the regulatory effect of RGAP on fecal FA, which can provide a scientific basis and new ideas for developing red ginseng as a functional food for supplementary treatment of T2DM.

PMID:39832227 | DOI:10.1111/1750-3841.70015

Europace. 2024 Dec 26;27(1):euae211. doi: 10.1093/europace/euae211.

ABSTRACT

AIMS: Trials on integrated care for atrial fibrillation (AF) showed mixed results in different AF populations using various approaches. The multicentre, randomized AF-EduCare trial evaluated the effect of targeted patient education on unplanned cardiovascular outcomes.

METHODS AND RESULTS: Patients willing to participate were randomly assigned to in-person education, online education, or standard care (SC) and followed for minimum 18 months. Education focused on four aspects of integrated AF care: (i) knowledge on AF and oral anticoagulation; (ii) reinforcement of medication adherence; (iii) awareness about risk factors; and (iv) reachability for AF-related questions. The primary endpoint was the composite of cumulative events of unplanned cardiovascular hospitalizations and consultations, emergency department visits for cardiovascular reasons, and cardiovascular death. A total of 1038 patients (69.8 ± 9.2 years) were followed up for 26.9 ± 9.4 months. Education (both in-person and online) significantly improved AF-related knowledge compared to SC (P < 0.001), increased patient awareness about risk factors, led to high medication adherence, and encouraged patients to ask health-related questions. However, in-person education did not show an effect on the primary outcome compared to SC [HR 1.02 (0.91-1.14); P = 0.80] that was also not the case when comparing online education vs. SC [HR 1.18 (0.95-1.46), P = 0.65]. Exploratory subgroup analyses showed a heterogeneous effect over the centres, but a positive impact of in-person education in patients with asymptomatic AF, being 70 years old or younger, and without a history of heart failure.

CONCLUSION: AF-EduCare showed that intensive targeted patient education did not lead to less unplanned cardiovascular events in the AF patient population as a whole, although subgroups might benefit.

PMID:39832209 | DOI:10.1093/europace/euae211

Cardiol Ther. 2025 Jan 18. doi: 10.1007/s40119-024-00393-2. Online ahead of print.

ABSTRACT

INTRODUCTION: This prospective, single-arm pharmacodynamic study assessed the effect of colchicine (COLC) [Strides Pharma UK Ltd, Watford, Hertfordshire, England] 0.5 mg administered orally once daily for 14 days on platelet reactivity with respect to aspirin reaction units (ARUs) and P2Y₁₂ reaction units (PRUs).

METHODS: Twenty-two patients with stable coronary artery disease (CAD) on dual antiplatelet therapy (DAPT) with daily maintenance aspirin and clopidogrel were recruited. Baseline platelet function was evaluated with the VerifyNow™ ARU and PRU assays (Werfen, Bedford, MA, USA) and assessed post-completion of COLC 0.5 mg once daily for 14 days.

RESULTS: In this study, the median ARU baseline score was 463, and post-COLC it was 436, which was not statistically significant (p = 0.485). The mean difference in scores was -18.31 (95% confidence interval [CI] -74.34 to 37.71, p = 0.504). At baseline, 27.3% of the patients had “aspirin resistance” or were non-responders, compared to 13.6% post-COLC (p = 0.423). The median baseline PRU score was 210, and post-COLC it was 199, which was also not statistically significant (p = 0.581). The mean difference in scores was -7.31 (95% CI -31.1 to 16.5, p = 0.530). At baseline, 50% of the patients had “clopidogrel resistance” or were non-responders, compared to 45.5% post-COLC (p = 0.999). Two patients experienced mild gastrointestinal upset during the trial without interruption of COLC, and there were no serious adverse events or treatment-emergent adverse events.

CONCLUSIONS: There were no significant differences in ARUs and PRUs post-COLC trial in patients with stable CAD. This pilot pharmacodynamic study could be clinically informative in patients on DAPT. Further studies are required to confirm these exploratory findings.

TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT06567678, prospectively registered 20/8/2024.

PMID:39826082 | DOI:10.1007/s40119-024-00393-2

J Mol Model. 2025 Jan 18;31(2):53. doi: 10.1007/s00894-024-06254-y.

ABSTRACT

CONTEXT: Ionization and adsorption in gas discharge are similar to electrophilic and nucleophilic reactions. The molecular descriptors characterizing reactions such as electrostatic potential descriptors are useful in predicting the electrical strength of environmentally friendly gases. In this study, descriptors of 73 molecules are employed for correlation analysis with electrical strength. These molecular descriptors are categorized into two types: area-related descriptors and reactivity-related descriptors. Furthermore, the predictive performance between statistical models and machine learning models is compared. The statistical models include multiple linear regression, and polynomial regression, while machine learning models consist of K-nearest neighbors, random forest, and gradient boosting decision trees. The results indicate that machine learning models are generally better than statistical models in terms of predictive accuracy and stability, with gradient boosting decision trees demonstrating the best performance. Specifically, the coefficient of determination and mean squared error on the testing set after 1000 training iterations are 0.864 and 0.105, respectively. Therefore, the application of molecular reactivity descriptors and machine learning methods can effectively predict the electrical strength of gaseous medium.

METHODS: The Gaussian 16 software is employed to optimize the molecular structure with the M06-2X functional and def2 series basis sets in this study. Then, the Multiwfn is utilized for wavefunction analysis to obtain molecular surface descriptors.

PMID:39826053 | DOI:10.1007/s00894-024-06254-y

Updates Surg. 2025 Jan 18. doi: 10.1007/s13304-025-02071-x. Online ahead of print.

ABSTRACT

The surgical risk is higher for obese patients undergoing laparoscopic left hemicolectomy. To enhance the surgical safety and efficacy for obese patients, we have innovatively integrated the advantages of various surgical approaches to modify a pancreas-guided C-shaped surgical procedure. The safety and quality were assessed through a retrospective analysis. Colon cancer patients who underwent laparoscopic left hemicolectomy were categorized into two groups, C-shaped group and Medial-to-lateral group. Baseline data, operative safety indices, operative quality indices and learning curve were subjected to statistical analysis. The complete mesocolic excision rate and R0 resection rate were 100% in both groups. In terms of surgical safety, C-shaped group experienced significantly less blood loss (50(20) mL vs. 50(50) mL, p = 0.002), shorter total operative time (252.65 ± 50.43 min vs. 280.12 ± 70.45 min, p = 0.004) and no organ damage occurred. All patients were classified into four BMI grades (I: BMI < 18.5 kg/m²; II: 18.5 ≤ BMI < 24 kg/m²; III: 24 ≤ BMI < 28 kg/m²; IV: BMI ≥ 28 kg/m²). The total operative time and estimated blood loss were significantly lower in obese patients (BMI grade III and IV) of C-shaped group. In addition, intra-group analysis further confirmed that this modified surgical technique could effectively enhance safety and efficiency for obese patients. Learning curve analysis revealed a significant reduction in total operative time after the completion of 20 surgeries. Utilization of the pancreas-guided C-shaped surgical procedure in obese patients ensures reliable surgical outcomes and significantly increases safety and efficiency. In addition, it is easier to learn and master.

PMID:39826041 | DOI:10.1007/s13304-025-02071-x

Intensive Care Med Exp. 2025 Jan 18;13(1):7. doi: 10.1186/s40635-025-00716-0.

ABSTRACT

PURPOSE: CytoSorb® (CS) adsorbent is a hemoadsorption filter for extracorporeal blood purification often integrated into continuous kidney replacement therapy (CKRT). It is primarily used in critically ill patients with sepsis and related conditions, including cytokine storms and systemic inflammatory responses. Up to now, there is no evidence nor recommendation for the use of CS filters in sepsis (22). There is limited clinical data on the effect of CS on the plasma concentrations of beta-lactams. We aimed to evaluate the statistical and clinical impact of CS in a post-filter CKRT-CS setting on the plasma concentrations of the antibiotics meropenem and piperacillin in critically ill patients.

METHODS: Patients admitted to the intensive care unit (ICU) who received a prolonged infusion of piperacillin or meropenem with CS-combined CKRT were included in this retrospective analysis. TDM (therapeutic drug monitoring) plasma blood samples were collected at three different points. The differences in antibiotic concentrations between Pre, Intra, and Post were statistically compared to evaluate the total and isolated contributions of CKRT and CS to antibiotic removal. CS, CKRT and combined clearance (CL) values were calculated. The hypothesis was that the CS filter would have no clinically relevant impact on antibiotic levels.

RESULTS: 207 TDM samples were taken from 24 critically ill patients requiring beta-lactam antibiotics. Among these, 129 were meropenem samples, and 78 were piperacillin samples. A decrease in both antibiotic levels was observed between Pre and Intra, and Pre and Post, and the median relative difference between was >15% (meropenem: Pre-Intra 34.8%, Pre-Post 35.8%; piperacillin: Pre-Intra 41.1%, Pre-Post 34.7%), indicating a statistically and clinically significant effect of CKRT on both antibiotic exposures. No significant difference was observed between Intra and Post indicating no clinically relevant drug removal via the CS filter. Changes in CL attributed to CS were minimal, with combined CL differing by ≤8.60% compared to CKRT clearance.

CONCLUSION: The application of CS does not appear to significantly affect plasma concentrations of meropenem and piperacillin in critically ill patients.

PMID:39826040 | DOI:10.1186/s40635-025-00716-0

Clin Exp Nephrol. 2025 Jan 18. doi: 10.1007/s10157-024-02623-2. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have suggested a potential role of estrogen in the pathophysiology of chronic kidney disease (CKD); however, the association and causality between estrogen and kidney function remain unclear.

METHODS: The cross-sectional correlation between serum estradiol concentration and estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) was analyzed using data from the National Health and Nutrition Examination Survey 2013-2016. Causality was tested using mutual bidirectional Mendelian randomization (MR) approaches based on six large-scale GWAS studies. Weighted generalized multivariate linear regression was employed to estimate the association between estradiol and eGFR and ACR, and a restricted cubic spline analysis was utilized to investigate potential nonlinear relationships.

RESULTS: A total of 8932 participants were included. Serum estradiol concentration was positively associated with eGFR after adjusting for potential covariates (β, 0.76; 95% CI 0.24 to 1.27) and with ACR (β, 5.99; 95% CI 1.62 to 10.36). A nonlinear positive association was found between estradiol and eGFR, while an inverse “V”-shaped relationship was seen with ACR. Sensitivity analyses confirmed the stability of the relationship between estradiol and eGFR but indicated a less robust association with ACR. Stratified analysis showed that the association between estradiol and eGFR was particularly significant in populations with CKD and hypertension. All forward MR analyses demonstrated a positive causal relationship between estradiol and eGFR, but no causality was found between estradiol and ACR. No reverse causal association was observed.

CONCLUSIONS: Serum estradiol concentration was causally associated with eGFR. Further longitudinal research is needed to validate these findings.

PMID:39826006 | DOI:10.1007/s10157-024-02623-2