Tag: pubmed

Int J Clin Pharm. 2021 Aug 6. doi: 10.1007/s11096-021-01314-2. Online ahead of print.

ABSTRACT

Background The American Diabetes Association recommends basal insulin or basal plus correctional insulin regimen for non-critically ill patients with type 2 diabetes mellitus unable to eat. There is limited evidence available examining ideal basal insulin dose reductions in this patient population. Aim This study aimed to determine the percent reduction of maintenance basal insulin that would provide the least hypoglycemic incidence in patients with type 2 diabetes mellitus in the non-intensive care unit setting. Methods This retrospective cohort study evaluated adult patients with type 2 diabetes mellitus prescribed outpatient basal insulin with a minimum unable to eat status of two hours. Patients were divided into four groups; <25%, 25-50%, 51-75%, > 75% of basal insulin administered compared to home dose. The primary endpoint was the incidence of hypoglycemia while unable to eat. Secondary endpoints included incidence of hyperglycemia, severe hypoglycemia, median daily blood glucose and hospital length of stay. Results A total of 173 patients were included. The primary outcome of hypoglycemia (5.9% vs. 8.8% vs. 14.3% vs. 12.3%; P = 0.578) was similar in all groups. There were no differences in hyperglycemia (P = 0.0701), severe hypoglycemia (P = 0.578) and median daily blood glucose (P = 0.428). Patients receiving 25-50% of home basal insulin had the longest unable to eat duration (11.5 h; P = 0.026); however, this was not statistically significant when adjusted using the Bonferroni correction for multiple tests. Conclusions No differences were observed in hypoglycemic events for patients unable to eat receiving various basal insulin dose reductions.

PMID:34363191 | DOI:10.1007/s11096-021-01314-2

Int J Clin Pharm. 2021 Aug 7. doi: 10.1007/s11096-021-01310-6. Online ahead of print.

ABSTRACT

Background Intravenous admixture preparation errors (IAPEs) may lead to patient harm. Insight into the prevalence as well as the determinants associated with these IAPEs is needed to elicit preventive measures. Aim The primary aim of this study was to assess the prevalence of IAPEs. Secondary aims were to identify the type, severity, and determinants of IAPEs. Method A prospective observational study was performed in a Dutch university hospital. IAPE data were collected by disguised observation. The primary outcome was the proportion of admixtures with one or more IAPEs. Descriptive statistics were used for the prevalence, type, and severity of IAPEs. Mixed-effects logistic regression analyses were used to estimate the determinants of IAPEs. Results A total of 533 IAPEs occurred in 367 of 614 admixtures (59.8%) prepared by nursing staff. The most prevalent errors were wrong preparation technique (n = 257) and wrong volume of infusion fluid (n = 107). Fifty-nine IAPEs (11.1%) were potentially harmful. The following variables were associated with IAPEs: multistep versus single-step preparations (adjusted odds ratio [OR_adj] 4.08, 95% confidence interval [CI] 2.27-7.35); interruption versus no interruption (OR_adj 2.32, CI 1.13-4.74); weekend versus weekdays (OR_adj 2.12, CI 1.14-3.95); time window 2 p.m.-6 p.m. versus 7 a.m.-10 a.m. (OR_adj 3.38, CI 1.60-7.15); and paediatric versus adult wards (OR_adj 0.14, CI 0.06-0.37). Conclusion IAPEs, including harmful IAPEs, occurred frequently. The determinants associated with IAPEs point to factors associated with preparation complexity and working conditions. Strategies to reduce the occurrence of IAPEs and therefore patient harm should target the identified determinants.

PMID:34363192 | DOI:10.1007/s11096-021-01310-6

Environ Sci Pollut Res Int. 2021 Aug 6. doi: 10.1007/s11356-021-15686-5. Online ahead of print.

ABSTRACT

The amphibian populations have faced a drastic decline over the past decades. This decline has been associated with the presence of contaminants in the environment, among other environmental stressors. The present study tested the responses following the exposure to lithium (2.5 mg L^-1) and selenium (10μg L^-1), both isolated and as a mixture, on the metabolic status of the tail muscle of premetamorphic American bullfrog (Lithobates catesbeianus) through the assessment of the total protein content, mobilization of glucose and triglycerides, and the activity of lactate dehydrogenase (LDH). The exposure followed a 21-day assay with two sampling periods (on the 7th and 21st day after the onset of exposure) to evaluate the effects over time. The group exposed to the mixture presented a statistically decreased LDH activity (P < 0.05) in both sampling periods. The presence of selenium elicited a statistically significant increase (P < 0.05) in the glucose mobilization after 7 days of exposure. After 21 days, the animals exposed to selenium presented levels of glucose mobilization comparable to the control group. The mobilization of glucose and triglycerides remained similar to the control group for the animals exposed to lithium and to the mixture in both periods of sampling (P > 0.05). The total protein content did not show any statistical difference in the treated groups throughout the experiment (P > 0.05). The presented results highlight the importance of the assessment of mixtures that can occur in the environment, since the combination of contaminants may elicit distinct toxicity compared with the effects triggered by the chemicals isolated.

PMID:34363154 | DOI:10.1007/s11356-021-15686-5

Environ Sci Pollut Res Int. 2021 Aug 6. doi: 10.1007/s11356-021-15674-9. Online ahead of print.

ABSTRACT

The floodplain wetland habitat in the lower Gangetic plains of West Bengal played a significant role in protecting from environmental degradation like pollution, lowering groundwater table, natural hazards, and others as well as supports for human wellbeing. Thus, it is needed to investigate the health status of wetlands and suggest restoration strategies to protect the livelihood patterns dependent on wetlands. This paper presents the health of the wetland ecosystem by comprising the wetland ecosystem health index (WHI) in 2011 and 2018 at the block level of Malda district, as a part of the lower Gangetic flood plain using the pressure-state-response model (PSR model) and AHP method. A total number of six Landsat satellite images and statistical census data were used to determine the wetland health. Wetlands are classified as very healthy (2.81-3.33), healthy (2.41-2.80), sub-healthy (2.01-2.40), unhealthy (1.61-2.00), and sick (0-1.60) category on the basis of the wetland ecosystem health index score. The results of this study showed that the wetlands located surrounding English Bazar, Manikchak, Ratua-II, and Kaliachak-II blocks have a sub-healthy to very healthy condition in 2011 but changed to unhealthy to sick category in 2018 due to the increase of rapid urbanization, population density, and development activities. These areas have belonged to the sub-healthy to sick category in the year 2011 as well as 2018 due to high wetland pressure. Our observation reveals that the ecosystem service value provided by wetlands decreased by 62.51% and 20.46 in the observed period. Management of WEH should emphasize on large (>100 ha) and medium (51-100 ha) sizes of wetlands in the Diara region of West Bengal. Developing local-level institutions and setting restoration goals are useful strategies to manage wetland resources, and protecting biodiversity should be guided by the Government organization and NGOs.

PMID:34363159 | DOI:10.1007/s11356-021-15674-9

Odontology. 2021 Aug 6. doi: 10.1007/s10266-021-00644-x. Online ahead of print.

ABSTRACT

This study aimed to evaluate the effect of three hydrofluoric acid (HF) etching periods on the micro-tensile bond strength between two CAD-CAM ceramic systems [Vita Suprinity (VS) and feldspathic CEREC blocs (CB)] and a composite resin. The ceramics were categorized into six groups based on the surface conditioning protocol used, as follows: G1: CB-HF 5% for 20 s; G2: CB-HF 5% for 40 s; G3: CB-HF 5% for 60 s; G4: VS-HF 5% for 20 s; G5: VS-HF 5% for 40 s; G6: VS-HF 5% for 60 s. Scotchbond Universal was applied onto the pretreated ceramic surfaces and covered with Filtek Z350 XT composite resin. After 24 h, the specimens were cut into microbars (n = 16) and a micro-tensile bond strength test (μTBS) was carried out. An optical microscope was used to examine the fractured microbars. The results showed statistically significant differences between the factors tested (p < 0.01). Moreover, the mean MPa of G1(17.27), G2(13.03), G3(12.82), G4(15.83), G5(21.66), and G6(14.50) was seen to significantly differ. The predominant failure type observed was adhesive, and all three periods of HF etching produced satisfactory bonding between the composite resin and CB. An etching time of 40 s provided the highest μTBS value for VS.

PMID:34363147 | DOI:10.1007/s10266-021-00644-x

Int Microbiol. 2021 Aug 7. doi: 10.1007/s10123-021-00199-5. Online ahead of print.

ABSTRACT

Naringin, considered as the main bitter component of grapefruit, requires the use of enzymes to reduce the level of this substance during juice processing. For this reason, it has been the focus of many studies. In this study, to increase the production of naringinase by Aspergillus niger cultivated in solid-state fermentation (SSF), a three-component simplex-centric mixing design along with a response surface methodology (RSM) was applied to generate statistical models and analyze the dataset. First, grapefruit peel, rice bran, and wheat bran were used for substrate selection for naringinase production and, finally, selected the best of the three inducers or their mixtures to remove the bitterness of grapefruit juice. Cultivation with 2.3 g of grapefruit peel, 2.5 g of rice bran, and 5.2 g of wheat bran and medium supplementation with a mixture of naringin, rutin, and hesperidin in the concentration of 2, 5, 4.5, and 3.0 g/L, respectively, resulted in a maximum activity of 28 U/mL. The results indicate that the sequencing procedure, which allowed the definition of an optimal mixture of components, is a new way for microorganisms to have a high naringinase yield, in particular by SSF, since our data showed a 96% increase in the production of naringinase. This dataset can help other researchers apply a mixing design to increase enzyme production.

PMID:34363150 | DOI:10.1007/s10123-021-00199-5

Prostate Cancer Prostatic Dis. 2021 Aug 6. doi: 10.1038/s41391-021-00433-1. Online ahead of print.

ABSTRACT

PURPOSE: Prostate cancer is a heterogeneous disease with variable clinical outcomes. Despite numerous recent approvals of novel therapies, castration-resistant prostate cancer remains lethal. A “real-world” clinical-genomic database is urgently needed to enhance our characterization of advanced prostate cancer and further enable precision oncology.

METHODS: The Prostate Cancer Precision Medicine Multi-Institutional Collaborative Effort (PROMISE) is a consortium whose aims are to establish a repository of de-identified clinical and genomic patient data that are linked to patient outcomes. The consortium structure includes a (1) bio-informatics committee to standardize genomic data and provide quality control, (2) biostatistics committee to independently perform statistical analyses, (3) executive committee to review and select proposals of relevant questions for the consortium to address, (4) diversity/inclusion committee to address important clinical questions pertaining to racial disparities, and (5) patient advocacy committee to understand patient perspectives to improve patients’ quality of care.

RESULTS: The PROMISE consortium was formed by 16 academic institutions in early 2020 and a secure RedCap database was created. The first patient record was entered into the database in April 2020 and over 1000 records have been entered as of early 2021. Data entry is proceeding as planned with the goal to have over 2500 patient records by the end of 2021.

CONCLUSIONS: The PROMISE consortium provides a powerful clinical-genomic platform to interrogate and address data gaps that have arisen with increased genomic testing in the clinical management of prostate cancer. The dataset incorporates data from patient populations that are often underrepresented in clinical trials, generates new hypotheses to direct further research, and addresses important clinical questions that are otherwise difficult to investigate in prospective studies.

PMID:34363009 | DOI:10.1038/s41391-021-00433-1

J Trop Pediatr. 2021 Jul 2;67(3):fmab060. doi: 10.1093/tropej/fmab060.

ABSTRACT

BACKGROUND: With Nigeria being one of the countries with the highest neonatal mortality rate globally, identifying the risk factors associated with neonatal mortality is essential as we strive to proffer sustainable solutions.

AIM: This retrospective hospital-based survey aimed to bridge this gap by evaluating the trends and risk factors associated with neonatal mortality in a teaching hospital in Southwestern Nigeria.

METHODS: Records of newborns admitted at the special care baby unit from January 2018 to December 2019 (n = 1098) were accessed, and available data were extracted. Descriptive analysis and inferential statistics were performed at 0.05 level of significance.

RESULTS: The mortality rate was determined to be 16.9% (inborn babies- 12.9% and out-born babies- 22.3%), with 83.3% of the newborns dying within the first week. Some of the factors associated with neonatal mortality were proximity of newborns’ mothers home to the hospital [p = 0.041; Odds Ratio (OR) = 0.670; 95% Confidence Interval (CI) = 0.455-0.985], maturity of the baby at delivery (p < 0.001; OR = 0.514; CI = 0.358-0.738), place of delivery-inborn or out-born (p < 0.001; OR = 0.515; CI = 0.375-0.709), place of delivery-in a hospital or a non-hospital setting (p = 0.048; OR = 0.633; CI = 0.401-0.999), and baby’s weight (p < 0.001; CI = -0.684 to -0.411).

CONCLUSION: Findings from the study indicate that newborns delivered at home, traditional birth attendant centres or hospitals without essential healthcare facilities have a higher mortality risk. This suggests that measures to improve the accessibility of pregnant women to essential healthcare services are a prerequisite to reducing the neonatal mortality rate in Nigeria.

PMID:34363078 | DOI:10.1093/tropej/fmab060

J Mol Model. 2021 Aug 7;27(9):239. doi: 10.1007/s00894-021-04852-8.

ABSTRACT

Protein kinases (in this case, HER-2 and EGFR) are involved in cancer-related diseases. Some reports have shown unique CoMFA models using the sum of activities expressed as pIC₅₀ (-log IC₅₀), as the classical CoMFA technique would not be the best strategy to construct models for multitarget therapy considering that the molecular alignment will not be the same for different targets. An alternative for this problem is the use of Topomer-CoMFA, a variation of CoMFA, which does not require the alignment step in the generation of 3D models. In this study, we propose the combined use of the sum of activities and Topomer-CoMFA for the construction of a unique dual 3D model considering the inhibitory activities against EGFR and HER-2. For this, 88 compounds from the literature were divided into two groups: training (71) and test (17) sets. The biological activity of each compound, expressed as IC₅₀ for EGFR and HER-2, was transformed into pIC₅₀, summed, and used as the dependent variable in the Topomer-CoMFA analyses. The obtained model was considered statistically robust in the prediction of the dual activity of new compounds. Finally, based on the obtained model, we proposed structural modifications to some of the compounds used to improve the biological data. From the 3D model, we suggested new derivative compounds with improved biological activity for both targets. Therefore, the combination of the techniques proposed in this study proves to be a good strategy to construct better statistical models that can predict biological activities in multitarget systems.

PMID:34363097 | DOI:10.1007/s00894-021-04852-8

Sci Rep. 2021 Aug 6;11(1):16014. doi: 10.1038/s41598-021-95282-2.

ABSTRACT

The ideal moment to withdraw respiratory supply of patients under Mechanical Ventilation at Intensive Care Units (ICU), is not easy to be determined for clinicians. Although the Spontaneous Breathing Trial (SBT) provides a measure of the patients’ readiness, there is still around 15-20% of predictive failure rate. This work is a proof of concept focused on adding new value to the prediction of the weaning outcome. Heart Rate Variability (HRV) and Cardiopulmonary Coupling (CPC) methods are evaluated as new complementary estimates to assess weaning readiness. The CPC is related to how the mechanisms regulating respiration and cardiac pumping are working simultaneously, and it is defined from HRV in combination with respiratory information. Three different techniques are used to estimate the CPC, including Time-Frequency Coherence, Dynamic Mutual Information and Orthogonal Subspace Projections. The cohort study includes 22 patients in pressure support ventilation, ready to undergo the SBT, analysed in the 24 h previous to the SBT. Of these, 13 had a successful weaning and 9 failed the SBT or needed reintubation -being both considered as failed weaning. Results illustrate that traditional variables such as heart rate, respiratory frequency, and the parameters derived from HRV do not differ in patients with successful or failed weaning. Results revealed that HRV parameters can vary considerably depending on the time at which they are measured. This fact could be attributed to circadian rhythms, having a strong influence on HRV values. On the contrary, significant statistical differences are found in the proposed CPC parameters when comparing the values of the two groups, and throughout the whole recordings. In addition, differences are greater at night, probably because patients with failed weaning might be experiencing more respiratory episodes, e.g. apneas during the night, which is directly related to a reduced respiratory sinus arrhythmia. Therefore, results suggest that the traditional measures could be used in combination with the proposed CPC biomarkers to improve weaning readiness.

PMID:34362950 | DOI:10.1038/s41598-021-95282-2