RESUMEN

Background: Frailty has been identified as an independent predictor of mortality in the elderly. We investigated the effects of frailty status on in-hospital outcomes of acute colonic diverticulitis (ACD) in the elderly, using the Hospital Frailty Risk Score. Methods: We used the National Inpatient Sample (NIS) databases from 2016-2020 to identify patients aged ≥75 years hospitalized with ACD. Using a 1:1 matching method, we created propensity-matched cohorts of frail (Hospital Frailty Risk Score ≥5) and non-frail (Hospital Frailty Risk Score ≤4) patients within the ACD population. Results: We identified 53.3% ACD patients as frail. We matched 21,720 frail ACD patients to an equal number of non-frail ACD patients using propensity score matching. Frail patients exhibited significantly higher mortality rates, longer hospital stays, and greater median inpatient costs. Frail patients also experienced a greater number of complications, including abscess formation, intestinal perforation, gastrointestinal fistula formation, sepsis without shock, sepsis with shock, acute kidney injury, hypovolemic or hemorrhagic shock, need for blood transfusion, cardiac arrest, and need for intensive care (all P-values <0.001). Additionally, frail patients underwent open colectomy and colostomy procedures more frequently, while laparoscopic colectomies were performed less frequently (all P-values <0.001). Conclusions: In this nationwide analysis, frailty in ACD is strongly associated with worse mortality, longer hospital stays and higher costs, as well as a greater incidence of local and systemic complications. Furthermore, frailty is linked to a greater need for open colectomy and colostomy procedures.

RESUMEN

Thiacloprid, a hazardous neonicotinoid insecticide, prevalent in daily agricultural practices, raises concerns due to the harmful effects of its residues on food items, and on unintended organisms poses a significant threat to human health. Introduced in 1990, Thiacloprid have gained popularity for its perceived effectiveness and reduced risks to non-target animals. However, emerging research in recent years reports significant toxic effects of Thiacloprid on non-target species, spanning neurotoxicity, immunotoxicity, hepatotoxicity, nephrotoxicity, and reproductive issues. Mammalian studies, particularly involving rodents, reveal cognitive impairment, hippocampal damage, and hepatic abnormalities upon Thiacloprid exposure. Reproductive toxicity and DNA damage are imminent concerns, disrupting gestational epigenetic reprogramming and suggesting persistent effects on future generations. Genotoxic effects, Embryotoxic, and observed reproductive toxicity accentuate the need for caution in the utilization of Thiacloprid. This review highlights reported toxic effects produced by Thiacloprid in recent years, challenging the initial belief in its lower toxicity for vertebrates.

Asunto(s)

RESUMEN

BACKGROUND: Composite Autonomic Symptom Score-31 (COMPASS-31) is an easy-to-use screening tool for the evaluation of autonomic dysfunction in various diseases affecting neural function but has rarely been used in the assessment of long coronavirus disease 2019 (COVID-19). This study aimed to evaluate the diagnostic accuracy of the COMPASS-31 score in detecting dysfunction of the autonomic nervous system in patients 3 months after COVID-19 infection. MATERIALS AND METHODS: Fifty-nine subjects were recruited and grouped into 2: (a) controls (n = 31) who had never had positive polymerase chain reaction results for COVID-19 before and (b) the post-COVID-19 patients (n = 28) who had confirmed COVID-19 infection 3-6 months before recruitment. COMPASS-31 questionnaire was utilized to evaluate subjective symptoms or evidence of autonomic dysfunction. Autonomic dysfunction was assessed objectively by cardiovascular autonomic reflex tests (CARTs) and heart rate variability (HRV). For comparison of quantitative variables between two groups, t-test or Mann-Whitney U test, as appropriate, were used. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), negative likelihood ratio (LR), and positive LR were used as measures of diagnostic accuracy. Receiver operating characteristic (ROC) curve analysis determined the overall accuracy of COMPASS-31. RESULTS: The median COMPASS score was found to be significantly higher in post-COVID-19 participants than controls (15.5 vs. 10, P = 0.021). The median total CART score was also significantly higher in post-COVID-19 participants (0 vs. 1, P < 0.001). Out of 6 domains of the COMPASS score, the median value for orthostatic dysfunction was found to be significantly higher in post-COVID-19 participants than controls (12 vs. 0, P = 0.008). There was significantly fair accuracy of the COMPASS score with an area under the receiver operating curve 0.68 (0.54-0.82) following the total CART score ≥2 as the gold standard in the diagnosis of autonomic dysfunction (P = 0.021). The best cutoff point of the total COMPASS score was 12.5, where the optimal values of sensitivity, specificity, and positive and negative predictive values were achieved. Nonsignificant and weak correlations between CARTs, HRV parameters, and COMPASS score were found. CONCLUSION: COMPASS-31 could be used as a user-friendly screening tool to detect autonomic dysfunction in post-COVID-19 cases with acceptable sensitivity and specificity.

RESUMEN

Background: Wide QRS complex (QRS) tachycardia in patients with atrial fibrillation (AF) or atrial flutter treated with antiarrhythmic drugs can occur for a variety of reasons and needs careful evaluation for appropriate management of the patient. Case summary: We report a case of wide QRS complex tachycardia in a patient with AF treated with Flecainide who received multiple external cardioversion attempts for a presumed diagnosis of ventricular tachycardia. Intravenous Diltiazem and an oral beta-blocker led to the resolution of wide QRS complex tachycardia. Discussion: Wide QRS tachycardia due to pro-arrhythmic effect or rate-dependency phenomenon of antiarrhythmic agents should be included in the differentials. In this brief report, we discuss the differential diagnosis and outline a practical approach for acute and long-term management of these patients.

RESUMEN

Parkinson's disease (PD) is a widely seen neurodegenerative condition recognized by misfolded α-synuclein (αSyn) protein, a prominent indicator for PD and other synucleinopathies. Motor symptoms like stiffness, akinesia, rest tremor, and postural instability coexist with nonmotor symptoms that differ from person to person in the development of PD. These symptoms arise from a progressive loss of synapses and neurons, leading to a widespread degenerative process in multiple organs. Implementing medical and surgical interventions, such as deep brain stimulation, has enhanced individuals' overall well-being and long-term survival with PD. It should be mentioned that these treatments cannot stop the condition from getting worse. The complicated structure of the brain and the existence of a semi-permeable barrier, commonly known as the BBB, have traditionally made medication delivery for the treatment of PD a challenging endeavor. The drug's low lipophilic nature, enormous size, and peculiarity for various ATP-dependent transport mechanisms hinder its ability to enter brain cells. This article delves at the potential of drug delivery systems based on chitosan (CS) to treat PD.

RESUMEN

OBJECTIVE: To investigate the efficacy of adding 0.5 micrograms/kg of dexmedetomidine to 0.2% ropivacaine in erector spinae plane block in terms of 24-hour opioid consumption after lumbar spine surgeries. STUDY DESIGN: A randomised controlled trial. Place and Duration of the Study: The Security Forces Hospital, Riyadh, Saudi Arabia, from 30th November 2022 to 30th March 2023. METHODOLOGY: Patients aged between 18-70 years, ASA 1-3 who were booked to undergo lumbar spine surgeries under general anaesthesia were inducted. Patients in the intervention group received erector spinae plane block (ESPB). Exclusion criteria were patient refusal, inability to give consent, patients with contraindications to regional anaesthesia, known allergy to study medications, inability to use patient-controlled analgesia (PCA), psychiatric disorders or patients using any psychiatric medications. The primary outcome measure of the study was 24-hour opioid consumption. RESULTS: The numeric rating scale (NRS) pain scores were significantly decreased in the ESPB-D group at 30 minutes (p = 0.042), at 1 hour (p = 0.018), at 2 hours (p = 0.044), at 12 hours (p = 0.039), at 18 hours (p = 0.011), and at 24 hours (p = 0.020). Intraoperative use of remifentanil was also significantly lower in the ESPB-D group (p <0.01). ESPB using dexmedetomidine also reduced opioid consumption over a period of 24 hours (p <0.01). Median patient satisfaction score and median ease of mobility were also significantly better in the ESPB-D group. CONCLUSION: Addition of dexmedetomidine in erector spinae plane block reduced pain scores and intraoperative and postoperative opioid consumption after lumbar spine surgery. KEY WORDS: Dexmedetomidine, Erector spinae plane block, Lumbar spine surgery, Opioid consumption, Pain control.

Asunto(s)

RESUMEN

Momordica charantia, commonly known as bitter melon, is a fruiting plant that has been used for several diseases including infectious diseases. In this study, we report the antibacterial, antifungal, and antiviral activity of different bitter melon fruit parts originating from India and Saudi Arabia. The in vitro experiments are supported by the molecular docking of karavilosides to verify their role in the bioactivity. The antimicrobial assays revealed activity against Candida albicans, Escherichia coli, and Staphylococcus aureus. The extracts exhibited the potent inhibition of HIV-I reverse transcriptase, with an IC50 of 0.125 mg/mL observed for the pith extract originating from Saudi Arabia and the standard drug doxorubicin. The molecular docking of karavilosides exhibited a significant affinity to reverse transcriptase comparable to Rilpivirine and higher than that of doxorubicin. These outcomes encourage the precious bioactive components of the seed and pith of the Saudi bitter melon fruits to be further studied for isolation and structure elucidation.

RESUMEN

As the prevalence of leadless pacemaker systems increases, identifying various methodologies for retrieval of these devices in certain instances becomes even more paramount. We describe a case demonstrating the utility of a coronary guide catheter as part of an improvised sheath-in-sheath technique for the challenging retrieval of a Micra™ leadless pacing system (Medtronic, Minneapolis, MN, USA).

RESUMEN

Bisphenol A (BPA) is a ubiquitous industrial chemical used in the production of polycarbonate plastics and epoxy resins, found in numerous consumer products. Despite its widespread use, its potential adverse health effects have raised significant concerns. This review explores the molecular mechanisms and evidence-based literature underlying BPA-induced toxicities and its implications for human health. BPA is an endocrine-disrupting chemical (EDC) which exhibits carcinogenic properties by influencing various receptors, such as ER, AhR, PPARs, LXRs, and RARs. It induces oxidative stress and contributes to cellular dysfunction, inflammation, and DNA damage, ultimately leading to various toxicities including but not limited to reproductive, cardiotoxicity, neurotoxicity, and endocrine toxicity. Moreover, BPA can modify DNA methylation patterns, histone modifications, and non-coding RNA expression, leading to epigenetic changes and contribute to carcinogenesis. Overall, understanding molecular mechanisms of BPA-induced toxicity is crucial for developing effective strategies and policies to mitigate its adverse effects on human health.

Asunto(s)

RESUMEN

The S1Q3T3 sign associated with cor pulmonale was first described by Sylvester McGinn and Paul White in 1935. It has since become an overlooked and relatively nonspecific finding associated with pulmonary embolism. We present this case to elucidate the importance for clinicians to promptly identify this electrocardiographic triad.

RESUMEN

Glioblastoma is a prevalent form of carcinoma that exhibits a greater incidence rate across diverse demographics globally. Despite extensive global efforts, GBM continues to be a highly lethal disease that is characterized by a grim prognosis. There is a wealth of evidence suggesting that the pathophysiology of GBM is associated with the dysregulation of numerous cellular and molecular processes. The etiology of GBM may involve various cellular and molecular pathways, including EGFR, PDCD4, NF-κB, MAPK, matrix metalloproteinases, STAT, and Akt. MicroRNAs, short non-coding RNA molecules, regulate gene expression and mRNA translation after transcription but before translation to exert control over a wide range of biological functions. Extensive research has consistently demonstrated the upregulation of miRNA-21 in glioma, indicating its involvement in diverse biological pathways that facilitate tumor cell survival. By explaining the intricate interplay between miR-21 and the regulation of apoptosis in GBM, this review has the potential to significantly enhance our comprehension of the illness and provide potential targets for therapeutic intervention.

Asunto(s)

RESUMEN

The electronic device, with its biocompatibility, biodegradability, and ease of fabrication process, shows great potential to embed into health monitoring and hardware data security systems. Herein, polyvinylpyrrolidone (PVP) biopolymer is presented as an active layer, electrochemically active magnesium (Mg) as a metal electrode, and chitosan-based substrate (CHS) to fabricate biocompatible and biodegradable physically transient neuromorphic device (W/Mg/PVP/Mg/CHS). The I-V curve of device is non-volatile bipolar in nature and shows a unique compliance-induced multilevel RESET-dependent-SET behavior while sweeping the compliance current from a few microamperes to milliamperes. Non-volatile and stable switching properties are demonstrated with a long endurance test (100 sweeps) and retention time of over 104  s. The physically transient memristor (PTM) has remarkably high dynamic RON /ROFF (ON/OFF state resistance) ratio (106 Ω), and when placed in deionized (DI) water, the device is observed to completely dissolve within 10 min. The pulse transient measurements demonstrate the neuromorphic computation capabilities of the device in the form of excitatory post synaptic current (EPSC), potentiation, depression, and learning behavior, which resemble the biological function of neurons. The results demonstrate the potential of W/Mg/PVP/Mg/CHS device for use in future healthcare and physically transient electronics.

RESUMEN

BACKGROUND: Climate change is arguably the greatest threat to global health of the 21st century. Although cataract surgery is a major contributor to global greenhouse gas emissions, recent literature review identified a paucity of evidence-based strategies for improving the environmental impact of cataract services. Our study aimed to assess the effectiveness of a departmental Delphi process for improving cataract services' environmental sustainability. METHODS: All members of ophthalmology theatre teams in a UK teaching hospital were invited to participate in a three-stage Delphi process. Team members were surveyed for suggestions for reducing the department's environmental impact. Suggested interventions were refined during a plenary face-to-face discussion and ranked. The highest ranked interventions were combined into a mutually agreed action plan. Data on the economic and environmental cost of cataract services was collected prior to and six months after the Delphi process using the Eyefficiency mobile application. RESULTS: Twenty-three interventions were suggested by a range of staff cadres. Interventions were ranked by 24 team members. The 2nd, 4th, 5th, 8th and 11th ranked interventions were combined into an "Eco-packs" project in collaboration with suppliers (Bausch + Lomb), saving 675 kg of waste and 350 kg of CO2 equivalent annually. CONCLUSIONS: The Delphi process is an effective method for provoking departmental engagement with the sustainability agenda that we would encourage all ophthalmology departments to consider utilising. The baseline per case CO2 equivalent measured in our department was reproducible and could serve as a maximum benchmark to be improved upon.

Asunto(s)

RESUMEN

Hemophagocytic lymphohistiocytosis (HLH) is a progressive and potentially life-threatening disorder. It is classified into primary and secondary HLH. The objective of our study was to determine the outcome of primary and secondary HLH in pediatric and adult patients based on HScore and treatment modality. We conducted a retrospective analysis done from July 2010 to June 2020. Variables analyzed included age, gender and history of death in siblings. HScore was used for disease classification while clinical and laboratory findings which were required to fulfill the HScore diagnostic criteria were also recorded. Continuous variables were summarized as median and categorical variables as frequencies and percentages. Categorical variables were compared using chi-square test and Fisher Exact test. Significance of different variables between primary and secondary HLH was calculated using independent-samples t test. A P value of < .05 was taken as significant. A total of 51 patients were included in the analysis (41 in primary and 10 in secondary HLH group). In primary HLH, 36 patients were in the pediatric age group and 12.2% had a history of death in sibling. All 41 patients had increased ferritin and decreased fibrinogen levels. The overall survival in primary HLH was 44%. In the secondary HLH group, viral infections were the most common etiology and ferritin was increased as well. The overall survival in secondary HLH was 60%. The median survival was 15 ± 4.8 months. The overall survival of both groups combined was 53%. Primary HLH should be considered in pediatric patients who present with pancytopenia and hepatosplenomegaly. In centers where genetic testing is not available, HScore along with serum ferritin and fibrinogen is a good substitute for disease classification.

Asunto(s)

RESUMEN

Introduction: The lifespan of an edentulous mandible with one median implant to hold a full denture for 24 months was evaluated to see if the early loading had any impact on it. Single-implant denture retention for the mandibular region was proposed by "Cordioli et al. in the 1990s. Objectives: Whether rapid loading and placement of a "single median implant" may result in the implant survival rate comparable to rehabilitation with a single implant and second-stage surgery. Methods: It was found that 81 of the 158 implant recipients had quick loading, whereas the rest had delayed loading (77 patients). Patients in the context of "delayed loading group" had follow-up appointments at 1 month, 4 months, 12 months, and 24 months. In addition, the nine implants failed in the 3 months after loading in a quick loading group, while just one implant failed before loading. Median implant survival at 2 years was the study's main goal. Direct loading had a 7% fatality rate advantage over traditional loading because of the alleged advantages of immediate loading, including the avoidance of second-stage surgery. Prosthetic problems were evaluated using Fisher's exact test. Results: A higher rate of implant survival was not seen when implants were loaded more quickly (P = 0.81). A statistically significant difference (P = 0.019) was seen in implant survival between the therapy groups. Conclusion: Single implant loading in an edentulous mandible has a worse survival rate than delayed loading, according to all available research.

RESUMEN

Speck assembly is the hallmark of NLRP3 inflammasome activation. The 1µm structure comprising of NLRP3 and ASC is the first observable phenotype of NLRP3 activation. While the common consensus is that the specks are the site of inflammasome activity, no direct experimental evidence exists to support this notion. In these 22 years, since the inflammasome discovery, several research studies have been published which directly or indirectly support or refute the idea of speck being the inflammasome. This review compiles the data from two decades of research to answer a long-standing question: "What are NLRP3-ASC specks?"

Asunto(s)

RESUMEN

Climate change, one of the severest environmental threats to humankind, disproportionately affects low-income, developing countries in the Global South. Having no feasible mitigation alternatives, these countries resort to adaptation efforts to address climate perturbations. Climate change adaptation (or resilience) is primarily a localized course of action that depends on individuals, social networks, economies, ecologies, political structures, and the capabilities of all those to work collectively to absorb, learn from, and transform in the face of new realities. With a view to controlling the floods that shattered the life and economy of the then East Pakistan, which is now Bangladesh, during the mid-twentieth century, the coastal embankment project (CEP) was instituted as an adaptation strategy to natural disasters in Southwestern Bangladesh. Based on a qualitative analysis of primary and secondary data, this paper seeks to critically evaluate the efficacy of the CEP in terms of the space for feasible action and ecological modernization. The findings of this research indicate that the CEP has become an unrealistic venture that hinders the growing economic activity of shrimp aquaculture in the area. This paper is expected to contribute to generating further theoretical and empirical discourse on the evaluation of similar development projects around the globe.

Asunto(s)

RESUMEN

Despite tremendous advancements in electrocardiography machine algorithms, accurately diagnosing dextrocardia, pseudodextrocardia, and limb lead reversal remains a serious challenge. We present the case of a patient with acquired cardiac dextroposition, or "pseudodextrocardia," in which the electrocardiography machine algorithm incorrectly interpreted the finding as "dextrocardia vs limb lead reversal." (Level of Difficulty: Advanced.).

RESUMEN

There are substantial public health consequences when hazardous heavy metal contaminants and antimicrobial drug residues are present in broiler edible tissues. This study aimed to assess the concentration of antimicrobial drugs and heavy metals residues in broiler meat, bones and edible composites (combinations of liver, kidney and gizzard). Samples were collected from different types of broiler farms, broiler wet meat markets and supermarkets, covering all five divisions of Bangladesh. The antimicrobial drug and heavy metal residues were analyzed by uHPLC and ICP-MS, respectively. In addition, a cross-sectional survey was conducted among broiler meat consumers in the study areas to evaluate their attitude towards the consumption of broiler meat. The survey clearly stated that broiler meat consumers in Bangladesh have a negative attitude toward the consumption of broiler meat, although all respondents reported to eat broiler meat regularly. The antibiotic with the highest prevalence of residues in broiler edible tissues was oxytetracycline, followed by doxycycline, sulphadiazine and chloramphenicol. On the other hand, all collected broiler edible tissues contained chromium and lead, followed by arsenic. The fact of the matter is that the antimicrobial drugs and heavy metals residues were found to be below the maximum residue limit (MRL), except for the lead content. In addition, the broiler meat samples from supermarkets had lower levels of antimicrobial drugs and heavy metals residue compared to the broiler meat collected from various types of farms and broiler wet meat markets. Irrespective of the source, broiler meat was found to contain antimicrobial drugs and heavy metals residues below the MRL, except for lead, suggesting that broiler meat is safe for human consumption. Therefore, raising public awareness regarding misconceptions about broiler meat consumption among consumers would be warranted.