Choice Of Agent Research Articles

Optimal delegation and information transmission under limited awareness

We study the delegation problem between a principal and an agent, who not only has better information about the performance of the available actions but also superior awareness of the set of actions that are actually feasible. We provide conditions under which the agent finds it optimal to leave the principal unaware of relevant options. By doing so, the agent increases the principal's cost of distorting the agent's choices and increases the principal's willingness to grant him higher information rents. We further show that the principal may use the option of renegotiation as a tool to implement actions that are not describable to her at the contracting stage. If the agent renegotiates, his proposal signals information about the payoff state. Due to her limited awareness, the principal makes a coarse inference from the agent's recommendations and, as a result, accepts a large number of the agent's proposals, which ultimately benefits both.

Antimicrobial agent usage patterns and their role in preventing surgical site infections at a tertiary care teaching hospital: A comprehensive study

Background: Surgical site infections (SSIs) present a formidable challenge in contemporary healthcare, impacting patient well-being and contributing to escalating healthcare costs. The judicious utilization of antimicrobial agents is paramount in effectively combating SSIs. This study, conducted at a Tertiary Care Teaching Hospital in Kerala, seeks to unravel the intricate patterns of antimicrobial agent usage within the General Surgery Department over 10 months. Aims and Objectives: The primary aim is to thoroughly examine antimicrobial agent patterns within the General Surgery Department, focusing specifically on patients undergoing surgical procedures. The study aims to assess the appropriateness of antimicrobial agent usage, encompassing the choice for prophylactic purposes, timing of pre-operative dosing, the occurrence of intraoperative dosing, and the selection appropriateness for post-operative prophylaxis. Materials and Methods: Crafted for robust analysis, the study included 150 cases, implementing specific inclusion and exclusion criteria to ensure data quality. The emphasis was placed on patients undergoing surgical procedures, focusing on prophylactic antimicrobial use. Data collection involved meticulously evaluating appropriateness across critical parameters, including the choice of prophylactic antimicrobial agent, pre-operative dosing timing, intraoperative dosing, and selection appropriateness for post-operative prophylaxis. Results: Analysis of 150 cases provided valuable insights into the age and gender distribution, predominantly within the 41–60 age groups. Prevalent surgical procedures, such as hernia and appendicitis, underscored the necessity for tailored antimicrobial protocols. Cephalosporins emerged as the dominant class, raising concerns about potential overuse and resistance. Pre-exposure prophylactic antibiotics, predominantly cephalosporins, were administered in 88 cases. Post-exposure prophylaxis mirrored this trend, necessitating a critical evaluation of antibiotic selection and duration. Detailed analysis of cephalosporin pre- and post-exposure prophylaxis identified prevalent choices such as Cefotaxime and Cefoperazone + Sulbactam, emphasizing the importance of scrutinizing cephalosporin selection. Conclusion: This study furnishes valuable insights into the appropriateness of antimicrobial agent usage for preventing SSIs, serving as a model for analogous healthcare settings. It underscores the significance of local antibiotic stewardship, guideline adherence, and the ongoing commitment to optimizing prophylactic antimicrobial usage for ensuring patient safety and advancing healthcare quality amidst evolving challenges.

Determining knowledge of antimicrobial therapy in practitioners (results of the KANT-IV project)

Objective. To determine the level of knowledge of doctors on the rational use of antimicrobial drugs in clinical practice and to compare with data of the previous stage of the study and results obtained from students in a parallel project. Materials and Methods. A multicenter questionnaire survey of practitioners with analysis of results – stage of KANT project (full name of the project – «Physicians’ (Students’) knowledge in antimicrobials usage») conducted in 2020–2023. Results. A total of 336 participants were surveyed in 5 centers (10 Russian regions: Belgorod, Novosibirsk, Rostov, Voronezh, Lipetsk, Sakhalin, Primorsky, Krasnodar, and Krasnoyarsk regions, Republic of Tatarstan). The average level of correct answers (LCA) for the whole questionnaire was 47.5% (taking into account the extended analysis of sub-items questions No. 8 and 9 – 46.8%). Doctors showed the best results in answering questions about the time interval during which the effectiveness of antimicrobial therapy is evaluated (LCA – 84.2%); about choosing the most rational action if antimicrobial therapy (AMT) has a positive clinical effect, but requires a long course of therapy (LCA – 72.6%); selection of rational diagnostic/treatment action in the diagnosis of acute tonsillitis or pharyngitis, in a case where etiologic diagnosis is required (LCA – 63.1%). The worst results were recorded in answering to the following questions: indication of the antimicrobial drug of choice in the treatment of various infections (LCA – 29.1%); the choice of auxiliary drugs in addition to the justified appointment of antimicrobial drugs in the treatment of bacterial infections of the respiratory tract for the entire period of the disease or in certain phases (LCA – 26.6% – 35.1%); indication of a combination of antimicrobial drugs that is irrational to prescribe in clinical practice due to a similar mechanism and/or spectrum of activity against pathogens (LCA – 24.4%). Significant differences were found between centers in a number of questions, between physicians in KANT-III and KANT-IV projects (p < 0.001), and between physicians and students in a parallel project (KANT-IV students, LCA – 42.6%, p < 0.001). Conclusions. An unsatisfactory level of physicians’ knowledge of AMT and choice of adjuvant agents, as well as appropriateness of antimicrobial combination was found. The authors believe there is a need for making more efforts in areas of increasing physicians’ compliance to clinical recommendations, expertise and quality control of pharmacotherapy, recruitment of clinical pharmacologists; to optimize the educational process in universities, to expand the scope and availability of additional educational programs within the system of continuous education, as well as to train physicians in using modern sources of scientific medical information.

Relational enforcement

A principal incentivizes an agent to maintain compliance and to truthfully announce any breaches of compliance. Compliance is imperfectly controlled by the agent's private effort choices, is partially persistent, and is verifiable by the principal only through costly inspections. We show that in principal‐optimal equilibria, the principal enforces maximum compliance using deterministic inspections. Periodic inspection cycles are suspended during periods of self‐reported noncompliance, during which the agent is fined. We show how commitment to random inspections would benefit the principal, and discuss possible ways for the principal to overcome her commitment problem.

Update on therapeutic approaches for invasive fungal infections in adults.

Invasive fungal infections are increasingly encountered with the expansion of iatrogenic immunosuppression, including not only solid organ and hematopoietic stem cell transplant recipients but also patients with malignancies or autoimmune diseases receiving immunomodulatory therapies, such as Bruton Tyrosine Kinase (BTK) inhibitor. Their attributable mortality remains elevated, part of which is a contribution from globally emerging resistance in both molds and yeasts. Because antifungal susceptibility test results are often unavailable or delayed, empiric and tailored antifungal approaches including choice of agent(s) and use of combination therapy are heterogeneous and often based on clinician experience with knowledge of host's net state of immunosuppression, prior antifungal exposure, antifungal side effects and interaction profile, clinical severity of disease including site(s) of infection and local resistance data. In this review, we aim to summarize previous recommendations and most recent literature on treatment of invasive mold and yeast infections in adults to guide optimal evidence-based therapeutic approaches. We review the recent data that support use of available antifungal agents, including the different triazoles that have now been studied in comparison to previously preferred agents. We discuss management of complex infections with specific emerging fungi such as Scedosporium spp., Fusarium spp., Trichosporon asahii, and Candida auris. We briefly explore newer antifungal agents or formulations that are now being investigated to overcome therapeutic pitfalls, including but not limited to olorofim, rezafungin, fosmanogepix, and encochleated Amphotericin B. We discuss the role of surgical resection or debridement, duration of treatment, follow-up modalities, and need for secondary prophylaxis, all of which remain challenging, especially in patients chronically immunocompromised or awaiting more immunosuppressive therapies.

Pre-emptive analgesia with preoperative oral gabapentin and pregabalin in lumbar narrow canal surgery

The success of pre-emption depends on the strategy pertaining to the choice of agent and when and how, to use. This study was aimed to evaluate the efficacy of pre-emptive analgesia regarding the postoperative pain management in lumbar spinal stenosis surgery. The oral gabapentin 800 mg or pregabalin 225 mg or placebo were administered 1 h before surgery. The pain and sedation scores were measured through Visual Analogue Scale (VAS) and Ramsay Sedation Scale (RSS). Three groups of 30 patients each were included in the study. Group 1 was administered with gabapentin 800 mg, Group 2 with pregabalin 225 mg, and Group 3 with placebo 1 hour before the surgery. VAS scores at the 1st, 2nd, 4th, 6th, 8th, 10th, 12th, 14th, 16th, 18th, 20th, 22nd and 24th hours of surgery, and RSS scores and analgesic drug usage in the 1st to 24 hours of surgery were recorded. There were statistically significant differences between the 1st, 2nd and 4th hour VAS score averages. RSS scores changed among the three groups in postoperative period. The total analgesics employed in gabapentin and pregabalin groups were lower than those in placebo group. Pre-emptive analgesia of oral pregabalin or gabapentin minimized the postoperative pain in patients undergoing lumbar stenosis surgery.

SYNTHESIS OF COPOLYMERS OF STEARYLMETHACRYLATE AND STEARYLACRYLATE WITH N-SUBSTITUTED ACRYLAMIDES IN THE PRESENCE OF REVERSIBLE CHAIN TRANSFER AGENTS AND STUDY OF THEIR EFFECT ON THE LOW-TEMPERATURE PROPERTIES OF DIESEL FUEL

The features of copolymerization of stearylacrylate (SA) and stearylmethacrylate with N-isopropylacrylamide and N,N-dimethylacrylamide in the presence of dibenzyltrithiocarbonate and 2-cyanoisopropyldodecyltrithiocarbonate as agents of reversible chain transfer have been studied. The choice of agents of reversible chain transfer (RAFT-agents) is due to the fact that sulfur-containing compounds with cyanoisopropyl radicals are most effective in the polymerization of methacrylic monomers, while benzyltrithiocarbonates are more active in the polymerization of acrylic monomers, as well as styrene and acrylonitrile. It has been established that polymerization of stearyl methacrylate (SMA) in the presence of RAFT-agents proceeds without a gel effect up to a high conversion. At the same time, although polystеarylmethacrylate samples are characterized by relatively high values of polydispersity coefficients (Mn/Mw) for controlled radical polymerization processes, they are nevertheless somewhat lower than for polymers of similar conversion synthesized in the absence of chain transfer agents. It has been shown that the process of copolymerization of stearyl acrylate and stearylmethacrylate with N-isopropylacrylamide and N,N-dimethylacrylamide in the presence of dibenzyltrithiocarbonate and 2-cyanoisopropyldodecyltrithiocarbonate proceeds without gelation to high conversions. The synthesized copolymers are characterized by a relatively narrow molecular weight distribution: the polydispersity coefficients of polymer samples vary from 1.18 to 1.57 in the case of using N-isopropylacrylamide and from 1.21 to 1.47 when using N,N-dimethylacrylamide as a comonomer to higher alkyl acrylates, which is typical for processes of radical polymerization proceeding in a controlled manner. At the same time, the synthesized copolymers exhibit a significant depressant effect when they are introduced into diesel fuel at a concentration of 1600 ppm. It has been established that copolymers of stearylmethacrylate and stearylacrylate with polar nitrogen-containing monomers have a more effective effect on the low-temperature properties of diesel fuel than homopolymers of stearylmethacrylate and stearylacrylate. At the same time, additives based on copolymers of stearylmethacrylate with N-isopropylacrylamide with a composition of 70/30 mol.% and stearylacrylate with N-isopropylacrylamide with a composition of 20/80 mol.% had the most significant effect on the low-temperature characteristics of the fuel.

Modern possibilities of phytotherapy for male infertility from the standpoint of evidence-based medicine

Introduction: Male infertility is an topical medical and social problem of modern reproductive medicine. Its pharmacotherapy is often empirical in nature, and the most popular method remains the use of various herbal substances (phytotherapy), the effectiveness of which remains still understudied in the framework of evidence-based medicine.
 Materials and Methods: The results of research, thematic, systematic and Cochrane reviews and meta-analyses were searched in Medline/PubMed medical databases over the past 5 years using the search queries "plants male infertility", "plants sperm", "phytotherapy male infertility", "phytomedicinal therapeutics male infertility", "systematic review", "meta-analysis", and "review".
 Results: The vast majority of herbal substances offered for the treatment of male infertility demonstrate insufficient or contradictory evidence base for their clinical effectiveness, although some of them can be very useful pharmacotherapeutic options in the combined therapy of male infertility.
 Conclusion: Not all plant substances with a "reproductive effect" positioned in them actually have proven reproductive effects in studies in humans, therefore, the choice of phytotherapeutic agents in the treatment of idiopathic male infertility should be currently approached extremely carefully, especially in cases when we choose phytotherapy as an option for empirical monotherapy of male reproductive disorders.

Trends in Hyperlipidemia Treatments: Summary of Recommendations for Statin and Non-Statin Options

Several treatment options and recommendations exist to guide a primary care provider to reduce overall cardiac morbidity and mortality risk through lipid control. The wealth of data from large studies, the choices of agents with varying mechanisms of action, and differing guidelines result in a challenge to keep abreast of this rapidly changing landscape. In this literature review the latest data regarding lipid management are reviewed and summarized. Current US and international cholesterol treatment guidelines recommend lifestyle modification followed by statin as first-line of therapy in management of hyperlipidemia. After optimizing statin dose if LDL remains above target goal, then the addition of ezetimibe provides added reductions in morbidity and mortality. Fibrates can be considered as an adjunct to statins therapy particularly in the diabetic population with persistent triglyceride elevations and provide modest reductions in coronary artery disease. PCSK9 inhibitors can reduce morbidity and mortality in a high-risk population when a statin or statin+ezetimibe does not bring LDL below the target goal. Some newer agents (ANGPTL3/ACL/MTP Inhibitors) are reserved for patients with a predisposition to ASCVD due to a familial genetic dyslipidemia. Cost for these adjunctive therapies is a concern for the patient and clinician and patient education along with a shared decision approach are warranted. To date, evidence for these agents is limited. Finally, there remains unclear guidance on the value between a “treat to dose” versus a “treat to target” approach to lipid management. Further research is needed to provide clarity on which strategy proves optimal for primary prevention of MACEs.

Modern ideas about the consequences of sympathoadrenal hyperactivation in hypertensive patients with metabolic disorders: modulation possibilities

The prevalence of hypertension (HTN) in the Russian Federation and the world continues to grow. This is largely due to the epidemic of obesity and related conditions — metabolic syndrome and type 2 diabetes. The most common and proven hypothesis of the relationship between hypertension and obesity is the activation of the sympathetic nervous system. However, modern research shows that the consequences of sympathetic hyperactivation are not limited only to hemodynamic effects, but extend to many organs and systems. Long-term sympathetic hyperactivation can lead to insulin resistance and type 2 diabetes. Neurotransmitters affect fat cells by increasing lipolysis and leading to increased fatty acid release, the liver by increasing gluconeogenesis, and pancreatic β-cells by decreasing insulin secretion. The sympathetic nervous system plays an important role in energy management by regulating metabolic rate. Obese individuals have significantly less pronounced postprandial thermogenesis, despite a higher insulin response, while the hemodynamic response to isometric or heterometric exercise is reduced. Chronic stress serves not only as a trigger for behavioral disorders, but also directly leads to various physiological disorders, including through sympathetic activation. However, the choice of antihypertensive agents affecting the sympathetic activity in patients with obesity and metabolic disorders is very limited. According to current guidelines, β-blockers are not the drugs of choice in patients with uncomplicated HTN, since it has a weaker evidence base compared to other classes of drugs and have metabolic and other side effects. Therefore, selective I1-imidazoline receptor agonists, and in particular, moxonidine may be the drugs of choice in this category of patients. Moxonidine in combination therapy of patients with HTN and metabolic disorders, including metabolic disorders in menopause, as well as with a physiological estrogen decrease, significantly improves the effectiveness of antihypertensive therapy and increases the achievement of target blood pressure. In addition, its metabolic effects improve prognosis of such patients.

Anti-Leishmania compounds can be screened using Leishmania spp. expressing red fluorescence (tdTomato).

The main challenges associated with leishmaniasis chemotherapy are drug toxicity, the possible emergence of resistant parasites, and a limited choice of therapeutic agents. Therefore, new drugs and assays to screen and detect novel active compounds against leishmaniasis are urgently needed. We thus validated Leishmania braziliensis (Lb) and Leishmania infantum (Li) that constitutively express the tandem tomato red fluorescent protein (tdTomato) as a model for large-scale screens of anti-Leishmania compounds. Confocal microscopy of Lb and Li::tdTomato revealed red fluorescence distributed throughout the entire parasite, including the flagellum, and flow cytometry confirmed that the parasites emitted intense fluorescence. We evaluated the infectivity of cloned promastigotes and amastigotes constitutively expressing tdTomato, their growth profiles in THP-1 macrophages, and susceptibility to trivalent antimony, amphotericin, and miltefosine in vitro. The phenotypes of mutant and wild-type parasites were similar, indicating that the constitutive expression of tdTomato did not interfere with the evaluated parameters. We applied our validated model to a repositioning strategy and assessed the susceptibility of the parasites to eight commercially available drugs. We also screened 32 natural plant and fungal extracts and 10 pure substances to reveal new active compounds. The infectivity and Glucantime treatment efficacy of BALB/c mice and golden hamsters infected with Lb and Li::tdTomato mutant lines, respectively, were very similar compared to animals infected with wild-type parasites. Standardizing our methodology would offer more rapid, less expensive, and easier assays to screen of compounds against L. braziliensis and L. infantum in vitro and in vivo. Our method could also enhance the discovery of active compounds for treating leishmaniasis.

Choice of Healing Agent for Self-Healing Asphalt Concrete.

The choice of a substance as a healing agent for asphalt concrete is determined by the scientific experience of researchers and the results of exploratory studies. There are no standard approaches for selecting healing agents or assessing their compatibility with the matrix components in asphalt concrete. However, such methods would make it possible to systematize research in the field of self-healing asphalt concrete and significantly expand the list of healing agents potentially suitable for encapsulation and ensuring the formation of a healing effect. An approach has been proposed for studying a substance and assessing the suitability of its use as a healing agent during encapsulation, using alginate technology in terms of solubility, homogeneity in a system with bitumen, and adhesive strength. This set of indicators can be used in the development and design of self-healing asphalt concrete, as well as for expanding the list of healing agents that can be used to implement self-healing technology. This article discusses sunflower oil and AR polymers as healing agents for self-healing asphalt concretes. The substances under consideration are capable of forming a homogeneous system ∆δ → 0 with bitumen, and the double systems "SfO-bitumen" and "ARP-bitumen" have a Gibbs energy value ∆G < 0, which confirms this. The studied healing agents are able to form an emulsion in alginate aqueous solutions, which was confirmed by the structuring effect and the extreme influence of their concentration on viscosity. The strength of the adhesive bonds under the influence of SfO was 14.2% of the initial value of the tensile strength during splitting. Under the influence of ARP, the strength of the adhesive bonds was 5.8% of the initial value of the tensile strength at splitting. The use of an activator in asphalt concrete makes it possible to increase the strength of the adhesive bonds to 25-45% of the initial splitting strength.

Navigating fungal infections and antifungal stewardship: drug resistance, susceptibility testing, therapeutic drug monitoring and future directions.

Antifungal stewardship refers to the rational use of antifungal agents. Historically, in some instances, the misuse or overuse of antifungal agents has predisposed patients to an elevated risk of systemic side-effects and treatment resistance, as well as increased healthcare costs. Superficial mycoses, such as onychomycosis, are sometimes treated without any diagnostic testing and is associated with a high likelihood of self-diagnosis and self-treatment, potentially leading to the emergence of resistance against commonly used antifungals like terbinafine. Practitioners need to ensure that a proper clinical diagnosis is backed up by appropriate testing. This may include the traditional light microscopy and culture; additionally, molecular techniques (such as polymerase chain reaction, terbinafine gene mutational analysis) and antifungal susceptibility testing are considerations as appropriate. The choice of antifungal agent should be guided by what is the standard of care in the location where the clinician practices as well as more broadly state and national prescription patterns. Recently, reports of treatment resistance concerning both superficial and deep fungal infections have added another layer of difficulty to clinical practice. This review aims to explore the phenomenon of antifungal drug resistance, and highlights the importance of adopting antifungal stewardship programs. We provide an overview of treatment resistance and mechanisms of resistance reported thus far in dermatophytes. Challenges of performing antifungal susceptibility testing and therapeutic drug monitoring are discussed, as well as principles, recommendations and future directions of antifungal stewardship programs.

Does the choice of induction agent in rapid sequence intubation in the emergency department influence the incidence of post-induction hypotension?

To describe the effects of different induction agents on the incidence of post-induction hypotension (PIH) and its associated interventions during rapid sequence intubation (RSI) in the ED. A single centre retrospective study of patients intubated between 2018 and 2021 was conducted in a regional Australian ED. The impact of induction agent choice, in addition to demographic and clinical factors on the incidence of PIH were determined using descriptive statistics and a multivariate analysis presented as adjusted odds ratios (aORs) and their 95% confidence intervals (CIs). Ketamine and propofol, used either individually or in conjunction with fentanyl, were significantly associated with PIH (ketamine aOR 4.5, 95% CI 1.35-14.96; propofol aOR 4.88, 95% CI 1.46-16.29). Age >60 years was associated with a greater requirement for vasopressors (aOR 4.46, 95% CI 2.49-7.97) and a higher risk of mortality after RSI (aOR 4.2, 95% CI 1.87-9.40). Patients with a shock index >1.0 were significantly more likely to require vasopressors (aOR 5.13, 95% CI 2.35-11.2) and have a cardiac arrest within 15 min of RSI (aOR 3.56, 95% CI 1.07-11.8). Exposure to both propofol and ketamine is significantly associated with PIH after RSI, alongside age and shock index. PIH is likely multifactorial in nature, and this data supports the sympatholytic effect of induction agents as the underlying cause of PIH rather than the choice of agent itself. Further prospective work including a randomised controlled trial between induction agents is justified to further clarify this important clinical question.

Antibiotic administration reduced intra-amniotic inflammation 7 days after preterm premature rupture of the membranes with intra-amniotic infection

Objective Intra-amniotic infections increase the risk of preterm delivery and short- and long-term fetal morbidity; however, no consensus exists on the choice of antimicrobial agents as treatment for these infections. We aimed to examine the efficacy of intravenous administration of sulbactam/ampicillin (SBT/ABPC) and azithromycin (AZM) for intra-amniotic infection in patients with preterm premature rupture of membranes (PPROM). Methods This study followed a single-centered retrospective cohort design. We compared changes in interleukin 6 (IL-6) levels and the load of Ureaplasma species DNA in the amniotic fluid between singleton pregnancy patients with intra-amniotic infection (Group A) and without either intra-amniotic inflammation (IAI) or microbial invasion of the amniotic cavity (MIAC) (Group B) who developed PPROM between week 22, day 0 and week 33, day 6 of gestation and maintained pregnancy for ≥7 d after diagnosis (August 2014 to April 2020). Patients in Group A were treated with SBT/ABPC and AZM, whereas those in Group B were treated with ABPC and AZM or clarithromycin. Results Thirty-one patients with IAI and 48 patients without either IAI or MIAC at diagnosis of PPROM underwent pregnancy/delivery management at our hospital. Following the study population selection, we evaluated six patients in Group A and 13 patients in Group B. Amniotic fluid IL-6 concentrations at the initial amniocentesis were high, ranging from 11.7 ng/mL to 139.2 ng/mL, indicating a state of severe IAI in all six patients in Group A. In five of the six patients in Group A, the amniotic fluid cultures during the first amniocentesis included Ureaplasma species only. In both groups, the amniotic fluid IL-6 concentration at the follow-up amniocentesis was lower than that at the initial amniocentesis (Group A: follow-up median 3.06 ng/mL [quartiles, 1.75–6.74], initial median 30.53 ng/mL [quartiles, 15.60–67.07], p＝.03; Group B: follow-up median 0.40 ng/mL [quartiles, 0.18–0.69], initial median 0.96 ng/mL [quartiles, 0.65–1.42], p＝.005); Group A showed a greater decrease than Group B (p < .001). No difference was found between the microbial loads of Ureaplasma species DNA in the initial and follow-up amniocentesis (p = .13). Conclusions In patients with PPROM and intra-amniotic infection, IL-6 levels in the amniotic fluid decreased significantly from before antimicrobial administration to day 7. This decrease is thought to be mainly due to the effects of intravenous AZM. The efficacy of AZM in patients with PPROM needs to be further confirmed via randomized controlled studies in the future.

Оцінка обізнаності щодо діагностики та менеджменту фарингіту в дітей серед лікарів загальної практики

Sore throat and pharyngitis account for up to 5.0% of all medical visits to a general practitioner. The etiology of pharyngitis in both adults and children is dominated by viruses, but in 20.0-30.0% of children the cause may be bacteria, most often the Group A β-hemolytic streptococcus. Purpose - to assess the knowledge of general practitioners regarding the diagnosis and management of pharyngitis in children, to determine further ways to increase their level of awareness. Materials and methods. A survey of 60 general practitioners in the Ternopil region of Ukraine was conducted to determine their awareness of the diagnosis and management of pharyngitis in children. The questionnaire and statistical methods were used. Results. In total, 45.0% of general practitioners in individual cases prescribed bacteriological cultures from the oropharynx to patients with acute pharyngitis. However, they rarely (6.7%) used the Center or McIsaac criteria to choose a treatment strategy for acute pharyngitis. Antibiotic therapy for the treatment of pharyngitis was used in individual cases by 86.7% of respondents. Amoxicillin was chosen as a first-line antibiotic by 38.3% of respondents, while protected aminopenicillins were chosen by 36.6%. Only 10.0% of general practitioners indicated a 10-day course of antibiotic therapy. A little more than half of the correct answers were to questions related to the appointment of antibacterial therapy to healthy children in whom the Group A β-hemolytic streptococcus was detected during bacteriological examination or an increased level of antistreptolysin-O in the blood. Conclusions. The results of our study showed a different level of knowledge of general practitioners regarding some aspects of diagnosis and management of pharyngitis in children. Insufficient knowledge was demonstrated regarding the possibilities of diagnosing the streptococcal etiology of pharyngitis, in particular the use of both clinical and laboratory research methods. Despite good knowledge about prescribing antibacterial therapy, poor awareness about the duration of antibacterial therapy and incomplete knowledge about the choice of antibacterial agent are shown. Relatively satisfactory knowledge was demonstrated regarding the strategy of management of streptococcal carriage in healthy children. The presented data indicate the need to improve the awareness of general practitioners regarding the diagnosis and treatment of pharyngitis, taking into account the modern complications of streptococcal infection. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Type of anesthesia for cancer resection surgery: No differential impact on cancer recurrence in mouse models of breast cancer.

Surgery is essential for curative treatment of solid tumors. Evidence from recent retrospective clinical analyses suggests that use of propofol-based total intravenous anesthesia during cancer resection surgery is associated with improved overall survival compared to inhaled volatile anesthesia. Evaluating these findings in prospective clinical studies is required to inform definitive clinical guidelines but will take many years and requires biomarkers to monitor treatment effect. Therefore, we examined the effect of different anesthetic agents on cancer recurrence in mouse models of breast cancer with the overarching goal of evaluating plausible mechanisms that could be used as biomarkers of treatment response. To test the hypothesis that volatile anesthesia accelerates breast cancer recurrence after surgical resection of the primary tumor, we used three mouse models of breast cancer. We compared volatile sevoflurane anesthesia with intravenous propofol anesthesia and used serial non-invasive bioluminescent imaging to track primary tumor recurrence and metastatic recurrence. To determine short-term perioperative effects, we evaluated the effect of anesthesia on vascular integrity and immune cell changes after surgery in animal models. Survival analyses found that the kinetics of cancer recurrence and impact on survival were similar regardless of the anesthetic agent used during cancer surgery. Vascular permeability, immune cell infiltration and cytokine profiles showed no statistical difference after resection with inhaled sevoflurane or intravenous propofol anesthesia. These preclinical studies found no evidence that choice of anesthetic agent used during cancer resection surgery affected either short-term perioperative events or long-term cancer outcomes in mouse models of breast cancer. These findings raise the possibility that mouse models do not recapitulate perioperative events in cancer patients. Nonetheless, the findings suggest that future evaluation of effects of anesthesia on cancer outcomes should focus on cancer types other than breast cancer.

Post-operative urinary retention is impacted by neuromuscular block reversal agent choice: A retrospective cohort study in US hospital setting

Study objectivePerioperative neuromuscular blocking agents are pharmacologically reversed to minimize complications associated with residual neuromuscular block. Neuromuscular block reversal with anticholinesterases (e.g., neostigmine) require coadministration of an anticholinergic agent (e.g., glycopyrrolate) to mitigate muscarinic activity; however, sugammadex, devoid of cholinergic activity, does not require anticholinergic coadministration. Single-institution studies have found decreased incidence of post-operative urinary retention associated with sugammadex reversal. This study used a multicenter database to better understand the association between neuromuscular block reversal technique and post-operative urinary retention. DesignRetrospective cohort study utilizing large healthcare database. SettingNon-profit, non-governmental and community and teaching hospitals and health systems from rural and urban areas. Patients61,898 matched adult inpatients and 95,500 matched adult outpatients. InterventionsNeuromuscular block reversal with sugammadex or neostigmine plus glycopyrrolate. MeasurementsIncidence of post-operative urinary retention by neuromuscular block reversal agent and the independent association of neuromuscular block reversal technique and risk of post-operative urinary retention. Main resultsThe incidence of post-operative urinary retention was 2-fold greater among neostigmine with glycopyrrolate compared to sugammadex patients (5.0% vs 2.4% inpatients; 0.9% vs 0.4% outpatients; both p < 0.0001). Multivariable logistic regression identified reversal with neostigmine to be independently associated with greater risk of post-operative urinary retention (inpatients: odds ratio, 2.20; 95% confidence interval, 2.00 to 2.41; p < 0.001; outpatients: odds ratio, 2.57; 95% confidence interval, 2.13 to 3.10; p < 0.001). Post-operative urinary retention-related visits within 2 days following discharge were five-fold higher among those reversed with neostigmine than sugammadex among inpatients (0.05% vs. 0.01%, respectively; p = 0.018) and outpatients (0.5% vs. 0.1%; p < 0.0001). ConclusionThough this study suggests that neuromuscular block reversal with neostigmine can increase post-operative urinary retention risk, additional studies are needed to fully understand the association.

Regional anesthesia and sickle cell crisis in pediatric patients: An educational-focused review.

Sickle cell disease (SCD) is the most common inherited hemoglobinopathy, affecting approximately 100 000 patients in United States and millions worldwide. Although the mainstay of pain management for VOC remains systemic opioids, given the potential for adverse effects including respiratory depression and hypoxemia, there remains interest in the use of regional anesthetic techniques (neuraxial or peripheral nerve blockade). A systematic search of pubMed, Scopus, and Google Scholar was conducted using the terms sickle cell disease, sickle cell crisis, pain crisis, vaso-occlusive crisis, regional anesthesia, peripheral nerve blockade, and neuraxial anesthesia. We identified 7 publications, all of which were retrospective case series or single case reports, outlining the use of neuraxial anesthesia in a total of 26 patients with SCD. Additionally, we identified 4 publications, including one retrospective case series and 3 single case reports, entailing the use of peripheral blockade in patients with VOC and SCD. The available literature, albeit all retrospective or anecdotal, suggests the potential utility of regional anesthesia to treat pain in patients with SCD. Additional benefits have included avoidance of the potential deleterious physiologic effects of systemic opioids and in one case series, an improvement in respiratory function as judged by pulse oximetry. The anecdotal and retrospective nature of the available reports with an absence of prospective trials limits the evidence based medicine available from which to develop to guidlines for the optimal local anesthetic agent to use, its concentration, the rate of infusion, and the choice of adjunctive agents.

UK clinicians' attitudes towards the application of molecular diagnostics to guide antibiotic use in ICU patients with pneumonias: a quantitative study.

Molecular diagnostic tests may improve antibiotic prescribing by enabling earlier tailoring of antimicrobial therapy. However, clinicians' trust and acceptance of these tests will determine their application in practice. To examine ICU prescribers' views on the application of molecular diagnostics in patients with suspected hospital-acquired and ventilator-associated pneumonia (HAP/VAP). Sixty-three ICU clinicians from five UK hospitals completed a cross-sectional questionnaire between May 2020 and July 2020 assessing attitudes towards using molecular diagnostics to inform initial agent choice and to help stop broad-spectrum antibiotics early. Attitudes towards using molecular diagnostics to inform initial treatment choices and to stop broad-spectrum antibiotics early were nuanced. Most (83%) were positive about molecular diagnostics, agreeing that using results to inform broad-spectrum antibiotic prescribing is good practice. However, many (58%) believed sick patients are often too unstable to risk stopping broad-spectrum antibiotics based on a negative result. Positive attitudes towards the application of molecular diagnostics to improve antibiotic stewardship were juxtapositioned against the perceived need to initiate and maintain broad-spectrum antibiotics to protect unstable patients.