Chronic State Research Articles

Nonsteroidal antiinflamatory drugs and risks of ulceration and other complications: some results of the problem investigation and own clinical observations

Nonsteroidal antiinflamatory drugs (NSAIDs) are widely used in clinical practice. Most widely used among them are “traditional” NSAIDs – 82,9 %, administration of selective COG-2 inhibitors was much less numerous. Starting from the primary care main attention upon using of mentioned drugs should be paid to safety, especially at chronic states, which require prolonged treatment. Safety should be in the center of attention considering influences on heart-and-vessel system and kidney. But mainly authors consider side effects on gastrointestinal tract, because of high spreading and severity. Moreover, side effects from lower segments of gastrointestinal tract demonstrate obvious trend for increasing. Some scientific results proved, that more than 40 % of injures connected with NSAIDs appeared in lower segments of gastrointestinal tract (small intestine and bowel). The article provides the results of own clinical observations of the case with multiple (eight) perforations of gastrointestinal tract upon uncontrolled self administered different NSAIDs by the multiply comorbided patient. We consider such a description demonstrative during practical classes in state and English languages at pre- and postgraduate levels.

Immunomodulatory and regenerative potentials of breast milk, prematurity and children’s heart

Recent expansion of fundamental knowledge on the physiology of lactation, and breast milk exosomes, stem cell biology, mother-child interactions from prenatal period to postnatal development requires a progressive, dynamic view from the scientific community and practicing physicians when analyzing known, generally accepted clinical phenomena and patterns (development of the immune system of infants and young children, natural and artificial feeding, features of postnatal development and growth of organs and tissues in children born prematurely). The components of the mother-breast-milk-infant triad are closely related to each other and influence developmental trajectory of the infant. According to modern concepts, breast milk of a nursing woman is a “living, metabolic / endocrine signaling system”, which may be considered an “immune organ” significant for postnatal growth and body programming of a premature baby. A valuable phenomenon of early postnatal development is actively discussed in the special literature, i,e., “microchimerism” caused by breastfeeding which, according to modern concepts, may play a key role in development of immune system and the whole body. Absence of protective (immunomodulatory and regenerative) effects of breast milk from a nursing woman on the spontaneous, uncorrectable impact of adverse factors of prematurity is likely predispose for remodeling and dysfunction of heart in prematurely born children, and, at longer range, in adults. The young children born prematurely show a unique cardiac phenotype characterized by reduced biventricular volume, relatively lower systolic and diastolic function, disproportionate muscle mass gain, clinically manifesting by increased risk of cardiovascular disease, hypertension, and decreased exercise tolerance. Hence, the premature birth may be considered a chronic disease state. Therefore, the natural feeding which provides a natural evolutionarily protective mechanism for the child’s heart should be attributed to the fundamental factors that play a vital role in prevention of cardiovascular diseases in prematurely born children and at later life periods.

Pathway from Acute Kidney Injury to Chronic Kidney Disease: Molecules Involved in Renal Fibrosis.

Acute kidney injury (AKI) is one of the main conditions responsible for chronic kidney disease (CKD), including end-stage renal disease (ESRD) as a long-term complication. Besides short-term complications, such as electrolyte and acid-base disorders, fluid overload, bleeding complications or immune dysfunctions, AKI can develop chronic injuries and subsequent CKD through renal fibrosis pathways. Kidney fibrosis is a pathological process defined by excessive extracellular matrix (ECM) deposition, evidenced in chronic kidney injuries with maladaptive architecture restoration. So far, cited maladaptive kidney processes responsible for AKI to CKD transition were epithelial, endothelial, pericyte, macrophage and fibroblast transition to myofibroblasts. These are responsible for smooth muscle actin (SMA) synthesis and abnormal renal architecture. Recently, AKI progress to CKD or ESRD gained a lot of interest, with impressive progression in discovering the mechanisms involved in renal fibrosis, including cellular and molecular pathways. Risk factors mentioned in AKI progression to CKD are frequency and severity of kidney injury, chronic diseases such as uncontrolled hypertension, diabetes mellitus, obesity and unmodifiable risk factors (i.e., genetics, older age or gender). To provide a better understanding of AKI transition to CKD, we have selected relevant and updated information regarding the risk factors responsible for AKIs unfavorable long-term evolution and mechanisms incriminated in the progression to a chronic state, along with possible therapeutic approaches in preventing or delaying CKD from AKI.

The disc-endplate-bone-marrow complex classification: progress in our understanding of Modic vertebral endplate changes and their clinical relevance

Background contextThe disc, endplate (EP), and bone marrow region of the spine form a single anatomical and functional interdependent unit; isolated degeneration of any one structure is rare. Modic changes (MC), however, are restricted to the subchondral bone alone and based on only T1 and T2 sequences of MRI. This results in poor reliability in differentiating fat from edema and hence may give a false impression of disease inactivity. PurposeTo study the changes in disc, endplate, and bone marrow as a whole in degeneration and propose a classification based on the activity status of this complex with the addition of STIR MRI sequences. Study designObservational cohort. Patient samplePatients with isolated brain, cervical, or thoracic spine injury and patients with low back pain (LBP) who underwent MRI formed the control and study groups, respectively. Outcome measuresDemographic data, the prevalence of MC and disc-endplate-bone marrow classification (DEBC) changes, EPs undergoing reclassification based on DEBC, and comparison of the prevalence of MC, DEBC, H+modifier and DEBC with H+concordance between control and LBP group. The study determined the risk of LBP patients undergoing surgery as well as the incidence of postoperative infection based on DEBC changes. Significance was calculated by binomial test and chi-square test with the effect size of 0.3 to 0.5. Prevalence and association of outcome were calculated by Altman's odds ratio with the 95% CI and the scoring of z statistics. Logistic expression was plotted for independent variables associated with each class of both Modic and DEBC against dependent variables surgery and nonsurgery. MethodsLumbar segments in both groups were assessed for MC types. The DEBC classification was developed with the addition of STIR images and studying the interdependent complex as a whole: type-A: acute inflammation; type-B: chronic persistence; type-C: latent and type-D: inactive. Modifier H+ was added if there was disc herniation. The classification was compared with MC and correlated to clinical outcomes. ResultsA total of 3,560 EPs of 445 controls and 8,680 EPs in 1,085 patients with LBP were assessed. Four nonMC, 560 MC-II, and 22 MC-III EPs were found to have previously undetected edema in STIR (n=542) or hyperintensity in discs (n=44) needing reclassification. The formerly undescribed type-B of DEBC, representing a chronic persistent activity state was the most common (51.8%) type. The difference between the control and LBP of H+(12% vs 28.8%) and its co-occurrence with DEBC type 1.1% vs 23.3%) was significant (p<.0001). The odds ratio for the need for surgery was highest (OR=5.2) when H+ and DEBC type change co-occurred. Postoperative deep infection (as determined by CDC criteria) was 0.47% in nonDEBC, compared with 2.4% in patients with DEBC (p=.002), with maximum occurrence in type-B. ConclusionClassification based on the classic MC was found to need a reclassification in 586 EPs showing the shortcomings of results of previous studies. Considering the DEBC allowed better classification and better predictability for the need for surgical intervention and incidence of postoperative infection rate than MC.

The direct disease burden of COVID-19 in Belgium in 2020 and 2021

BackgroundBurden of disease estimates have become important population health metrics over the past decade to measure losses in health. In Belgium, the disease burden caused by COVID-19 has not yet been estimated, although COVID-19 has emerged as one of the most important diseases. Therefore, the current study aims to estimate the direct COVID-19 burden in Belgium, observed despite policy interventions, during 2020 and 2021, and compare it to the burden from other causes.MethodsDisability-adjusted life years (DALYs) are the sum of Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) due to disease. DALYs allow comparing the burden of disease between countries, diseases, and over time. We used the European Burden of Disease Network consensus disease model for COVID-19 to estimate DALYs related to COVID-19. Estimates of person-years for (a) acute non-fatal disease states were calculated from a compartmental model, using Belgian seroprevalence, social contact, hospital, and intensive care admission data, (b) deaths were sourced from the national COVID-19 mortality surveillance, and (c) chronic post-acute disease states were derived from a Belgian cohort study.ResultsIn 2020, the total number of COVID-19 related DALYs was estimated at 253,577 [252,541 − 254,739], which is higher than in 2021, when it was 139,281 [136,704 − 142,306]. The observed COVID-19 burden was largely borne by the elderly, and over 90% of the burden was attributable to premature mortality (i.e., YLLs). In younger people, morbidity (i.e., YLD) contributed relatively more to the DALYs, especially in 2021, when vaccination was rolled out. Morbidity was mainly attributable to long-lasting post-acute symptoms.ConclusionCOVID-19 had a substantial impact on population health in Belgium, especially in 2020, when COVID-19 would have been the main cause of disease burden if all other causes had maintained their 2019 level.

Increased alpha-synuclein and neuroinflammation in the substantia nigra triggered by systemic inflammation are reversed by targeted inhibition of the receptor for advanced glycation end products (RAGE).

The receptor for advanced glycation end products (RAGE) is a protein of the immunoglobulin superfamily capable of regulating inflammation. Considering the role of this receptor in the initiation and establishment of neuroinflammation, and the limited understanding of the function of RAGE in the maintenance of this condition, this study describes the effects of RAGE inhibition in the brain, through an intranasal treatment with the antagonist FPS-ZM1, in an animal model of chronic neuroinflammation induced by acute intraperitoneal injection of lipopolysaccharide (LPS). Seventy days after LPS administration (2 mg/kg, i.p.), Wistar rats received, intranasally, 1.2 mg of FPS-ZM1 over 14 days. On days 88 and 89, the animals were submitted to the open-field test and were killed on day 90 after the intraperitoneal injection of LPS. Our results indicate that blockade of encephalic RAGE attenuates LPS-induced chronic neuroinflammation in different brain regions. Furthermore, we found that intranasal FPS-ZM1 administration reduced levels of gliosis markers, RAGE ligands, and α-synuclein in the substantia nigra pars compacta. Additionally, the treatment also reversed the increase in S100 calcium-binding protein B (RAGE ligand) in the cerebrospinal fluid and the cognitive-behavioral deficits promoted by LPS-less time spent in the central zone of the open-field arena (more time in the lateral zones), decreased total distance traveled, and increased number of freezing episodes. In summary, our study demonstrates the prominent role of RAGE in the maintenance of a chronic neuroinflammatory state triggered by a single episode of systemic inflammation and also points to possible future RAGE-based therapeutic approaches to treat conditions in which chronic neuroinflammation and increased α-synuclein levels could play a relevant role, such as in Parkinson's disease.

Aptamer-based Biosensors: Promising Sensing Technology for Diabetes Diagnosis in Biological Fluids.

Diabetes is a chronic disease state in which the pancreas fails to secrete sufficient insulin, resulting in an elevation of blood glucose levels. As one of the most prevalent diseases worldwide, diabetes is recognized as a global health concern that, if undiagnosed or untreated, can lead to serious and life-threatening complications, such as kidney failure, cardiovascular disease and diabetic retinopathy. Despite progress in the diagnosis of diabetes, limitations still exist with current analytical techniques, and, therefore, the development of precise sensing devices for on-site, real-time detection of diabetes is needed. Biosensors have contributed significantly to the field of diabetes healthcare, due to their cost-effectiveness, portability, ease of use, and rapid assay time. Recently, there has been a preference for the utilization of aptamers over antibodies in designing biosensors. Aptasensors, biosensors made with aptamers, offer potential in the diagnosis of diabetes. Aptamers, due to having lower molecular weight, low price, and stability over a wide temperature range and pH range, their in vitro synthesis, and the ability to refold after being removed from denaturing conditions compared to antibodies, have some distinctive characteristics as well as diverse types, such as optical FNA-based biosensors, colorimetric biosensors, fluorescent biosensors and electrochemical FNA-based biosensors. With this in mind, we highlight the recent developments and novel perspectives in the field of aptasensor design to quantitatively monitor diabetes biomarkers. Finally, some results are highlighted to offer a basis for the future design of aptasensor kits for diabetes diagnosis.

Histopathologic diagnosis and patient characteristics in cats with small intestinal obstructions secondary to trichobezoars.

The aim of the present study was to describe the distribution of gastrointestinal histopathology findings associated with gastrointestinal obstructions secondary to trichobezoar formation in cats. A total of 100 surgical gastrointestinal biopsies were obtained from 44 cats with gastrointestinal obstructions secondary to a trichobezoar. Medical records, including signalment, type and duration of clinical signs, surgical reports and histopathologic analysis, were reviewed for each cat. Biopsies taken near the site of the trichobezoar were more likely to show neutrophilic inflammation and mucosal erosion/ulceration compared with biopsies taken elsewhere in the small intestine. Lymphoplasmacytic and mixed lymphocytic and eosinophilic populations were the most common histopathologic findings from all biopsies followed by alimentary small cell lymphoma. Biopsy samples were more likely to represent a diagnosis of alimentary lymphoma in cats older than 10 years. Gastrointestinal biopsies taken at the time of surgery in cats with trichobezoar obstructions may represent an important diagnostic tool for further evaluation of potential feline chronic enteropathy. Biopsies taken at the site of the obstruction should be interpreted cautiously as the presence of a trichobezoar may induce an acute inflammatory reaction. The resultant histologic interpretation at this site may not represent the chronic state of the intestinal mucosa, supporting the utility of obtaining multiple biopsies orad and aborad to the obstruction.

Multistate Model of the Natural History of Inflammatory Pancreatic Diseases: A Nationwide Population-based Cohort Study

Understanding the nature of inflammatory pancreatic diseases is essential for planning health care system requirements and interventions. The aim of this study was to quantify the trajectories of inflammatory pancreatic diseases and their association with pancreatic cancer in a population-based setting. National health registries were used to identify all Danish residents (18 years or older) in the period from 2000 through 2018 with incident cases of acute pancreatitis (AP), recurrent acute pancreatitis (RAP), chronic pancreatitis (CP), and pancreatic cancer. We used a multistate model to examine transitions from a healthy state to intermediate states of acute pancreatic inflammation (AP and RAP) to chronic states (CP and pancreatic cancer) and, ultimately, death. Results were reported as transition incidence rates per 1000 person-years with 95% CIs. There were 4,663,864 individuals included (mean age, 46 years; 51% were women). During a mean follow-up of 16.8 years, 31,396 individuals were diagnosed with incident AP, 5546 with RAP, 8898 with CP, and 18,182 with pancreatic cancer. The cumulative incidence of pancreatitis (acute and chronic) during the study period was 0.80% (95% CI, 0.79%-0.80%). The transition incidence rates to CP were 12.1 (95% CI, 8.1-18.1) from AP, 46.8 (95% CI, 31.6-69.3) from RAP, and 0.07 (95% CI, 0.04-0.13) from a healthy state. Similar patterns were observed for transitions to pancreatic cancer. Most patients diagnosed with CP (64.2%) and pancreatic cancer (96.4%) transitioned directly from a healthy state. Among patients with pancreatitis, 41.0% (95% CI, 40.5%-41.5%) died during follow-up. The study findings revealed an increased risk of CP and pancreatic cancer in patients with a history of AP. However, most patients with CP and pancreatic cancer transitioned directly from a healthy state.

Cognitive Performance, Sociodemographic Factors, Pure-Tone Audiometry, and their Association with Speech Discrimination: A Prospective Population-Based Study of 1,061 Older Adults.

Hearing loss is increasingly recognized as a chronic disease state with important health sequelae. Although considered a central component of routine audiometric testing, the degree to which various patient factors influence speech discrimination is poorly characterized to date. The primary objective of the current work was to describe associations of cognitive performance, sociodemographic factors, and pure-tone audiometry with speech discrimination in older adults. Prospective study. Olmsted County, Minnesota. There were 1,061 study participants 50 years or older at enrollment in the population-based Mayo Clinic Study of Aging between November 2004 and December 2019 who underwent formal audiometric and cognitive testing included in the current investigation. The primary outcome measure was word recognition scores (WRSs; measured as <100% vs 100% as well as continuous), with pure-tone averages (PTAs; 0.5, 1, 2, and 3 kHz), age, sex, years of education, state area deprivation index (ADI) quintiles, and global cognition z scores as explanatory features. The mean (SD) age among the 1,061 participants was 76 (9) years with 528 (50%) males. Participant age [OR (95% CI) for a 10-year increase of 1.8 (1.4-2.3), p < 0.001], male sex [OR = 2.6 (1.9-3.7), p < 0.001], and PTA [OR for a 10-dB hearing loss increase of 2.4 (2.1-2.8), p < 0.001] were all significantly associated with <100% WRSs, with the greatest explanatory ability attributable to the PTA. Years of education ( p = 0.9), state ADI quintile ( p = 0.6), and global cognitive performance ( p = 0.2) were not associated with WRS. The multivariable model demonstrated strong predictive ability for less than perfect WRSs, with a c index of 0.854. Similar results were seen for WRSs analyzed as continuous, with the multivariable model resulting in an R2 value of 0.433. Although PTA exhibited the greatest influence on speech discrimination, advancing age and male sex both independently increased the likelihood of having worse speech discrimination among older adults, even after accounting for years of education, neighborhood-level socioeconomic disadvantage, and cognitive function. These findings help identify patient factors that can be instrumental when designing screening programs for adult-onset hearing loss.

Awareness of Hepatitis B Virus Infection and Vaccination Rate Among Adults Attending the Out-Patient Clinic of General Hospital, Ilorin, Nigeria

Background: Hepatitis B virus (HBV) is a potentially life-threatening infection affecting the liver from acute disease to chronic infection state and sometimes even leading to death. This study was done to determine the level of awareness of the hepatitis B virus as a disease, the availability of its vaccine, as well as the vaccination rate among the study population. Methods: This study was a descriptive cross-sectional study, and it was done at the General Hospi-tal Ilorin, Kwara State, Nigeria. The study population was adults aged 18 years and above attend-ing outpatient clinics. The sample size for this study was 377, with a male to female ratio of 128:249. The study instrument was a structured and semi-structured interviewer-administered questionnaire. The data was analyzed using Statistical Packages for Social Sciences IBM (SPSS) 21. Results: The overall level of awareness of HBV infection was very low (19.4%), only 38% of the participants knew HBV infection as a disease, while very few of them knew the causative agent (4.9%), and only 15.4% of the participants knew the transmission routes of the HBV. However, about half of the participants were aware of the existence of the HBV vaccine (50.8%). Only very few participants had ever received the vaccine as an adult, with a vaccination rate of 4.6%. There were statistically significant associations between HBV vaccination status, knowledge of the dis-ease, knowledge of HBV causative agent (P &lt;0.001), and knowledge of HBV transmission routes (P &lt;0.001). These factors positively impact vaccination uptake in this study. It was also observed that more young people were more likely to have received the HBV vaccine when compared to the elderly ones (P &lt;0.001). Similarly, secondary education students were more likely to receive the HBV vaccine (P = 0.039). Conclusion: The awareness of HBV infection and the knowledge of the disease were very low, same with vaccination uptake. Young people and those with formal education would likely obtain the HBV vaccination.

Seeing beyond gait: A case study identifying chronic laminitis in 3 goats

Identification of goat lameness on farm is typically recognised as either an overt gait abnormality or non-weight bearing limbs. Subclinical and chronic laminitis in goats tends to present as a mild, uneven gait with abnormally shaped claws; it is possible that animals with these symptoms are experiencing pain, however due to our reliance on overt gait changes, they will not be identified to receive appropriate management, potentially leaving them in a chronic state of suffering. This case study identified the pathological changes associated with laminitis, with a hypothesis that mild lameness does not always correlate with severity of disease process. Three Saanen does, part of a research herd but originally sourced from a commercial milking herd in New Zealand, were suspected to have chronic laminitis. Following photographs, radiographs and infrared thermography, goats were euthanised and claw longitudinal sections were taken; tissue was submitted for histology. Two goats stood and walked normally, and one also stood normally but walked with a slight uneven gait; all goats presented various hoof conformation issues. Radiographs showed distal phalanx remodelling and rotation in all three cases. Post-mortem hoof longitudinal sections and histology presented multiple abnormalities, including but not limited to: irregular cortex of the distal phalanx, distended blood vessels in the dermis and laminae, laminae necrosis, development of abnormal fibrous tissue, and distorted laminae epidermal cells. Histology from two of the goats confirmed the presence of dermal inflammation, and this was seen visually in one goat using infrared thermography. Our case study approach allowed for detailed physical and histological examination of the changes caused by laminitis in ex-commercial dairy goats. This work suggests that chronic laminitis can result in dramatic pathological changes, and that lameness score alone is not a good indication of the severity of these changes. Better interpretation of external abnormalities, such as clubbed and distorted claws, as well as the use of radiographs and infrared thermography, should be more commonly considered for identifying at risk animals in order to initiate appropriate management or end-of-life decisions.

ELearning improves allied health professionals' knowledge and confidence to manage medically unexplained chronic fatigue states: A randomized controlled trial

ObjectivesTo evaluate the impact of eLearning by allied health professionals on improving the knowledge and confidence to manage people with medically unexplained chronic fatigue states (FS). MethodsUsing a parallel randomized controlled trial design, participants were randomized 1:1 to a 4-week eLearning or wait-list control group. Knowledge and self-reported confidence in clinical skills to implement a therapeutic intervention for patients with FS were assessed at baseline, post-intervention and follow-up. Secondary outcomes (adherence and satisfaction with online education, knowledge retention) were also assessed. Data was analyzed using intention-to-treat. ResultsThere were 239 participants were randomized (eLearning n = 119, control n = 120), of whom 101 (85%) eLearning and 107 (89%) control participants completed baseline assessments and were included in the analysis. Knowledge (out of 100) improved significantly more in the eLearning group compared to the control group [mean difference (95% CI) 8.6 (5.9 to 11.4), p < 0.001]. Knowledge was reduced in the eLearning group at follow-up but was still significantly higher than baseline [6.0 (3.7 to 8.3), p < 0.001]. Median change (out of 5) in confidence in clinical skills to implement the FS intervention was also significantly greater in the eLearning group compared to the control group [knowledge: eLearning (1.2), control (0); clinical skills: eLearning (1), control (0.1); both p < 0.001)]. Average time spent on the eLearning program was 8.8 h. Most participants (80%) rated the lesson difficulty as at the “right level”, and 91% would recommend it to others. ConclusionseLearning increased knowledge and confidence to manage FS amongst allied health professionals and was well-accepted.Registration: ACTRN12616000296437 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370222&isReview=true.

Nanoparticles in Medicine: Current Status in Cancer Treatment.

Cancer is still a leading cause of deaths worldwide, especially due to those cases diagnosed at late stages with metastases that are still considered untreatable and are managed in such a way that a lengthy chronic state is achieved. Nanotechnology has been acknowledged as one possible solution to improve existing cancer treatments, but also as an innovative approach to developing new therapeutic solutions that will lower systemic toxicity and increase targeted action on tumors and metastatic tumor cells. In particular, the nanoparticles studied in the context of cancer treatment include organic and inorganic particles whose role may often be expanded into diagnostic applications. Some of the best studied nanoparticles include metallic gold and silver nanoparticles, quantum dots, polymeric nanoparticles, carbon nanotubes and graphene, with diverse mechanisms of action such as, for example, the increased induction of reactive oxygen species, increased cellular uptake and functionalization properties for improved targeted delivery. Recently, novel nanoparticles for improved cancer cell targeting also include nanobubbles, which have already demonstrated increased localization of anticancer molecules in tumor tissues. In this review, we will accordingly present and discuss state-of-the-art nanoparticles and nano-formulations for cancer treatment and limitations for their application in a clinical setting.

Moderator Effect of Chronic Disease on The Relationship Between Marriage Adjustment and Satisfaction in Married Couples

Objective: The purpose of our study is to show how the relationship between marital adjustment and satisfaction will change in cases of chronic disease in either or both spouses of married couples using a multivariate statistical analysis method. Methods: Marriage adjustment ve marriage satisfaction scales were used. A structural equation modeling - multiple group analysis method was used in the study, which was designed as a relational screening model. Results: In the study, which included 898 participants, 56.6% of the participants were female and 43.4% were male. The mean age of the participants was 36.94 ± 8.72 standard deviations. First, the relationship between marital adjustment and satisfaction was analyzed using structural equation modeling, and the relationship between the scales was found to be statistically significant (p=0.001). In the model, which was significant and sufficient, the variable of chronic disease was coded on the arrow representing the regression coefficient between the scales, and multiple group analysis was applied. The relationship between marital adjustment and satisfaction was found to be weak among individuals with chronic diseases. The rate of marriage satisfaction explaining marriage adjustment was lower in individuals without chronic disease (R2=0.16) than in those without chronic disease (R2=0.10). While ego scores were not significant in individuals without chronic disease (p=0.237), they were statistically significant in individuals with chronic disease (p=0.017). Conclusion: Chronic diseases has been found to have a significant impact on the relationship between spouses. Many studies have examined the effects of chronic diseases on marriage. However, our study differs from other studies because of the analytical methods used. In the scales, it was determined whether the chronic disease showed a change in the relationship between the scales, not the scores in the chronic disease state.

Is the SIRS Criteria a Good Predictor of Blood stream Infection in Cirrhosis? A Single-Center Retrospective Analysis

IntroductionCirrhosis-associated immune dysfunction (CAID) is a chronic vasodilatory state with hyperdynamic circulation and alterations in thermoregulation that may make patients more susceptible to and mask underlying infection. This study aims to determine whether SIRS criteria are an accurate tool for predicting bloodstream infection (BSI) in cirrhosis. MethodsIn our retrospective chart review, study population included patients with cirrhosis that were 18 years or older. For all study patients, model for end-stage liver disease (MELD) scores and values for each SIRS variable at the time of admission and blood culture data were recorded. Univariable and multivariable logistic regression analysis was performed to identify any associations between dichotomized SIRS variables that fulfill SIRS positivity and BSI. ResultsSignificantly more patients without BSI met positivity criteria for WBC counts (30% vs 13% p < .001). In the analysis of the SIRS variables as continuous variables in prediction of BSI, the AUC curves generated were all unsatisfactory with the temperature (36-38°C) and WBC count (4 × 103 to 12 × 103 mcL) at the time of admission having the highest areas under the ROC curve (0.52 and 0.55, respectively). Looking at the SIRS variables dichotomized (according to whether fulfilling SIRS criteria or not) in univariable logistic regression, only WBC counts meeting SIRS criteria were significantly associated with BSI OR 0.37 (0.18-0.77); p = .008, but this was an inverse association. This association was true even in the multivariable model OR 0.38 (0.18-0.80); p = .01. ConclusionOur study shows that SIRS criteria are a poor predictor of BSI among patients with cirrhosis.

Development of a Systems Medicine Approach to Spinal Cord Injury.

Traumatic spinal cord injury (SCI) causes a sudden onset multi-system disease, permanently altering homeostasis with multiple complications. Consequences include aberrant neuronal circuits, multiple organ system dysfunctions, and chronic phenotypes such as neuropathic pain and metabolic syndrome. Reductionist approaches are used to classify SCI patients based on residual neurological function. Still, recovery varies due to interacting variables, including individual biology, comorbidities, complications, therapeutic side effects, and socioeconomic influences for which data integration methods are lacking. Infections, pressure sores, and heterotopic ossification are known recovery modifiers. However, the molecular pathobiology of the disease-modifying factors altering the neurological recovery-chronic syndrome trajectory is mainly unknown, with significant data gaps between intensive early treatment and chronic phases. Changes in organ function such as gut dysbiosis, adrenal dysregulation, fatty liver, muscle loss, and autonomic dysregulation disrupt homeostasis, generating progression-driving allostatic load. Interactions between interdependent systems produce emergent effects, such as resilience, that preclude single mechanism interpretations. Due to many interacting variables in individuals, substantiating the effects of treatments to improve neurological outcomes is difficult. Acute injury outcome predictors, including blood and cerebrospinal fluid biomarkers, neuroimaging signal changes, and autonomic system abnormalities, often do not predict chronic SCI syndrome phenotypes. In systems medicine, network analysis of bioinformatics data is used to derive molecular control modules. To better understand the evolution from acute SCI to chronic SCI multi-system states, we propose a topological phenotype framework integrating bioinformatics, physiological data, and allostatic load tested against accepted established recovery metrics. This form of correlational phenotyping may reveal critical nodal points for intervention to improve recovery trajectories. This study examines the limitations of current classifications of SCI and how these can evolve through systems medicine.

Cellular and extracellular vaginal changes following murine ovarian removal.

Loss of estrogen as a result of aging, pelvic cancer therapy, genetics, or eating disorders affects numerous body systems including the reproductive tract. Specifically, a chronic hypoestrogenic state fosters debilitating vaginal symptoms like atrophy, dryness, and dyspareunia. Current treatment options, including vaginal estrogen and hyaluronan (HA), anecdotally improve symptoms, but rectifying mechanisms are largely understudied. In order to study the hypoestrogenic vaginal environment, in particular the extracellular matrix (ECM), as well as understand the mechanisms behind current treatments and develop new therapies, we characterized a reliable and reproducible animal model. Bilateral ovariectomies (OVX) were performed on 9-week-old CD1 mice. After 1 month of estrogen loss due to ovarian removal, a phenotype that is similar to human vaginal tissue in an estrogen reduced state was noted in mice compared to sham-operated controls. The uterine to body weight ratio decreased by 80% and vaginal epithelium was significantly thinner in OVX compared to sham mice. Estrogen signaling was altered in OVX, but submucosal ERα localization did not reach statistical differences. HA localization in the submucosal area was altered and CD44 expression decreased in OVX mice. Collagen turn-over was altered following OVX. The inflammation profile was also disrupted, and submucosal vaginal CD45+ and F4/80+ cell populations were significantly reduced in the OVX mice. These results show altered cellular and molecular changes due to reduced estrogen levels. Developing new treatments for hypoestrogenic vaginal symptoms rely on better understanding of not only the cellular changes, but also the altered vaginal ECM environment. Further studies using this mouse model has the potential to advance women's vaginal health treatments and aid in understanding the interplay between organ systems in both healthy, aged, and diseased states.

NosP Detection of Heme Modulates Burkholderia thailandensis Biofilm Formation.

Aggregated bacteria embedded within self-secreted extracellular polymeric substances, or biofilms, are resistant to antibiotics and cause chronic infections. As such, they are a significant public health threat. Heme is an abundant iron source for pathogenic bacteria during infection; many bacteria have systems to detect heme assimilated from host cells, which is correlated with the transition between acute and chronic infection states. Here, we investigate the heme-sensing function of a newly discovered multifactorial sensory hemoprotein called NosP and its role in biofilm regulation in the soil-dwelling bacterium Burkholderia thailandensis, the close surrogate of Bio-Safety-Level-3 pathogen Burkholderia pseudomallei. The NosP family protein has previously been shown to exhibit both nitric oxide (NO)- and heme-sensing functions and to regulate biofilms through NosP-associated histidine kinases and two-component systems. Our in vitro studies suggest that BtNosP exhibits heme-binding kinetics and thermodynamics consistent with a labile heme-responsive protein and that the holo-form of BtNosP acts as an inhibitor of its associated histidine kinase BtNahK. Furthermore, our in vivo studies suggest that increasing the concentration of extracellular heme decreases B. thailandensis biofilm formation, and deletion of nosP and nahK abolishes this phenotype, consistent with a model that BtNosP detects heme and exerts an inhibitory effect on BtNahK to decrease the biofilm.

EFFECT OF BRIGHT LIGHT ON THE COGNITIVE AND OCCUPATIONAL PERFORMANCE OF ELDERLY PEOPLE UNDERGOING HEMODIALYSIS: INITIAL DATA FROM CLINICAL TRIAL

INTRODUCTION: Chronic kidney disease (CKD) has no expectation of cure, therefore, the treatment is based on maintaining the chronic state of the disease, through renal replacement therapies, such as hemodialysis or kidney transplant. The CKD can compromise occupational performance, since the beginning of hemodialysis, adaptation to new life habits is required. OBJECTIVE: To analyze the effects of bright light on occupational performance of elderly people with end-stage renal disease (ESRD) on hemodialysis in the state of Ceará, aiming at its impact on the quality of life of these patients. METHOD: Randomized, placebo-controlled clinical trial with and qualitative-quantitative approach, with the use of bright light or placebo light in their homes for 30 minutes, for 4 weeks in the afternoon. From this perspective, the evaluation instruments were used before and after the light: The Dynamic Lowenstein Occupational Therapy Cognitive Assessment – for Geriatric Population (DLOTCA-G) adapted version for the Portuguese language. The sample consisted of 26 elderly people on dialysis, and the collection period comprised the months of August 2022 to May 2023. RESULTS: They were 69% (18/26) male and between 60 and 94 years old. The analysis of the impacts of such equipment on these individuals' memory, mental operations and visual-motor skills revealed that the bright light group had better results than the placebo group (linear regression, p&lt;0.001). CONCLUSIONS: Bright light exposure therapy proved to be very beneficial, especially for the memory and mediation of these elderly people, thus reflecting on the improvement of their quality of life.