Daily Dose Research Articles (Page 1)

Intravenous regional limb perfusion (IVRLP) of antibiotics is a therapeutic method used to treat distal limb infections in horses. The objectives of this study were to determine the pharmacokinetic parameters and tolerance of sodium benzylpenicillin (NaBP) administered via IVRLP; to compare the feasibility, tolerance, and efficacy of performing IVRLP on a flexed limb versus a weightbearing limb; and to predict the efficacy of IVRLP using gentamicin or NaBP. A prospective crossover study was conducted with six horses, each undergoing four phases of antibiotic infusion (gentamicin at 2.2mg/kg vs. NaBP at 7,333 IU/kg of BP) and limb positioning (weightbearing vs. flexed). Each antibiotic administration was followed by serial synovial and blood sampling to assess antibiotic concentrations. Inflammation and sensitivity to palpation were evaluated at both the injection site and the sampled joint. A pharmacokinetic/pharmacodynamic analysis was carried out to predict the efficacy of IVRLP by estimating area under the concentration-time curve to minimum inhibitory concentration (AUC/MIC) index values for various minimum inhibitory concentrations (MICs). High synovial concentrations of NaBP and gentamicin were achieved, with notable variability between horses. NaBP IVRLP was well tolerated, although cephalic vein inflammation scores were significantly higher following NaBP infusion than gentamicin (p = 3.4 × 10- 11). For all horses and both antibiotics, synovial antibiotic exposures were significantly greater in weightbearing limbs than in flexed limbs (p = 0.04 and 0.02 for NaBP and gentamicin, respectively). Cephalic vein inflammation scores were also significantly lower in weightbearing limbs than in flexed limbs (p = 2.5 × 10- 5). In terms of predicted efficacy, a daily dose of 2.2mg/kg gentamicin should be adequate to treat synovial infections involving Escherichia coli or Staphylococcus aureus, including resistant strains. For NaBP, a daily or every-other-day dose of 7,333 IU/kg of BP should be adequate to treat infections caused by Streptococcus equi and sensitive Staphylococcus aureus. These findings suggest that daily IVRLP with NaBP (7,333 IU/kg of BP) could be an effective treatment for distal limb infections caused by susceptible bacteria with a MIC of ≤ 2µg/mL, with only mild local inflammation at the injection site. IVRLP with 2.2mg/kg gentamicin appears effective for treating infections involving susceptible bacteria with an MIC of ≤ 16µg/mL. Performing IVRLP on a weightbearing limb resulted in higher antibiotic exposure in the metacarpophalangeal joint and better tolerance than the flexed limb method.

Tramadol (TRM) is a centrally acting analgesic drug used for management of moderate to severe pain. Granulocyte colony-stimulating factor (G-CSF) is a cytokine that has the ability to mobilize stem cells from the bone marrow to the peripheral circulation. This study was performed to evaluate the histological and biochemical alterations in the adrenal cortex after intake of tramadol and the possible protective role of G-CSF on it. Fifty adult male albino rats were divided into three groups: Group I as a control group, group II (TRM treated group) received a daily dose of 80 mg/kg body weight orally via gastric tube for 12 weeks and group III (TRM+G-CSF-treated group) received subcutaneous injections of 100 μg/kg body weight of G-CSF for seven consecutive days, then TRM from the 8th day to the end of the experiment in the same dose as group II. At the end of the experiment, blood samples were taken for hormonal essay and tissue samples were processed. Light and electron microscopic studies were done. Morphometric and statistical studies were carried out. The study revealed that TRM induced histological and ultrastructural degenerative changes, decreased serum levels of aldosterone, cortisol, and dehydroepiandrosterone, as well as a strong positive Bax immune reaction. However, G-CSF reversed these alterations and showed a strong positive CD34 immune reaction. In conclusion: G-CSF improved histological, biochemical and immunohistochemical metrics in the rat adrenal cortex after tramadol-induced injury.

Irrational antibiotic use is one of the most important reasons for the rise of antibiotic resistance worldwide. This study questioned how dentists comply with rational antibiotic use (RAU) principles when prescribing antibiotics, their inadequacy, and the need for training. The study included 324 dentists working with patients from public, private, and university settings in Turkey. An online survey was conducted to evaluate demographic information, approaches, and attitudes toward antibiotic prescribing. 64% of the participants were female dentists. 50.6% of all participants are dentists working in private clinics, and the rate of those with less than five years of professional experience is 48.5%. While the participants mainly prescribe antibiotics for infection treatment (89.2%), the rate of those who inform their patients about the maximum daily dose is 91.7%. Participants reported that they had a lack of knowledge about drug interactions (76.2%) and pharmacological properties (44.4%), and it was determined that these participants wanted to receive training on RAU. The rate of participants who wish to receive RAU training is 86.1%. It would be beneficial for dentists to update their training in rational antibiotic prescribing in order to monitor antimicrobial resistance patterns and to obtain the necessary information about contraindications and disinfection protocols.

In vivo and insilico toxicity studies of hydroalcoholic extract of Vetiveria zizanioides roots.

Background/Objectives: Our objective was to describe the safety and efficacy of enteral droxidopa, a norepinephrine prodrug, for intravenous (IV) vasopressor weaning in intensive care unit (ICU) patients. Methods: This was a single-center, retrospective descriptive study of adult ICU patients. Patients who received ≥ 4 consecutive doses of droxidopa for IV vasopressor weaning were included. The cessation of the IV vasopressor without re-initiation within 72 h of droxidopa initiation was the primary outcome. The adverse events assessed included hypotension, hypertension, and arrhythmias. Results: Forty-six patients were included, with a median age of 61. Forty-two patients (91%) were on midodrine at the time of droxidopa initiation. The median daily midodrine dose was 80 mg. The median time from ICU admission to droxidopa initiation was 17 days. Patients were on a median of one IV vasopressor at the time of droxidopa initiation, with norepinephrine as the most common agent (50%). The median initial daily droxidopa dose was 300 mg, with a median maximum daily dose of 900 mg. Vasopressor support was discontinued within 72 h of droxidopa initiation in 46% of patients, with a median time to IV vasopressor cessation of 3.3 days. There were no incidences of hypotension, hypertension, arrhythmias, or ICU readmissions related to droxidopa. Droxidopa was continued upon discharge in 29% of patients. Conclusions: Droxidopa may be a safe and effective option to facilitate the weaning of IV vasopressor support in patients who are refractory or intolerant to midodrine. Larger prospective studies are needed to confirm these findings.

Reducing antimicrobial use (AMU) in animal husbandry is imperative to curb the rising threat of antimicrobial resistance. Therefore, sustainable monitoring of AMU is essential to ensure responsible use, minimize resistance and promote long-term effectiveness. Examining the on-farm AMU in broiler production in Pakistan aimed to encourage farmers to adopt responsible antimicrobial practices, while also helping to observe trends in AMU during the fattening period as well as differences between farms. The data were obtained using the international AMU monitoring system VetCAb-ID (©TiHo Hannover, Germany). In this study, the results of monitoring four commercial broiler farms, each with 20 flocks, were investigated for a period of one year. Treatment frequency (TF) based on Used Daily Dose was used to determine flock, farm and season specific differences in AMU. Describing the relative TF of different antimicrobial classes. Shows that the use of antimicrobial classes varied between farms, among flocks within a farm and across fattening weeks within a flock. Overall, the most frequently used classes were polymyxins (27.2%), fluoroquinolones (20.4%), macrolides (17.1%) and tetracyclines (15.9%). The TF was higher in winter than in summer flocks. A statistically significant difference between summer and winter flocks could be observed in the use of fluoroquinolones ( p = 0.0463) and macrolides ( p = 0.0325). Using the shared international database VetCAb-ID, detailed and internationally comparable information on the on-farm use of antibiotics in Pakistan broiler production could be obtained and analyzed to identify differences between farms and flocks.

Adjunctive Corticosteroid Use and Clinical Outcomes in Non-HIV Pneumocystis jirovecii Pneumonia.

Hair dyes are widely used cosmetic products that can contain trace metals and metalloids, posing potential health risks through dermal exposure. This study aimed to assess and compare the concentrations of selected metals and metalloids in six brands of commercial hair dyes sold in Brazil and Paraguay and to evaluate their average daily dermal exposure doses, hazard quotients, hazard indices, and carcinogenic risk. Concentrations of Cr, Cd, Co, Cu, Fe, Mn, Mo, Ni, As, Al, Pb, Ba, Ag, and Zn in hair dye were quantified by standardized analytical methods. The Paraguayan brand showed the highest levels for several elements, including As (4.17 mg/kg), Al (130.276 mg/kg), and Fe (30.033 mg/kg). Estimated dermal exposure doses reached up to 3.35 × 10−6 mg/kg/day for arsenic, 1.68 × 10−3 mg/kg/day for aluminum, and 8.59 × 10−8 mg/kg/day for chromium. Although all hazard indices remained below 1, suggesting low non-carcinogenic risk, the calculated carcinogenic risk for arsenic in the Paraguayan product was 1.23 × 10−5, entering the medium-risk range. These findings highlight relevant differences in raw material control and potential cumulative health risks, especially for frequent users. Continuous quality control, harmonized regulatory standards, clear labeling, and further biomonitoring studies are strongly recommended to minimize long-term exposure to toxic elements in hair dye formulations and to ensure safer consumer products.

Healthcare-associated infections (HAIs) are a significant public health issue, increasing costs and mortality. Antimicrobial resistance (AMR) is a global concern exacerbated by indiscriminate antibiotic use, leading to longer hospital stays and higher mortality. Antimicrobial stewardship programs (PROA) promote the optimal use of antibiotics to reduce resistance and improve clinical outcomes. The COVID-19 pandemic led to excessive antibiotic use globally, worsening AMR. This study followed the Plan-Do-Check-Act cycle with four stages: initial diagnosis; standardization of antibiotic prescription and treatment algorithms based on resistance profiles; cultural transformation through education and communication with healthcare teams; and active monitoring and evaluation. The program improved adherence to rational antibiotic use from 74.82 % in 2023 to 91.13 % in 2024 among 1,135 patients. HAIs decreased by 55.74 % compared to the previous year, reaching the lowest rate in six years. Carbapenem-resistant bacterial infections declined significantly. Antibiotic consumption, measured in Defined Daily Dose, decreased alongside increased adherence. Economic analysis revealed cost savings with ceftriaxone and ciprofloxacin, with reductions of 2 406 123 COP and 9 482 696 COP, respectively between 2023 and 2024. The program generated a significant positive economic impact alongside clinical benefits. It effectively reduced HAIs and antimicrobial resistance through interdisciplinary leadership, standardized prescribing protocols, education, active surveillance, and data-driven decision-making. This initiative has positioned the institution as a local reference for antimicrobial stewardship.

The number older patients with cancer who are terminally ill is expected to increase with global population aging. However, reports on the actual use of opioids for pain relief in patients aged ≥ 90years with cancer at the end of life are limited. To investigate opioid use in older patients with cancer aged ≥ 90years who died in a palliative care unit. Patients with cancer who died in the palliative care unit between August 2020 to August 2024 and were aged ≥ 90years were included. We analyzed their data on opioid use, including opioid type and route of administration, and morphine equivalent daily dose (MEDD), at the time of death. Ninety-one patients with cancer were included in the study. Their median age was 92.0years (interquartile range [IQR] 91.0-93.0). Seventy-six patients (83.5%) were administered opioids at the time of death, and hydromorphone delivered via continuous subcutaneous injection was the most common (41 patients). The median MEDD at the time of death for the 76 patients was 19.6mg/day (IQR 12-42). Four patients were administered high doses of opioids (MEDD of > 120mg/day) at the time of death. Of the patients aged ≥ 90years with cancer who were terminally ill, more than 80% had used opioids. Their median MEDD tended to be low at 19.6mg/day. Future studies are required to help appropriately use opioids for patients aged ≥ 90years with cancer.

Synthetic pyrethroids, such as permethrin, are commonly used insecticides in crop agriculture, clothing items such as camping and military uniforms, and for treating insect infestations in people and pets. Growing epidemiological evidence supports an association between pyrethroid insecticide exposures and cardiovascular diseases risk, including coronary heart disease. Studies in rats show that pyrethroid insecticides are pro-atherogenic, in part, by increasing circulating total LDL-C and oxidized LDL-C and cholesterol accumulation in the aorta. Here, we used the ApoE Null mouse model to test the hypothesis that chronic exposure to permethrin promotes atherosclerosis. Male and female mice were fed a custom diet based on the "What we eat in America” analysis (NHANES). Cholesterol was included at 296 mg per 1000 kcal (i.e., the 90 th percentile of cholesterol intake in the typical American diet). The mice were exposed to vehicle or 10, 50 and 500 µg/kg/day doses of permethrin delivered in food for 11-12 weeks. By comparison, the Environmental Protection Agency identifies a maximum daily exposure of 50 µg permethrin/kg/day as protective of adverse effects. Using allometric scaling, the approximate human-equivalent doses were 1, 4 and 41 µg/kg/day. For comparison, US military personnel wearing permethrin-treated uniforms have an estimated average daily dose of permethrin of 3-9 µg/kg/day. We observed that at a daily dose as low as 50 μg permethrin/kg for 11-12 weeks, atherosclerotic plaque area was larger in permethrin-exposed compared to vehicle-exposed mice. While the effect of permethrin on plaque area was not different between sexes, we observed a greater reduction in weight gain in female mice and a greater increase in liver lipids in male mice at 500 μg/kg/day. No differences in serum liver enzymes (i.e., AST and ALT) were observed. Given that pyrethroid insecticides have been shown to activate several nuclear receptors in vitro , we analyzed total liver RNA for the expression of target genes of peroxisome proliferator activated receptor α, constitutive androstane receptor and pregnane X receptor, however no significant differences across groups were observed. Our results demonstrate that chronic exposure to pyrethroid insecticides accelerates atherosclerosis in murine models that may represent a mechanism for the clinical epidemiological observations linking pyrethroids to increased cardiovascular disease risk.

Background : Infection remain one of the leading causes of morbidity in tropical regions such as Indonesia, with Escherichia coli being one of the most freequently identified pathogens. The high incidence of Escherichia coli-related infections has led to increased antibiotics use, considering that this commensal gut bactericum can cause both asymptomatic infections and symtomatic diarrhe, either bloody or non-bloody. Objective : This study aimed to evaluate use in pediatric patiens with diarrea at Hospital X, Semarang Regency, in 2023. Methods: This was a retrospective study uutilizing medical records of 323 pediatric patiens who met the inclusion and exclusion criteria. Data analysis was performed using the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Result:The analysis revealed that Ceftriaxone injection was the most frequently used antibiotic (61.95%), followed by Ampicillin, Amikacin, Gentamicin, and Cefotaxime. Ceftriaxone was often prefered due to its efficacy against both gram-positive and gram-negative bacteria comonly associated with pediatric diarrhea, as well as the advantage of accurate dosing trough injectable formulations. Most diarrhea cases occurred in boys (62.54%) and in children under five years of age (65.63%). Conclusion:Injectable formulations were chosen to reduce the risk of vomiting and to facilitate precise and effective dosing. Evaluation using the ATX/DDD method highlighted the need for more rational antibiotic management to prevent bacterial resistance in the future. Optimizing antibiotic stewardship is crucial to ensure targeted in the future. Optimizing antibiotic stewardship is crucial to ensure targeted, effective use and to preserve therapeutic efficacy in the long term.

Background: The use of antibiotics serves as therapy for various types of infections caused by pathogens or for other preventive measures, such as major surgeries. Evaluating antibiotic use is necessary to ensure effectiveness, accuracy, and safety in rational usage. Purpose: The aim of this study was to evaluate the use of antibiotics at dr. T.C. Hillers Maumere General Hospital in 2019 among inpatients undergoing digestive surgery. Method: This research is a descriptive, non-experimental study with a cross-sectional design. A quantitative and qualitative approach was used, employing the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) method and the Gyssens flowchart based on retrospective data. The study involved reviewing medical records from January to December 2019. A total of 338 data samples were collected, including 9 types of oral antibiotics and 8 types of parenteral antibiotics according to the ATC classification. Results: The results showed that among oral antibiotics, Cefadroxil 500 mg had the highest DDD value at 9.51 DDD/100, while among parenteral antibiotics, Cefotaxime 1 g injection had the highest DDD value at 10.74 DDD/100. Conclution: The evaluation using the Gyssens flowchart indicated that 68.34% of antibiotic use was appropriate, while 31.66% was inappropriate. In conclusion, the use of antibiotics for digestive surgery inpatients was generally appropriate, but further evaluation is needed regarding antibiotic use that does not comply with clinical guidelines.

Background: Antibiotic resistance is a critical global health problem resulting from the inappropriate use of antibiotics. Understanding the pattern of antibiotic utilization is necessary to support rational prescribing and reduce resistance.Objective: This study aimed to evaluate the pattern of antibiotic use among inpatients at Hospital X in Semarang Regency in 2023. Methods: A retrospective study was conducted among inpatients aged 19–59 years who received antibiotic therapy between January and December 2023. Data were analyzed using the Anatomical Therapeutic Chemical/Defined Daily Dose method and Drug Utilization 90% to assess consumption patterns. Results: A total of 1,402 patients were included, with most patients being female and within the 49–59 age group. The majority of hospital stays lasted 1–5 days. Ceftriaxone injection is the most frequently used antibiotic and records the highest defined daily dose, followed by levofloxacin and ampicillin sulbactam. Conclusion: The study shows that ceftriaxone injection dominates antibiotic utilization. Regular evaluation using standardized methods is essential to ensure appropriate use and prevent resistance. Antibiotic procurement policies should be guided by actual consumption data to improve efficiency in drug management.

This study aimed to describe annual trends in sodium-glucose cotransporter-2 inhibitor (SGLT2i) prescriptions among patients with rheumatoid arthritis (RA) and diabetes mellitus (DM), and to assess whether SGLT2i use increases urinary tract infection (UTI) risk, emulating a target trial. An administrative claim database identified RA patients aged ≥18 years with type 2 DM from April 2015 to April 2023. Population 1 included RA patients with DM for assessing diabetes medication status. Population 2 included those with newly initiated first- or second-line antidiabetic medications. The primary outcome was UTI, defined using diagnostic code and antibiotic prescription. For intention-to-treat (ITT) analysis, we used quasi-Poisson regression, whereas for as-treated (AT) analysis, we applied Poisson mixed-effects models. Among the 26 754 patients in Population 1, SGLT2i prescriptions notably increased, while traditional diabetes medications decreased. Population 2 included 9,772 patients (mean age 69.8 years, 60% women, 13% SGLT2i initiators, 42% on glucocorticoids). During a mean 34-month follow-up, 2,269 UTI events occurred in 1,373 patients. ITT analysis showed no significant difference between SGLT2i and other antidiabetic drug. However, AT analysis demonstrated statistically significant association (adjusted incidence rate ratio 1.64, 95% CI 1.26-2.13). The SGLT2i- daily glucocorticoid dose interaction was not significant in either model. Among RA patients with DM, SGLT2i use may inherently increase the risk of UTI compared with other antidiabetics. However, the ITT analysis findings support the safety of SGLT2i selection in routine clinical practice, including in patients receiving glucocorticoids.

Introduction: Beta blockers (BB) and calcium channel blockers (CCB) are recommended in non-obstructive hypertrophic cardiomyopathy (HCM) based on limited documentation. Hypothesis: BB and CCB enhance the cardiovascular response to exercise in patients with non-obstructive HCM. Methods: In this randomized, double-blind, placebo-controlled triple-crossover trial, patients with non-obstructive HCM (Left ventricular wall thickness ≥15 mm and left ventricular outflow tract gradient <30 mmHg), and ≥1 marker of disease severity: NYHA class ≥II, NT-proBNP >300 ng/L, or non-sustained ventricular tachycardi were included. Each patient underwent three treatment periods with daily target doses of bisoprolol 7.5 mg, verapamil 360 mg and placebo. The main outcomes, compared to placebo, were oxygen consumption (VO 2 ), heart rate (HR), blood pressure (BP), anaerobic threshold (AT), ventilatory volume/carbon dioxide output (VE/VCO 2 ) slope, as marker of ventilatory efficiency, rate-pressure product (RPP), as marker of myocardial work and O 2 -pulse, as marker of stroke volume. Outcomes were evaluated by a cardiopulmonary exercise test after two weeks of steady state treatment. Results: Thirty-two patients aged 54 years were included. At peak exercise, bisoprolol reduced VO 2 to 25.7±8.7 mL/kg/min (-2.5 mL/kg/min, p=0.002) compared to placebo. Bisoprolol further reduced HR (-37 min -1 , p<0.001), diastolic BP (-16 mmHg, p=0.007), RPP (-7234 min -1 × mmHg, p<0.001), and increased O 2 -pulse (+3.30 mL/beat, p<0.001). At peak exercise, verapamil reduced VO 2 to 28.2±8.6 mL/kg/min (-0.7 mL/kg/min, p=0.990) compared to placebo. Verapamil further reduced HR (-17 min -1 , p<0.001) and increased O 2 -pulse (+1.58 mL/beat, p=0.001) at peak exercise, but RPP, systolic and diastolic BP were unchanged. The VO 2 at AT and the VE/VCO 2 slope were unchanged for both bisoprolol and verapamil compared to placebo. At rest, bisoprolol reduced HR (-13 min -1 , p<0.001), systolic BP (-8 mmHg, p=0.002), diastolic BP (-7 mmHg, p<0.001), RPP (-3005 min -1 × mmHg, p<0.001), and increased O 2 -pulse, (+2.73 mL/beat, p<0.001). Resting VO 2 was unchanged. Verapamil reduced resting HR (-6 min -1 , p<0.001), diastolic BP (-5 mmHg, p=0.010), RPP (-1212 min -1 × mmHg, p<0.001), but resting systolic BP, VO 2 and O 2 -pulse were unchanged. Conclusion: Bisoprolol significantly reduced oxygen consumption and estimates of myocardial work at peak exercise compared to placebo, while verapamil did not affect these markers significantly compared to placebo.

Background: Clinical trials have demonstrated mavacamten’s efficacy in improving health status of patients with obstructive hypertrophic cardiomyopathy (oHCM), but real-world data remain limited. Research Question: What is mavacamten’s impact on health status changes in patients with oHCM in real-world settings? Methods: The COMPASS-HCM study (NCT06551129) prospectively recruited US adults with oHCM prescribed mavacamten, excluding those with moderate lung disease, recent hospitalization (≤ 2 weeks), recent heart/lung surgery or stroke/transient ischemic attack (≤ 6 months), or mavacamten treatment ≥7 days prior to enrollment. Participants completed the Kansas City Cardiomyopathy Questionnaire (KCCQ; higher scores are better) and HCM Symptom Questionnaire (HCMSQ; lower scores are better) at baseline, weeks 2, 4, 8, 12, 24, and 30 after initially starting mavacamten. Patient characteristics and health status changes from baseline through week 30 were described. Results: A total of 108 patients (mean [± SD] age 66.7 ± 12.5 years, 61.1% women, and 94.4% White) completed baseline surveys and initiated mavacamten following enrollment. Baseline mean scores were 60.3 ± 20.9 for KCCQ Overall Summary Score (KCCQ-OSS), 65.9 ± 19.3 for KCCQ Clinical Summary Score (KCCQ-CSS), 6.9 ± 3.5 for HCMSQ Shortness of Breath (SoB) domain, and 4.5 ± 2.0 for HCMSQ Total score. At baseline, 85.2% of patients were on background oHCM therapy. Follow-up surveys were completed by 78, 74, 62, 52, 24, and 18 patients treated with mavacamten for 2, 4, 8, 12, 24, and 30 weeks, respectively. At last follow-up, daily mavacamten dose was 2.5 mg in 16.7%, 5 mg in 38.9%, 10 mg in 22.2%, and 15 mg in 22.2% of patients. Mean improvements from baseline to week 30 were 20.7 ± 17.1 for KCCQ-OSS (Figure 1), 16.4 ± 12.8 for KCCQ-CSS, -3.9 ± 3.5 for HCMSQ SoB domain, and -2.0 ± 2.0 for HCMSQ Total score. At week 12, 69.2% and 38.5% of patients achieved large (≥10 points) and very large (≥20 points) improvements in KCCQ-OSS, respectively, increasing to 83.3% and 50.0% at week 30 (Figure 2). A ≥ 2.5 point reduction in HCMSQ-SoB score was observed in 58.8% of patients at week 12, increasing to 70.6% at week 30 (Figure 3). Conclusion(s): Real-world mavacamten treatment led to rapid and substantial health status improvements that appear to accrue through week 30 in oHCM, highly consistent with the EXPLORER-HCM findings in a more restricted population.

Introduction With the global energy demand on the rise, natural gas plays a crucial role as a clean and efficient energy source. However, wellbore liquid loading has become a key constraint on the stable production of gas fields in their mid-to-late stages—specifically, it affects approximately 40% of the gas wells in the Liaohe Oilfield, leading to productivity declines or even well shut-ins. Foam Assisted Lift (FAL) is a mainstream technical solution to mitigate wellbore liquid loading due to its low cost and strong adaptability. Nevertheless, FAL is plagued by crude design of dosing parameters in practical applications, which either causes unnecessary chemical waste (from overdosing) or results in operational failure (from underdosing), limiting its efficiency and economic viability. Methods This study focused on three typical gas wells (Well Y-1, Y-2, and Y-3) with distinct liquid loading and FAL application statuses: Well Y-1 did not adopt foam drainage technology; Well Y-2 achieved good liquid production after FAL application but suffered from excessive foam drainage agent injection; Well Y-3 used FAL but failed to meet the expected foam drainage target. To address the limitations of traditional FAL parameter design, this research innovatively treated foam as a special type of liquid to align with existing wellbore pressure (e.g., Beggs-Brill method) and temperature distribution models. On this basis, three core technical components were developed: 1) a segmented liquid loading calculation model based on the casing-tubing pressure difference; 2) a comprehensive dosing parameter optimization system covering initial dosage, daily replenishment amount, and injection cycle; and 3) validation of critical liquid-carrying velocity models (including the Turner model, Li Min model, and Wang Yizhong model) to screen the most applicable one for foam systems. Results The optimized FAL scheme yielded significant performance improvements and cost reductions. In terms of liquid-carrying capacity: Well Y-1 (previously without FAL) saw a 26.89% enhancement, and Well Y-3 (with underperforming FAL) saw a 22.64% enhancement. In terms of cost control: the daily dosing amount for Well Y-2 was reduced to 32.3% of the original dosage, and the FAL operation cycle for Well Y-3 was extended from 6 days to 17 days, reducing both chemical consumption and operational frequency. Additional key findings include: 1) the Wang Yizhong model was confirmed to have high engineering applicability for predicting foam liquid-carrying capacity, outperforming the Turner and Li Min models; 2) the SP-7 foaming agent exhibited better foaming and liquid-carrying performance under low-salinity conditions; and 3) concentration of the foaming agent, gas flow rate, and wellbore temperature were identified as key factors significantly influencing the efficacy of SP-7. Discussion This research addresses the core problem of crude dosing parameter design in traditional FAL technology by integrating a segmented liquid loading calculation model and a targeted parameter optimization system. The confirmation of the Wang Yizhong model’s applicability provides a reliable theoretical tool for foam liquid-carrying prediction, while the insights into SP-7’s performance under different conditions offer practical guidance for foaming agent selection in field operations. Overall, this study establishes a technical foundation for efficient, cost-effective foam drainage in liquid-loading gas wells, particularly those in mid-to-late-stage gas fields like the Liaohe Oilfield, and provides a reference for solving similar liquid loading challenges in other gas-producing regions.

Background: The main complications of hepatic hydatid disease are infection and rupture into the biliary tree or into the peritoneal cavity. Fungal infections within the biliary tract and the liver are very rare, whereas cases of hepatic echinococcal cysts infected by fungi have not been previously reported. Case Presentation: We report on a 63-year-old male patient with a 3-day history of dull, non-radiating pain in the right hypochondrium, low-grade fever, and malaise. His past medical history included a Roux-en-Y hepatico-jejunostomy and gastro-enteroanastomosis for locally extended adenocarcinoma of the intra-pancreatic common bile duct. Laboratory analyses showed elevated WBC and C-reactive protein levels. The computed tomography scan showed an infected hydatid cyst grade CE5 according to Gharbi's and WHO classifications. Catheterization was performed, and cultures revealed Candida glabrata. Anidulafungin was initiated with a loading dose of 200 mg, followed by a daily dose of 100 mg. After 23 days, cultures of the draining fluid showed no fungi or other bacteria. Two days later the catheter was removed, the patient was discharged, and at the time of follow-up at 1 and 2 months, remained well. Conclusion: Fungal infections should be considered in patients with an infected echinococcal cyst of the liver. Understanding of the etiology and epidemiology, along with early and rapid detection of C. glabrata, is necessary for prompt treatment.

Opioid use in Asian patients with inflammatory bowel disease (IBD) remains poorly understood. This study aimed to investigate the trends in chronic opioid use, associated clinical factors, and effects of advanced therapy (AT) on opioid use in Korean patients with IBD. This nationwide cohort study used administrative claims data from the Korean National Health Insurance Service (2010-2022). Chronic opioid use was defined as opioid use for ≥90 days or ≥3 prescriptions within a calendar year. Logistic regression was used to identify clinical factors associated with chronic opioid use. The impact of AT on opioid use was analyzed through pre- and post-initiation comparisons using McNemar's tests, generalized estimating equations (GEE), and a linear mixed model. Chronic opioid use increased over the study period, with a higher prevalence in Crohn's disease (CD) than in ulcerative colitis (UC) (CD: 1.38%, UC: 0.53% in 2010; CD: 5.38%, UC: 1.98% in 2020). Among 49 548 newly diagnosed IBD patients, female sex, steroid and immunomodulator treatments, hospitalizations, emergency room visits, and mental disorders were positively associated with chronic opioid use in CD and UC. AT was positively associated with chronic opioid use in UC (odds ratio [OR] 1.627, P < .0001) but negatively associated with CD (OR 0.786, P = .0013). In CD, AT significantly reduced opioid users (McNemar's test: P < .0001; GEE: OR 0.478, P < .0001) and average daily doses (mean difference -15.8 morphine milligram equivalents, P = .0073). Chronic opioid use has increased over the past decade among Korean patients with IBD, particularly among those with CD. AT is crucial for reducing opioid use in patients with CD.