Increased Treatment Costs Research Articles

Совершенствование организационных и лечебно-профилактических мероприятий, направленных на профилактику избыточной массой тела и ожирения.

Relevance. Obesity is a serious public health problem due to its high prevalence, increasing treatment costs and adverse effects. In this regard, the development of preventive measures aimed at preventing the formation and progression of obesity based on modern information and digital technologies seems to be an urgent and extremely important task. Research objective: development of a system for early diagnosis of overweight and obesity with the identification of predictors of their formation to prevent the progression of the pathological process and effective prevention of its occurrence. Materials and methods. To assess the prevalence of overweight and obesity, an analysis of the data of the reporting forms of federal statistical observation № 30 «Information about the medical organization» and № 12 «Information on the number of diseases registered in patients living in the service area of the medical organization» for the period 2012–2023 was carried out. To assess the economic component, we used the data from reports on the summary of expenses at the expense of budget funds, funds received from the provision of paid services. The study used the following methods: analytical, statistical, comparative analysis and content analysis. Statistical processing of materials was carried out using calculation tables in Excel format. Results. The article presents data on the relevance and prevalence of overweight and obesity in the adult group, including the workingage population. The risks of human health impairment with possible disability and mortality due to overweight and obesity are analyzed. Socioeconomic factors leading to obesity are considered. The economic consequences of this problem, as well as unresolved problems of obesity prevention are noted. Priority areas of comprehensive prevention programs are identified and prognostic models for the development of overweight and obesity are developed, taking into account the identified individual medical and social risk factors. The results of the study will allow personalizing preventive measures aimed at preventing obesity and its complications.

Метод комбінованого лікування медіастиніту після аортокоронарного шунтування

Post-sternotomy mediastinitis (PM) or deep wound sternal infection is one of the most dreaded complications after cardiac surgery. Thanks to modern hygiene standards in hospitals and the rational use of antibiotics, the overall prevalence of PM is generally considered low. In cases of coronary artery bypass grafting using the internal mammary artery, this rate can significantly increase. However, even if this complication is relatively rare, it is associated with high mortality and morbidity level. Deep wound sternal infection not only leads to bad outcomes but is also accompanied by significant morbidity in surviving patients, prolonged hospital stays, increased treatment costs, and a substantial deterioration in long-term survival rates. At present, there is no standard treatment regimen for PM. Clinicians can choose different methods depending on the classification form of the disease, but all without exception include three main concepts: infection control, classical, irrigation, or vacuum wound drainage, and its reconstruction. Today, surgeons continuously propose new treatment methods, all of them have its own advantages and disadvantages as well. We present a case report of successful combined treatment (vacuum therapy followed by thoracoplasty) of PM after coronary artery bypass grafting.

Economic Burden Associated with Switching to Second Line Asparaginase (Recombinant Erwinia) in Pediatrics, Adolescents and Young Adults (AYA) with Acute Lymphoblastic Leukemia (ALL)

Background: Long-acting asparaginases derived from E. coli (pegaspargase [PEG] and calaspargase pegol [CAL-PEG]) are critical components of frontline (1L) chemotherapy regimens in pediatrics, adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL). In the event of ≥grade 3 hypersensitivity reactions based on CTCAE version 5.0, to an E. coli asparaginase, patients often switch to second line (2L) asparaginase derived from Erwinia (Recombinant Erwinia), which has an increased dosing of thrice/week due to its shorter half-life. Infusion reactions may masquerade as hypersensitivity reactions, leading to unnecessary formulation switches and potentially increased economic and healthcare burdens on patients and the healthcare system. Formulation switches may be mitigated through therapeutic drug monitoring (TDM) utilization which may help differentiate between neutralizing and non-neutralizing antibody-mediated reactions through quantification of serum asparaginase activity levels. This study aims to quantify the costs and healthcare resource utilization (HRU) associated with switching from 1L to 2L asparaginases in pediatrics and AYA patients with ALL, overall and by use of TDM. Methods: This is a retrospective study using Optum's deidentified Clinformatics® data mart. Pediatric/AYA patients (<40 years) diagnosed with ALL between Jan. 2021 and Sep. 2023 and treated with frontline asparaginase-containing regimen were identified throughout the US. Treatment start date was designated as the index date. Descriptive analyses were used to assess baseline demographics in the pre-index period, and use of premedication, TDM and proportion of switchers to recombinant Erwinia in the follow-up (post-index) period. Annualized mean HRU and costs were compared in the follow-up period between switchers and non-switchers, and by use of TDM in terms of inpatient admissions, outpatient visits, emergency department (ED) visits, and medical and prescription drugs. Among switchers, HRU and costs were also compared pre- and post-switching. Costs were adjusted and inflated to 2023 dollars. Results: A total of 154 pediatric or AYA patients with ALL were identified, of which 116 received PEG and 38 received CAL-PEG. Median (IQR) age was 8 (6-15) years. No patient >22 years received CAL-PEG, while 11% of patients receiving PEG were >22 years old. Nearly two-third were male. Median (IQR) follow-up duration was 11.3 (6-19.4) months. Approximately 58% of patients were given premedication- all on the same day as PEG/CAL-PEG infusion; 40% had TDM performed, 25% had both and 29% had none. Overall, 35 of 154 patients (23%) switched to recombinant Erwinia; including 21% of those on PEG and 29% of those on CAL-PEG. Switchers had a significantly higher mean outpatient visits per year compared to non-switchers (83 vs. 72; p=0.0466). This was mainly driven by the increased visits associated with recombinant Erwinia administration vs PEG/CAL-PEG administration (mean # of visits: 18 vs. 3, respectively; p<0.0001). Mean total healthcare costs were three times higher in switchers than non-switchers ($1,272,846 vs. $467,773; p<0.0001). This was mainly driven by outpatient costs which were nearly four times higher in switchers than non-switchers ($1,094,941 vs. $286,243). ED costs were higher for switchers ($11,960 vs $8,930), while outpatient prescription costs were lower ($5,273 vs $9,416) (all p<0.0001). No significant differences were found for inpatient costs. Among switchers, the outpatient costs were higher post-switching compared to pre-switching ($1,130,975 vs. $528,237; p<0.0001) further suggesting that the majority of the higher costs in the switchers was driven by administration of recombinant Erwinia. When compared by use of TDM, 28% switched to recombinant Erwinia in the non-TDM group and 14.8% in the TDM group. Mean outpatient costs were $511,810 and $384,396 (p<0.0001) in the non-TDM and TDM groups, respectively. Conclusions: Switch from 1L asparaginase to 2L recombinant Erwinia is relatively common in pediatric and AYA ALL patients which significantly increases treatment costs and HRU, mainly driven by higher outpatient medical costs of recombinant Erwinia. Consideration should be given to performing TDM which may have important implications for mitigating unnecessary switches as well as reducing healthcare burden and achieving substantial cost savings for payers.

Perioperative care of a patient with immune thrombocytopenia purpura undergoing tubo-ovarian abscess incision and drainage: Case report.

Tubo-ovarian abscess (TOA) is a serious health hazard for women, causing severe sepsis. Antimicrobial treatment is effective, but one-third of patients experience unfavorable outcomes. ITP, an autoimmune condition, can lead to bruising and bleeding. Diagnosing TOA in women of childbearing age is crucial, and combining emergency surgery with ITP patients can increase treatment costs and reduce quality of life. ITP can lead to severe complications, including postoperative hemorrhage, and may require platelet transfusions, glucocorticosteroids, and immunoglobulin. These treatments increase costs, decrease quality of life, and impact prognosis. Preventing ITP is crucial. Patients should be administered blood products based on platelet count and anemia or spontaneous bleeding tendencies. Perioperative blood management should aim for a target platelet level of 30 × 109/L and a hemoglobin concentration of 80 g/L before surgery. Post-surgery, perioperative care is crucial and vigilant for secondary bleeding. A tubo-ovarian abscess (TOA) is a frequently encountered inflammatory mass in therapeutic settings. TOA is a serious consequence of pelvic inflammatory disease (PID) that can lead to severe sepsis. In recent years, the incidence of TOA has increased, presenting a significant health hazard for women. To effectively target the diverse range of bacteria responsible for TOA, it is essential to use antimicrobial medicines that have a wide spectrum of activity. Nevertheless, the efficacy of antibiotic treatment stands at approximately 70%, while a significant proportion of patients, around one-third, experience unfavorable clinical outcomes necessitating drainage or surgical intervention. Immune thrombocytopenia (ITP) is an autoimmune condition characterized by a marked decrease in the quantity of platelets present in the bloodstream. ITP is characterized by thrombocytopenia, which leads to a heightened susceptibility to bruising and bleeding. The diagnosis of ITP and the prediction of treatment response continue to pose important and persistent issues in the field of hematology. The platelet count is commonly employed as a surrogate indicator of disease severity in patients with ITP and thus plays a crucial role in determining the necessity of treatment. A 25-year-old woman with a history of sexual activity underwent open abdominal exploration due to the sudden onset of lower abdominal pain. During the operation, a left TOA was discovered, and an incision and drainage were performed. Symptomatic treatments, such as anti-infectives and abdominal drainage, were administered. The culture of pus in the abdominal cavity suggested the presence of Escherichia coli. However, the patient presented with ITP and had a platelet count of less than 50 × 109/L before the operation. After the operation, the patient developed incisional and pelvic hematomas with signs of infection. As a result, the patient was discharged from the hospital after undergoing another laparotomy and receiving platelet transfusions and immunotherapy. Clinicians should be vigilant when diagnosing TOA in women of childbearing age, even in the absence of high-risk factors. A timely antibiotic or surgical intervention is necessary to preserve fertility and ensure quality of life. Combining emergency surgery with ITP patients poses a significant challenge for clinicians in terms of treatment. ITP can lead to serious complications, such as postoperative bleeding, which may require platelet transfusions, glucocorticoids, and immunoglobulin. This can increase the cost of treatment, reduce the quality of life, and seriously affect the prognosis. Therefore, preventing ITP is crucial. It is important to pay attention to the perioperative care of patients after surgery and be alert to the possibility of secondary hemorrhage.

CANNABIS: USO TERAPÊUTICO E DESAFIOS PARA SUA APLICABILIDADE MEDICINAL NO BRASIL

Introduction: The legalization of medicinal marijuana use has been a controversial and constantly debated topic in recent years worldwide. Marijuana, also known as cannabis, is a plant that contains various chemical components, including THC (tetrahydrocannabinol) and CBD (cannabidiol), which are the main compounds responsible for its medicinal effects. Although many countries have already established regulations for the therapeutic use of cannabis, there are still many barriers to overcome. Objective: To explore the methodology of therapeutic use and the challenges for the application of cannabis, focusing on its medicinal use, identifying notable challenges and the regulatory aspects involved. Methodology: This study is based on a bibliographic review with a qualitative methodology, centered on the subjective nature of the verified bibliography through literary studies. The works reviewed were published between 2020 and 2023, collected from three main sources: LILACS and PUBMED databases. Results: The review identified significant evidence pointing to the therapeutic potential of Cannabis sativa L., particularly in the treatment of neurological conditions such as epilepsy, multiple sclerosis, and anxiety disorders. However, it also highlighted the major regulatory challenges faced in countries like Brazil, where the cultivation of cannabis for medicinal purposes remains prohibited. This prohibition increases treatment costs and limits accessibility for patients. Additionally, the results revealed a growing acceptance among healthcare professionals and patients, suggesting a likely increase in the demand for medicinal cannabis in the coming years. Conclusion: Although there is robust evidence supporting the efficacy of cannabis for medicinal purposes, significant regulatory and legal barriers remain, particularly in countries with restrictive policies. A reformulation of regulatory frameworks is urgently needed to expand patient access and promote the development of local medicinal cannabis industries. Further investment in scientific research is also essential to ensure that regulatory decisions are based on comprehensive and context-specific data.

The use and impact of pathology tests in emergency department patients with mental health-related complaints: A cross sectional study.

To evaluate the use and impact of pathology tests in patients who present to the ED with mental health-related complaints. The primary objective is to measure the proportion of patients undergoing pathology tests and assess whether these tests trigger a change in management. In this retrospective study, we reviewed all recorded mental health presentations to our regional ED between January and June 2021. Patient characteristics, pathology tests, subsequent change in management, treatment costs and time to Emergency Physician and Psychiatrist were extracted. Descriptive statistics and multivariate analysis were used to explore associations between variables of interest, ED length of stay (LOS) and change in management. Of 37 900 ED visits, 1462 (3.9%) were mental health-related presentations. Pathology tests were conducted in 47.7% of cases, with 3% leading to a change in management. Pathology tests were associated with increased treatment costs (45% increase for blood tests, 17% for urine), and increased ED LOS (48%). Patients with coexisting medical conditions were three times more likely to have a change in management. Pathology tests should be reserved for patients with high-risk features and based on clinical assessment. Strategic use of pathology tests could avoid unnecessary delays and costs, enhancing patient care in mental health-related ED presentations.

A multifunctional electronic dressing with textile-like structure for wound pressure monitoring and treatment

In the treatment of infected wounds in bedridden or lying chair patients with mobility problems, improper wound care can lead to wound deterioration, prolong disease pain, increase treatment and care costs, and bring heavier psychological, physical, and economic burdens to patients. In the process of wound recovery, patients with mobility problems mainly face the comprehensive problems of poor air permeability, wound pressure could not be monitored, wound infection and slow healing. Therefore, in the process of wound care for such patients, it is imperative to develop a gas permeable dressing that can monitor the patient’s wound compression status in real time and promote wound healing. Here, we developed a textile-shaped gel dressing with pressure-responsive properties. Polydopamine (PDA)-silver coated calcium phosphate nanoparticles (CPNPs）and vascular endothelial growth factor (VEGF) were introduced into the gel to give the gel good antibacterial and therapeutic effects, while enhancing the pressure resistance of the gel to meet the needs of wound pressure monitoring. The textured gel morphology greatly improves the gas permeability of the gel and further improves the pressure sensitivity of the gel. This multifunctional textile-like gel dressing provides a new strategy for the development of treatment monitoring integrated dressing and has broad application prospects.

The Effect of Complementary Acupressure Therapy on Nausea and Vomiting After Regional Block Anesthesia (Spinal Anesthesia) in the Recovery Room Imelda Indonesian Workers General Hospital, Medan

Postoperative nausea and vomiting is one of the side effects that often occurs in spinal anesthesia. Nausea and vomiting affect patient morbidity such as stress, discomfort, dehydration, prolonging treatment time and increasing treatment costs. This study aims to determine the effect of acupressure therapy on the incidence of nausea and vomiting after spinal anesthesia in the recovery room at the Imelda Workers Indonesia General Hospital, Medan. This type of research is quantitative research with quasi-experimental research methods. Data reports in the province of North Sumatra showed that there were 25,602 patients who underwent surgery. Meanwhile, at the Indonesian Umim Workers Hospital in Medan, data on surgical patients for January-March 2024 totaled 666 patients, and 250 patients had spinal anesthesia. This research was carried out in February - June 2024 at the Imelda Indonesian Workers General Hospital, Medan. The research sample was taken as many as 20 respondents. incidence of nausea and vomiting after spinal anesthesia at the Imelda Workers Indonesia General Hospital, Medan. Based on the characteristics of respondents based on age, they were in the age range of 36-40 years, namely 55%, based on gender, the majority of respondents were women, namely 60%, respondents based on smoking history were the majority 65%, the distribution of respondents with a history of nausea and vomiting was the majority 55% and the majority of respondents with nausea and vomiting were 60%. The recommendation for this research is that acupressure therapy can be applied in nursing practice so that patients are able to perform it independently. For the Imelda Workers Indonesia General Hospital, Medan, it is necessary to score the risk of nausea and vomiting in patients before surgery to minimize the incidence of post-operative nausea and vomiting.

The Effect of Complementary Acupressure Therapy on the Incidence of Nausea and Vomiting After Regional Block Anesthesia (Spinal Anesthesia) in the Recovery Room of the Imelda Buruh Indonesia General Hospital, Medan

Postoperative nausea and vomiting is one of the common side effects of spinal anesthesia. Nausea and vomiting affect patient morbidity such as stress, discomfort, dehydration, prolonging treatment time and increasing treatment costs. This study aims to determine the effect of acupressure therapy on the incidence of nausea and vomiting after spinal anesthesia in the recovery room of the Imelda Labor Indonesia General Hospital, Medan. This type of research is a quantitative study with a quasi-experimental research method. Data reports in the province of North Sumatra, there are 25,602 patients undergoing surgery. While at the Umim Labor Indonesia Hospital, Medan, the data on surgical patients as of January-March 2024 amounted to 666 patients, 250 patients were found to have spinal anesthesia. This study was conducted in February - June 2024 at the Imelda Labor Indonesia General Hospital, Medan. A sample of 20 respondents was taken.: The results of the statistical test obtained an α value of 0.000 (α <0.05), thus it was concluded that there was an effect of acupressure therapy on the incidence of nausea and vomiting after spinal anesthesia at the Imelda Labor Indonesia General Hospital, Medan. Based on the characteristics of respondents based on age, they were in the age range of 36-40 years, which was 55%, based on gender, the majority of respondents were women, which was 60%, respondents based on a history of smoking were 65%, the distribution of respondents with a history of nausea and vomiting was 55% and the majority of respondents with an incidence of nausea and vomiting was 60%. The recommendation for this study is that acupressure therapy can be applied in nursing practice so that patients are able to do it independently. For the Imelda Labor Indonesia General Hospital, Medan, it is necessary to carry out a risk scoring of nausea and vomiting in patients before surgery to minimize the incidence of nausea and vomiting after surgery.

Etiological Agents of Superficial Surgical Site Infections among Post Operative Patients Attending a Teaching Hospital in Southeastern Nigeria

Surgical site infections (SSI) are infections at or around the site of incision where surgical procedure is conducted. It is a major cause of hospital morbidity, resulting in prolonged hospital stay, increased treatment costs, higher rates of re-operation, and even increased mortality rates. The etiological agents of superficial surgical site infections among post-operative patients attending a Teaching Hospital in Southeastern Nigeria were evaluated using standard microbiological methods. Seventy superficial surgical wound swab specimens were properly and aseptically obtained from post-operative patients after ethical clearance was duly obtained from the hospital’s ethical committee. Pure microbial cultures were obtained after 24 - 48 hours incubation, aerobically at 25oC, on blood, nutrient and Sabouraud’ Dextrose agar plates. The isolates were identified based on their morphological, physiological, biochemical and molecular characteristics. Out of the 70 surgical swab specimens collected, 81% were bacterial isolates which included Staphylococcus aureus 41%, Escherichia coli 16%, Pseudomonas aeruginosa 14% and Staphylococcus xylosus 10%. The fungi isolates (19%) were Candida tropicalis 8% and Trichosporon asahii 11%. These isolates were probably endogenous and exogenous flora from the patients’ and hospital’ environments respectively; thereby necessitating the need for adequate patient care before, during and after surgical procedures.

Trends in Antimicrobial Resistance of Uropathogens Isolated from Urinary Tract Infections in a Tertiary Care Hospital in Dhaka, Bangladesh.

Background/Objectives: Urinary tract infection (UTI) is a prevalent microbial infection in medical practise, leading to significant patient morbidity and increased treatment costs, particularly in developing countries. This retrospective study, conducted at a tertiary care hospital in Dhaka, Bangladesh, aims to examine the antimicrobial resistance (AMR) patterns of uropathogens and evaluate whether these patterns are influenced by demographic factors such as gender, age, or patient status. Methods: Standard microbiological techniques were used to identify uropathogens, and AMR patterns were determined using the Kirby-Bauer disc diffusion method. Results: Out of 6549 urine samples, 1001 cultures were positive. The infection was more prevalent in females compared to males. The incidence of UTIs in children aged 0-10 years accounted for 12.59% of the total cases, with this age group also exhibiting the highest rate of polymicrobial infections. Among the bacterial uropathogens, 71.19% of isolates were multidrug resistant (MDR) and 84.27% were resistant to at least one antibiotic. Escherichia coli (n = 544, 73.90% MDR) and Klebsiella species (n = 143, 48.95% MDR) were the most common Gram-negative uropathogens, while Enterococcus species (n = 78, 94.87% MDR) was the predominant Gram-positive isolate in this study. Our results indicate that most uropathogens showed resistance against ceftazidime, followed by cefuroxime, trimethoprim-sulfamethoxazole, amoxicillin-clavulanate, and netilmicin. Moderate levels of resistance were observed against ciprofloxacin, levofloxacin, aztreonam, and cefpodoxime. Conclusions: Amikacin was observed to be effective against Gram-negative uropathogens, whereas cefixime was more active against Gram-positive microorganisms, such as Enterococcus species. Moreover, a principal coordinate analysis (PCoA) depicted no significant influence of gender, patient status, or age on AMR patterns. For the continued usefulness of most antibiotics, periodic analysis of the AMR patterns of uropathogens can help assess the rise of MDR bacteria, and therefore guide the selection of appropriate antibiotic treatment strategies.

Isolation and characterization of a multidrug-resistant Staphylococcus aureus infecting phage and its therapeutic use in mice.

In recent years, the emergence of multidrug-resistant bacteria has limited the selection of drugs for treating bacterial infections, reduced clinical efficacy, and increased treatment costs and mortality. It is urgent to find alternative antibiotics. In order to explore a new method for controlling methicillin-resistant Staphylococcus aureus (S. aureus), this study isolated and purified a multidrug-resistant S. aureus broad-spectrum phage JPL-50 from wastewater. JPL-50 belongs to the Siphoviridae family after morphological observation, biological characterization, and transmission electron microscopy (TEM) fragmentation spectrum analysis. It can cleave 84% of tested S. aureus (168/200), in which 100% of tested mastitis-associated strains (48/48) and 72.04% of MRSA strains (67/93) were lysed. In addition, it has an optimal growth temperature of about 30°C, a high activity within a wide pH range (pH 3-10), and an optimal multiplicity of infection of 0.01. The one-step growth curve shows a latent time of 20 min, an explosive time of 80 min. JPL-50 was 16 927bp in length and was encoded by double-stranded DNA, with no genes associated with bacterial resistance or virulence factors detected. In a therapeutic study, injection of the phage JPL-50 once and for 7 times in 7 days protected 40% and 60% of the mice from fatal S. aureus infection, respectively. More importantly, JPL-50-doxycycline combination could effectively inhibit host S. aureus in vitro and reduce the use of doxycycline within 8 h. In conclusion, the bacteriophage JPL-50 has a wide lysis spectrum, high lysis rate, high tolerance to extreme environments, and moderate in vivo activity, providing ideas for developing multidrug-resistant S. aureus infections.

Antibiotic prophylaxis for the prevention of surgical site infections following colorectal surgery: protocol for network meta-analysis of randomized trials

BackgroundSurgical site infections continue to be a significant challenge following colorectal surgery. These can result in extended hospital stays, hospital readmissions, increased treatment costs, and negative effects on patients’ quality of life. Antibiotic prophylaxis plays a crucial role in preventing infection during surgery, specifically in preventing surgical site infections after colorectal surgery in adult patients. However, the optimal antibiotic regimen is still unclear based on current evidence. Considering the limitations of existing reviews, our goal is to conduct a comprehensive systematic review and network meta-analysis of randomized controlled trials to evaluate the comparative benefits and harms of available antibiotic prophylaxis regimens for preventing surgical site infections following colorectal surgery in adult patients.MethodsWe will search the Medline, EMBASE, CINAHL, Scopus, and Cochrane Central Register of Controlled Trials databases to identify relevant randomized controlled trials. We will include trials that (1) enrolled adults who underwent colorectal surgeries and (2) randomized them to any systemic administration of antibiotic (single or combined) prophylaxis before surgery compared to an alternative systemic antibiotic (single or combined antibiotic), placebo, control, or no prophylactic treatment. Pairs of reviewers will independently assess the risk of bias among eligible trials using a modified Cochrane risk of bias instrument for randomized trials. Our outcomes of interest include the rate of surgical site infection within 30 days of surgery, hospital length of stay, 30-day mortality, and treatment-related adverse effects. We will perform a contrast-based network meta-analysis using a frequentist random-effects model assuming a common heterogeneity parameter. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be utilized to assess the certainty of evidence for treatment effects.DiscussionBy synthesizing evidence from available RCTs, this study will provide valuable insight for clinicians, patients, and health policymakers on the most effective antibiotics for preventing surgical site infection.Systematic review registrationPROSPERO CRD42023434544.

Using a Bacterial Protein to Selectively Target Bacterial Biofilms: Treatment of S. epidermidis Biofilms with Targeted Photothermal Gold Nanoparticles.

Biofilm-related infections are associated with high mortality and morbidity, combined with increased treatment costs. Traditional antibiotics are becoming less effective due to the emergence of drug-resistant bacterial strains. The need to treat biofilms on medical implants is particularly acute, and one persistent challenge is selectively directing nanoparticles to the biofilm site. Here, we present a protein-based functionalization strategy that targets the extracellular matrix of biofilms. The protein, derived from the extracellular Staphylococcus epidermidis autolysin, directs nanoparticles to S. epidermidis cell wall components, which are not expected to be present in mammalian tissues. This functionalization is applied to a gold nanoparticle (AuNP) core, along with elastin-like polypeptides (ELPs), which generate a robust photothermal response. In addition to biofilm targeting, the particles exhibit low protein binding, and the photothermal conversion can be modulated by changing the ELP transition temperature. These functionalized AuNPs strongly interact with biofilms under static and flow conditions but exhibit weak interactions with serum-coated surfaces. Near-infrared laser irradiation resulted in a 10,000-fold improvement in killing efficiency compared to untreated controls (p < 0.0001). The targeting strategy utilized here represents a versatile approach to targeting drug-resistant infections and could be readily expanded to other anti-biofilm nanoparticle platforms.

Association of Preoperative Neutrophil to Lymphocyte Ratio with Early Postoperative Acute Kidney Injury Following Isolated Off-Pump Coronary Artery Bypass Grafting

Objective: Acute kidney injury (AKI) is a frequent complication after off-pump coronary artery bypass grafting (OPCAB) that complicates recovery, increases treatment cost and mortality. Neutrophil to lymphocyte ratio (NLR) is a systemic inflammatory marker easily derived from complete blood count that has many prognostic potentials. The purpose of this study was to evaluate if there is an association of preoperative NLR with early postoperative AKI following isolated OPCAB. Methods: This cross-sectional study was carried out in the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD) on a total of 60 patients aged 31-70 years with no preoperative renal dysfunction undergoing isolated OPCAB between August 2021 and July 2022. Group A included 30 patients with preoperative NLR &lt; 2.65 and Group B included 30 patients with preoperative NLR ≥ ≥≥2.65. Patients were monitored for development of early postoperative AKI according to serum creatinine criteria of Kidney Disease Improving Global Outcomes (KDIGO) 2012 guideline. Results: Two patients from group A and twenty patients from group B developed early postoperative AKI (p &lt; 0.001). Events of AKI were significantly higher in group B patients at all postoperative time points. Multivariate binary logistic regression analysis revealed preoperative NLR ≥ ≥≥2.65 as an independent predictor of early post OPCAB AKI (p = 0.004, OR = 13.746). In receiver operating curve (ROC) analysis area under curve (AUC) was 0.933 (95% CI 0.874-0.992, p &lt; 0.001). It showed 90.91% sensitivity and 73.7% specificity at the pre-set cut off value of NLR at 2.65 where optimal predictability of post-OPCAB AKI occurred with 66.67% positive predictive value, 93.33% negative predictive value and 80% accuracy. Conclusion: Preoperative NLR is significantly associated with early postoperative AKI following isolated OPCAB and therefore it should be incorporated in routine clinical practice for early prediction of AKI and implementing timely preventive strategies. (Bangladesh Heart Journal 2024; 39(2): 151-160

Papillomavirus infection and male infertility: A systematic review and meta-analysis.

Increasing attention is being paid to the role of human papillomavirus (HPV) in men and specifically reproduction. Growing evidence suggests an association between HPV infection with many adverse effects including the impairment of semen parameters, the increase of blastocyst apoptosis, the reduction of endometrial implantation of trophoblastic cells, as well as the increase rate of miscarriages and spontaneous preterm birth. We systematically searched PubMed/MEDLINE, Scopus, Embase, Web of Science, CINHAL, PsycINFO, and ERIC from inception to 2nd of July 2024, for studies that investigated the association between HPV infection with sperm parameters and fertility outcomes. The meta-analysis was conducted on mean data and standard deviations. We included 25 studies with a total of 6942 patients. Sperm morphology was lower in HPV positive groups versus HPV negative control groups (SMD = -0.52 95% CI -0.84; -0.21; p = 0.001). Sperm motility was also significantly lower in HPV positive groups when compared to HPV negative controls (SMD = -0.82 95% CI -1.07; -0.57; p = <0.001). Sperm volume, concentration, and pH were not significantly different between the two groups. The other 15 studies included in the systematic review for which it was not possible to conduct a meta-analysis showed strong associations between HPV infection and impairment of sperm parameters, reduced couple fertility and increased risk of pregnancy loss. The current evidence highlights the link between HPV infection and sperm parameters, male fertility and reproductive outcomes, which has the potential to lead to a decreased couple fertility, increased risk of pregnancy loss, re-infection and increased treatment costs.

Determining Factors in the Implementation of Biosecurity Measures by Hospital Nurses in Piura, Peru.

Nosocomial infections are a significant cause of morbidity, mortality, and increased treatment costs in hospitals. This study aimed to analyze the factors determining the implementation of biosafety measures by the nursing staff of four hospitals in Piura via a structural equation modeling (SEM) approach. A total of 215 nurses from various hospitals in the region participated by completing an online survey. The results demonstrated that extrinsic factors (FEX) positively influence the implementation of biosafety measures (BIOM) (β = 0.319 ***), as do intrinsic factors (FINT) (β = 0.520 **). Furthermore, intrinsic factors mediate the relationship between extrinsic factors and the implementation of biosafety measures (β = 0.443 ***). In conclusion, this study provides a deeper understanding of biosafety dynamics in healthcare settings and lays the groundwork for the development of customized interventions and ongoing training programs that ensure the optimal implementation of biosafety measures in hospitals.

Economic Value of Bronchoscopy Technologies that Improves Sensitivity for Malignancy for Peripheral Pulmonary Lesions.

While previous studies have assessed the clinical or economic value of specific technologies, the economic value of improving sensitivity for malignancy for lung cancer diagnoses broadly across technologies is unclear. To identify the economic value of improving sensitivity of bronchoscopy biopsy for the diagnosis of lung cancer. A decision analytic model was developed to quantify the economic value of increased sensitivity for malignancy for bronchoscopy biopsy of peripheral pulmonary lesions. Primary clinical outcomes included time-to-diagnosis and survival. Economic outcomes included (i) net monetary benefit (NMB), defined as the health benefits measured in quality-adjusted life year (QALY) times willingness to pay ($100,000/QALY) net of changes in medical costs, and (ii) incremental cost-effectiveness ratio (ICER). A decision tree modeling framework-with two Markov module branches-was developed. The two Markov modules corresponded to cancer patients who were (i) diagnosed and treated or (ii) undiagnosed and remained untreated. Outcomes were measured from a US payer perspective over 30 years. Improving sensitivity for malignancy by 10 percentage points decreased average time-to-diagnosis for lung cancer patients by 0.85 months (4 weeks) and increased survival by 0.36 years (19 weeks), due to faster treatment initiation. Overall health outcomes improved by 0.20 QALYs per patient. Cost increased by $6,727 per patient primarily through increased treatment costs among those diagnosed with cancer. Increasing sensitivity for malignancy by 10 percentage points improved NMB by $8,729 over 30 years (ICER of $34,052), driven largely by improved sensitivity to early-stage cancer (stage-specific NMB: I/II: $19,805; III: $2,101; IV: -$1,438). Forty-two percent of overall NMB ($3,668) accrued within 5 years of biopsy. The relationship between change in sensitivity and NMB was approximately linear (1% vs. 10% sensitivity improvement corresponded to NMB of $885 vs $8,729). The model was most sensitive to cancer treatment efficacy and follow-up time after a negative result. Increasing sensitivity of malignancy by 10 percentage points resulted in a $8,729 improvement in net economic value. Health systems can use this information when making decisions regarding the value of new bronchoscopy technologies. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ).

Bioactive Compounds and Probiotics Mitigate Mastitis by Targeting NF-κB Signaling Pathway.

Mastitis is a significant inflammatory condition of the mammary gland in dairy cows. It is caused by bacterial infections and leads to substantial economic losses worldwide. The disease can be either clinical or sub-clinical and presents challenges such as reduced milk yield, increased treatment costs, and the need to cull affected cows. The pathogenic mechanisms of mastitis involve the activation of Toll-like receptors (TLRs), specifically TLR2 and TLR4. These receptors play crucial roles in recognizing pathogen-associated molecular patterns (PAMPs) and initiating immune responses through the NF-κB signaling pathway. Recent in vitro studies have emphasized the importance of the TLR2/TLR4/NF-κB signaling pathway in the development of mastitis, suggesting its potential as a therapeutic target. This review summarizes recent research on the role of the TLR2/TLR4/NF-κB signaling pathway in mastitis. It focuses on how the activation of TLRs leads to the production of proinflammatory cytokines, which, in turn, exacerbate the inflammatory response by activating the NF-κB signaling pathway in mammary gland tissues. Additionally, the review discusses various bioactive compounds and probiotics that have been identified as potential therapeutic agents for preventing and treating mastitis by targeting TLR2/TLR4/NF-κB signaling pathway. Overall, this review highlights the significance of targeting the TLR2/TLR4/NF-κB signaling pathway to develop effective therapeutic strategies against mastitis, which can enhance dairy cow health and reduce economic losses in the dairy industry.

A scoping review of the impact of COVID-19 on dentistry: financial aspects

BackgroundThe technological advancements of the past few decades in various aspects that are directly or indirectly related to health, along with the emphasis on public health in societal development, have improved the quality of life.However, the occurrence of pandemics and crises underscores how various aspects of individual life can be impacted. The financial consequences resulting from the COVID-19 pandemic have particularly affected the field of dentistry and public oral health. This study aims to investigate the financial effects of the COVID-19 virus on dentistry through a scoping review.MethodsA comprehensive literature search was conducted across four databases (Medline through PubMed, Embase, Scopus, and Cochrane Central) using keywords such as COVID-19 and its equivalents, dentistry, oral health, dental education, dental services, dental clinics, financial impact, financial opportunities and economic impact. Articles addressing the financial impact of COVID-19 on dentistry and oral health were then screened and reviewed.ResultsOut of 1015 articles related to COVID-19 and dentistry, 84 were focused on the financial impact of COVID-19 on dentistry. The majority of these articles originated from the United States, Brazil, and Saudi Arabia, with a prevalence of cross-sectional and review articles. The review categorized the articles into two main themes: financial problems and proposed solutions. Moreover, the following themes were extracted: the effects of practice closure on dentists and staff, increased treatment costs and impacts on oral health, personal protective equipment and unforeseen costs, psychological effects of financial issues, and financial challenges within the dental education system.ConclusionsWhile many high-income countries seem able to mitigate COVID-19-induced financial problems, the economic effects on dentistry might persist despite the pandemic's end. These financial challenges have spurred new opportunities and infrastructure development but can pose significant risks to community oral health. This study aimed to highlight these problems and propose solutions, contributing to efforts to improve the oral health of communities globally. Further research is needed to understand long-term impacts.