Guidelines For Monitoring Research Articles

2-power domination number for Knödel graphs and its application in communication networks

In a graph G, if each node v ∈ V(G) \ S is connected to some node in S, then the set S of nodes is referred to as a dominating set. The domination number of G is the minimum cardinality of all dominating sets of G and is represented by γ(G). If a dominating set S monitors every node in the system under a set of guidelines for power systems monitoring, then the set S is referred to as a power-dominating set of G. The power domination number of G is the least number of vertices of a power dominating set of G. A generalization of power domination is the k-power domination in a graph G. The k-power domination number of G is the minimum cardinality of all k-power dominating sets of G and is represented by γp,k(G). In this paper, we have obtained the 2-power domination number represented by γp,2(G) for 4-regular Knödel graphs and given the lower bound for 5-regular Knödel graphs.

Gestational weight gain charts for Latin American adolescents.

Monitoring gestational weight gain (GWG) throughout pregnancy among adolescents is important for detecting individuals at risk and timely intervention. However, there are no specific tools or guidelines for GWG monitoring of this group. We aimed to construct GWG charts for pregnant adolescents (10-19 years old) according to pre-pregnancy body mass index (BMI) using a pooled dataset from nine Latin American countries. Datasets from Argentina, Brazil, Chile, Colombia, Mexico, Panama, Paraguay, Peru, and Uruguay collected between 2003 and 2021 were combined after data cleaning and harmonization. Adolescents free of diseases that could affect GWG and who gave birth to newborns weighing between 2,500-4,000 g and free of congenital malformations were included. Multiple imputation techniques were applied to increase the sample size available for underweight and obesity categories. Generalized Additive Models for Location, Scale, and Shape were used to construct the charts of GWG according to gestational age. Internal and external validation procedures were performed to ensure that models were not over-adjusted to the data. The cohort included 6,414 individuals and 29,414 measurements to construct the charts and 1,684 individuals and 8,879 measurements for external validation. The medians (and interquartile ranges) for GWG at 40 weeks according to pre-pregnancy BMI were: underweight, 14.9 (11.9-18.6); normal weight, 14.0 (10.6-17.7); overweight, 11.6 (7.7-15.6); obesity, 10.6 kg (6.7-14.3). Internal and external validation showed that the percentages above/below selected percentiles were close to those expected, except for underweight adolescents. These charts describe the GWG throughout pregnancy among Latin American adolescents and represent a significant contribution to the prenatal care of this group. GWG cut-offs based on values associated with lower risks of unfavorable outcomes for the mother-child binomial should be determined before implementing the charts in clinical practice.

Association of Isolated Nocturnal Hypertension (INH) and Target Organ Damage in Light of the 2022 American Heart Association (AHA) Pediatric Ambulatory Blood Pressure Monitoring (ABPM) Guidelines

Association of Isolated Nocturnal Hypertension (INH) and Target Organ Damage in Light of the 2022 American Heart Association (AHA) Pediatric Ambulatory Blood Pressure Monitoring (ABPM) Guidelines

1 Ototoxicity and Cognitive Outcomes among Children Treated for Brain Tumors in Infancy

Objective:Treatment of childhood central nervous system (CNS) tumors can lead to sensorineural hearing loss (SNHL), with prior research indicating associations between SNHL and cognitive difficulties. Infants (0-3 years) treated for CNS tumors are at particular risk for neurocognitive deficits due to increased vulnerability of the developing brain and missed developmental opportunities secondary to prolonged treatment. This study expands upon existing research by examining the association between treatment-related SNHL and later neurocognitive outcomes among infants.Participants and Methods:Serial audiology and neurocognitive assessments were conducted as part of a prospective, multisite, longitudinal trial (SJYC07). Children with newly diagnosed CNS tumors were treated with chemotherapy, with or without focal proton or photon radiation therapy (RT). SNHL was dichotomized based on hearing in the better ear as present versus not present (Chang grade ≥1a vs. <1a). Neurocognitive assessments included intellectual functioning (IQ), and parent ratings of executive functioning and behavioral functioning. Demographic and clinical variables investigated included: sex, age at diagnosis (years), treatment type (chemotherapy only vs. chemotherapy + RT), risk group (low vs. intermediate vs. high), and socioeconomic status (SES, continuous). Logistic regression models were used to identify factors associated with SNHL. Change point longitudinal models were used to examine the effect of each covariate individually and the potential impact of SNHL on trajectories of neurocognitive outcomes.Results:Of 135 patients (median age at diagnosis= 1.5 years), 67% had mild-to-severe SNHL as defined by Chang grade ≥1a at last follow-up. SNHL occurred early after treatment with a 1-year cumulative incidence 63.0% ±4.3%. SNHL was associated with age at diagnosis (p <.001) but not sex, treatment exposure or study risk arm (p >.10). At pretreatment baseline, IQ was associated with age at diagnosis (older age= higher IQ) and SES (higher SES= higher IQ) with a change in the trajectory of IQ after SNHL (stable prior to SNHL and declined 1.46 points/year after SNHL), which was impacted by tumor location (patients with supratentorial tumors stable prior to SNHL and declined 2.84 points/year after SNHL; whereas, patients with infratentorial tumors increased 1.93 points/year prior to SNHL and were stable after SNHL). At pre-treatment baseline, adaptive functioning was associated with age at diagnosis (older age= higher skills) with a change in adaptive functioning after SNHL that varied by age. There was a change in trajectory of attention problems (stable before SNHL and worsening 1.39 points/year after SNHL). SNHL was not associated with parent report of emerging executive functioning.Conclusions:Children with brain tumors experience SNHL and cognitive difficulties early in treatment that can worsen over time. Younger age at diagnosis is associated with greater risk for SNHL and cognitive difficulties. Analyses of the time course between the emergence of SNHL and cognitive late effects suggests even mild SNHL is associated with a clinically signficant decline in IQ and attention problems. These findings have notable implications with respect to refining monitoring guidelines, informing modifications to treatment, advocating for interventions, and helping educate parents, teachers, and providers about the significant impact of mild SNHL.

Today and tomorrow: the use of biomarkers in inflammatory bowel disease

Biomarkers play important roles in clinical care for people with inflammatory bowel diseases (IBD). Biomarkers are also central to the development of new therapies and as endpoints in their evaluation.
 The recommendations from the STRIDE-II study emphasize the central role of clinical indices and biomarkers such as fecal calprotectin (FC) and C-reactive protein (CRP) in the management of Crohn’s disease (CD) and ulcerative colitis (UC).
 This review will focus on the established roles for FC and CRP, emerging roles for alternative and composite biomarkers, limitations of current biomarkers, and unmet needs in the field. This is an evolving area, with recent clinical practice guidelines from the American Gastroenterological Association in UC. In addition, updates are expected from the European Crohn’s and Colitis Organisation on their multi-society guideline for IBD monitoring.

A roadmap out of medical deserts into supportive health workforce initiatives and policies, results from the ROUTE-HWF study

Abstract Background Medical deserts are coined as a specific term for areas dealing with low levels of health workers and health services. Health-underserved areas are a Europe wide problem, but still there is a lack of understanding on the different types and causes of medical ‘desertification’. In absence of a clear definition and categorization, countries acknowledge the severity of medical desert problems and take action. But they do so without taking opportunities to learn from each other, in terms of finding the rationale underlying the appropriate choice of policies and measures. Aims and Objectives The aim of the ROUTE-HWF project that will be presented is to develop an elaborated taxonomy on medical deserts that supports country comparison, and improves the matching of different policy initiatives with different types of medical deserts. This includes guidelines on how to monitor and measure medical deserts, and solutions like task shifting and retention of health workers. Methods The ROUTE-HWF project is based on a systematic literature review, a survey among European countries, and workshops with case studies among a selected number of countries. During each stage of the project the taxonomy and a roadmap ‘out of medical deserts’ is further developed. Results We present the ROUTE-HWF taxonomy and roadmap with guidelines for monitoring and measuring medical deserts. Three main distinctive types of medical deserts are defined: medical deserts mainly caused by problems with the accessibility of health workers and facilities, medical deserts mainly caused by problems with population needs in area, and medical deserts with (cumulation) of problems both at the demand and supply side of the local health system. We show that this categorization is useful to tailor health policy measures to the distinctive causes and solutions for medical deserts, enabling mutual or cluster country learning within Europe.

Clozapine monitoring at a specialised psychiatric hospital: A retrospective chart review

Background: Clozapine is the only Food and Drug Administration (FDA) and National Institute for Care and Excellence (NICE) approved drug for treatment-resistant schizophrenia (TRS). Its potentially life-threatening haematological side effects of neutropaenia and agranulocytosis mandate rigorous monitoring of neutrophil counts, presenting unique, Third-World population challenges.Aim: To describe the Clozapine white blood cell monitoring practice and outcomes in a local psychiatric hospital.Setting: At a specialist Psychiatry unit in Durban, KwaZulu-Natal, which follows a modified algorithm of the South African Standard Treatment Guidelines for Clozapine monitoring.Methods: A retrospective chart review composed of 120 patients on Clozapine treatment from 01 July 2018–31 December 2020. Demographic and clinical information was captured in a Redcap database. Descriptive statistics using categorical variables were used.Results: The study population was from a low socioeconomic background, with low levels of education and employment. A baseline neutrophil count was recorded in 58 files (48.3%). Clozapine was stopped in 6 out of the 120 patients due to ‘neutropaenia’ (absolute neutrophil counts ranging from 1.18 to 1.6); none developed agranulocytosis. Their duration of Clozapine treatment ranged from 2 weeks–15 years.Conclusion: Haematological monitoring frequency and documentation of patients receiving Clozapine were not in compliance with the hospital’s adapted guidelines and may have resulted in the termination of treatment before true neutropaenia developed. Patients developed neutropaenia at low doses of Clozapine and after many years of treatment.Contribution: These results suggest local Clozapine monitoring guidelines should be more strictly adhered to.

Spatial and Temporal Variation of Particulate Matter (PM10 and PM2.5) and Its Health Effects during the Haze Event in Malaysia

This study aims to assess and compare levels of particulate matter (PM10 and PM2.5) in urban and industrial areas in Malaysia during haze episodes, which typically occur in the south west monsoon season. The high concentrations of atmospheric particles are mainly due to pollution from neighbouring countries. Daily PM concentrations were analysed for urban and industrial areas including Alor Setar, Tasek, Shah Alam, Klang, Bandaraya Melaka, Larkin, Balok Baru, and Kuala Terengganu in 2018 and 2019. The analysis employed spatiotemporal to examine how PM levels were distributed. The data summary revealed that PM levels in all study areas were right-skewed, indicating the occurrence of high particulate events. Significant peaks in PM concentrations during haze events were consistently observed between June and October, encompassing the south west monsoon and inter-monsoon periods. The study on acute respiratory illnesses primarily focused on Selangor. Analysis revealed that Klang had the highest mean number of inpatient cases for acute exacerbation of bronchial asthma (AEBA) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with values of 260.500 and 185.170, respectively. Similarly, for outpatient cases of AEBA and AECOPD, Klang had the highest average values of 41.67 and 14.00, respectively. Shah Alam and Sungai Buloh did not show a significant increase in cases during periods of biomass burning. The statistical analysis concluded that higher concentrations of PM were associated with increased hospital admissions, particularly from June to September, as shown in the bar diagram. Haze episodes were associated with more healthcare utilization due to haze-related respiratory illnesses, seen in higher inpatient and outpatient visits (p < 0.05). However, seasonal variability had minimal impact on healthcare utilization. These findings offer a comprehensive assessment of PM levels during historic haze episodes, providing valuable insights for authorities to develop policies and guidelines for effective monitoring and mitigation of the negative impacts of haze events.

Comparative Effectiveness of Intracranial Pressure Monitoring on 6-Month Outcomes of Critically Ill Patients With Traumatic Brain Injury

While the relationship between persistent elevations in intracranial pressure (ICP) and poorer outcomes is well established for patients with traumatic brain injury (TBI), there is no consensus on how ICP measurements should drive treatment choices, and the effectiveness of ICP monitoring remains unknown. To evaluate the effectiveness of ICP monitoring on short- and mid-term outcomes of patients with TBI. CREACTIVE was a prospective cohort study that started in March 2014 and lasted 5 years. More than 8000 patients with TBI were enrolled at 83 intensive care units (ICUs) from 7 countries who joined the CREACTIVE Consortium. Patients with TBI who met the Brain Trauma Foundation guidelines for ICP monitoring were selected for the current analyses, which were performed from January to November 2022. Patients who underwent ICP monitoring within 2 days of injury (exposure group) were propensity score-matched to patients who were not monitored or who underwent monitoring 2 days after the injury (control group). Functional disability at 6 months as indicated by Glasgow Outcome Scale-Extended (GOS-E) score. A total of 1448 patients from 43 ICUs in Italy and Hungary were eligible for analysis. Of the patients satisfying the ICP-monitoring guidelines, 503 (34.7%) underwent ICP monitoring (median [IQR] age: 45 years [29-61 years]; 392 males [77.9%], 111 females [22.1%]) and 945 were not monitored (median [IQR] age: 66 years [48-78 years]; 656 males [69.4%], 289 females [30.6%]). After matching to balance the variables, worse 6-month recovery was observed for monitored patients compared with nonmonitored patients (death/vegetative state: 39.2% vs 40.6%; severe disability: 33.2% vs 25.4%; moderate disability: 15.7% vs 14.9%; good recovery: 11.9% vs 19.1%, respectively; P = .005). Monitored patients received medical therapies significantly more frequently. In this cohort study, ICP monitoring was associated with poorer recovery and more frequent medical interventions with their relevant adverse effects. Optimizing the value of ICP monitoring for TBI requires further investigation on monitoring indications, clinical interventions, and management protocols.

Guideline adherence for cardiometabolic monitoring of patients prescribed antipsychotic medications in primary care: a retrospective observational study

BackgroundDespite their known effectiveness, antipsychotics possess significant cardiometabolic adverse event profiles. Guidelines emphasise routine monitoring, however, practices are known to be suboptimal.AimTo investigate the level of cardiometabolic monitoring among people prescribed antipsychotic therapy in primary care, and patient-related factors that may influence monitoring patterns.MethodData were collected for patients with mental disorders and prescribed antipsychotics at two general practices in England (February 2016–February 2021). The main outcome measures were the proportion of patients with evidence of monitoring for cardiometabolic parameters (body composition, anthropometrics, lipids, glucose outcomes). Regression analysis was used to explore factors predicting monitoring practices.ResultsData from 497 patients were included. The proportion of patients receiving cardiometabolic monitoring at least once yearly varied across different parameters. Patients were mostly monitored for BP (92.0%), body weight (BMI > 85.0%) and HDL (72.0%), but to a lesser extent for other lipid parameters (non-HDL < 2.0%) and blood glucose (< 2.0%). Ageing (OR:2.0–7.0, p < 0.001) and chronic conditions (e.g., CVD and Type 2 DM, p < 0.05) were associated with frequent cardiometabolic monitoring. Conversely, antipsychotics with high metabolic risks (olanzapine), patients prescribed antipsychotic polypharmacy (≥ 2 antipsychotics) and cardiometabolic dysregulations (e.g., dyslipidaemias) did not improve monitoring frequencies.ConclusionCardiometabolic health monitoring was generally infrequent, irregular, and did not change in response to abnormal test results or antipsychotic treatment with high cardiometabolic risks, suggesting more efforts need to be made to ensure the guidelines for cardiometabolic monitoring are followed. Future studies should investigate practices by using a large UK primary care database.

Development of a Screening Algorithm for Lung Disease in Systemic Juvenile Idiopathic Arthritis.

Lung disease (LD) is an increasingly recognized complication of systemic juvenile idiopathic arthritis (sJIA). As there are no currently available guidelines for pulmonary screening in sJIA, we sought to develop such an algorithm at our institution. A multidisciplinary workgroup was convened, including members representing rheumatology, pulmonary, stem cell transplantation, and patient families. The workgroup leaders drafted an initial algorithm based on published literature and experience at our center. A modified Delphi approach was used to achieve agreement through three rounds of anonymous, asynchronous voting and a consensus meeting. Statements approved by the workgroup were rated as appropriate with moderate or high levels of consensus. These statements were organized into the final approved screening algorithm for LD in sJIA. The workgroup ultimately rated 20 statements as appropriate with a moderate or high level of consensus. The approved algorithm recommends pulmonary screening for newly diagnosed patients with sJIA with clinical features that the workgroup agreed may confer increased risk for LD. These "red flag features" include baseline characteristics (young age of sJIA onset, human leukocyte antigen type, trisomy 21), high disease activity (macrophage activation syndrome [MAS], sJIA-related ICU admission, elevated MAS biomarkers), respiratory symptoms or abnormal pulmonary examination findings, and features of drug hypersensitivity-like reactions (eosinophilia, atypical rash, anaphylaxis). The workgroup achieved consensus on the recommended pulmonary work-up and monitoring guidelines. We developed a pulmonary screening algorithm for sJIA-LD through a multidisciplinary consensus-building process, which will be revised as our understanding of sJIA-LD continues to evolve.

Comparison of the predictive accuracy of the physiologically based pharmacokinetic (PBPK) model and population pharmacokinetic (PPK) model of vancomycin in Japanese patients with MRSA infection

IntroductionThe latest therapeutic drug monitoring guidelines for vancomycin (VCM) recommend that area under the concentration-time curve is estimated based on model-informed precision dosing and used to evaluate efficacy and safety. Therefore, we predicted VCM concentrations in individual methicillin-resistant Staphylococcus aureus-infected patients using existing a physiologically based pharmacokinetic (PBPK) model and 1- and 2-compartment population pharmacokinetic (PPK) models and confirmed and verified the accuracy of the PBPK model in estimating VCM concentrations with the PPK model. MethodsThe subjects of the study are 20 patients, and the predicted concentrations were evaluated by comparing the observed and predicted trough and peak values of VCM concentrations for individual patients. ResultsThe results showed good correlation between the observed and predicted trough and peak concentrations of VCM was observed generally in the PBPK model, R2 values of 0.72, 0.62, and 0.40 with trough values of 0.49, 0.40, and 0.34 with peak values for PBPK model, 1-compartment, and 2-compartment model, respectively. ConclusionsAlthough the performance of the PBPK model is not as predictive as the PPK model, generally similar predictive trends were obtained, suggesting that it may be a valuable tool for rapid and accurate prediction of AUC for VCM.

Applicative experience of Italian Guidelines for safety and monitoring of existing bridges

Bridges are vital for transportation systems, as their collapse can pose serious threats to modern communities' safety, well-being, and economy. Recently, specific Guidelines for the classification and risk management, safety assessment, and monitoring of existing bridges have been issued in Italy as mandatory code. The Guidelines need to be applied and tested to identify any drawbacks and highlight the main factors influencing their results. This paper proposes a reasoned application of the Guidelines in a provincial context. A representative sample of concrete structures located in the province of Parma under the management of a single entity was considered. The determination of the structural attention class allowed for considerations on some applicative difficulties of the Guidelines. Particular attention was given to the analysis of the most recurrent pathologies of the structures.

Multivariate Statistical Methods and GIS-Based Evaluation of Potable Water in Urban Children’s Parks Due to Potentially Toxic Elements Contamination: A Children’s Health Risk Assessment Study in a Developing Country

Contamination of potentially toxic elements (PTEs) has received widespread attention in urban children’s parks (UCPs) worldwide in the past few decades. However, the risk assessment of PTEs in drinking water sources of UCPs is still unknown particularly in developing countries. Hence, the present study investigated the spatial distribution, sources for PTEs (Cd, Cr, Pb, Ni, and Cu), and health risk assessment in drinking water sources of UCPs in Khyber Pakhtunkhwa, Pakistan. Among PTEs, Cd, Cr, and Pb had low to high concentrations and exceeded the safe limits of WHO and PAK-EPA in most UCPs. PCA results showed high anthropogenic and low natural sources, contributing to the release of PTEs in all UCPs. Heavy-metal pollution index (PTE-PI) results showed low to high pollution levels for all UCPs, with the highest values of 113 and 116 for Sardaryab Park Charsadda (SPC) and Zoo Park Peshawar (ZPP), respectively. Heavy-metal evaluation index (PTE-EI) results also showed low to high pollution levels for all UCPs. UCPs samples (50%) showed low pollution levels in PTE-PI results. To the contrary, UCPs samples (50%) exhibited high pollution levels in PTE-EI results. The non-carcinogenic risk of HQ and HI values of all PTEs were below the permissible limit (&lt;1) for adults and children via ingestion and dermal contact. CR and TCR results showed that PTEs (Cr, Cd, Pb, and Ni) had the highest carcinogenic risk (&gt;1.00 × 10−4) for both adults and children in all UCPs, except Cd and Ni for adults via the ingestion route, while Cr values (&gt;1.00 × 10−4) were exceeded for children in some of the UCPs via the dermal route. Consequently, long-term exposure to toxic PTEs could pose a carcinogenic risk to the local population. Thus, the present study suggests that the government should implement enforcement with firm protocols and monitoring guidelines of environmental regulations to mitigate PTEs originating from anthropogenic sources in order to reduce health risks and improve public health safety in urban areas.

Amyloid-related Imaging Abnormalities in Alzheimer Disease Treated with Anti-Amyloid-β Therapy.

Alzheimer disease (AD) is the most common form of dementia worldwide. Treatment of AD has mainly been focused on symptomatic treatment until recently with the advent and approval of monoclonal antibody (MAB) immunotherapy. U.S. Food and Drug Administration-approved drugs such as aducanumab, as well as upcoming newer-generation drugs, have provided an exciting new therapy focused on reducing the amyloid plaque burden in AD. Although this new frontier has shown benefits for patients, it is not without complications, which are mainly neurologic. Increased use of MABs led to the discovery of amyloid-related imaging abnormalities (ARIA). ARIA has been further classified into two categories, ARIA-E and ARIA-H, representing edema and/or effusion and hemorrhage, respectively. ARIA is thought to be caused by increased vascular permeability following an inflammatory response, leading to the extravasation of blood products and proteinaceous fluid. Patients with ARIA may present with headaches, but they are usually asymptomatic and ARIA is only diagnosable at MRI; it is essential for the radiologist to recognize and monitor ARIA. Increased incidence and investigation into this concern have led to the creation of grading scales and monitoring guidelines to diagnose and guide treatment using MABs. Cerebral amyloid angiopathy has an identical pathogenesis to that of ARIA and is its closest differential diagnosis, with imaging findings being the same for both entities and only a history of MAB administration allowing differentiation. The authors discuss the use of MABs for treating AD, expand on ARIA and its consequences, and describe how to identify and grade ARIA to guide treatment properly. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center See the invited commentary by Yu in this issue.

Individualized Delivery of Vancomycin by Model-Informed Bayesian Dosing Approach to Maintain an AUC24 Target in Critically Ill Patients

Introduction: Monitoring of AUC24 was updated recommendation in the guideline for the therapeutic drug monitoring (TDM) of vancomycin in Chinese pharmacological society published in 2020. Vancomycin pharmacokinetic profiles are diverse and unique in critically ill patients because of the drastic variability of the patients’ physiological parameters, while the study for population pharmacokinetic (PPK) models in Chinese critically ill patients has been rarely reported. The objectives of this study were to construct a PPK model to describe the pharmacokinetic characteristics of vancomycin in critically ill patients and to individualize vancomycin dosing by model-informed Bayesian estimation for maintenance of AUC24 target at 400–650 mg h/L recommended by the 2020 guideline. Methods: Vancomycin with different dosing was administered intravenously over 1 h for critically ill patients, TDM was started at 48 h or 72 h since initiation of vancomycin therapy for patients. Blood samples were collected from patients for trough concentrations or Cmax. Vancomycin concentrations were determined by high-performance liquid chromatography method with ultraviolet detection. PPK model was performed using the nonlinear mixed-effect model (NONMEM®). Individual PK parameters for critically ill patients treated with vancomycin were estimated using a post hoc empirical Bayesian method based on the final PPK model. AUC24 was calculated as the total daily dose divided by the clearance (L/h). Results: The PPK of vancomycin was determined by a one-compartment model with creatinine clearance as fixed effects. The PK estimates in the final model generally agreed with the median estimates and were contained within the 95% CI generated from the bootstrap results, indicating good precision and stability in the final model. The visual predictive check plots showed the adequate predictive performance of the final PK model and supported a good model fit. The model-informed Bayesian estimation was used to predict the AUC24 of critically ill patient by the acquired TDM results, and the dosing adjustment by maintenance of AUC24 at 400–650 mg h/L had made a great therapeutic effect for the case. Conclusion: This study established a PPK model of vancomycin in Chinese critically ill patients, and individualized dosing of vancomycin by model-informed Bayesian estimation to maintain an AUC24 target at 400–650 mg h/L has been successfully applied in clinic. This result supports the continued use of model-informed Bayesian estimation to vancomycin treatment in critically ill patients.

Diabetic control and compliance using glycated haemoglobin (HbA1C) testing guidelines in public healthcare facilities of Gauteng province, South Africa.

This study aimed at evaluating diabetic control and compliance with testing guidelines, across healthcare facilities of Gauteng Province, South Africa, as well as factors associated with time to achieve control. South Africa's estimated total unmet need for care for patients with type 2 diabetes mellitus is 80%. The data of 511 781 patients were longitudinally evaluated. Results were reported by year, age category, race, sex, facility and test types. HbA1C of ≤7% was reported as normal, >7 - ≤9% as poor control and >9% as very poor control. The chi-squared test was used to assess the association between a first-ever HbA1C status and variables listed above. The Kaplan-Meier analysis was used to assess probability of attaining control among those who started with out-of-control HbA1C. The extended Cox regression model assessed the association between time to attaining HbA1C control from date of treatment initiation and several covariates. We reported hazard ratios, 95% confidence intervals and p-values. Data is reported for 511 781 patients with 705 597 laboratory results. Poorly controlled patients constituted 51.5%, with 29.6% classified as very poor control. Most poorly controlled patients had only one test over the entire study period. Amongst those who started with poor control status and had at least two follow-up measurements, the likelihood of achieving good control was higher in males (adjusted Hazard Ratio (aHR) = 1.16; 95% CI:1.12-1.20; p<0.001) and in those attending care at hospitals (aHR = 1.99; 95% CI:1.92-2.06; p<0.001). This study highlights poor adherence to guidelines for diabetes monitoring.

Observed isavuconazole exposure: 5-year experience of azole TDM from a Spanish reference laboratory.

We aimed to assess patient exposure to isavuconazole (ISZ) from samples received in our laboratory for therapeutic antifungal monitoring. We used liquid chromatography coupled with ultraviolet (UV) absorbance detection adapted from a multiplex-validated method with photodiode array (PDA) detection to monitor the analytes. The latter device allows the characterization of the azoles UV spectra. The method was validated according to international guidelines for efficient ISZ monitoring. The assay exhibited linearity between 0.25 and 16mg/l for ISZ. Accuracy and intra- and inter-day precision were within acceptable ranges, and the method was successfully applied to quantify azoles and major metabolites from clinical samples collected from treated patients. We focus on ISZ blood concentrations and compared them to those of voriconazole, posaconazole, and itraconazole for a period of 5 years (2017-2021). Median ISZ concentration was 2.92mg/l (interquartile range 1.82-5.33mg/l) with 89% of measurements classified as adequate exposure (> 1mg/l). Additionally, 71% of samples reach concentration values > 2mg/l. Different ISZ exposure between adults to children were found. In conclusion, ISZ achieves excellent blood concentrations compared to other azole drugs, they are almost identical to those previously described, they exceed the MICs of most fungi for which its use was recommended and they differ depending on the patient's age. The method we describe for antifungal monitoring is simple, robust, and efficient. It simultaneously analyzes azoles and metabolites, and can be used for tailored interventions, achieve exposures associated with therapeutic success, decrease treatment-related toxicity, and help prevent resistance emergence due to continuous azole sub-optimal concentrations.

Antibiotic pollution: The forerunner of global health catastrophe?

AbstractThe rapid enhancement in the emergence of resistant bacteria occurring globally has endangered the efficacy of the conventional antibiotics causing threat to human at a large extent. Traces of antimicrobial drugs and their metabolites in various natural environments have resulted in enhancement of antimicrobial resistance (AMR) among the natural flora and fauna of the water resources. Contamination of the environment with antimicrobials encourages the bacteria to evolve ways to acquire competence which may result in the conversion of antibiotic susceptible strains to resistant bacteria. The spread of AMR varies from planktonic to sessile forms of the bacterial species by cross resistance or horizontal gene transfer resulting in blooming populations that would otherwise can be kept in check. This has created a tremendous threat to human health due to the enhancement in the resistance of microorganisms and other microbes to various types of antimicrobial drugs. Rampant use of antibiotics and improper detection of antibiotics from the sewages of the factories has resulted in the enhancement of concentration of antibiotics in the environment. This has resulted in the enhancement of death due to the persistence of such infections those cannot be treated with the conventional drugs causing a global health crisis. Hence, mitigation of this problem is of utmost importance to save lives of human beings and animals. This has forced to find out some alternate way on an urgent basis for risk management including adoption of stringent guidelines for surveillance and monitoring of these industries and development of policies are warranted to develop policies on checking antibiotic pollution as a “One Health Approach”.

Evaluating national guidelines for monitoring early growth using routinely collected data in Bergen, Norway.

The overarching aim of this study was to evaluate the Norwegian guidelines for growth monitoring using routinely collected data from healthy children up to five years of age. We analysed criteria for both status (size for age) and change (centile crossing) in growth. Longitudinal data were obtained from the electronic health record (EHR) at the well-baby clinic for 2130 children included in the Bergen growth study 1 (BGS1). Measurements of length, weight, weight-for-length, body mass index (BMI) and head circumference were converted to z-scores and compared with the World Health Organization (WHO) growth standards and the national growth reference. Using the WHO growth standard, the proportion of children above +2SD was generally higher than the expected 2.3% for all traits at birth and for length at all ages. Crossing percentile channels was common during the first two years of life, particularly for length/height. By the age of five years, 37.9% of the children had been identified for follow-up regarding length/height, 33% for head circumference and 13.6% for high weight-for-length/BMI. The proportion of children beyond the normal limits of the charts is higher than expected, and a surprisingly large number of children were identified for rules concerning length or growth in head circumference. This suggests the need for a revision of the current guidelines for growth monitoring in Norway.