Non-specific Indicators Research Articles

What Clinicians Think About When They Think About Sepsis: Results From a Survey Across the University of Maryland Medical System.

Sepsis, a leading cause of death in the hospital, is a heterogeneous syndrome without a defined or specific set of symptoms. We conducted a survey of clinicians in practice to understand which clinical findings they tend to associate with sepsis. A survey was distributed to physicians and advanced practice providers across a multihospital health system during April 2022 and May 2022 querying likelihood of suspecting sepsis and initiating sepsis care in response to various normal and abnormal clinical findings. Strength of association between clinical findings and suspicion of sepsis were based on median and interquartile range of complete responses. Comparisons between individual questions were performed using Wilcoxon rank-sum testing. Among 179 clinicians who opened the survey, 68 (38%) completed all questions, including 53 (78%) attending physicians representing six different hospitals. Twenty-nine respondents (43%) worked primarily in the ICU, and 16 (24%) worked in the emergency department. The clinical findings most strongly associated with suspicion of sepsis were hypotension, tachypnea, coagulopathy, leukocytosis, respiratory distress, and fever. The abnormal clinical findings least likely to prompt suspicion for sepsis were elevated bilirubin, elevated troponin, and abdominal examination suggesting ileus. On average, respondents were more likely to suspect sepsis with high temperature than with low temperature (p = 0.008) and with high WBC count than with low WBC count (p = 0.003). Clinicians in practice tend to associate the diagnosis of sepsis with signs of severe illness, such as hypotension or respiratory distress, and systemic inflammation, such as fever and leukocytosis. Except for coagulopathy, nonspecific laboratory indicators of organ dysfunction have less influence on decision-making.

Expression of POU2F3 Transcription Factor and POU2AF2, POU2F3 Coactivator, in Tuft Cell-like Carcinoma and Other Tumors.

Epithelial chemosensory cells in hollow organs, also known as tuft cells, were implicated in tumorigenesis, including a tuft cell-like small cell lung carcinoma. Expression of the POU2F3 transcription factor is a marker of tuft cell lineage. However, tuft cell development, differentiation, and proliferation are controlled by the expression of the complex formed by POU2F3 and POU2AF2 or POU2AF3 transcriptional coactivators. A cohort of epithelial (n=6064) and mesenchymal/neuroectodermal (n=2730) tumors was screened for POU2F3 expression by immunohistochemistry. Variable immunoreactivity ranging from diffuse to scattered positive cells was found in ∼12.4% of epithelial and 4.6% of mesenchymal/neuroectodermal tumors. Cases with predominantly diffuse or patchy POU2F3 positivity representing various types of malignant tumors (n=43) were selected for further study, including POU2AF2 immunohistochemistry. Thirteen of 15 tumors with neuroendocrine differentiation originating from the lung, colon, head and neck, skin, and bladder revealed diffuse POU2F3 positivity. Most of those tumors (n=9) co-expressed POU2AF2, usually extensively. Seven squamous and basal cell carcinomas from the oral cavity, skin, lung, and thymus with diffuse POU2F3 immunostaining except one, lacked POU2AF2 expression. Other variably POU2F3-positive carcinomas (n=13) from the colon, pancreas, liver, kidney, testis, endometrium, ovary, and breast lacked POU2AF2 immunoreactivity. All POU2F3-positive mesenchymal and neuroectodermal tumors (n=8), including synovial sarcoma, solitary fibrous tumor, glioblastoma, Wilms tumor, and melanoma were POU2AF2-negative. POU2F3 expression is a highly sensitive but nonspecific indicator of tuft cell differentiation. Co-expression of POU2F3 and POU2AF2 appears to be a more specific marker, although it may not pinpoint tumors driven by the POU2F3-POU2AF3 complex.

2259 Assessing antibiotic usage on a geriatric ward

Abstract Introduction The World Health Organisation lists antibiotic resistance as one of the biggest threats to global health [1]. We contribute to this as clinicians, through errors such as delayed review of prescriptions or prescribing against local trust guidelines. Method We have carried out a quality improvement project to improve antibiotic prescriptions on a geriatric ward at Croydon University Hospital. We carried out a fortnightly cross-sectional analysis of the antibiotic prescriptions on a geriatric ward. This included looking at the antibiotic prescribed, indication, duration, route of administration and presence of a review date. These were then compared to trust guidelines. After the first 8-weeks, we delivered a departmental teaching session on antibiotic prescriptions. We then re-audited the prescriptions. Following this, we sent out weekly email reminders on locating trust guidelines and information on prescriptions. We then re-audited following this. Finally, we created an e-learning resource to deliver to the ward on antibiotic prescriptions. We are planning to deliver this to the ward and re-audit afterwards. Results Initially, up to 90.0% of prescriptions differed from trust guidelines. Common reasons for differences when compared included incorrect drug prescribed, incorrect frequency of dosing, or non-specific indications leading to difficulty comparing. Following all interventions, approximately 32% of prescriptions differed from trust guidelines. This showed sustained improvement across 2 complete PDSA cycles (plan, do, study, act). A 3rd PDSA cycle is ongoing at present and preliminary data has shown approximately 28% of prescriptions differed from trust guidelines. Conclusion This quality improvement project has successfully contributed to a reduction in prescription errors and safe prescribing. We will continue to provide information to our colleagues on antibiotic stewardship, to further encourage safe prescribing. [1]. Antibiotic resistance (2020) World Health Organisation. Available at: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance (Accessed: May 2023).

Cranial fluctuating asymmetry and its relationship with non-specific physiological stress indicators in a contemporary South African cadaveric skeletal sample

ObjectivesBiological anthropologists frequently explore skeletal asymmetry, together with population health and disease. Given the conflicting findings in existing literature, this study aimed to clarify whether an association exists in a South African sample. MaterialsDry bone and cranial micro-focus X-ray Computed Tomography (micro-XCT) scans of 115 South African individuals were assessed. MethodsFluctuating asymmetry (FA) indices were calculated from interlandmark distances, and the frequency of four types of non-specific signs of physiological stress were documented to explore the relationship between FA and disease. ResultsBlack South Africans did not exhibit a high FA index; however, they had the highest prevalence of non-specific signs of physiological stress. However, no significant correlations were detected between FA indices and pathological lesions. ConclusionNo correlation was observed between FA and populations from different socio-economic backgrounds. However, individuals of lower socio-economic status (SES) demonstrated a greater prevalence of non-specific signs of physiological stress. SignificanceThis research suggests that skeletal indicators of stress may be a suitable biological marker for assessing differences in SES among population groups, while indicating that levels of cranial FA is an inadequate biological marker. LimitationsPossible limitations may include measurement error, and the lack of information on the life history and medical records of individuals in this sample. Suggestions for further researchFuture research should include a larger sample with more South African groups, and should evaluate the potential association among age, FA, and expression of skeletal markers of disease.

A new disease mapping method for improving data completeness of syndromic surveillance with high missing rates

AbstractSyndromic surveillance is a type of public health surveillance that utilizes nonspecific indicators or symptoms associated with a particular disease or condition to detect and track disease outbreaks early. However, data completeness has been a significant challenge for syndromic surveillance systems in many countries. Incomplete data may make it difficult to accurately identify anomalies or trends in surveillance data. In this study, a new disease mapping method based on a high‐accuracy, low‐rank tensor completion (HaLRTC) algorithm is proposed to estimate the quarterly positivity rate of the human influenza virus (IFV) based on highly insufficient 2010–2015 respiratory syndromic surveillance data from the subtropical monsoon region of China. The HaLRTC algorithm is a spatiotemporal interpolation method applied to fill in missing or incomplete data using a low‐rank tensor structure. The results show that the accuracy (R2 = 0.880, RMSE = 0.037) of the proposed method is much higher than that of three traditional disease mapping methods: Cokriging, hierarchical Bayesian, and sandwich estimation methods. This study provides a new disease mapping approach to improve the quality and completeness of data in syndrome surveillance or other familiar systems with a large proportion of missing data.

P-273 Image-based oocyte model predictive of blastocyst development correlates with ploidy status across a broad spectrum of PGT-A indications, accounting for confounding variables

Abstract Study question Does MAGENTA, an AI assessment of oocyte quality, indicate ploidy potential of the developed blastocysts in the presence of confounding variables? Summary answer MAGENTA correlates to oocytes that develop into euploid embryos across diverse demographics, highlighting its robust ability to assess oocyte quality and genetic potential. What is known already MAGENTA is a non-invasive AI-image analysis tool that assesses images of mature oocytes and provides a score from 0-10, where higher scores indicate higher chances of developing into a blastocyst. MAGENTA has also displayed a correlation to blastocyst morphological quality. The ploidy status of blastocysts plays a significant role in cycle success and is often utilized for the selection of embryos to transfer. Despite the selection of embryos based on their genetic normality, many transfers are unsuccessful. With most chromosomal errors arising in the oocyte, assessment at the gamete level is critical to improving outcomes. Study design, size, duration A retrospective study using CRM Weill Cornell Medicine data included 3,342 mature oocytes that developed into blastocysts and underwent PGT-A in 2021. Blastocysts tested as mosaic (n = 753) or inconclusive (n = 13) were excluded. Images of the oocytes were obtained immediately post-ICSI using EmbryoScope time-lapse incubators (Vitrolife, Sweden). Blastocyst morphological grades were categorized by quality: highest (ICM+TE grade A), high (ICM+TE grade A/B), medium (ICM+TE grade B), or low quality (ICM or TE grade C/D). Participants/materials, setting, methods Data was obtained from 629 patients (females 26-45 years old) with an average of 5.3 blastocysts (range 1-20) with PGT-A results per patient. MAGENTA assessed each oocyte image and provided a score (0-10), with higher scores representing a greater potential to develop into a blastocyst embryo. In this dataset, 1827 (55%) blastocysts were tested as euploid and 1515 (45%) were tested as aneuploid. PGT-A was conducted for various specific and non-specific indications in these patients. Main results and the role of chance MAGENTA was positively associated with oocytes that developed into blastocysts of increasing quality, with significance between highest and high-quality (7.4 vs 7.0,p<0.05) and medium and low-quality (6.9 vs 6.1,p<0.01). Of the blastocysts, the MAGENTA score further displayed significant differences between oocytes that developed into euploid (7.0) compared to aneuploid blastocysts (6.6) (p < 0.001;Welch’s t-test). Although MAGENTA does not predict ploidy, a threshold of 8.8 MAGENTA score was determined to best distinguish between ploidy outcomes with 61% euploidy rate above this threshold compared to 51% below, a significantly different proportion (p < 0.001;Two-Sample Proportions z-test). Therefore, oocytes scored ≥8.8 display a 19.6% relative increase in chance of developing into a euploid blastocyst. To account for female age, subgroup analysis was conducted and found MAGENTA scores to be significantly different between oocytes that developed into euploid and aneuploid blastocysts for patients <35 years old (7.2 vs 6.6, p < 0.01;Welch’s t-test) and ≥35 years old (6.8 vs. 6.5, p < 0.05;Welch’s t-test). Blastocyst morphological grade was also investigated as a confounding factor. No significant differences existed between MAGENTA scores of euploid and aneuploid blastocysts among the low, high, or highest-quality. Significantly, differences were only found within medium quality blastocysts (7.0 vs 6.6,p<0.05), which had the greatest sample size (n = 1854). Limitations, reasons for caution MAGENTA was not trained to predict euploid embryo development from images of mature oocytes. Further data is required to discern the correlation of MAGENTA to chromosomal ploidy status, apart from blastocyst quality. Additionally, investigation into sperm DNA fragmentation as a potential contributor to ploidy determination is warranted. Wider implications of the findings MAGENTA can identify oocytes of better quality that not only have higher chances of blastocyst development and higher morphological grades, but also indicates oocytes that are more likely to become euploid embryos across patients of various PGT-A indications and a broad age demographic. Trial registration number not applicable

Analysis of Differences in Neonatal Sepsis Caused by Streptococcus Agalactiae and Escherichia Coli.

Streptococcus agalactiae (GBS) and Escherichia coli (E. coli) are the main pathogenic bacteria in neonatal sepsis. Therefore, the clinical characteristics, nonspecific indicators, and drug susceptibilities of these two bacteria were studied. In total, 81 and 80 children with sepsis caused by GBS and E. coli infection, respectively, admitted to the neonatal department of our hospital between May 2012 and July 2023, were selected, and the clinical characteris-tics of the two groups were analyzed. Nonspecific indicators and drug sensitivity test results were analyzed retrospectively. Birth weight, tachypnea, groan, tachycardia or bradycardia, and the incidence of complications, such as pneumonia, respiratory failure, and purulent meningitis, were higher in the GBS group than in the E. coli group. The children were born prematurely, and the mother had a premature rupture of membranes. The incidence of jaundice, abdominal distension, atypical clinical manifestations, and complications of necrotizing enterocolitis was lower than of the E. coli group, and the differences were statistically significant (p < 0.05). The WBC, NE#, NE#/LY#, hs-CRP, and PCT of the GBS group were higher than those of the E. coli group, whereas the MPV, D-D, and FDP levels were lower than those in the E. coli group. The differences were all statistically significant (p < 0.05). The 81-bead GBS had high resistance rates against tetracycline (95%), erythromycin (48.8%), and clindamycin (40%), and no strains resistant to vancomycin, linezolid, penicillin, or ampicillin appeared, whereas 80 strains of E. coli were more resistant to penicillin and third-generation cephalosporins, with the higher resistance rates to ampicillin (68.30%), trimethoprim/sulfamethoxazole (53.6%), and ciprofloxacin (42.90%). Resistance rates to carbapenems and aminoglycosides were extremely low. Both GBS and E. coli neonatal sepsis have specific clinical characteristics, especially in terms of clinical manifestations, complications, non-specific indicators, and drug resistance. Early identification is important for clinical diagnosis and treatment.

Chromosomal aberration analysis: Novel noninvasive techniques for early-stage cancer screening

ObjectiveChromosome breakage is a catastrophic event that leads to the progressive development and progression of cancer. In order to analyze the changes of peripheral blood microenvironment of tumor patients, to explore the indicators of non-specific non-invasive tumor early screening. This paper presents a new idea of whether the gene sequence near the DNA damage break point is the gene sequence that controls the unrestricted growth of normal cells. MethodsThe chromosomal aberrations of peripheral blood lymphocytes were analysed in 60 healthy adult and 49 cancer patients before radiotherapy. ResultsThe detection rate of chromosomal aberrations was high in tumor patients, and “dicentric + translocations” of chromosomes were detected in 36 patients (73.47 %). The chi-square test showed statistically significant differences (P < 0.01), and chromosome adhesion and dissolution were observed. Conclusions“Dicentric + Translocation” chromosome can be used as a nonspecific early screening indicator for cancer. This is worthy of further study. This index can be used to determine the genetic basis of various cancers at the gene level to modify the base sequence and prevent the occurrence of cancer. It is worthy of further study, and it can provide a new method for gene therapy of tumors.

Exploring the link between tooth loss, cognitive function, andbrain wellness in the context of healthy aging.

The aim of this study was to evaluate the utility of using MRI-derived tooth count, an indirect and nonspecific indicator of oral/periodontal health, and brain age gap (BAG), an MRI-based measure of premature brain aging, in predicting cognition in a population of otherwise healthy adults. This retrospective study utilized data from 329 participants from the University of South Carolina's Aging Brain Cohort Repository. Participants underwent neuropsychological testing including the Montreal Cognitive Assessment (MoCA), completed an oral/periodontal health questionnaire, and submitted to high-resolution structural MRI imaging. The study compared variability on cognitive scores (MoCA) accounted for by MRI-derived BAG, MRI-derived total tooth count, and self-reported oral/periodontal health. We report a significant positive correlation between the total number of teeth and MoCA total scores after controlling for age, sex, and race, indicating a robust relationship between tooth count and cognition, r(208) = .233, p < .001. In a subsample of participants identified as being at risk for MCI (MoCA <= 25, N = 36) inclusion of MRI-based tooth count resulted in an R2 change of .192 (H0 = 0.138 → H1 = 0.330), F(1,31) = 8.86, p = .006. Notably, inclusion of BAG, a valid and reliable measure of overall brain health, did not significantly improve prediction of MoCA scores in similar linear regression models. Our data support the idea that inclusion of MRI-based total tooth count may enhance the ability to predict clinically meaningful differences in cognitive abilities in healthy adults. This study contributes to the growing body of evidence linking oral/periodontal health with cognitive function.

Leptospirosis in a patient with cardiac manifestation: A case report study and literature review

Key Clinical MessageCommon cardiac arrhythmias seen in patients with leptospirosis are usually atrial fibrillation or first‐degree atrioventricular block, with bradyarrhythmia being rare in this group. It is essential to prioritize the examination of the patient's medical background, clinical symptoms, and comprehensive physical evaluation in order to promptly identify and address the patient's condition.AbstractLeptospirosis, a zoonotic disease that is widespread worldwide, has a significant impact on tropical areas and can affect various organs throughout the infection. During the initial stage, symptoms are typically non‐specific. Although cases of all three cardiac layers being affected have been reported, issues with the conduction system are especially significant in the early phase of the disease. The most frequent discoveries in these patients are atrial fibrillation or first‐degree atrioventricular block, with bradyarrhythmia being rare. We describe a 37‐year‐old male farmer who initially sought medical attention for general symptoms that had been deteriorating despite receiving outpatient treatment for 3 days for a presumed diagnosis of influenza. During his initial assessment, he exhibited sinus bradycardia, anemia, leukocytosis, elevated levels of direct and total bilirubin, and abnormal liver function test results. Through thorough history‐taking, physical examination, and laboratory analyses, a diagnosis of leptospirosis was conclusively established for him. Focusing on the patient's medical history, clinical manifestations, and thorough physical assessment is crucial for promptly diagnosing and treating patients. This becomes particularly significant for individuals who exhibit atypical symptoms, exemplified by our patient presenting with nonspecific indications and cardiac issues manifested as bradycardia.

Assessment of the biological effect of natural silicon when entering the body of experimental animals with drinking water. Part 1

Introduction. The biological effect of natural silicon (Si) and its hygienic regulation in drinking water still remain subjects of controversy in the scientific literature and in the practice of providing favourable conditions for water use by the population. In this regard, an assessment was made of the effect of natural silicon contained in drinking water in concentrations close to the maximum permissible concentration on the body of laboratory animals.&#x0D; Materials and methods. Drinking waters containing natural Si at MPC levels in water were studied, their effect was assessed in a three-month experiment on 80 white outbred male rats. Observations were made of the general condition, appearance of the animals, body weight dynamics, water consumption. &#x0D; The morphological composition of whole blood was studied. Biochemical indices of the condition of internal organs, including the liver, were determined &#x0D; in serum samples (the ALT and AST activity, the level of total protein and albumin), pancreas (α-amylase activity), kidneys (creatinine content), as well as lactate dehydrogenase activity as a nonspecific indicator of tissue damage.&#x0D; Results. In animals received 17±3.4 mg/L silicon with drinking water at a hardness of 2.25±0.47 mg-eq/L, a significant decrease in ALT activity was found on the 30th and 90th days of the experiment, AST – on 90th day, increase in the content of total protein and albumin in the serum on the 30th day of the experiment. Drinking water with silicon concentrations of 20.5±4.1 mg/L and hardness 3.55±0.76 mg-eq/L decreased ALT activity and serum creatinine concentration on the 30th day and increased amylase activity on the 90th day of the experiment. The animals had the highest water consumption and intake of silicon from drinking water over the first month of the experiment.&#x0D; Limitations. Limitations of the study are related to the short duration of observation and the small number of points for determining biochemical parameters over time.&#x0D; Conclusion. Consumption of drinking water containing natural silicon for 90 days led to changes in biochemical indices, largely indicating the positive effect of the element in concentrations of 17±3.4 mg/L and 20.5±4.1 mg/L on the body of laboratory animals.

Haptoglobin as an indicator for diseases during early lactation of dairy cows, with particular consideration of udder health

s an acute-phase protein Haptoglobin (HP) is part of the non-specific immune response and represents a strong indicator for inflammatory conditions in cattle. The purpose of this article is to provide an overview of previous study results on serum and milk HP related to diseases in early lactation with special consideration of udder health. During inflammatory diseases of the reproductive tract, metabolism and musculoskeletal system, HP increases in the serum and may serve as a non-specific indicator for diseases during early lactation. Threshold values are available for the differentiation of healthy from diseased animals. A correlation exists between HP in blood and milk. The HP concentration in milk is not only influenced by systemic disorders, as the udder epithelium is also independently capable of synthesizing HP in case of an infection. In mastitis, HP concentration may be used to estimate the severity of the disease. In addition, HP may provide certain suspicions regarding the causative pathogen. Threshold values for milk HP are available for the differentiation of healthy individuals from subclinically resp. clinically affected animals.

Clozapine metabolism and cardiotoxicity: A prospective longitudinal study

BackgroundClozapine-induced myocarditis and cardiomyopathy are difficult to detect clinically and may be fatal if not detected early. The current/routine biomarkers for clozapine-induced myocarditis are non-specific indicators of inflammation (C-reactive protein) or cardiomyocyte damage (troponins I and T) that lack sensitivity, and for which changes often arise too late to be clinically useful. MethodsThe Clozapine Safety Study was a prospective, longitudinal, observational study to determine what, if any, the plasma concentrations of clozapine, N-desmethylclozapine, and clozapine-N-oxide in patients contribute to cardiotoxicity. Samples were collected and analysed using liquid chromatography mass spectrometry over a 41-month period from patients in the Auckland District Health Board. ResultsSixty-seven patients were included. Six patients were diagnosed with myocarditis; none were diagnosed with cardiomyopathy in the study period. In patients not undergoing dose titration, clozapine biotransformation may shift to the N-oxide pathway rather than the N-desmethyl pathway with increasing dose. During dose titration, the timeframe in which myocarditis occurs, the rate of increase in the plasma concentration of clozapine-N-oxide, as well as the ratio of N-oxidation relative to N-desmethylation, were significantly higher in patients diagnosed with myocarditis. ConclusionsThe assessment of clozapine-N-oxide formation, and N-oxidation relative to N-desmethylation ratios during treatment, may help identify a biomarker to aid the early detection of patients at risk of developing clozapine-induced cardiotoxicity.

Effect of fermented lemon peel as a functional feed additive on growth, non-specific immune responses, and Vibrio alginolyticus resistance in whiteleg shrimp, Litopenaeus vannamei

The study evaluated the impact of lemon peel fermented with Lactobacillus plantarum (FLP) being a practical feed additive, and its effects on growth performance, non-specific immune indicators, and disease resistance for whiteleg shrimp (Litopenaeus vannamei). The FLP was incorporated into the control diet at a graded level of 0%, 1%, 2%, and 3%. Four experimental feeds were randomly assigned to 4 replicates of L. vannamei with average weight of 2.37 g in a recirculation system for 56 days. Shrimp fed the four diets revealed similar (p > 0.05) weight gain percentage (489.01%−520.25%), feed conversion rate (2.46–2.70), protein efficiency ratio (1.05–1.14), and survival (78.75%−90.00%) after the feeding trial. Total hemocyte count (THC) was higher in shrimp delivered feeds containing 1% and 2% FLP whereas the phenoloxidase (PO) activity was advanced in shrimp fed the feed containing 2% FLP comparing with the FLP-free control group. In the V. alginolyticus challenge test, final survival after 72 h injection was higher in shrimp delivered feeds containing 2% and 3% FLP (66.67%−70.00%) than that in the control group (43.33%). The findings emphasize that fermented lemon peel is a potential functional feed additive on improving immunity and disease resistance for whiteleg shrimp, and showing no negative effects on growth and hepatopancreas morphology. An inclusion rate of 2% FLP is suggested for whiteleg shrimp to maximize the THC and PO activity and resistance ability to V. alginolyticus.

Color Doppler Ultrasound of the Testis in Young Men with a Serum Testosterone Level below the Average Values of the Standard for a Prolonged Period

Introduction: This study aimed to correlate the testicular volume, ultrasound imaging, and blood flow parameters, determined using color Doppler ultrasonography in young men with a testosterone level below the average values of the standard for a prolonged period. Material and Methods: From January 2013 and December 2019, we examined 73 men aged 37 to 45 years with a testosterone level below the average values of the standard for a prolonged period and а 20 age-matched men with a testosterone level above the average values of the standard. We use color Doppler ultrasound as a method to evaluate the volume, ultrasound imaging and Doppler parameters of the testicular blood flow. Results: We obtained significantly lower but still within the reference range values for total testosterone (p&lt;0.001), compared to those of the control group. We found no differences in the ultrasound characteristics of the testicular parenchyma and significant differences between testicular volumes in patients with a testosterone level below the average values of the standard for a prolonged period and those in the control group. In the color Doppler ultrasound we recorded fluctuations only in the blood flow of a aa.intratesticularis, expressed in a slight increase in the resistance index. Conclusions: Ultrasonography of young men with a serum T level below the average values of the standard for a prolonged period found no reduction in testicular volume and no change in the ultrasound characteristic of the parenchyma, which suggests to us that this is not a congenital condition, but cannot answer the question of whether it will lead to structural changes in the testicles in the future and if so what. The non-significant increase in RI in the intratesticular arteries in all examined men is a non-specific indicator that directs the specialist’s attention to additional testing of total testosterone in patients with complaints from the male reproductive system.

Association between linear enamel hypoplasia, cribra orbitalia and porotic hyperostosis in a South African skeletal sample

Background: Linear enamel hypoplasia (LEH) and porous cranial lesions such as cribra orbitalia (CO) and porotic hyperostosis (PH) are considered nonspecific indicators of early childhood metabolic stress. Objectives: The study aims to describe the association of LEH with CO and PH in a sample of the Kirsten Skeletal Collection (KSC) rep- resenting a cohort in the Western Cape, South Africa. This will be used to determine if one or more of these lesions can be used as an indicator of adult mortality. Sample and Methods: Skulls (n = 412) of both sexes with known demo- graphics from the KSC were macroscopically scored for LEH, CO and PH lesions using a ring light. This study was ethically approved by the Health Research and Ethics Committee of Stellenbosch Uni- versity (S13/05/100).Statistical chi-square tests were used to deter- mine the association between lesions and student’s t-tests to deter- mine if there was a significant difference in mean age-of-death be- tween groups. Results: There was no association when comparing LEH with CO and PH in the cohort, although an association was found between CO and PH. Individuals who exhibited the pathological lesions for LEH, CO or PH (or a combination thereof) were observed to have a younger mean age-at-death than the individuals without any of the three disease lesions. Conclusions: The lesions may potentially be used as an indicator of adult mortality. However, the results of this study might represent a biased population of low socio-economic status in the Western Cape as represented in the KSC, rather than the general population of the region.

Validation of the "Indication for Use" (INDO) Variable in the Danish National Prescription Registry.

Despite its potential value in register-based pharmacoepidemiologic research, recorded information on "indication for use" (INDO) in the Danish National Prescription Registry has rarely been used, likely because of questions about the variable's validity, which to our knowledge no study has systematically assessed. We extracted data on 80,814 prescriptions from the software systems (PharmaNet and C2) of five Danish community pharmacies filled between 4 and 16 February 2019 and 2020. Using the indication information recorded in the pharmacy software systems as the gold standard, we evaluated the extent and quality of the corresponding information from the Prescription Registry. Of all prescriptions identified, we captured >99% in the Prescription Registry. The proportion of prescriptions with recorded indication codes in the Prescription Registry was 82% (n = 66,164) but was lower for C2 than PharmaNet. Correcting for the overrepresentation of C2 data in our sample, the estimated proportion of registration was ≈88%. Almost 100% (66,158 of 66,164) of the prescriptions with recorded indication codes in the Prescription Registry had correctly recorded indication codes. Nonspecific indication codes were present in 5.6%-36% of selected drugs and drug classes. Prescriptions filled at Danish community pharmacies are accurately captured by the Danish National Prescription Registry, and the recorded information on indication is generally valid and usable in research. However, minor concerns remain about missingness, nonspecific recorded indication codes, and lower validity, and a higher proportion of missingness of recorded indication codes is expected before 2017.A supplementary digital video by the article's co-author, Hanin Harbi, is available at http://links.lww.com/EDE/C89.

Development and validation of a convolutional neural network to identify blepharoptosis

Blepharoptosis is a recognized cause of reversible vision loss and a non-specific indicator of neurological issues, occasionally heralding life-threatening conditions. Currently, diagnosis relies on human expertise and eyelid examination, with most existing Artificial Intelligence algorithms focusing on eyelid positioning under specialized settings. This study introduces a deep learning model with convolutional neural networks to detect blepharoptosis in more realistic conditions. Our model was trained and tested using high quality periocular images from patients with blepharoptosis as well as those with other eyelid conditions. The model achieved an area under the receiver operating characteristic curve of 0.918. For validation, we compared the model's performance against nine medical experts—oculoplastic surgeons, general ophthalmologists, and general practitioners—with varied expertise. When tested on a new dataset with varied image quality, the model's performance remained statistically comparable to that of human graders. Our findings underscore the potential to enhance telemedicine services for blepharoptosis detection.

Candidiasis in Birds: An Update

Candidiasis is a fungal disease that is induced by yeast from the genus Candida spp. This opportunistic pathogen is present in the skin and gastrointestinal tract of the host, and it tends to induce disease when the host's immune system is suppressed. The aim of this study was to present a short review of Candidiasis in birds, covering aspects, such as host, species, pathogeny, and diagnosis. Candida comprises approximately 200 species, but only a few of them are pathogenic. Among these, Candida albicans is the most frequently isolated in clinical cases. Candida spp. is a polymorphic fungus that can appear in the form of budding yeast, hyphae, or pseudohyphae, depending on the growth environment. They are pretty common in birds, being observed in almost every species. In birds, they can cause infections in the upper digestive system and skin. Clinically, candidiasis in birds is characterized by low morbidity and mortality rates. Affected birds typically display nonspecific indications like depression, anorexia, and inhibited growth. Diagnosis can be performed by laboratory culture, cytology, histopathology, and PCR. On postmortem examination is possible to observe a pseudomembrane with a whitish to yellowish color, easily removed, and an eroded mucosal epithelium of the crop. Infections can be prevented by good sanitary conditions.

Lc-pPG-612-OmpU-CTB: A promising oral vaccine for protecting Carassius auratus against Vibrio mimicus infection.

Vibrio mimicus (V. mimicus) is known to cause severe bacterial diseases with high mortality rates in fish, resulting in significant economic losses in the global aquaculture industry. Therefore, the objective of this study was to develop a safe and effective vaccine for protecting Carassius auratus (C. auratus) against V. mimicus infection. Recombinant Lactobacillus casei (L. casei) strains, Lc-pPG-612-OmpU and Lc-pPG-612-OmpU-CTB (surface-displayed), were constructed using a L. casei strain (ATCC 393) as an antigen delivery carrier and the cholera toxin B subunit (CTB) as an adjuvant. The two recombinant strains of L. casei were administered to C. auratus via oral immunization, and the protective efficacy of the oral vaccines was assessed. The results demonstrated that oral immunization with the two strains significantly increased the levels of nonspecific immune indicators in C. auratus, including alkaline phosphatase (AKP), lysozyme (LYS), acid phosphatase (ACP), complement 3 (C3), complement 4 (C4), lectin, and superoxide dismutase (SOD). Moreover, the experiment groups exhibited significant increases in specific immunoglobulin M (IgM) antibodies against OmpU, as well as the transcription of immune-related genes (ie., IL-1β, TNF-α, IL-10, and TGF-β), when compared to the control groups. Following infection of C. auratus with V. mimicus, the mortality rate of the recombinant L. casei-treated fish was observed to be lower compared to the control group. This finding suggests that recombinant L. casei demonstrates effective protection against V. mimicus infection in C. auratus. Furthermore, the addition of the immune adjuvant CTB was found to induce a more robust adaptive and innate immune response in C. auratus, resulting in reduced mortality after infection with V. mimicus.