Routine Strategy Research Articles

Antimicrobial Resistance Patterns and Biofilm Analysis via Sonication in Intensive Care Unit Patients at a County Emergency Hospital in Romania

Background/Objectives: Ventilator-associated pneumonia (VAP) remains a critical challenge in ICU settings, often driven by the biofilm-mediated bacterial colonization of endotracheal tubes (ETTs). This study investigates antimicrobial resistance patterns and biofilm dynamics in ICU patients, focusing on microbial colonization and resistance trends in tracheal aspirates and endotracheal tube biofilms at a county emergency hospital in Romania. Methods: We conducted a longitudinal analysis of ICU patients requiring mechanical ventilation for more than 48 h. Tracheal aspirates and ETT biofilms were collected at three key time points: T1 (baseline), T2 (48 h post-intubation with ETT replacement), and T3 (92–100 h post-T2); these were analyzed using sonication and microbiological techniques to assess microbial colonization and antimicrobial resistance patterns. Results: In a total of 30 patients, bacteria from the ESKAPEE group (e.g., Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus) dominated the microbiota, increasing their prevalence over time. Resistance to carbapenems, colistin, and vancomycin was notably observed, particularly among K. pneumoniae and A. baumannii. Biofilm analysis revealed high persistence rates and the emergence of multidrug-resistant strains, underscoring the role of ETTs as reservoirs for resistant pathogens. The replacement of ETTs at T2 correlated with a shift in microbial composition and reduced biofilm-associated contamination. Conclusions: This study highlights the temporal evolution of antimicrobial resistance and biofilm-associated colonization in a limited number of ICU patients (30 patients). The findings support implementing routine ETT management strategies, including scheduled replacements and advanced biofilm-disruption techniques, to mitigate VAP risk and improve patient outcomes.

Field study on the suitability of oral fluid samples for monitoring of Lawsonia intracellularis and Brachyspira hyodysenteriae by multiplex qPCR under field conditions

BackgroundMonitoring or surveillance of infectious diseases is crucial in terms of herd health management of livestock. Investigations of oral fluids have become an animal friendly routine strategy to monitor respiratory pathogens in pigs. Less is known about the suitability of oral fluids for the detection of enteric pathogens in swine. In the present study we evaluated the use of oral fluids to monitor B. hyodysenteriae and L. intracellularis compared to pooled fecal samples by multiplex qPCR in a pen-wise follow-up of fattening pigs. Therefore, we collected oral fluids at an age of 12, 16 and 20 weeks of life and compared them to pooled fecal samples collected from the same pens on two fattening farms.ResultsCohen´s Kappa analysis revealed a substantial agreement between oral fluids and pooled fecal samples on pen level (Cohen´s Kappa: 0.745; p < 0.001). DNA-loads of L. intracellularis were tendentially higher (p = 0.053) in pooled fecal samples than in the corresponding OFs.ConclusionsThe present study shows that oral fluids are an appropriate tool to monitor B. hyodysenteriae and L. intracellularis on conventional fattening farms under field conditions. However, multiple pen testing should be conducted to increase the diagnostic performance and sensitivity.

Inappropriate prescribing of drugs for peptic ulcer and gastro-esophageal reflux disease remains a matter of concern: Results from the LAPTOP-PPI cluster randomized trial.

Proton pump inhibitors (PPIs) are among the most commonly and inappropriately prescribed drugs by general practitioners (GPs), resulting in increased risk of adverse outcomes for patients and in avoidable costs for Italy's National Health Service (NHS). This study aims to assess the effectiveness of a low-cost and easily implementable informative intervention directed at GPs to enhance the appropriate prescription of PPIs. The LAPTOP-PPI study is a pragmatic, cluster-randomized controlled trial designed to improve the appropriateness of PPI prescriptions among community-dwelling individuals aged ≥65years. In June 2021, GPs in the Local Health Units (LHUs) of Bergamo (Northern Italy) and Caserta (Southern Italy) were randomly allocated to either an intervention group (summary reports on prescribing habits, scientific documents on the Italian Medicine Agency's therapeutic indications, strategies for PPI de-prescribing, along with educational materials for patients), and a control group (standard practice). PPI appropriateness was assessed through an algorithm specifically designed and based on NHS prescription appropriateness and reimbursement criteria. Intervention efficacy was evaluated by comparing data from the baseline period (July 1 to 31 December 2019) with those from the follow-up period (July 1 to 31 December 2021), 6months after randomization. The analysis was performed on the intention-to-treat principle and according to GP level. To estimate the effectiveness of the intervention, we used a difference-in-differences (DID) approach. Overall, 942GPs (540 from Bergamo and 402 from Caserta LHUs) were included in the analysis. At baseline, 171,978 patients aged ≥65 received drug prescriptions for acid-related diseases and were assessable for evaluation of appropriateness. At follow-up, this number was 137,699. The overall inappropriateness rate at baseline among GPs included in the analysis was 57.4% (std.dev. 8.4%) in the intervention arm and 57.6% (std.dev. 8.8%) in the control arm; 6months after the intervention delivery, they were 59.2% (std.dev. 8.0%) and 58.5% (std.dev. 7.3%), respectively. Given their widespread use, improving the prescription quality of PPIs is a major concern. Educational interventions for GPs and patients are routine strategies to address inappropriateness, but they appear to be insufficient for independently improving prescribing practice, especially in a critical situation such as the post-pandemic period.

ЗНАЧИМОСТЬ ЗДОРОВЬЯ ПОЛОСТИ РТА ВО ВРЕМЯ БЕРЕМЕННОСТИ

This article discusses the dynamic monitoring of oral health in pregnant women, emphasizing the increasing incidence of dental diseases during pregnancy. The study's objective was to identify changes in dental and periodontal conditions and assess the correlation between oral health, hemoglobin levels, and iron deficiency anemia. Conducted at based at the women's consultation department of Clinical Hospital No.5 in Volgograd, the research involved 200 pregnant women aged 18-40, who underwent initial and follow-up oral exams. Results showed a high caries prevalence, especially in the 18-20 age group, and a significant correlation between hemoglobin levels and caries progression in women with anemia. Acute caries progression was observed in a notable portion of the participants, with new carious lesions forming in previously intact teeth. Dynamic monitoring of oral health during pregnancy facilitates early detection and prevention of dental diseases, significantly improving maternal and infant health outcomes. The study highlights the importance of routine dental check-ups and preventive strategies, suggesting further research in this area. The findings could guide the development of clinical recommendations and increase awareness among healthcare professionals and pregnant women regarding the importance of oral care during pregnancy. This study also emphasizes the need for educational programs aimed at pregnant women, educating them about the impact of oral diseases on both maternal and fetal health. The results provide critical insights for formulating comprehensive preventive healthcare programs aimed at enhancing dental health and ensuring the well-being of mothers and their children during pregnancy and postpartum. A comprehensive approach that includes outreach to pregnant women helps develop sustainable oral health habits and increases their adherence to preventative measures. Overall, this research underscores the necessity for integrated healthcare approaches that consider both oral and general health, fostering better health outcomes for families and encouraging proactive involvement in preventive care.

Vaccination strategies to identify and reach zero-dose and under-immunized children in crisis-affected states in Sudan: a qualitative study

Abstract Background Globally, 21 million children were un- or under-vaccinated with Diphtheria-Tetanus-Pertussis (DTP)-containing vaccines in 2023. Around 20% of zero-dose children, those who had not received any DTP doses, live in conflict-affected settings in low and middle-income countries. There is insufficient evidence on vaccination interventions to identify and reach zero-dose children in these settings. This study aimed to map and assess current vaccination strategies to identify and reach zero-dose and under-vaccinated children in the crisis-affected states of South Kordofan, South Darfur and Blue Nile in Sudan. Methods We conducted a cross-sectional qualitative study guided by the (Identify-Reach-Monitor-Measure-Advocate (IRMMA) framework, developed by Gavi, the Vaccine Alliance. We conducted 20 individual semi-structured interviews during November and December 2022. We interviewed governmental and non-governmental vaccination stakeholders at federal, state and locality levels. We used the IRMMA framework to analyze the interview transcripts. Results Zero-dose and under-immunized children in the study sites were concentrated in opposition-controlled areas, nomadic communities, and remote rural areas. Zero-dose and under-immunized children in accessible areas were identified through routine vaccination strategies and surveillance reports. Various strategies were used in inaccessible areas. This includes tasking local institutions and individuals trusted by communities to identify and reach children, and infrequent integration and co-delivery of routine vaccines with other health interventions such as COVID-19 vaccination and insecticidal net distribution. There are inaccurate population estimates and a lack of guidance from ministries of health for measuring and monitoring zero-dose and under-immunized children. Respondents conflated advocacy with mobilization, and advocacy was broadly characterized as an ad hoc activity mostly connected to immunization campaigns. Conclusions Our study underscored the complexity of vaccinating zero-dose and under-immunized children in crisis-affected states of Sudan. Further research is needed to evaluate these practices and the role of non-governmental organizations (NGOs) and community engagement in improving vaccination coverage. Furthermore, exploring alternative funding methods and using geographic information systems (GIS) could enhance vaccination data and address funding limitations.

Economic evaluation of short message service intervention for HIV prevention among men who have sex with men in China: a modelling study

BackgroundMen who have sex with men (MSM) globally face a high risk of HIV infection. Previous studies indicate that customized short message service (SMS) interventions could reduce high-risk behaviors that associated with HIV transmission. This study aims to evaluate the health and economic impacts of such interventions among MSM in China.MethodsA decision tree-Markov model was developed for a simulated cohort of 100,000 MSM of 20 years old. We assessed three intervention strategies: (1) routine strategy with standard health information; (2) SMS strategy with customized messages based on individual high-risk behaviors, with 50.1% efficacy and 50% coverage; (3) LEN-LA (lenacapavir long-acting) strategy as pre-exposure prophylaxis (PrEP), with 100% efficacy lasting for 0.5-year and 50% coverage. The study period was 45 years. Primary outcomes included the number of HIV infections and HIV-related deaths. The cost-effectiveness, cost-utility and cost-benefit analyses were conducted along with sensitivity analyses from the healthcare sector perspective.ResultsThe SMS strategy was more effective, averting 6,191 (22.0%) HIV infections and 2,100 (38.5%) HIV-related deaths when compared with routine strategy. The average cost-effectiveness ratios (ACERs) were US$6,361 (95% CI: 5,959-6,613) per HIV infection averted and US$18,752 (95% CI: 17,274 − 20,530) per HIV-related death averted. It had incremental cost-effectiveness ratios (ICERs) of US$1,743 (95% CI: 1,673-1,799) per QALY, with a benefit cost ratio (BCR) of 1.98 (95% CI: 1.94–2.02), compared with routine strategy. While the LEN-LA strategy may be the most effective, its high cost, coupled with the highest ICER, currently presents a considerable obstacle to its widespread adoption. The ICERs were most affected by the probability of HIV infection, intervention cost and coverage.ConclusionsSMS strategy for preventing HIV among MSM in China is cost-effective and could be a promising strategy for HIV prevention. These findings may have implications for public health policy and resource allocation in HIV prevention efforts targeting high-risk populations.

Modification and analysis of context-specific genome-scale metabolic models: methane-utilizing microbial chassis as a case study.

The interrogation of various types of data is a routine strategy to explore the relationship between genotype and phenotype. An efficient approach for integrating and cross-comparing experimental multi-scale data in the context of whole-genome-based metabolic network reconstruction becomes a powerful tool that facilitates fundamental and applied research discoveries. The present study describes the reconstruction of a context-specific (CS) model for the methane-utilizing bacterium, Methylotuvimicrobium alcaliphilum 20ZR. M. alcaliphilum 20ZR is becoming an attractive microbial platform for the production of biofuels, chemicals, pharmaceuticals, and bio-sorbents for capturing atmospheric methane. We demonstrate that this pipeline can help reconstruct metabolic models that are similar to manually curated networks. Furthermore, the model is able to highlight previously overlooked pathways, thus advancing fundamental knowledge of non-model microbial systems or promoting their development toward biotechnological or environmental implementations.

Circulating Tumor DNA Testing in Curatively Resected Colorectal Cancer and Salvage Resection

Serial circulating tumor DNA (ctDNA) has emerged as a routine surveillance strategy for patients with resected colorectal cancer, but how serial ctDNA monitoring is associated with potential curative outcomes has not been formally assessed. To examine whether there is a benefit of adding serial ctDNA assays to standard-of-care imaging surveillance for potential curative outcomes in patients with resected colorectal cancer. In this single-center (City of Hope Comprehensive Cancer Center, Duarte, California), retrospective, case cohort study, patients with stage II to IV colorectal cancer underwent curative resection and were monitored with serial ctDNA assay and National Cancer Center Network (NCCN)-guided imaging surveillance from September 20, 2019, to April 3, 2024. The median duration of follow-up was 26 months (range, 2-54 months). Serial ctDNA assays were performed every 3 months for 2 years and every 6 months for the 3 following years in conjunction with NCCN-guided radiographic surveillance. The primary outcome was the proportion of patients with clinical benefit from ctDNA testing, defined as the proportion of patients with a newly positive ctDNA assay and negative scheduled imaging (most recent or concurrent) that subsequently led to early imaging confirmation of recurrence, followed by curative-intent intervention with no evidence of recurrence at the time of data cutoff. Recurrence was categorized by ctDNA recurrence, radiographic recurrence, or concurrent ctDNA and imaging recurrence. Salvage resections and associated durable remissions were described within each of the 3 categories. Descriptive statistics were used to characterize the patient population. In total, 184 patients (median age, 59 years [range, 32-88 years]; 97 female [52.7%]) were included in this study, and 129 (70.1%) had stage II to III disease. Forty-five patients (24.5%) had ctDNA or imaging-confirmed recurrence. Of these 45 patients, 14 had radiographic recurrence with negative ctDNA, and 11 had concurrent ctDNA and imaging recurrence. Twenty of 45 patients had ctDNA positivity with negative imaging at first ctDNA positivity; 6 had reflex imaging that was positive for recurrence, and 14 continued with serial imaging and ctDNA monitoring. Ten of 14 patients had subsequent recurrent disease, 3 patients had a spontaneous clearance of ctDNA, and 1 patient remained imaging negative 7 months after positive ctDNA, after which she was lost to follow-up. Altogether, 11 of 20 patients with ctDNA recurrence without initial concurrent imaging recurrence had subsequent metastasectomy, and only 3 were disease-free at the cutoff date in April 2024, representing 1.6% of the surveilled population. In this cohort study of patients with stage II to IV colorectal cancer who underwent curative-intent resection, the addition of serial tumor-informed ctDNA assay to the standard NCCN-recommended surveillance had limited clinical benefits. Additional prospective research is needed to clarify the value of ctDNA testing in the surveillance setting.

Assessment of Current Practices for Perioperative Antibiotic Prophylaxis in Kidney Transplantation in China: Results from a Nationwide Survey.

Current guidelines support routine perioperative antibiotic prophylaxis (PAP) to minimize surgical site infection in kidney transplantation (KT), though data regarding the current practices of PAP is lacking in China. To survey the routine PAP strategies in KT, and analyze main clinical considerations associated with adjusted antibiotic dosing regimens in different Chinese hospitals. A nationwide survey was conducted on behalf of the National Alliance of Transplant Pharmacists. An online questionnaire was created via Wen Juan Xing (http://www.wjx.cn) and sent to all pharmacists in the Alliance. Twenty-three pharmacists from different teaching hospitals with Grade IIIA participated in the survey, with a response rate of 46.0%. There were wide differences in routine dosing regimens and clinical considerations. Six strategies were involved in living-donor KT and monotherapy was most often used (80.9%), while combination therapy was most common (69.6%) among the ten strategies in deceased-donor KT. Of fifteen antibiotics submitted in the survey, eight agents were prescribed with different doses and/or frequencies among different hospitals. Only 37.5% and 23.1% of the hospitals would stop PAP within 72hours in living-donor KT and deceased-donor KT, respectively. Among 28 preset factors, four factors were considered significantly important to decide PAP regimens, and eight factors were considered significantly unimportant (P<0.05). There was wide variability in routine dosing regimens and clinical considerations in PAP decisions in KT. Further investigations are warranted to obtain high-quality evidence and to make PAP in KT more rational.

Geospatial Variation in Vaccination Coverage and Zero-Dose Prevalence at the District, Ward and Health Facility Levels Before and After a Measles Vaccination Campaign in Nigeria.

Many measles endemic countries with suboptimal coverage levels still rely on vaccination campaigns to fill immunity gaps and boost control efforts. Depending on local epidemiological patterns, national or targeted campaigns are implemented, following which post-campaign coverage surveys (PCCSs) are conducted to evaluate their performance, particularly in terms of reaching previously unvaccinated children. Due to limited resources, PCCS surveys are designed to be representative at coarse spatial scales, often masking important heterogeneities in coverage that could enhance the identification of areas of poor performance for follow-up via routine immunization strategies. Here, we undertake geospatial analyses of the 2021 measles PCCS in Nigeria to map indicators of coverage measuring the individual and combined performance of the campaign and routine immunization (RI) at 1 × 1 km resolution and the ward and district levels in 13 states. Using additional geospatial datasets, we also produced estimates of numbers of unvaccinated children during the campaign and numbers of measles-containing vaccine (MCV) zero-dose children before and after the campaign at these levels and within health facility catchment areas. Our study revealed that although the campaign reduced the numbers of MCV zero-dose children in all the districts, areas of suboptimal campaign and RI performance with considerable numbers of zero-dose children remained. Our analyses further identified wards and health facility catchment areas with higher numbers of unvaccinated children within these areas. Our outputs provide a robust evidence base to plan and implement follow-up RI strategies and to guide future campaigns at flexible and operationally relevant spatial scales.

Abstract 4143258: Sex Differences in Health Status Outcomes: Analysis of the ISCHEMIA Randomized Clinical Trial

Background: Despite a lesser extent and severity of coronary artery disease (CAD), women had a higher burden of angina than men in the ISCHEMIA trial, suggesting that other factors may explain symptom severity in women. We aim to describe demographic and clinical characteristics, as well as differences in care patterns, associated with health status differences in women, as compared with men, in the conservative and invasive treatment groups of the ISCHEMIA trial. Methods: The ISCHEMIA trial randomized participants with moderate or severe ischemia to a routine invasive strategy of cardiac catheterization with complete revascularization plus guideline-directed medical therapy (GDMT), or an initial conservative strategy of GDMT alone with catheterization reserved for GDMT failure. Health status was a key secondary outcome. Using linear regression models we compared raw and adjusted Seattle Angina Questionnaire (SAQ) scores in women and men at baseline and at 1 year, stratified by randomized treatment strategy. Within the invasive strategy, sex differences were adjusted for completeness of revascularization among those with ≥1 coronary stenosis ≥70%. Results: Of 4,617 ISCHEMIA participants with valid SAQ data, women had lower (worse) baseline SAQ summary scores (SS) throughout follow up (Figure) after adjustment for demographics and clinical characteristics, including severity of CAD (difference 5.4 points, 95% CI 4.0-6.7). Women had lower SAQ SS after adjustment for post-randomization treatment (i.e., medical therapy, achievement of risk factor goals and, in the invasive strategy, complete revascularization), 2.4 points lower (95% CI 0.7-4.1) in the conservative group (Figure), and 1.9 points lower than in men (95% CI 0.1-3.7) in the invasive group. Findings were similar for all SAQ subscales. Conclusions: Women with chronic coronary disease in ISCHEMIA had worse health status than men at baseline and 1 year later, which was not explained by demographic or clinical characteristics, intensity of medical therapy, or completeness of revascularization.

Retrospective analysis of ferrotherapy methodology in patients with chronic heart failure and chronic kidney disease

The course of chronic non-infectious diseases is often accompanied by the development of comorbid conditions. In chronic heart failure and chronic kidney disease, special attention is drawn to iron deficiency and anemia. Intravenous iron preparations have become widely used for the prevention and treatment of anemia. Their use contributes to the progression of structural changes in vital organs. However, attempts to implement high-dose intravenous ferrotherapy as a routine strategy for compensating iron deficiency in patients with heart failure, with or without anemia, raise questions related to the search for diagnostic markers of iron deficiency states, goals, and conditions for its use. The article discusses the influences of a combination of opposing factors (inflammation, hypoxia) on the erythron system, its humoral regulators, and iron metabolism based on the author’s own research to justify the choice of strategy and tactics for ferrotherapy in patients with heart failure and chronic kidney disease.

The Impact of Different Revascularization Strategies Implemented in Acute Myocardial Infarction on the Recovery of Left Ventricular Functional and Deformational Parameters

Background: Despite well-established therapeutic techniques, such as direct revascularization through percutaneous coronary intervention (PCI), acute myocardial infarction (AMI) remains a leading cause of mortality and morbidity. Objectives: To determine if two-dimensional speckle tracking echocardiography (STE) deformation parameters and the early recovery of left ventricular (LV) functions are affected by the timing of PCI in AMI. Methods: A total of 200 cases with newly-onset acute myocardial infarction (AMI) who had a baseline left ventricular ejection fraction (LVEF) higher than 40% and received effective therapy with percutaneous coronary intervention (PCI) were included in this investigation. cases were categorized as either ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). cases were grouped into four groups according to the time between presentation and PCI. Using standard echocardiography and two-dimensional (2D) ST-elevation STE, individuals were re-evaluated three months later to find out if remodeling had taken place or if the LV function had returned. Results: Of the 200 AMI patients, including 140 males (70%), improvement in global longitudinal strain (GLS) and harmed longitudinal strain (HLS) were better in STEMI and NSTEMI patients received urgent revascularization with PCI (groups I and III) versus patients with pharmacoinvasive strategy or routine invasive strategy (Groups II and IV) (P &lt; 0.05) while there was an insignificant difference between group I and III (P = 0.79). Of the 200 patients, 47 patients (23.5%) presented signs of LV remodeling at 3 months follow up. Age, smoking history, hypertension, dyslipidemia, Killip class, peak creatine phosphokinase - MB level, baseline left ventricular end diastolic volume (LVEDV), HLS, and harmed longitudinal strain rate (HLSR) were all factors that were found to be significantly associated with left ventricular remodeling (P&lt;0.05) in the univariate logistic regression analysis. The following factors were identified as independent predictors of left ventricular remodeling in multivariate logistic regression analysis: damaged left ventricular ejection fraction (EF) and end-systolic volume, peak troponin I, Killip class, culprit left anterior descending (LAD), 2 and 3-vessel coronary artery disease (CAD), and wall motion score index (WMSI). Conclusion: Earlier PCI in AMI helps earlier improvement in myocardial strain parameters. HLS and HLSR are excellent predictors for LV remodeling and may do better than global parameters.

Impact of Biologic and Disease-Modifying Anti-rheumatic Drug (DMARD) Therapies on Oral Health in Rheumatologic Patients: A Case-Control Study.

Disease-modifying anti-rheumatoid drugs (DMARDs) and biological therapies are known to alter immune function, which may increase the risk of oral infections and mucosal changes. Immunosuppression induced by these medications can make patients more susceptible to conditions like oral candidiasis. Furthermore, there is limited research exploring the long-term oral health outcomes associated with these treatments, particularly in rheumatologic patients who are already at a higher risk of systemic inflammation. This study aims to address these gaps by assessing the impact of these therapies on oral health status and quality of life. This case-control study assesses oral health in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis receiving DMARD or biologic therapy. One hundred and fifty individuals were examined (50 cases on biological therapy, 50 cases on DMARDs, and 50 controls). Individuals undergoing systemic/biologic therapy for rheumatologic diseases were enlisted from outpatient clinics at Rizgary Teaching Hospital in Erbil, Iraq. All participants underwent a standardized oral health (OH) and quality of life (QoL) assessment following the World Health Organization (WHO) guidelines, whichincluded both a questionnaire and an OH examination. Controls (healthy individuals) matched for age and sexwere recruited from Khanzad Specialized Dental Teaching Center in Erbil, Iraq. The OH documentation of patients with rheumatologic diseases was recorded through oral examinations and medical chart reviews, which also included an assessment of the disease activity of each rheumatoid disease. Comparative analysis of OH behaviors showed significant differences between the groups. Patients receiving biologic therapies reported a lower frequency of regular dental check-ups compared to the DMARD and control groups (p < 0.05). Additionally, the use of interdental cleaning aids was less common among biological therapy patients, which may have contributed to the higher prevalence of periodontal issues observed in this group. Oral mucosal lesions (OML) were most prevalent in the DMARDs group with 37 participants (74%), followed by the biological group with 34 participants (68%), and least in the control group with 16 participants (32%) (p < 0.001). Dry mouth affected 38 participants (76%) in the biological group, 28 participants (52%) in the DMARDs group, and eight participants (16%) in the control group (p < 0.001). The DMARDs group also exhibited a significantly higher incidence of decayed and missing teeth compared to the biological and control groups (p = 0.002 and p = 0.008, respectively). In the biological group, the most common OMLs were candidiasis in 11 participants (22%)and ulceration in nine participants (18%), while in the DMARDs group, candidiasis affected 12 participants (24%) and ulceration affected seven participants (14%). Patients with rheumatologic disease have poorer OH and OH-related QoL, more dry mouth, more decay, and missing teeth compared to control. Regarding OML, patients with rheumatologic disease are more susceptible to candidiasis. The findingsindicate a need for routine OH monitoring and preventive strategies in these patient populations.

Machine learning to improve the understanding of rabies epidemiology in low surveillance settings

In low and middle-income countries, a large proportion of animal rabies investigations end without a conclusive diagnosis leading to epidemiologic interpretations informed by clinical, rather than laboratory data. We compared Extreme Gradient Boosting (XGB) with Logistic Regression (LR) for their ability to estimate the probability of rabies in animals investigated as part of an Integrated Bite Case Management program (IBCM). To balance our training data, we used Random Oversampling (ROS) and Synthetic Minority Oversampling Technique. We developed a risk stratification framework based on predicted rabies probabilities. XGB performed better at predicting rabies cases than LR. Oversampling strategies enhanced the model sensitivity making them the preferred technique to predict rare events like rabies in a biting animal. XGB-ROS classified most of the confirmed rabies cases and only a small proportion of non-cases as either high (confirmed cases = 85.2%, non-cases = 0.01%) or moderate (confirmed cases = 8.4%, non-cases = 4.0%) risk. Model-based risk stratification led to a 3.2-fold increase in epidemiologically useful data compared to a routine surveillance strategy using IBCM case definitions. Our study demonstrates the application of machine learning to strengthen zoonotic disease surveillance under resource-limited settings.

Pulmonary embolism work-up in chronic obstructive pulmonary disease exacerbations: what is the best strategy for clinicians?

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural course of COPD, as they increase morbidity and mortality. Acute pulmonary embolism may mimic the symptoms of COPD exacerbations. However, the exact prevalence of pulmonary embolism in unexplained exacerbations of COPD is unclear based on the current data. This review provides a practical approach to patients with COPD complaining of worsening respiratory symptoms. A randomized clinical trial has shown that a routine pulmonary embolism diagnostic work-up does not improve care of patients with acute exacerbations of COPD. However, review of the recent literature suggests that a nonnegligible proportion of otherwise unexplained exacerbations of COPD may be caused by pulmonary embolism. To date, nevertheless, there are limited studies developing and validating clinical models that might aid in the identification of patients requiring additional tests for the diagnosis of pulmonary embolism. Until new evidence becomes available, we believe that a routine diagnostic strategy for pulmonary embolism is not appropriate for patients with acute exacerbations of COPD. Recommendations for routine pulmonary embolism diagnostic work-up necessitate further development of prognostic models and conduct of clinical trials that assess important health outcomes.

Rationale and design of the multicentric randomized EVAOLD trial: Evaluation of a strategy guided by imaging versus routine invasive strategy in elderly patients with ischemia

BackgroundThe management of myocardial infarction without ST segment elevation (NSTEMI) in elderly patients remains challenging, in particular the benefit/risk balance of routine revascularization remains uncertain. Study designEVAOLD is s a multicenter, prospective, open-label trial with 2 parallel arms in NSTEMI patients ≥ 80 years of age. The aim of the trial is to test whether a strategy of selective invasive management guided by ischemia stress imaging (IMG group) will be non-inferior in preventing Major Adverse Cardiac and Cerebrovascular Events (MACCE, ie all-cause death, non-fatal myocardial infarction, non-fatal stroke) rates at 1 year compared with a routine invasive strategy (INV Group). Geriatric assessment and cost- effectiveness analysis will also be performed. A sample size of 1756 patients (assuming a 10% rate of patients lost to follow-up) is needed to show non-inferiority with 80% power. Non-inferiority based on exponential survival curves will be declared if the upper limit of the one-sided 97.5% confidence interval for the hazard ratio is lower than 1.24, corresponding to a non-inferiority margin of 7% in absolute difference and an event rate of 40% in the INV group. ConclusionEVAOLD is a nationwide, prospective, open-label trial testing the non-inferiority of a strategy of selective invasive management guided by ischemia stress imaging versus routine invasive strategy in elderly NSTEMI patients. ClinicalTrials.gov Identifier: NCT03289728

Progressive cancer targeting by programmable aptamer-tethered nanostructures.

Scientific research in recent decades has affirmed an increase in cancer incidence as a cause of death globally. Cancer can be considered a plurality of various diseases rather than a single disease, which can be a multifaceted problem. Hence, cancer therapy techniques acquired more accelerated and urgent approvals compared to other therapeutic approaches. Radiotherapy, chemotherapy, immunotherapy, and surgery have been widely adopted as routine cancer treatment strategies to suppress disease progression and metastasis. These therapeutic approaches have lengthened the longevity of countless cancer patients. Nonetheless, some inherent limitations have restricted their application, including insignificant therapeutic efficacy, toxicity, negligible targeting, non-specific distribution, and multidrug resistance. The development of therapeutic oligomer nanoconstructs with the advantages of chemical solid-phase synthesis, programmable design, and precise adjustment is crucial for advancing smart targeted drug nanocarriers. This review focuses on the significance of the different aptamer-assembled nanoconstructs as multifunctional nucleic acid oligomeric nanoskeletons in efficient drug delivery. We discuss recent advancements in the design and utilization of aptamer-tethered nanostructures to enhance the efficacy of cancer treatment. Valuably, this comprehensive review highlights self-assembled aptamers as the exceptionally intelligent nano-biomaterials for targeted drug delivery based on their superior stability, high specificity, excellent recoverability, inherent biocompatibility, and versatile functions.

A Descriptive Study on the Phenotypic Variability of Pseudomonas aeruginosa Identified by MALDI-TOF

This descriptive study investigates the phenotypic variability of 50 Pseudomonas aeruginosa colonies isolated from wastewater, identified using MALDI-TOF mass spectrometry. The contamination of wastewater by opportunistic pathogens like P. aeruginosa poses significant public health risks due to their potential to cause severe infections and contribute to the spread of antimicrobial resistance. Pseudomonas aeruginosa is particularly concerning because of its remarkable adaptability, resilience, and intrinsic and acquired antibiotic resistance mechanisms, including the production of beta-lactamases, efflux pumps, and target site mutations. Our study highlights the phenotypic diversity and antibiotic resistance profiles of P. aeruginosa strains isolated from urban and hospital environments. Using MALDI-TOF MS, we rapidly and accurately characterized these strains, providing species-level identification within minutes. This technology surpasses traditional biochemical methods in speed and accuracy, revolutionizing microbial diagnostics by offering a high-throughput, cost-effective, and reliable tool. By analyzing the phenotypic traits and resistance mechanisms of these strains, we aim to provide critical insights into their ecology and inform strategies to mitigate the risks associated with their presence in the environment. The antibiotic resistance profiles revealed varied susceptibility among the strains, with notable resistance to drugs such as erythromycin, cefoxitin, and tetracycline. The study's findings underscore the importance of integrating advanced diagnostic technologies like MALDI-TOF MS into routine environmental monitoring and public health strategies to address the challenges posed by P. aeruginosa in wastewater. Ultimately, this research contributes to understanding the dynamics of contamination and resistance in urban environments. By detailing the methodology used for the identification and characterization of the strains, as well as the results obtained, this publication aims to provide a valuable database for researchers and practitioners engaged in combating nosocomial infections and environmental pollution by P. aeruginosa. This study highlights the need for effective management measures to control the dissemination of this pathogen in aquatic systems, promoting public health and environmental safety.

Weekly Journal Scan: Do older patients with non-ST-segment elevation myocardial infarction receive any benefit from a routine invasive strategy?

Weekly Journal Scan: Do older patients with non-ST-segment elevation myocardial infarction receive any benefit from a routine invasive strategy?