Significant Risk Research Articles

Distribution of the SLC2A9 genotype and its association with the uric acid level in patients with arterial hypertension and atrial fibrillation

Asymptomatic hyperuricemia (HU) is widespread in the population and is one of the main risk factors for cardiovascular diseases. Evidence of numerous studies supports the association between increased uric acid (UA) levels and the risk of arterial hypertension (HTN) and/or atrial fibrillation (AF). One of the causes for an increase in UA levels and a significant risk factor for HU is the polymorphism of the SLC2A9 gene, a highly specific urate transporter in proximal renal tubule cells, encoding the GLUT9 protein.The aim of the study is to investigate the frequency of genotypes and alleles of the SLC2A9 gene rs734553 polymorphic variant and its association with the UA level in patients with HTN and AF, as well as in healthy individuals. 141 patients, including 50 healthy patients (group 1), 68 – with HTN and AF (group 2), 23 – with HTN (group 3) were examined.In the overall group of patients, the frequencies of the SLC2A9 gene rs734553 polymorphism were as follows: AA – 46.1 % (n = 65), AC – 36.2 % (n = 51), CC – 17.7 % (n = 25). According to the genotyping results of patients, in group 1 the AA genotype was 64 % (n = 32), AC – 22 % (n = 11), CC – 14 % (n = 7); in group 2 – 32.4 % (n = 22), 48.5 % (n = 33) and 19.1 % (n = 13); in group 3 47.8 % (n = 11), 30.4 % (n = 7) and 21.7 % (n = 5), respectively. The CC genotype patients (420 [413; 424] μmol/l) and the AC genotype patients (330 [284; 412] μmol/l) had higher uricemia values than those with the AA genotype (310 [281; 341] μmol/l) ( p = 0,003). HU with the AA genotype in group 2 was diagnosed in 2 (2.9 %) patients, with the AC genotype in 12 (17.6 %), and with the CC genotype in 10 (14.7 %) patients; in group 3 – 1 (4.3 %), 1 (4.3 %) and 3 (13 %), respectively. One patient (2 %) with HU in group 1 had the CC genotype.The distribution of genotype and allele frequencies of the SLC2A9 gene rs734553 polymorphic variant and its association with the UA level in patients with HTN and AF, as well as in healthy individuals were established. In patients with HTN and AF, the AC genotype occurred 3 times more often and the CC genotype occurred 2 times more often than in healthy patients. HU occurred significantly more often ( р = 0.003) in the group of patients with HTN and AF and the CC genotype, as well as in patients with the CC genotype.

Assessment of risk factors for nephrolithiasis in Rawat.

Objective: To identify the risk factors for nephrolithiasis among all patients found to have nephrolithiasis on renal sonography. The study will help us report the incidence of renal stones in this area, and as they cause significant morbidity and high costs of healthcare, and guide towards the introduction of public health measures to reduce the incidence of nephrolithiasis. Study Design: Descriptive, Questionnaire Based Cross-sectional study. Setting: Watim General Hospital, Rawalpindi. Period: Jul 1st, 2023 to Sep 30th, 2023. Material & Methods: The data of all adult patients who underwent renal sonography and were documented to have nephrolithiasis was obtained through physician administered questionnaires from the ultrasound department records. Data was then entered and analyzed by using the Statistical Package for the Social Sciences (SPSS), version 16. Results: Data was collected on 115 patients, of these, 57% were males. 48% of the patients were aged between 18-30 years of age. 54% of the patients belonged to lower socio-economic class. 55% of them had low water intake, and 81% consumed non-purified water. 51% patients also had a positive family history. 81% of the patients had less intake of citrus fruits and 37% of them never exercised. Conclusion: Many significant risk factors were assessed. Awareness campaigns and preventive health measures should be implemented addressing the critical risk factors. This will help decrease the burden on patients, and on the health care system.

Get on the Round Dial: Fighter Pilot Strategies for Recovering Situation Awareness After Disorienting Physiological Events

Despite decades of research and training, adverse physiological events continue to present a significant risk to pilots. This paper describes a naturalistic study of fighter pilot experiences with disorienting physiological events such as gravity-induced loss of consciousness (G-LOC), hypoxia, and spatial disorientation. We conducted a cognitive task analysis with 10 experienced fighter pilots to elicit incidents in which the pilot or another pilot in the flight experienced a physiological event, exploring how they recognized something was wrong, assessed the level of impairment, and regained situation awareness. We describe cognitive requirements, specific cues and strategies, as well as complexities associated with managing these disorienting physiological events. Implications for decision support design and training are discussed.

Prevalence of Upper Cross Syndrome in Multipara Women

Background: Upper Cross Syndrome (UCS) is now a commonly emerging syndrome in the presently existent population. In terms of clinical features, it can be defined as a postural disorder resulting from constriction of the pectoral muscles coupled with weakness of the trapezius and deep neck flexors, leading to forward-facing head stance, rounded shoulders, and kyphosis of the thoracic cavity. Comprehensive documentation of the incidence of this syndrome in multiparous communities is lacking in the literature. As a result, a study was carried out to ascertain the prevalence of UCS in multiparous women. Objective: To determine the prevalence of UCS in multiparous women. Methods: This study was approved by the Ethical Committee and the Protocol Committee (protocol no. 629/2022-2023). The subjects of the prospective cohort study were women who are multiparous and reside in Karad, Maharashtra, India. Using cluster sampling, 76 multiparous participants were included. Assessments were conducted for individuals within the age range of 23 to 58 years, evaluating them based on Craniovertebral Angle (CVA), Forward Head Posture (FHP), pectoralis minor tightness, and deep neck flexor strength. Results: This research looked at 76 participants involved in the study out of which 66.7% were prone to upper cross syndrome. Conclusion: The prevalence of UCS was notably high among multiparous women, with poor posture habits identified as a significant risk factor.

Quantifying the role of saltmarsh as a vulnerable carbon sink: A case study from Northern Portugal

Saltmarshes play a crucial role in carbon sequestration and storage, although they are increasingly threatened by climate change-induced sea level rise (SLR). This study assessed the potential variation in Blue Carbon stocks across regional and local scales, and estimated their economic value and potential habitat loss due to SLR based on the IPCC AR6 scenarios for 2050 and 2100 in three estuarine saltmarshes in northern Portugal, the saltmarshes of the Minho, Lima and Cávado estuaries. The combined carbon stock of these saltmarshes was 38,798 ± 2880 t of organic carbon, valued at 3.96 ± 0.38 M€. Local and regional differences in carbon stocks were observed between common species, with the cordgrass Spartina patens and the reed Phragmites australis consistently showing higher values in the Lima saltmarsh in some of the parameters. Overall, the Lima saltmarsh had the highest total carbon per species cover, with S. patens showing the highest values among common species. Bolboschoenus maritimus had the highest values in the Minho saltmarsh, while the other species presented a similar carbon storage capacity. Potential habitat loss due to SLR was most evident in the Cávado saltmarsh over shorter timescales, with a significant risk of inundation even for median values of SLR, while the Lima saltmarsh was shown to be more resistant and resilient. If habitat loss directly equates to carbon loss within these saltmarshes, projected CO2 emissions may range from 22,000 to 43,449 t by 2050 and 33,000 to 130,000 t by 2100 (under the IPCC SSP5–8.5 scenario). The study shows the importance of Blue Carbon site-specific estimates, acknowledging the potential future repercussions from habitat loss due to SLR. It emphasizes the need to consider local and regional variability in Blue Carbon stocks assessments and highlights the critical importance of preserving and rehabilitating these ecosystems to ensure their continued efficacy as vital carbon sinks, thereby contributing to climate change mitigation efforts.

Analyzing prehospital delays in recurrent acute ischemic stroke: Insights from interpretable machine learning

ObjectiveThis study investigates prehospital delays in recurrent Acute Ischemic Stroke (AIS) patients, aiming to identify key factors contributing to these delays to inform effective interventions. MethodsA retrospective cohort analysis of 1419 AIS patients in Shenzhen from December 2021 to August 2023 was performed. The study applied the Extreme Gradient Boosting (XGBoost) algorithm and SHapley Additive exPlanations (SHAP) for identifying determinants of delay. ResultsLiving with others and lack of stroke knowledge emerged as significant risk factors for delayed hospital presentation in recurrent AIS patients. Key features impacting delay times included residential status, awareness of stroke symptoms, presence of conscious disturbance, diabetes mellitus awareness, physical weakness, mode of hospital presentation, type of stroke, and presence of coronary artery disease. ConclusionPrehospital delays are similarly prevalent among both recurrent and first-time AIS patients, highlighting a pronounced knowledge gap in the former group. This discovery underscores the urgent need for enhanced stroke education and management. Practice implicationThe similarity in prehospital delay patterns between recurrent and first-time AIS patients emphasizes the necessity for public health initiatives and tailored educational programs. These strategies aim to improve stroke response times and outcomes for all patients.

Effects of poor recruitment on riverine Smallmouth Bass population dynamics

AbstractObjectiveAltered flow regimes pose significant risks to the stability of populations of riverine Smallmouth Bass Micropterus dolomieu. Periods of poor recruitment, due to early life stage mortality resulting from high‐flow events, can cause size‐structure and density alterations of populations. The aim of this study was to opportunistically test for changes in dynamic rates of a riverine Smallmouth Bass population using a long‐term data set that spanned a period of poor recruitment.MethodsOur study evaluated size‐specific CPUE (fish/h), mortality, growth, and condition and tested for recruitment determinants of Smallmouth Bass through three consecutive years of poor age‐0 recruitment in the South Branch Potomac River, West Virginia. We used fall nighttime boat electrofishing surveys during 2009–2022 to monitor this population before and after the poor‐recruitment time frame (2016–2018).ResultAge‐0 CPUE was greater during the time frame prior to the poor‐recruitment time frame. However, there was no difference in the CPUE of quality‐length Smallmouth Bass between the two time frames and CPUE of preferred‐length fish was greater during the poor‐recruitment time frame. Growth and relative weight increased during the poor‐recruitment time frame. There was no significant difference detected in mortality between the recruitment time frames. Streamflow during the spawning period was a significant factor influencing fall recruitment of age‐0 Smallmouth Bass. A Ricker density‐dependent model with an added streamflow term performed as well as a basic, log‐linear streamflow model and a density‐independent model that also incorporated a streamflow term.ConclusionOur results provide evidence of density‐dependent structuring in this population. Decreases in population density increased population dynamic rates that maintained or improved size structure. High adult biomasses did not increase age‐0 recruitment. Many riverine Smallmouth Bass populations may display favorable density‐dependent responses to declines in juvenile recruitment. Thus, management agencies should better understand the resiliency of these populations prior to establishing expensive programs or regulations, which may be ineffective, to combat alterations in juvenile recruitment.

(090) Depression Among Infertile Women: Prevalence and Risk Factors

Abstract Introduction Infertility is a significant issue that affects many couples worldwide. Depression is one of the most common psychiatric disorders among infertile patients. Objective This study aims to determine the prevalence of depression and its determinant factors among infertile patients in the Andrology and Fertility Hospital of Hanoi based on the PHQ-9. Methods The study was conducted among 360 infertile patients who visited the Andrology and Fertility Hospital of Hanoi between August 2022 and January 2023. Depression was measured using the Patient Health Questionnaire-9 (PHQ-9). The relationships between depression and demographic/fertility characteristics were explored using univariate and multiple logistic regression with an odds ratio (OR) and 95% confidence interval (CI). Results The mean total PHQ-9 score was 4.47 (SD = 4.14). Using a cut-off value of 10, the prevalence of depression was 11.7%. Depression was significantly associated with being age over 35 years old (OR = 2.24, 95% CI =1.05 – 4.76), having an income per month of less than 10 million VND (OR=2.01; 95%CI (1.01 – 4.72), husbands feeling pressured to have children (OR = 2.26, 95%CI = 1.08 – 4.72), feeling uncomfortable when others find out about infertility (OR=2.78, 95%CI = 1.36 – 5.67), not receiving support from the workplace (OR=2.55, 95%CI = 1.25 – 5.20) and believing they can be happy without children (OR=4.41, 95%CI = 1.37 – 14.18). Conclusions The high prevalence of depression among infertile patients in this study highlights the need for healthcare providers to screen and provide psychological support to this population. The finding that female aged above 35, low income, with husbands pressuring them to have kids, feeling uncomfortable when others know about their infertility, and lacking support from their workplace was found to be significant risk factors for depression are significant determinants of depression among infertile patients suggests that interventions should be targeted toward these groups. Disclosure No.

High hand grip strength is a significant risk factor and a useful predictor of postoperative pancreatic fistula following pancreaticoduodenectomy.

Postoperative pancreatic fistula (POPF) is one of the most critical complications of pancreaticoduodenectomy (PD). Studies on predictive factors for POPF that can be identified preoperatively are limited. Recent reports have highlighted the association between the preoperative nutritional status, including sarcopenia, and postoperative complications. We examined preoperative risk factors for POPF after PD, focusing on nutritional indicators. A total of 153 consecutive patients who underwent PD at our institution were enrolled in this study. Preoperative nutritional parameters, including hand grip strength (HGS) and skeletal muscle mass as components of sarcopenia, were incorporated into the analysis. POPFs were categorized according to the International Study Group of Pancreatic Fistula (ISGPF) definition as biochemical (grade A) or clinically relevant (CR-POPF; grades B and C). Thirty-seven of the 153 patients (24.1%) fulfilled the ISGPF definition of CR-POPF postoperatively. In the univariate analysis, the incidence of CR-POPF was associated with male sex, non-pancreatic tumor diseases, a high body mass index, a high HGS and a high skeletal muscle mass index. In the multivariate analysis, non-pancreatic tumor diseases and an HGS ≥23.0 kg were selected as independent risk factors for CR-POPF (P <0.05). A high HGS, a screening tool for sarcopenia, was a risk factor for CR-POPF. It can accurately serve as a useful predictor of POPF risk in patients undergoing PD. These results highlight the potential of sarcopenia to reduce the incidence of POPF and highlight the need to clarify the mechanism of POPF occurrence.

Predictive Scoring System for Spontaneous Closure of Infant Ventricular Septal Defect: The P-VSD Score.

Ventricular septal defect (VSD) is a common congenital heart disease. However, consensus on the utility of echocardiography in predicting spontaneous closure (SC) of VSD remains lacking. This study aimed to identify and validate significant predictors of SC through a predictive scoring system. This retrospective study included medical records of 712 echocardiography instances performed on 304 patients diagnosed with VSD from 2016 to 2020 in their first year of life. A novel scoring system for predicting the SC of VSD was developed and validated using another dataset from different hospitals. Of the 304 patients, 215 (70.7%) had perimembranous (PM) VSDs and 89 had muscular (29.3%) VSDs. The median follow-up periods were 36.2 (interquartile range [IQR], 13-59) months and 13.7 9 (IQR, 5-37.4) days for PM and muscular VSDs, respectively. The overall SC rate during follow-up was 29.3%. Pulmonary hypertension (HTN), concomitant left ventricle (LV)-right atrium (RA) shunt, VSD size to aortic valve (AV) annulus size ratio, and left ventricular end-diastolic dimension (LVEDD) z-score were significant risk factors affecting SC of VSD. The "P-VSD" score, a new scoring system, demonstrated an area under the curve for predictability of 0.769. Pulmonary HTN, concomitant LV-RA shunt, LVEDD z-score, and VSD size-to-AV annulus size ratio at diagnosis were significantly associated with non-SC VSD after infancy. The P-VSD score can predict the SC of VSD in clinical settings and simplify the identification and appropriate management of high-risk patients.

Relationship between hyperleptinemia and cardiometabolic risk in persons with obesity

Background. Obesity remains a global social and medical problem today. The results of recent research demonstrate the pre­sence of overweight in 30–70 % and obesity in 10–30 % of adults, while the prevalence of obesity is increasing at an alarming rate in both economically developed and developing countries of the world. In Ukraine, according to the World Health Organization, 41.2 % of men and 58.5 % of women are overweight or obese. Obesity is a risk factor for the development of a number of diseases — type 2 diabetes, hypertension, coronary heart disease, non-alcoholic fatty liver disease, gastroesophageal reflux disease, obstructive sleep apnea syndrome, etc. The presence of hyperleptinemia and weight loss resistance are common characteristics of obesity. The purpose of the study was to reveal the relationship between leptin levels and cardiometabolic risk in obese patients. Materials and methods. Fifty-three patients (43 women, 10 men) were examined. Body mass index was calculated as the ratio of body weight (kg) to height (m2). The classification criteria of the World Health Organization were used to diagnose overweight, obesity, and its degree. The level of leptin was assessed by an enzyme immunoassay on the ImmunnoChem-2000 device. The relationship between indicators was evaluated using the Spearman’s rank correlation coefficient. Results. Hyperleptinemia in obese patients is an indicator of low-grade inflammation. A significant increase in the serum leptin is noted in obese patients. Correlation analysis of waist circumference with leptin level in women and men demonstrated its importance both before and after treatment. A significant cardiometabolic risk was detected in the examined patients from the Ukrainian population. Against the background of a comprehensive treatment for six months, a decrease in body weight, waist circumference (p &lt; 0.05) and in leptin level (p &lt; 0.05) was noted in both women and men. Conclusions. The relationship was found between leptin level and cardiometabolic risk in obese patients.

Multidisciplinary management of diabetic foot infection associated with improved 8-year overall survival

AimsDiabetic foot syndrome is a global challenge best managed through multidisciplinary collaboration. This study aimed to investigate the effect of a systematic multidisciplinary team (MDT) on the overall survival and major amputation-free survival of hospitalized patients with diabetic foot infection (DFI). MethodsThis retrospective cohort study was conducted at Tampere University Hospital. Cohorts of hospitalized patients with DFI before and after the initiation of multidisciplinary wound ward were compared after an 8-year follow-up. ResultsKaplan-Meier analysis revealed significantly higher overall survival in the post-MDT cohort (37.8 % vs 22.6 %, p < 0.05) in 8-year follow-up. Similarly, major amputation-free survival was superior in this cohort (31.8 % vs 16.9 %, p < 0.05). Additionally, early major amputation was associated with inferior overall survival (35.1 % vs 12.0 %, p < 0.05). In a multivariable Cox-regression analysis cohort (hazard ratio [HR] 1.38, 95 % confidence interval [CI95%] 1.01–1.87), early amputation (HR 1.64, CI95% 1.14–2.34) and diagnosed peripheral artery disease (HR 2.23, CI95% 1.61–3.09), congestive heart failure (HR 2.13, CI95% 1.47–3.08), or moderate kidney disease (HR 1.95, CI95% 1.34–2.84) were identified as significant risk factors affecting overall survival. ConclusionsAfter systematic MDT approach we found improved long-term overall and major amputation-free survival. Multidisciplinary approach is therefore highly recommended for managing patients hospitalized for DFI.

Low albumin combined with low-molecular-weight heparin as risk factors for liver injury using azvudine: Evidence from an analysis of COVID-19 patients in a national prospective pharmacovigilance database.

Azvudine is an effective treatment for patients infected with common COVID-19. However, physicians have reported a series of adverse reactions, including multiple cases of liver injury, caused by azvudine in clinical practice. This study assessed the incidence, clinical features, and associated risk factors of liver injury induced by azvudine in real-world settings, offering guidance for safe clinical use. This study utilized the Chinese Hospital Pharmacovigilance System (CHPS) to retrospectively analyze the treatment of COVID-19 patients with azvudine at Changsha Central Hospital from December 19, 2022, to June 6, 2023. A case-control study was conducted to analyze the occurrence of azvudine-induced liver injury in COVID-19 patients who triggered a CHPS alert compared to normal COVID-19 patients. Among the total of 2,141 COVID-19 patients, 31 (1.45%) developed azvudine-induced liver injury, which is classified as an occasional adverse reaction. Liver injury was observed in 93.55% of patients between days 4 and 12 of the azvudine treatment, with elevated transaminases as the primary clinical manifestation. Univariate and binary logistic regression analyses indicated that low albumin levels and co-administration of low-molecular-weight heparin were statistically significant risk factors (p<0.05). This study represents the first investigation of azvudine-induced liver injury and high-risk patients using the CHPS. The findings provide valuable insights to promote the safety of anti-COVID-19 drugs, serving as an important reference for future drug safety measures.

Evaluating Clinical Presentations and Diagnostic Procedures in Pediatric Autoimmune Hepatitis

Background: The aim of the current research was to assess the clinical manifestations and diagnostic methods used in juvenile cases of Autoimmune Hepatitis (AIH). Methods: This study employed a retrospective cross-sectional design to investigate pediatric patients diagnosed with AIH at Children’s Medical Center Hospital, which is affiliated to Tehran University of Medical Sciences (TUMS), Tehran, Iran. The study included patients who received routine examinations, treatments, and follow-ups during the period from 2018 to 2021. Results: The present investigation encompassed the evaluation of 52 pediatric patients, mostly female, with a mean age of 7.76 years. The vast majority of patients have encountered the occurrence of acute AIH. Positive findings for the Anti-Smooth Muscle Antibodies (ASMA) test were seen in 50% of the patients. The mean score for fibrosis in the observed individuals was 2.56, whereas the mean value for the Hepatitis Activity Index (HAI) in a subset of 29 patients was found to be 7.34. One patient succumbed to the condition, one case underwent transplantation, and another individual was identified as a candidate for liver transplantation. Conclusion: Patients with AIH saw a decrease in long-term survival. There was no observed disparity in prognosis based on gender; nevertheless, it was noted that males had a shorter lifespan, perhaps attributable to an earlier beginning of the illness. The presence of cirrhosis at the time of diagnosis constituted a significant risk factor for unfavorable prognosis, as it was associated with an elevated overall risk of mortality owing to liver dysfunction.

Ferulic acid attenuates difenoconazole exposure induced liver injury in carp by modulating oxidative damage, inflammation and apoptosis

Difenoconazole (DFZ) is a widely used triazole fungicide in agricultural production. However, the presence of DFZ residue in the environment poses a significant risk to non-target organisms. Ferulic acid (FA) is a phenolic compound known for its antioxidant and anti-inflammatory properties. This study aims to investigate the hepatic damage caused by DFZ in carp and explore the mechanism through which FA alleviates this damage. The findings revealed that FA enhanced the antioxidant capability of the carp's liver and reduced the accumulation of reactive oxygen species (ROS) in the liver tissue. Moreover, FA regulated the transcriptional levels of inflammation-related factors, effectively preventing the inflammatory response triggered by the NF-κB signaling pathway. Additionally, TUNEL results demonstrated that DFZ initiated apoptosis, while dietary supplementation with FA decreased the protein expression levels of Bax and Cytochrome C (Cyt c) and the transcriptional levels of bax, caspase3, caspase9, p53 genes. Furthermore, FA increased the protein expression and transcriptional levels of Bcl-2. In conclusion, FA protects against liver injury induced by DFZ exposure in carp by modulating oxidative damage, inflammation, and apoptosis.

Quantitative T2 mapping-based longitudinal assessment of brain injury and therapeutic rescue in the rat following acute organophosphate intoxication

Acute intoxication with organophosphate (OP) cholinesterase inhibitors poses a significant public health risk. While currently approved medical countermeasures can improve survival rates, they often fail to prevent chronic neurological damage. Therefore, there is need to develop effective therapies and quantitative metrics for assessing OP-induced brain injury and its rescue by these therapies. In this study we used a rat model of acute intoxication with the OP, diisopropylfluorophosphate (DFP), to test the hypothesis that T2 measures obtained from brain magnetic resonance imaging (MRI) scans provide quantitative metrics of brain injury and therapeutic efficacy. Adult male Sprague Dawley rats were imaged on a 7T MRI scanner at 3, 7 and 28 days post-exposure to DFP or vehicle (VEH) with or without treatment with the standard of care antiseizure drug, midazolam (MDZ); a novel antiseizure medication, allopregnanolone (ALLO); or combination therapy with MDZ and ALLO (DUO). Our results show that mean T2 values in DFP-exposed animals were: (1) higher than VEH in all volumes of interest (VOIs) at day 3; (2) decreased with time; and (3) decreased in the thalamus at day 28. Treatment with ALLO or DUO, but not MDZ alone, significantly decreased mean T2 values relative to untreated DFP animals in the piriform cortex at day 3. On day 28, the DUO group showed the most favorable T2 characteristics. This study supports the utility of T2 mapping for longitudinally monitoring brain injury and highlights the therapeutic potential of ALLO as an adjunct therapy to mitigate chronic morbidity associated with acute OP intoxication.

Early warning systems, mobile technology, and cholera aversion: Evidence from rural Bangladesh

In Bangladesh, cholera poses a significant environmental health risk. Yet, information about the severity of cholera risk is limited as risk varies over time and changing weather patterns make historical cholera risk predictions less reliable. In this paper, we examine how households use geographically and temporally personalized cholera risk predictions to inform their beliefs and behaviors related to cholera and its aversion. We estimate how access to a smartphone application containing monthly cholera risk predictions unique to a user’s home location affects households’ beliefs about their cholera risk and their water use and hygiene behaviors. We find that households with access to this application feel more equipped to respond to environmental and health risks and reduce their reliance on surface water for bathing and washing – a common cholera transmission pathway. We do not find that households invest additional resources into drinking water treatment, nor do we find reductions in self-reported cholera incidence. Further, households with a static, non-personalized app containing public health information about cholera exhibit similar patterns of beliefs updating. Taken together, our results suggest that access to risk information can help households make safer water choices, yet improving design and credibility remain important dimensions for increasing application usability.

Advances in Treatments for Epidermolysis Bullosa (EB): Emphasis on Stem Cell-Based Therapy.

Epidermolysis bullosa (EB) is a rare genetic dermatosis characterized by skin fragility and blister formation. With a wide phenotypic spectrum and potential extracutaneous manifestations, EB poses significant morbidity and mortality risks. Currently classified into four main subtypes based on the level of skin cleavage, EB is caused by genetic mutations affecting proteins crucial for maintaining skin integrity. The management of EB primarily focuses on preventing complications and treating symptoms through wound care, pain management, and other supportive measures. However, recent advancements in the fields of stem cell therapy, tissue engineering, and gene therapy have shown promise as potential treatments for EB. Stem cells capable of differentiating into skin cells, have demonstrated positive outcomes in preclinical and early clinical trials by promoting wound healing and reducing inflammation. Gene therapy, on the other hand, aims to correct the underlying genetic defects responsible for EB by introducing functional copies of mutated genes or modifying existing genes to restore protein function. Particularly for severe subtypes like Recessive Dystrophic Epidermolysis Bullosa (RDEB), gene therapy holds significant potential. This review aims to evaluate the role of new therapeutic approaches in the treatment of EB. The review includes findings from studies conducted on humans. While early studies and clinical trials have shown promising results, further research and trials are necessary to establish the safety and efficacy of these innovative approaches for EB treatment.

Influence of humic acid on the bioaccumulation, elimination, and toxicity of PFOS and TBBPA co-exposure in Mytilus unguiculatus Valenciennes

Tetrabromobisphenol A (TBBPA) and Perfluorooctane sulfonate (PFOS) are emerging contaminants which coexist in marine environments, posing significant risks to ecosystems and human health. The behavior of these contaminants in the presence of dissolved organic matter (DOM), specifically the co-contamination of TBBPA and PFOS, is not well understood. The bioaccumulation, distribution, elimination, and toxic effects of TBBPA and PFOS on thick-shell mussels (Mytilus unguiculatus V.), with the absence and presence of humic acid (HA), a typical DOM, were studied. The results showed that the uptake of TBBPA decreased and the uptake of PFOS increased when exposed to 1 mg/L HA. However, at higher concentrations of HA (5 and 25 mg/L), the opposite effect was observed. Combined exposure to HA, TBBPA, and PFOS resulted in oxidative stress in the digestive gland, with the severity of stress dependent on exposure time and HA dose. Histological analysis revealed a positive correlation between HA concentration and tissue damage caused by TBBPA and PFOS. This study provides insights into the influence of HA on the bioaccumulation-elimination patterns and toxicity of TBBPA and PFOS in marine bivalves, offering valuable data for ecological and health risk assessments of combined pollutants in aquatic environments rich in DOM.

Incidence of Clostridium difficile in Patients with Antibiotic Associated Diarrhea

Background: This study was performed to determine the magnitude of Clostridioides difficile infection (CDI) in a tertiary care hospital in patients with antibiotic associated diarrhea (AAD) and to study the risk factors associated with this disease.&#x0D; Methods: A descriptive study was conducted in the department of Microbiology in a tertiary care hospital during December 2019 to May 2021. Stool samples were collected from patients with signs and symptoms of AAD who had been consuming antibiotic or anticancer drugs durng six weeks before the sampling. The samples were subjected to C. difficile glutamate dehydrogenase (GDH) enzyme and CD toxin A &amp; B detection by Enzyme Linked Fluorescent Assay (ELFA). Patient’s demographic features and clinical details were noted and statistically correlated with the test results&#x0D; Results: Among the total 70 samples tested 20 (28%) were positive for GDH alone and 12 (17%) were positive for both GDH and CD toxin A and B. Fluoroquinolones was a significant risk factor in the study. Sepsis and colitis was found to have significant association with C.difficile infection in our study. The crude mortality rate was 17%.&#x0D; Conclusion: Prompt and precise diagnosis and knowledge about the risk factors of CDI helps in effective management and prevention of CDI.