Susceptible Patients Research Articles

Comparison of ultraviolet C light and isopropyl alcohol for the disinfection of cellular phones in a paediatric intensive care unit setting.

A considerable proportion of cellular phones (cell phones) used by healthcare workers (HCWs) have been shown to be contaminated with pathogenic micro-organisms, making these devices reservoirs to infect susceptible patients. Although many units have well-defined infection control protocols, methods for the decontamination of cell phones are scarce. To compare the efficacy of ultraviolet C (UVC) light with that of 70% isopropyl alcohol in disinfecting cell phones used by HCWs in a paediatric intensive care unit (ICU). A randomised controlled study in a paediatric ICU setting was conducted. Cell phones of HCWs or other personnel entering the ICU were swabbed prior to and after decontamination with either the 70% isopropyl alcohol or UVC light method. The reduction ratio of colony-forming units (CFUs) before and after intervention was analysed using the Mann-Whitney U-test. In addition, the effectiveness of the disinfection methods was compared using the Wilcoxon signed-rank paired test. A total of 74 cell phones were acquired from HCWs working in the paediatric ICU. After excluding 5, 69 samples were therefore available for statistical analysis, with 34 samples subjected to disinfection using 70% isopropyl alcohol-based swabs and 35 samples treated with UVC light disinfection. Disinfection with 70% isopropyl alcohol (z=5.16; p<0.000001) and with UVC light (z=3.28; p<0.005) were individually statistically significantly effective in reducing CFUs. The CFU reduction ratio indicated that disinfection using a 70% isopropyl alcohol solution was 67% more effective than UVC light disinfection (Mann-Whitney U-test score 968; p<0.001). Although both 70% isopropyl alcohol and UVC light disinfection effectively reduced CFUs following decontamination, 70% isopropyl alcohol was determined to be much more effective.

Double negative T cells promote surgery-induced neuroinflammation, microglial engulfment and cognitive dysfunction via the IL-17/CEBPβ/C3 pathway in adult mice

CD3(+) CD4(−) CD8(−) double negative T cells (DNTs) manifest themselves in autoimmune diseases and associated inflammation. In the central nervous system, the increased presence of DNTs is associated with the progression of neurological conditions and brain injury. Active DNTs that produce IL-17 have been regarded as a pro-inflammatory phenotype. The IL-17 signaling pathway mediates neuroinflammatory responses by inducing glial activation and producing inflammatory factors. Neuroinflammation is considered integral to the pathogenesis of perioperative neurocognitive disorders (PNDs), commonly developed after surgery in susceptible patients. We and others have demonstrated a significant role for complement C3 in surgery-induced neuroinflammation and cognitive impairment but the regulatory mechanisms for this remain unexplored. We hypothesized that surgery induces DNT infiltration into the CNS that in turn upregulate complement C3 expression and this causes changes that contribute to cognitive impairment. Using an adult murine abdominal surgery model, we investigated perioperative changes in cognitive performance, quantifying the presence of T cell subsets and phenotype, IL-17 signaling pathway activation, glial cell activation and C3 expression in the brain. Postoperative IL-17 specific inhibitor GSK2981278 administration or preoperatively conditional CEBPβ knock-down by AAV9 viral vector were then applied to evaluate the effect of inhibiting IL-17 signaling pathway on postoperative C3 expression and cognitive performance. The results showed an increased hippocampus infiltration of DNTs with augmented IL-17 production, along with C3 upregulation and cognitive impairment. Both inhibition of IL-17 or knock-down of CEBPβ significantly suppressed C3 expression, synaptic engulfment by microglia and attenuated cognitive impairment. These findings indicate that DNTs promote postoperative neuroinflammation and cognitive impairment via the IL-17/CEBPβ/C3 pathway and targeting this IL-17 axis could be a potential therapeutic strategy to ameliorate postoperative neuroinflammation and cognitive impairment.

Fractional-Order Mathematical Modeling of Methicillin- Resistant Staphylococcus aureus Transmission in Hospitals

This article investigates the environmental contamination and antibiotic exposure effect on the transmission dynamics of the Methicillin-Resistant Staphylococcus aureus (MRSA) model in hospitals using the fractional Adams–Bashforth–Moulton Method (ABMM). This epidemic model simulates the dynamics of patient populations, bacterial contamination, and healthcare worker safety under varying conditions. This model provides critical insights into the interactions between hospital practices, environmental factors, and infection dynamics, demonstrating the importance of symmetry in balancing hospital admission and discharge rates to manage infection spread effectively. The analysis extends to the impact of environmental bacterial density and hospital admission rates on patient colonization. Increasing admission rates introduce more susceptible patients, exacerbating infection spread when bacterial density is high. Conversely, lower admission rates and bacterial density result in a more controlled infection environment. The model further investigates how varying discharge rates influence colonization dynamics, highlighting that effective discharge practices can mitigate infection spread, especially in high-bacterial density scenarios. It must be noted that this model is studied fractionally for the first time. Overall, this model provides critical insights into the interactions between hospital practices, environmental factors, and infection dynamics, offering valuable guidance for infection control strategies and hospital policy formulation. By adjusting fractional order constant (σ) values and analyzing different scenarios, this research aids in understanding and managing bacterial infections in healthcare settings. The proposed method is able to provide the results presented in the figures within this study considering the influence of many factors.

Does patient-ventilator asynchrony really matter?

Past observational studies have reported the association between patient-ventilator asynchronies and poor clinical outcomes, namely longer duration of mechanical ventilation and higher mortality. But causality has remained undetermined. During the era of lung and diaphragm protective ventilation, should we revolutionize our clinical practice to detect and treat dyssynchrony? Clinicians' ability to recognize asynchronies is typically low. Automatized softwares based on artificial intelligence have been trained to largely outperform human eyesight and are close to be implemented at the bedside. There is growing evidence that in susceptible patients, dyssynchrony may lead to ventilation-induced lung injury (or patient self-inflicted lung injury) and that clusters of such dyssynchronous events have the highest association with poor outcomes. Dyssynchrony may also be associated with harm indirectly when it reflects over-assistance or over-sedation. However, the occurrence of reverse triggering by means of low inspiratory efforts during passive ventilation may prevent diaphragm dysfunction and atrophy and be beneficial. Most recent evidence on the topic suggests that synchrony between the patient and the mechanical ventilator is a critical element for protecting lung and diaphragm during the time of invasive mechanical ventilation or may reflect inadequate settings or sedation. Therefore, it is a complex situation, and clinical trials are still needed to test the effectiveness of keeping patient-ventilator interaction synchronous on clinical outcomes.

The presence of yeasts and bacteria in free-living amoebae isolated from COVID-19 patients: concern for secondary infections

ABSTRACT This study aimed to investigate the presence of SARS-CoV-2, yeasts, and bacteria in isolated free-living amoeba (FLA) from COVID-19 patients. Nasopharyngeal swabs (n = 60) were obtained from COVID-19 patients. After cultivation, morphological characterization, and RNA/DNA extraction, the presence of selected microorganisms was investigated. From 60 COVID-19 samples, 18 (30%) were positive for FLA. Acanthamoeba sp. Naegleria australiensis, Tetramitus sp. and Vermamoeba vermiformis were characterized in 12 (80%), 1 (6.66%), 2 (13.33%), and 7 (38.88%) of samples, respectively. SARS-CoV-2 RNA was not detected in FLA. Candida albicans, C. tropicalis, and C. parapsilosis were detected in (11/18; 61.11%), (3/18; 16.67%), and (3/18; 16.67%) of samples, respectively. Geotrichum candidum was detected in 10/18 (55.55%) of samples. Streptococcus spp. and Staphylococcus spp. were identified in 16/18 (88.88%) and 3/18 (16.67%), respectively. The presence of yeasts and bacteria signifies the possible role of FLA in distribution of secondary infections in susceptible patients.

Comparison of the Gut Microbiota of Patients Who Improve with Antibiotic Combination Therapy for Ulcerative Colitis and Those Who Do Not: Investigation by Fecal Metagenomic Analyses.

Background/Objectives: The cause of ulcerative colitis (UC) may be related to commensal bacteria in genetically susceptible patients. We previously demonstrated that triple antibiotic combination therapy induces remission in patients with active UC in randomized controlled trials (RCTs). Now, we investigate changes in the gut microbiota of patients who responded to the antibiotic combination therapy. Methods: Thirty-one patients with UC given ATM/AFM (amoxicillin, metronidazole, and tetracycline or fosfomycin) therapy for two weeks were enrolled in this study. The clinical conditions of these UC patients were evaluated by the partial Mayo score. The gut microbiota was compared via the metagenomic shot gun analysis of fecal samples. Results: Of the 31 patients, 16 and 8 experienced complete and partial remission, respectively, over three months in response to ATM/AFM therapy, whereas ATM/AFM showed no efficacy in 7 patients. The dysbiosis before treatment in the active stage could be associated with increased populations of Bacteroides, Parabacteroides, Rickenella, Clostridium, Flavonifractor, Pelagibacter, Bordetella, Massilia, and Piscrickettsia species. Metagenomic analysis revealed dramatic changes in the gut microbiota at an early stage, that is, just two weeks after starting ATM/AFM therapy. After treatment in the responder group, the populations of bifidobacterium and lactobacilli species were significantly increased, while the population of bacteroides decreased. Conclusions: These results suggest that metagenomic analysis demonstrated a marked change in the gut microbiota after antibiotic combination treatment. In the triple antibiotic combination therapy, remission was associated with an increase in bifidobacterium and lactobacilli species.

Prediction of major intravascular hemolysis during pulsed electric field ablation of atrial fibrillation using a pentaspline catheter.

Pulsed electric field (PEF) has emerged as a promising energy source for catheter ablation of atrial fibrillation (AF). However, data regarding the in-vivo effect of PEF energy on erythrocytes during AF ablation procedures are scarce. This study aimed to quantify the impact of PEF energy on erythrocyte damage during AF ablation by assessing specific hemolytic biomarkers. A total of 60 patients (age: 68 years, males: 72%, serum creatinine: 91 µmol/L) with AF underwent catheter ablation of AF using PEF energy delivered by a multipolar pentaspline Farawave catheter (Farapulse, Boston Scientific, Inc.). Ablation beyond pulmonary vein isolation was performed at the operator's discretion. Peripheral venous blood was sampled for assessing the plasma levels of free hemoglobin (fHb), direct (conjugated) bilirubin, lactate dehydrogenase (LDH), and creatinine before, immediately after the ablation, and on the next day. Following the PEF ablation with duration of [median (interquartile range)] 75 (58, 95) min, with 74 (52, 92) applications and PVI only in 27% of patients, fHb, LDH, and direct bilirubin significantly increased, from 40 (18, 65) to 493 (327, 848) mg/L, from 3.1 (2.6, 3.6) to 6.8 (5.0, 7.9) µkat/L, and from 12 (9, 17) to 28 (16, 44) µmol/L, respectively (all p < .0001). A strong linear correlation was found between the peak fHb and the number of PEF applications (R = 0.81, p < .001). The major hemolysis (defined as fHb >500 mg/L) was predicted by the number of PEF applications with the corresponding area under the receiver operating characteristic curve of 0.934. The optimum cut-off value of >74 PEF applications predicted the major hemolysis with 89% sensitivity and 87% specificity. Catheter ablation of AF using PEF energy delivered from a pentaspline catheter is associated with significant intravascular hemolysis. More than 74 PEF applications frequently resulted in major hemolysis. However, the critical amount of PEF energy that may cause kidney injury in susceptible patients remains to be investigated.

Paracetamol-induced hepatotoxicity after normal therapeutic doses in the Hong Kong Chinese population.

Paracetamol is generally safe at normal therapeutic doses of ≤4 g/day in adults. However, paracetamol-induced hepatotoxicity after normal therapeutic doses use has been reported. We investigated the epidemiology of this adverse drug reaction in the Hong Kong Chinese population. This territory-wide retrospective observational study included adult patients with suspected paracetamol-induced hepatotoxicity after normal therapeutic doses use from January 2011 to June 2022. We evaluated the demographic characteristics; paracetamol dose, duration, and reason for use; preexisting hepatotoxicity risk factors; laboratory findings; and their relationship with clinical outcomes. We identified 76 patients (median age: 74 years, 23 males) with suspected paracetamolinduced hepatotoxicity after normal therapeutic doses use. There were 14 cases with significant clinical outcomes (five deaths and nine cases of acute hepatic failure), with an incidence of 1.2 cases per year. For patients with significant clinical outcomes, they were significantly older (age >80 years), had a lower body weight (<50 kg), exposed to longer durations (>2 days) and higher daily doses (>3 g), and with higher proportion of malnutrition. Paracetamol-induced hepatotoxicity can occur at normal therapeutic doses in the Hong Kong Chinese population. The identified risk factors are consistent with international guidelines regarding susceptible patients. Considering the widespread local use of paracetamol and low incidence of severe hepatotoxicity, the current dosage recommendations are considered safe for the general population. For susceptible patients, a reduced maximum dose of ≤3 g/day is recommended, with liver function and serum paracetamol monitoring in place.

6771 New onset Graves’ Disease in a Patient with Hashimoto's Thyroiditis and Positive Thyroid Peroxidase Autoantibodies. Case Report

Abstract Disclosure: M.M. Eid: None. J.L. Zapater: None. Introduction: Hashimoto’s Thyroiditis (HT) and Graves’ Disease (GD) are the most common thyroid autoimmune disorders. Transition of GD to HT is common, but transition of HT to GD is rare. Case: A 55 year old, female with depression, HTN and fibromyalgia. She was referred for evaluation of chronic fatigue and reduction in functional capacity. Five years earlier, she had also been evaluated for fatigue. Labs at that time: TSH 3.80 µIU/ml (0.35-3.74 µIU/ml), free T4 0.8 ng/dl (0.76-1.46 ng/dl), thyroid peroxidase antibody (anti-TPO) 605.6 U/ml (0-60 U/ml), and anti-thyroglobulin antibody (anti-TG) 37.2 U/ml (0-60 U/ml). Subclinical hypothyroidism was diagnosed, but no levothyroxine was initiated. Her TSH was found to be normal in 2019 and 2021. At the current clinical encounter, other than fatigue she denies weight/voice change, tremor, palpitation, anxiety, recent flu like illness or radiation exposure, neck swelling/pain, heat intolerance, or difficulty swallowing. Her daily medications are amlodipine 10mg and duloxetine 20mg. She had menopause 2 years ago. She has no known allergy. She has a brother with rheumatoid arthritis. She denies smoking or alcohol consumption. On exam, vital signs are normal, and BMI is 28.1. There is diffuse, firm thyromegaly without a palpable nodule. There is no cervical lymphadenopathy, tremor, neck tenderness, exophthalmos, or lid lag. Creatinine, liver enzymes are normal but hemoglobin is 9gm/dl. Anti-tissue transglutaminase and anti-gliadin antibodies were negative. Her thyroid labs were: TSH &amp;lt;0.008 uIU/ml, free T4 1.06ng/dl, free T3 4.07 pg/ml (2.3-4.2 pg/ml), total T3 1.74 ng/ml (0.60-1.81 ng/ml), anti-TPO antibody 12,414 U/ml, anti-TG antibody 22 U/ml, thyrotropin receptor antibody (TRAB) 15.24 IU/L (0-1.75 IU/L), and thyroid stimulating immunoglobulin (TSI) 331% (&amp;lt;130%). Thyroid uptake scan showed 49% iodine-131 uptake in symmetric and homogenous uptake, and no hot or cold nodules. GD was diagnosed, methimazole 5mg daily was initiated. Conclusion: Our case had subclinical HT with positive anti-TPO antibodies 5 years preceding the onset of GD. Causes of autoimmune conversion are not well understood. Viral infection or radiation exposure in genetic susceptible patients have been assumed as triggers (1). The blocking and stimulating action of TRAB on TSH receptors is considered as a possible mechanism of switching between hypothyroidism and hyperthyroidism. Clinical and biochemical evaluation for possible conversion to GD in patients with HT is recommended (2).

Antibiotic susceptibility of uropathogens: a 3-year retrospective study at Ho Teaching Hospital of Ghana

BackgroundUrinary tract infection (UTI) remains one of the most treated infections in primary healthcare over the last two decades. The infection is treated with antibiotics. However, there have been reported cases of increasing antibiotic resistance globally, limiting the available antibiotics for the treatment of the infection. The study aimed to determine the frequency of bacterial urinary tract infections and their antibiotic resistance pattern in Ho Teaching Hospital of Ghana from 2019–2021.MethodologyData on urine culture and susceptibility testing and patient demographics from 2019–2021 were collected from the microbiology unit archives with a designed Microsoft Excel 2019 form and later exported to IBM SPSS (v26) for statistical analysis on the uropathogens and their antibiotic resistance pattern. P-value < 0.05 was considered statistically significant.ResultsOut of 4806 records, 1005 bacterial isolates were found, with a total prevalence of 20.91%. The most prevalent group of organisms was the Enterobacteriaceae, with E. coli 409 (40.70%) being the most frequent isolate. Of the 772 isolates subjected to amikacin, 48(6.22%) and 6(0.78%) of the Gram-negative and Gram-positive bacterial organisms showed resistance to the antibiotic respectively. 58.96% (148/251) and 3.59% (9/251) of Gram-negatives and Gram-positives were resistant to cotrimoxazole. Out of the 1005 bacterial isolates, 165(16.42%), 161(16.02%) and 2(0.20%) showed multidrug resistance (MDR), extensively-drug resistance (XDR), and pandrug resistance (PDR) respectively.ConclusionThere was a high antibiotic-resistant pattern among the uropathogens reported in this current study, hence, the Standard Treatment Guidelines may need to be updated to reflect the high rates of antibiotic resistance exhibited by most prevalent isolates.

Inflammatory and genomic interactions within keratoconus susceptible patients: a nationwide registered case–control study

PurposeThis study aimed to investigate the association between variants in the interleukin (IL)-1 gene cluster and susceptibility to keratoconus (KC) in an Iranian population.MethodsIn the case group, there were 188 KC patients diagnosed by clinical findings and corneal tomography. The control group included all 205 healthy controls with no personal or family history of eye-related, metabolic, or immune system-related disease. Using the standard salting out extraction procedure, genomic DNA was isolated from peripheral blood leukocytes. The genotypes were determined by applying agarose gel electrophoresis for the IL-1RN 86 bp VNTR and polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) for rs16944 and rs1143634.ResultsThe results showed a significant association between the IL-1β rs1143634 (rs1143634 T allele, P = 0.008) and IL-1RN 86 bp VNTR polymorphisms (LL and LS genotype, P = 0.048 and 0.012 respectively) and susceptibility to KC in the Iranian population. The genotype distributions of rs1143634 (P = 0.004) and rs2234663 (P = 0.042) significantly differed between case and control groups, with certain genotypes demonstrating a protective effect against KC. Logistic regression analysis revealed a protective effect of the IL-1RN L allele [odds ratio (OR) = 0.367, 95% confidence interval (CI): 0.240–0.562; P = 0.000] and certain haplotypes (OR = 0.628, 95% CI: 0.447–0.884; P = 0.007) against KC. However, no significant association was found for the IL-1β rs16944 polymorphism.ConclusionThis study provides evidence for an association between variants in the IL-1 gene cluster and susceptibility to KC in an Iranian population. Further research on larger and more diverse populations is warranted to validate these findings and explore the underlying mechanisms involved.

Allergies to Allergens from Cats and Dogs: A Review and Update on Sources, Pathogenesis, and Strategies

Inhalation allergies caused by cats and dogs can lead to a range of discomforting symptoms, such as rhinitis and asthma, in humans. With the increasing popularity of and care provided to these companion animals, the allergens they produce pose a growing threat to susceptible patients’ health. Allergens from cats and dogs have emerged as significant risk factors for triggering asthma and allergic rhinitis worldwide; however, there remains a lack of systematic measures aimed at assisting individuals in recognizing and preventing allergies caused by these animals. This review provides comprehensive insights into the classification of cat and dog allergens, along with their pathogenic mechanisms. This study also discusses implementation strategies for prevention and control measures, including physical methods, gene-editing technology, and immunological approaches, as well as potential strategies for enhancing allergen immunotherapy combined with immunoinformatics. Finally, it presents future prospects for the prevention and treatment of human allergies caused by cats and dogs. This review will improve knowledge regarding allergies to cats and dogs while providing insights into potential targets for the development of next-generation treatments.

Targeted therapy evolution from defining a sub-population to crossing multi-indications

Targeted therapy has transformed the landscapes of medical care and pharmaceutical innovation fundamentally, due to selective efficacy on pathological tissues and minimized toxicity to normal cells particularly in oncology. As a necessary tool for implementing targeted therapy, biomarkers of pathogenesis-driven pathways were initially validated to determine the susceptible patient subgroup with a disease. Subsequently such biomarkers were also corroborated in some patients from multiple disease types, conferring a rationale to run drug development in a less risky and more affordable manner through repurpose or tissue-agnostic approval recently. To reflect the evolving trend, this article thus presents an update on the outstanding targeted medications with an extending list of clinical indications in oncology and beyond. It tends not only to shed lights on an emerging classification framework of disease according to the shared molecular pathogenesis across various organs/tissues，but also to inspire more efficient paradigms of pharmaceutic innovation in a broader medical perspective.

Long term follow-up of a completely metal free total knee endoprosthesis in comparison to an identical metal counterpart

Aseptic loosening is a feared and not yet fully-understood complication of total knee arthroplasty (TKA). Hypersensitivity reactions may be the underlying cause within some susceptible patients. Metal-free implants have been developed as a possible solution. The aim of this prospective, observational long-term study was the assessment of a completely metal-free ceramic knee replacement system compared to its identical metal counterpart 8 years after implantation, conducted as a follow-up of a previous report. A total of 88 patients (mean age 69 years) were enrolled in this prospective, observational long-term 8-year follow-up study. The “ceramic group” with a completely metal-free total knee replacement system was compared to the “conventional group” with an identical metal TKA system at the final follow-up. Clinical assessment included Knee Society Score (KSS), Oxford Knee Score (OKS), European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-L), European Quality of Life 5 Dimension Visual Analogue Scale (EQ-VAS) and High Activity Arthroplasty Score (HAAS) as well as perioperative or postoperative complications and need for revision. The tibial/femoral positioning, signs of periprosthetic fissures/fractures or radiolucent lines were documented radiographically. All postoperative clinical scores in the ceramic group primarily improved from baseline to 4-year follow-up, but then decreased at the final 8-year follow-up. At the final follow-up, statistically non-significant differences were found in comparison of both groups for the KSS (ceramic: 166 ± 31, conventional: 162 ± 29; p > 0.05), OKS (ceramic: 37, conventional: 39; p > 0.05), EQ-VAS (ceramic: 77 ± 17, conventional: 72 ± 18; p > 0.05), and HAAS (ceramic: 8.29 ± 3.32, conventional: 9.28 ± 4.44; p > 0.05). A significant difference was found for EQ-5D-L (ceramic: 0.819 ± 0.284, conventional: 0.932 ± 0.126; p ≤ 0.05). Progressive radiolucent lines have been found around the uncemented tibial stem (0.8 mm at initial diagnosis (mean 19 months); 1.3 mm at 4-year follow-up; 1.6 mm at 8-year follow-up) without any clinical signs of loosening. One revision surgery was performed after a traumatic polyethylene inlay-breakage. No allergic reactions could be detected. The used ceramic TKA system meets the functional performance standards of an established identical metal TKA system after an 8-year follow-up period, offering a safe option for patients with prior hypersensitivity reactions to metallic materials. Full cementation of ceramic components is recommended.

Seroprevalence of hepatitis B virus markers of infection and immunity among people living in Libreville, Gabon

ObjectivesIn Gabon, data on hepatitis B virus (HBV) infection are limited to hepatitis B surface antigen (HBsAg) detection among specific populations and rural regions. This is the first study aimed at determining the seroprevalence of HBV markers among the Gabonese population. MethodsA retrospective study was conducted from January 2002 through December 2022. All patients who requested HBV marker screening (HBsAg, anti-HBc, anti-HBs, anti-HBe, hepatitis B e antigen) were included in this study. ResultsA total of 496 people were included in this study. The prevalence of HBV exposure was high (59.5%) and significantly associated with age, sex, pregnancy status, and social status. Among individuals with evidence of HBV exposure, only 89 (33.7%) had effectively cleared the virus. Overall, HBsAg was detected in 108 of the 496 (21.8%) people included in the study. HBsAg infection was more common among individuals in the 16-25 (35.1%) and 26-35-year (30.6%) age groups. Moreover, most of HBsAg-infected patients were health care workers (HCWs) (P = 0.0096). Among the 496 individuals included in this study, 126 (25.4%) were still susceptible to HBV. Most of the susceptible female patients were pregnant (P <0.0001). HCWs had a significantly lower probability of being naïve to HBV infection (P = 0.0001). There was a similar prevalence of susceptibility in male and female patients (50 [24.5%] male and 76 [26.0%] female patients). Only 15.1% of the studied population was vaccinated. ConclusionsOur findings revealed a high seroprevalence of HBV infection in the study area and very low HBV immunization coverage. Additional care and resources should be provided to promote HBV vaccination and block vertical HBV transmission.

Effects of Co-administration of Fentanyl and Nitroglycerin on Hemodynamic Responses During Intubation and Extubation: A Randomized Clinical Trial

PurposeThis study was conducted with the aim of investigating the effects of simultaneous administration of fentanyl and nitroglycerine on hemodynamic responses. DesignThis randomized controlled trial was conducted with 50 patients undergoing elective inguinal hernia surgery. MethodsPatients were randomly divided into two groups. In one group, fentanyl (F) was administered 5 minutes before intubation and extubation. In the other group, in addition to F, sublingual nitroglycerine spray was administered 2 minutes before intubation and extubation. Systolic, diastolic, and mean blood pressure and heart rate were measured before, immediately after, and at 1, 3, and 5 minutes after both procedures. FindingsSystolic, diastolic, and mean blood pressure and heart rate were significantly lower in the group receiving fentanyl and nitroglycerine than in the group receiving fentanyl alone. In both groups, a reduction in hemodynamic variables was observed immediately after both procedures, up to 5 minutes later, but it was significantly reduced in the group receiving simultaneous administration of the two drugs. ConclusionsCo-administration of nitroglycerine and fentanyl significantly weakened the hemodynamic responses and reflexes induced by intubation and extubation during the anesthesia process. Preventing these unwanted complications can lead to safer anesthesia for susceptible patients.

Malignant Hyperthermia.

A narrative expert review aiming to summarize the clinical epidemiology and management of critically ill patients with malignant hyperthermia (MH). Medline searches were conducted to identify relevant articles describing the epidemiology, pathophysiology, and management of MH. Guidelines from key MH organizations were also incorporated into this review. Relevant studies regarding MH in both ICU and perioperative settings were reviewed. Data from relevant studies were summarized and qualitatively assessed. MH is a severe reaction triggered by inhalational volatile anesthetics and succinylcholine in genetically susceptible patients. The condition is characterized by an early onset (min to hr) rise in temperature, hypercarbia, and muscular rigidity following exposure to triggering medications with potential complications of coagulopathy, rhabdomyolysis, and acute kidney injury. Acute management necessitates a coordinated multidisciplinary team approach with specific management using dantrolene, active cooling, and hyperventilation. A suspected MH reaction has important implications for future anesthetic exposure for both the patient and their family. All suspected reactions should be followed up at a specialized MH testing center using muscle contracture and genetic testing. Increasing use of inhalational anesthetics in the ICU underscores the need for enhanced education on the diagnosis and management of MH to ensure optimal patient sedation care and safety.

“When less is more and more is less” red cell alloimmunization in multitransfused patients attending a medical institution with a newly developed blood center in North India: A multifactorial study

Abstract: INTRODUCTION: Multiple blood transfusions with one or more nonself, genetically mismatched donor red blood cells (RBCs) may result in the production of alloantibodies, complicating future transfusions and increasing patient morbidity. This could be averted if adequate prophylactic measures are implemented in the vulnerable group. Due to the paucity of data in our region, we planned this study to identify the alloimmunization pattern in relation to clinical and demographic patient factors. MATERIALS AND METHODS: A prospective observational study was carried out in a newly developed Medical Institution of National importance in Northern India, for 1 year. The red cell antibody screening and identification were done for 770 patients receiving two or more transfusions. The patient and transfusion-related factors were statistically compared between alloimmunized and nonalloimmunized cases. RESULTS: The overall seroprevalence of RBC alloimmunization among the multi-transfused patients was 4.02% (31/770). Thirty-six alloantibodies were identified in the 31 alloimmunized patients, which comprised 13 different alloantibody specificities. Most of them belonged to the Rh system (38.8%), followed by MNS (25%) and Lewis (27.7%) blood group systems. On Multivariate logistic regression analysis, the highest risk was found to be associated with recipients having more than three transfusions with an odds ratio of 8.4. CONCLUSIONS: The highest alloimmunization risk was found in multi-transfused patients receiving more than three transfusions and with female gender. Rh blood group system was found to be predominating the alloantibody specificity pattern. This highlights the need for the provision of extended Rh (DCcEe) matched packed red cells for susceptible patients.

Perioperative Management of Patients with Diabetes and Cancer: Challenges and Opportunities.

Both diabetes and cancer are major global health issues that are among the leading causes of morbidity and mortality. There is a high prevalence of diabetes among cancer patients, many of whom require a surgical procedure. This review focuses on the operative complications in patients with diabetes and cancer, and the perioperative management of diabetes in cancer patients. A literature search of articles in English-published between January 2010 and May 2024-was carried out using the databases PubMed, MEDLINE, Google Scholar, and the Cochrane Database of Systematic Reviews. The search primarily focused on the operative complications in patients with diabetes and cancer, and perioperative management strategies. The relationship between cancer and diabetes is complex; cancer patients have a high risk of developing diabetes, while diabetes is a risk factor for certain cancers. In addition, various cancer therapies can induce or worsen diabetes in susceptible patients. Many individuals with cancer and diabetes require surgery, and due to underlying diabetes, they may have elevated risks for operative complications. Optimal perioperative management for these patients includes managing perioperative glycemia and other comorbid illnesses, adjusting diabetic and cancer treatments, optimizing nutrition, minimizing the duration of fasting, supporting early mobilization, and providing patient education to enable self-management. While evidence is limited, optimal perioperative management for patients with both diabetes and cancer is necessary in order to reduce surgical complications. Future studies are needed to develop evidence-informed perioperative strategies and improve outcomes for these patients.

Green synthesis of zinc oxide nanoparticles and its antibacterial Activity on Pseudomonas aeruginosa

Zinc oxide (ZnO) nanoparticles have wide-ranging applications and can be synthesized using environmentally friendly green synthesis methods as an alternative to conventional approaches. Pseudomonas aeruginosa (P. aeruginosa) is an extremely perilous bacterium known for its multidrug-resistant (MDR) nature, posing a significant threat to hospitalized patients and those with compromised immune systems. The bacterium's ability to withstand multiple antibiotics, combined with its capacity to form biofilms, contributes to its high rates of morbidity and mortality. The intrinsic resistance of P. aeruginosa, along with its ability to form biofilms, further complicates treatment and exacerbates the severity of infections, particularly in susceptible patient populations. Objective: The main objective of this study was to utilize extracts from Ocimum basilicum leaves in a green synthesis approach to produce zinc oxide nanoparticles. Additionally, the research aimed to assess the antibacterial effectiveness of these synthesized nanoparticles against P. aeruginosa. Materials and Methods: In this study, ZnO nanoparticles were synthesized using the leaf extract of O. basilicum plants under various parameters. The biosynthesis of zinc oxide nanoparticles was verified using a UV-visible spectrophotometer and characterized using Scanning Electron Microscopy (SEM), Atomic Force Microscopy (AFM), and Fourier Transform Infrared Spectroscopy (FTIR). The synthesized ZnO nanoparticles exhibited significant antibacterial efficacy. Specifically, they demonstrated antimicrobial activity against P. aeruginosa pathogens. Different concentrations of both O. basilicum extract and synthesized ZnO nanoparticles were tested against P. aeruginosa and observed antibacterial activity. Results: indicated that the ZnO NPs synthesized from O. basilicum exhibited stronger antibacterial activity compared to the plant extract alone. The most effective concentrations were found to be 1.0, 1.5, and 3 mg/ml of prepared ZnO nanoparticles. Increasing the concentration of ZnO nanoparticles resulted in enhanced inhibition of bacterial growth in P. aeruginosa. Conclusion: The green synthesis of ZnO NPs using plant extracts has demonstrated significant antibacterial activity against P.aeruginosa. The high concentration of the ZnO NPs resulted in larger inhibition zones at higher concentrations. These findings underscore the possibility of green-synthesized ZnO NPs as an antimicrobial agent for P. aeruginosa. The environmentally friendly and cost-effective nature of the green synthesis method further enhances its appeal for future applications in antibacterial treatments.