Lost and Found: Misdiagnosis of AIDS-Related Bone Marrow Suppression As Neutropenic Fever and Benign Ethnic Neutropenia in a Patient With Congenital HIV.

Neutropenia is a relatively uncommon but notable secondary effect of HIV infection. While the various hematopoietic effects of HIV and AIDS are well-described in the literature, high-quality evidence directly linking neutropenia with mortality in HIV-infected patients remains limited. The multifactorial etiology of neutropenia complicates its diagnosis, particularly when it occurs secondary to HIV. We present the case of a 35-year-old African American male with congenital HIV, who presented with severe neutropenia accompanied by a fever in the context of untreated HIV. The initial differential diagnosis was broad, including benign ethnic neutropenia (given the patient's African American ethnicity), tuberculosis (given the potential for anti-tuberculosis therapy to cause neutropenia and its commonality as a co-infection in HIV patients), sepsis-related neutropenia, and AIDS-related bone marrow suppression. However, through further workup, it became apparent that HIV-related bone marrow suppression ultimately led to pancytopenia. This case highlights how HIV patient non-adherence to antiretroviral therapy (ART) and hematologic abnormalities complicate the diagnosis of hematopoietic abnormalities from HIV. It also discusses how vertical transmission and abrupt ART discontinuation create a new phenotype of HIV patients with delayed presentations of AIDS-related complications. This patient's presentation also provides insight into the consequences of untreated HIV following the self-discontinuation of long-term HIV management therapy due to low healthcare literacy and loss of follow-up. The patient's clinical course, laboratory findings, imaging studies, and treatment outcomes are discussed, emphasizing the need for timely diagnosis and a multidisciplinary approach to care while exploring potential barriers to care in different social contexts.

Incorporation of Polygonatum cyrtonema extracts of NADES into chitosan/soybean isolate protein films: Impact on sweet cherry storage quality.

This study developed a biodegradable food film, incorporating bioactive components of Polygonatum cyrtonema extracted using natural deep eutectic solvents (NADES) into a matrix of chitosan and soy protein isolate. The films containing varying concentrations (0 %-5 %) of P. cyrtonema extract (PCE) were characterized. The addition of PCE improved the mechanical (+25.9 MPa for tensile strength), optical (+11.29 mm-1 for opacity), and thermal stability (-14.39 % for weight loss) of the films. The DPPH and ABTS radical scavenging rates increased by approximately 1.1 times and 0.5 times, respectively, and malondialdehyde formation reduced by 8 %. The films also effectively inhibited the growth of Staphylococcus aureus or Escherichia coli. The films showed complete biodegradability after 7 days. Using the NADES-PCE coated film reduced the weight loss of sweet cherries by 41.04 % while significantly decreasing the loss of hardness, total phenols, vitamin C, total soluble solids, and titratable acidity, thereby considerably extending the storage life of the sweet cherries. Overall, this study developed a new environmentally friendly packaging material and improved the functionality of the packaging film by leveraging natural plant extracts, demonstrating tremendous potential in the field of food preservation and packaging.

Anastomotic leak occurs independently from microbiota shifts associated with surgical bowel preparation.

Following bowel surgery, infectious complications, including anastomotic leak (AL), remain major sources of morbidity and mortality. Bowel preparation is often administered with the assumption that gut decontamination reduces post-surgical complications. In this study, we tested this hypothesis using a murine model of colon surgery. The mice were fed either regular chow or a high-fat, high-sugar Western diet. The day before surgery, the mice received one of four interventions: water (control), mechanical bowel preparation (MBP), oral antibiotics (OA), or both MBP and OA. We found no differences in the rates of AL among the experimental groups, and diet did not appear to affect the outcomes. Exploratory analyses showed changes in the gut microbiome consistent with the different treatments, but investigations of fecal short-chain fatty acids and RNA sequencing of colonic tissue did not reveal specific effects of the treatments or the presence of AL. However, we did identify bacterial genera that may be causally associated with AL and developed a predictive index from stool samples as a marker for the presence of AL. Future research is needed to identify and validate a microbial predictive tool and to uncover the microbial-driven mechanisms that lead to AL.

A Systematic Review and Meta-Analysis of Catheter Ablation Versus Anti-arrhythmic Drugs for Treatment of Ventricular Arrhythmia.

Catheter ablation (CA) and anti-arrhythmic drugs (AADs) minimize implanted cardioverter-defibrillator (ICD) shocks in individuals with ischemic cardiomyopathy and an ICD, while the best strategy is still unknown. CA has been proposed as a potentially effective means of reducing the occurrence of ICD events in a number of studies; however, there were insufficient relevant dates from randomized controlled trials. A meta-analysis and systematic review of randomized controlled trials were carried out to evaluate the efficacy of CA for the prevention of VA in patients with ischemic heart disease. Cardiovascular mortality, an unscheduled hospitalization due to increasing heart failure, appropriate ICD shock, or serious treatment-related consequences comprised the composite primary outcome. AADs were examined in six trials (n = 1564; follow-up = 15 ± 8 months), while CA was evaluated in four trials (n = 682; follow-up = 12 ± 6 months). Both CA (odds ratio (OR) 0.65, 95% confidence interval (CI) 0.47-0.82, p = 0.001) and AADs (OR 0.76, 95% CI 0.32-0.84, p = 0.034) significantly reduced the number of suitable ICD interventions, with no discernible difference between the two treatment approaches. AADs were observed to reduce incorrect ICD interventions (OR 0.38, p = 0.001), but CA did not. During follow-up, there was no correlation seen between reduced mortality and either CA or AAD. When compared to AAD, CA decreased the composite endpoint of cardiovascular death, adequate ICD shock, heart failure-related hospitalization, or severe treatment-related consequences in ICD patients with ischemic cardiomyopathy and symptomatic VT.

Predictive modeling of hepatitis B viral dynamics: a caputo derivative-based approach using artificial neural networks.

A fractional model for the kinetics of hepatitis B transmission was developed. The hepatitis B virus significantly affects the world's economic and health systems. Acute and chronic carrier phases play a crucial part in the spread of the HBV infection. The Hepatitis B infection can be spread by chronic carriers even though they show no symptoms. In this article, we looked into the Hepatitis B virus's various stages of infection-related transmission and built a nonlinear epidemic. Then, a fractional hepatitis B virus model using a Caputo derivative and vaccine effects is created. First, we determined the proposed model's essential reproductive value and equilibria. With the aid of Fixed Point Theory, a qualitative analysis of the problem's approximative root has been produced. The Adams-Bashforth predictor-corrector scheme is used to aid in the iterative approximate technique's evaluation of the fractional system under consideration that has the Caputo derivative. In the final section, a graphical representation compares various noninteger orders and displays the discovered scheme findings. In this study, we've utilized Artificial Neural Network (ANN) techniques to partition the dataset into three categories: training, testing, and validation. Our analysis delves deep into each category, comprehensively examining the dataset's characteristics and behaviors within these divisions. The study comprehensively analyzes the fractional HBV transmission model, incorporating both mathematical and computational approaches. The findings contribute to a better understanding of the dynamics of HBV infection and can inform the development of effective public health interventions.

Alkali metal cations enhance CO2 reduction by a Co molecular complex in a bipolar membrane electrolyzer.

The electrochemical reduction of CO2 is a promising pathway for converting CO2 into valuable fuels and chemicals. The local environment at the cathode of CO2 electrolyzers plays a key role in determining activity and selectivity, but currently some mechanisms are still under debate. In particular, alkali metal cations have been shown to enhance the selectivity of metal catalysts, but their role remains less explored for molecular catalysts especially in high-current electrolyzers. Here, we investigated the enhancement effects of cations (Na+, K+, Cs+) on Co phthalocyanine (CoPc) in a state-of-the-art reverse-biased bipolar membrane electrolyzer. When added to the anolyte, these cations increased the Faradaic efficiency for CO, except in the case of Na+ in which the effect was transient, but the effects are convoluted with the transport process through the membrane. Alternatively, these cations can also be added directly to the cathode as chloride salts, allowing the use of a pure H2O anolyte feed, leading to sustained improved CO selectivity (61% at 100 mA cm-2 after 24 h). Our results show that cation addition is a simple yet effective strategy for improving the product selectivity of molecular electrocatalysts, opening up new avenues for tuning their local environment for CO2 reduction.This article is part of the discussion meeting issue 'Green carbon for the chemical industry of the future'.

Comparative outcome of ultrasound guided vs. fluoroscopy guided hydrodilatation in adhesive capsulitis: a prospective study.

BACKGROUND: The incidence of adhesive capsulitis varies from 2-5% in the general population to 20% in people with diabetes. One of the most effective treatment methods is hydrodilatation, which can be done under US-guidance or Fluoroscopic guidance. However, the clinical effectiveness of US-guided injections in comparison to fluoroscopy-guided injections is still debatable. The possibility of severe side effects, the expense, and the time required to carry out this minimally invasive procedure highlight how crucial it is for patients to have a precise intra-articular injection. This study aims to compare the effectiveness of Ultrasound-guided vs. Fluoroscopic guided hydrodilatation for patients with adhesive capsulitis. METHODS: Sixty-four patients were randomly selected for hydrodilatation using any one of the techniques. The patients were evaluated for clinical improvements using the visual analog scale (VAS), oxford shoulder score (OSS), and range of motion (ROM). RESULTS: The US-guided group experienced more pain reduction than the fluoroscopy group within the first four weeks (P < 0.001). The increase in ROM was much more significant in the US-guided group for the first 8 weeks. Improvement in Abduction and External rotation was much more significant (P < 0.001) in the first 4 weeks after hydrodilatation in the US-guided group. The improvement in ROM was maintained on long-term follow-up (mean 24 months), with 45 out of 64 (70.3%) reporting a normal or near normal ROM. On assessing the Oxford shoulder score improvements, the US-guided group's score significantly increased after the first week (P = 0.003), but the fluoroscopy-guided group's score increased after the second week. On comparison between the two groups, the amount of score improvement was more significant in the US-guided group than in the fluoroscopy-guided group in the first 4 weeks (P < 0.001). CONCLUSION: US-guided technique for intra-articular injection for patients with adhesive capsulitis provided a quicker pain reduction and a larger improvement in range of motion and overall shoulder functions.

Correlation of APOE polymorphism, expression, and plasma levels with cardiac comorbidities among lipodystrophy in HIV-infected patients.

Lipodystrophy in HIV-infectedpatients(LDHIV) includes morphological and metabolic abnormalities, including lipid and glucose metabolism. ApoE plays a role in the transport and clearance of lipoprotein. In the general population, ApoE 112 (rs429358) and 158 (rs7412) polymorphisms were linked to severe dyslipidemia. Therefore, we investigated ApoE polymorphism using PCR-RFLP in 200 HIV patients (100 with HIV-associated lipodystrophy (HIVLD), 100 without HIVLD), as well as 100 healthy controls. We also assessed ApoE expression using qRT-PCR and measured its level using ELISA. The APOE 4/4, 3/4, and 2/4 genotypes have been associated with a decreased risk of HIV-1 infection. (P=0.0001, OR=0.18; P=0.006, OR=0.87; P=0.006, OR=0.09) when compared between HIV-positive individuals and healthy controls. Conversely, APOE allele 2 was linked to a higher risk of acquiring HIV-1 (P=0.03, OR=3.02). APOE allele 2 was linked to a higher likelihood of HIVLD severity when compared between patients with and without HIVLD(P=0.05, OR=2.82). When comparing patients with HIVLD to healthy controls, the APOE 4/4 and 2/4 genotypes as well as allele 4 were linked with the reduced risk of LDHIV (P=0.0006, OR=0.21; P=0.01, OR=0.18; P=0.0002, OR=0.40). When compared to patients without HIVLD from healthy controls, the APOE 4/4 genotype, 2 and 4 alleles, were linked to a reduced risk of developing HIVLD (P=0.0009, OR=0.14; P=0.0001, OR=0.17; P=0.00001, OR=0.39). When comparing impaired to normal cholesterol levels in patients without HIVLD, the APOE 3/4 genotype was linked with the increased risk of impaired cholesterol levels (P=0.02, OR=3.37). When comparing impaired and normal glucose levels in patients without HIVLD, the APOE 4/4 genotype was associated to an elevated risk of impaired glucose levels (P=0.03, OR=8.27). In multivariate analysis, independent impaired cholesterol, LDL, and glucose levels were associated with a higher risk of lipodystrophy severity (P=0.04, OR=2.33; P=0.001, OR=4.05; P=0.05, OR=2.63). APOE expression was up-regulated in LDHIV with a fold change value of 4.02 compared to those without HIVLD. APOE protein level was found to be higher in patients of the HIVLD group (3.01 mg/dL) compared to those without HIVLD group (2.83 mg/dL). In conclusion, individuals with APOE allele 2 were at higher risk for HIV-1 acquisition and severity of HIVLD, whereas those with APOE allele 4 were at reduced HIVLD severity and development risk. It's possible that APOE's increased level and itsoverexpression are related to the APOE allele 2 in HIVLD patients. The development of LDHIV may be facilitated by the APOE ¾ and 4/4 genotypes as well as abnormalglucose and cholesterol levels.

Proximate Analysis and Techno-Functional Properties of Berberis aristata Root Powder: Implications for Food Industry Applications.

Berberis aristata, commonly known as Indian barberry, has been traditionally used for its medicinal properties. Despite its recognized pharmacological benefits, its potential application in the food industry remains underexplored. This study aims to investigate the proximate analysis and techno-functional properties of Berberis aristata root powder to evaluate its feasibility as a functional food ingredient. The root powder of Berberis aristata was subjected to proximate analysis to determine its moisture, ash, protein, fat, fiber, and carbohydrate content. Techno-functional properties, including water and oil absorption capacity, emulsifying and foaming properties, and bulk density, were evaluated using standardized analytical techniques. The proximate analysis revealed a high fiber content and a significant number of bioactive compounds. The root powder exhibited favorable water and oil absorption capacities, making it suitable for use as a thickening and stabilizing agent. Emulsifying and foaming properties were comparable to conventional food additives, indicating their potential in various food formulations. The findings suggest that Berberis aristata root powder possesses desirable techno-functional properties that could be leveraged in the food industry. Its high fiber content and bioactive compounds offer additional health benefits, making it a promising candidate for functional food applications. Further research on its incorporation into different food matrices and its sensory attributes is recommended to fully establish its utility.

Management of Non-Union Distal Femur Fracture with Augmentation Nail-Plate Construct: A Case Report.

Introduction: Non-union fractures of the distal femur pose significant challenges in orthopedic surgery, often requiring revision procedures to achieve successful bone healing. In cases where the initial implant has failed, innovative solutions are necessary to promote bone union and functional recovery. Case Report: We present a case of a non-union distal femur fracture in a 22-year-old male patient, with a broken implant in situ. The patient had previously undergone internal fixation with a locking plate, which subsequently failed to promote bone healing. The patient was reoperated using a supracondylar nail and augmented with a distal femur locking plate to address the non-union. The combination of the supracondylar nail and distal femur locking plate successfully provided stability to the fracture site, promoting bone union and enabling functional recovery. Radiographic evidence and clinical assessment demonstrated excellent healing progress. Conclusion: This case report highlights the importance of individualized treatment for non-union distal femur fractures, especially when prior implant failure occurs. The combined approach of a supracondylar nail and distal femur locking plate can be a valuable option in addressing complex non-union fractures, achieving stable fixation, and facilitating successful bone healing.

Coumarins as versatile therapeutic phytomolecules: A systematic review.

BACKGROUND: Coumarins, abundantly distributed in a plethora of biologically active compounds, serve as a fundamental motif in numerous natural products, drugs, and therapeutic leads. Despite their small size, they exhibit a diverse range of biological activities, intriguing researchers with their immense pharmacological potential. PURPOSE: This study consolidates the evidence regarding the essential role of coumarins in modern drug discovery, exploring their broad-spectrum pharmaceutical effects, structural versatility, and mechanisms of action across various domains. METHODS: For literature search, we utilized PubMed, Google scholar, and SciFinder databases. Keyword and keyword combinations such as "coumarins", "natural coumarins", "specific natural coumarins for particular diseases", and "therapeutic effects" were employed to retrieve relevant studies. The search encompassed articles published between 2005 and 2023. Selection criteria included studies reporting on the pharmacological activities of natural coumarins against various diseases. RESULTS: The results highlight the therapeutic potential of natural coumarins against various diseases, demonstrating anti-cancer, anti-oxidant, and anti-inflammatory activities. They also act as monoamine oxidase inhibitors and phosphodiesterase inhibitors, and as anti-thrombotic, anti-diabetic, and hepatoprotective agents. They also show efficacy against diabetic nephropathy, neurodegenerative diseases, microbial infections and many other diseases. CONCLUSION: This review underscores the significant role of natural coumarins in medicinal chemistry and drug discovery. Their diverse biological activities and structural versatility make them promising therapeutic agents. This study serves as a catalyst for further research in the field, aiming to address emerging challenges and opportunities in drug development.

Microbial-inoculated biochar for remediation of salt and heavy metal contaminated soils.

Numerous harmful contaminants (i.e. salt and heavy metals) have become major threats to soil and are being introduced into the soil through human and geological activities. These contaminants are raising global concerns about their toxic effects on food safety, human health and reclamation mechanisms. Microbial-inoculated biochar can improve soil environment by immobilizing and transforming contaminants in soil and altering the physico-chemical and biochemical properties of soil. In this review we will discuss the positive effects of microbial-modified biochar on physicochemical properties of contaminated soil. It can decrease the pH, EC while increase CEC, OM and other biochemical properties of soil. Additionally, we discuss the efficacy of biochar as a microbial carrier for salt and heavy metals-contaminated soil and plant growth in those soils. This review provides a better understanding of the potential of microbial biochar can be used for bioremediation of contaminated soil, which will help the researcher to modify biochar in a targeted way for specific applications.

Innovative Bedaquiline-Based Delivery Systems for Multidrug-Resistant Tuberculosis Treatment.

The increasing incidence of multidrug-resistant tuberculosis (MDR-TB) is one of the most challenging tasks in tuberculosis treatment. Conventional TB treatment regimens have proven ineffective in treating MDR-TB, thus demanding the development of new drugs followed by delivery systems. Bedaquiline, a novel anti-TB drug, has been reported to inhibit the ATP synthase required for the growth and replication of TB bacteria. Bedaquiline is able to target the persistent or latent form of TB, which remains difficult to treat with conventional drugs. This makes bedaquiline an important drug in the fight against MDR-TB. The drug has been approved by the US FDA as well as European Medicines Agency and is now widely used as part of combination therapy for the treatment of MDR-TB. Bedaquiline and its ad-vanced drug delivery system play a key role in tackling MDR-TB, providing a much-needed boost to control and eventually eliminate the disease. However, the cost of the drug remains a concern, and efforts are underway to make bedaquiline more accessible and affordable to patients in resource-limited settings. Nevertheless, the development of bedaquiline nanofor-mulations represents a significant step forward in the fight against TB and offers hope to millions of patients across the globe.

Engineered Amine-Functionalized Metal-Organic Framework to Fabricate a Composite for Next-Generation Asymmetric Supercapacitors with Ultrahigh Performance: Modulating the Energy Storage Barrier.

The present work summarizes the fabrication of an amine-functionalized cadmium-based metal-organic framework (MOF), {[Cd(AT)(BP)]·4DMF}n or Cd_AT-BP, by adopting a simple solvothermal approach using 2-aminoterephthalic acid (AT) as the main linker, while 4,4'-bipyridyl (BP) as an auxiliary linker. The structure of Cd_AT-BP was validated by the single-crystal X-ray diffraction technique that revealed the formation of an overall three-dimensional network with BP acting as a bridge between the 2D sheets of the MOF. The robust framework of Cd_AT-BP decorated with a free amine functional group was utilized for energy storage application. The electrochemical measurements of Cd_AT-BP revealed a maximum areal capacitance of 9.8 mF/cm2 at a scan rate of 5 mV/s. Further, to enhance the practical utility of Cd_AT-BP in energy storage devices, two composites of Cd_AT-BP with reduced graphene oxide (rGO) and multiwalled carbon nanotubes (CNTs), viz., Cd_AT-BP/rGO and Cd_AT-BP/CNT, were prepared by adopting a facile ultrasonication approach. The synthesized Cd_AT-BP/rGO and Cd_AT-BP/CNT composites displayed an impressive areal capacitance of 117 and 37 mF/cm2 (58.5 and 17.5 F/g) at a scan rate of 5 mV/s, respectively, and a capacitance retention of up to 118 and 100% after 5000 cycles at a constant current density of 5 mA/cm2. The highest energy density of about 4.23 mW h/cm2 (2.12 W h/kg) at a current density of 1 mA/cm2 was shown by Cd_AT-BP/rGO among all the three materials attributable to the layered structure of rGO, providing a larger surface area accessible for ion adsorption. Enticed by the remarkable outcomes exhibited by Cd_AT-BP/rGO, we fabricated a two-electrode asymmetric supercapacitor (ASC) device. The developed ASC device revealed energy and power densities of 26.7 mW h/cm2 (13.4 W h/kg) and 3760 mW/cm2 (1880 W/kg), respectively, with a galvanostatic charge-discharge stability of up to 10,000 cycles. The findings identify Cd_AT-BP/rGO as a potential contender for future-generation supercapacitors.

Inhibitory action of antimicrobial peptides against the formation of carcinogenic and mutagenic heterocyclic amines in meat.

Thermal processing of meat leads to the development of Maillard's reaction intermediates, and carcinogenic toxicants. For the first time, the effectiveness of three (HX-12A, HX-12B and HX-12C) antimicrobial peptides (AMPs) against the formation of heterocyclic amines (HAs) in chemical and meat model systems. The results showed that AMPs especially 12A and 12C have strong metal chelation potential (48 and 40% at 1 mg/ml) and antioxidant activity (35 and 25% at 1 mg/ml), respectively, which were endorsed by their secondary structure (FTIR analysis) in terms of high ß-sheets (1628 cm-1 and 1672 cm-1) in those AMPs. UPLC-MS analysis revealed that 12A and 12C were the most capable AMPs in MeIQx and PhIP-producing chemical models, respectively, whereas 12B promoted the HAs formation even higher than control. In particular, 12C AMP significantly (P < 0.05) decreased the most abundant carcinogenic HAs (PhIP) up to 90% at 9 mg/100 g of fresh meat, whereas 12A inhibited up to 80% of mutagenic HAs at same level compared to control and 12B. Low Field Nuclear Magnetic Resonance (LF-NMR) test showed that inhibitory effect of 12A and 12C was mediated by means of retaining water (lower T22 and T23 relaxation time) inside the macromolecules. This favorable effect was also evidenced by significantly enhanced tryptophan fluorescent intensity. Finally, based on correlation and principle component analysis, the mechanism of action has been proposed. These outcomes recommend that 12A and 12C are potential AMPs for the attenuation of HAs in thermally processed meat-based products.

Bioactivity and application potential of O/W emulsions derived from carboxylic acid-based NADES-extracted total saponins from Polygonatum cyrtonema Hua.

This study focuses on evaluating new methods for the green extraction of saponin compounds from Polygonatum cyrtonema Hua (PCH). This study utilized a combination of carboxylic acid-based natural deep eutectic solvents (NADES) and various extraction techniques including conventional heat reflux-, ultrasound-, and microwave-assisted extraction. The primary objectives were to assess total saponin yield, antioxidant capacity, and enzyme inhibition efficiency. Additionally, the solvents and extracts were evaluated for their antibacterial activity. Oil-in-water (O/W) emulsions of NADES extracts were also characterized and analyzed for stability. Results indicated that three NADES systems were effective in extracting saponins, with choline chloride and lactic acid (ChCl-LA) system being the most efficient. The ChCl:LA extract exhibited antimicrobial and antioxidant activities superior to conventional organic solvent extracts. Additionally, it demonstrated maximum inhibitory activity (IC50 values: 0.98 ± 0.03 and 1.46 ± 0.07 mg/mL, respectively) against α-glucosidase and α-amylase. The NADES extract as an aqueous phase significantly improved the stationarity of the O/W emulsion. Collectively, the study highlights the antimicrobial and technological advantages of NADES as a potential solvent for extracting saponin compounds from PCH.

Prescribing Trend of Antibiotics Among the Patients Admitted in Intensive Medical Care Unit: A Prospective Observational Study.

BACKGROUND: Intensive medical care units (IMCUs) usually admit patients who are in critical medical need and require the utmost attention of healthcare professionals, along with the best treatment options available. These patients are prone to infections and require various antibiotics for the treatment. Varying costs of antibiotics, variable dosage forms, and antibiotic resistance cause an economic burden on patients Methodology: This study was designed and conducted prospectively to evaluate the prescribing pattern of antibiotics at the IMCU in a tertiary care hospital. A total of 102 patients were included in the study based on the exclusion and inclusion criteria, and the collected data was tabulated in an Excel sheet and analyzed using Prism GraphPad software. Data were presented as numbers and percentages. RESULTS: Most of the patients were in the age group of 41-50 years. The number of male patients was slightly more than that of female patients. The majority of the patients admitted to the IMCU had acute pulmonary edema and cerebrovascular accidents. Most antibiotics were prescribed empirically and administered parenterally, of which Amoxicillin + Potassium clavulanate was the most commonly used antibiotic. Tigecycline had the highest daily defined dose per 100 bed days value, and injection Sulbactam + Cefoperazone was the costliest of all antibiotic therapy. CONCLUSION: Antibiotic therapy used in the IMCU consisting of Sulbactam + Cefoperazone was found to be costlier, and Amoxicillin + Potassium clavulanate were the commonly prescribed antibiotics among the other prescribed antibiotics. The average cost of antibiotics was found to be higher, which increased the economic healthcare burden for patients and their families.

Computational screening of chemical constituents derived from berry fruits as allosteric caspace-3/-7 inhibitors.

With the aim of finding the plant-derived allosteric inhibitors of caspase-3/-7, we conducted computational investigations of bioactive compounds present in various berry fruits. In a molecular docking study, perulactone demonstrated excellent binding affinity scores of -12.1 kcal/mol and -9.1 kcal/mol for caspase 7 and 3, respectively, whereas FDA-approved allosteric inhibitors (DICA and FICA) were found to show lower docking scores (-5.6 and -6.1 kcal/mol) against caspase 7 while (-5.0 and -5.1 kcal/mol) for caspase 3, respectively. MD simulations were used to validate the binding stability of perulactone in the active sites of caspase-7/-3, and the results showed outstanding stability with lower ligand RMSDs of 1.270-3.088 Å and 2.426-9.850 Å against the targeted receptor. Furthermore, we performed MMGBSA free binding energy, where the perulactone values of ΔG Bind were determined to be -63.98 kcal/mol and -66.32 kcal/mol for both receptors (3IBF and 1NME), which are significantly better than the -45.16 kcal/mol and -39.51 kcal/mol for DICA as well as -26.37 kcal/mol and -15.50 kcal/mol for FICA, respectively. The drug resemblance of perulactone was effectively evaluated by ADMET. Thus, our findings indicated that perulactone could be an orally administered therapeutic candidate for regulating apoptosis in a variety of disorders. However, there may be an urgent need to study using in vitro and in vivo experiments. Supplementary Information: The online version contains supplementary material available at 10.1007/s13205-024-04067-7.

Prevalence of nephropathy among diabetic patients in North American region: A systematic review and meta-analysis.

BACKGROUND: Nephropathy is one of the most common microvascular impediments of diabetes mellitus. In this study, we aimed to estimate the prevalence of nephropathy in diabetic patients across the North American region. METHODS: Eligible studies were screened out from 3 electronic databases, for example, PubMed, Google Scholar, and ScienceDirect using specific search keywords based on the eligibility criteria. Extracting the data from the included studies publication bias, quality assessment, outlier investigation, and meta-analysis was done followed by the subgroup analysis. A total of 11 studies met the study inclusion criteria. Meta-analysis was performed with the extracted data. RESULTS: Pooled prevalence of 28.2% (95% confidence interval [CI]: 19.7-36.7) with a high rate of heterogeneity (I2 = 100%) was identified. The pooled prevalence of nephropathy among diabetic patients in the United States of America, Canada, and Mexico was 24.2% (95% CI: 13.8-34.5), 31.2% (95% CI: 25.8-36.5), and 31.1% (95% CI: 20.8-41.5), respectively. CONCLUSION: The prevalence of nephropathy among diabetic patients was found lower in the United States of America as compared to Canada and Mexico. Besides, the pooled prevalence of the North American region was found to be lower as compared to the African, European, and Asian regions. Minimizing the pathogenic factors, sufficient diagnostic, healthcare facilities, and awareness are recommended to improve the situation.

Antibiotic Resistance Profiles of Extended-Spectrum ß-Lactamase (ESBL)- and Metallo-ß-Lactamase (MBL)-Producing Klebsiella pneumoniae Isolates From Diabetic Foot Ulcers: Implications for Treatment Strategies.

Background Diabetic foot ulcers (DFUs) are prevalent complications of diabetes mellitus, often leading to severe infections and adverse clinical outcomes. Klebsiella pneumoniae, a gram-negative bacterium, has emerged as a significant causative agent in DFU infections, raising concerns due to its increasing antibiotic resistance, particularly in extended-spectrum ß-lactamase (ESBL) and metallo-ß-lactamase (MBL) production. Aim This study aimed to comprehensively assess the prevalence, antibiotic resistance profiles, and clinical correlates of ESBL- and MBL-producing K. pneumoniae isolates specifically derived from DFUs. Methods A cross-sectional observational study was conducted at Krishna Vishwa Vidyapeeth from January 2023 to June 2023, involving 126 patients diagnosed with DFUs. Clinical and demographic data were collected, and wound swabs underwent microbiological analysis. Phenotypic detection methods were employed to identify ESBL and MBL production, followed by standardized antibiotic susceptibility testing. Results Among the 126 isolates tested, 36 (28.6%) were identified as ESBL-producing and 21 (16.7%) as MBL-producing strains. ESBL-producing isolates exhibited high resistance rates to antibiotics such as ampicillin (92.3%), amoxicillin-acid (84.6%), and cephalosporins, including ceftriaxone (76.9%), and cefepime (73.8%). MBL-producing isolates demonstrated even broader resistance profiles, including resistance to fluoroquinolones (ciprofloxacin, 60.0%; levofloxacin, 57.1%), aminoglycosides (gentamicin, 42.9%), and carbapenems (meropenem, 38.1%; imipenem, 35.7%). Conclusion This study identifies a significant prevalence of ESBL- and MBL-producing K. pneumoniae in DFUs, showcasing high antibiotic resistance rates. Comorbidities correlate significantly with the presence of resistant isolates, necessitating treatment strategies for effective management.