Design of a targeted blood transcriptional panel for monitoring immunological changes accompanying pregnancy.

Background: Immunomodulatory processes exert steering functions throughout pregnancy. Detecting diversions from this physiologic immune clock may help identify pregnant women at risk for pregnancy-associated complications. We present results from a data-driven selection process to develop a targeted panel of mRNAs that may prove effective in detecting pregnancies diverting from the norm. Methods: Based on a de novo dataset from a resource-constrained setting and a dataset from a resource-rich area readily available in the public domain, whole blood gene expression profiles of uneventful pregnancies were captured at multiple time points during pregnancy. BloodGen3, a fixed blood transcriptional module repertoire, was employed to analyze and visualize gene expression patterns in the two datasets. Differentially expressed genes were identified by comparing their abundance to non-pregnant postpartum controls. The selection process for a targeted gene panel considered (i) transcript abundance in whole blood; (ii) degree of correlation with the BloodGen3 module; and (iii) pregnancy biology. Results: We identified 176 transcripts that were complemented with eight housekeeping genes. Changes in transcript abundance were seen in the early stages of pregnancy and similar patterns were observed in both datasets. Functional gene annotation suggested significant changes in the lymphoid, prostaglandin and inflammation-associated compartments, when compared to the postpartum controls. Conclusion: The gene panel presented here holds promise for the development of predictive, targeted, transcriptional profiling assays. Such assays might become useful for monitoring of pregnant women, specifically to detect potential adverse events early. Prospective validation of this targeted assay, in-depth investigation of functional annotations of differentially expressed genes, and assessment of common pregnancy-associated complications with the aim to identify these early in pregnancy to improve pregnancy outcomes are the next steps.

Phloretin: a comprehensive review of its potential against diabetes and associated complications.

OBJECTIVES: Phloretin is ubiquitous in apples (Malus domestica) and other fruits and has potential antidiabetic properties. Considering the preclinical potential of phloretin, its transition to clinical observations has unintentionally been neglected, particularly within the diabetic population. Furthermore, a comprehensive understanding of its pharmacokinetics remains elusive. This review seeks to offer valuable insights into phloretin's physical properties, pharmacokinetics, and pharmacodynamics, aiming to unveil opportunities for additional research on its therapeutic potential in the context of diabetes. KEY FINDINGS: All pharmacokinetic reports of phloretin confirm that the utilization of phloretin gets enhanced during diabetic conditions. Phloretin targets pathomechanisms such as glucose transporter 4 (GLUT4) and peroxisome proliferator's activity-activated receptor-γ (PPAR-γ) to decrease insulin resistance in diabetic conditions. Moreover, phloretin targets inflammatory, oxidative, and apoptotic signaling to minimize the progression of diabetes-associated macro- and microvascular complications. SUMMARY: The pleiotropic antidiabetic action of phloretin is mainly dependent on its pharmacokinetics. Nevertheless, further investigation into the altered pharmacokinetics of phloretin during diabetic conditions is essential. Additionally, the results derived from clinical studies utilized apples, apple extract, and supplements containing phloretin. Greater emphasis should be placed on future clinical studies to assess the potential of phloretin as a standalone compound.

Mac-2-Binding Protein Glycosylation Isomer to Albumin Ratio Predicts Bacterial Infections in Cirrhotic Patients.

INTRODUCTION: Mac-2-binding protein glycosylation isomer (M2BPGi) is a novel biomarker for liver fibrosis, but little is known about its role in cirrhosis-associated clinical outcomes. This study aimed to investigate the predictive role of M2BPGi in cirrhosis-associated complications. METHODS: One hundred and forty-nine cirrhotic patients were retrospectively enrolled. Patients were followed up for 1 year, and cirrhosis-associated clinical events were recorded. Receiver operating characteristic curve (ROC) analysis was used to establish the values of the predictive models for cirrhotic outcomes, and Cox proportional hazards regression models were used to identify predictors of clinical outcomes. RESULTS: Sixty (40.3%) patients experienced cirrhosis-associated clinical events and had higher M2BPGi levels compared to those without events (8.7 vs. 5.1 cutoff index, p < 0.001). The most common cirrhosis-associated complications were bacterial infections (24.2%). On ROC analysis, M2BPGi to albumin ratio (M2BPGi/albumin) had comparable discriminant abilities for all cirrhosis-associated events (area under the ROC curve [AUC] = 0.74) compared with M2BPGi, Child-Pugh, model for end-stage liver disease, albumin-bilirubin scores, and neutrophil-to-lymphocyte ratio and was superior to M2BPGi alone for all bacterial infectious events (AUC = 0.80). Cox regression analysis revealed that the M2BPGi/albumin, but not M2BPGi alone, independently predicted all cirrhosis-associated events (hazard ratio [HR] = 1.34, p = 0.038) and all bacterial infectious events (HR = 1.51, p = 0.011) within 1 year. However, M2BPGi/albumin did not predict other cirrhotic complications and transplant-free survival. DISCUSSION/CONCLUSION: M2BPGi/albumin might serve as a potential prognostic indicator for patients with cirrhosis, particularly for predicting bacterial infections.

Incontinence during and following hospitalisation: a prospective study of prevalence, incidence and association with clinical outcomes.

BACKGROUND: Incontinence is common in hospitalised older adults but few studies report new incidence during or following hospitalisation. OBJECTIVE: To describe prevalence and incidence of incontinence in older inpatients and associations with clinical outcomes. DESIGN: Secondary analysis of prospectively collected data from consecutive consenting inpatients age 65 years and older on medical and surgical wards in four Australian public hospitals. METHODS: Participants self-reported urinary and faecal incontinence 2 weeks prior to admission, at hospital discharge and 30 days after discharge as part of comprehensive assessment by a trained research assistant. Outcomes were length of stay, facility discharge, 30-day readmission and 6-month mortality. RESULTS: Analysis included 970 participants (mean age 76.7 years, 48.9% female). Urinary and/or faecal incontinence was self-reported in 310/970 (32.0%, [95% confidence interval (CI) 29.0-35.0]) participants 2 weeks before admission, 201/834 (24.1% [95% CI 21.2-27.2]) at discharge and 193/776 (24.9% [95% CI 21.9-28.1]) 30 days after discharge. Continence patterns were dynamic within the peri-hospital period. Of participants without pre-hospital incontinence, 74/567 (13.1% [95% CI 10.4-16.1) reported incontinence at discharge and 85/537 (15.8% [95% CI 12.8-19.2]) reported incontinence at 30 days follow-up. Median hospital stay was longer in participants with pre-hospital incontinence (7 vs. 6 days, P = 0.02) even in adjusted analyses and pre-hospital incontinence was significantly associated with mortality in unadjusted but not adjusted analyses. CONCLUSION: Pre-hospital, hospital-acquired and new post-hospital incontinence are common in older inpatients. Better understanding of incontinence patterns may help target interventions to reduce this complication.

Therapeutic Effects of Curcumin Derivatives against Obesity and Associated Metabolic Complications: A Review of In Vitro and In Vivo Studies.

Obesity is a major cause of morbidity and mortality globally, increasing the risk for chronic diseases. Thus, the need to identify more effective anti-obesity agents has spurred significant interest in the health-promoting properties of natural compounds. Of these, curcumin, the most abundant and bioactive constituent of turmeric, possesses a variety of health benefits including anti-obesity effects. However, despite its anti-obesity potential, curcumin has demonstrated poor bioavailability, which limits its clinical applicability. Synthesizing curcumin derivatives, which are structurally modified analogs of curcumin, has been postulated to improve bioavailability while maintaining therapeutic efficacy. This review summarizes in vitro and in vivo studies that assessed the effects of curcumin derivatives against obesity and its associated metabolic complications. We identified eight synthetic curcumin derivatives that were shown to ameliorate obesity and metabolic dysfunction in diet-induced obese animal models, while five of these derivatives also attenuated obesity and associated metabolic complications in cell culture models. These curcumin derivatives modulated adipogenesis, lipid metabolism, insulin resistance, steatosis, lipotoxicity, inflammation, oxidative stress, endoplasmic reticulum stress, apoptosis, autophagy, fibrosis, and dyslipidemia to a greater extent than curcumin. In conclusion, the findings from this review show that compared to curcumin, synthetic curcumin derivatives present potential candidates for further development as therapeutic agents to modulate obesity and obesity-associated metabolic complications.

Association of triglyceride glucose index and triglyceride HDL ratio with glucose levels, microvascular and macrovascular complications in Diabetes Mellitus Type-2.

Objective: To find out the role of triglyceride glucose index (TGI) and triglyceride HDL ratio (THR) as predictors of insulin resistance and control of glucose status in type two diabetes mellitus (T2DM). Method: This cross-sectional study was conducted in Dr. Akbar Niazi Teaching Hospital, January-April 2022. A total of 56 individuals, both males and females aged 30-75 years having T2DM with fasting blood glucose ≥ 110 mg/dl and HbA1c ≥ 5.7% were included. Biochemical markers were estimated by applying standard methods. Independent sample t-test, Fisher exact test, and linear regression were applied. Results: TGI and triglyceride HDL ratio were significantly raised (p=0.01) in patients with poor glycemic control as compared to controlled glucose levels (17.8 ± 4.7vs7.3 ± 1.75) and (3.84 ± 1.3vs2.12 ± 0.64) respectively. These two indices have a significant association (p=0.01) with HbA1c (r=0.963, r=0.757), fasting blood glucose (r=0.964, r=0.748), and HOMA-IR (r=0.955, r=0.718) respectively. Moreover, TGI and THR were found to have a more significant association with the development of cardiovascular disease (CVD) (r=0.717, r=0.555) and a significant but weak association with nephropathy (r=0.385, r=0.302) respectively. Regression analysis revealed that both TGI and THR have significant predictive ability for HbA1c, fasting blood glucose, HOMA-IR and CVD (delta R2=0.738vs 0.408, 0.740vs0.395, 0.725vs0.362, 0.354vs0.170) respectively, after controlling all confounding variables. Conclusions: TGI and THR have a strong association and predictive capability to identify insulin resistance and detect the development and progression of T2DM. Moreover, TGI can be more precisely used for prediction analysis as compared to THR.

Thrombosis Development After mRNA COVID-19 Vaccine Administration: A Case Series.

The coronavirus disease 2019 (COVID-19) pandemic remains one of the largest global health crises of the last century. Fortunately, COVID-19 vaccines have proven to be one of the most promising options in halting the progression of the pandemic. As more and more people receive COVID-19 vaccines, the medical community has learned a great deal about their efficacy and the occurrence of very rare adverse effects. While the number of thromboembolic events post-adenoviral vaccines has been well-documented in the medical literature, there has been limited information regarding thrombosis development after receiving a messenger RNA (mRNA)-based vaccine. This case series highlights four different patients who received an mRNA-based COVID-19 vaccine and subsequently developed venous thromboembolism. Therefore, we hope that after reviewing this article, physicians will be more aware of thrombosis-related developments following mRNA vaccine administration for COVID-19. Fortunately, with early diagnosis and prompt treatment, patients can still expect full recovery from any vaccine thrombosis-associated complications, and the benefits of receiving an mRNA-based COVID-19 vaccine still outweigh the risks of post-vaccination complications.

Association between ventilator-associated events and implementation of acute respiratory distress syndrome (ARDS) ventilator weaning protocol.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a severe and life-threatening condition that can occur in critically ill patients. Mechanical ventilation is a commonly used intervention with ARDS patients, but weaning patients off the ventilator can be challenging. An ARDSnet-like ventilator weaning protocol was implemented with the goal of reducing triggers for ventilator-associated events (VAEs). METHODS: The implementation of the new protocol was used to complete a retrospective investigation of patient outcomes for 1,233 ventilator periods. Periods were included between April and December 2022 for any ventilated patient lasting at least 4 days. National Health Care Safety Network VAE criteria were used to surveille the patient data. Triggers were based on the positive end-expiratory pressure increases or fraction of inspired oxygen (FiO2) increases. The preset weaning criteria was a reduction by 2 cmH2O per 24 hours. RESULTS: Of the total 1,233 individual ventilator periods, VAE criteria were met in 10%. Of the total 126 periods with VAE, 39.2% met the criteria for appropriate protocol implementation. There was a statistically significant relationship between VAE identification and implementation of the protocol. CONCLUSIONS: The implementation of a protocol for ventilator weaning affects the outcome of developing a VAE. The findings emphasize the importance of implementing the ARDS weaning protocol as a template to reduce the triggers for VAEs and improve overall patient outcomes.

Intrinsic capacity in acutely hospitalized older adults.

OBJECTIVES: We aimed to examine the association between intrinsic capacity (IC) and adverse outcomes of hospitalization. DESIGN: A prospective observational cohort study. SETTING AND PARTICIPANTS: We recruited patients aged 65 years or older who were admitted to the geriatric ward of an acute hospital between Oct 2019 and Sep 2022. MEASUREMENTS: Each of the five IC domains (locomotion, cognition, vitality, sensory, and psychological capacity) was graded into three levels, and the composite IC score was calculated (0, lowest; 10, highest). Hospital-related outcomes were defined as in-hospital death, hospital-associated complications (HACs), length of hospital stay, and frequency of discharge to home. RESULTS: In total, 296 individuals (mean age 84.7 ± 5.4 years, 42.7 % males) were analyzed. Mean composite IC score was 6.5 ± 1.8, and 95.6 % of participants had impairment in at least one IC domain. A higher composite IC score was independently associated with lower frequency of in-hospital death (odds ratio [OR] 0.59) and HACs (OR 0.71), higher frequency of discharge to home (OR 1.50), and shorter length of hospital stay (ß = -0.24, p < 0.01). The locomotion, cognition, and psychological domains were independently associated with the occurrence of HACs, discharge destination, and length of hospital stay. CONCLUSION: Evaluating IC was feasible in the hospital setting and was associated with outcomes of hospitalization. For older inpatients with decreased IC, integrated management may be required to achieve functional independence.

Predicting respiratory decompensation in mechanically ventilated adult ICU patients.

Introduction: Mechanical ventilation is a life-saving treatment in the Intensive Care Unit (ICU), but often causes patients to be at risk of further respiratory complication. We created a statistical model utilizing electronic health record and physiologic vitals data to predict the Center for Disease Control and Prevention (CDC) defined Ventilator Associated Complications (VACs). Further, we evaluated the effect of data temporal resolution and feature generation method choice on the accuracy of such a constructed model. Methods: We constructed a random forest model to predict occurrence of VACs using health records and chart events from adult patients in the Medical Information Mart for Intensive Care III (MIMIC-III) database. We trained the machine learning models on two patient populations of 1921 and 464 based on low and high frequency data availability. Model features were generated using both basic statistical summaries and tsfresh, a python library that generates a large number of derived time-series features. Classification to determine whether a patient will experience VAC one hour after 35 h of ventilation was performed using a random forest classifier. Two different sample spaces conditioned on five varying feature extraction techniques were evaluated to identify the most optimal selection of features resulting in the best VAC discrimination. Each dataset was assessed using K-folds cross-validation (k = 10), giving average area under the receiver operating characteristic curves (AUROCs) and accuracies. Results: After feature selection, hyperparameter tuning, and feature extraction, the best performing model used automatically generated features on high frequency data and achieved an average AUROC of 0.83 ± 0.11 and an average accuracy of 0.69 ± 0.10. Discussion: Results show the potential viability of predicting VACs using machine learning, and indicate that higher-resolution data and the larger feature set generated by tsfresh yield better AUROCs compared to lower-resolution data and manual statistical features.

The study of double-J stent free mode of flexible ureteroscopy and laser lithotripsy: a single centre experience.

OBJECTIVE: To evaluate the effectiveness and safety of flexible ureteroscopy in the treatment of kidney and upper ureteral calculi under double-J stent free mode. METHODS: Data from patients who underwent flexible ureteroscopy and laser lithotripsy between February 2018 and September 2021 were retrospectively and analysed. Cases were grouped according to pre- or postoperative use of the double-J stent (6 Fr): Post-F group (preoperative double-J stent but no postoperative double-J stent); Pre-F group (no preoperative stenting but with postoperative double-J stent); and Routine group (preoperative and postoperative double-J stenting). RESULTS: A total of 554 patients (390 male and 164 female) were included. The mean operation time was similar between the three groups, with no statistically significant difference. Incidence of grade 0-1 ureteral injury was significantly higher in the Pre-F group versus other groups, but there were no significant between-group differences in other operation-related complications. During follow-up, stent-associated complications were observed in the Pre-F and Routine groups, but not in the Post-F group. Stone clearance rates were similar between all groups at 1, 3 and 6 months following surgery. CONCLUSIONS: Flexible ureteroscopy using double-J stent free mode was found to be safe, feasible and effective in treating renal and upper ureteral calculi.

Fractura de astrágalo asociado a fractura del cuboides en un niño de 9 años: reporte de caso / Talar fracture associated with cuboid fracture in a 9-year-old boy: case report / Fratura do tálus associada à fratura do cubóide em menino de 9 anos: relato de caso

Introducción: El astrágalo tiene una anatomía única y juega un papel fundamental en la función del tobillo y pie. Las fracturas de astrágalo se consideran una urgencia ortopédica especialmente las fracturas de cuello desplazadas, debido al alto riesgo de necrosis avascular. Sin embargo, estas son raras en los niños con una prevalencia estimada del 0,008% de todas las fracturas pediátricas. Las fracturas del cuello del astrágalo se asocian con una alta tasa de complicaciones, entre las más importantes se destacan la artrosis postraumática y la necrosis avascular. Éstas están relacionadas principalmente con el grado de desplazamiento inicial del cuello del astrágalo y la incidencia puede ser del 100%. Objetivos: Los objetivos del presente trabajo son demostrar la evolución de un paciente con una patología poco frecuente, con una asociación lesional no reportada hasta el momento y realizar una revisión bibliográfica del tema. Material y métodos: Se evaluó de forma retrospectiva un paciente de sexo masculino de 9 años con una luxo-fractura de cuello de astrágalo de pie izquierdo asociado a una fractura de cuboides. Se evaluaron los resultados clínicos radiológicos y funcionales luego de 3 años de evolución. Resultados: En nuestro caso se realizó reducción abierta y fijación percutánea. Se logró una excelente consolidación ósea sin complicaciones y con buena funcionalidad del tobillo luego de 3 años de seguimiento. Se realizó la escala AOFAS obteniendo una puntuación de 93/100. No presentó limitaciones en cuanto al dolor, con un total de 40 puntos, no mostró limitaciones en cuanto a la función, con un total de 45 puntos. Observamos una leve desaxación en valgo del retropie, asintomático, con un total de 8 puntos. Conclusiones: Las fracturas del astrágalo son raras en la población pediátrica pero pueden ocasionar complicaciones graves. En nuestro caso observamos una fractura grave, con una asociación lesional no descrita hasta el momento, que presentó muy buena evolución, con una consolidación ósea, sin complicaciones y con buen resultado funcional a los 3 años de la cirugía. Al tratarse de una patología muy poco frecuente y rara, la bibliografía revisada es en general de baja evidencia científica y se basa en su mayoría en reporte de casos clínicos, excepto una revisión sistemática con bajo numero de pacientes.

Introduction: The talus has a unique anatomy and plays a fundamental role in the function of the ankle and foot. Talar fractures are considered an orthopedic emergency, especially displaced neck fractures, due to the high risk of avascular necrosis. However, these are rare in children with an estimated prevalence of 0.008% of all pediatric fractures. Talar neck fractures are associated with a high rate of complications, the most important of which include post-traumatic osteoarthritis and avascular necrosis. These are mainly related to the degree of initial displacement of the talar neck and the incidence can be 100%. Objectives: The objectives of this work are to demonstrate the evolution of a patient with a rare pathology, with an injury association not reported so far and to carry out a bibliographic review of the topic. Material and methods: A 9-year-old male patient with a talar neck fracture dislocation of the left foot associated with a cuboid fracture was retrospectively evaluated. Clinical, radiological and functional results were evaluated after 3 years of evolution. Results: In our case, open reduction and percutaneous fixation were performed. Excellent bone union was achieved without complications and with good ankle functionality after 3 years of follow-up. The AOFAS scale was performed, obtaining a score of 93/100. It did not present limitations in terms of pain, with a total of 40 points, it did not show limitations in terms of function, with a total of 45 points. We observed a slight valgus dexation of the hindfoot, asymptomatic, with a total of 8 points. Conclusions: Talar fractures are rare in the pediatric population but can cause serious complications. In our case we observed a serious fracture, with an injury association not described until now, which presented a very good evolution, with bone consolidation, without complications and with good functional result 3 years after surgery. As it is a very infrequent and rare pathology, the literature reviewed is generally of low scientific evidence and is based mostly on clinical case reports, except for a systematic review with a low number of patients.

Introdução: O tálus possui anatomia única e desempenha papel fundamental na função do tornozelo e do pé. As fraturas do tálus são consideradas uma emergência ortopédica, principalmente as fraturas deslocadas do colo, devido ao alto risco de necrose avascular. No entanto, estas são raras em crianças, com uma prevalência estimada de 0,008% de todas as fraturas pediátricas. As fraturas do colo do tálus estão associadas a uma alta taxa de complicações, sendo as mais importantes a osteoartrite pós-traumática e a necrose avascular. Estas estão relacionadas principalmente ao grau de deslocamento inicial do colo do tálus e a incidência pode ser de 100%. Objetivos: Os objetivos deste trabalho são demonstrar a evolução de um paciente com patologia rara, com associação de lesão até o momento não relatada e realizar uma revisão bibliográfica sobre o tema. Material e métodos: Foi avaliado retrospectivamente um paciente do sexo masculino, 9 anos de idade, com fratura luxação do colo do tálus do pé esquerdo associada a fratura do cuboide. Os resultados clínicos, radiológicos e funcionais foram avaliados após 3 anos de evolução. Resultados: No nosso caso foi realizada redução aberta e fixação percutânea. Excelente consolidação óssea foi alcançada sem complicações e com boa funcionalidade do tornozelo após 3 anos de acompanhamento. Foi realizada a escala AOFAS, obtendo pontuação de 93/100. Não apresentou limitações em termos de dor, com um total de 40 pontos, não apresentou limitações em termos de função, com um total de 45 pontos. Observamos leve dexação em valgo do retropé, assintomática, com total de 8 pontos. Conclusões: As fraturas do tálus são raras na população pediátrica, mas podem causar complicações graves. No nosso caso observamos uma fratura grave, com associação de lesão até então não descrita, que apresentou evolução muito boa, com consolidação óssea, sem complicações e com bom resultado funcional 3 anos após a cirurgia. Por se tratar de uma patologia muito pouco frequente e rara, a literatura revista é geralmente de baixa evidência científica e baseia-se maioritariamente em relatos de casos clínicos, exceto uma revisão sistemática com um número reduzido de doentes.

Effects of green tea polyphenol extract and epigallocatechin-3-O-gallate on diabetes mellitus and diabetic complications: Recent advances.

Diabetes mellitus is one of the major non-communicable diseases accounting for millions of death annually and increasing economic burden. Hyperglycemic condition in diabetes creates oxidative stress that plays a pivotal role in developing diabetes complications affecting multiple organs such as the heart, liver, kidney, retina, and brain. Green tea from the plant Camellia sinensis is a common beverage popular in many countries for its health benefits. Green tea extract (GTE) is rich in many biologically active compounds, e.g., epigallocatechin-3-O-gallate (EGCG), which acts as a potent antioxidant. Recently, several lines of evidence have shown the promising results of GTE and EGCG for diabetes management. Here, we have critically reviewed the effects of GTE and EGCC on diabetes in animal models and clinical studies. The concerns and challenges regarding the clinical use of GTE and EGCG against diabetes are also briefly discussed. Numerous beneficial effects of green tea and its catechins, particularly EGCG, make this natural product an attractive pharmacological agent that can be further developed to treat diabetes and its complications.

COVID-19 Vaccine-Induced Acute Perimyocarditis: A Case Report.

Perimyocarditis is the inflammation of the pericardium along with the myocardium. Presentation is similar to acute pericarditis, but it is associated with myocardial damage, leading to an elevation in serum troponin and a left ventricular dysfunction (manifested as an ejection fraction of less than 55 percent). Perimyocarditis is mostly managed like acute myocarditis. Etiology is generally idiopathic and likely secondary to viral infections. Cases of vaccine-associated myocarditis have been infrequently reported in past, most recently with the COVID-19 mRNA vaccine. We present a rare case of a young healthy adolescent male who developed perimyocarditis after the first booster dose of the COVID-19 mRNA vaccine.

Parenteral Nutrition Overview.

Parenteral nutrition (PN) is a life-saving intervention for patients where oral or enteral nutrition (EN) cannot be achieved or is not acceptable. The essential components of PN are carbohydrates, lipids, amino acids, vitamins, trace elements, electrolytes and water. PN should be provided via a central line because of its hypertonicity. However, peripheral PN (with lower nutrient content and larger volume) can be administered via an appropriate non-central line. There are alternatives for the compounding process also, including hospital pharmacy compounded bags and commercial multichamber bags. PN is a costly therapy and has been associated with complications. Metabolic complications related to macro and micronutrient disturbances, such as hyperglycemia, hypertriglyceridemia, and electrolyte imbalance, may occur at any time during PN therapy, as well as infectious complications, mostly related to venous access. Long-term complications, such as hepatobiliary and bone disease are associated with longer PN therapy and home-PN. To prevent and mitigate potential complications, the optimal monitoring and early management of imbalances is required. PN should be prescribed for malnourished patients or high-risk patients with malnutrition where the feasibility of full EN is in question. Several factors should be considered when providing PN, including timing of initiation, clinical status, and risk of complications.

The Outcomes of Robotic Rehabilitation Assisted Devices Following Spinal Cord Injury and the Prevention of Secondary Associated Complications.

Spinal cord injuries (SCIs) have major consequences on the patient's health and life. Voluntary muscle paralysis caused by spinal cord damage affects the patient's independence. Following SCI, an irreversible motor and sensory deficit occurs (spasticity, muscle paralysis, atrophy, pain, gait disorders, pain). This pathology has implications on the whole organism: on the osteoarticular, muscular, cardiovascular, respiratory, gastrointestinal, genito-urinary, skin, metabolic disorders, and neuro-psychic systems. The rehabilitation process for a subject having SCIs can be considered complex, since the pathophysiological mechanism and biochemical modifications occurring at the level of spinal cord are not yet fully elucidated. This review aims at evaluating the impact of robotic-assisted rehabilitation in subjects who have suffered SCI, both in terms of regaining mobility as a major dysfunction in patients with SCI, but also in terms of improving overall fitness and cardiovascular function, respiratory function, as well as the gastrointestinal system, bone density and finally the psychosocial issues, based on multiple clinical trials, and pilot studies. The researched literature in the topic revealed that in order to increase the chances of neuro-motor recovery and to obtain satisfactory results, the combination of robotic therapy, a complex recovery treatment and specific medication is one of the best decisions. Furthermore, the use of these exoskeletons facilitates better/greater autonomy for patients, as well as optimal social integration.

Circular RNAs in diabetes mellitus and its complications.

Diabetes mellitus (DM) is an endocrine disorder characterized by a relative or absolute lack of insulin due to the dysfunction or destruction of ß-cells. DM is one of the fastest growing challenges to global health in the 21st century and places a tremendous burden on affected individuals and their families and countries. Although insulin and antidiabetic drugs have been used to treat DM, a radical cure for the disease is unavailable. The pathogenesis of DM remains unclear. Emerging roles of circular RNAs (circRNAs) in DM have become a subject of global research. CircRNAs have been verified to participate in the onset and progression of DM, implying their potential roles as novel biomarkers and treatment tools. In the present review, we briefly introduce the characteristics of circRNAs. Next, we focus on specific roles of circRNAs in type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes mellitus and diabetes-associated complications.

Antimycobacterial prophylaxis regarding Bacillus Calmette-Guérin -associated complications in children with primary immunodeficiency.

OBJECTIVE: Bacillus Calmette-Guérin (BCG) vaccine derived from Mycobacterium bovis can cause BCG vaccine associated complications (BCG-VAC) especially in patients with primary immunodeficiencies (PID). No consensus exists for antimycobacterial prophylactic therapy for patients with PID who receive the BCG vaccine. AIM: This study aimed to define the risk factors in the development of BCG-VAC and effect of antimycobacterial prophylaxis in PID patients vaccinated with BCG. METHODS: This is a retrospective cohort study. 104 patients diagnosed with PID who received the BCG vaccination were referred to pediatric pulmonology in a single center were enrolled. The demographic characteristics, type, dosage and duration of antimycobacterial prophylaxis regimen, treatment modalities for BCG-VAC were documented. Regression analysis was performed to evaluate the effect of covariates for predicting BCG-VAC in patients with PIDs. RESULTS: Among 104 patients 21 (21.2%) developed BCG-VAC. The frequency of BCG-VAC was highest in patients with Mendelian susceptibility to mycobacterial disease (46.2%) followed by patients with severe combined immunodeficiency (22.4%) and those with chronic granulomatous disease (9.5%). Prophylactic therapy against mycobacterium was initiated for 72 patients (69.2%). Among patients who received the antimycobacterial prophylaxis, BCG-VAC developed in only four patients (5.6%), whereas 17 patients (53.1%) developed BCG-VAC in the non-prophylaxis group and this difference was statistically significant (p < 0.001). Multivariable regression analysis with age at diagnosis, type of PID, receiving antimycobacterial prophylaxis, median T cell number at the time of PID diagnosis and HSCT status showed that not receiving antimycobacterial prophylaxis and lower median T cell number were predictors, with antimycobacterial prophylaxis having the highest odds ratio for BCG-VAC prediction in patients with PIDs (p:<0.001, R2:0.64). CONCLUSION: The lower frequency of BCG-VAC in our cohort can be explained by two main reasons; relatively late BCG vaccination schedule and receiving antimycobacterial prophylaxis. It is reasonable to begin antimycobacterial prophylaxis in patients with PIDs who are susceptible to BCG-VAC.

Septic and Crystal-Induced Arthritis (Pseudogout) Post-COVID-19 Vaccination.

Severe acute respiratory syndrome coronavirus 2 infection has been a global public health crisis for the past two years. Vaccination has been a mainstay preventive approach among other strategies such as hand washing, social distancing, and wearing facemasks. Here, we present a case of concomitant calcium pyrophosphate deposition disease flare and septic arthritis of the right knee following coronavirus disease 2019 (COVID-19) booster vaccination in a 69-year-old African American male who presented with a painful swollen right knee with associated fever, chills, and rigors three days post-vaccination. Right knee synovial fluid aspirate appeared turbid with elevated white cell count, positive for both intra and extracellular calcium pyrophosphate crystals, and positive for beta-hemolytic Streptococcus group C. The swollen joint improved with right knee arthroscopic irrigation and intravenous antibiotics on admission. The patient subsequently completed a total of six weeks of antibiotics with clinical improvement and normalization of inflammatory markers. No reported incidence of gout or pseudogout post-COVID-19 vaccination has been reported despite reported cases of gout flares with other vaccines. Improper aseptic vaccination technique has been implicated as a possible cause of septic arthritis post-vaccination. Healthcare providers must discuss such adverse events with their patients prior to vaccine administration.