Subacute stroke: new-onset poststroke bladder and bowel dysfunctions and possible associated factors.

PURPOSE: Bladder and bowel poststroke dysfunctions negatively impact patients' health. Stroke-related characteristics associated to these dysfunctions are poorly known. This study aims to estimate the prevalence of new-onset poststroke bladder and bowel dysfunctions, characterize their associated factors, and describe the dysfunctions' clinical approach. MATERIALS AND METHODS: Cross-sectional study including 157 patients admitted to a single hospital's stroke unit with a first-ever stroke, during 3 months. An 18-item questionnaire was applied to assess dysfunctions pre and poststroke. The McNemar test was used to compare pre and poststroke prevalence. A logistic regression was used to estimate associations (OR, 95% CI) between individual characteristics and new-onset dysfunctions. RESULTS: We had 113 (72%) respondents. There was a significant increase in the prevalence of bladder and bowel dysfunctions poststroke (p < 0.001). Higher stroke severity was significantly associated with both new-onset poststroke bladder and bowel dysfunctions (OR = 15.00, 95% CI [4.92,45.76] and OR = 5.87,95%CI [2.14,16.12], respectively). Total anterior circulation strokes, cardioembolic strokes, and lower functionality at discharge were also significantly associated with both dysfunctions. Thirteen patients (11.5%) reported that health professionals addressed these dysfunctions. CONCLUSIONS: Poststroke bladder and bowel dysfunctions are highly prevalent. Being aware of their epidemiology helps draw attention to patients at higher risk of developing these dysfunctions, enhancing the rehabilitation process.IMPLICATIONS FOR REHABILITATIONPoststroke bladder and bowel dysfunctions are highly prevalent and under-recognised consequences of stroke.Being aware of their epidemiology and associated factors may help identify patients at higher risk of developing these dysfunctions.It is necessary to raise clinical awareness to ensure a more efficient diagnostic and therapeutic approach, enhancing patients' rehabilitation process, quality of life and lowering collateral societal burden.

Impact of pulmonary valve replacement on ventricular function and cardiac events in patients with tetralogy of Fallot. A retrospective cohort study.

INTRODUCTION AND OBJECTIVES: Our aim was to assess the impact of prosthetic pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF) on changes in biventricular volumes and function and on adverse cardiac events. METHODS: Adults with rTOF were identified from the SACHER-registry. Data from serial cardiac magnetic resonance imaging, echocardiography, exercise capacity and n-terminal pro b-type natriuretic peptide (NT-proBNP) were collected. The primary endpoint was right ventricular ejection fraction (RVEF) as measured by cardiac magnetic resonance. Secondary endpoints were biventricular volumes, left ventricular ejection fraction, exercise capacity and NT-proBNP levels, and time to adverse cardiac outcomes (atrial and ventricular arrhythmia, endocarditis). Associations between previous PVR and longitudinal changes in functional outcomes and time to adverse cardiac outcomes were analyzed using linear mixed-effects models and Cox proportional hazards models, respectively. RESULTS: A total of 308 patients (153 with and 155 without PVR) with 887 study visits were analyzed. Previous PVR was not significantly associated with changes in RVEF (CE, -1.33; 95%CI, -5.87 to 3.21; P=.566). Previous PVR was associated with lower right ventricular end-diastolic volume but had no significant effect on left ventricular ejection fraction, exercise capacity, or NT-proBNP-levels. Previous PVR was associated with an increased hazard of atrial arrhythmias (HR, 2.09; 95%CI, 1.17-3.72; P=.012) and infective endocarditis (HR, 12.72; 95%CI, 4.69-34.49; P<.0001) but not with an increased hazard of sustained ventricular arrhythmias (HR, 0.64; 95%CI, 0.18-2.27; P=.490). CONCLUSIONS: Previous PVR was not significantly associated with changes in RVEF but was associated with an increased risk of atrial arrhythmias and infective endocarditis.

Some new insights into the biological activities of carboxymethylated polysaccharides from Lasiodiplodia theobromae.

BACKGROUND: Carboxymethylated Lasiodiplodan (LaEPS-C), Lasiodiplodia theobromae ß-glucan exopolysaccharide derivative, has a well-known range of biological activities. Compared to LaEPS-C, its fractions, Linear (LLaEPS-C) and Branched (BLaEPS-C), have biological potentialities scarcely described in the literature. So, in this study, we investigate the immunomodulatory, antiviral, antiproliferative, and anticoagulant activities of LLaEPS-C and BLaEPS-C and compare them to the LaEPS-C. METHODS: LaEPS was obtained from L. theobromae MMBJ. After carboxymethylation, LaEPS-C structural characteristics were confirmed by Elementary Composition Analysis by Energy Dispersive X-Ray Detector (EDS), Fourier Transform Infrared (FTIR), and Nuclear Magnetic Resonance (NMR). The immunomodulatory activity on cytokine secretion was evaluated in human monocyte-derived macrophage cultures. The antiviral activity was evaluated by Hep-2 cell viability in the presence or absence of hRSV (human respiratory syncytial virus). In vitro antiproliferative activity was tested by sulforhodamine B assay. The anticoagulant activity was determined by APTT (Activated Partial Thromboplastin Time) and PT (Prothrombin Time). RESULTS: LaEPS-C showed low macrophage cell viability only at 100 µg/mL (52.84 ± 24.06, 48 h), and LLaEPS-C presented no effect. Conversely, BLaEPS-C showed cytotoxicity from 25 to 100 µg/mL (44.36 ± 20.16, 40.64 ± 25.55, 33.87 ± 25.16; 48 h). LaEPS-C and LLaEPS-C showed anti-inflammatory activity. LaEPS-C presented this at 100 µg/mL (36.75 ± 5.53, 48 h) for IL-10, and LLaEPS-C reduces TNF-α cytokine productions at 100 µg/mL (18.27 ± 5.80, 48 h). LLaEPS-C showed an anti-hRSV activity (0.7 µg/ml) plus a low cytotoxic activity for Hep-2 cells (1.4 µg/ml). LaEPS-C presented an antiproliferative activity for NCI-ADR/RES (GI50 65.3 µg/mL). A better PT was achieved for LLaEPS-C at 5.0 µg/mL (11.85 ± 0.87s). CONCLUSIONS: These findings demonstrated that carboxymethylation effectively improves the biological potential of the LaEPS-C and their fractions. From those polysaccharides tested, LLaEPS provided the best results with low toxicity for anti-inflammatory, antiviral, and anticoagulant activities.

Demographics, clinical findings and diagnoses of cranial thoracic myelopathies (T1-T6 vertebrae) in cats.

OBJECTIVES: The aim of the study was to describe the patient demographics, clinicopathological features and presumptive or final diagnoses in cats with myelopathies between the T1 and T6 vertebrae. METHODS: This retrospective multicentre case study enrolled cases between 2015 and 2022 that were diagnosed with myelopathies between the T1 and T6 vertebrae as the primary cause for the presenting clinical signs. RESULTS: A total of 21 cases matched the inclusion criteria, 13 males (11 castrated and 2 entire) and 8 spayed females (median age 93 months; range 5-192). Most of the cases presented with a chronic and progressive history (76% and 86%, respectively), with a median duration of 29 days (range 1-2880). At the time of presentation, 90% of the cases were localised to the T3-L3 spinal cord segments based on neurological examination. The most common underlying pathology was neoplasia (42.9%), followed by inflammatory (24%), anomalous (19%), degenerative (9.5%) and vascular (4.8%) disorders. The most common location was T3-T4 (29%), followed by T2-T3 and T5-T6 (19% each). The cutaneous trunci reflex was normal in 86% of the cases and most of the cases (71%) did not show spinal discomfort upon admission. CONCLUSIONS AND RELEVANCE: Neoplasia was the most common cause of cranial thoracic myelopathy in this study. The lack of pathognomonic clinical signs for this specific region highlights the importance of assessing the entire thoracolumbar region up to and including at least the T1 vertebra when investigating cases with signs consistent with a T3-L3 myelopathy.

Trends in Antibiotic Resistance Patterns and Burden of Escherichia Coli Infections in Young Children: A Retrospective Cross-Sectional Study in Shenzhen, China from 2014-2018.

Purpose: The emergence of multi-drug resistant ESBL-producing E. coli poses a global health problem. In this study, we aimed to investigate the prevalence of E. coli infections and their antibiotic susceptibility profiles in paediatric clinical cases in Shenzhen, China from Jan 1, 2014, to Jan 30, 2019, while also determining temporal trends, identifying ESBL-producing strains, and recommending potential empirical antibiotic therapy options. Methods: We isolated a total of 4148 E. coli from different specimens from a single paediatric healthcare centre. Additionally, we obtained relevant demographic data from the hospital's electronic health records. Subsequently, we performed antimicrobial susceptibility testing for 8 classes of antibiotics and assessed ESBL production. Results: Out of the 4148 isolates, 2645 were from males. The highest burden of E. coli was observed in the age group of 0-1 years, which gradually declined over the five-year study period. Antimicrobial susceptibility results indicated that 82% of E. coli isolates were highly resistant to ampicillin, followed by 52.36% resistant to cefazolin and 47.46% resistant to trimethoprim/sulfamethoxazole. Notably, a high prevalence of ESBL production (49.54%) was observed among the E. coli isolates, with 60% of them displaying a multi-drug resistance phenotype. However, it is worth mentioning that a majority of the isolates remained susceptible to ertapenem and imipenem. Our findings also highlighted a decrease in E. coli infections in Shenzhen, primarily among hospitalized patients in the 0-1 year age group. However, this decline was accompanied by a considerably high rate of ESBL production and increasing resistance to multiple antibiotics. Conclusion: Our study underscores the urgent need for effective strategies to combat multi-drug resistant ESBL-producing E. coli Infections.

Análise comparativa de classificação do risco nutricional entre a Mini Avaliação Nutricional Reduzida e a NutritionalRisk Screening 2002 em pacientes hospitalizados com insuficiência cardíaca / Comparative analysis of nutritional risk classification between the MiniNutritional Assessment-Short Form and the Nutritional Risk Screening 2002in hospitalized patients with heart failure

Introdução: A triagem nutricional é responsável pela prévia seleção e encaminhamento do paciente em RiscoNutricional (RN) para avaliações mais sensíveis. A NutritionalRisk Screening-2002 (NRS-2002) foi confiável em detectar apresença ou o risco de desenvolver desnutrição em um estudo recente. A Mini Nutritional Assessment-Short Form(MNA-SF) é voltada para idosos, mas atualmente é amplamente utilizada entre demais adultos, e demonstrou se correlacionar fortemente com a MNA completa.Objetivos: verificar se a aplicação da MNA-SF reclassificará os pacientes internados com resultados semelhantes àNRS-2002 e analisar as concordâncias e discordâncias entreas triagens, considerando a classificação do risco nutricional,ingestão alimentar e perda de peso.Metodologia: estudo transversal realizado com pacientesrecém internados com insuficiência cardíaca, onde a NRS-2002 e a MNA-SF foram aplicadas no mesmo momento, nasprimeiras 72 horas. As avaliações contínuas dos escores NRS2002 e MNA-SF foram apresentadas com a sua relação linear,e descrita por coeficientes de correlação de Pearson. A concordância entre os métodos foi apresentada com intervalos deconfiança de 95% e coeficiente de Kappa.Resultados: foram incluídos 148 pacientes, com média deidade de 63,1 ± 14,0 anos, onde 28 eram desnutridos, 62 eu-tróficos e 38 estavam em sobrepeso ou obesidade segundoIMC. A NRS-2002 classificou 4 pacientes a mais em RN que aMNA-SF (136 vs. 132), porém, apresentaram concordânciafraca (kappa=0,21). Ingestão alimentar e perda de pesoapresentaram discordância significativa. A correlação dePearson foi de -0,44.Conclusão: A NRS-2002 classificou 4 pacientes a mais emRN, onde o IMC e a insuficiência cardíaca foram cruciais paraclassificar os pacientes dessa maneira. Apesar da semelhança,nossa pesquisa apresentou concordância fraca em relação aoRN, condizendo com a literatura. Ingestão alimentar e perdade peso discordaram siginitivamente entre as triagens.(AU)

Introducción: El cribado nutricional es responsable de laselección precoz y derivación de pacientes en riesgo nutricional (RN) para evaluaciones más sensibles. El Nutrition RiskScreening-2002 (NRS-2002) demostró ser fiable para detectar la presencia o el riesgo de desarrollar malnutrición en unestudio reciente. La Mini Nutritional Assessment-Short Form(MNA-SF) está pensada para personas mayores, pero ahorase utiliza ampliamente entre otros adultos, y ha mostrado unafuerte correlación con la MNA completa. Objetivos: comprobar si la aplicación del MNA-SF reclasifica a los pacientes hospitalizados con resultados similares alos del NRS-2002 y analizar las concordancias y discordanciasentre los cribados, considerando la clasificación de riesgo nu-tricional, la ingesta de alimentos y la pérdida de peso. Metodología: estudio transversal realizado con pacientesrecién hospitalizados con insuficiencia cardiaca, donde se lesaplicó el NRS-2002 y el MNA-SF al mismo tiempo, en las primeras 72 horas. Las evaluaciones continuas de las puntuaciones de NRS 2002 y MNA-SF se presentaron con su relaciónlineal y se describieron mediante los coeficientes de correlación de Pearson. La concordancia entre métodos se mostrócon intervalos de confianza del 95% y coeficiente Kappa.Resultados: se incluyeron 148 pacientes, con una edadmedia de 63,1 ± 14,0 años, donde 28 estaban desnutridos,62 eutróficos y 38 con sobrepeso u obesidad según IMC. ElNRS-2002 clasificó a 4 pacientes más como RN que el MNA-SF (136 vs. 132), sin embargo, presentaron mala concordancia (kappa=0,21). La ingesta de alimentos y la pérdida depeso mostraron un desacuerdo significativo. La correlación dePearson fue de -0,44. Conclusión: La NRS-2002 clasificó a 4 pacientes más enRN, donde el IMC y la insuficiencia cardiaca fueron crucialespara clasificar a los pacientes de esta forma. A pesar de la similitud, nuestra investigación mostró una pobre concordanciarespecto al RN, consistente con la literatura...(AU)

Abstract: Nutritional screening is responsible for the earlyselection and referral of patients at nutritional risk (NR) formore sensitive assessments. The Nutrition Risk Screening-2002 (NRS-2002) was reliable in detecting the presence orrisk of developing malnutrition in a recent study. The MiniNutritional Assessment-Short Form (MNA-SF) is intended forthe elderly, but currently is widely used among other adults,and has been shown strongly correlation with the full MNA.Objectives: assess whether the application of the MNA-SFreclassifies inpatients with similar results to those of the NRS-2002 and analyze the concordances and disagreements between the screenings, considering the classification of nutritional risk, dietary intake and weight loss Methodology: crosssectional study carried out withnewly hospitalized patients with heart failure, where the NRS-2002 and the MNA-SF were applied at the same time, in thefirst 72 hours. Continuous assessments of NRS 2002 andMNA-SF scores were presented with their linear relationship,and described by Pearson’s correlation coefficients.Agreement between methods was shown with 95% confidence intervals and Kappa coefficient.Results: 148 patients were included, with a mean age of63.1 ± 14.0 years, where 28 were malnourished, 62 eutrophicand 38 were overweight or obese according to BMI. The NRS-2002 classified 4 more patients as NR than the MNA-SF (136vs. 132), however, they presented poor agreement(kappa=0.21). Food intake and weight loss showed signifi-cant disagreement. Pearson’s correlation was -0.44.Conclusion: The NRS-2002 classified 4 more patients intoNR, where BMI and heart failure were crucial for classifyingpatients this way. Despite the similarity, our investigationshowed poor agreement regarding NR, consistent with the literature. Dietary intake and weight loss disagreed significantlybetween the screenings.(AU)

Resistance genomics and molecular epidemiology of high-risk clones of ESBL-producing Pseudomonas aeruginosa in young children.

Introduction: The emergence of multidrug-resistant Pseudomonas aeruginosa poses a global threat, but the distribution and resistance profiling are unclear, especially in young children. Infections due to P. aeruginosa are common, associated with high mortality, and increasingly ß-lactam drug resistant. Methods: We studied the molecular epidemiology and antibiotic resistance mechanisms in 294 clinicalisolates of P. aeruginosa from a pediatric hospital in China. Non-duplicate isolates were recovered from clinical cases and were identified using an API-20 kit followed by antimicrobial susceptibility testing using the VITEK®2 compact system (BioMerieux, France) and also by broth dilution method. In addition, a double-disc synergy test for the ESBL/E-test for MBL was performed. The presence of beta-lactamases, plasmid types, and sequence types was determined by PCR and sequencing. Results: Fifty-six percent (n = 164) of the isolates were resistant to piperacillin-tazobactam, followed by cefepime (40%; n = 117), ceftazidime (39%; n = 115), imipenem (36%; n = 106), meropenem (33%; n = 97), and ciprofloxacin (32%; n = 94). Forty-two percent (n = 126) of the isolates were positive for ESBL according to the double-disc synergy test. The blaCTX-M-15 cephalosporinase was observed in 32% (n = 40/126), while 26% (n = 33/126) werepositive for blaNDM-1 carbapenemase. Aminoglycoside resistance gene aac(3)IIIawas observed in 16% (n = 20/126), and glycylcyclines resistance gene tet(A) was observed in 12% (n = 15/126) of the isolates. A total of 23 sequence types were detected, including ST1963 (12%; n = 16), followed by ST381 (11%; n = 14), ST234 (10%; n = 13), ST145 (58%; n = 10), ST304 (57%; n = 9), ST663 (5%; n = 7), and a novel strain. In ESBL-producing P. aeruginosa, 12 different Incompatibility groups (Inc) were observed, the most common being IncFI, IncFIS, and IncA/C. The MOBP was the most common plasmid type, followed by MOBH, MOBF, and MOBQ. Discussion: Our data suggest that the spread of antibiotic resistance is likely due toclonal spread and dissemination of different clinical strains of P. aeruginosa harbouring different plasmids. This is a growing threat in hospitals particularly in young children which needs robust prevention strategies.

Thoracic to lumbar vertebral column length and length ratios in miniature dachshunds with and without thoracolumbar intervertebral disc extrusion.

BACKGROUND: The chondrodystrophic body type predisposes miniature dachshunds to thoracolumbar intervertebral disc extrusion (IVDE). However, the relationship between thoracolumbar IVDE and the relative lengths of the thoracic and lumbar vertebral columns has not yet been evaluated. METHODS: This prospective multicentre study included 151 miniature dachshunds with (n = 47) and without (n = 104) thoracolumbar IVDE. All dogs had their thoracic and lumbar vertebral columns measured with a tape measure. Detailed descriptions were provided to facilitate consistent measurement. A thoracic to lumbar vertebral column ratio was calculated. Thoracolumbar IVDE was confirmed by magnetic resonance imaging or computed tomography. RESULTS: The thoracic to lumbar vertebral column length ratio and absolute thoracic vertebral column length were significantly smaller in miniature dachshunds with IVDE than in those without IVDE (p < 0.0001 for both). There were no significant differences in lumbar vertebral column length, age, sex or neuter status between the two groups. LIMITATIONS: The dogs without IVDE did not undergo a neurological examination and the thoracic and lumbar vertebral column measurements were not validated. CONCLUSIONS: The relative lengths of the thoracic and lumbar vertebral column segments could contribute to the development of thoracolumbar IVDE in miniature dachshunds. Further studies are needed to evaluate ideal thoracic to lumbar vertebral column length ratios in miniature dachshunds.

Análise comparativa de classificação do risco nutricional entre a mini avaliação nutricional reduzida e a nutritional risk screening 2002 em pacientes hospitalizados com insuficiência cardíaca / Comparative analysis of nutritional risk classification between the mini nutritional assessment-short form and the nutritional risk screening 2002 in hospitalized patients with heart failure

INTRODUÇÃO: A triagem nutricional é responsável pela prévia seleção e encaminhamento do paciente em Risco Nutricional (RN) para avaliações mais sensíveis. A Nutritional Risk Screening-2002 (NRS-2002) foi confiável em detectar a presença ou o risco de desenvolver desnutrição em um estudo recente. A Mini Nutritional Assessment-Short Form (MNA-SF) é voltada para idosos, mas atualmente é amplamente utilizada entre demais adultos, e demonstrou se correlacionar fortemente com a MNA completa. OBJETIVOS: verificar se a aplicação da MNA-SF reclassificará os pacientes internados com resultados semelhantes à NRS-2002 e analisar as concordâncias e discordâncias entre as triagens, considerando a classificação do risco nutricional, ingestão alimentar e perda de peso. METODOLOGIA: estudo transversal realizado com pacientes recém-internados com insuficiência cardíaca, onde a NRS2002 e a MNA-SF foram aplicadas no mesmo momento, nas primeiras 72 horas. As avaliações contínuas dos escores NRS 2002 e MNA-SF foram apresentadas com a sua relação linear, e descrita por coeficientes de correlação de Pearson. A concordância entre os métodos foi apresentada com intervalos de confiança de 95% e coeficiente de Kappa. RESULTADOS: foram incluídos 148 pacientes, com média de idade de 63,1 ± 14,0 anos, onde 28 eram desnutridos, 62 eutróficos e 38 estavam em sobrepeso ou obesidade segundo IMC. A NRS-2002 classificou 4 pacientes a mais em RN que a MNA-SF (136 vs. 132), porém, apresentaram concordância fraca (kappa=0,21). Ingestão alimentar e perda de peso apresentaram discordância significativa. A correlação de Pearson foi de -0,44. CONCLUSÃO: A NRS-2002 classificou 4 pacientes a mais em RN, onde o IMC e a insuficiência cardíaca foram cruciais para classificar os pacientes dessa maneira. Apesar da semelhança, nossa pesquisa apresentou concordância fraca em relação ao RN, condizendo com a literatura. Ingestão alimentar e perda de peso discordaram siginitivamente entre as triagens.

Molecular Epidemiology and Characterization of Multidrug-Resistant MRSA ST398 and ST239 in Himachal Pradesh, India.

Aim: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of severe and difficult-to-treat infections in humans and animals. We aimed to identify the predominant lineages of methicillin-resistant S. aureus in Himachal Pradesh, India, to understand the genomic epidemiology along with the genotypic and phenotypic characteristics. Methods: We isolated 250 S. aureus from two district hospitals in Himachal Pradesh, India. Methicillin-Resistant S. aureus (MRSA) isolates were subjected to MLST, SCCmec typing, and resistance as well as virulence determinants were determined by PCR and sequencing. Bio-typing was also performed for source tracking. Results: A 17.6% (44/250) of isolates were classified as MRSA by both the MRSA detection kit and disc diffusion methods. Antimicrobial Susceptibility Testing of MRSA isolates (n = 44) showed high resistance to oxacillin (77.27%), erythromycin (77.27%), tetracycline (75%), cefoxitin (65.9%), and gentamicin (61.36%), while low resistance was observed for teicoplanin (36.36%), vancomycin and levofloxacin (31.81%) and fusidic acid (18.18%). All isolates were sensitive to linezolid, quinupristin-dulfopristin, dalbavancin, and cefazoline. The SCCmec-II was observed in 20.45% of isolates, SCCmec-I in 11.36%, SCCmec-III in 9%, SCCmec-IV in 40.9% and SCCmec-V in 18.18%. The mecA gene was present in all isolates (n = 44) and 50% also had the vanA gene. 35% of isolates had the lukS-PV/lukf-PV toxin gene and 11.36% had the co-existence of mecA, vanA, and lukS-PV/lukf-PV. The major strain was ST398 (39%) followed by ST239 (27%), ST217 (16%), ST121 (11%), and ST338 (7%). The MRSA isolates produced staphylokinase and ß-hemolysis but were negative for bovine plasma coagulation tests. In Conclusion: The predominant MRSA clones in Himachal Pradesh, India, were hospital-associated multi-drug resistant-MRSA ST239 with PVL and community-associated MRSA ST398.

Determinants of Advanced Liver Fibrosis in Adult Patients After Fontan Palliation: Usefulness of Ultrasound Transient Elastography.

BACKGROUND: Fontan-associated liver disease is an increasing concern. Our aim was to assess prevalence and predictors of advanced liver fibrosis with a specific focus on utility of liver stiffness measurement by ultrasound transient elastography. METHODS: A total of 97 adult Fontan patients (55% male, median age: 23.1 years, interquartile range [IQR]: 18.7-30.6); 92 (95%) were evaluated with transient elastography, and 50 (52%) underwent transjugular liver biopsy. Advanced liver fibrosis was defined as congestive hepatic fibrosis score 3 or 4. RESULTS: Only 4 patients (4%) had liver stiffness values < 10 kilopascal (kPa). Liver-stiffness measurements correlated weakly with peak oxygen uptake on exercise testing and Fontan pressure but not with Model for End-Stage Liver Disease excluding INR (MELD-XI) score or spleen size. Serial follow-up liver stiffness measurements in 73 clinically stable patients showed large variability among individual patients. Advanced liver fibrosis was present in 35 of 50 (70%) patients on liver biopsy and was associated to MELD-XI-Score ≥ 11 and splenomegaly but not to liver-stiffness measurements. Advanced liver fibrosis was not associated with patient age or time since Fontan operation but with younger age at completion of Fontan (3.7 years, IQR: 2.3-6.3 vs 6.8 years; IQR: 3.5-12.1; P = 0.037). CONCLUSIONS: In our cohort, advanced liver fibrosis was present in the majority of adult Fontan patients. Liver stiffness as measured by transient elastography was not associated with the degree of liver fibrosis. Because of its high variability on serial measurements, it seems not to be useful for clinical decision making. The unexpected finding that younger age at completion of Fontan was associated with advanced liver fibrosis merits further evaluation.

The Potential of Alternative Therapies and Vaccine Candidates against Helicobacter pylori.

Alternative therapies and vaccination are essential to combat the emergence of multidrug-resistant Helicobacter pylori and to prevent the development of gastroduodenal diseases. This review aimed to systematically review recent studies on alternative therapies, i.e., probiotics, nanoparticles, and natural products from plants, as well as recent progress in H. pylori vaccines at the preclinical stage. Articles published from January 2018 to August 2022 were systematically searched using PubMed, Scopus, Web of Science, and Medline. After the screening process, 45 articles were eligible for inclusion in this review. Probiotics (n = 9 studies) and natural products from plants (n = 28 studies) were observed to inhibit the growth of H. pylori, improve immune response, reduce inflammation, and reduce the pathogenic effects of H. pylori virulence factors. Natural products from plants also showed anti-biofilm activity against H. pylori. However, clinical trials of natural products from plants and probiotics are still lacking. A paucity of data assessing the nanoparticle activity of N-acylhomoserine lactonase-stabilized silver against H. pylori was observed. Nonetheless, one nanoparticle study showed anti-biofilm activity against H. pylori. Promising results of H. pylori vaccine candidates (n = 7) were observed at preclinical stage, including elicitation of a humoral and mucosal immune response. Furthermore, the application of new vaccine technology including multi-epitope and vector-based vaccines using bacteria was investigated at the preclinical stage. Taken together, probiotics, natural products from plants, and nanoparticles exhibited antibacterial activity against H. pylori. New vaccine technology shows promising results against H. pylori.

Computational exploration of molecular flexibility and interaction of meropenem analogs with the active site of oxacillinase-23 in Acinetobacter baumannii.

Background: Carbapenem-resistant Acinetobacter baumannii is an opportunistic pathogen responsible for nosocomial infections and is one of the biggest global threats according to the World Health Organization (WHO), particularly causing substantial morbidity and mortality. Objectives: This study aimed at using computational approaches to screen meropenem and its analogs against OXA-23-positive Acinetobacter baumannii, analyzing the correlations between kinetic and phenotypic characteristics. Methods: A total of 5,450 compounds were screened using virtual screening workflow (HTVS, Glide-SP, and Glide-XP) to identify the best compounds based on their binding energy and interactions against OXA-23 and OXA-27 as they had phenotypic data available. Molecular dynamics simulation and density functional theory (DFT) studies were performed from the outcome of molecular docking analysis. Results: During simulations, meropenem and its analogs exhibited high-level stable interactions with Ser79, Ser126, Thr217, Trp219, and Arg259 of OXA-23. Meropenem displayed a CovDock energy of about -3.5 and -1.9 kcal mol-1 against OXA-23 and OXA-27, respectively. Among the 5,450 compounds, Pubchem_10645796, Pubchem_25224737, and ChEMBL_14 recorded CovDock energy between -6.0 and -9.0 kcal mol-1. Moreover, the infra-red (IR) spectrophotometric analysis revealed C=O and C-N atoms showing bands at 1,800 and 1,125 cm-1, respectively. These observed data are in congruence with the experimental observations. Conclusion: The identified compounds showed good agreement with the spectrophotometric analysis using DFT methods. In the earlier studies, meropenem's MIC value was 32 µg mL-1 in OXA-23-positive isolate A2265 compared to the MIC of 1 µg mL-1 in Δbla OXA-23 A2265. Comparing the CovDock energy and hydrogen-bonding interactions, the predicted results are in good agreement with the experimental data reported earlier. Our results highlight the importance of OXA-23 molecular docking studies and their compliance with the phenotypic results. It will help further in developing newer antibiotics for treating severe infections associated with carbapenem-resistant A. baumannii.

Impact of pharmacogenetics on aspirin resistance: a systematic review.

BACKGROUND: Pharmacogenetics promises better control of diseases such as cardiovascular disease (CVD). Acetylsalicylic acid, aspirin, prevents the formation of an activating agent of platelet aggregation and vasoconstriction, and it is used to prevent CVD. Nevertheless, patients may have treatment failure due to genetic variants that modify the metabolism of the drug causing aspirin resistance (AR). OBJECTIVES: To realize a systematic literature review to determine the impact of genetic variants on AR. METHODS: Articles published in the MEDLINE/PubMed, Cochrane, Scopus, LILACS, and SCIELO databases were systematically screened. A total of 290 articles were identified and 269 articles were excluded because they did not comply with the previously established inclusion criteria. A total of 20 case-control studies and 1 cohort was included. RESULTS: The genetic variants rs1126643 (ITGA2), rs3842787 (PTGS1), rs20417 (PTGS2), and rs5918 (ITGB3) were the most studied. As for relevance, of the 64 genetic variants evaluated by the articles, 14 had statistical significance (p < 0.05; 95% confidence interval [CI]) in at least one article. Among them, the following have had unanimous results: rs1371097 (P2RY1), rs1045642 (MDR1), rs1051931 and rs7756935 (PLA2G7), rs2071746 (HO1), rs1131882 and rs4523 (TBXA2R), rs434473 (ALOX12), rs9315042 (ALOX5AP), and rs662 (PON1), while these differ in real interference in AR: rs5918 (ITGB3), rs2243093 (GP1BA), rs1330344 (PTGS1), and rs20417 (PTGS2). As study limitations, we highlight the nonuniform methodologies of the analyzed articles and population differences. CONCLUSION: It is noteworthy that pharmacogenetics is an expanding area. Therefore, further studies are needed to better understand the association between genetic variants and AR.

ANTECEDENTES: A farmacogenética promete melhorar o controle de doenças como as cardiovasculares. O ácido acetilsalicílico, a aspirina, previne a formação de um agente ativador da agregação plaquetária e vasoconstrição e é usado na prevenção de tais doenças. No entanto, os pacientes podem ter falha no tratamento devido a variantes genéticas que modificam o metabolismo da droga causando resistência à aspirina (RA). OBJETIVOS: Realizar uma revisão sistemática da literatura para determinar o impacto das variantes genéticas na resistência à aspirina. MéTODOS: Artigos publicados nos bancos de dados MEDLINE/PubMed, Cochrane, Scopus, LILACS e SCIELO foram sistematicamente selecionados. Foram identificados 290 artigos e, destes, 269 artigos foram excluídos por não atenderem aos critérios de inclusão previamente estabelecidos. Um total de 20 estudos caso-controles e 1 coorte foi incluído. RESULTADOS: As variantes genéticas rs1126643 (ITGA2), rs3842787 (PTGS1), rs20417 (PTGS2) e rs5918 (ITGB3) foram as mais estudadas. Quanto à relevância, das 64 variantes genéticas avaliadas pelos artigos, 14 tiveram significância estatística (p < 0,05; intervalo de confiança [IC] de 95%) em pelo menos um artigo. Entre eles, os seguintes tiveram resultados unânimes: rs1371097 (P2RY1), rs1045642 (MDR1), rs1051931 e rs7756935 (PLA2G7), rs2071746 (HO1), rs1131882 e rs4523 (TBXA2R), rs434473 (ALOX12), rs9315042 (ALOX5AP) e rs662 (PON1), enquanto estes diferiram na interferência real na RA: rs5918 (ITGB3), rs2243093 (GP1BA), rs1330344 (PTGS1) e rs20417 (PTGS2). Como limitações do estudo, destacam-se as metodologias não uniformes dos artigos analisados e as diferenças populacionais. CONCLUSãO: Vale ressaltar que a farmacogenética é uma área em expansão. Portanto, mais estudos são necessários para entender melhor a associação entre variantes genéticas e RA.

Impact of pharmacogenetics on aspirin resistance: a systematic review / Impacto da farmacogenética na resistência à aspirina: uma revisão sistemática

Abstract Background Pharmacogenetics promises better control of diseases such as cardiovascular disease (CVD). Acetylsalicylic acid, aspirin, prevents the formation of an activating agent of platelet aggregation and vasoconstriction, and it is used to prevent CVD. Nevertheless, patients may have treatment failure due to genetic variants that modify the metabolism of the drug causing aspirin resistance (AR). Objectives To realize a systematic literature review to determine the impact of genetic variants on AR. Methods Articles published in the MEDLINE/PubMed, Cochrane, Scopus, LILACS, and SCIELO databases were systematically screened. A total of 290 articles were identified and 269 articles were excluded because they did not comply with the previously established inclusion criteria. A total of 20 case-control studies and 1 cohort was included. Results The genetic variants rs1126643 (ITGA2), rs3842787 (PTGS1), rs20417 (PTGS2), and rs5918 (ITGB3) were the most studied. As for relevance, of the 64 genetic variants evaluated by the articles, 14 had statistical significance (p< 0.05; 95% confidence interval [CI]) in at least one article. Among them, the following have had unanimous results: rs1371097 (P2RY1), rs1045642 (MDR1), rs1051931 and rs7756935 (PLA2G7), rs2071746 (HO1), rs1131882 and rs4523 (TBXA2R), rs434473 (ALOX12), rs9315042 (ALOX5AP), and rs662 (PON1), while these differ in real interference in AR: rs5918 (ITGB3), rs2243093 (GP1BA), rs1330344 (PTGS1), and rs20417 (PTGS2). As study limitations, we highlight the nonuniform methodologies of the analyzed articles and population differences. Conclusion It is noteworthy that pharmacogenetics is an expanding area. Therefore, further studies are needed to better understand the association between genetic variants and AR.

Resumo Antecedentes A farmacogenética promete melhorar o controle de doenças como as cardiovasculares. O ácido acetilsalicílico, a aspirina, previne a formação de um agente ativador da agregação plaquetária e vasoconstrição e é usado na prevenção de tais doenças. No entanto, os pacientes podem ter falha no tratamento devido a variantes genéticas que modificam o metabolismo da droga causando resistência à aspirina (RA). Objetivos Realizar uma revisão sistemática da literatura para determinar o impacto das variantes genéticas na resistência à aspirina. Métodos Artigos publicados nos bancos de dados MEDLINE/PubMed, Cochrane, Scopus, LILACS e SCIELO foram sistematicamente selecionados. Foram identificados 290 artigos e, destes, 269 artigos foram excluídos por não atenderem aos critérios de inclusão previamente estabelecidos. Um total de 20 estudos caso-controles e 1 coorte foi incluído. Resultados As variantes genéticas rs1126643 (ITGA2), rs3842787 (PTGS1), rs20417 (PTGS2) e rs5918 (ITGB3) foram as mais estudadas. Quanto à relevância, das 64 variantes genéticas avaliadas pelos artigos, 14 tiveram significância estatística (p< 0,05; intervalo de confiança [IC] de 95%) em pelo menos um artigo. Entre eles, os seguintes tiveram resultados unânimes: rs1371097 (P2RY1), rs1045642 (MDR1), rs1051931 e rs7756935 (PLA2G7), rs2071746 (HO1), rs1131882 e rs4523 (TBXA2R), rs434473 (ALOX12), rs9315042 (ALOX5AP) e rs662 (PON1), enquanto estes diferiram na interferência real na RA: rs5918 (ITGB3), rs2243093 (GP1BA), rs1330344 (PTGS1) e rs20417 (PTGS2). Como limitações do estudo, destacam-se as metodologias não uniformes dos artigos analisados e as diferenças populacionais. Conclusão Vale ressaltar que a farmacogenética é uma área em expansão. Portanto, mais estudos são necessários para entender melhor a associação entre variantes genéticas e RA.

Identifying the sources of human campylobacteriosis in Nigeria.

Campylobacter spp. have been shown to be the most common cause of bacterial gastroenteritis worldwide. Cases of human campylobacteriosis are usually reported as sporadic and not part of an outbreak which makes the identification of the source of infection difficult. A study of the relationships within isolate populations in Nigeria and source attribution analysis of Nigerian human Campylobacter spp. to other animal isolates was carried out to determine the possible sources for human Campylobacter infection in Nigeria. The results showed nine sequence types (STs) common to both humans and livestock isolated from abattoirs, farms and live bird markets with similar STs clustering together on a phylogenetic tree, confirming a degree of genetic similarity. Source attribution analysis suggests wild birds as the most important reservoir (38%) for human Campylobacter spp. infection in Nigeria followed by chicken (23%), pig (19%), cattle (11%) and sheep (8%). This might be an indication of the importance of this infection source to humans in Nigeria and probably other low-income countries due to farming practices and human habits.

Correlação entre Capacidade Funcional e Qualidade de Vida em Pacientes Oncológicos em Cuidados Paliativos / Correlation between Functional Capacity and Quality-of-life in Cancer Patients in Palliative Care / Correlación entre Capacidad Funcional y Calidad de Vida en Pacientes Oncológicos en Cuidados Paliativos

Introdução: Cuidados paliativos são descritos como um conjunto de terapêuticas que visam minimizar as implicações negativas das doenças graves que ameaçam a vida e o bem-estar do indivíduo acometido. A progressão da doença e a sintomatologia provocam uma deterioração gradual e generalizada do estado do doente, e os sintomas físicos ocasionam a perda progressiva da capacidade funcional que, associados às manifestações emocionais pelo momento em que o paciente se encontra, impactam a sua qualidade de vida. Objetivo: Correlacionar a capacidade funcional com a qualidade de vida de pacientes oncológicos em cuidados paliativos. Método: Estudo transversal de abordagem quantitativa com 225 indivíduos. Os dados foram coletados por meio de questionário sociodemográfico, do índice de Barthel e do European Organization for Research in the Treatment of Cancer Questionnaire Palliative (EORTC QLQ-C15-PAL). Resultados: Dos 225 indivíduos elegíveis, observou-se homogeneidade entre a porcentagem de homens e mulheres, com média de 55,73±15,14 anos de idade. A análise estatística demonstrou associação positiva entre o escore do índice de Barthel e o escore de qualidade de vida do EORTC QLQ-C15-PAL com coeficiente de 0,74 e nível significância de p<0,05, bem como correlação negativa para as subescalas funcional e de sintomas com coeficiente de -0,702 e -0,544, respectivamente. Conclusão: Há uma correlação significativa entre a capacidade funcional e a qualidade de vida em pacientes oncológicos em cuidados paliativos.

Introduction: Palliative care is described as a set of therapies that aim to minimize the negative implications of severe life-threatening illnesses on the well-being of the individual affected. The progression of the disease and the symptomatology cause a gradual and generalized deterioration of the patient's condition and the physical symptoms cause the progressive loss of the functional capacity which, associated with emotional manifestations due to the moment the patient is living through, impact its quality-of-life. Objective: To correlate the functional capacity with the quality-of-life of cancer patients in palliative care. Method: Quantitative investigation with 225 individuals whose data were collected through sociodemographic questionnaire, Barthel Index and the European Organization for Research in the Treatment of Cancer Questionnaire Palliative (EORTC QLQ-C15- PAL) Results: The sample of 225 eligible individuals consisted in men and women evenly distributed with mean age of 55.73±15.14 years. Statistical analysis showed a positive association of 0.74 between the Barthel Index and the EORTC QLQ-C15-PAL quality-of-life with level of significance of p<0.05, as well as a negative correlation of -0.702 and -0.544 for the subscales functional and symptoms, respectively. Conclusion: There is a significant correlation between functional capacity and quality of life in cancer patients undergoing palliative care

Introducción: Cuidados paliativos se describen como un conjunto de terapias que tienen como objetivo minimizar las implicaciones negativas de enfermedades graves que amenazan la vida y el bienestar del individuo afectado. La progresión de la enfermedad y la sintomatología provocan un deterioro paulatino y generalizado del estado del paciente, los síntomas físicos provocan la pérdida progresiva de la capacidad funcional, asociados a manifestaciones emocionales debido al momento en el que se encuentra el paciente, impactando en la calidad de vida del paciente. Objetivo: Correlacionar la capacidad funcional con la calidad de vida de pacientes oncológicos en cuidados paliativos. Método: Estudio transversal con un enfoque cuantitativo en el que participaron 225 individuos. Los datos se recogieron mediante un cuestionario sociodemográfico, el índice de Barthel y el European Organisation for Research in the Treatment of Cancer Questionnaire Palliative (EORTC QLQ-C15-PAL). Resultados: De los 225 individuos elegibles, se observó homogeneidad de género, con una edad promedio de 55,73±15,14 años. El análisis estadístico mostró una asociación positiva entre la puntuación del índice de Barthel y la puntuación de calidad de vida de la EORTC QLQ-C15-PAL con un coeficiente de 0,74, adoptando una significancia de p<0,05, así como una correlación negativa para las subescalas funcional y de síntomas con un coeficiente de -0,702 y -0,544, respectivamente. Conclusión: Existe una correlación significativa entre la capacidad funcional y la calidad de vida en pacientes oncológicos en cuidados paliativos.

Argon plasma application on the surface of titanium implants: osseointegration study / Aplicação de plasma de argônio na superfície de implantes de titânio: estudo de osseointegração

Introduction: The development of new biomaterials with improved properties is a trend in regenerative medicine. The successful healing of implants is related to their osseointegration and the topographic geometry of their surface. Treatment with argon plasma acts on the surface of the implants, bringing several benefits to their osseointegration in the body. Material and Methods: Previously the in vivo study, the topography implants were observed by scanning electron microscopy (SEM). Following the implants were inserted in 14 male rats, and one perforation was made in the right and left tibias for implant placement without the surface treatment (control group), and with the argon plasma surface treatment (experimental group), respectively. The rats were euthanized at 4 weeks, a time in which tibia fragments were submitted for histological and histomorphometric examination, and torque removal test for comparison and analysis of osseointegration. Results: The SEM images showed the argon plasma surface treatment altered the topography. At the end of the study, both greater bone formation and better osseointegration were verified in the experimental group, and a statistically significant difference between the groups was observed. Conclusion: It was concluded that implants with this surface treatment can bring more practicality in the rehabilitation treatment, and more comfort in the patients' postoperative time (AU)

Introdução: O desenvolvimento de novos biomateriais com propriedades aprimoradas é uma tendência na medicina regenerativa. A cicatrização bem-sucedida dos implantes está relacionada à sua osseointegração e à geometria topográfica de sua superfície. O tratamento com plasma de argônio atua na superfície dos implantes, trazendo diversos benefícios para sua osseointegração no corpo. Materiais e Métodos: Antes do estudo in vivo, a topografia dos implantes foi observada por microscopia eletrônica de varredura (MEV). Em seguida, os implantes foram inseridos em 14 ratos machos, e uma perfuração foi feita nas tíbias direita e esquerda para a colocação do implante sem o tratamento de superfície (grupo controle) e com o tratamento de superfície de plasma de argônio (grupo experimental), respectivamente. Os ratos foram sacrificados após 4 semanas, momento em que fragmentos das tíbias foram submetidos a exame histológico e histomorfométrico, além do teste de remoção de torque para comparação e análise da osseointegração. Resultados: As imagens de MEV mostraram que o tratamento de superfície com plasma de argônio alterou a topografia. Ao final do estudo, foi verificada maior formação óssea e melhor osseointegração no grupo experimental, e foi observada diferença estatisticamente significativa entre os grupos. Conclusão: Concluiu-se que os implantes com esse tratamento de superfície podem trazer mais praticidade no tratamento de reabilitação e maior conforto no pós-operatório dos pacientes (AU)