Integrating Pre-test Probability and Point-of-Care Ultrasound (POCUS) in the Emergency Department (ED) Diagnosis of Small Bowel Obstruction (SBO).

Introduction A computed tomography (CT) scan and point-of-care ultrasound (POCUS) are commonly employed for diagnosing small bowel obstructions (SBOs). Prior studies demonstrated that POCUS has 90-95% sensitivity and specificity compared with CT scanning, which is the gold standard. Unlike other imaging modalities (in which the ordering and performing clinician are not the same), POCUS-performing/interpreting sonologists must recognize the risk of confirmation bias in the POCUS application. Per Bayesian analysis, the likelihood of a diagnosis being true following a diagnostic test is based on the ordering clinician's pre-test probability and the test characteristics (sensitivity and specificity, from which positive and negative likelihood ratios can be calculated). Consequently, establishing pre-test probability is important in informing downstream diagnostic or therapeutic interventions, as pre-test probability influences post-test odds. Little research has been done on the role of POCUS sonologist's pre-test probability and actual POCUS results regarding SBO. This study assessed the role of POCUS, integrating pre-test probability and POCUS results to determine post-test odds. Methods One hundred six patients were recruited on a convenience basis and underwent POCUS and CT between April 2017 and December 2022. All sonographers were credentialed in POCUS. POCUS sonologists' pre-test probabilities and POCUS and CT results were captured, which were compared. Sensitivity, specificity, LR+, and LR- were calculated, and correlations were made between pre-test probability and POCUS and CT results.  Results POCUS exhibited a sensitivity of 92% and specificity of 90%, with a corresponding positive likelihood ratio (LR+) of 9.3 and a negative likelihood ratio (LR-) of 0.09 for diagnosing SBO. Among patients with a high pre-test probability of SBO, a negative ultrasound yielded post-test odds of 0.4%, whereas a positive POCUS yielded post-test odds of 39.6%. Among patients with a low pre-test probability, a negative POCUS resulted in post-test odds of 0%, while a positive POCUS led to post-test odds of 2.1%, yielding a number needed to scan (NNS) of ~50 to identify a patient with an SBO on CT. Conclusion This study confirmed POCUS's sensitivity and specificity of ~90-95% and a corresponding LR+ of 9.2 and LR- of 0.9. Pre-test probability substantially affected post-test odds. Patients with a high pre-test probability and a positive POCUS had post-test odds of 39.6 and should have a confirmatory CT, while those with a negative POCUS have very low post-test odds and very likely will not benefit from CT. Patients with low pre-test probability and a positive POCUS have post-test odds of 2.1%, similar to the Wells Score and HEART score; such patients may not benefit from a CT, though clinicians should use their judgment/discretion. Patients with a low pre-test probability and a negative POCUS have post-test odds of 0% and should not have a CT. Among low pre-test probability patients, the NNS was ~50 to identify patients with an SBO on CT.

Neighborhood-Level Risk Factors for Severe Hyperglycemia among Emergency Department Patients without a Prior Diabetes Diagnosis.

A person's place of residence is a strong risk factor for important diagnosed chronic diseases such as diabetes. It is unclear whether neighborhood-level risk factors also predict the probability of undiagnosed disease. The objective of this study was to identify neighborhood-level variables associated with severe hyperglycemia among emergency department (ED) patients without a history of diabetes. We analyzed patients without previously diagnosed diabetes for whom a random serum glucose value was obtained in the ED. We defined random glucose values ≥ 200 mg/dL as severe hyperglycemia, indicating probable undiagnosed diabetes. Patient addresses were geocoded and matched with neighborhood-level socioeconomic measures from the American Community Survey and claims-based surveillance estimates of diabetes prevalence. Neighborhood-level exposure variables were standardized based on z-scores, and a series of logistic regression models were used to assess the association of selected exposures and hyperglycemia adjusting for biological and social individual-level risk factors for diabetes. Of 77,882 ED patients without a history of diabetes presenting in 2021, 1,715 (2.2%) had severe hyperglycemia. Many geospatial exposures were associated with uncontrolled hyperglycemia, even after controlling for individual-level risk factors. The most strongly associated neighborhood-level variables included lower markers of educational attainment, higher percentage of households where limited English is spoken, lower rates of white-collar employment, and higher rates of Medicaid insurance. Including these geospatial factors in risk assessment models may help identify important subgroups of patients with undiagnosed disease.

Novel Discharge Center for Transition of Care in Vulnerable Emergency Department Treat and Release Patients.

Introduction The majority of emergency department (ED) patients are discharged following evaluation and treatment. Most patients are recommended to follow up with a primary care provider (PCP) or specialist. However, there is considerable variation between providers and EDs in discharge process practices that might facilitate such follow-up (e.g., simply discharging patients with follow-up physician names/contact information vs. making appointments for patients). Patients who do not follow up with their PCPs or specialists are more likely to be readmitted within 30 days than those who do. Furthermore, vulnerable patients have difficulty arranging transitional care appointments due to poor health literacy, inadequate insurance, appointment availability, and self-efficacy. Our innovative ED discharge process utilizes an Emergency Department Discharge Center (EDDC) staffed by ED Care Coordinators and assists patients with scheduling post-discharge appointments to improve rates of follow-up with outpatient providers. This study describes the structure and activities of the EDDC, characterizes the EDDC patient population, and demonstrates the volume and specialties of appointments scheduled by EDDC Care Coordinators. The impact of the EDDC on operational metrics (72-hour returns, 30-day admissions, and length-of-stay [LOS]) and the impact of the EDDC on patient satisfaction are evaluated. Methods The Long Island Jewish Medical Center (LIJMC) EDDC is an intervention developed in July 2020 within a 583-bed urban hospital serving a racially, ethnically, and socio-economically diverse population, with many patients having limited access to healthcare. Data from the Emergency Medicine Service Line (EMSL), an ED Care Coordinator database, and manual chart review were collected from July 2020 to July 2021 to examine the impact of the EDDC on 72-hour returns, 30-day admissions, and Press Ganey's® "likelihood to recommend ED" score (a widely used patient satisfaction survey question). The EDDC pilot cohort was compared to non-EDDC discharged patients during the same period. Results In unadjusted analysis, EDDC patients were moderately less likely to return to the ED within 72 hours (5.3% vs. 6.5%; p = 0.0044) or be admitted within 30 days (3.4% vs. 4.2%). The program was particularly beneficial for uninsured and elderly patients. For both EDDC and non-EDDC patients, most revisits and 30-day admissions were for the same chief complaint as the index visit. The length-of-stay increased by ~10 minutes with no impact on satisfaction with ED visits. Musculoskeletal conditions (~20%) and specialties (~15%) were the most commonly represented. Approximately 10% of referrals were to obtain a PCP. Nearly 90% were to new providers or specialties. Most scheduled appointments occurred within a week.  Conclusion This novel EDDC program, developed to facilitate outpatient follow-up for discharged ED patients, produced a modest but statistically significant difference in 72-hour returns and 30-day admissions for patients with EDDC-scheduled appointments vs. those referred to outpatient providers using the standard discharge process. ED LOS increased by ~10 minutes for EDDC vs. non-EDDC patients, with no difference in satisfaction. Future analyses will investigate impacts on 72-hour returns, 30-day admissions, LOS, and satisfaction after adjusting for characteristics such as age, insurance, having a PCP, and whether the scheduled appointment was attended.

Non-Small Cell Lung Cancer Treatment with Molecularly Targeted Therapy and Concurrent Radiotherapy-A Review.

Lung cancer is the leading cause of death worldwide for both men and women. Surgery can be offered as a radical treatment at stages I and II and selected cases of stage III (III A). Whereas at more advanced stages, combined modalities of treatment are applied: radiochemotherapy (IIIB) and molecularly targeted treatment (small molecule tyrosine kinase inhibitors, VEGF receptor inhibitors, monoclonal antibodies, and immunological treatment with monoclonal antibodies). Combination treatment, composed of radiotherapy and molecular therapy, is increasingly employed in locally advanced and metastatic lung cancer management. Recent studies have indicated a synergistic effect of such treatment and modification of immune response. The combination of immunotherapy and radiotherapy may result in the enhancement of the abscopal effect. Anti-angiogenic therapy, in combination with RT, is associated with high toxicity and should be not recommended. In this paper, the authors discuss the role of molecular treatment and the possibility of its concurrent use with radiotherapy in non-small cell lung cancer (NSCLC).

Adding Mealworm (Tenebrio molitor L.) Powder to Wheat Bread: Effects on Physicochemical, Sensory and Microbiological Qualities of the End-Product.

Entomophagy, that is, the consumption of insects, is gaining more and more popularity. The research carried out so far on the use of edible insects in the food industry has shown that they are a valuable source of protein, and do not significantly affect the functional and sensory properties of food. Edible insects also contribute to sustainable, environment friendly food production. Taking the above into account, the influence of adding insect powder on the physicochemical properties, sensory characteristics, and microbiological qualities of wheat bread was evaluated. This study aimed to partially replace wheat flour (5, 10, and 15%) in bread with mealworm powder (T. molitor) to produce protein-fortified bread. Bread containing mealworm powder showed similar density and water activity compared to the control wheat bread. The addition of mealworm powder did not negatively affect the properties of bread. The total color difference increased significantly (p < 0.05) with the insect flour share in bread formulation and ranged between 2.27 for M5, 4.00 for M10, and 4.50 for M15. The protein content in bread fortified with 5−15% mealworm powder increased by 15−59% compared to the control bread, whereas fat content increased by 35% to 113%. Results of sensory evaluation revealed that modification of the recipe, depending on the mealworm powder addition level, significantly (p < 0.05) affected bread color, odor, flavor, and overall sensory quality. The research showed that the optimal enrichment level is using 5% mealworm flour in the bread recipe. Moreover, the obtained variants of bread were characterized by good microbiological quality after baking. In bread M10, no yeasts and molds were found during a period of 2 days of storage. The number of yeasts and molds in the other bread variants was relatively low. To conclude, the results confirmed the usefulness of insect powder in making protein-fortified bread of good quality comparable to traditional wheat bread.

Differential diagnosis of a calcified cyst found in an 18th century female burial site at St. Nicholas Church cemetery (Libkovice, Czechia).

During archaeological excavations in burial sites, sometimes stoned organic objects are found, in addition to human remains. Those objects might be of a different origin, depending on various factors influencing members of a community (i.e. diseases, trauma), which provides information about their living conditions. The St. Nicholas Church archaeological site (Libkovice, Czechia) in the 18th century horizon of the cemetery, yielded a maturus-senilis female skeleton with a stone object in the left iliac fossa. This object was an oviform cyst-like rough structure, measuring 54 mm in length, 35 mm in maximum diameter and 0.2-0.7 mm shell thickness. Within the object there were small fetal bones (long bones, i.e. femur and two tibias, two scapulas, three ribs, vertebrae and other tiny bone fragments). Methods utilized to analyze the outer and inner surface morphology of the cyst and its inside, included: X-ray, CT imaging, SEM, histological staining and EDS. The EDS analysis revealed the presence of primarily oxygen, calcium and phosphorus in bone samples, and oxygen and silicon, in stone shell. Based on the length of the femur (20.2 mm) and tibia (16 mm) shafts, the fetal age was determined as being in the 15-18 week of pregnancy. The differential diagnosis was conducted, including for the three most probable cases: fetiform teratoma (FT), fetus-in-fetu (FIF) and lithopedion. The possibility of fetiform teratoma was discounted due to the presence of an anatomically correct spine, long bones and the proportions of the find. Although the low calcium content in the shell (2.3% atom mass), the lack of skull bones and the better developed lower limbs indicate fetus-in-fetu rather than lithopedion, the analyses results are unable to conclusively identify the object under one of these two categories since there are insufficient such cases in excavation material with which to draw comparison.

Prevalence of ESBL-producing Pseudomonas aeruginosa isolates in Warsaw, Poland, detected by various phenotypic and genotypic methods.

Knowledge of the prevalence of ESBL enzymes among P. aeruginosa strains compared to the Enterobacteraiceae family is limited. The phenotypic tests recommended by EUCAST for the detection of ESBL-producing Enterobacteriaceae are not always suited for P. aeruginosa strains. This is mainly due to the presence of other families of ESBLs in P. aeruginosa isolates more often than in Enterobacteriaceae, production of natural AmpC cephalosporinase and its overexpression, and co-production of metallo-ß-lactamases. The aim of this study was to determine the occurrence of ESBLs in P. aeruginosa isolated from patients from hospitals in Warsaw, to evaluate the ESBL production of these isolates using currently available phenotypic tests, their modifications, multiplex PCR and molecular typing of ESBL-positive isolates by PFGE. Clinical isolates of P. aeruginosa were collected in 2000-2014 from four Warsaw hospitals. Based on the data obtained in this study, we suggest using three DDST methods with inhibitors, such as clavulanic acid, sulbactam and imipenem, to detect ESBL-producing P. aeruginosa strains. Depending on the appearance of the plates, we suggest a reduction in the distance between discs with antibiotics to 15 mm and the addition of boronic acid at 0.4 mg per disc. The analysed isolates carried genes encoding ESBL from the families VEB (69 isolates with VEB-9), GES (6 with GES-1, 1 GES-5, 5 GES-13 and 2 with GES-15), OXA-2 (12 with OXA-15, 1 OXA-141, 1 OXA-210, 1 OXA-543 and 1 with OXA-544) and OXA-10 (5 isolates with OXA-74 and one with OXA-142). The most important result of this study was the discovery of three new genes, blaGES-15, blaOXA-141 and blaOXA-142; their nucleotide sequences have been submitted to the NCBI GenBank. It is also very important to note that this is the first report on the epidemiological problem of VEB-9-producing bacterial strains, not only in Poland but also worldwide.

Antioxidant capacity of crude extracts containing carotenoids from the berries of various cultivars of Sea buckthorn (Hippophae rhamnoides L.).

Comparative analysis of antioxidant capacity was performed using FRAP and DPPH methods on extracts containing carotenoids acquired from fruits of Sea buckthorn. The examination included nine varieties of Sea buckthorn growing in the comparative cultivation. Conducted analysis allowed to compare the antioxidant capacity with carotenoids content measured with spectrophotometric and HPLC methods. Three of the examined cultivars indicating high antioxidant activity in both, FRAP and DPPH methods, also revealed highest ('Aromatnaya') and high ('Botanicheskaya', 'Arumnyj') total carotenoids content in HPLC analysis.

In situ photoexcitation of silver-doped titania nanopowders for activity against bacteria and yeasts.

Photocatalytic and in situ microbial activity of the amorphous and annealed states of Ag-doped and un-doped titania were examined. Studies on their structure, morphology, composition, and the photo-absorption characteristics of these materials were performed. These results were correlated with the photocatalytic and microbial activity against methicillin resistant Staphylococcus aureus K324 (MRSA), methicillin susceptible S. aureus ATCC 25923 (MSSA), Escherichia coli PA 170, and yeasts Candida albicans ATCC 90028. The annealed powders containing anatase form of titania exhibited relatively higher photocatalytic activity,corresponding to activity against MRSA,when exposed to UV-A radiation. In comparison, amorphous powders exhibited low photoactivity and showed poor antibacterial performance against MRSA under UV-A exposure. Doping of amorphous titania with Ag resulted in an anti-MRSA effect without exposure to UV radiation. In the Ag-doped crystalline anatase samples, the size of Ag primary nanocrystallites increased, which led to the decrease in the surface concentration of Ag and detriment anti-MRSA activity.

Image processing guided analysis for estimation of bacteria colonies number by means of optical transforms.

A novel method for evaluation of bacterial colonies number (Colony Forming Units--CFU), is described. Proposed algorithm, based on the Mellin transform, allows the CFU evaluation, invariant for the spatial orientation and scale changes. The proposed method involves image recording of bacteria grown in Petri dishes, calculation of the Fourier spectrum followed by coordinates transformation, and determination of the Mellin transform. It was proved that there is a high correlation between CFU and maxima of Mellin spectra. The method was practically implemented for evaluation of antibacterial activity of silver-based nanomaterials and the effect of an additional laser light irradiation.

Total antioxidant status and 8-hydroxy-2'-deoxyguanosine levels in gingival and peripheral blood of periodontitis patients.

INTRODUCTION: The aim of this study was to determine 8-OHdG concentration as a biomarker of oxidant-induced DNA damage and to assess total antioxidant status (TAS) in gingival and peripheral blood during periodontal lesion. MATERIALS AND METHODS: The study included 56 untreated periodontitis patients (26 with aggressive periodontitis, and 30 with chronic periodontitis (CP). The control group consisted of 25 healthy volunteers without pathological changes in the periodontium. Competitive ELISA was used to measure 8-OHdG. A colorimetric method based on the reduction of ABTSo+ radical cation generation was used to measure TAS. RESULTS: Significantly higher 8-OHdG concentrations were detected in the gingival blood in both groups of patients with periodontitis than in the control group. Subjects with CP had significantly decreased TAS levels in the gingival blood compared with the control group. A significantly decreased TAS level in the peripheral blood in both patient groups compared with the control group was found. Significant positive correlation between TAS levels in venous and gingival blood in all the periodontitis patients and in the CP group was observed. CONCLUSIONS: The oxidative burst in periodontitis may lead to significant local damage to nucleic acids. The significantly decreased TAS level in the gingival blood of CP patients compared with the healthy subjects suggests the possibility of a significant decrease in local antioxidant system capacity during the course of periodontitis. The decreased TAS level in the peripheral blood in the group of all patients with periodontitis may be one of the pathogenic mechanisms underlying the links between periodontal disease and several systemic diseases for which periodontitis is regarded as a independent risk factor.

[Some salivary proteins as a biomarkers of local and general diseases. Literature review]. / Wybrane bialka sliny jako biomarkery miejscowych i ogólnych procesów chorobowych. Przeglad pismiennictwa.

The article is a review of literature concerning proteins present in saliva, which matter in diagnostics. Much consideration has been given to osteonectin, a not well known glycoprotein. Osteonectin is a normal matrix bone component, which might serve as a marker of bone resorption and could be a potential marker for periodontal disease activity. The authors also mentioned oxidative stress and associations between the state of the oral cavity and general diseases.

[Influence of tobacco smoking and periodontitis on selected factors of oxidative stress]. / Wplyw nikotynizmu i zapalen przyzebia na wybrane parametry stresu oksydacyjnego.

UNLABELLED: The aim of the study was to estimate the influence of tobacco smoking and the clinical type of periodontitis on the chosen parameters of oxidative stress (superoxide anion generation on the ground of cytochrome c reduction in the whole blood, the concentration of autoantibodies for oxidized low-density lipoprotein in venous and gingival blood, the level of 8-hydroxy-2-deoxyguanosine (8-OHdG) as a marker of oxidative DNA damage in venous and gingival blood and the total antioxidant capacity in venous and gingival blood). MATERIAL AND METHODS: The study included 50 periodontitis patients (20 patients with generalized aggressive periodontitis - GAP and 30 patients with chronic periodontitis--CP), aged 28-55 (the mean value 40.3). There were 28 females and 22 males. The control group consisted of 25 volunteers in good general health, aged 2-50 (the mean value 37.8). There were 15 women in this group. In clinical examination ofperiodontium following indexes were included: plaque index (Silness and Löe), aproximal plaque index (Lange et al.), bleeding upon probing (Saxer and Mühlemann), pockets depth, the number of teeth. RESULTS: Significant influence of periodontal diagnosis on the level of 8-OHdG in gingival blood and total antioxidant capacity and also all analyzed clinical parameters was revealed. Significant total influence ofperiodontal diagnosis with tobacco smoking on total antioxidant capacity was also seen in venous blood (p = 0.004). CONCLUSIONS: 1) periodontal status impacted in significant way on the level of 8-OHdG in gingival blood and total antioxidant capacity in venous blood, 2) tobacco smoking and chronic periodontitis presence were connected with significantly decreasing levels of total antioxidant capacity in venous blood; this fact may be under importance in connection between periodontitis and atherosclerosis, 3) tobacco smoking was a significant factor in the progression ofperiodontitis (higher levels of plaque indexes, deeper periodontal pockets in nicotine addicted patients).

[Effect of 10-15% carbamide peroxide on enamel fluoride concentration in vital bleached teeth]. / Wplyw 10-15% nadtlenku karbamidu na stezenie fluorków w szkliwie wybielanych zebów zywych.

The objective of the study was to evaluate the concentration of fluoride in human enamel before and after bleaching using 10-15% carbamide peroxide and after application of the fluoride varnish. Microsamples of enamel were collected using acid biopsy and the concentration of fluoride in the superficial and underlying layer was assayed. No significant differences were observed in the concentration of fluoride in both layers of enamel before and after bleaching as well as after varnish application. Bleaching with 10-15% carbamide peroxide has no influence on the concentration of fluoride in enamel.

[Reactive oxygen species and antioxidant mechanisms in the pathogenesis of periodontitis]. / Mechanizmy tlenowe i antyoksydacyjne w patogenezie zapalen przyzebia.

The aim of this study done in patients with periodontitis was (a) to determine superoxide anion production in whole blood by measuring cytochrome c reduction; (b) to assess the effects of oxidative burst in periodontal disease by analyzing lipid peroxidation and degradation of DNA bases in the peripheral and gingival blood; (c) to search for associations between superoxide anion production, lipid peroxidation, 8-hydroxy-2-deoxyguanosine concentration and clinical parameters. Total antioxidant status in peripheral and gingival serum was also studied and correlated with periodontal clinical status. The effects of some risk factors of periodontitis on oxidative stress were analyzed. The study group included 56 patients with untreated periodontitis. The control group consisted of 25 healthy volunteers without any pathological changes in the periodontium. The most important findings of the study are: (a) negative correlation between cytochrome c reduction and periodontal disease index in the study group (p=0.026); (b) positive correlation between anti-ox-LDL autoantibody titres in gingival blood and 8-OHdG levels in venous blood (p<0.001); (c) negative correlation between 8-OHdG concentration in venous blood and total antioxidant status (TAS) in gingival blood serum in patients and positive correlation in controls; (d) significantly higher levels of 8-OHdG in gingival blood in each subgroup of patients as compared with controls; (e) significantly lower TAS in venous blood serum in each subgroup as compared with controls; (f) negative correlation between 8-OHdG concentration in gingival blood and TAS in venous blood serum (p=0.028). Oxidative stress in periodontitis expressed by elevated concentrations of ROS and accompanied by suppressed antioxidant activity in gingival blood may accelerate lesion formation in periodontal tissues.