A mixed-methods landscape assessment of supportive care for heart failure.

Aim: Understanding factors that shape leading health systems' (LHS) perspectives around heart failure (HF) treatment. Patients & methods: First of its kind study using a cross-sectional, descriptive, mixed-method design (from executives and frontline healthcare providers) with quantitative survey (n = 35) and qualitative interview (n = 12) data from 47 participants (41 different LHS). Results: 97% of LHS had dedicated HF programs, but variations in maturity highlights opportunities for care standardization. Treatment innovations continue, though practitioners may struggle to keep pace amid provider/patient barriers. HF programs strive to co-locate supportive care services to optimize treatment, but access can prove challenging. Conclusion: Opportunities exist, with external partner support, for LHS to become more comprehensive HF care providers, increasing standardization of care across LHS and improved HF treatment.

What is this summary about? We interviewed frontline healthcare workers (such as doctors and nurses) as well as executives at large US health systems to understand how they treat people with heart failure. What were the results? We learned that healthcare workers as well as executives would like to provide many different services to help people with heart failure. However, many health systems do not have all of these services available and can only provide a few basic services. We also learned healthcare workers sometimes struggle to keep up to date with new scientific discoveries and heart failure treatments. What do the results mean? With support from external healthcare partners, health systems can improve their ability to treat people with heart failure.

Prospective Validation and Comparison of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) and Site Other Than Lower Limb, Immunosuppression, Age, Renal Impairment, and Inflammatory Markers (SIARI) Scoring Systems for Necrotizing Fasciitis.

INTRODUCTION: Necrotizing fasciitis (NF) is a rapidly progressing infection of the soft tissues associated with high morbidity and mortality and hence it is a surgical emergency. Early diagnosis and treatment are of paramount importance. LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) and SIARI (Site other than lower limb, Immunosuppression, Age, Renal impairment, and Inflammatory markers) scoring systems have been established for early and accurate diagnosis of necrotizing fasciitis. This study compared the two scoring systems for diagnosing NF, predicting management, and elucidating the prognostic performance for re-operation and mortality. METHODS: This prospective study was conducted in PGIMER Chandigarh, India, between February 2020 and June 2021. The study was approved by the Institutional Review Board (No. INT/IEC/2020-90). The clinical presentation, laboratory parameters, and imaging were used to classify patients into NF or severe cellulitis groups. We also calculated the LRINEC and SIARI scores. Demographic variables and mortality were recorded. The area under the receiver operating characteristic was used to express the accuracy of both scores at a cut-off LRINEC and SIARI scores of ≥6 and ≥ 4, respectively. RESULTS: The study comprised 41 patients with NF and 11 with severe cellulitis. Informed written consent was taken from all the participants. At LRINEC score ≥6, the C-statistic for NF diagnosis was 0.839 (95% confidence interval [CI] 0.682-0.995, P 0.001), which was better than SIARI score at ≥ 4, C-statistic of 0.608 (95% CI 0.43-0.787, P 0.297). Both scores accurately predicted 30-day mortality. The LRINEC score showed a C-statistic of 0.912 (95% CI 0.798-1, P 0.001). Simultaneously, the SIARI score showed 70% sensitivity and 77% specificity, with a C-statistic of 0.805 (0.62-0.99, P = 0.017). CONCLUSIONS: LRINEC score is an effective diagnostic tool for distinguishing necrotizing fasciitis from severe cellulitis. Additional research is required to establish the SIARI score's external validity.

Dengue Transmission From Donor to Recipient After Deceased Donor Liver Transplant; Report of a Case and Review of Literature: Is Liver a Privileged Organ?

Nonvector transmission of dengue virus via organ transplantis rare.We report a probable case of dengue virus transmission via deceased donorlivertransplant. The donor was asymptomatic for dengue infection, and the liver recipient developed fever and thrombocytopenia 8 days after transplant. The recipient's testresults were positive forthe antigen for nonstructural protein 1 and for immunoglobulin M; however, donor serum samples were not available. Other transplant recipients (renal allograft) also showed dengue-positive test results during the same period, and these patients eventually died. Dengue illness in the liver recipient was severe and associated with shock and cardiomyopathy that required mechanical ventilation, intensive care, and cessation of immunosuppression; however, the patient subsequently improved and was discharged. This case highlights the importance of a high index of suspicion for dengue infection in the presence of graft dysfunction in dengue-endemic areas like India, as well as the importance of the test for the nonstructural protein 1 antigen during dengue outbreaks. These considerations should be included on the standard evaluation of solid-organ transplant donors.

Does Primary Care Fill the Gap in Access to Specialty Mental Health Care? A Mixed Methods Study.

BACKGROUND: Broad consensus supports the use of primary care to address unmet need for mental health treatment. OBJECTIVE: To better understand whether primary care filled the gap when individuals were unable to access specialty mental health care. DESIGN: 2018 mixed methods study with a national US internet survey (completion rate 66%) and follow-up interviews. PARTICIPANTS: Privately insured English-speaking adults ages 18-64 reporting serious psychological distress that used an outpatient mental health provider in the last year or attempted to use a mental health provider but did not ultimately use specialty services (N = 428). Follow-up interviews were conducted with 30 survey respondents. MAIN MEASURES: Whether survey respondents obtained mental health care from their primary care provider (PCP), and if so, the rating of that care on a 1 to 10 scale, with ratings of 9 or 10 considered highly rated. Interviews explored patient-reported barriers and facilitators to engagement and satisfaction with care provided by PCPs. KEY RESULTS: Of the 22% that reported they tried to but did not access specialty mental health care, 53% reported receiving mental health care from a PCP. Respondents receiving care only from their PCP were less likely to rate their PCP care highly (21% versus 48%; p = 0.01). Interviewees reported experiences with PCP-provided mental health care related to three major themes: PCP engagement, relationship with the PCP, and PCP role. CONCLUSIONS: Primary care is partially filling the gap for mental health treatment when specialty care is not available. Patient experiences reinforce the need for screening and follow-up in primary care, clinician training, and referral to a trusted specialty consultant when needed.

8-Hydroxyquinoline derived p-halo N4-phenyl substituted thiosemicarbazones: Crystal structures, spectral characterization and in vitro cytotoxic studies of their Co(III), Ni(II) and Cu(II) complexes.

The current paper deals with 8-hydroxyquinoline derived p-halo N4-phenyl substituted thiosemicarbazones, their crystal structures, spectral characterization and in vitro cytotoxic studies of Co(III), Ni(II) and Cu(II) complexes. The molecular structures of the ligands, (E)-4-(4-halophenyl)-1-((8-hydroxyquinoline-2-yl)methylene)thiosemicarbazones (halo = fluoro/chloro/bromo) are determined by single crystal X-ray diffraction method. The crystal structures reveal that the ligands are non-planar and exist in their thioamide tautomeric forms. The various physicochemical investigations of the synthesized complexes reveal metal to ligand stoichiometry to be 1:2 in Co(III) complexes whereas 1:1 in Ni(II) and Cu(II) complexes. The ligands coordinate in a tridentate NNS fashion around Co(III) centers to form an octahedral geometry and square planar geometry around Ni(II) and Cu(II) metal centers. The oxidation of Co(II) to Co(III) is observed on complexation. The synthesized compounds are subjected to in vitro cytotoxicity studies. When compared to bare ligands, the complexes show enhancement of the antiproliferative activity against MCF-7, breast cancer cell lines. The Co(III) complexes of fluoro and bromo derivatives of ligands have displayed remarkable results with roughly two fold increase in their activity in correlation to the standard drug, Paclitaxel. Moreover, the fluorescence microscopy images of cells stained with acridine orange-ethidium bromide suggest an apoptotic mode of cell death.

Bis-(2-Hydroxybenzylidene)-1H-Pyrazole 3,5-Dicarbohydrazide as a Novel Chemosensor for the Detection of Endogenous Zinc: A Fluorometric Study.

The study reports synthesis and photophysical studies of a new zinc sensing pyrazole scaffold structurally characterized to be bis(2-hydroxybenzylidene)-1H-pyrazole-3,5-dicarbohydrazide (PHSA). Excitation of the probe at 330 nm results in an emission band at 417 nm which ratiometrically red shifts to 466 nm upon Zn2+ addition in an unprecedented way. The photo induced electron transfer (PET) coupled intramolecular charge transfer (ICT) working for a dual-channel fluorescence emission pathway is observed and studies were supported with density functional theory and NMR titration experiments. The probe exhibited dissociation constant of 1.2156 and detection limit as low as 992 nM. The cytotoxic effects of the probe on 60 tumour cell lines were tested. The intracellular zinc sensing with reversible binding potential is verified with fluorescence microscopy experiment.

Nuevos compuestos que contienen núcleos 1, 3, 4-­oxadiazol y pirazol-­3-­ona. Sintesis y actividad antimicrobiana "in vitro" / Novel Compounds containing 1, 3, 4-oxadiazole and pyrazole-3-one Nuclei - Synthesis and in vitro Antimicrobial Evaluation

New series of heterocycles containing 1,3,4-oxadiazole and pyrazole-3-one moiety have been synthesized and evaluated in vitro against Staphylococus aureus NCCS 2079, Bacillus cereus NCCS 2106, Escherichia coli NCCS 2065, Pseudomanas aeruginosa NCCS 2200, Aspergillus niger NCCS 1196 and Candida albicans NCCS 2106. The compounds demonstrated moderate antimicrobial activity against selected fungal and bacterial strains

Nuevas series de compuestos heterocíclicos que contienen 1,3,4-oxadiazol y pyrazol-3-ona han sido sintetizadas y evaluadas in-vitro contra Staphylococus aureus NCCS 2079, Bacillus cereus NCCS 2106, Escherichia coli NCCS 2065, Pseudomanas aeruginosa NCCS 2200, Aspergillus niger NCCS 1196 y Candida albicans NCCS 2106. Los compuestos demostraron actividad antimicrobiana moderada contra estirpes fúngicas y bacterianas seleccionadas