bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of Drug Clearance in Preterm and Term Neonates by Minimal Physiologically Based Pharmacokinetic Model and Allometry: A Comparison with Whole BODY Physiologically Based Pharmacokinetic Model
Authors: Mahmood Iftekhar
Published: September 2023

Objectives: The objective of this study is to compare the predictive performance of a minimal physiologically based Pharmacokinetic model (mPBPK) and an allometric model with a whole body physiologically based pharmacokinetic Model (PBPK) to predict clearance of drugs in preterm and term neonates. Methods: From the literature, 6 studies were identified in which clearance of drugs in preterm and term neonates were predicted by whole body PBPK model. The mPBPK model consisted of four physiological parameters; liver and kidney weights and blood flow to these organs. From allometric models, the values of these physiological parameters were predicted in the neonates. The sum of these four physiological parameters were then used to predict CL in the neonates using adult CL values. The allometric model was based on Age Dependent Exponent Model (ADE). ADE uses different allometric exponents across the age groups. These exponents are 1.2 for preterm and 1.1 for term neonates for age 0-3 months, exponents 1.0, 0.90, and 0.75 for >3 months-2 years, >2-5 years, and >5 years, respectively. For the prediction of CL in the neonates from allometry adult CL values were used. The predicted clearance values using PBPK and mPBPK and ADE model were compared with the experimental (clinical) values. The acceptable prediction error was within 0.5-1.5-fold. Results: There were 26 drugs with 86 observations. From PBPK, mPBPK, and allometric models, 90.7%, 98.8%, and 93.0% observations were within 2-fold prediction error, respectively. From PBPK, mPBPK, and allometric models, 81.4%, 90.7%, and 84.9% observations were within 0.5-2-fold prediction error, respectively. Conclusions: This study indicates that the predictive performance of whole body PBPK, mPBPK and allometric models are essentially similar for the prediction of drug clearance in preterm and term neonates. mPBPK and allometry are much easier to develop than whole body PBPK and are as accurate and robust as whole body PBPK.
Changing trends in the diagnosis of genitourinary tuberculosis in post Covid-19 pandemic era
Authors: Krishnamoorthy Sriram , Ramachandran Kalpana
Published: September 2023

efforts to achieve a TB-free world by 2030. The health professionals and the health care support team suffered a major setback in reaching out to the patients due to various restrictions imposed on them during this pandemic period. Patients found it difficult to reach out to the health care team, owing largely to the fear factor and also due to inaccessibility to health care services. The delay in TB notifications, emergence of drug resistant strains and restrictions in the supply- chain added further to the difficulties faced. India is a nation with one of the largest numbers of TB victims. The strategic measures taken by the Government of India (GOI) took a sudden jolt with the onset of the COVID-19 pandemic. The TB elimination measures reverted back to TB containment measures. Various African countries including Ethiopia recorded a massive fall out of more than 75% during the various lockdown measures imposed. However, India took collateral measures to combat this setback. Its National Tuberculosis Elimination Programme (NTEP) involved private players to combat TB epidemic, recruited Patient provider support agencies and actively engaged Private Sectors through innovative patient provider incentives to bring down numbers of the TB victims. The diagnostic methods that took about 4 to 6 weeks to confirm the diagnosis of TB had earlier put the diagnosis and management of TB to the back seat. However, recent innovations in the molecular biology, immunology and genomic sequencing techniques have greatly aided an earlier and accurate diagnosis of tuberculosis. One individual, one health agency or one Government cannot achieve the goal TB elimination by 2030. A global effort is the basic pre-requisite, incorporating advanced molecular diagnosis and appropriate treatment would ensure achieving a TB free world by 2030.
An Examination of Organizational Messages during the COVID-19 Pandemic Using Risk Communication and Social Support Frameworks
Authors: Xie Wenjing , Damiano Amanda
Published: September 2023

Background: The COVID-19 virus continues to plague the world, though not at its alarming rate at the peak of the pandemic in 2020-2021. Throughout that time, a great deal of organizational messages were disseminated to audiences in response to the virus. Aims: This study examined organizational messages in the United States about COVID-19 between March and September 2020. The purpose of the project was to identify patterns in these organizational messages to identify where messaging can be improved to better support the public when contending with health emergencies. Method: A total of 106 organizational messages were assessed (N = 106) through risk communication and social support lenses. Results: It was found that the organizational messages provided informational, instrumental, and emotional support. Organizational messages tended to frame risks as low hazard and low outrage. Strategies involving both rational and emotional appeals were used. The most frequently promoted preventive behavior was social distancing. It was found that different organizations promoted preventive behaviors differently, specifically government using their messages to promote wearing face coverings more than other industries. Conclusions: Not only does this project fill a research gap, it also serves a practical function, as the findings can be presented to organizations as helpful information for the development of a comprehensive communication strategy during a public health situation.
Trans-Thoracic Echocardiographic Parameters for Prognostic Assessment Across the Spectrum of Heart Failure
Authors: Hameed Imran
Published: September 2023

Heart failure with increasing life expectancy has become the leading cause of morbidity and mortality in modern day world, begetting great economic burden. Usually diagnosed by specific criteria, Framingham’s being the most commonly employed, heart failure has been classified on the basis of left ventricular ejection fraction measured by transthoracic echocardiography as heart failure with preserved ejection fraction (HFpEF, LVEF ≥ 50%), heart failure with mid-range EF (HFmrEF, LVEF 41-49%) and heart failure with reduced EF (HFrEF, LVEF ≤ 40%), constituting the “spectrum”. For the diagnosis of HFpEF, elevated biochemical markers and presence of cardiac structural abnormalities or diastolic dysfunction are also required whereas for the other types only ejection fraction, with appropriate symptoms/signs are needed. It is quite clear that echocardiography plays a central role in diagnosis and classification of heart failure. Mostly, of the prognostic markers mortality and hospitalization have been assessed in clinical trials. Here also echocardiography plays a prominent role and every modality of it (with numerous parameters) including M-mode, 2D, color, spectral and tissue Doppler along with recent addition of strain imaging provide important clues. These clues not only work for heart failure as a whole but also for the individual classes. Many studies have provided insights into the comparative efficacy of these markers across the spectrum. The prognostic power of these echo parameters has been assessed either individually or in combination. Various scoring systems have also been formulated. An individual patient can transit through the classes of heart failure over time and certain echo parameters provide an indication in this regard as well. Structural parameters of both sides of the heart along with functional and hemodynamic assessment provide prognostic insights with strain measures showing superiority. No large-scale clinical trial has yet been done in which all the parameters across the spectrum of heart failure have been studied. An appraisal of clinically important echo markers for prognostic assessment across the spectrum is the subject of this descriptive review.
Single Lead Implantable Cardioverter Defibrillator (ICD) with a Floating Atrial Dipole: A Systematic Review and Non-Comparative Meta-Analysis
Authors: Freitag Andreas , Schmetz Andrea , Alili Houcine , Mehra Nishant , Smala Antje , Leventogiannis Georgios
Published: September 2023

Background: A DX implantable cardioverter defibrillator (ICD) system consists of an ICD and a shock lead equipped with two ring electrodes positioned in the atrium, referred to as the DX-lead. This system allows the collection of atrial signals using a single lead. Multiple studies on the device have been conducted over more than a decade. Aims: The aim of this study is to summarise these data in a non-comparative meta-analysis. Methods: A systematic literature review targeting publications on studies including a certain type of ICD, VR-DX ICD, was conducted. Subsequently a meta-analysis of proportions was conducted. Endpoints selected for evaluation included p-wave amplitude (at day 0, <6 months, 6-12 months and >12 months), appropriate and inappropriate shock rates, and all-cause mortality. Results: One randomised controlled trial, 11 prospective cohort studies and registries, and two retrospective studies were selected for analysis. P-wave amplitudes were consistently in a range where they can support clinical decision making across studies and remained stable over a follow-up of up to two years. Pooled shock incidence was consistent with industry standard for appropriate (10.7%) and inappropriate shocks (2.4%) across studies. All-cause mortality was at an average of 5%, increasing, as expected, with duration of study follow-up. Like shock results, mortality was within the expected range. Conclusion: This analysis shows that the VR-DX ICD system works reliably and provides an added benefit compared to single chamber ICD in the form of atrial sensing. Atrial view without requiring a second lead provides clinicians with an attractive, hardware-sparing option for the continuous monitoring of atrial activity.
Role and Limitations of Laparoscopy in Abdominal Trauma
Authors: Jr Marcelo , Tebar Gabriela , Salgueiro José , Galindo Gabriel , Hughes Joy , Sayari Ahmed , Soucy Erik , Mohseni Shahin
Published: September 2023

Trauma surgery is traditionally carried out through open procedures; however, the use of laparoscopy in stable patients has been gaining room due to favorable outcomes reported in different studies available in the literature. Nowadays, laparoscopy applied to trauma cases can be divided into screening, diagnosis, and therapeutic applications. Laparoscopic surgery application was initially limited to screening procedure focused on finding peritoneal violations; such a procedure would be followed by exploratory laparotomy. The benefits of using laparoscopy in trauma cases as diagnostic tool to rule out intra-abdominal injuries that may have gone unnoticed in computed tomography, such as diaphragmatic injuries can be easily seen. It can be used to prevent unnecessary laparotomies in patients with penetrating injuries, whose fascial breach cannot be clinically or radiologically ruled out. This paper describes the current indications for the use of laparoscopy in trauma, its potential benefits as well as complications related to the technique. We highlight and describe the importance of systematization for investigation of the peritoneal cavity as well as the expansion of indications for treatment of certain lesions by exclusive laparoscopic approach. This is due to the development of equipment as well as a greater number of surgeons trained in advanced laparoscopic surgery. We also present the main potential complications related to the method as well as the limitations still encountered today.
ASSESSMENT OF BIODENTINE PULPOTOMY AS AN ALTERNATIVE TO CONVENTIONAL ROOT CANAL TREATMENT FOR PERMANENT TEETH IN CHILDREN-AN IN VIVO STUDY
Authors: T.A mubeena , Adyanthaya Amith , Raheema Marium , R.V Anju , Nair Karthik , Ismail Asif , K.K Afroza , Gopan Gopika , M.U Preema
Published: September 2023

A vital pulp tissue is responsible for supporting the tooth structure through reparative dentin production. Preserving pulp vitality is essential in maintaining vascularization and nutrition to the tooth that eventually will support tooth structure & reduce teeth mortality. Root canal treatment for permanent teeth in children is a complex procedure requiring lengthy appointments and multiple visits and often require a full coverage restoration. on the other hand vital pulpotomy requires shorter appointments and usually accomplished in one visit. Vital pulp therapy can help to retain vital permanent teeth that are able to withstand normal function. Vital pulp therapy (VPT) has been increasingly considered as a minimally invasive approach for the management of teeth with inflamed pulps compared to the conventional approach of root canal treatment. Aim To assess the outcome of Biodentine in complete coronal pulpotomy in permanent teeth with symptomatic reversible pulpitis. Methodology In the present study 30 healthy children of age below 12 years requiring pulpotomy were selected after clinical and radiographic assessment. Pulpotomy technique was carried out after local anaesthesia and rubber dam application. After exposure, pulp was amputated to the level of canal orifices (full pulpotomy) using a sterile spoon excavator and high-speed round bur under water coolant. Hemostasias is achieved by cotton pellet moistened with 3 % NaOCl for 2 minutes and repeat as needed, after haemostasis achieved Biodentine was mixed according to the manufacturer’s instructions and gently placed over the pulp to a thickness of 2-3 mm and after that a permanent restoration was placed. All treated patients were followed up at 3-month,6-month,9-month interval for clinical and radiographic evaluation. Resulting data were tabulated and statistically analyzed. Results. Out of the 30 study samples,2 patient cases revealed abnormal clinical and radiographical changes at the end of 3 months and one more patient reported with pain and tenderness to percussion at the end of 6 months. At the end of 9 months follow up, clinical and radiographical success rate was 90.0% respectively. Conclusion Biodentine as a pulpotomy agent has a high successful rate and fulfilled all requirements of an ideal pulpotomy medicament.
Late and Distant Metastases of Retinoblastoma to Long Bones: A Purpose of a Case
Authors: Willians Luis , Marin Marthelena
Published: September 2023

The case of a 13-year-old male patient is presented, with a history of Bilateral Retinoblastoma since he was 2 years old, undergoing enucleation of the right eye in June 2007, and salvage of the left eye by chemotherapy and radiotherapy, said patient 11 years after This episode presented metastasis in the distal end of the right radius, performing neoadjuvant treatment and subsequent wide oncological resection with healthy margins of the distal end of the radius plus reconstruction with the proximal end of the ipsilateral fibula and arthrodesis of the wrist. . It is important to point out that distant bone involvement and that of long bones are very few cases reported in the literature, therefore this case was a challenge for diagnosis and treatment, since a retinoblastoma was obtained that metastasized 12 years later. of the enucleation of the eye with the primary tumor and in turn performed it in the long bone (radius), it is emphasized that said patient was followed up free of disease for 2 years after surgery (wrist fusion). Given the limitations of knowledge of the genetics of retinoblastoma metastasis to long bones, not all alterations are currently known. It is considered that a genetic study should be done in patients diagnosed on time.
Challenges in Thyroid Function Testing: Interferences and Clinical Implications
Authors: Carvalho Gisah , Drobrzenski Beatriz
Published: September 2023

In recent decades, significant advancements have been made in the methodologies used for evaluating thyroid dysfunctions. These advancements include the development of radioimmunoassays, immunometric assays, and liquid chromatography coupled with mass spectrometry. The main thyroid function tests include thyroid-stimulating hormone (TSH) and the measurement of triiodothyronine (T3) and thyroxine (T4), including their total and free fractions. Over time, different generations of TSH tests have been developed, starting from radioimmunoassays to immunometric assays, and more recently, tests utilizing fluorophores and chemiluminescent molecules. The third-generation tests are currently the most widely used due to their high sensitivity and specificity. Thyroid-stimulating hormone is preferred as the initial test for evaluating thyroid function since it has a log-linear relationship with free T4 levels, enabling the identification of subclinical hypothyroidism and subclinical hyperthyroidism. The reference range for normal TSH levels is typically between 0.45 and 4.5 mIU/L. However, there can be variations in TSH levels based on factors such as sex, age, and ethnicity. Specific reference values may be required for certain populations, such as the elderly, pregnancy, and neonates. In the elderly, an increase in TSH levels is expected. In the neonatal period, TSH levels are high after birth and take a few weeks to normalize. During pregnancy, various physiological changes occur, leading to alterations in thyroid hormones to meet fetal demands. Laboratory interferences in thyroid hormone assays must be considered to ensure accurate results. Biotin interference can lead to falsely low TSH and falsely high free T3 and T4 levels. Macro-thyrotropin can cause elevated TSH levels with normal thyroid hormone levels. Heterophilic antibodies can also cause false results. Additionally, the evaluation of autoantibodies and markers used in thyroid cancer follow-up needs special attention. Patients experiencing conditions like trauma, particularly in severe cases, may undergo changes in thyroid hormone levels, even without having a specific thyroid disease, which is called low triiodothyronine syndrome. In conclusion, it is essential to be aware of potential laboratory interferences and consider individual variations to ensure accurate interpretation and appropriate management of patients.
Mask-Wearing Onboard Airplanes During COVID-19 - Identifying Passenger Segments Using Cluster Analysis
Authors: Yu Pan , Dahai Liu
Published: September 2023

The COVID-19 crisis has had an unprecedented impact on air traffic, but its long-term effect on how people view and conduct air travel could be more significant. While some studies have identified factors that can affect the perception of COVID-19 and behaviors in transportation, few have examined factor impact at the segment level, especially with respect to mask-wearing as a protective measure onboard airplanes during COVID-19. This study fills the research gap by identifying passenger segments with different perceptions of mask use onboard airplanes, and which factor in the theory of planned behavior (TPB) model can be best distinguished in the different segments. Survey data was collected from MTurk for cluster analysis, which considered the comfort of mask-wearing, risk avoidance, and information-seeking jointly as the cluster variates. The analysis led to the formation of three passenger segments: 1) Comfort First – most attention was paid to the comfort of mask-wearing; 2) Risk Avoider – the greatest importance was given to avoiding the risk and searching for information about COVID-19; and 3) Balanced Group – having a balanced view on the importance of the three cluster variables. The multinomial logistic regression analysis showed that the three passenger segments differed most in their attitude toward masks, suggesting that attitude, compared to the other two TPB constructs (subjective norms and perceived behavioral control) can best predict the cluster membership of air travelers with regards to mask-wearing onboard airplanes. The findings provide useful guidance for the airline industry to recover safely and effectively from the COVID-19 pandemic, and may aid in preparations for future pandemics.
Characterization of Extended Spectrum β-lactamase and AmpC Producing Organisms Isolated from a Third Level Hospital Patients in Dominican Republic
Authors: Roque Yori , Luna David , Calo Silvia , Lora Alfredo
Published: September 2023

Extended-spectrum β-lactamases (ESBLs) producing Enterobacteriaceae have become a challenge for clinicians as they frequently show co-resistance to other antibiotic classes. AmpC-type β-lactamases (AmpCs), tend to be more difficult to treat as they could be induced during antibiotic therapy. To characterize ESBLs and AmpCs producing organisms, we collected clinical samples identified through MicroScan® as members of the Enterobacteriaceae family and ESBLs producers, following Clinical Laboratory Standards Institute indications, from January through March 2021, in a third level hospital in Santiago de Los Caballeros, Dominican Republic. Samples underwent manual confirmation via ESBL + AmpC screen discs kit (Liofichelm® srl, Italy) and a genotype analysis was done by DNA extraction for detection of specific genes related with ESBL ((blaSHV, blaTEM, blaCTX, and blaCMY-4) or AmpC (CIT, MOX, DHA and FOX) expression. 54 samples were confirmed as ESBL and/or AmpC producers with Escherichia coli as the most frequent (33/61%) followed by Klebsiella sp. (9/17%). blaCTX was detected in 29 (67%) isolates, followed by blaTEM (23/53%) and blaSHV (18 /40%) . Among the AmpC encoding genes, DHA and CIT gene pools were detected in 3 (7%) and 2 (5%) of the samples, respectively. Two or more genes were detected in 19 (44%) samples. All the AmpC genes were found in an isolate which already had, at least, two other β-lactamase encoding genes. In this cohort, ESBLs and AmpCs -producing organisms with multiple resistance genes were detected. Efforts to curb antibiotic availability and to establish antimicrobial stewardship programs are needed.
Dr Cerebrolysin Improves Motor Abilities and Reverses the Long-Term Memory Acquisition Deficit in Rats with Hypoxic-Ischemic Encephalopathy
Authors: Zavalza Ericka , Leyva Celia , Lozano MAnuel , Flores Gonzalo , Martínez-Fong Daniel , Chávez Bertha , Anguiano Anabel , Barrios Juan
Published: September 2023

Background: Hypoxic-ischemic encephalopathy (HIE) is a neurological condition that leads to motor disabilities and even death in neonates. Unfortunately, few therapeutic alternatives can contribute to brain recovery after HIE damage. Cerebrolysin is a neuropeptide mixture that performs neuroprotective and neurotrophic effects on injured brain tissue after systemic administration. Aims: This study evaluates the effects of the Cerebrolysin intraperitoneal administration, Methods:10 mL/kg; once a day for 7 days, since postnatal day 8 (PD8) to PD14 on the neonatal neurobehavior in an HIE rat model was administrated. Results: Cerebrolysin administration after a hypoxic-ischemic insult minimized brain damage and increased cellular viability. Furthermore, this neuroprotective effect lasted until adulthood, improving some motor abnormalities and reversing the long-term memory acquisition deficit caused by HIE. Conclusion: Repeated Cerebrolysin administration can reduce HIE Motor Disabilities and Reverses the Long-Term Memory Acquisition Deficit in neonatal rats safely and effectively.
Understanding exercise adherence in a prospective cohort study of patients with COPD: Extending the Theory of Planned Behavior with the concept of alliance.
Authors: Ricke Ellen , Dijkstra Arie
Published: September 2023

Introduction: Pulmonary rehabilitation (PR) is considered an important method of improving health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). A critical component to the success of PR is exercise adherence, which is often lower than 50%. When there is a better understanding on the psychological determinants of adherence, theory-informed interventions can be developed to improve adherence. Therefore, the aim of this study was to examine the utility of the Theory of Planned Behavior (TBP) in combination with the therapeutic alliance in explaining exercise adherence in a prospective cohort study of PR in patients with COPD to ultimately increase adherence with psychological interventions. In addition, we examined the influence of the TPB determinants and alliance in combination with clinical determinants on adherence. Methods: At baseline, 196 patients from 53 physiotherapy practices in the Netherlands and Belgium completed measures of the TPB, and disease and demographic characteristics. After three months they completed measures of alliance. Their physiotherapist provided exercise adherence measures after 12 months. Data were analyzed using Spearman’s correlations, hierarchical linear multiple regression analyses (HMRA) and mediation analysis. Results: HMRA indicated that intention (b = 0.72; p < 0.001) and alliance (b = 0.26; p < 0.001) explained 24.8% of the variance in exercise adherence. After adding MRC dyspnea score and depression to the model, 35.6% of the variance could be explained. Perceived behavioral control, attitude, and alliance, explained 37.9% of variance in exercise intention. The effect of alliance on adherence was partially mediated by intention. Conclusion: Extending the TPB with the concept of alliance is a promising innovation to understand exercise adherence of patients who are coached by a health care professional. Healthcare providers should obtain information about their patients’ attitudes, perceived behavioral control, and alliance, to inform their coaching and further psychosocial interventions. Concrete recommendations are provided for effectively addressing these psychosocial determinants of adherence within the patient-coaching relationship.
Managing Genu Varum in Adolescents to Reduce Risks of Progression to Knee Osteoarthrosis
Authors: Ng Yin-Ling , Ng Shu-Yan
Published: September 2023

Introduction: Genu varum is not uncommon in adolescents. Managing the condition to reduce its progression may decrease the prevalence of incident knee osteoarthrosis in adulthood. The present review examines studies on risk factors contributing to the progression of genu varum and associated with the degeneration of the medial tibiofemoral joint. We proposed approaches to decrease the magnitude of genu varum and external knee adduction moment, to reduce the incidence of knee osteoarthrosis in the aged population. Methods and Materials: Literature searches were conducted in Pubmed, Embase, and Cochrane Systematic Reviews, using keywords individually and in combinations. We excluded papers on pathological genu varum, tibia vara, Blount disease, nutritional rickets, imaging, and surgery and included only articles on genu varum involving children and young adults. Reference lists of the included papers were also screened manually for additional references. Results and Discussion: Search results showed that many children with physiologic genu varum are deficient or insufficient in vitamin D. High-impact exercises in late children and adolescents promote genu varum. In contrast, therapeutic exercises reduce the magnitude of genu varum in young adults with postural bowlegs. Lateral wedge insoles decrease the external knee adduction moment. We proposed to check the serum vitamin D level of children and adolescents with genu varum. Growing children with genu varum should be advised to reduce the frequency of performing high-impact exercises. Adolescents with genu varum should strengthen the external hip rotators and use lateral wedged insoles.
Challenges and Opportunities in Thoracic Robotic Surgery
Authors: Razi Adli
Published: September 2023

Robotic surgery is a platform for minimally invasive thoracic surgery with similar general advantages as in VATS (Video Assisted Thoracic Surgery) including small incisions, faster recovery, minimal blood loss and shorter hospital stay. The extra advantages of using a robotic platform in thoracic surgery include a three-dimensional surgical view, elimination of physiological tremors, and enabling surgical manipulation in a natural orientation because of the presence of forceps that move in the same manner as human wrist joints. These advantages allow more complex procedures to be performed safely and easier technically, thus leading to better outcomes and improvement in the overall result. As a new advance in thoracic surgery, it has challenges that may become the reason why this technique has difficulty being adopted by a number of surgeons including cost, advancement in VATS technique and instrumentation. Despite the challenges, robotic thoracic surgery offers the platform for the expansion and improvement of thoracic surgery. Development in instrument technologies and designs, in addition to progress and interest in other futuristic technology, are notable opportunities for thoracic robotic surgery.
US Opioid Guidelines 2022 – More and Less Than Meets The Eye
Authors: Lawhern Richard
Published: September 2023

The United States is currently embroiled in a contentious and multi-dimensional public conversation about addiction-related mortality, chronic pain, and government regulation of clinicians who employ opioid analgesic pain relievers in treating pain. The US Centers for Disease Control and Prevention (CDC) have published and updated guidelines to clinicians concerning appropriate practices for managing severe chronic pain by means of opioid analgesic pain relievers. This Critical Policy Review briefly outlines the history of US public health policy on regulation of prescription opioid pain relievers. The author then compares recommendations and data sources of the updated November 2022 CDC guidelines against findings from a wide range of pertinent clinical literature. He finds that the most recent effort by CDC is fatally flawed by weak evidence and methodologically unsound research, disproportionate emphasis on risk, and failure to address genetically mediated variability in minimum effective opioid dose between individuals. Compounding these difficulties are indications of professional conflicts of interest and persistent anti-opioid bias on the part authors of the most recently released CDC guidelines.
Review Efficacy and theoretical basis of low-intensity shock wave therapy in the management of different forms of wound healing – own experiences and a review of the literature
Authors: Rassweiler Jens , Ringeisen Martin , Knobloch Karsten , Schaden Wolfgang
Published: September 2023

Objectives: Wound healing is a complex process that involves inflammation, proliferation, and tissue remodeling to restore damaged tissue integrity. Chronic wounds and ulcers, with incomplete healing and a high risk of recurrence, pose significant challenges to conventional treatments. Extracorporeal Shock Wave Therapy (ESWT) has emerged as a promising wound healing therapy. Material and Methods: In this review, we summarize the current state of ESWT for wound management based on personal experiences and a comprehensive literature review. Among 184 data sources from 1990 to 2022, 19 relevant publications were identified, including systematic reviews, meta-analyses, and clinical studies applying focused and radial ESWT for various wound types. Results: ESWT's mechanism of action involves generating focused or radial shock waves, stimulating tissue repair through angiogenesis, fibroblast proliferation, and collagen expression. Data extracted from systematic reviews showed positive outcomes for wound healing, healing rate, and wound area reduction for chronic wounds such as diabetic foot ulcers, pressure ulcers, and venous ulcers. Studies on radial ESWT revealed similar positive effects in pain reduction and wound healing, with no serious adverse events reported. ESWT exhibited a well-tolerated safety profile, with minor and transient side effects such as reddening, swelling, and mild pain at the treatment site. Comparatively, Hyperbaric Oxygenation Therapy (HBO), an alternative treatment option, showed unique adverse events not observed with ESWT. Our evaluation confirms ESWT as a safe and effective treatment for wound management, offering hope for patients with chronic wounds or ulcers. Conclusions: ESWT presents a compelling non-invasive and safe treatment option for various wound healing challenges, improving outcomes for patients with chronic wounds and ulcers. This review highlights the potential of ESWT as an advanced wound healing therapy, complementing conventional approaches. Further studies should explore potential differences between focal and radial ESWT for wound healing.
Knowledge, attitude, practice about awareness of basic life support facilities for medical emergencies among dental practitioners: a cross sectional questionnaire study
Authors: Fegade Anushree Ashish , Pereira Treville , Anjali A. K. , Lalai Megha , Pereira Christina , Kallianpur Ruchika
Published: September 2023

Background: Healthcare professionals should be trained in basic life support (BLS), as it is a basic skill which can save lives if implemented timely. An ability to react immediately to the emergency at hand and having the proper equipment and drugs needed for the emergency, can mean the difference between successful management and failure.  Objective of this study is to assess the knowledge, awareness and attitude of dental practitioners towards BLS facilities.
Methods: This is a cross sectional study conducted from January to March 2021 among 250 dental interns, BDS and MDS doctors by assessing responses to 10 selected questions pertaining to BLS among dental practitioners in Mumbai/Navi Mumbai. Inclusion criteria: BDS, MDS doctors.
Results: The results of my study showed that almost (77.5%) enquire about medical history. Only (32.2%) felt competent in responding to emergency situation at clinics. (46.6%) were confident about administrating IV, I.M injections and performing cardiopulmonary resuscitation (CPR). They were also assessed for the emergency drugs and emergency kits, which were available with (49.5%).
Conclusions: The survey shows that there is substantial lack of BLS knowledge among dental practitioners. Prompt recognition & efficient management of medical emergencies can increase the likelihood of a satisfactory income. This is feasible by incorporating BLS in academic curriculum on regular basis and through hands on workshops.
Comparison of physics forceps to conventional forceps in simple dental extraction
Authors: Sambyal Shanender Singh , Saxena Vivek , Gopalkrishnan V. , H. Rangarajan , Kumar Andrews Navin
Published: September 2023

Background: In this study, Conventional forceps & Physics forceps were compared in simple dental extractions with respect to crown and root fracture of tooth during extraction, alveolar bone plate fracture, gingival laceration, requirement of sutures, duration of surgery, comparative pain evaluation through visual analogue scale and analgesic requirement in the first 24 hours post operatively.
Methods: This study was conducted at our centre where 200 patients requiring simple dental extractions were randomly divided into two groups, each having 100 patients. Extractions in one group were done using Conventional forceps and in other group were done using Physics forceps. All parameters were measured during surgery & questionnaires were given to all the patients to assess the pain perception & analgesic requirement postoperatively till 24 hours.
Results: The results of present study showed decreased incidence of crown and root fracture of tooth, alveolar bone plate fracture, gingival lacerations, requirement of sutures, lesser duration for extraction and lesser pain perception in Physics forceps group. No significant difference was found between two groups for analgesic intake.
Conclusions: Physics forceps group patients had superior results compared to patients in Conventional forceps group which may be attributed to lesser hard and soft tissue injuries and better pain control in Physics forceps group.
Molecular characterization of typing and subtyping of Staphylococcal cassette chromosome SCCmec types I to V in methicillin-resistant Staphylococcus aureus from clinical isolates from COVID-19 patients
Authors: Jadhav Vivekanand , Bhakare Meenakshi , Paul Arundhuti , Deshpande Sumedh , Mishra Madhusmita , Apte-Deshpande Anjali , Gupta Neetu , Jadhav Savita V
Published: September 2023

Background and Objectives: Methicillin resistance is acquired by the bacterium due to mecA gene which codes for pen- icillin-binding protein (PBP2a) having low affinity for β-lactam antibiotics. mecA gene is located on a mobile genetic el- ement called staphylococcal cassette chromosome mec (SCCmec). SCCmec genomic island comprises two site-specific recombinase genes namely ccrA and ccrB [cassette chromosome recombinase] accountable for mobility. Currently, SCCmec elements are classified into types I, II, III, IV and V based on the nature of the mec and ccr gene complexes and are further classified into subtypes according to variances in their J region DNA. SSCmec type IV has been found in community-ac- quired isolates with various genetic backgrounds. The present study was undertaken to categorize the types of SCCmec types and subtypes I, II, III, IVa, b, c, d, and V and PVL genes among clinical MRSA isolates from COVID-19 confirmed cases.
Materials and Methods: Based on the Microbiological and Molecular (mecA gene PCR amplification) confirmation of MRSA isolated from 500 MRSA SCCmec clinical samples, 144 cultures were selected for multiplex analysis. The multiplex PCR method developed by Zhang et al. was adapted with some experimental alterations to determine the specific type of these isolates.
Results: Of the total 500 MRSA, 144 MRSA (60 were CA-MRSA and 84 were HA-MRSA) were selected for characteriza- tion of novel multiplex PCR assay for SSCmec Types I to V in MRSA. Molecular characterization of multiplex PCR analysis revealed results compare to the phenotypic results. Of the 60 CA-MRSA; in 56 MRSA strains type IVa was found and signifi- cantly defined as CA-MRSA while 4 strains showed mixed gens subtypes. Type II, III, IA, and V were present in overall 84 HA-MRSA. Molecular subtyping was significantly correlated to define molecularly as CA-MRSA and HA-MRSA however 15 (10%) strains showed mixed genes which indicates the alarming finding of changing epidemiology of CA-MRSA and HA-MRSA as well.
Conclusion: We have all witnessed of COVID-19 pandemic, and its mortality was mostly associated with co-morbid con- ditions and secondary infections of MDR pathogens. Rapid detections of causative agents of these superbugs with their changing epidemiology by investing in typing and subtyping clones are obligatory. We have described an assay designed for targeting SSCmec types and subtypes I, II, III, IVa,V according to the current updated SCCmec typing system. Changing patterns of molecular epidemiology has been observed by this newly described assay.
Bacterial etiology, antimicrobial resistance and factors associated with community acquired pneumonia among adult hospitalized patients in Southwest Ethiopia
Authors: Mussema Abdulhakim , Beyene Getenet , Kebede Gudina Esayas , Alelign Dagninet , Mohammed Tofik , Bawore Solomon Gebre , Mohammed Seid Abdurezak , Tadesse Wondwossen , Gashaw Mulatu
Published: September 2023

Background and Objectives: Antibiotic resistance is a significant problem that restricts the options for treating bacterial pneumonia. This research aimed to determine the bacterial causes of pneumonia and antibiotic resistance among hospitalized patients in southwest Ethiopia.
Materials and Methods: We collected and analyzed 150 sputum samples from individuals with community-acquired pneu- monia from April 1st  to October 30th, 2019. Standard bacteriological procedures were used to identify the bacteria. Kirby Bauer's disk diffusion method was used to assess the bacteria's susceptibility patterns. Production of carbapenemase and extended-spectrum-lactamase were confirmed phenotypically. Odds ratios and the chi-square test were computed.
Results: On the whole, bacterial pathogens were verified in 50% of the sputum samples. The predominant bacterial isolates were Klebsiella species, followed by Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pneumoniae. About 77.5% of isolates were multidrug resistant. Moreover, 40.5% and 10.8% of the isolates were ESBL and carbapene- mase producers, respectively. Aging, tobacco smoking, previous history of pneumonia, heart disease, and chronic respiratory disease had association with sputum culture-positivity.
Conclusion: As a result, it is important to regularly monitor the bacterial etiologies and their patterns of resistance. Addition- ally, sociodemographic and clinical characteristics should all be taken into account while managing patients with pneumonia empirically in this context.
Prevalence of Gardnerella vaginalis infection and antibiotic resistance pattern of isolates of gynecology clinic patients at Shahriar Noor Hospital from January to June 2020 by PCR and culture methods
Authors: Rashidifar Saghi , Harzandi Naser , Jahromi Sahar Honarmand , Gharavi Mohammad Javad
Published: September 2023

Background and Objectives: Gardnerella vaginalis is one of the most important causes of prevalent genital infections that pose serious risks. This study aimed to determine the prevalence of Gardnerella vaginalis and antibiotic resistance pattern of isolates of patients referred to the gynecology clinic of Shahriar Noor Hospital by PCR and culture methods.
Materials and Methods: The study was conducted on 500 patients who had suffered from a vaginal infection. The demo- graphic data of patients were studied. For diagnosis of Gardnerella vaginalis isolates, cultivation in anaerobic conditions, biochemical tests, PCR and Gardnerella vaginalis antibiotic susceptibility test to metronidazole and clindamycin were per- formed. Data analysis was performed utilizing SPSS statistical software version 19 and the Chi-square test.
Results: Among the 500 patients, 173 were diagnosed with Gardnerella vaginitis. There was a significant relationship be- tween age group, level of education, and contraceptive method with Gardnerella vaginosis incidence. Performing antibiotic susceptibility tests showed that the resistance of Gardnerella vaginalis isolated strains to metronidazole and clindamycin was 86.12% and 17.34%, respectively.
Conclusion: The high prevalence of Gardnerella vaginalis infections confirms the critical role of the bacterium in the oc- currence of bacterial vaginosis. Therefore, it is necessary to check the prevalence of bacterial infections to recommend the correct medical treatment in different societies.
Characterization of beta-lactamase producing Enterobacterales isolated from an urban community wastewater treatment plant in Iran
Authors: Hasani Kamal , Sadeghi Hadi , Vosoughi Mehdi , Sardari Mehran , Manouchehrifar Meysam , Arzanlou Mohsen
Published: September 2023

Background and Objectives: he occurrence and characteristics of Extended Spectrum- and AmpC-β-lactamase producing Enterobacterales (ESBL-PE and AmpC-PE) in an urban wastewater treatment plant (WWTP) were investigated.
Materials and Methods: A total of 30 wastewater samples were collected from all sections of WWTP. Enterobacterales were isolated and identified using standard microbiological tests. The antibiotic resistance profile was determined by the Kir- by–Bauer disk diffusion method. Phenotypic screening for ESBL-PE and AmpC-PE isolates was performed by double-disk synergy and boronic acid disk potentiation tests, respectively. The isolates were examined for AmpC- and ESBL-encoding genes by PCR and sequencing methods.
Results: Among 146 Enterobacterales isolates, 8.9% (n=13) [ESBL-only; 5.48% (n=8) and ESBL + AmpC; 3.42% (n=5)] were ESBL-producers and 15.75% (n=23) [AmpC-only; 12.33% (n=18) and ESBL + AmpC; 3.42% (n=5)] AmpC-produc- ers. Hafnia spp. with 33.33% (n=1/3) and E. coli with 20.58% (n=7/34) [ESBL-only; 17.64% (n=6/34) and ESBL + AmpC; 2.94% (n=1/34)] were the most common ESBL-producing bacteria. Enterobacter spp. with 37.50% (n=6/16) of isolates were the most common AmpC-producing organisms. ESBL- and/or AmpC-producing isolates were identified in all parts of the WWTP including 80% (n=8/10) of samples taken from effluent. Among ESBL-producing isolates, bla CTX-M TEM , and bla SHV ESBL-encoding genes were found in 61.5% (n=8), 15.3% (n=2), and 7.7% (n=1) of isolates, respectively. All CTX-M- type enzymes belonged to the CTX-M-1 group and CTX-M-15 subgroup. bla TEM and bla SHV type genes belonged to bla TEM-20 and bla HSV-12 subtypes, respectively. bla with 73.9% (n=17/23), and bla CIT and bla with 30.4% (n=7/23) each, were the most common AmpC-encoding genes among AmpC-producing isolates. Overall, 75% of ESBL-producing and 55.5% of AmpC-producing isolates exhibited multi-drug resistance phenotypes. The organisms were most resistant against ampicillin (82.2%) nalidixic acid (43.8%) and cephalexin (41.1%).
Conclusion: ESBL- and AmpC-producing Enterobacterales spp. with diverse genetic resistance backgrounds in WWTP effluent poses a significant risk to public health.
Evaluation of anti-biofilm activity of Lactobacillus rhamnosus GG and Nisin on the expression of aap, ica-A and ica-D as biofilm-associated genes of Staphylococcus epidermidis
Authors: Dalvand Mohammad , Mirhosseini Seyed Ali , Amini Kiumarss , Khani Soghra , Hosseini Hamideh Mahmoodzadeh , Mansoori Kowsar
Published: September 2023

Background and Objectives: In the present study, the anti-biofilm activity of Lactobacillus rhamnosus GG and Nisin was investigated on biofilm-forming abilities of Staphylococcus epidermidis strains and the expression of the biofilm-associated genes.
Materials and Methods: In this study, the standard strain of L. rhamnosus GG (ATCC 53103) and Nisin were used to assess their anti-microbial and anti-biofilm effects on S. epidermidis (RP62A).
Results: The MIC and MBC analysis showed that Nisin at 256 μg/mL and 512 μg/mL, and L. rhamnosus GG at 1×107 CFU/ mL and 1×108 CFU/mL have anti-microbial activity compared to the negative control respectively. L. rhamnosus GG bacteria and Nisin inhibited the biofilm formation of S. epidermidis based on optical density of at 570 nm (P <0.001). The relative mRNA expression of aap, icaA, and icaD genes was significantly reduced compared to the negative control after treating S. epidermidis with sub-MIC of Nisin (0.44, 0.25 and 0.6 fold, respectively) (P>0.05). In addition, the relative expression of aap and icaA genes, but not icaD (P>0.05), was significantly lower than the negative control (0.62 and 0.7 fold, respectively) (P>0.05), after exposure to the sub MIC of L. rhamnosus GG.
Conclusion: Nisin and L. rhamnosus GG exhibit potent activity against biofilm-forming abilities of S. epidermidis and these agents could be utilized as an anti-biofilm agents against S. epidermidis infections.