Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

PURPOSE

In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials.

METHODS

We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021.

RESULTS

2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28.

CONCLUSIONS

HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.

Effects of fresh-cow grouping strategy and rumen-protected glucose on production performance, reproductive variables and risk of culling in Holstein cows

BACKGROUND

The interaction effects of duration of stay in fresh-cow diet and supplementation with rumen-protected glucose (RPG) on productivity of dairy cows are largely unknown. We hypothesised that a faster transition from fresh-cow diet (higher forage:concentrate) to lactation-cow diet (lower forage:concentrate), combined with supplementation of fresh-cow diet with RPG will have positive effects on production and health of dairy cows.

OBJECTIVES

To investigate the immediate and long-term effects of length of stay in fresh-cow diet and supplementation with RPG on productive and reproductive performance of high-producing dairy cows.

METHODS

A total of 264 multiparous Holstein cows (average parity ± standard deviation = 3.2 ± 1.3, ranging from 2 to 6) were used in a 2 × 2 factorially arranged trial. Treatments were the feeding duration of a fresh-cow diet for 14 or 21 days, each combined by daily supplementation of the fresh-cow diet with ground corn grain or RPG product top dressed at 500 g/day/head.

RESULTS

The earlier transition from fresh-cow to lactation diet resulted in greater milk production from 15 through 21 days in milk (DIM; by 2.28 kg/day), and also fat-corrected milk production on 30 and 60 DIM, respectively. Corn grain or RPG supplementation did not affect the average milk production (1 to 21 DIM), as well as milk production and composition on 30 and 60 DIM. Although extent of body condition loss at transition tended to be lesser in cows switching faster to lactation diet, these cows lost more body condition from 30 to 90 DIM. Survival analysis on calving-to-conception interval and time to removal from herd did not find any significant difference across treatments.

CONCLUSIONS

The positive effects of earlier transition from fresh-cow to lactation diet were evident by greater milk production from 15 through 21 DIM, and fat-corrected milk production (30 and 60 DIM), at the expense of body condition in high-producing dairy cows. A daily topdress of RPG on fresh-cow diet had no immediate or carryover effects on production of dairy cows.

Lessons learned from COVID-19 pandemic: Vaccine platform is a key player

The SARS-CoV-2 outbreak and emergence of COVID-19 resulted in the development of different vaccines based on various platforms to combat the disease. While the conventional platforms of inactivated/live attenuated, subunit proteins and virus-like particles (VLPs) have provided efficient and safe vaccines, novel platforms of viral vector- and nucleic acid-based vaccines opened up new horizons for vaccine development. The emergence of COVID-19 pandemic showed that the availability of platforms with high possibility of quick translation from bench to bedside is a prerequisite step in vaccine development in pandemics. Moreover, parallel development of different platforms as well as considering the shipping, storage condition, distribution infrastructure and route of administration are key players for successful and robust response. This review highlights the lessons learned from the current COVID-19 pandemic in terms of vaccine development to provide quick response to future outbreaks of infectious diseases and the importance of vaccine platform in its storage condition and shipping. Finally, the potential application of current COVID-19 vaccine platforms in the treatment of non-infectious diseases has been discussed.

Novel 2-substituted-5-(4-chloro-2-phenoxy)phenyl-1,3,4-oxadiazole derivatives, ligands of GABAA/benzodiazepine receptor complex: Design, synthesis, radioligand binding assay, and pharmacological evaluation

Agonists of Benzodiazepine (BZD) receptor are exhaustively used in the control of muscle spasms, seizure, anxiety, and insomnia. BZDs have some unwanted effects; therefore, the development of new BZD receptor agonists with better efficacy and fewer unwanted effects is one of the subjects of interest. In this study, based on the pharmacophore/receptor model of the BZD binding site of GABA_A receptors, a series of new 2-substituted-5-(4-chloro-2-phenoxy)phenyl-1,3,4-oxadiazole derivatives (6a-f) were designed. Energy minima conformers of the designed compounds and diazepam were well matched in conformational analysis and showed proper interaction with the BZD-binding site of the GABA_A receptor model (α1β2ϒ2) in docking studies. The designed compounds were synthesized in acceptable yield and evaluated for their in vitro affinity to the benzodiazepine receptor of rat brains by radioligand receptor binding assay. The results demonstrated that the affinities of most of the novel compounds were even higher than diazepam. The novel compound 6a with the best affinity in radioligand receptor binding assay (K_i=0.44 nM and IC₅₀= 0.73±0.17 nM) had considerable hypnotic activity and weak anticonvulsant and anxiolytic effects with no negative effect on memory in animal models. Flumazenil as a selective benzodiazepine receptor antagonist was able to prevent hypnotic and anticonvulsant effects of 6a indicating the role of BZD receptors in these effects.

Bacterial profiles and their antibiotic resistance background in superinfections caused by multidrug-resistant bacteria among COVID-19 ICU patients from southwest Iran

This study investigated the bacterial causes of superinfections and their antibiotic resistance pattern in severe coronavirus disease 2019 (COVID-19) patients admitted to the intensive care unit (ICU) of Razi Hospital in Ahvaz, southwest Iran. In this cross-sectional study, endotracheal tube (ETT) secretion samples of 77 intubated COVID-19 patients, confirmed by reverse transcription-quantitative polymerase chain reaction, were investigated by standard microbiology test and analytical profile index kit. Antibiotic susceptibility testing was performed by disc diffusion. The presence of Haemophilus influenzae and Mycoplasma pneumoniae was investigated by the polymerase chain reaction (PCR). Using culture and PCR methods, 56 (72.7%) of the 77 COVID-19 patients (mean age of 55 years, 29 male and 27 female) had superinfections. Using culture, 67 isolates including 29 (43.2%) Gram-positive and 38 (56.7%) Gram-negative bacteria (GNB) were identified from 49 COVID-19 patients. The GNB were more predominant than the Gram-positive pathogens. Klebsiella pneumoniae (28.4%, n = 19/67) was the most common isolate followed by Staphylococcus aureus (22.4%, n = 15/67). Using PCR, 10.4% (8/77) and 11.7% (9/77) of ETT secretion specimens had H. influenzae and M. pneumoniae amplicons, respectively. Gram-positive and Gram-negative isolates showed high resistance rates (>70.0%) to majority of the tested antibiotics including fluoroquinolone, carbapenems, and cephalosporins and 68.7% (46/67) of isolates were multidrug-resistant (MDR). This study showed a high frequency rate of superinfections by MDR bacteria among COVID-19 patients in southwest Iran. The prevention of long-term consequences caused by COVID-19, demands continuous antibiotic surveillance particularly in management of bacterial superinfections.

Integrating machine learning and digital microfluidics for screening experimental conditions

Digital microfluidics (DMF) has the signatures of an ideal liquid handling platform - as shown through almost two decades of automated biological and chemical assays. However, in the current state of DMF, we are still limited by the number of parallel biological or chemical assays that can be performed on DMF. Here, we report a new approach that leverages design-of-experiment and numerical methodologies to accelerate experimental optimization on DMF. The integration of the one-factor-at-a-time (OFAT) experimental technique with machine learning algorithms provides a set of recommended optimal conditions without the need to perform a large set of experiments. We applied our approach towards optimizing the radiochemistry synthesis yield given the large number of variables that affect the yield. We believe that this work is the first to combine such techniques which can be readily applied to any other assays that contain many parameters and levels on DMF.

Wastewater irrigation: An opportunity for improving soil phosphorus availability; PHREEQC modeling and adsorption studies

Wastewater, an alternative supply of water and nutrients, is being allocated as a priority for human population sustainability in arid and semi-arid regions. This work proposes phosphorus (P), a vital growth-limiting nutrient, adsorption behavior in wastewater irrigated agricultural soils in comparison to non-irrigated soils using laboratory batch experiments. The adsorption mechanism was assessed using different adsorption isotherm models. Saturation indices were modeled, using the hydro-geochemical transport code PHREEQC and MINTEQ geochemical software. Phosphorus buffering parameters were also calculated based on the standard equations. The equilibrium data were well fitted with the Freundlich isotherm model. The physical adsorption mechanism was found based on the calculated isotherm parameters. The maximum adsorption capacity was two times more in non-wastewater irrigated soils than irrigated. Results highlighted the effectiveness of wastewater irrigation in P availability in soil. Based on the PHREEQC modeling data, precipitation of Pb and Zn mineral phases was probable in soils by wastewater influence. Meanwhile, the precipitation of stable calcium phases, that affect the P sorption and/or co-precipitation, in non-wastewater irrigated soils was highlighted in the PHREEQC calculations. The standard buffer capacity (SBC) was 43 and 64 L kg^-1 in wastewater irrigated soils and non-irrigated soils, respectively. Findings of the present study demonstrate the importance of wastewater reuse opportunities for agricultural application, especially soil P availability, and are helpful to minimize the environmental impacts of wastewater and solid waste.

Identification and characterization of murine glycoprotein 2-expressing intestinal dendritic cells

The intestinal lamina propria (LP) contains distinct subsets of classical dendritic cells (cDC), each playing key non-redundant roles in intestinal immune homeostasis. Here, we show that glycoprotein 2 (GP2), a GPI-anchored protein and receptor for bacterial type-I fimbriae, is selectively expressed by CD103+CD11b+ cDC in the murine small intestine (SI). GP2 expression was induced on CD103+CD11b+ cDC within the SI-LP and was regulated by IRF4, TGFβR1- and retinoic acid signalling. Mice selectively lacking Gp2 on CD103+CD11b+ cDC (huLang-Cre.gp2fl/fl mice) had normal numbers and proportions of innate and adaptive immune cells in the SI-LP suggesting that GP2 expression by CD103+CD11b+ cDC is not required for intestinal immune homoeostasis.

Targeted co‐delivery of paclitaxel and anti P‐gp shRNA by low molecular weight PEI decorated with L‐3,4‐dihydroxyphenylalanine

Co-delivery of small chemotherapeutic molecules and nucleic acid materials via targeted carriers has attracted great attention for treatment of resistant tumors and reducing adverse effects. In this study, a targeted carrier for co-delivery was prepared based on low-molecular weight polyethylenimine (LMW PEI). Paclitaxel (PTX) was covalently conjugated onto PEI via a succinate linker. The PEI conjugate was decorated with L-DOPA in order to target large neutral amino acid transporter-1 (LAT-1) that is over-expressed on various cancer cells. This PEI conjugate was complexed with human ABCB1 shRNA plasmid to down-regulate the expression of P-glycoprotein, as one of the major efflux pumps inducing resistance against chemotherapeutics. The formation of PEI conjugate enhanced the solubility of PTX and resulted in the condensation and protection of plasmid DNA in nanosized polyplexes. The results of targeted delivery into the cells demonstrated that PEI conjugate transferred the payloads to the cells over-expressing LAT-1 transporter, while the biological effects on the cells lacking the transporter was negligible. Also, shRNA-mediated down-regulation of P-gp led to the increase of toxic effects on the cells over-expressing P-gp. This study suggests a promising approach for co-delivery of small molecules and nucleic acid materials in a targeted manner for cancer therapy.

Effects of different milk feeding levels and frequencies on performance of Holstein heifers during weaning and first lactation

In the present study, the effects of milk feeding amount and feeding frequency (FF) on performance, blood metabolites, rumen fermentation, and performance of dairy heifers during the first artificial insemination (AI) and first lactation were investigated. The treatment group consisted of 48 female Holstein heifer calves (12/treatment) distributed in a 2 × 2 factorial arrangement with milk feeding [high = 8 L/d, HL or medium = 6 L/d, ML] and feeding frequency [2 × or 3 ×]. All calves were fed on a step-up/step-down method, weaned from milk at 56 d of age, and observed until 70 d of age. Heifer calves were kept uniform from 70 d of age until the first lactation to evaluate the long-term effects of the treatments. We observed no FF effect and no interaction between the level and FF on feed intake, average daily gain (ADG), feed efficiency (FE), body weight (BW), structural growth, blood metabolites, and rumen fermentation parameters. Calves fed HL milk had higher total dry matter intake (DMI), BW, and ADG during the pre- and post-weaning periods. During the preweaning period, HL-fed calves had higher serum insulin (trend) and glucose concentrations compared to ML-fed calves. Lower age at first AI was observed in calves fed HL rather than ML regardless of FF. Weight at first AI, milk yield (305 d), and energy-corrected milk (ECM-305 d) in the first lactation showed a trend toward higher values in HL-fed calves compared to ML-fed calves. Preweaning performance and calf maturity can be positively affected by feeding high amounts of milk at both FF.

Postpartum depression and its correlates: a cross-sectional study in southeast Iran

Background

Postpartum depression has a negative impact on both infants and women. This study aimed to determine the correlates of postpartum depression in women in southern Iran.

Methods

This cross-sectional study was performed on 186 mothers who had recently given birth to a baby. Data were collected using the demographic form, Quality of Prenatal Care Questionnaire, Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety and Stress Scale—21 items (DASS-21) 3 days after delivery and EPDS and DASS-21 6 months after childbirth.

Results

Postpartum depression (PPD) was 24.2% and 3.2% 3 days and 6 months after delivery, respectively. Anxiety, Prenatal Care Quality and educational level predicted 34.0% of the variance of PPD 3 days after delivery (R² = 34.0%). Anxiety, type of delivery, and stress predicted 24% of the variance of PPD 6 months after delivery (R² = 24.0%).

Conclusions

With an increase in stress and anxiety and a reduction in the quality of prenatal care, the risk of postpartum depression increases. Therefore, attention to the quality of prenatal care and postpartum stress and anxiety should be carefully evaluated to prevent PPD. Psychological support and interventions are recommended to promote the mental health of women before and after childbirth.

Performance of Holstein calves receiving equal solids per day from high-solids milk and milk replacer blend once or twice daily combined with dry versus wet fine-particle starter diet

This study examined the effects of frequency of feeding high-solids milk and milk replacer (MMR) blend combined with dry matter (DM) content of starter feed on the performance of dairy calves. Forty-eight Holstein calves (40.2 ± 3.33 kg of body weight) were randomly assigned to 1 of 4 treatments in a completely randomized design. Based on a combination of 2 MMR feeding frequencies (once versus twice daily) and 2 starter DM levels (91.1 and 50% DM), 4 treatments were designed as (1) once daily + dry starter feed (OD), (2) once daily + wet starter feed (OW), (3) twice daily + dry starter feed (TD), and (4) twice daily + wet starter feed (TW). The amount of milk replacer powder added to whole milk was adjusted at each feeding frequency to ensure that calves received similar solids from the MMR blend via the twice-daily (total solids = 18.6%) or once-daily (total solids = 31.0%) programs. Starter intake in the preweaning period did not differ between treatments (average 0.39 kg of DM/d), but the postweaning starter intake was greater in calves fed the wet starter (OW and TW) than in those fed the dry starter (OD and TD). Calves receiving the high-solids MMR blend twice versus once daily grew faster before weaning, which was reflected by a greater weaning weight in the TD and TW groups (88.9 kg) than in the OD and OW groups (83.2 kg). The daily growth rate after weaning did not differ between treatments and averaged 1.15 kg/d. Gain-to-feed ratio during the preweaning period was greater in calves from TD and TW (mean 0.67) than in calves from the OD or OW groups (mean 0.58). Postweaning gain-to-feed ratio was not different among treatments and averaged 0.38. Days to first diarrhea and duration of diarrhea (4.66 ± 0.38), as well as days that animals were treated with antibiotics, remained unaffected with treatments. Although preweaning body weight gain was lower with once-daily milk feeding, calves were twice as heavy at weaning as at birth in both milk feeding programs regardless of starter moisture content, which may qualify the once-daily milk feeding program as a cost-effective management strategy in commercial calf-rearing operations. Feeding solutions with a high solids content (above 15%) may be associated with an increased risk of abomasal bloat and should be used with caution.

A review on the latest developments of mesoporous silica nanoparticles as a promising platform for diagnosis and treatment of cancer

Cancer is the second cause of human mortality after cardiovascular disease around the globe. Conventional cancer therapies are chemotherapy, radiation, and surgery. In fact, due to the lack of absolute specificity and high drug concentrations, early recognition and treatment of cancer with conventional approaches have become challenging issues in the world. To mitigate against the limitations of conventional cancer chemotherapy, nanomaterials have been developed. Nanomaterials exhibit particular properties that can overcome the drawbacks of conventional therapies such as lack of specificity, high drug concentrations, and adverse drug reactions. Among nanocarriers, mesoporous silica nanoparticles (MSNs) have gained increasing attention due to their well-defined pore size and structure, high surface area, good biocompatibility and biodegradability, ease of surface modification, and stable aqueous dispersions. This review highlights the current progress with the use of MSNs for the delivery of chemotherapeutic agents for the diagnosis and treatment of cancer. Various stimuli-responsive gatekeepers, which endow the MSNs with on-demand drug delivery, surface modification strategies for targeting purposes, and multifunctional MSNs utilized in drug delivery systems (DDSs) are also addressed. Also, the capability of MSNs as flexible imaging platforms is considered. In addition, physicochemical attributes of MSNs and their effects on cancer therapy with a particular focus on recent studies is emphasized. Moreover, major challenges to the use of MSNs for cancer therapy, biosafety and cytotoxicity aspects of MSNs are discussed.

Association of Higher-Dose Fluoroquinolone Therapy With Serious Adverse Events in Older Adults With Advanced Chronic Kidney Disease

IMPORTANCE

Population-based data are needed to inform the safe prescribing of fluoroquinolone antibiotics to patients with advanced chronic kidney disease (CKD).

OBJECTIVE

To quantify the 14-day risk of a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event in patients with advanced CKD newly prescribed a fluoroquinolone at a higher vs a lower dose.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study in Ontario, Canada (January 1, 2008, to March 17, 2020) used linked health care data to identify new users of fluoroquinolone antibiotics. Participants included adults 66 years or older with advanced CKD (an estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2 but not receiving dialysis). Data analysis was performed from January 1 to April 30, 2021.

EXPOSURES

A new prescription for a higher-dose fluoroquinolone (ciprofloxacin, 501-1000 mg/d; levofloxacin, 501-750 mg/d; or norfloxacin, 401-800 mg/d) vs a lower-dose fluoroquinolone (ciprofloxacin, 500 mg/d; levofloxacin, 250-500 mg/d; or norfloxacin, 400 mg/d).

MAIN OUTCOMES AND MEASURE

The primary outcome was the 14-day risk of a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event. Secondary outcomes included a hospital visit with sepsis, retinal detachment or other tendinopathies, all-cause hospitalization, all-cause mortality, and sudden cardiac death. Inverse probability of treatment weighting on the propensity score was used to balance comparison groups on baseline health. Weighted risk ratios and risk differences were obtained using modified Poisson regression and binomial regression, respectively.

RESULTS

Of 11 917 patients (median age, 83 years [IQR, 77-89 years]; 7438 women [62.4%]; median eGFR, 25 [IQR, 21-28] mL/min/1.73 m2) included in the analysis, 5482 (46.0%) received a higher-dose and 6435 (54.0%) received a lower-dose fluoroquinolone. After weighting, the primary composite outcome-a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event-occurred in 68 of 5482 patients (1.2%) treated with a higher-dose fluoroquinolone and in 47 of 5516 (0.9%) treated with a lower-dose fluoroquinolone (weighted risk ratio, 1.45 [95% CI, 1.01-2.08]; weighted risk difference, 0.39% [95% CI, 0.01%-0.76%]). The risk of sepsis, retinal detachment, all-cause hospitalization, all-cause mortality, and sudden cardiac death did not differ significantly between groups.

CONCLUSIONS AND RELEVANCE

These findings suggest that older patients with advanced CKD who were prescribed a fluoroquinolone at a higher-than-recommended dose were significantly more likely to experience the composite outcome of a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event, although the absolute risk of these events was less than 2%.

Halophytes play important role in phytoremediation of salt-affected soils in the bed of Urmia Lake, Iran

Soil salinity is a major threat in agriculture even in semi-arid regions of the world which can accelerate land degradation and desertification and decrease agricultural productivity and consequently jeopardize environmental and food security. Halophytes play important role in phytoremediation. This study is assessed the potential of Halocnemum strobilaceous, Atriplex verruciferae, Salsola crassae, and Salicornia europaeae in phytoremediation of saline soils occurred after water level desiccation of Urmia Lake. Three distances from the water body (500, 1000, and 1500 m) was selected for evaluating. Soils and plants were analyzed using standard methods. The mean values of salinity indices of the saline-sodic soil samples were identified as pH 8.6 and electrical conductivity (EC_e) 65.34 dS m⁻¹, also sodium adsorption ratio (SAR), and exchangeable sodium percentage (ESP) were higher than 13 and 15%, respectively. The maximum soil exchangeable Na⁺, K⁺, and Ca²⁺ concentrations (7200, 1900, and 1400 mg kg⁻¹, respectively), also the concentrations of Mn²⁺ (12.5 mg kg⁻¹), Fe²⁺ (5.5 mg kg⁻¹), and Cu²⁺ (1.5 mg kg⁻¹), were significantly different at various distances. However, the highest amounts were obtained at 500 m. In addition the concentration of Fe²⁺ (511.85 mg kg⁻¹), Zn²⁺ (99.97 mg kg⁻¹), and Na⁺ (25.65 mg kg⁻¹) was the highest, especially in shoots. Furthermore, Salicornia and Halocnemum were more effective in salinity-remediation in comparison to other halophytes. The maximum dry matter (38%), protein (16%), and oil percentage (3.5%) were found in Salicornia, followed by Halocnemum. The findings indicated that salt-accumulating halophytes could be considered as the suggestions for phytoremediation saline soils and desalinating soil in arid and semi-arid regions.

IRF8 deficiency induces the transcriptional, functional, and epigenetic reprogramming of cDC1 into the cDC2 lineage

Conventional dendritic cells (cDCs) consist of two major functionally and phenotypically distinct subsets, cDC1 and cDC2, whose development is dependent on distinct sets of transcription factors. Interferon regulatory factor 8 (IRF8) is required at multiple stages of cDC1 development, but its role in committed cDC1 remains unclear. Here, we used Xcre-cre to delete Irf8 in committed cDC1 and demonstrate that Irf8 is required for maintaining the identity of cDC1. In the absence of Irf8, committed cDC1 acquired the transcriptional, functional, and chromatin accessibility properties of cDC2. This conversion was independent of Irf4 and was associated with the decreased accessibility of putative IRF8, Batf3, and composite AP-1-IRF (AICE)-binding elements, together with increased accessibility of cDC2-associated transcription-factor-binding elements. Thus, IRF8 expression by committed cDC1 is required for preventing their conversion into cDC2-like cells.

Traditional versus extended hybrid cardiac rehabilitation based on the continuous care model for coronary artery bypass surgery patients in a middle-income country: an embedded mixed method

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac rehabilitation (CR) is a proven method to reduce the risk of disease, but unfortunately in low-and middle-income countries (LMICs), it is either unavailable or done in small quantities.

Purpose

To compare traditional (1-month supervised) vs hybrid cardiac rehabilitation (CR; usual care) with an additional 3 months offered remotely based on the continuous care model (intervention) in patients who have undergone coronary artery bypass graft (CABG).

Methods

The embedded method has been used for the conduction of this study in two phases. The first phase of the study was carried out using a randomised clinical trial. Of 107 eligible patients who were referred to CR during the period of study, 82.2% (N=88) were enrolled (target sample size). Participants were randomly assigned 1:1 (concealed; 44 per parallel arm). After CR, participants were given a mobile application and communicated biweekly with the nurse from months 1-4 to control risk factors. Quality of life (QOL, Short Form-36, primary outcome); functional capacity (treadmill test); and the Depression, Anxiety and Stress Scale were evaluated pre-CR, after 1 month, and 3 months after CR (end of intervention), as well as re-hospitalisation. In the second phase, a qualitative study was conducted using the conventional content analysis method. 17 patients from the intervention group and 3 members of their families were interviewed.

Results

The results of the quantitative stage showed the analysis of variance interaction effects for the physical and mental component summary scores of QOL were &lt;.001, favoring intervention (per protocol); there were also significant increases from pre-CR to 1 month, and from 1 month to the final assessment in the intervention arm (P&lt;.001), with change in the control arm only to 1 month. The effect sizes were 0.115 and 0.248, respectively. Similarly, the interaction effect for functional capacity was significant (P&lt;.001), with a clinically significant 1.5 metabolic equivalent of task increase in the intervention arm. There were trends for group effects for the psychosocial indicators, with paired t tests revealing significant increases in each at both assessment points in the intervention arm. At 4 months, there were 4 (10.3%) re-hospitalisations in the control arm and none in intervention (P=.049). Intended theoretical mechanisms were also affected by the intervention. From the analysis of qualitative data, 20 subcategories, 6 categories, and three themes, including promotion and continuity of self-care, self-efficacy enhancement, belief, and lifestyle modification were extracted. Finally, qualitative findings supported quantitative findings.

Conclusions

Extending CR in this accessible manner, rendering it more comprehensive was effective in improving outcomes. Therefore, using the CCM can greatly reduce the gap due to cardiac rehabilitation in LMICs.

New analytical methods using carbon-based nanomaterials for detection of Salmonella species as a major food poisoning organism in water and soil resources

Salmonella is one of the most prevalent causing agents of food- and water-borne illnesses, posing an ongoing public health threat. These food-poisoning bacteria contaminate the resources at different stages such as production, aggregation, processing, distribution, as well as marketing. According to the high incidence of salmonellosis, effective strategies for early-stage detection are required at the highest priority. Since traditional culture-dependent methods and polymerase chain reaction are labor-intensive and time-taking, identification of early and accurate detection of Salmonella in food and water samples can prevent significant health economic burden and lessen the costs. The immense potentiality of biosensors in diagnosis, such as simplicity in operation, the ability of multiplex analysis, high sensitivity, and specificity, have driven research in the evolution of nanotechnology, innovating newer biosensors. Carbon nanomaterials enhance the detection sensitivity of biosensors while obtaining low levels of detection limits due to their possibility to immobilize huge amounts of bioreceptor units at insignificant volume. Moreover, conjugation and functionalization of carbon nanomaterials with metallic nanoparticles or organic molecules enables surface functional groups. According to these remarkable properties, carbon nanomaterials are widely exploited in the development of novel biosensors. To be specific, carbon nanomaterials such as carbon nanotubes, graphene and fullerenes function as transducers in the analyte recognition process or surface immobilizers for biomolecules. Herein the potential application of carbon nanomaterials in the development of novel Salmonella biosensors platforms is reviewed comprehensively. In addition, the current problems and critical analyses of the future perspectives of Salmonella biosensors are discussed.

Protective effect of Zataria multiflora Boiss against sodium nitrite-induced hepatotoxicity in rats

Objective

Sodium nitrite (NaNO₂) is used as a color stabilizer and antimicrobial agent in preservation of cured meat and fish. However, extensive use of this agent in the meat industries increased worries about its detrimental effects on human health. Zataria multiflora (Z. multiflora) is a well-known plant with therapeutic properties in the traditional medicine. Therefore, the present study was conducted to investigate the protective effect of this plant against sodium nitrite-induced hepatotoxicity.

Materials and methods

Thirty-two male Wistar rats were divided into 4 groups: Control (without any treatment), nitrite (350 mg/kg by gavage for 60 days), NaNO₂ plus Z. multiflora (rats treated with NaNO₂ 350 mg/kg gavage for 60 days and simultaneously received Z. multiflora extract at 200 mg/kg, ip) and Z. multiflora group (rats treated with Z. multiflora extract at 200 mg/kg, ip). At the end of the study, rats were euthanized and liver tissue samples were taken and studied under microscopy. Also, serum levels of liver function enzymes and antioxidant defense systems were measured. The results were analyzed using SPSS software and a p<0.0.5 was considered significant.

Results

Results showed that NaNO₂ induces liver injuries and altered hepatic histo-architecture. Also, NaNO₂ significantly altered the biochemical profiles and antioxidant defense parameters of the liver. However, treatment with Z. multiflora improved tissue integrity as well as antioxidant defense status and biochemical conditions of the liver.

Conclusion

Administration of Z. multiflora extract has beneficial effects on the NaNO₂-induced histological and functional toxicity in the liver.