A green and simplified approach for the quantitative and sensitive analysis of heavy metal ions in sea and stream waters

Elimination of the matrix effect is a major challenge in developing a method for the quantification of heavy metals (HMs) in water samples. In this regard, the current research describes the simultaneous analyses of Cu(II), Cd(II), and Ni(II) ions in water matrices through flame atomic absorption spectrophotometry (FAAS) after preconcentration with carrier element-free co-precipitation (CEFC) technique by the help of an organic co-precipitant, 3-{[5-(4-Chlorobenzyl)-3-(4-chlorophenyl)-1H-1,2,4-triazol-1-yl]-methyl}-4-[2,4-(dichlorobenzylidene)amino]-1H-1,2,4-triazole-5(4H)-thione (CCMBATT). Based on our literature research, CCMBATT was employed for the first time in this study as an organic co-precipitant for the preconcentration of HMs. Factors such as solution pH, concentration of co-precipitant, sample volume, standing time, centrifugation rate, and time were thoroughly examined and optimized to achieve the highest efficiency in terms of HM recovery. The limits of detection (LODs) (with 10 number of tests) of 0.54, 0.34, and 1.95 μg L-1 and the relative standard deviations (RSD %) of 2.1, 3.3, and 3.0 were determined for Cu(II), Cd(II) and Ni(II) ions, respectively. Recovery results of HMs for the spiked samples were in the range of 92.8-101.0%, demonstrating the trueness of the method and its applicability to the water samples matrix.

Enhancement of adsorptive removal efficiency of an anionic dye from aqueous solutions using carboxylic acid-modified mulberry leaves: Artificial neural network modeling, isotherm, and kinetics evaluation

Natural mulberry leaves and carboxylic acid-modified mulberry (Morus alba L.) leaves were used for the first time to scrutinize the effects of modification on the retention efficiency of an anionic dye (Remazol Brilliant Blue R (RBBR)) from aqueous solutions to suggest an economical and promising adsorbent for the treatment of dye-contaminated water. The characterization of the adsorbents was accomplished through common techniques including SEM, FTIR, and pH_pzc determination. Several parameters studied in batch experiments pointed out that the initial pH of 2.0 and the contact time of 240 min were optimum conditions for all the developed RBBR uptake processes. An artificial neural network (ANN) model was applied to formulate a forecast model for the uptake efficiency of RBBR. The experimental data were assessed by different kinetic and isotherm models to explain the mechanism of the developed processes in more detail. Maximum monolayer adsorption capacities of natural mulberry leaves and acetic acid-, citric acid-, and oxalic acid-modified mulberry leaves were determined as 64.5, 95.2, 84.8, and 91.7 mg g^-1, respectively, by the Langmuir isotherm model. These results demonstrated that the modification with carboxylic acids significantly increases the anionic dye adsorption capacity of the mulberry leaves.

Insights into brewed tea waste as a green and low-priced adsorbent for solid-phase extraction of Cd(II) ions: isotherm, kinetic, and artificial neural network approach

In the present research, brewed tea waste (BTW) was utilized as a green, low-priced, and abundant adsorbent for separation/preconcentration of Cd(II) ions through solid-phase extraction method from water and foods for the first time. BTW was applied as a natural adsorbent, without using any chelating agent to bind Cd(II) ions or any chemical reagent for its modification. A three-layer artificial neural network model using backpropagation algorithm was utilized to explicate a prediction model for the extraction performance of Cd(II) ions by selecting the input parameters as solution pH, quantity of BTW, sample volume, eluent concentration and volume, and equilibrium time for desorption. The preconcentration factor, relative standard deviation, and detection limit were attained as 100, 3.03%, and 0.56 µg L−1, respectively. It was decided that the Langmuir isotherm model is acceptable to characterize the retention of Cd(II) ions on BTW. This result pointed out that the active binding sites on the BTW surface are homogeneously distributed. Adsorption capacity of BTW was achieved as 41.5 mg g−1 which is higher than several expensive and difficult-to-prepare adsorbents. Adsorption kinetics was elucidated by pseudo-second order kinetic model. After confirmed the accuracy of the method with spike/recovery studies, it was employed for Cd(II) determination in water (stream and sea water) and food (eggplant, lettuce, parsley, apple, and apricot) samples with high accuracy. The inferences of the study proved that the BTW offers a magnificent application prospect in the extraction of Cd(II) ions.

Preparation of melon peel biochar/CoFe2O4 as a new adsorbent for the separation and preconcentration of Cu(II), Cd(II), and Pb(II) ions by solid-phase extraction in water and vegetable samples

The present research describes the successful preparation of melon peel biochar modified with CoFe₂O₄ (MPBC/CoFe₂O₄) followed by its usage as a new sorbent to separate, preconcentrate, and determine the toxic heavy metal ions by magnetic solid-phase extraction. The metal ion desorption was performed by 0.1 M HCl solution with a volume of 5.0 mL. Flame atomic absorption spectrometry (FAAS) was utilized for detection of the analyte levels. SEM-EDX, TEM, XRD, and FTIR techniques were carried out to illuminate the structure of MPBC/CoFe₂O₄. The fundamental variables affecting the adsorption and elution efficiencies of the analyte ions including solution pH, MPBC/CoFe₂O₄ amount, type and concentration of eluent, adsorption and desorption equilibrium time, and sample volume were optimized. The detection limits were calculated as 0.41, 1.82, and 3.16 µg L^-1 for Cu²⁺, Cd²⁺, and Pb²⁺ ions, respectively, with the relative standard deviation of lower than 4.2%. There were no substantial interference effects on the analyte ion recovery due to the presence of foreign ions at high levels. Five minutes of contact time was adequate to attain the adsorption equilibrium. The adsorption capacity of MPBC/CoFe₂O₄ was obtained as 106.4, 65.4, and 188.7 mg g^-1 for Cu²⁺, Cd²⁺, and Pb²⁺ ions, respectively, by utilizing Langmuir isotherm model. The pseudo-second order model is favorable to identify the adsorption kinetics. The method was validated by spike/recovery test, and then, it was successfully implemented to determine the aforementioned analyte levels in sea and stream water, pepper, black cabbage, eggplant, and tomato samples.

Surmortalité dans les maisons de retraite pendant la pandémie de COVID-19

Introduction

La maladie à coronavirus (COVID-19) est associée à un faible taux de mortalité global d’environ 2 % dans la population générale. La gravité et la mortalité du COVID-19 varient largement en fonction de plusieurs facteurs de risque tels que l’âge, la présence d’une insuffisance respiratoire chronique, l’immunosuppression et les facteurs de risque cardiovasculaires. La pandémie de COVID-19 a mis en évidence la vulnérabilité des résidents des établissements de soins de longue durée (ESLD), les patients âgés très dépendants étant les plus exposés au risque de décès. Cependant, la surmortalité en maison de retraite par rapport aux années précédentes n’a pas été entièrement étudiée. Nous avons cherché à comparer le taux de mortalité par semaine dans un réseau national français de maisons de retraite en 2020 aux taux de mortalité des années précédentes.

Matériels et méthodes

Une étude de cohorte rétrospective multicentrique a été réalisée auprès d’un réseau national de 28 maisons de retraite, également réparties en France, sur une période allant du 1^er septembre 2017 au 31 novembre 2020. Les données ont été extraites d’une base de données centralisée (Netvie), où la mortalité toutes causes du réseau était rapportée chaque semaine, avec le sexe et l’âge des participants.

Résultats

Au cours de la période d’étude, un total de 4029 résidents de maisons de soins infirmiers ont été identifiés ; parmi eux, 1972 (48,9 %) étaient décédés. Au cours des périodes 2017, 2018, 2019 et 2020, 4599, 4946, 5268 et 4722 résidents (p > 0,05) vivaient dans les maisons de soins infirmiers de l’étude, et 2238 (48,7 %), 2568 (51,9 %), 2561 (48,6 %) et 2679 (56,7 %) étaient décédés, respectivement. L’âge médian de l’ensemble de la cohorte était de 89,0 [intervalle interquartile (IQR) : 84,0–93,0] ans, et l’âge médian de la population décédée était de 90,0 [IQR : 85,0–94,0] ans. Le rapport des sexes (M/F) dans l’ensemble de la cohorte et dans la population décédée était de 0,39 et 0,44, respectivement. Nous avons remarqué une augmentation du taux de mortalité jusqu’à 9,1 % durant les semaines 13 à 16 de 2020 par rapport à un taux de mortalité de 1,7 % en 2018 (p < 10⁻⁵) et de 1,7 % en 2019 (p < 10⁻⁵) durant la même période. Au cours des semaines 13 à 16 de 2018, 2019 et 2020, l’âge médian de tous les résidents était de 90,0 [IQR : 85,0–94,0], 89,0 [IQR : 84,0–93,0] et 89,0 [IQR : 83,0–93,0], tandis que l’âge médian des résidents décédés était de 89,0 [IQR : 86,0–96,0], 91,0 [IQR : 88,0–95,0] et 89,0 [IQR : 84,0–93,8], respectivement. Au cours de ces semaines, le sex-ratio (M/F) dans l’ensemble de la cohorte était de 0,33 en 2018, 0,36 en 2019 et 0,36 en 2020. Parmi la population décédée, le sex-ratio était de 0,17 en 2018, 0,29 en 2019 et 0,55 en 2020.

Conclusion

Ainsi, nous pouvons conclure que la mortalité a été multipliée par plus de 5 lors de la première vague de la pandémie de COVID-19 dans les maisons de retraite, sans différence concernant le sex-ratio et l’âge avec la population décédée des années précédentes. Plusieurs rapports ont mis l’accent sur la mortalité élevée chez les personnes âgées, notamment dans les ESLD mais peu de données sont disponibles sur les maisons de retraite. Le personnel, les résidents et les proches doivent rester vigilants pour prévenir l’introduction et la propagation du SRAS-CoV-2 dans leurs établissements.

Rôle de la pharmacie dans l’investigation allergologique des patients ayant présenté un exanthème en cours d’hospitalisation pour COVID-19

Introduction

Les manifestations cutanées observées chez les patients COVID-19 sont multiples et fréquentes : engelures, exanthème, urticaire, purpura, eczéma. Chez les patients recevant des antiinfectieux et présentant ces symptômes compatibles avec des réactions d’hypersensibilités retardées (HSR), le diagnostic de toxidermie est systématiquement évoqué.

Méthodes

À partir de la cohorte bicentrique des patients présentant des manifestations cutanéo-muqueuses au cours du COVID-19 nous décrirons la démarche collaborative entre les services de médecine et la pharmacie hospitalière et l’étude de faisabilité des préparations magistrales de patch tests, prick-tests et tests IDR.

Résultats

Parmi la cohorte de 59 patients hospitalisés pour une pneumonie COVID-19 en mars 2020, 68 % avait des atteintes cutanées (exanthèmes dans 80 %) ; 23 des 40 patients présentant des manifestations cutanées (58 %) avaient reçu au moins un antiinfectieux (hydroxychloroquine [HCQ], azithromycine [AZT], spiramycine [SPR], amoxicilline [AMX] et/ou ceftriaxone [CFX]). Une revue complète de la littérature a été réalisée et les PUI réalisant ce type de tests ont été contactées pour déterminer les concentrations non irritantes, dilutions optimales, nature des diluants, vérification de la texture, choix des contrôles positifs et négatifs, conditionnement le plus approprié et évaluation des moyens humains et matériels nécessaires. Quinze fiches de fabrication ont été rédigées. La pharmacie a élaboré des tests épicutanés dosés à 30 % dans de la vaseline à partir des formes orales (HCQ, AZT) ; 10 % (lyophilistas) ou 30 % (solutions) dans vaseline pour les solutions injectables (AMX, CFX et SPR). Les prick-tests et les tests IDR en seringues ont été préparés en conditions stériles, à partir des formes injectables (AMX, CFX et SPR). Les tests cutanés seront réalisés à 1 an de l’épisode (mars 2021) : résultats à venir.

Conclusion

Ce travail a favorisé le travail pluridisciplinaire entre les services. Les résultats des tests allergologiques permettront d’identifier les HSR allergiques qui contre-indiqueront la réintroduction des molécules et la meilleure compréhension des atteintes dermatologiques observées chez les patients atteints de COVID-19.

Première série de cas de DRESS syndrome au cours d’une pneumonie sévère COVID-19

Introduction

Lors de la première vague de COVID-19, les praticiens ont largement prescrit l’association hydroxychloroquine (HCQ) – azythromycine (AZM).

Méthodes

Nous rapportons une série de 3 cas de DRESS certains, selon le score REGISCAR, chez des patients atteints de pneumonies COVID-19 sévères.

Résultats

Le premier patient a 58 ans, est diabétique, hypertendu et obèse. Il présente à J20 du début des symptômes de COVID-19 un exanthème maculo papuleux diffus, œdème du visage, adénomégalies supra centimétriques et une hyperéosinophilie à 0,74 G/L ; à J15 d’un traitement par ceftriaxone (CTX), AZM et HCQ. La deuxième patiente a 76 ans, est diabétique, hypertendue et atteinte d’une SEP. Elle présente à 1 mois du début de sa pneumonie COVID-19 ; et à 21 jours post-prises de CTX, AZM et HCQ une éruption cutanée sévère compatible avec un DRESS. Elle a présenté une hyperéosinophilie concomitante à 0,65 G/L avant traitement par dermocorticoides. Le troisième patient a 56 ans et aucune comorbidité. Il présente à J3 du début des symptômes de COVID-19 un volumineux œdème du visage et des lésions érythémateuses maculopapuleuses purpuriques ; à J8 d’un traitement antipaludéens et AINS. Pour chacun d’entre eux, la biopsie cutanée appuie le diagnostic de DRESS ; les PCR sanguines HHV6, EBV, CMV, VIH, VHB, VHC, parvovirus B19 sont négatives ; et l’évolution a été lentement favorable avec un blanchiement complet de la peau en plus de 15 jours d’application de Clobetasol.

Discussion

Le DRESS syndrome est une toxidermie rare qui peut-être fatale. Aucun cas de toxidermie type DRESS n’avait été rapportée jusqu’à ce jour dans un contexte de COVID-19. Moins d’une dizaine de cas de DRESS ont été rapportés dans la littérature avec l’un ou l’autre des traitements par HCQ ou AZM. Les réactivations virales sont classiquement décrites avec HHV6 ou d’autres herpes virus (EBV, CMV), mais aucune de ces réplications virales classiques n’ont été objectivées chez nos patients qui étaient atteints de formes actives sévères d’infections par le SARS-CoV-2, probablement réplicatif. L’implication du SARS-CoV-2 est supposée ici.

Conclusion

Il s’agit ici de la première série de cas de DRESS certains chez des patients atteints de formes sévères de COVID-19.

Development of pancreatic injuries in the course of COVID-19

BACKGROUND AND STUDY AIMS

To investigate the clinical and laboratory characteristics of the cases with high lipase levels in the course of COVID-19.

PATIENTS AND METHODS

Hospital records of all cases, where lipase levels were measured, and the reverse transcriptase-polymerase chain reaction test due to SARS-CoV-2 was found positive, were retrospectively investigated. Of 127 COVID-19 patients tested for lipase, 20 (15.7%) had serum lipase levels above the upper laboratory limit. The patient group with the "high lipase level" was created from these subjects, and the rest constituted the "control" group.

RESULTS

While body mass index (BMI) levels were higher in the high lipase group, (p=0.014), the number of those with pre-existing diabetes mellitus (DM) was also found higher in the high lipase group than the controls (p=0.002). The history of DM was detected to increase the risk of developing high lipase level 4.63 times higher. Only two patients were diagnosed with acute pancreatitis (AP). While oxygen saturations on admission (p=0.019) and discharge (p=0.011) were lower in the high lipase group than the controls, amylase (p<0.001), C-reactive protein (CRP) (p=0.002) and D-dimer (p=0.004) levels were found higher. In addition, more patients required the treatment in intensive care unit in the high lipase group, compared to the controls (p=0.027). Accordingly, time of hospital stay became also prolonged (p=0.003).

CONCLUSIONS

Pancreatic injuries or even AP may develop during SARS-CoV-2 infection, especially in those with pre-existing DM. Monitoring of pancreatic enzymes is important in COVID-19 patients, especially with pre-existing DM.

[Nasopharyngeal carriage of SARS-CoV-2 among health personnel with symptoms suggestive of COVID-19 in a University Hospital in the Paris suburbs]

Introduction

Une consultation dédiée aux professionnels de santé symptomatiques a été ouverte au début de l'épidémie de COVID-19, afin de répondre aux besoins spécifiques de cette population. L'objectif de ce travail était d'estimer la fréquence du portage nasopharyngé du SARS-Cov-2 chez les personnels de santé symptomatiques suspects de COVID-19, et de déterminer les facteurs associés à ce portage.

Méthodes

Étude descriptive des caractéristiques cliniques et épidémiologiques des consultants, conduite du 5 mars au 17 avril 2020. Le recueil des données cliniques et des résultats du test RT-PCR a été conduit à l'aide de formulaires standardisés.

Résultats

Des 522 consultants, 308 exerçaient à l'Hôpital et 214 à l'extérieur. Ils avaient des formes bénignes de COVID-19 et des signes cliniques non spécifiques à l'exception de l'agueusie/anosmie, significativement plus fréquente chez ceux avec RT-PCR positive. Le taux de positivité de la RT-PCR était globalement de 38 %, sans différence significative selon la profession, supérieur chez les consultants extérieurs (47 % versus 31 %). À l'hôpital, ce taux était significativement moindre pour les personnels symptomatiques des secteurs de soins, comparé aux personnels des plateaux techniques et laboratoires (24 %, versus 45 %, p = 0,006 et 54 %, p < 0,001, respectivement), mais ne différait pas entre personnels des unités COVID et des autres secteurs de soins (30 % versus 28 %). Parmi les consultants extérieurs, les taux de positivité des personnels des EHPAD et des libéraux (53 % et 55 % respectivement) étaient plus du double de celui du personnel soignant hospitalier (24 %, p < 0,001).

Conclusions

Ces données confirment l'impact fort du COVID-19 sur les professionnels de santé. Les taux de positivité plus élevés chez les professionnels symptomatiques exerçant en dehors de l'hôpital, comparativement à ceux exerçant à l'hôpital, pourraient s'expliquer en partie par une pénurie en équipements de protection et par des difficultés d'accès au diagnostic virologique, qui étaient plus importants en dehors de l'hôpital quand l'épidémie a commencé.

Cloud-Point Extraction of Rhodamine 6G by Using Triton X-100 as the Non-Ionic Surfactant

Cloud-point extraction (CPE) using the non-ionic surfactant Triton X-100 was used successfully to remove a highly toxic dye, rhodamine 6G (R6G), from water and wastewater. The effects of different analytical parameters such as pH, concentration of Triton X-100 (TX-100) and salts, equilibrium temperature, and incubation time on the efficiency of the extraction of R6G were studied in detail, and optimum conditions for dye extraction were obtained. Thermodynamic parameters including changes in Gibbs free energy, enthalpy, and entropy were also calculated, and these parameters indicated that the CPE of R6G was feasible, spontaneous, and endothermic in the temperature range of 75–95°C. The equilibrium solubilization capacity of TX-100 was found to be 1.10 mmol/mol by using Langmuir isotherm models. No significant interference effects were observed in the presence of phenol and its derivatives, some acidic and basic dyes and most of the anions and cations. It was concluded that the CPE process described in this paper can be an alternative technique for removal of dyes and other pollutants from waters and wastewaters.

A Novel Method for Speciation of Chromium: Coprecipitation Without Carrier Element by Using a Triazole Derivative

A coprecipitation method has been established for speciation of chromium(III) and chromium(VI) in real samples. The procedure is based on the coprecipitation of Cr(III), by using a new organic coprecipitant, 3-phenyl-4-o-hydroxybenzylidenamino-4,5-dihydro-1,2,4-triazole-5-one, without adding any carrier element. After reduction of Cr(VI) by concentrated H2SO4 and ethanol, the method was applied to the determination of total Cr. The level of Cr(VI) was calculated by the difference of total Cr and Cr(III) levels. For optimum recovery of Cr(III), different analytical factors such as pH, amount of coprecipitant, centrifugation rate and time, and effect of sample volume, were investigated. The influences of some anions, cations, and transition metals on the recoveries were also investigated, and no significant interferences were observed. The preconcentration factor was 100. The detection limit based on 3 times standard deviation () of the blank (n = 10) for Cr(III) was 0.50 g/L. In order to evaluate the accuracy of the method, certified reference materials (CRM-TMDW-500 Drinking Water and National Institute of Standards and Technology Standard Reference Material 1573a Tomato Leaves) were analyzed, and the results obtained were in good agreement with certified values. The presented procedure was applied for Cr speciation in various solid and liquid samples with successful results.

Urinary tract infections in patients with neurogenic bladder

Urinary tract infections (UTIs) in patients with neurogenic bladder are a major public health issue due to their high incidence and major consequences. Despite their frequency and potential severity, their physiopathology and management are poorly known. We provide a narrative literature review on the epidemiology, physiopathology, diagnostic criteria, microbiology, antimicrobial management, and prevention. UTIs among patients with neurogenic bladder are associated with high morbidity and healthcare utilization. Risk factors for UTI among this population are: indwelling catheter, urinary stasis, high bladder pressure, and bladder stones. Their diagnosis is a major challenge as clinical signs are often non-specific and rare. A urinary sample should be analyzed in appropriate conditions before any antibiotic prescription. According to most guidelines, a bacterial threshold≥103CFU/ml associated with symptoms is acceptable to define UTI in patients with neurogenic bladder. The management of acute symptomatic UTI is not evidence-based. A management with a single agent and a short antibiotic treatment of 10 days or less seems effective. Antibiotic selection should be based on the patient's resistance patterns. Asymptomatic bacteriuria should not be treated to avoid the emergence of bacterial resistance. Regarding preventive measures, use of clean intermittent catheterization, intravesical botulinum toxin injection, and prevention using antibiotic cycling are effective. Bacterial interference is promising but randomized controlled trials are needed. Large ongoing cohorts and randomized controlled trials should soon provide more evidence-based data.

Veillonella parvula spondylodiscitis

OBJECTIVES

Veillonella parvula is an anaerobic Gram-negative coccus rarely involved in bone and joint infections.

PATIENTS AND METHOD

We report the case of a Veillonella parvula vertebral osteomyelitis (VO) in a female patient without any risk factor.

RESULTS

The 35-year-old patient was immunocompetent and presented with Veillonella parvula VO. She was admitted to hospital for inflammatory lower back pain. The discovertebral sample was positive for Veillonella parvula. Literature data on Veillonella VO is scarce. Reported cases usually occurred in immunocompromised patients. Diagnosis delay can be up to four months. Patients are usually afebrile. Outcome with antimicrobial treatment alone is favorable in half of cases. Other patients must undergo surgery.

CONCLUSIONS

Veillonella VO may occur in immunocompetent patients and have a clinical spectrum of mechanical lower back pain.

Cabozantinib for the treatment of patients with metastatic non-clear cell renal cell carcinoma: A retrospective analysis

BACKGROUND

Cabozantinib prolongs overall survival (OS) and progression-free survival (PFS) in patients with metastatic clear cell renal cell carcinoma (RCC) that progressed on first-line vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI). The role of cabozantinib has not been established in non-clear cell renal cell carcinoma (nccRCC).

METHODS

This is a retrospective study of 30 patients with nccRCC who received cabozantinib from January 2013 to January 2017. Information collected included baseline characteristics, toxicity, dose reductions, PFS and OS. A fellowship trained abdominal radiologist, blinded to patient history and clinical data, assessed radiographic response using RECIST, v1.1.

RESULTS

With a median follow-up of 20.6 months (95% confidence interval [CI]: 11.4-28.8), median PFS was 8.6 months (95% CI: 6.1-14.7), and median OS was 25.4 months (95% CI: 15.5-35.4). Of the 28 patients with measurable disease, 4 had partial responses (2 papillary, 1 chromophobe and 1 unclassified RCC), 18 had stable disease (64.2%) and 6 had progressive disease (21.4%), resulting in a 14.3% objective response rate and a 78.6% disease control rate. Two patients with papillary RCC who had experienced disease progression on savolitinib achieved durable partial response and stable disease, respectively, following treatment with cabozantinib. Of the 21 patients who started cabozantinib at 60 mg/d, 12 (57.1%) required dose reduction due to toxicity.

CONCLUSION

In this retrospective study, cabozantinib produced a clinically meaningful benefit in patients with metastatic nccRCC, the majority of whom had disease progression on prior VEGFR-TKIs. Prospective trials of cabozantinib in nccRCC are warranted.

The effects of smoking cessation on visceral adiposity index levels

Background

: Known to cause important metabolic disturbances, weight gain becomes a major health problem after smoking cessation. Visceral adiposity index (VAI) is becoming increasingly popular in the detection of cardiometabolic risks in several disorders and general population. Here, we aimed to investigate the effects of quitting smoking on VAI levels.

Materials and Methods

: Of 350 participants included into the cigarette cessation program, 70 (20%) completed the study and were enrolled into the analyses. VAI levels were calculated at the baseline and 3^rd month after cigarette cessation.

Results

: Thirty-eight (54.3%) out of 70 participants were male. While the mean age was found as 42 ± 1.0 years, mean starting age of smoking was found to be 16.87 ± 0.45 years, and mean smoking time was 23.07 ± 1.18 years. While VAI levels were found higher in men at the baseline, VAI levels were found similar in both genders at the end of the study. Higher VAI levels were found in those smoking >20 cigarettes/day, compared to those smoking ≤20 cigarettes/day. Although weight, waist circumference, body mass index (BMI), and high-density lipoprotein cholesterol levels increased, VAI levels were found to decrease significantly at the 3^rd month. In subgroup analyses, VAI levels were seen to decrease significantly only in men (P = 0.005). Furthermore, VAI levels were found to decrease (P < 0.001) in those with BMI ≥25 kg/m², whereas no significant change was observed in those with BMI <25 kg/m².

Conclusions

Although body weight increases significantly after quitting smoking, VAI levels, an indicator of cardiovascular risks, decrease significantly, especially in men or obese patients.

Clearance of carbapenem-resistant Enterobacteriaceae vs vancomycin-resistant enterococci carriage after faecal microbiota transplant: a prospective comparative study

BACKGROUND

Carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant enterococci (VRE) carriage are increasing worldwide. Faecal microbiota transplantation (FMT) appears to be an attractive option for decolonization. This study aimed to evaluate CRE vs VRE clearance by FMT among carriers.

METHODS

A multi-centre trial was undertaken on patients with CRE or VRE digestive tract colonization who received FMT between January 2015 and April 2017. Adult patients with CRE or VRE colonization, confirmed by three consecutive rectal swabs at weekly intervals, including one in the week prior to FMT, were included in the study. Patients with immunosuppression or concomitant antibiotic prescription at the time of FMT were excluded. Successful decolonization was determined by at least two consecutive negative rectal swabs [polymerase chain reaction (PCR) and culture] on Days 7, 14, 21 and 28, and monthly for three months following FMT.

RESULTS

Seventeen patients were included, with a median age of 73 years [interquartile range (IQR) 64.3-79.0]. Median duration of carriage of CRE or VRE before FMT was 62.5 days (IQR 57.0-77.5). One week after FMT, three of eight patients were free of CRE colonization and three of nine patients were free of VRE colonization. After three months, four of eight patients were free of CRE colonization and seven of eight patients were free of VRE colonization. Qualitative PCR results were concordant with culture. Six patients received antibiotics during follow-up, three in each group. No adverse events were reported.

CONCLUSION

CRE and VRE clearance rates were not significantly different in this study, possibly due to the small sample size, but a trend was observed. These data should be confirmed by larger cohorts and randomized trials.

Environmental evaluation of natural radioactivity in soil near a lignite-burning power plant in Turkey

Natural radionuclides are released into the environment together with fly ash from the coal-burning power plant and cause an increase in the natural radioactivity in environmental samples. The study concerns to the evaluation the influence of Kangal lignite-burning power plant (LBPP) with a power of 457 MWe, which has been in operation since 1989, on natural radionuclide a concentration in surface soil samples around it. Activity concentrations of natural radionuclides (²²⁶Ra, ²³²Th, ⁴⁰K and ²²²Rn) in the soil samples, and emanation coefficient (EC) and mass (ER_M) and surface (ER_S) exhalation rate of radon were determined by using a gamma-ray spectrometer with an HPGe detector. The average values of ²²⁶Ra, ²³²Th, ⁴⁰K and ²²²Rn, EC, ER_M and ER_S were found as 37±5, 17±3, 222±30Bqkg^-1 and 9±1kBqm^-3, 12%, 12.1 µBq kg^-1 s^-1 and 7.1mBqm^-2 s^-1, respectively. Absorbed gamma dose rate in outdoor air and the corresponding effective dose rate from external exposure and excess lifetime cancer risk were estimated to evaluate radiological hazards for human population. The results revealed that the Kangal LBPP has caused a small increment in ²²⁶Ra concentration in the studied area. No influence was observed for ²³²Th and ⁴⁰K.

Impact of an antimicrobial stewardship programme to optimize antimicrobial use for outpatients at an emergency department

BACKGROUND

Antimicrobial stewardship programmes (ASPs) have been effective in optimizing antibiotic use for inpatients. However, an emergency department's fast-paced clinical setting can be challenging for a successful ASP.

AIM

In April 2015, an ASP was implemented in our emergency department and we aimed to determine its impact on antimicrobial use for outpatients.

METHODS

This was a single-centre study comparing the quality of antibiotic prescriptions between a one-year period before ASP implementation (November 2012 to October 2013) and a one-year period after its implementation (June 2015 to May 2016). For each period, antimicrobial prescriptions for all adult outpatients (hospitalized for <24h) were evaluated by an infectious disease specialist and an emergency department physician to assess compliance with local prescribing guidelines. Inappropriate prescriptions were then classified.

FINDINGS

Before and after ASP, 34,671 and 35,925 consultations were registered at our emergency department, of which 25,470 and 26,208 were outpatients. Antimicrobials were prescribed in 769 (3.0%) and 580 (2.2%) consultations, respectively (P < 0.0001). There were 484 (62.9%) and 271 (46.7%) (P < 0.0001) instances of non-compliance with guidelines before and after ASP implementation. Non-compliance included unnecessary antimicrobial prescriptions, 197 (25.6%) vs 101 (17.4%) (P<0.0005); inappropriate spectrum, 108 (14.0%) vs 54 (9.3%) (P=0.008); excessive treatment duration, 87 (11.3%) vs 53 (9.1%) (P>0.05); and inappropriate choices, 11 (1.4%) vs 15 (2.6%) (P>0.05).

CONCLUSION

The implementation of an ASP markedly decreased the number of unnecessary antimicrobial prescriptions, but had little impact on most other aspects of inappropriate prescribing.

Visceral adiposity index levels in overweight and/or obese, and non-obese patients with polycystic ovary syndrome and its relationship with metabolic and inflammatory parameters

BACKGROUND

Visceral adiposity index (VAI) is a proposed parameter to evaluate visceral obesity instead of waist circumference (WC) in patients with polycystic ovary syndrome (PCOS). We aimed to evaluate VAI levels in overweight and/or obese, and non-obese PCOS patients and investigate the association between metabolic and inflammatory parameters.

METHODS

Seventy-six PCOS patients between 18 and 40, and 38 age- and BMI-matched controls were enrolled into the study. Both PCOS groups and controls were classified into two subgroups according to body mass index (BMI) <25 and ≥25 kg/m².

RESULTS

In PCOS patients, waist/hip ratio (WHR) (p = 0.023), diastolic blood pressure (DBP) (p = 0.001), insulin (p = 0.011), homeostasis of model assessment (HOMA-IR) (p = 0.006) and uric acid (UA) (p = 0.002) were higher than controls. In overweight and/or obese PCOS group, DBP (p < 0.001), insulin (p = 0.002), HOMA-IR (p = 0.001), triglyceride (p = 0.015) and VAI (p = 0.031) were higher than overweight and/or obese controls. In non-obese PCOS group, WHR (p = 0.016), WC (p = 0.030), DBP (p = 0.010) and UA (p < 0.001) were higher than non-obese controls. Similar VAI levels were found in all PCOS and non-obese PCOS subgroups than peer controls. Overweight and/or obese PCOS group had higher VAI levels than non-obese PCOS group (p < 0.001). VAI levels were positively correlated with WHR, glucose, HOMA-IR, high-sensitive CRP and UA in PCOS group. In controls, VAI levels were positively correlated with WHR, insulin and HOMA-IR.

CONCLUSION

We found that VAI levels were higher in overweight and/or obese PCOS patients compared to peer controls and non-obese PCOS patients, and associated with some metabolic and inflammatory parameters.

Kidney transplantation for end-stage renal disease in lupus nephritis, a very safe procedure: a single Latin American transplant center experience

Background

Lupus nephritis (LN) is one of the most frequent complications of SLE and occurs in up to 50% of cases depending on the studied population. Of these, approximately 20% progress to end-stage renal disease (ESRD), with the treatment of choice being a kidney transplant.

Objective

The objective of this study was to describe the clinical outcome of patients transplanted due to LN, compared with patients transplanted for other causes, in a Latin American population from the Fundación Valle del Lili in Cali, Colombia.

Methods

Observational, retrospective case study with controls matched by age, sex and type of donor in a single center between 1996 and 2014.

Results

Sixty-five kidney transplants were performed in patients with LN and ESRD. The survival of patients with LN was 98% at 1, 10 and 15 years ( p = .99). For controls by age and sex, survival was also 98% at 15 years post-transplant, and for controls by donor, the survival rate was 100% at 5 years and 98% at 15 years. Graft survival in patients with LN to 1, 5 and 15 years was 92%, 83% and 71%, respectively; for controls by age and sex, it was 90%, 84% and 64%, respectively, and for the controls by donor, it was 89%, 86% and 79%, respectively ( p = .7718). There were no statistically significant differences found in the cumulative incidence of acute graft rejection in the first year, but it was found that acute rejection is a factor that relates to the loss of function of the renal graft ( p = .032). Of the patients transplanted for LN, two (3.1%) experienced a recurrence of the disease. One patient died after a diagnosis of recurrence of LN due to an infection.

Conclusions

Kidney transplantation is a good option for patients with ESRD due to LN. In this Hispanic population, the survival of patients, graft survival, and cumulative incidence of graft rejection are not different from those of other transplanted patients. In addition, recurrence of LN was rare, showing the benefits of renal transplantation in LN patients with ESRD.

Is faecal microbiota transplantation an option to eradicate highly drug-resistant enteric bacteria carriage?

Carbapenem-resistant Enterobacteriaceae (CRE) or vancomycin-resistant enterococci (VRE) carriage present a major public health challenge. Decolonization strategies are lacking. We aimed to evaluate the impact of faecal microbiota transplantation (FMT) on a cohort of patients with digestive tract colonization by CRE or VRE. Eight patients were included: six carrying CRE and two colonized by VRE. One month after FMT, two patients were free from CRE carriage, and another patient was free from VRE after three months. In our experience, this strategy is safe.

Jejunojejunal intussusception secondary to lipoma in an adult

Lipoma is a rare cause of adult intussusception. We present the CT findings of an adult patient with jejunojejunal intussusception secondary to submucosal lipoma as the lead point in this case report.

Prospective evaluation of antibiotic treatment for urological procedure in patients presenting with neurogenic bladder

OBJECTIVES

Patients presenting with neurogenic bladder often require urological procedures (urodynamic testing and botulinum toxin injections) and a preventive antibiotic therapy. We aimed to assess the efficacy of this little known strategy in a cohort of patients.

PATIENTS AND METHODS

All patients presenting with neurogenic bladder who underwent urological procedure were included in the study. They received an antibiotic therapy in accordance with the urine cytobacteriological examination results. The antibiotic therapy was initiated two days before the procedure and prolonged up until two days after the procedure if the culture was positive. Patients were treated with a single dose of fosfomycin-trometamol in case of a negative culture. The main study outcome was the occurrence of urinary tract infection (UTI), defined by a positive urine culture and symptoms, up until 14 days after the procedure.

RESULTS

A total of 80 urological procedures were performed. Mean patient age was 47±13.1 years (sex ratio 1.22); 59 (73.8%) presented with asymptomatic bacteriuria before the procedure. Nine (11.1%) UTIs were recorded on Day 14, of which one (1.2%) was febrile. Two patients required an additional curative antibiotic therapy. No patient was hospitalized. Overall, 77.8% of UTIs were cured without antibiotic therapy.

CONCLUSION

Screening and treating asymptomatic bacteriuria before urological procedures seems unnecessary and vainly exposes this population at high risk of infectious diseases to antibiotic therapies. This data should be confirmed by a randomized clinical trial.

Diagnostic delay of pyogenic vertebral osteomyelitis and its associated factors

OBJECTIVES

Pyogenic vertebral osteomyelitis (PVO) is a rare disease with possible severe complications (e.g. sepsis and spinal cord injury). In the 1990s, diagnostic delay (DD) was often extensive as PVO has a non-specific clinical spectrum, mostly afebrile with back pain, and access to magnetic resonance imaging (MRI) was not straightforward. Our aim was to perform a new study focusing on the clinical spectrum and DD of PVO and its associated factors.

METHOD

This study examined a prospective cohort of 88 patients having PVO with microbiological identification between 15 November 2006 and 15 November 2010.

RESULTS

The 88 patients included in the study (female:male ratio 1:8) had a mean age of 64.1 years. The mean (sd) DD was 45.5 (50.4) days (range 2-280), and 46 patients (52.2%) were febrile at diagnosis. The main microorganism involved was Staphylococcus (n = 45; 51.1%). In univariate and multivariate analyses, age > 75 years, antecedent back pain, involvement of bacteria, topography of PVO, and anti-inflammatory drug intake did not affect the DD, unlike a C-reactive protein (CRP) value > 63 mg/L or a positive blood culture (DD lowered from 73 to 17 days and from 90 to 30 days, respectively). Conversely, X-ray investigation was associated with a longer DD (from 14 to 34.7 days). Severity at diagnosis was not significantly different depending on the intake of anti-inflammatory drugs.

CONCLUSIONS

Despite easier access to MRI, the DD for PVO remains long. One shortening factor is a high CRP value, which could be a useful diagnostic tool in case of back pain. Anti-inflammatory drugs seem to have no impact on DD and severity at diagnosis.

The mean platelet volume and neutrophil to lymphocyte ratio in obese and lean patients with polycystic ovary syndrome

PURPOSE

Mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) are the new markers of the detection of inflammation. Our aim is to investigate MPV and NLR in lean and obese patients with polycystic ovary syndrome (PCOS).

METHODS

This study was designed to investigate MPV, NLR, and high-sensitive C-reactive protein (hsCRP) levels in 25 obese patients with PCOS and 16 lean patients with PCOS, and our study group was matched with 16 obese and 14 non-obese controls, respectively.

RESULTS

PCOS group had higher MPV, NLR, neutrophil count, neutrophil to total leucocyte ratio, basophil count, waist circumference (WC), insulin, glucose, and HOMA-IR rates than those of controls. hsCRP levels were similar in both groups. Subgroup analyses revealed that obese PCOS group had higher insulin and HOMA-IR levels, compared to those of controls. In this subgroup, total leucocyte counts, MPV, and hsCRP levels were similar. On the other hand, lean PCOS group had higher WC, NLR, MPV, and basophil count than controls. In correlation analysis, hsCRP was positively correlated with body mass index (BMI), WC, total leucocyte count, neutrophil count, while negatively correlated with lymphocyte ratio. Although leucocyte count was positively correlated with BMI, MPV was negatively correlated with BMI, total leucocyte, platelet, and neutrophil counts. NLR was positively correlated with HOMA-IR, hsCRP, BMI, WC, and insulin.

CONCLUSION

Our study demonstrated that MPV and NLR levels are increased despite similar hsCRP levels in patients with PCOS. However, we failed to demonstrate these differences in obese PCOS patients. Further studies with larger sample size are required to determine the significance of BMI in the inflammation of PCOS patients.

Geostatistical analysis of the relationship between heavy metals in drinking water and cancer incidence in residential areas in the Black Sea region of Turkey

In the study described in this article, the authors examined the relationship between heavy metals in the drinking water and cancer densities in residential areas. The Turkish cities of Trabzon, Rize, and Giresun in the eastern Black Sea region were chosen as the study areas. Cancer registry data, population information, heavy metal chemical analysis results for drinking water, and other spatial information for the region were collected in a database designed in GIS. Information on a total of 13,012 registered cancer cases from the years 2000-2007 was obtained from a cancer record center and depicted spatially on a map. The incidence values explaining cancer density in residential units were calculated. Chemical analyses were then conducted to determine the presence of 17 different heavy metals by collecting a total of 541 drinking water samples. It was determined that among the 17 analyzed heavy metals, beryllium, nickel, antimony, and molybdenum had a significant relationship with cancer incidence values in the residential units.