Advancements in non-invasive skin sampling: Clinical conditions characterization via the assessment of skin surface cytokine biomarkers

The skin is increasingly recognized as a biological active organ interacting with the immune system. Given that the epidermal skin layer actively releases various cytokines, non-invasive skin sampling methods could detect these cytokines, offering insights into clinical conditions. This study aims non-invasively measuring cytokine levels directly from the skin surface to characterize different inflammatory chronic disorders in the adult and elderly population: psoriasis, diabetes type 2, rosacea, chronic kidney disease (CKD) and aging. Cytokines IL-1β, IL-8 and IL-10 were sampled from healthy subjects and patients aged 18-80 using skin surface wash technique. A well with sterile phosphate-buffered saline solution was placed on the skin for 30 min, and the extracted solution was collected from the well for further cytokine levels analysis using ELISA assay. Results show distinct cytokine profiles in different pathological processes, healthy controls, affected and unaffected areas. Aging was associated with increased IL-1β, IL-8, and IL-10 levels in skin. In diabetes, IL-1β and IL-8 levels were elevated in lesional areas, while IL-10 levels were decreased in non-lesional skin. Psoriatic lesions showed elevated levels of IL-1β and IL-8. Rosacea patients had lower IL-10 levels in both lesional and non-lesional areas. CKD patients exhibited significantly lower IL-10 levels compared to healthy individuals. In conclusion, skin surface wash-derived cytokine profiles could serve as "alert biomarkers" for disease prediction, enabling early detection. Additionally, this method's cost-effectiveness allows pre-screening of molecules in clinical studies and holds potential as a tool for biomarkers and omics analysis, enhancing disorder characterization and disease management.

Newborns' clinical conditions are correlated with the neonatal assessment manual scorE (NAME)

OBJECTIVE

To investigate the relationship between the Neonatal Assessment Manual scorE (NAME) and newborns' clinical condition on a large number of infants. The NAME model was developed as an instrument to assess the infant's general conditions, especially in NICUs, by evaluating how the infant's body responds to an external stressor such as static touch. Previous studies, employing experienced assessors, showed good validity indices as well as high inter-rater reliability.

STUDY DESIGN

Newborns were recruited at the "Vittore Buzzi" Pediatric Hospital NICU ward in Milan and their clinical conditions were collected through a standardized form-the complexity index. Two manual practitioners assessed all eligible newborns using the NAME scores. Data was analyzed using Kendall's τ correlation and odds ratio (OR) to assess the relationship between the NAME scores and the complexity index.

RESULTS

Two hundred two newborns (46% female; 34.1 w ± 4.3; birth weight of 2,093.4 gr ± 879.8) entered the study. The Kendall's correlation between the clinical conditions (complexity index) and the NAME score was -0.206 [95% CI: (-0.292, -0.116), p-value < 0.001], corresponding to an OR of 0.838 [95% CI: (0.757, 0.924), p-value < 0.001]. Further exploratory analyses showed significant correlation between gestational age, birth weight and NAME scores.

CONCLUSION

The present paper adds evidence to the NAME model validity by demonstrating its applicability in the clinical neonatological context.

Khat Chewing and Clinical Conditions Determine the Epidemiology of Primary Drug Resistance Tuberculosis in Amhara Region of Ethiopia: A Multicenter Study

BACKGROUND

Rifampicin and/or multidrug-resistant tuberculosis (RR/MDR-TB) remains an uncontrolled public health emergency that has been synergized by the recently increased person-to-person transmission in the community as primary RR/MDR-TB, which is defined as RR/MDR-TB in new TB patients with no prior exposure to anti-TB treatment for more than one month. This study aimed to measure the prevalence and associated factors of primary drug-resistance among drug-resistant tuberculosis patients, as evidenced by the Amhara region treatment initiating centers.

METHODS

An institutional-based multicenter cross-sectional study was conducted from September 2010 to December 2017, among 580 RR/MDR-TB patients on the second-line anti-TB drug in the Amhara regional state. Data were collected from patient charts and registration books using a standardized data abstraction sheet. The data were entered using Epi-data 4.2.0.0 and transferred to Stata 14 software for further data management and analysis. A bivariable and multivariable binary logistic model was run subsequently, and finally, a p-value of less than 0.05 with a 95% confidence interval (CI) was used to declare the significance of the explanatory variable.

RESULTS

The magnitude of primary drug resistance among drug-resistant tuberculosis patients was 15.69% (95% CI: 12.94, 18.89). Alcohol drinking (adjusted odds ratio [AOR] = 0.31, 95% CI: 0.12-0.82), khat chewing (AOR = 4.43; 95% CI: 1.67-11.76), ambulatory and bedridden functional status (AOR = 0.43; 95% CI: 0.24-0.76) and (AOR = 0.41; 95% CI: 0.19-0.91), respectively, positive sputum smear result (AOR = 0.48; 95% CI: 0.26-0.90), and HIV coinfection (AOR= 2.31; 95% CI: 1.31-4.06) remained statistically significant associated factors of primary RR/MDR-TB.

CONCLUSION

Primary drug resistance is a public health problem in the study setting. Different behavioral and clinical conditions were significant factors of primary drug-resistant development. Mitigation strategies targeted on the patient's clinical condition, substance-related behaviors, and universal DST coverage might be very important for early detection and treatment of RR/MDR-TB to prevent community-level transmission.

Effects of the Probiotic Mixture Slab51® (SivoMixx®) as Food Supplement in Healthy Dogs: Evaluation of Fecal Microbiota, Clinical Parameters and Immune Function

The gut microbiota plays a crucial role in several physiologic functions of the host. In humans and animals, manipulation of the intestinal microbiota by oral administration of probiotic lactic acid bacteria plays a significant role in modulating the immune system. The aim of this study was to evaluate the safety of the probiotic mixture Slab51® and the capacity of this mixture to stimulate immune function in healthy dogs. Twenty dogs were divided in two groups and received a control diet or the same diet supplemented with a dose of 400 billion cfu of lyophilized bacteria for a period of 60 days. Body weight, food intake, body condition score (BCS), fecal score (FSS), fecal immunoglobulin IgA concentration, plasma IgG concentration, and fecal microbiota composition were monitored. Weight, food intake, BCS, FSS, and biochemical parameters remained unchanged during the treatment in both groups of animals. The fecal microbiota showed a significant decrease in the abundance of Clostridium perfringens and a significant increase in the abundance of beneficial Bifidobacterium and Lactobacillus organisms (p < 0.05). Fecal IgA and plasma IgG levels were significantly higher in the group receiving the probiotic compared to healthy controls. These data show that dietary supplementation with the probiotic mixture Slab51® is safe and well-tolerated, modulating the composition of the intestinal microbiota, and enhancing specific immune functions in healthy dogs.

Frequency and prevalence of clinical conditions and therapeutic drugs used in dog and cat at Teaching Veterinary Hospital, Chattogram Veterinary and Animal Sciences University

Objective

This study was carried out to determine the frequency and prevalence of clinical conditions and their treatment, especially antibiotics in dogs and cats.

Materials and Methods

A period of 12-month retrospective study was conducted at the Teaching Veterinary Hospital, Chattogram Veterinary and Animal Sciences University, Chittagong, Bangladesh from July 2018 to June 2019. A total of 849 cases, including 488(57.5%) and 361 (42.5%) dogs and cats respectively, were in account to espy the clinical conditions. Season, age, sex, and breed were the parameters to analyze the prevalence of those clinical conditions.

Results

From the study, it was found that the endoparasitic infestation was highly frequent in both dog and cat (55% in dogs and 59% in cats). The endoparasitic infestation was highly prevalent in cats (91.53%) significantly (p = 0.003), which were ≤1 year of age. On the other hand, the ectoparasitic infestation was found prevalent significantly (p = 0.06) in the winter than any season and dewormed dogs (p = 0.03). Prevalence of canine parvovirus infection in dogs and wound in cats were substantially higher (p < 0.001 and p=0.05 respectively) in the winter whereas the prevalence of myiasis in dogs was prominent in the rainy season significantly (p = 0.01). The mostly used antibiotic was ceftriaxone (9.5% in dogs and 4% in cats).

Conclusion

Different endoparasitic, ectoparasitic, and infectious diseases found prone to infect pet animals, mainly dogs, and cats. By maintaining proper anthelmintics and vaccine shots may act as a prevention procedure to those infections.

A Systematic Review of Efficacy, Safety, and Tolerability of Duloxetine

Duloxetine is a serotonin-norepinephrine reuptake inhibitor approved for the treatment of patients affected by major depressive disorder (MDD), generalized anxiety disorder (GAD), neuropathic pain (NP), fibromyalgia (FMS), and stress incontinence urinary (SUI). These conditions share parallel pathophysiological pathways, and duloxetine treatment might be an effective and safe alternative. Thus, a systematic review was conducted following the 2009 Preferred Reporting Items (PRISMA) recommendations and Joanna Briggs Institute Critical (JBI) Appraisals guidelines. Eighty-five studies focused on efficacy, safety, and tolerability of duloxetine were included in our systematic review. Studies were subdivided by clinical condition and evaluated individually. Thus, 32 studies of MDD, 11 studies of GAD, 19 studies of NP, 9 studies of FMS, and 14 studies of SUI demonstrated that the measured outcomes indicate the suitability of duloxetine in the treatment of these clinical conditions. This systematic review confirms that the dual mechanism of duloxetine benefits the treatment of comorbid clinical conditions, and supports the efficacy, safety, and tolerability of duloxetine in short- and long-term treatments.

Medical student education in emergency medicine: do students meet the national standards for clinical encounters of selected core conditions?

BACKGROUND

Establishing a core curriculum for undergraduate Emergency Medicine (EM) education is crucial to development of the specialty. The Clerkship Directors in Emergency Medicine (CDEM) National Curriculum Task Force recommended that all students in a 4(th)-year EM clerkship be exposed to 10 emergent clinical conditions.

OBJECTIVES

To evaluate the feasibility of encountering recommended core conditions in a clinical setting during a 4(th)-year EM clerkship.

METHODS

Students from three institutions participated in this ongoing, prospective observation study. Students' patient logs were collected during 4-week EM clerkships between July 2011 and June 2012. De-identified logs were reviewed and the number of patient encounters for each of the CDEM-identified emergent conditions was recorded. The percentage of students who saw each of the core complaints was calculated, as was the average number of core complaints seen by each.

RESULTS

Data from 130 students at three institutions were captured; 15.4% of students saw all 10 conditions during their rotation, and 76.9% saw at least eight. The average number of conditions seen per student was 8.4 (range of 7.0-8.6). The percentage of students who saw each condition varied, ranging from 100% (chest pain and abdominal pain) to 31% (cardiac arrest).

CONCLUSIONS

Most students do not encounter all 10 conditions during patient encounters throughout a 4-week EM rotation, although most have exposure to at least eight. Certain conditions are far less likely than others to be encountered, and may need to be taught in a nonclinical setting.

Clinical Significance of Conditions Presenting with ECG Changes Mimicking Acute Myocardial Infarction

The electrocardiogram (ECG) is the primary tool in the diagnosis of acute myocardial infarction (AMI). However, other clinical conditions, both cardiac and noncardiac originated pathologies, may result in ECG tracing of AMI. This may lead to an incorrect diagnosis, exposing the patients to unnecessary tests and potentially harmful therapeutic procedures. The aim of this report is to increase the still insufficient awareness of clinicians from multiple disciplines, regarding the different clinical syndromes, both cardiac and noncardiac, associated with ECG abnormalities mimicking AMI, to avoid unjustified thrombolytic therapy or intervention procedures. During a 9-year period, the data from six patients (five females, one male; mean age, 50 years [range, 18 to 78 years]) who were admitted to cardiac care unit (CCU) with transient ECG changes resembling AMI were recorded retrospectively. During this 9-year period, 5,400 patients were hospitalized in CCU: 1,350 patients were diagnosed as ST-elevation myocardial infarction (STEMI) and 4,050 patients were diagnosed as non-ST-elevation myocardial infarction (NSTEMI). Only two out of six patients had chest pain with ECG changes criteria suspicious of AMI. STEMI was suspected in four out of six patients. All patients, but one, had normal left ventricular (LV) function. One patient had transient LV dysfunction. All patients, but one, with perimyocarditis, had normal serum cardiac markers. In four out of six patients, who underwent coronary arteries imaging during hospitalization (by angiography or by CT scan), normal coronary arteries were documented. Two patients who underwent ambulatory cardiac CT scan imaging after being discharged from hospital documented patent coronary arteries (case no. 3), or some insignificant irregularities (case no. 4). The discharge diagnoses from CCU were as follows: postictal syndrome, pericarditis, hypothermia, stress-induced ("tako-tsubo") cardiomyopathy, anaphylactic reaction, and status of postchemotherapy. All patients experienced full recovery with normal ECG tracing. During the 5-year follow-up, all patients were alive, and cardiac morbidity was not reported. We conclude that both cardiac and noncardiac clinical syndromes may mimic AMI. Comprehensive clinical examination and profound medical history are crucial for making the correct diagnosis in conditions with ECG changes mimicking AMI.

Clinically Relevant Measures of Children's Theory of Mind and Knowledge about Thinking: Non-Standard and Advanced Measures

Measures of Theory of Mind (ToM) in clinical disorders and conditions are reviewed, focusing on non-standard and advanced measures. Relevant studies linking these measures to social problems and cognitive symptoms are reviewed. The multifaceted nature of ToM is stressed and clinically relevant aspects of ToM are suggested. Strategies to select relevant measures for clinical research and practice are presented and examples are discussed in more detail. It is recommended to consider specific aspects of ToM in relation to specific clinical conditions and symptoms. Relationships between ToM and other cognitive deficits, and implications for clinical practice and intervention are also discussed.