Search Results (35,168)

Background/Objectives: Carbapenem-resistant Enterobacterales (CRE) are a global health threat due to their high morbidity and mortality rates and limited treatment options. This study examines the plasmid-mediated transmission of virulence and antibiotic resistance determinants in carbapenem-resistant Klebsiella pneumoniae (Kpn) and Escherichia coli (E. coli) isolated from Russian hospitals. Methods: We performed short- and long-read whole-genome sequencing of 53 clinical isolates (48 Kpn and 5 E. coli) attributed to 15 genetic lineages and collected from 21 hospitals across nine Russian cities between 2016 and 2022. Results: The plasmid analysis identified 18 clusters that showed high concordance with replicon typing, with all clusters having a major replicon type. The majority of plasmids in the IncHI1B(pNDM-MAR)/IncFIB(pNDM-Mar)-like cluster (79.16%) carried both antibiotic resistance genes (e.g., bla_NDM-1 and bla_OXA-48) and virulence factors (VFs) such as siderophore genes. We hypothesized that hybrid plasmids could play a critical role in the dissemination of antibiotic resistance genes and VFs. Comparative analyses with global plasmid databases revealed high-risk lineages of hybrid plasmids that are predominantly spread throughout Russia at present. Conclusions: Our findings underscore the importance of monitoring plasmid backbones for clinical management, surveillance, and infection control activities. Full article

New healthcare management strategies aim to reduce in-person visits and patient hospitalization while ensuring patient safety. These strategies optimize resources, alleviate pressure on healthcare services, and decrease travel and mobility within healthcare environments. This research analyzes the environmental impact and sustainability associated with transportation and mobility in traditional hospital-based healthcare services, which have been relocated to bring healthcare closer to patients. This retrospective study utilizes data from two hospital centers spanning the years 2021 to 2023. The objective is to highlight the environmental benefits and sustainability of providing healthcare in the patient’s environment. The methodology employs life cycle analysis to compare three scenarios: traditional healthcare in hospitals, healthcare provided at the patient’s location through home hospitalization and medical consultations at nearby health centers, and healthcare professionals’ travel using electric vehicles. The results demonstrate that healthcare professionals traveling to the patient’s home or nearby health centers reduce environmental impact across all analyzed impact categories. Promoting home hospitalization, specialized consultations at local health centers, and primary care can effectively reduce unnecessary patient travel and minimize environmental impact, enhancing sustainability. Health policies should prioritize actions to reduce hospital visits, emphasizing prevention over disease treatment. Such practices would not only benefit patients but further promote sustainability and environmental protection. Full article

Background: Preventing postoperative infection and promoting patient safety are essential responsibilities of the operating room nurse. In some hospitals, splash basins are used to rinse instruments during surgery, although previous studies emphasise the risk of bacterial contamination. A recent systematic review calls for further investigation into surgical teams’ use of splash basins. Objectives: Our objective was to investigate bacterial contamination in splash basins and to identify the variables that may have an influence on this contamination. Methods: This prospective observational pilot study involved collecting, cultivating, and analysing water samples obtained from splash basins during operations performed in the thoracic and neurosurgical departments. The ventilation systems, length of surgery, number of instruments in the splash basin, number of persons present in the operating room, frequency of door openings during surgery, and type of bacteria were observed. Results: Bacterial growth was found in 44% of the final water samples: 41% from the thoracic surgical department, which had laminar airflow ventilation systems/unidirectional airflow ventilation, and 47% from the neurosurgical department, which had conventional ventilation systems/turbulent mixing ventilation. However, the binary logistic regression analysis revealed no significant correlation between bacterial growth and the ventilation systems, length of surgery, number of instruments in the splash basin, number of people in the operating room, or frequency of door openings. The most common types of bacteria found were coagulase-negative staphylococci and Micrococcus luteus. Conclusions: Splash basins become contaminated with bacteria during surgery. Therefore, using splash basins with sterile water is not recommended. Further research is needed to determine the best evidence-based practice for rinsing instruments perioperatively. Full article

Background/Objectives: We aimed to determine the proportion of bacterial etiology in pediatric acute epididymitis (AE) and to compare the predictive accuracy of C-reactive protein (CRP) and urinalysis. Methods: Pediatric patients diagnosed with AE in National Taiwan University Hospital from 2009 to 2018 were retrospectively identified. Patient profiles, including clinical symptoms, physical findings, laboratory data, and treatment types, were collected. Patients were categorized into acute bacterial epididymitis (ABE) or acute non-bacterial epididymitis (ANBE) groups based on the presence or absence of bacterial growth in urine cultures. The primary endpoints were the proportion of patients with ABE and those who received antibiotic therapy. The secondary endpoint was to assess the diagnostic accuracy of CRP and urinalysis for ABE. Results: The final cohort comprised of 289 patients, of whom 216 (74.7%) received antibiotics. Urine culture was obtained for 167 (57.8%) patients, and 52 (31.1%) were positive for a bacterial source. The median CRP and positive rate for urinalysis were significantly higher in the ABE group compared to the ANBE group (CRP: 3.68 vs. 0.25 mg/dL; p < 0.001; urinalysis: 41% vs. 23%; p = 0.005). Multivariate analysis revealed that elevated CRP was significantly associated with AE (odds ratio [OR], 61.96; p < 0.001), whereas positive urinalysis was not (OR, 2.09; p = 0.33). The area under the receiver operating characteristic curves for CRP was higher than that for urinalysis (0.82 vs. 0.72). Conclusions: Serum CRP proved to be a more accurate and reliable tool than urinalysis for predicting pediatric ABE. This could provide guidance to practitioners when prescribing antibiotics in the future. Full article

Background: The rapid onset of COVID-19 placed immense strain on many already overstretched healthcare systems. The unique physiological changes in pregnancy, amplified by the complex effects of COVID-19 in pregnant women, rendered prioritization of infected expectant mothers more challenging. This work aims to use state-of-the-art machine learning techniques to predict whether a COVID-19-infected pregnant woman will be admitted to ICU (Intensive Care Unit). Methods: A retrospective study using data from COVID-19-infected women admitted to one hospital in Astana and one in Shymkent, Kazakhstan, from May to July 2021. The developed machine learning platform implements and compares the performance of eight binary classifiers, including Gaussian naïve Bayes, K-nearest neighbors, logistic regression with L₂ regularization, random forest, AdaBoost, gradient boosting, eXtreme gradient boosting, and linear discriminant analysis. Results: Data from 1292 pregnant women with COVID-19 were analyzed. Of them, 10.4% were admitted to ICU. Logistic regression with L₂ regularization achieved the highest F₁-score during the model selection phase while achieving an AUC of 0.84 on the test set during the evaluation stage. Furthermore, the feature importance analysis conducted by calculating Shapley Additive Explanation values points to leucocyte counts, C-reactive protein, pregnancy week, and eGFR and hemoglobin as the most important features for predicting ICU admission. Conclusions: The predictive model obtained here may be an efficient support tool for prioritizing care of COVID-19-infected pregnant women in clinical practice. Full article

Objective: A controversial aspect of pediatric septic shock management is corticosteroid therapy. Current guidelines do not recommend its use in forms responsive to fluids and inotropes but leave the decision to physicians in forms refractory to the first steps of therapy. Data Sources: Review of literature from January 2013 to December 2023 from online libraries Pubmed, Medline, Cochrane Library, and Scopus. Study Selection: The keywords “septic shock”, “steroids” and “children” were used. Data Extraction: Of 399 articles, 63 were selected. Data Synthesis: Regarding mortality, although the 2019 Cochrane review supports reduced mortality, benefits on long-term mortality and in patients with CIRCI (critical illness-related corticosteroid insufficiency) are not clear. Yang’s metanalysis and retrospective studies of Nichols and Atkinson show no difference or even an increase in mortality. Regarding severity, the Cochrane review claims that hydrocortisone seems to reduce the length of intensive care hospitalization but influences the duration of ventilatory and inotropic support, and the degree of multi-organ failure appears limited. Further controversies exist on adrenal function evaluation: according to literature, including the Surviving Sepsis Campaign guidelines, basal or stimulated hormonal dosages do not allow the identification of patients who could benefit from hydrocortisone therapy (poor reproducibility). Regarding side effects, muscle weakness, hypernatremia, and hyperglycemia are the most observed. Conclusions: The literature does not give certainties about the efficacy of corticosteroids in pediatric septic shock, as their influence on primary outcomes (mortality and severity) is controversial. A subgroup of patients suffering from secondary adrenal insufficiency could benefit from it, but it remains to be defined how to identify and what protocol to use to treat them. Full article

Background: Multimodal prehabilitation programs, which may incorporate nutritional supplementation and exercise, have been developed to combat sarcopenia in surgical patients to enhance post-operative outcomes. However, the optimal regime remains unknown. The use of beta-hydroxy beta-methylbutyrate (HMB) has beneficial effects on muscle mass and strength. However, its effect on muscle quality in the perioperative setting has yet to be established. This study aims to explore the impact of a multimodal prehabilitation program using a bundle of care that includes high-protein oral nutritional supplementation (HP ONS) with HMB and resistance exercise on muscle quality and functional outcomes in sarcopenic surgical patients. Methods: Sarcopenic adult patients undergoing elective major gastrointestinal surgeries were recruited for this pilot interventional cohort study. They were enrolled in a 2–4-week multimodal prehabilitation program comprising resistance exercise, nutritional supplementation, vitamin supplementation, comorbid optimization and smoking cessation. Participants were provided three units of HP ONS with HMB per day pre-operatively. The primary outcome was changes in intramuscular adipose tissue (IMAT) as a proxy of muscle quality, assessed using Artificial Intelligence (AI)-aided ultrasonography. Secondary outcomes include changes in anthropometric measurements and functional characteristics. Outcomes were measured before prehabilitation, after prehabilitation and 1 month post-operatively. Results: A total of 36 sarcopenic patients, with a median age of 71.5 years, were included in this study. There was an increase in the IMAT index after two weeks of prehabilitation (p = 0.032) to 1 month after surgery (p = 0.028). Among functional parameters, improvement was observed in gait speed (p = 0.01) after two weeks of prehabilitation, which returned to baseline post-operatively. The median length of hospital stay was 7 (range: 2–75) days. Conclusions: The increase in the IMAT index in a sarcopenic surgical cohort undergoing prehabilitation may be due to altered muscle metabolism in elderly sarcopenic patients. A prehabilitation regime in sarcopenic patients incorporating HP ONS with HMB and resistance exercise is feasible and is associated with increased gait speed. Full article

This study explores the application of generalized conformable derivatives in modeling hotel demand dynamics in Mexico, using the Gompertz-type model. The research focuses on customizing conformable functions to fit the unique characteristics of the Mexican hotel industry, considering the Tourist Area Life Cycle (TALC) model and aiming to enhance forecasting accuracy. The parameter adjustment in all cases was made by designing a convex function, which represents the difference between the theoretical model and real data. Results demonstrate the effectiveness of the generalized conformable derivative approach in predicting hotel demand trends, showcasing its potential for improving decision-making processes in the Mexican hospitality sector. The comparison between the logistic and Gompertz models, in both integer and fractional versions, provides insights into the suitability of these modeling techniques for capturing the dynamics of hotel demand in the studied regions. Full article

Atrial fibrillation (AF) is the leading cause of arrhythmia-related morbidity and mortality. Recurrent symptoms, hospitalizations, and cost burden to patients have necessitated treatments beyond antiarrhythmic drugs (AADs) for patients with AF. Catheter ablation has proven to be effective over medical therapy alone; however the recurrence rates for atrial tachyarrhythmias post-ablation remain significant, particularly in patients with persistent and long-standing persistent AF. Hence, new techniques for catheter ablation have arisen, such as non-thermal energy sources, novel catheters, electroanatomical mapping, and ablation of additional targets. In this review, we discuss the recent advances in the field of catheter ablation, including newer modalities for the prevention of adverse events and future perspectives. Full article

Objective: Osteoporosis is prevalent in patients with chronic kidney disease (CKD), with risk increasing as CKD progresses, subsequently elevating fracture risk. While previous studies have shown a link between low skeletal muscle mass and osteoporosis in the general population, there is limited research exploring this relationship in patients with advanced CKD (stages 3-5D). This study aimed to evaluate whether skeletal muscle area (SMA), as measured by abdominal CT, is correlated with bone mineral density (BMD) in advanced CKD patients beginning hemodialysis. Methods: This single-center, retrospective cohort study included patients who started maintenance hemodialysis at Daejeon St. Mary’s Hospital from January 2018 to September 2021. Patients who underwent abdominal CT and BMD assessments within three months of dialysis initiation were enrolled, resulting in a sample of 87 individuals. Baseline characteristics were analyzed, with patients stratified by sex and SMA quartiles. Pearson’s correlation and multivariate regression analyses were conducted to the relationship between SMA and BMD T-scores. Results: The study cohort had an average age of 65.4 years, with 52.9% of participants being male. Male patients exhibited significantly higher SMA and BMD T-scores in both the lumbar spine and femur compared to female patients. SMA showed the strongest positive correlation with BMD at both sites (lumbar spine, r = 0.424; femur, r = 0.514; p < 0.001). Multivariate analysis identified SMA as an independent positive predictor of BMD, while alkaline phosphatase (ALP) was independently associated with lower femur BMD. In the SMA-based subgroup analysis, patients with lower SMA had significantly lower BMD T-scores and a higher risk of osteoporosis. Logistic regression indicated that patients in the lowest SMA quartile had substantially increased odds of osteoporosis compared to those in the highest quartile, with an adjusted odds ratio of 30.59 (p = 0.008). Conclusions: Lower skeletal muscle mass is significantly associated with lower bone density and a higher risk of osteoporosis in advanced CKD patients initiating hemodialysis. SMA, as measured by abdominal CT, may serve as a useful marker for identifying patients at elevated osteoporosis risk in this population. Full article

Objectives: Current guidelines recommend systematic screening for rheumatic diseases (RDs), including antiphospholipid syndrome (APS), in patients with recurrent pregnancy loss (RPL). However, these recommendations are based on limited evidence, as data on the prevalence of RD in this specific population remain scarce. In particular, the impact of the recent update to the ACR/EULAR classification criteria for APS on the prevalence of RD among RPL patients has yet to be clarified. To address these gaps, this study aims to (i) assess the impact of the 2023 ACR/EULAR APS classification criteria in patients with recurrent pregnancy loss (RPL); and (ii) analyze the prevalence of RD in these patients. Methods: We conducted a retrospective cohort study at Rennes University Hospital. From January 2010 to December 2021, all patients referred to the Clinical Immunology Department for RPL were included. Patients were eligible if they had undergone a full RPL evaluation, according to guidelines. Results: We included 165 women with RPL. APS according to the Sydney criteria was found in 24 (14.5%) patients. No significant differences in obstetric history or clinical signs were observed between APS-positive and APS-negative individuals. Only two patients fulfilled the updated 2023 APS criteria, resulting in 163 (98.8%) patients being classified as having unexplained recurrent pregnancy loss (uRPL). Among them, 108 had a new pregnancy following uRPL, resulting in 87 (81%) live births and 21 (19%) recurrent miscarriages. We did not identify any prognostic factor associated with subsequent pregnancy outcomes, including the patients’ antiphospholipid biological profile. We found a prevalence of non-APS RD of only 2.4% in the study population, including systemic lupus erythematosus, rheumatoid arthritis, and Behçet’s disease. Conclusions: APS was identified in 14.5% of the patients based on the former Sydney criteria and 1.2% according to the revised criteria. The lack of clinical differences between APS and non-APS patients aligns with previously reported limitations of the Sydney criteria in accurately identifying aPLA-related RPL. According to the rarity of APS as per the updated criteria, future large collaborative trials will be needed to further characterize APS-related RPL patients and to determine the best treatment strategy for future pregnancies. Full article

Background/Objectives: Cardiopulmonary bypass can lead to hemodilution, causing a fluid shift to the interstitial space. Albumin helps counteract the intravascular fluid movement to the extravascular space and reduces the risk of complications associated with fluid imbalance. Our main objective was to evaluate the effectiveness of albumin addition in the cardiopulmonary bypass priming solution compared to standard priming, focusing on its role in reducing pleural effusion development. Methods: This was a single-center randomized controlled trial conducted at a tertiary care hospital specializing in cardiology and cardiac surgery. It involved 70 individuals scheduled for elective open-heart surgery. All cases were randomly assigned into two groups of 35 patients. The study group replaced 100 mL of standard CPB priming solution with 100 mL of 20% human albumin. We measured serum albumin levels before and after the surgery, 6 and 12 h after, and calculated colloid oncotic pressure. Thorax CT scans were performed on the first postoperative day to measure and calculate pleural effusion volume. Results: Albumin addition to cardiopulmonary bypass priming solution led to a significant reduction in pleural effusion development after CPB. An albumin level <35 g/L after the surgery showed a significant increase in pleural effusion development, and 100 mL of 20% albumin was sufficient to maintain serum albumin levels > 35 g/L. Conclusions: Our study suggests a link between postoperative hypoalbuminemia and the early development of pleural effusion after CPB, as well as the possible benefits of adding 100 mL of 20% albumin compared to standard crystalloid CPB priming to minimize postoperative pleural effusion development. Full article

The incidence of infections caused by the Mycobacterium avium complex (MAC) has risen significantly, posing diagnostic and therapeutic challenges. This study analyzed 134 clinical isolates of the Mycobacterium avium complex from southern Spain, performing in vitro antimicrobial susceptibility testing using a commercial microdilution technique to generate additional data, refine treatment strategies, and improve patient outcomes. Phenotypic susceptibility testing revealed clarithromycin and amikacin as the most effective antibiotics, with susceptibility rates exceeding 90%, while linezolid and moxifloxacin exhibited limited activity, with resistance rates of 49.3% and 41.8%. A comparative analysis between M. avium and M. intracellulare showed significant differences in resistance to amikacin and linezolid, with M. avium exhibiting higher resistance rates. Additionally, species-specific differences were observed in MIC distributions for ethionamide, ciprofloxacin, and streptomycin. Our data reveal regional variability in resistance patterns, particularly for moxifloxacin and linezolid, which exhibit differing resistance rates compared to studies from other regions. The significant MIC differences for several antibiotics between M. avium and M. intracellulare underscore the importance of species-level identification and the heterogeneity in resistance mechanisms within MAC. Full article

The aim of this study is to examine the mediating role of cultural intelligence in the relationship between leadership behaviors and leadership effectiveness. A quantitative approach was adopted to test the hypotheses, and data were collected through surveys from 410 employees working in four- and five-star hotels in Istanbul. The analysis of the obtained data was conducted using Structural Equation Modeling (SEM), regression analysis, and the PROCESS macro. The results of the analysis revealed that cultural intelligence has a mediating effect on the relationships between task-oriented leadership behaviors and leadership effectiveness, relationship-oriented leadership behaviors and leadership effectiveness, and change-oriented leadership behaviors and leadership effectiveness. In the globalized world, cultural diversity in businesses is increasing, which is especially pronounced in the hospitality industry. The fact that guests come from different cultural backgrounds further highlights the importance of leaders’ cultural awareness and cultural intelligence. As a result, both academics and managers attach great importance to this issue. However, there are still significant gaps in understanding the relationship between cultural intelligence and leadership. In this context, the study aims to contribute to the literature on leadership and cultural intelligence. Full article

Multiple myeloma (MM) is a malignant disease characterized by the proliferation of plasma cells, primarily in the bone marrow. It accounts for approximately 1% of all cancers and 10% of hematologic malignancies. Clinical manifestations include hypercalcemia, anemia, renal failure, and bone lesions. The pathogenesis of MM involves complex interactions between myeloma cells and their microenvironment. Galectins, a family of β-galactoside-binding proteins, particularly galectin-1, -3, -4, -7, and -9, have been implicated in MM development. This study aimed to assess the plasma levels of these galectins in newly diagnosed MM patients and explore their correlation with clinical parameters. Peripheral blood samples were collected from patients at the Oncohematology Service of the Hospital de Câncer de Pernambuco, and galectin levels were measured using ELISA. Plasma levels of galectins-3, -7, and -9 were significantly higher in MM patients compared to the control group. Three clusters of MM patients were identified based on galectin plasma levels, with cluster 3, characterized by high levels of galectin-1, -4, and -7, being associated with a worse prognosis. A strong positive correlation was found between galectin-1, -4, and -7 levels and markers of kidney function (urea, creatinine, and β2-microglobulin), while negative correlations were observed with hematocrit and hemoglobin. Additionally, galectin-9 showed high accuracy in distinguishing MM patients from healthy controls (AUC = 0.931). Elevated galectin levels were indicative of disease aggressiveness and renal impairment in MM patients. Overall, our findings suggest that galectins-1, -4, -7, and -9 could serve as potential biomarkers for MM progression and severity, warranting further investigation into their utility in MM diagnosis and treatment. Full article