SciCombinator

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The aim of this study is to evaluate the distribution, sources, clinical features and mortality rates of bacteremia due to Extensively Drug-Resistant (XDR) gram negative among Solid-Organ Transplant (SOT) recipients. Materials and Methods A retrospective study of SOT recipients with bacteremia due to XDR gram negative pathogens in 11 centers between 2016 and 2018 was conducted. Patients records were evaluated. Results Of 171 bacteremia occurred in164 SOT recipients 93 (56.7%) were liver, 46 (28%) kidney, 14 (8.5%) heart and 11 (6.7%) lung recipients. Bacteremia episodes were recorded in the first year in 63.7% of the patients (n = 109), early-onset bacteremia was recorded in 45% (n = 77) of the episodes. In multivariate analysis, catheter-associated bacteremia was an independent risk factor for 7-day mortality (p=0.037), and early-onset bacteremia was found as an independent risk factor for 30-day mortality (p = 0.017). Conclusion Difficult-to-treat infections due to XDR bacteria in SOT recipients shadow the success of transplantation. Central venous catheters and antibiotic use seem to be the two main factors. Judicious use of medical devices and antibiotics are of pivotal importance.

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As gene therapy enters mainstream medicine, it is more important than ever to have a grasp of exactly how to leverage it for maximum benefit. The development of new targeting strategies and tools makes treating patients with genetic diseases possible. Many Mendelian disorders are amenable to gene replacement or correction. These often affect post-mitotic tissues, meaning that a single stably expressing therapy can be applied. Recent years have seen the development of a large number of novel viral vectors for delivering specific therapies. These new vectors - predominately recombinant adeno-associated virus (AAV) variants - target nervous tissues with differing efficiencies. This review gives an overview of current gene therapies in the brain, ear, and eye, and describes the optimal approaches, depending on cell type and transgene. Overall, this work aims to serve as a primer for gene therapy in the central nervous and sensory systems.

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Deserts are among the harshest environments on Earth. The multiple ages of different deserts and their global distribution provide a unique opportunity to study repeated adaptation at different timescales. Here, we summarize recent genomic research on the genetic mechanisms underlying desert adaptations in mammals. Several studies on different desert mammals show large overlap in functional classes of genes and pathways, consistent with the complexity and variety of phenotypes associated with desert adaptation to water and food scarcity and extreme temperatures. However, studies of desert adaptation are also challenged by a lack of accurate genotype-phenotype-environment maps. We encourage development of systems that facilitate functional analyses, but also acknowledge the need for more studies on a wider variety of desert mammals.

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Evolving capabilities in environmental data collection, sharing, and processing, are enabling unprecedented use of data from a wide range of sources. Yet data freshness, an important quality dimension associated with the age of data, is a poorly reported aspect of data quality that can lead to additional uncertainty in research findings.

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Shear wave elastography (SWE) is an ultrasonic technique able to quantitatively assess the mechanical properties of tissues by combining acoustic radiation force and ultrafast imaging. While utilizing coherent plane wave compounding enhances echo and shear wave motion signal-to-noise ratio (SNR), it also reduces the effective pulse repetition frequency (PRFe), affecting the accuracy of the measurements of motion and, consequently, of material properties. It is important to maintain both high-motion SNR and PRFe, particularly for the characterization of (material and/or geometrical) dispersive tissues such as arteries. This work proposes a method for SWE measurements with high SNR, while maintaining a high PRFe, using conventional clinical ultrasound scanners. A time alignment process is applied after acquiring data from plane wave transmissions at different angles. The time alignment uses interpolation to obtain data points at higher frame rates, and the time-aligned data are compounded to increase the SNR. The method is used for SWE in tissue-mimicking phantoms of different stiffness and is compared with traditional plane wave compounding. Increases of 58% and 36% in spatial and temporal bandwidth compared with conventional plane wave compounding, respectively, can be achieved for SWE measurements of representative arterial stiffness values. Improvements in phase velocity accuracy and bandwidth in an arterial phantom are also described, to emphasize the beneficial advantage in dispersive cases.

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In France, the cystic fibrosis (CF) care pathway is performed in 45 CF centers, the life expectancy of patients has steadily increased, but to date there are no national recommendations for the transition from pediatric to adult care. The transition to an adult CF center still raises questions about the relevance of its organizational arrangements. The “SAFETIM need” study aimed to identify the organizational needs both of patients and of parents before the transfer to an adult CF center.

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To identify the incidence of delirium in a Pediatric Intensive Care Unit (PICU); to determine the factors associated with the occurrence of delirium and the agreement between two scales used for detection of pediatric delirium in critically ill children.

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A previously healthy 51-y-old male presented to his local emergency department with subjective fevers, myalgias, dyspnea, and generalized weakness that had been progressive for several weeks. He was initially diagnosed with bilateral pneumonia, septic shock, and rhabdomyolysis requiring transfer to a tertiary care facility. He was treated for sepsis with broad-spectrum antibiotics, steroids, and a fluid bolus before transfer. Once he arrived at the tertiary care facility, he developed respiratory failure requiring intubation and ventilatory support. Ceftriaxone and metronidazole were started in the intensive care unit to cover common causes of community-acquired versus aspiration pneumonia, and doxycycline was included to cover tick-borne disease based on a history of tick exposure from working in his rural yard. Blood polymerase chain reaction testing later confirmed ehrlichiosis. The patient had a prolonged hospital course requiring ventilatory support and vasopressors, followed by a 4-wk stay in a rehabilitation unit after discharge. Wilderness medical providers should counsel their patients on prevention of tick bites and keep tickborne illness in the differential for acute illness, based on local epidemiology.

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Lupini beans are legume seeds of the genus Lupinus, consumed in many parts of the world. The main species are Lupinus mutabilis, Lupius angustifolius, and Lupinus albus. The latter is commonly eaten as a snack in Mediterranean countries. The beans are very rich in alkaloids, which give them a bitter taste. One of these alkaloids was shown to cause anticholinergic effects. Lupini beans, if inadequately prepared, can cause toxicity manifesting as an anticholinergic syndrome. We present the case of a 50-y-old woman who presented with bilateral mydriasis, mouth dryness, and anxiety. We confirmed that the patient consumed partially debittered lupini beans a few hours before presentation. The rest of her physical and ophthalmic examination results were within normal limits. Her symptoms resolved without therapy within 12 h from presentation and were attributed to ingestion of incorrectly prepared lupine seeds.

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The neutrophil-lymphocyte ratio (NLR) and the absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC before and after curative-intent radiotherapy for NSCLC on disease recurrence and overall survival.