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Abstract Introduction International guidelines recommend definitive combination antibiotic therapy for the management of serious infections involving carbapenem-resistant Acinetobacter (CRAB) species. The commonly available combination options include high-dose sulbactam, polymyxins, tetracyclines, and cefiderocol. Scanty prospective data exist to support this approach. Methods Patients with CRAB bacteraemia, ventilator-associated pneumonia (VAP), or both were categorized based on whether they received combination therapy or monotherapy. The 30-day mortality was compared between the two groups. Inverse probability treatment weighting (IPTW) was done using propensity score (PS) for a balanced comparison between groups. Results Between January 2021 and May 2023, of the 161 patients with CRAB bacteraemia (n = 55, 34.2%), VAP (n = 46, 28.6%), or both (n = 60, 37.3%) who received appropriate intravenous antibiotic therapy, 70% (112/161) received monotherapy, and the rest received combination therapy. The overall 30-day mortality was 62% (99/161) and not different (p = 0.76) between the combination therapy (31/49, 63.3%) and monotherapy (68/112, 60.7%) groups. The propensity score matching using IPTW did not show a statistical difference (p = 0.47) in 30-day mortality for receiving combination therapy with an adjusted odds ratio (OR) P of 1.29 (0.64, 2.58). Conclusion Combination therapy for CRAB infections needs further study in a randomised controlled trial, as this observational study showed no difference in 30-day mortality between monotherapy and combination therapy.

Background: Monoclonal antibodies (mAbs) are agents that are clones of homogenous parent B cells used in managing and diagnosing multiple conditions. They are used for individualized therapy for patients due to their high specificity for an antigen/epitope. Much needs to be understood about their utilization patterns in a developing country like India, where accessibility and cost play a major role in patient care. Objectives: The objectives of this study were to evaluate the drug prescribing patterns and indications for use of mAbs and compare their availability, with the essential drug list of the World Health Organization (WHO) and the National list of essential medicines in India (NLEM). Materials and Methods: This is a retrospective cross-sectional study conducted from July to December 2021. Data were collected from 237 patients who have visited the tertiary care center or been admitted and have received mAbs. Demographic data, department of admission, diagnosis on admission, and mAbs used during treatment were recorded and analyzed. Results: Out of the 237 patients, who were eligible for this study, 61.6% of them were males and 38.4% were females. The department of ophthalmology used mAbs most commonly (65.8%). Ranibizumab was the most used mAb in this department and overall. Conclusion: Out of the mAbs being used in the tertiary care center, only rituximab was part of the NLEM (India) essential drug list, and six more drugs were present in the WHO essential drug list. The advent of biosimilars is expected to bring costs down significantly for the patient and have better treatment outcomes.

INTRODUCTION: The lifetime of a sensor network completely relies on the potentialities of the utilized Cluster Head (CH) selection scheme that aids in building efficient Wireless Sensor Networks (WSNs). Most of the existing CH selection approaches use an impractical condition which mainly emphasizes that the nodes that are trustworthy and highly energy competitive have better likelihood of being selected as CHs.OBJECTIVES: In this paper, a Markov Process-based Opportunistic Trust Factor Estimation Mechanism (MPOTFEM) is proposed for achieving optimal CH selection that enhances the possibility of maintaining network lifetime and energy stability in the network. METHODS: MPOTFEM is proposed for ensuring efficient CH selection and thereby enhancing the lifetime of WSNs. The proposed MPOTFEM incorporates the merits of Markov process for computing the Opportunistic and Trust factors that assesses the maximum likelihood of nodes with the possibility of being selected as the CH by exploring multiple transition states of nodes in the networks. RESULTS: The results of the propounded MPOTFEM confirm to be significant in improving the network longevity by 39.21% with minimized energy consumption of 34.82% when compared to the baseline CH election mechanisms taken for analysis.CONCLUSION: The results prove that MPOTFEM is better when compared to the benchmarked CH selection schemes in terms of network lifespan and energy stability.

Introduction: Crohn's disease impairs patients' perception of health and has a negative impact on health-related quality of life. Although it is apparent that uncertainty is a significant factor that decreases quality of life, it has never been studied in patients with Crohn's disease. The objective of the present study was to examine the association between level of certainty, self-epistemic authority, Internet information gathering habits, and health-related quality of life., Methods: A cross-sectional study of 105 Crohn's disease patients was conducted. Data were collected using a questionnaire composed of five parts: (1) demographic and clinical information; (2) health-related quality of life; (3) level of certainty; (4) self-epistemic authority; and (5) Internet information gathering habits regarding Crohn's disease., Results: A significant positive correlation was demonstrated between levels of certainty and health-related quality of life. Self-epistemic authority correlated positively with certainty, while information gathering via the Internet was related to decreased certainty. Multiple regression analysis for factors associated with health-related quality of life showed a positive association with the level of certainty, while negative associations were found between Internet information seeking and disease activity with the quality of life., Conclusion: Level of certainty proved an important variable associated with health-related quality of life in Crohn's disease patients. Improving patients' self-epistemic authority can increase certainty and, thus, improve health-related quality of life.

Introduction: Extravasation is a well-recognized complication estimated to be between 0.1% and 0.9% of contrast medium administrations. According to the UC San Diego (UCSD) health system policy, all contrast medium extravasation (CME) reports are reviewed by the department of Risk Management, and the appropriate action is taken. Despite this strategy, a decrease in the incidence of CME could not be demonstrated., Aim: The aims of this study were to determine the frequency, management, and outcome of CME in UC San Diego patients and to assess the knowledge regarding CME among radiology technologists based on policy and guidelines. The secondary aim was to assess the manual ability of the radiology technologists in the performance of the procedure., Methods: The study has 2 parts; the first was retrospective, including data collection and interpretation of all radiology procedures using intravenous contrast medium injection between January 1, 2010, and September 30, 2011, and the second was prospective, including proactive observations and knowledge questionnaire., Results: There were 83 (0.48%) cases of CME of 17,200 patients, 54 women (0.64%) and 29 men (0.33%), P = 0.005. The patients with CME were older, and their cannula was inserted in other departments than Radiology Department, P < 0.000. There was a gap between the high theoretical knowledge that was found in the knowledge questionnaire and its implementation that was demonstrated in the proactive observation., Conclusions: Our data demonstrate that sex, age, and where the cannula was inserted are predictive factors for CME. We believe that CME could be prevented by proper educational program and establishment of efficient strategy.

Objectives: Constipation is a common complaint, frequently treated with cleansing enema. Enemas can be very effective but may cause serious adverse events, such as perforation or metabolic derangement. Our aim was to evaluate the outcome of the use of cleansing enema for acute constipation and to assess adverse events within 30 days of therapy., Methods: We performed a two-phase study: an initial retrospective and descriptive study in 2010, followed by a prospective study after intervention, in 2011. According to the results of the first phase we established guidelines for the treatment of constipation in the Emergency Department and then used these in the second phase., Results: There were 269 and 286 cases of severe constipation in the first and second periods of the study, respectively. In the first study period, only Fleet® Enema was used, and in the second, this was changed to Easy Go enema (free of sodium phosphate). There was a 19.2% decrease in the total use of enema, in the second period of the study (P < 0.0001). Adverse events and especially, the perforation rate and the 30-day mortality in patients with constipation decreased significantly in the second phase: 3 (1.4%) versus 0 (P = 0.0001) and 8 (3.9%) versus 2 (0.7%) (P = 0.0001), for perforation and death in the first and second period of the study, respectively., Conclusion: Enema for the treatment of acute constipation is not without adverse events, especially in the elderly, and should be applied carefully. Perforation, hyperphosphatemia (after Fleet Enema), and sepsis may cause death in up to 4% of cases. Guidelines for the treatment of acute constipation and for enema administration are urgently needed.

In recent years, computerized information systems have become one of the most important tools for promoting, developing and supporting quality improvement in healthcare. The unique contribution of these systems is related to the collection, storage and analysis of data as well as user-friendly and sophisticated access to end-users. Israel's nursing system has yet to fully implement the use of these systems in order to facilitate systematic measurement and improvement of nursing care quality.

The colorectal cancer (CRC) screening program in Israel offers the average-risk population fecal occult blood tests from the age of 50 years. Compliance, however, is very low, reaching only 6% of eligible persons in 2005. Our aim in this study was to describe the results of an improved CRC screening program directed at the in-house staff of Beilinson Hospital. All employees of Beilinson Hospital over age 50 years were sent a letter explaining the new CRC screening program and an accompanying questionnaire. Responders who reported a family history of CRC or related cancers or symptoms were offered colonoscopy; the remainder were offered sigmoidoscopy or, if they preferred, colonoscopy. Two hundred twenty of the 888 candidates (24.7%) completed the questionnaire, of whom 144 (16.2%) agreed to further investigation. These included 90 of 105 patients with a positive questionnaire and 20 of 115 with a negative questionnaire who underwent colonoscopy and 34 of 115 with a negative questionnaire who underwent sigmoidoscopy. The colonoscopy group included 26 of the 30 patients (86.6%) with a positive family history. Early-stage CRC was diagnosed in three patients (1.36%), all with a positive questionnaire. There were no pathologic findings on sigmoidoscopy. The sensitivity, specificity, and positive and negative predictive values of the questionnaire for identifying subjects with CRC or advanced adenoma were 100.00%, 18.86%, 2.27%, and 100.00%, respectively. In conclusion, using hospital facilities, we initiated a unique CRC screening program for employees. Our method may be applicable in other medical centers for the detection of adenomas and CRCs in the early, curative stages.

The importance of post-transcriptional regulation by small non-coding RNAs has recently been recognized in both pro- and eukaryotes. Small RNAs (sRNAs) regulate gene expression post-transcriptionally by base pairing with the mRNA. Here we use dynamical simulations to characterize this regulation mode in comparison to transcriptional regulation mediated by protein-DNA interaction and to post-translational regulation achieved by protein-protein interaction. We show quantitatively that regulation by sRNA is advantageous when fast responses to external signals are needed, consistent with experimental data about its involvement in stress responses. Our analysis indicates that the half-life of the sRNA-mRNA complex and the ratio of their production rates determine the steady-state level of the target protein, suggesting that regulation by sRNA may provide fine-tuning of gene expression. We also describe the network of regulation by sRNA in Escherichia coli, and integrate it with the transcription regulation network, uncovering mixed regulatory circuits, such as mixed feed-forward loops. The integration of sRNAs in feed-forward loops provides tight repression, guaranteed by the combination of transcriptional and post-transcriptional regulations.

A high retention rate of patients and control subjects is an important criterion for the credibility and accuracy of prospective, randomized, controlled clinical trials. Retention and adherence depend on a combination of patient-, physician- and coordinator-related factors, and these need to be carefully evaluated to ensure success. The aim of the study was to evaluate predictive factors for patient retention in a clinical trial. Questionnaires containing items on demographic and clinical data and specific questions related to patient motivation were distributed to 31 patients participating in a clinical study comparing rofecoxib (Vioxx) and placebo for the prevention of colonic polyp recurrence. Adherence of the group with the rofecoxib study and the questionnaire was 100%. The sample included 24 men (77%) and 7 women of mean age 66+/-9 years; 90% were married, 42% were employed. A family history of colorectal cancer (CRC) was reported by 29%. The main reasons for adherence reported by the patients (on an analog scale of 0-10) were 24-hour availability of a nurse (9.2+/-1.9), the chance to prevent CRC (9.1+/-1.9), and participation in a multicenter study (9.1+/-2.2). The least important factor was support of the family physician (5.8+/-4.1). In conclusion, retention in a clinical trial mainly depends on the subject of the trial and the scientific/professional setting where it takes place, and less on the support of the family physician.

Background: Capsule endoscopy can identify lesions of the small bowel that cannot be detected by other techniques. In addition to patient safety, quality of care and cost-efficiency, good preparation is an important factor for good visualization., Aim: To evaluate the efficacy of oral sodium phosphate preparation., Methods: Forty-six consecutive patients scheduled for capsule endoscopy in two medical centres. The patients treated in Dallas were prepared by 12 h fasting (group A), and those treated in Israel were also asked to drink 45 mL of sodium phosphate with water (group B). An experienced endoscopist, blinded to the method used, graded the quality of preparation according to visual capability, and to relative durations of each grade., Results: The quality of the preparation was poor in 35% of group A compared with 4% of group B (P = 0.023). The mean duration of good preparation with excellent visualization was 122 +/- 110 min in group A and 180 +/- 96 min in group B (P = 0.006). Preparation with sodium phosphate and lower patient weight were significant predictive factors for good visualization., Conclusions: Bowel preparation offers better visualization than overnight fasting alone and is associated with fewer disturbances by intraluminal turbid fluid.

Capsule endoscopy (CE) has been recommended as the method of choice for diagnostic endoscopy of the small bowel. An experienced nurse, after proper training, may contribute to the endoscopy procedures as previously described for sigmoidoscopy. The aim of this study was to evaluate the ability of an experienced gastroenterology nurse to prepare CE records for physician interpretation, by detecting abnormal thumbnails. A prospective, observational design was used. Fifty CE videos were pre-read by a specially trained gastroenterology nurse who thumbnailed the abnormalities detected for interpretation by the gastroenterologist. The nurse's description of the lesions and the calculated gastric and bowel transit times were compared to the interpretation of the videos made directly by the gastroenterologist (gold standard). The primary end point of the study was the quality of the nurse's pathology findings; the secondary end point was the cost effectiveness of this practice. There was complete agreement between the nurse and gastroenterologist for all 12 cases interpreted as normal by the gastroenterologist. In the remaining 38 cases, the nurse created 130 thumbnail selections and the physician, 99. Complete interobserver agreement was achieved for 93 of the 96 lesions categorized as "significant" by the physician (96.9%). After all relevant variables were taken into account, this approach saved dollar 324 per CE examination. The use of nurse practitioner to pre-read CE videos and prepare thumbnail selections for further assessment by the gastroenterologist appears to be safe, reliable, and cost effective.

Helicobacter pylori infection has a high prevalence in the elderly, but its characteristics and treatment in the geriatric population are not well defined. The aims of the study were to characterize geriatric patients according to referral patterns and results of the 13C-urea breath test (13C-UBT) and to investigate the results of treatment combinations for H. pylori eradiction. The 13C-UBT was performed with 75 mg urea labeled with 13C. Physicians who ordered the test completed a questionnaire covering demographic data, indication for the test, chronic use of a proton pump inhibitor, or nonsteroidal anti-inflammatory drug, and type of eradiction therapy. The study sample consisted of 2128 patients, aged 70-102 years, 958 (45%) men, referred for 13C-UBT. The test was positive on 697 (33%). History of peptic disease was the main indication for referral, following by validation of successful eradication, Israeli origin screening for gastric cancer, treatment with regimen containing metronidazole, history of peptic disease, and recurrence of symptoms were predictive factors for a positive 13C-UBT. Multivariate logistic regression analysis revealed a significant influence of eradication therapy on negative results. History of peptic disease and validation of successful eradication are the main indications for referral of the elderly for 13C-UBT. Our results are in accordance with the increase in metronidazole resistance of H. pylori stains and the cohort effect of H. pylori infection on the elderly Israeli-born population.

Background: Lesions of the small bowel that cannot be detected by other techniques can be indentified by capsule endoscopy. Good preparation before any endoscopic procedure is the most important factor for patient safety, quality of care and cost effectiveness. This should also apply to capsule endoscopy. The aim of this study was to evaluate the quality and efficacy of preparation with oral sodium phosphate for capsule endoscopy., Methods: A retrospective cohort study design was used. The study sample consisted of 32 consecutive patients scheduled for capsule endoscopy in two periods; the first 10 patients were prepared with overnight fasting only, and the next 22 with oral sodium phosphate. An experienced endoscopist and gastroenterology nurse, who were blinded to the method used, graded the quality of preparation., Results: Small-bowel cleansing was significantly better in patients given sodium phosphate. Five patients (50%) received a poor preparation rating in the first period compared with only 1 (4.5%) of the 22 patients given oral sodium phosphate (P = 0.01). Intraluminal fluid was noted in 9 patients (90%) in the first group after a mean of 53 +/- 60 min, and in 17 patients (77%) in the second group after a mean of 158 +/- 71 min (P < 0.001). The proportion of non-ideal preparation was significantly higher in group 1 than in group 2, significant visualization disturbances being more prevalent in the first period., Conclusions: Bowel preparation with sodium phosphate before capsule endoscopy offers better visualization than overnight fasting alone and induces fewer disturbances by intraluminal turbid fluid.

Background: Colorectal cancer (CRC) is the most common of the gastrointestinal cancers in Israel, with an incidence of 50 cases per 100,000 for men and 45 per 100,000 for women in 2000., Aim: The low rate of patient compliance noted in CRC screening program conducted in our center, prompted the present survey of the knowledge and practices regarding CRC screening recommendations., Methods: A 23-item questionnaire formulated according to the Israeli Ministry of Health policy and recommendation of the American Gastroenterological Association was distributed among the physicians of the six departments of internal medicine, and the department of surgery of the Rabin Medical Center. The relative ratio of correct answers was calculated for every question and by subgroups: internists and surgeons, experts and residents in internal medicine and in surgery., Results: Fifty-five of 80 physicians (69%) completed the questionnaire. The total score for all participants was 15.82 (average 0.68), significantly lower than the optimal correct score of 23 (average 1.00). The internists had a similar total score to the surgeons, 15.61 and 15.28. When the questions were clustered according to specific issues and only the correct answers for each cluster scored, the success rate decreased with a range of 19-69%. Only 22% of responders did not advise fecal occult blood test (FOBT) for the high-risk population; 57% thought the screening age range was 40-65 years, and only 37% knew that the high-risk criteria include a family history of ovarian cancer., Conclusion: Both internists and surgeons' knowledge about screening recommendations of CRC can be improved. Health authorities should invest greater efforts in continuing physician education. We believe that this strategy will increase the participation rate in CRC preventive programs.