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Objective: The global emergence of carbapenem‐resistant Klebsiella pneumoniae is considered a significant contemporary concern., as carbapenems are the last resort for treating infections caused by multidrug‐resistant Gram‐negative bacteria. This study aimed to investigate the carbapenem‐resistance genes in extended‐spectrum β‐lactamase producing K. pneumoniae isolates. Methods: Seventy‐five non‐duplicate clinical K. pneumoniae strains were isolated from urine, blood, sputum, and wound samples. Antimicrobial susceptibility tests for 12 different antibiotics were performed using the disk diffusion method, followed by determining minimum inhibitory concentrations of imipenem and meropenem. Phenotypic detection of extended‐spectrum β‐lactamase and carbapenemase enzymes was performed by double‐disc synergy test and modified Hodge test, respectively. PCR assay further investigated resistant isolates for extended‐spectrum β‐lactamase and carbapenemase‐encoding genes. Results: The highest and lowest resistance rates were observed against ampicillin (93.3%) and tigecycline (9.3%). According to phenotypic tests, 46.7% of isolates were positive for extended‐spectrum β‐lactamase enzymes and 52.8% for carbapenemase. A total of 11 isolates contained carbapenemase genes, with blaOXA‐48 (19.4%; 7/36) being the predominant gene, followed by blaNDM (8.3%; 3/36). Conclusion: The study's findings reveal the alarming prevalence of beta‐lactamase enzymes in K. pneumoniae strains. Early detection of carbapenem‐resistant isolates and effective infection control measures are necessary to minimise further spread, as carbapenem resistance has become a public health concern. [ABSTRACT FROM AUTHOR]

Background: The last-resort classes of antibiotics with the best success in treating severe Pseudomonas aeruginosa (P. aeruginosa) infections caused by drug-resistant P. aeruginosa are carbapenems. So, we aimed to assess the frequency of carbapenem-resistant genes in P. aeruginosa. Methods: Samples isolated from critically ill patients at Intensive Care Units (ICUs) and surgical wards in Minia, Egypt were examined for imipenem-resistance phenotypically by Modified Hodge test (MHT) and Modified carbapenem inactivation method (mCIM) test and genotypically by PCR. Results: Fifty isolates (64%) of P. aeruginosa were resistant to carbapenems (imipenem and meropenem), of which: 16 (32%) were (MHT) positive and 26 (52 %) were (mCIM)-positive. Regarding resistance genes, blaIMP, blaVIM, and blaKPC were detected in 14%, 20%, and 48% of the carbapenem resistant Pseudomonas aeruginosa (CRPA) isolates; respectively, while blaGIM, blaSIM, blaNDM-1 and blaSPM-1 were not detected. Conclusion: There is a high prevalence of multi-drug resistant (MDR) strains of P. aeruginosa. Doctors should pay attention to carbapenem resistance. mCIM test was much more sensitive than MHT for phenotypic detection of CRPA isolates. blaKPC gene was the most frequently detected gene.

Background: The last-resort classes of antibiotics with the best success in treating severe Pseudomonas aeruginosa (P. aeruginosa) infections caused by drug-resistant P. aeruginosa are carbapenems. So, we aimed to assess the frequency of carbapenemresistant genes in P. aeruginosa. Methods: Samples isolated from critically ill patients at Intensive Care Units (ICUs) and surgical wards in Minia, Egypt were examined for imipenem-resistance phenotypically by Modified Hodge test (MHT) and Modified carbapenem inactivation method (mCIM) test and genotypically by PCR. Results: Fifty isolates (64%) of P. aeruginosa were resistant to carbapenems (imipenem and meropenem), of which: 16 (32%) were (MHT) positive and 26 (52 %) were (mCIM)- positive. Regarding resistance genes, blaIMP, blaVIM, and blaKPC were detected in 14%, 20%, and 48% of the carbapenem resistant Pseudomonas aeruginosa (CRPA) isolates; respectively, while blaGIM, blaSIM, blaNDM-1 and blaSPM-1 were not detected. Conclusion: There is a high prevalence of multi-drug resistant (MDR) strains of P. aeruginosa. Doctors should pay attention to carbapenem resistance. mCIM test was much more sensitive than MHT for phenotypic detection of CRPA isolates. blaKPC gene was the most frequently detected gene. [ABSTRACT FROM AUTHOR]

Introdução A Monitorização do Horizonte Tecnológico (MHT) é uma atividade de ATS, cujo objetivo central é identificar tecnologias emergentes e avaliar os possíveis impactos destas no sistema de saúde. A importância da MHT está em auxiliar os gestores na antecipação de demandas que possam surgir. Parcerias com NATS auxiliam o DGITIS no programa de MHT, o NUTES-UEPB é um dos integrantes desta parceria. Terapias gênicas e terapias celulares estão entre tecnologias avançadas que demandam atenção quando se faz MHT. A leucodistrofia metacromática (LDM) é um distúrbio genético, autossômico recessivo, causado por mutações no gene da arilsulfatase A (ARSA). Pacientes com esta doença apresentam manifestações neurológicas do SNC e periférico. A LDM é dividida em: infantil tardia, juvenil e adulta. As formas mais precoces são mais graves. Não há terapias consideradas curativas para LDM. Não existe um PCDT para a LDM. Há opções de tratamento em pesquisa: TRE, transplante de células de placenta, terapia gênica celular e a terapia gênica ex vivo. A atidarsagene autotemcel é uma terapia gênica ex vivo com vetor lentiviral, que foi licenciada pela EMA em 12/22. O objetivo dos autores é mostrar o MHT como ferramenta de sustentabilidade, tendo como exemplo o trabalho conjunto feito pelo DGITIS e NUTES-UEPB sobre o “atidarsagene autotemcel”. Métodos Um revisão da literatura focadas nos ensaios clínicos para a terapia foi feita nas seguintes bases ClinicalTrials.gov, Cortellis, Medline via PubMed, Embase e Cochrane Library, pesquisando-se pelo termo “atidarsagene autotemcel”, sem restrições de língua ou de outros tipos (artigos completos e resumos foram avaliados). Resultados Foram encontrados os registro de três estudos clínicos: NCT04283227, um estudo fase 3 com 6 pacientes da forma juvenil; NCT01560182 fase 1/2 com 20 pacientes pediátricos em fase assintomática ou de início recente e NCT03392987; e, um estudo de fase 2, com 10 pacientes pediátricos ou da forma juvenil. Destes apenas um (NCT01560182) resultou em publicações nas bases mencionadas até o momento, sendo um artigo científico completo e de três resumos de congresso. O tratamento retardou a progressão do declínio motor na maioria dos pacientes, também a maioria manteve a cognição normal ou quase normal. Houve 4 óbitos associados à progressão da doença (não relacionados à terapia). Não houve eventos adversos graves, nem malignidades ou evidência de expansão clonal anormal. Encontrou-se ainda uma série de 5 casos, em uso compassivo tratados entre 2020 e 2022, esta mostrou que a ARSA foi restaurada a níveis supranormais logo após a terapia gênica. Os eventos adversos relatados se relacionaram, ao condicionamento mieloablativo. Todos os pacientes apresentam aquisição de habilidades motoras e cognitivas. Discussão e conclusões Há ainda poucos dados clínicos sobre a terapia inovadora avaliada, adicionalmente esta é preconizada em fases pré-sintomáticas, ou bem no início dos sintomas. Por se tratar de doença rara amostras grandes são uma dificuldade, porém dados de acompanhamento a longo prazo são essenciais. O seu altíssimo custo (é hoje uma das 2 mais caras terapias licenciadas na EU) deve representar um fator limitante importante para o acesso. Já existe um estudo publicado em congresso indicando que este não é custo efetivo no contexto da França (um país desenvolvido). O processo de inclusão de tecnologias no SUS é bem delineado no Brasil, sendo a análise Conitec essencial, conforme disposto na Lei nº 12.401/2011. Mas os desafios advindos do surgimento de terapias inovadoras e de altíssimo custo, como a aqui descrita ou outras já licenciadas no país pela ANVISA como a ‘CAR-T’ são também grandes e o MHT auxilia no dimensionamento destes desafios.

Magnesium is an important cofactor for metabolic reactions involving more than 300 enzymes, regulating a series of fundamental processes, such as myocardial contraction and blood pressure control, glucose regulation, participation in neuromuscular transmission. The prevalence of magnesium deficiency in various cohorts of fertile age women comprises up to 73.8 %. In clinical studies it was demonstrated that magnesium deficiency is associated with diseases and states such as dysmenorrhea, premenstrual syndrome (PMS), polycystic ovary syndrome (POS), climacteric syndrome, osteoporosis, use of combined oral contraceptives (COCs) and menopausal hormone therapy (MHT). Magnesium supplementation in combination with basic therapy can positively affect course and outcome of such pathologies. Magnesium organic salts could be used for countering magnesium deficiency. Among such agents, magnesium citrate has some advantage used in combination with pyridoxine (vitamin B6) providing additional effects. Health care professionals should be guided by the criteria for Mg-containing preparation selection, defined by the Russian Society of Obstetricians and Gynecologists (RSOG).

Acinetobacter is an important nosocomial pathogen causing health care associated infections. It is highly antibiotic resistant gram-negative bacilli. The study was done to determine the prevalence of Acinetobacter species isolated from various clinical samples with their antibiotic susceptibility pattern. To determine the antimicrobial susceptibility pattern of the isolated Acinetobacter species and also the multidrug resistant mechanisms by phenotypic characterization. The retrospective study was carried out in patients diagnosed with Acinetobacter infection in the Microbiology Department, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Deemed To Be University, Karad, a tertiary care hospital, including the clinical departments, during the period of two years from November 2020 till November 2022. Organism identification, biochemical test, antibiotic resistance pattern and phenotypic tests such as ESBL, MBL and Carbapenemase production were performed as per the Clinical and Laboratory Standards Institute (CLSI). The Modified Hodge test (MHT) was performed for Carbapenemase production detection in Acinetobacter species. A total of 150 Acinetobacter species were isolated from clinical samples. Acinetobacter baumannii was the most prevalent species 138 (92%), followed by Acinetobacter lwoffii 10 (7%) and Acinetobacter hemolyticus 2 (1%). The isolates showed highest resistance to Ampicillin 130 (87%) and sensitive to Colistin 113 (75.3%). Most of the isolates of of Acinetobacter baumannii showed maximum ESBL 21(14%) and MBL 75 (93%) production. Modified Hodge test showed positive results in Acinetobacter baumannii, only 11 (7%). The study showed that Acinetobacter baumannii was the most prevalent species showing drug resistance by phenotypic detection methods. At present Acinetobacter is a frequent pathogen in hospital acquired infections in critically ill patients admitted to ICU. The isolates of Acinetobacter species in our study showed resistant to most commonly used antibiotics. The study showed that ESBL production in Acinetobacter was 22 (15%) and MBL 80 (53%). Most Acinetobacter isolates were Multi Drug Resistant (MDR). MDR Acinetobacter is widely increasing due to inappropriate use of antibiotics in healthcare hospital. In our study, detection of carbapenemase by Modified Hodge test was positive in 11 (7%) isolates.

Cloud computing (CC) refers to the transmission, storage, and processing of any type of information at a location that is not owned or controlled by the information owner. This information can be stored and accessed anytime, from anywhere, and using any device. However, several challenges threaten the deployment of cloud computing technology within organizations, including user privacy, data integrity, and managing the retention of the vast amount of data that will be stored and analyzed in this environment. In recent years, various data integrity checking systems and data storage mechanisms have been proposed to address these diverse challenges. Nevertheless, some protocols do not guarantee data confidentiality against auditors during the auditing process, while others do not provide batch auditing. Additionally, the majority of these protocols do not support the deduplication technique. Therefore, in this research work, the security features of blockchain technology and those of multi-agent systems (MAS) have prompted us to propose models that enable both data deduplication, saving storage space, and data integrity auditing, efficiently verifying the accuracy of data outsourced to CC environments. Implementation findings indicate that the suggested system is highly feasible and applicable in real-world scenarios. [ABSTRACT FROM AUTHOR]

Menopause is accompanied by several metabolic adaptations, which are related to insulin resistance, increased total body fat mass, and central abdominal fat accumulation, predisposing women to type 2 diabetes mellitus (T2DM) development. Metabolic syndrome has a high prevalence in postmenopausal women, indicating the loss of estrogen protection on metabolic and cardiovascular health. Moreover, earlier age at menopause has been related to increased risk of T2DM. Menopausal hormone therapy (MHT) has favorable results in glucose metabolism. Indeed, it reduces the risk of T2DM in women without this condition and improves glycemic control in women with T2DM. Before MHT initiation in women with clinical indications, it is imperative to assess their cardiovascular disease (CVD) risk, using official electronic algorithms for score calculation. The latter will determine regimen, dose, and administration route of MHT. Oral estrogens are preferable in women with low CVD risk, while transdermal administration is indicated in those with moderate and high CVD risk, as the risk of stroke and venous thromboembolism (VTE) is increased with oral administration. Oral 17β-estradiol is usually preferred in women with T2DM, as this route has more beneficial effects on glucose metabolism. Oral estrogens are also suggested in perimenopausal or recently postmenopausal women with low CVD risk. Although oral estrogens have favorable effects when indicated, the risk of VTE or stroke should always be considered. Micronized progesterone, dydrogesterone, and transdermal norethisterone are the progestogens used in postmenopausal women with T2DM and intact uterus. MHT should not be initiated in women > 60 years or > 10 years in menopause, as there is an increased thromboembolic risk in women with established atherosclerosis and no additional cardiovascular benefit in women without atherosclerosis. In conclusion, MHT administration in postmenopausal women with T2DM can be safe and effective as long as the therapeutic regimen has been properly selected according to their cardiovascular, metabolic, and fracture risk. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer incidence is higher in men, and a protective hormone-related effect in women is postulated. We aimed to investigate and quantify the relationship in the Stomach cancer Pooling (StoP) Project consortium. Methods: A total of 2,084 cases and 7,102 controls from 11 studies in seven countries were included. Summary odds ratios (ORs) and 95% confidence intervals (CIs) assessing associations of key reproductive factors and menopausal hormone therapy (MHT) with gastric cancer were estimated by pooling study-specific ORs using random-effects meta-analysis. Results: A duration of fertility of ≥ 40 years (vs. < 20), was associated with a 25% lower risk of gastric cancer (OR = 0.75; 95% CI: 0.58–0.96). Compared with never use, ever, 5–9 years and ≥ 10 years use of MHT in postmenopausal women, showed ORs of 0.73 (95% CI: 0.58–0.92), 0.53 (95% CI: 0.34–0.84) and 0.71 (95% CI: 0.50–1.00), respectively. The associations were generally similar for anatomical and histologic subtypes. Conclusion: Our results support the hypothesis that reproductive factors and MHT use may lower the risk of gastric cancer in women, regardless of anatomical or histologic subtypes. Given the variation in hormones over the lifespan, studies should address their effects in premenopausal and postmenopausal women. Furthermore, mechanistic studies may inform potential biological processes. [ABSTRACT FROM AUTHOR]

Acinetobacter is an important nosocomial pathogen causing health care associated infections. It is highly antibiotic resistant gram-negative bacilli. The study was done to determine the prevalence of Acinetobacter species isolated from various clinical samples with their antibiotic susceptibility pattern. To determine the antimicrobial susceptibility pattern of the isolated Acinetobacter species and also the multidrug resistant mechanisms by phenotypic characterization. The retrospective study was carried out in patients diagnosed with Acinetobacter infection in the Microbiology Department, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Deemed To Be University, Karad, a tertiary care hospital, including the clinical departments, during the period of two years from November 2020 till November 2022. Organism identification, biochemical test, antibiotic resistance pattern and phenotypic tests such as ESBL, MBL and Carbapenemase production were performed as per the Clinical and Laboratory Standards Institute (CLSI). The Modified Hodge test (MHT) was performed for Carbapenemase production detection in Acinetobacter species. A total of 150 Acinetobacter species were isolated from clinical samples. Acinetobacter baumannii was the most prevalent species 138 (92%), followed by Acinetobacter lwoffii 10 (7%) and Acinetobacter hemolyticus 2 (1%). The isolates showed highest resistance to Ampicillin 130 (87%) and sensitive to Colistin 113 (75.3%). Most of the isolates of of Acinetobacter baumannii showed maximum ESBL 21(14%) and MBL 75 (93%) production. Modified Hodge test showed positive results in Acinetobacter baumannii, only 11 (7%). The study showed that Acinetobacter baumannii was the most prevalent species showing drug resistance by phenotypic detection methods. At present Acinetobacter is a frequent pathogen in hospital acquired infections in critically ill patients admitted to ICU. The isolates of Acinetobacter species in our study showed resistant to most commonly used antibiotics. The study showed that ESBL production in Acinetobacter was 22 (15%) and MBL 80 (53%). Most Acinetobacter isolates were Multi Drug Resistant (MDR). MDR Acinetobacter is widely increasing due to inappropriate use of antibiotics in healthcare hospital. In our study, detection of carbapenemase by Modified Hodge test was positive in 11 (7%) isolates. [ABSTRACT FROM AUTHOR]

Joint probabilistic data association (JPDA) filter methods and multiple hypothesis tracking (MHT) methods are widely used for multitarget tracking (MTT). However, they are known to exhibit undesirable behavior in tracking scenarios with targets in close proximity: JPDA filter methods suffer from the track coalescence effect, i.e., the estimated tracks of targets in close proximity tend to merge and can become indistinguishable, while MHT methods suffer from an opposite effect known as track repulsion, i.e., the estimated tracks of targets in close proximity tend to repel each other in the sense that their separation is larger than the actual distance between the targets. In this paper, we review the JPDA filter and MHT methods and discuss the track coalescence and track repulsion effects. We also consider a more recent methodology for MTT that is based on the belief propagation (BP) algorithm. We argue that BP-based MTT does not exhibit track repulsion because it is not based on maximum a posteriori estimation, and that it exhibits significantly reduced track coalescence because certain properties of the BP messages related to data association encourage separation of target state estimates. Our theoretical arguments are confirmed by numerical results for four representative simulation scenarios.

Cardiovascular disorders (CVD) in female population are the main cause of mortality, and an increase in the prevalence of myocardial infarction among women is observed in the recent decades, in contrast to the male population showing a decrease in this indicator. Certainly, the mechanisms underlying CVD in people of different sexes have much in common, however, one cannot ignore the differences associated with fundamental genetic determinants of ageing, different characteristics of metabolism and fundamentally different types of hormonal status. It has been found that realization of activity of sex hormones is among major factors ensuring protection against cardiovascular disorders in premenopausal women. The increase in the rate of cardiovascular disorders and the lack of menopausal hormone therapy (MHT) prescription to women in their post-reproductive stage may be partially correlated. Aim. To analyze the data provided by advanced scientific research focused on prescription of menopausal hormone therapy (MHT) aimed at preventing cardiovascular disorders in the post-reproductive period. Methods. Analytical review of domestic and foreign papers on the topic, including using PubMed, Elseviewer, Cochrane library, Elibrary databases. Conclusions. Despite the fact that the issue of prevention and treatment of cardiovascular disorders attracts particular attention of global healthcare, CVDs still rank first in the world as the cause of deaths. In menopausal women, hypoestrogenism is among major pathogenetic links of cardiac abnormalities. To increase adherence of peri- and postmenopausal women to early diagnosis, general practitioners should give due consideration to referral of such women to obstetricians-gynecologists for timely correction of estrogen deficiency. It is also necessary to further study the issue in order to identify early diagnostic predictors of cardiovascular disorders.

Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), was looked upon as a fountain of youth that kept women young and reduced cardiovascular disease. This led to a large-scale study called the Women's Health Initiative (WHI) that was conducted to show the cardiovascular benefits of HRT. This study was suspended early because of adverse side effects. The USFDA responded by slapping a “black box” warning on all HRT products. USFDA-approved bioidentical HRT formulations are safe and effective. We propose that these formulations have the “black box” warning removed so that doctors feel more confident in prescribing these products for symptoms of menopause and chronic conditions such as cardiovascular health. We propose eliminating the sale of products containing medroxyprogesterone acetate (MPA) because of the increased risk of heart attacks and breast cancers associated with this medication.

Background: Carbapenems are frequently used as a last resort antibiotic in the treatment of infections due to multidrug-resistant Enterobacteriaceae. Their alarming increase worldwide is worrisome and is left with very restricted therapeutic alternatives. Objectives: This study compares the various phenotypic methods for detection of carbapenemase producers in Klebsiella species isolated from different clinical samples. Methods: All specimens received for culture and sensitivity were processed as per standard guidelines. Identification of Klebsiella spp. was done using biochemical tests as per standard guidelines. Carbapenemase production was detected phenotypic screening methods as per CLSI guidelines. Confirmation done by using Modified Hodge Test, Modified carbapenem inactivation method (mCIM) and EDTA-modified carbapenem inactivation method (eCIM) Results: Out of total 160 Klebsiella isolates test for carbapenemase production 101 (63.1%) was positive. MHT was positive in 76.2% isolates, whereas MCIM and ECIM were positive in 91.1% isolates. The sensitivity, specificity and PPV of MHT with MCIM were 82.6%, 88.9%, and 98.7% respectively, whereas sensitivity, specificity and PPV of ECIM with MCIM were 100%, 100%, and 100% respectively. Conclusion: MCIM in conjunction with ECIM test could be considered as more reliable phenotypic diagnostic methods for carbapenemase detection than the MHT in conjuction with the MCIM. [ABSTRACT FROM AUTHOR]

Menopausal Hormone Therapy (MHT) is recommended for climacteric peri- and postmenopausal symptoms. The rate of use of MHT in China is much lower than the western regions. Therefore, a survey was conducted for the understanding and utilization of MHT among clinical staff in various hospitals of China. A total of 3216 eligible questionnaires were included for the evaluation. According to 19.2% participant opinion, MHT could relieve menopausal symptoms, whereas the majority had no knowledge of the benefits and risks of MHT. The most common concern about MHT was the risk of cancer and about 430 (13.4%) and 176 (5.5%) participants were apprehensive that MHT could increase the risk of breast and endometrial cancer, respectively. This survey demonstrated that the knowledge of clinical staff was not comprehensive and they should be educated more about the use of MHT so that this knowledge can be imbibed into the general population. What is already known on this subject? Menopausal Hormone Therapy (MHT) is recommended for climacteric peri- and postmenopausal symptoms. The rate of use of MHT in China is much lower than the western regions. What do the results of this study add? Only 19.2% of the respondents were of the opinion that MHT could relieve menopausal symptoms. The most common concern about MHT was the risk of cancer and about 430 (13.4%) and 176 (5.5%) participants were apprehensive that MHT could increase the risk of breast and endometrial cancer. What are the implications of these findings for clinical practice and/or further research? The survey demonstrated that Chinese medical professionals had some understanding about MHT, but their knowledge was not comprehensive. Thus, it is necessary to educate these medical professionals which in turn will help them to imbibe this knowledge among the general population. [ABSTRACT FROM AUTHOR]

Background. The increase in the proportion of patients with menopausal syndrome (MS) and surgical menopause, including women in the recovery phase after radical surgical treatment of the reproductive system cancer, is a characteristic trend of the 21st century. Part of them receive menopausal hormone therapy (MHT). This determines the relevance of the analysis of the specified cohort of patients to enhance rehabilitation programs designed to improve the quality of life (QoL) in this category of gynecological patients.Objective: subanalysis of primary data from the MAGYN study cohort of MHT treated women with MS and surgical menopause.Material and methods. The MAGYN observational non-interventional study of the real clinical practice included 9168 women, of whom 1528 represented a group of previously not characterized MHT treated women with MS and surgical menopause. To determine the number of patients with magnesium deficiency (MD), a Magnesium Deficiency Questionnaire (MDQ) was used, a biochemical blood test with an indicator of serum magnesium concentration was evaluated. The profile of the participants was analyzed by the presence of general somatic pathologies, obstetric, gynecological history, complaints, symptoms of MD on a visual-analog scale. The QoL was assessed with the help of The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) before the start of a 4-week course of MD supplementation and after treatment.Results. According to the MDQ results, the prevalence of DM was 79.4%, which exceeded the results of all other groups in the study. Women with MD had a higher incidence of viral infections (19.2% vs. 22.7%; p=0.028), vegetative-vascular dystonia (26.2% vs. 29.7%; p=0.0466) and osteochondrosis (42.9% vs. 46.8%; p=0.0453). A subgroup of participants with verified MD demonstrated significantly more pronounced symptoms, such as irritability (4.9±3.5 vs. 4.6±3.4 points in the general group; p=0.0437), sleep disorders (4.4±2.3 vs. 4.2±2.3 points; p=0.0491), back pain (3.9±2.0 vs. 3.7±2.0; p=0.0405), and increased fatigue (4.6±2.3 vs. 4.4±2.3 points; p=0.0444). After the end of the course of therapy with fixed dose combination of magnesium citrate and pyridoxine, the sum of MDQ scores decreased from 46.0±12.7 to 29.2±15.1 points (p

Spatiotemporal big data are a kind of data that marks time information and geographic location and has been widely applied in various fields. However, there are always security issues with spatiotemporal big data, especially in data collection and authentication. Traditional authentication protocols are less efficient in the face of ultra-large-scale IoT (Internet of Things, IoT) device verification, and the threat of single-point failure is relatively large. Given these complications, a group authentication scheme is proposed in this paper with blockchain spatiotemporal big data. The decentralization of the blockchain is utilized to solve the single point of failure, and the single-point authentication is combined with the group authentication, the authentication efficiency is improved through the group authentication, and the illegal nodes are accurately identified using the single-point authentication. The simulation results demonstrate that using the MHT (Merkel Hash Tree, MHT) algorithm for group authentication can effectively improve the authentication efficiency of the entire system when the number of users exceeds 200. The time overhead is only 4 ms when the number of users is 16,000. It can have a large throughput (400–500 tps) and a low latency (1–2 s) at the same time when the block size is 1500 KB. This study not only verifies the legitimacy of each device and protects the security of spatiotemporal big data, but also significantly reinforces the authentication efficiency compared with similar schemes. [ABSTRACT FROM AUTHOR]

We describe a case of carbapenem resistant E. coli isolated from urine in an 87-year-old woman with recurrent urinary tract infections. Using whole genome sequencing (WGS), we identified the carbapenem resistance mechanism to be a combination of ompC porin loss and plasmid-mediated AmpC gene blaCMY-2 , which was not detected by routine molecular and phenotypic carbapenemase assays. Our case raises a concern for the limitation of current CRE screening tools for emerging resistance mechanisms and demonstrates the utility of WGS as a better tool for characterization of CRE in the clinical setting.

Surgical and natural menopause is often associated with depression symptoms. Along with the postpartum period, perimenopause is a “window of vulnerability” for depression development, because decline in estrogen level accounts for extinction of reproductive function, emotional disorders, genitourinary menopausal syndrome, which are combined with non-endocrine risk factors, such as decreasing income levels, low social support, and stress. Although a direct relationship between blood estrogens level and depression has not been demonstrated, the relation between menopause symptoms and depression has been proven, i.e., the symptoms of menopause can be considered as risk factors. Here, we summarizes the current view on the correct counseling and routing of menopausal women with depression symptoms in primary health care facilities, the principles of managing patients with risk factors, including genitourinary menopausal syndrome, as well as methods of rehabilitation and informational support. This will aid to improve the quality of medical care for such patients.

One of the most common approaches for enhancing network performance is to retrieve data from nearby data holders that have previously obtained the desired data, not only from the original data source itself. In this case, since a data receiver cannot identify a practical data sender, it is necessary to verify both the received data and the data sender. Moreover, a data sender generally fragments the data into several small segments and sends them. Therefore, if these segments are retrieved from multiple unknown senders, the receiver must verify every segment to safely use the data. MHT (Merkle hash tree) is suitable for efficiently verifying the set of segments shared in the network. NDN (named-data networking) and Bitcoin utilize MHT to verify transmitted data. However, a data authentication scheme based on the MHT has an inefficient factor that repeatedly computes the same node values of the MHT and are repeatedly computed. The larger the size of the MHT is, the greater the number of calculation iterations. Therefore, as a result, the authentication scheme's inefficiency is also more severe. When a sender transmits data consisting of many segments through NDN, the data authentication time may take longer than the data transmission time. Hence, in this paper, the degree of the MHT's inefficiency and the pattern of the iterated operation of the MHT are analyzed first. The proposed improvement is to find repeatedly used node values, store them internally, and use the stored node values without recalculation when required to reuse them. For that process, a rule to select such node values is given. Additionally, when verifying the leaf node value of the MHT, the MHT-based authentication scheme asks a verifier to compute all node values on the path from the leaf node to the root node of the MHT. This paper demonstrates the proposed shortest path selection for verifying the leaf node value. The proposed scheme, using saved node values and the shortest path, reduces the computational overhead of the MHT and improves service latency. It has been proven from performance evaluations that the proposed scheme decreases the computational overhead by more than one-third if the number of segments is more than 1024. [ABSTRACT FROM AUTHOR]

Abstract Background The emergence of carbapenem-resistant Pseudomonas aeruginosa is one of the most important challenges in a healthcare setting. The aim of this study is double-locus sequence typing (DLST) typing of bla NDM-1 positive P. aeruginosa isolates. Methods Twenty-nine bla NDM-1 positive isolates were collected during three years of study from different cities in Iran. Modified hodge test (MHT), double-disk synergy test (DDST) and double-disk potentiation test (DDPT) was performed for detection of carbapenemase and metallo-beta-lactamase (MBL) producing bla NDM-1 positive P. aeruginosa isolates. The antibiotic resistance genes were considered by PCR method. Clonal relationship of bla NDM-1 positive was also characterized using DLST method. Results Antibiotic susceptibility pattern showed that all isolates were resistant to imipenem and ertapenem. DDST and DDPT revealed that 15/29 (51.8%) and 26 (89.7%) of bla NDM-1 positive isolates were MBL producing isolates, respectively. The presence of bla OXA-10, bla VIM-2 , bla IMP-1 and bla SPM genes were detected in 86.2%, 41.4%, 34.5% and 3.5% isolates, respectively. DLST typing results revealed the main cluster were DLST 25-11 with 13 infected or colonized patients. Conclusions The presence of bla NDM-1 gene with other MBLs encoding genes in P. aeruginosa is a potential challenge in the treatment of microorganism infections. DLST showed partial diversity among 29 bla NDM-1 positive isolates.

Aim: to evaluate an impact of menopausal hormone therapy (MHT) on late postmenopausal multimorbid women’s quality of life (QoL).Materials and Methods. 132 late postmenopausal women were enrolled to the study and were divided into two groups: group 1 consisted of 66 subjects with moderate multimorbidity and Charlson Comorbidity Index (CCI) < 3; group 2 (66 patients) had high multimorbidity (CCI ≥ 3). Women receiving or not MHT were subdivided in both groups. SF-36 questionnaire was used to assess QoL, Hospital Anxiety and Depression scale (HADS) – for evaluating emotional status, MMSE test (Mini-Mental State Examination) – for cognition evaluation. Modified Menopausal Index (MMI) was calculated as well.Results. Women with a low level of comorbidity who had previously received MHT have a significantly higher QoL. The median age for subjects was 69 [65; 71] years, median CCI score was 3.5 [2.5; 5.0]. In addition, in group 2 there were found significantly lower physical functioning (p < 0.001), role-physical functioning (p = 0.028), physical health (p = 0.002) domains, as well as more severe persistent menopausal symptoms (p = 0.011) and depression (p = 0.043). History of MHT in group 1 was associated with higher levels of physical functioning (p = 0.033) and role-physical functioning (p = 0.023), whereas in group 2 MHT was associated with better cognition (p = 0.028) and lower depression symptoms compared with those lacking history of MHT.Conclusion. Multimorbidity in late postmenopausal women was associated with impaired QoL physical domains. MHT allows to effectively improve QoL in women with moderate multimorbidity and to protect cognitive state to higher level as well as reduce depression symptoms in women with severe multimorbidity.

Abstract Aim Although carbapenem is the last-resort drug for treating drug-resistant Gram-negative bacterial infections, prevalence of carbapenem-resistant bacteria has substantially increased worldwide owing to irrational use of antibiotics particularly in developing countries like Nepal. Therefore, this study was aimed to determine the prevalence of carbapenemase-producing K. pneumoniae and to detect the carbapenemase genes (blaNDM-2 and blaOXA-48) in at a tertiary care hospital in Nepal. Materials and methods A hospital-based cross-sectional study was carried out from June 2018 to January 2019 at the Microbiology Laboratory of Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal. Different clinical samples were collected and cultured in appropriate growth media. Biochemical tests were performed for the identification of K. pneumoniae. Antibiotic susceptibility testing (AST) was performed by the Kirby–Bauer disc diffusion method. The modified Hodge test (MHT) was performed to detect carbapenemase producers. The plasmid was extracted by the modified alkaline hydrolysis method. Carbapenemase-producing K. pneumoniae were further confirmed by detecting blaNDM-2 and blaOXA-48 genes by PCR using specific forward and reverse primers followed by gel electrophoresis. Results Out of the total 720 samples, 38.9% (280/720) were culture positive. K. pneumoniae was the most predominant isolate 31.4% (88/280). Of 88 K. pneumoniae isolates, 56.8% (50/88) were multi-drug resistant (MDR), and 51.1% (45/88) were MHT positive. Colistin showed the highest sensitivity (100%; 88/88), followed by tigecycline (86.4%; 76/88). blaNDM-2 and blaOXA-48 genes were detected in 24.4% (11/45) and 15.5% (7/45) of carbapenemase-producing K. pneumoniae isolates, respectively. Conclusion The rate of MDR and carbapenemase production was high in the K. pneumoniae isolates. Colistin and tigecycline could be the drug of choice for the empirical treatments of MDR and carbapenemase-producing K. pneumoniae. Our study provides a better understanding of antibiotic resistance threat and enables physicians to select the most appropriate antibiotics.

This study investigated the use of real-time PCR melting curves for the diagnosis of blaKPC and blaNDM genes among the most frequently detected carbapenemase-producing Enterobacteriaceae in Korea. As a means of addressing the shortcomings of phenotype tests and conventional PCR. The modified Hodge test confirmed positivity in 25 of 35 strains, and carbapenemase inhibition testing confirmed positivity in 14 strains by meropenem+PBA or meropenem+EDTA. PCR analysis showed amplification products in 25 strains of Klebsiella pneumoniae carbapenemases (KPC), 10 of K. pneumoniae, 5 of E. coli, 5 of A. baumannii, 4 of P. aeruginosa, and 1 of P. putida. New Delhi metallo β-lactamase (NDM) identified amplification products in 8 strains, that is, 2 K. pneumoniae, 3 E. coli, 1 P. aeruginosa, 1 E. cloacae, and 1 P. retgeri strains. Real-time PCR melting curve analysis confirmed amplification in 25 strains of KPC and 8 strains of NDM, and these results were 100% consistent with PCR results. In conclusion, our findings suggest early diagnosis of carbapenem resistant Enterobacteriaceae by real-time PCR offers a potential means of antibacterial management that can prevent and control nosocomial infection spread.

Background and Objectives: The human brain presents a functional asymmetry for every cognitive function, and it is possible that sexual hormones could have an impact on it. Visual–spatial attention, one of the most lateralized functions and one that is mainly dependent on the right hemisphere, represents a sentinel for functional cerebral asymmetry (FCA). The aim of this study was to evaluate whether menopausal hormone therapy (MHT) or phytoestrogens could modulate FCA in postmenopausal women. Materials and Methods: We enrolled postmenopausal women who were taking MHT or soy isoflavones or receiving no therapy and asked them to perform the line bisection test at study enrollment and after 18 and 36 months. Results: Ninety women completed the follow-up. At zero time, women who had not been subjected to therapy showed a leftward deviation (F = −3.0), whereas, after 36 months, the test results showed a rightward deviation (F = 4.5; p < 0.01). Women taking MHT showed a leftward deviation at the start (F = −3.0) and a persistent leftward deviation after 36 months (F = −4.0; p = 0.08). Conversely, women taking soy isoflavones started with a leftward deviation (F = −3.0) that became rightward (F = 3.0), with a significant difference shown after 36 months (p < 0.01). Conclusions: Our data suggest that hormonal modulation improves the interplay between the two hemispheres and reduces FCA. We propose, therefore, that the functions of the right hemisphere are mainly affected by aging and that this could be one of the reasons why the right hemisphere is more susceptible to the effects of MHT. [ABSTRACT FROM AUTHOR]

In this review we summarize current data on prevalence, etiology and pathogenesis resulting in premature ovarian insufficiency (POI). In particular, genetic, autoimmune, metabolic, iatrogenic disorders as well as unfavorable impact of environmental factors represent key pathogenetic mechanisms underlying POI development. Clinical picture of this disease is mainly manifested by oligo- and amenorrhea as well as genitourinary menopausal syndrome (GUMS). Special attention is paid to a link between such clinical signs and psychosocial discomfort not being a life-threatening condition but still able to markedly lower quality of woman’s life and considered as a comorbidity with type 2 diabetes mellitus, osteoporosis and cardiovascular diseases. Hormone replacement therapy (HRT) serves as the first-line therapeutic approach for treating POI, which is performed according to the principles similar to those used to perform menopausal hormone therapy (MHT) in case of natural menopause that should be continued until reaching at least the average age for the onset of menopause. Topical estriol therapy eliminates GUMS symptoms, which in turn positively affects sexual function and woman’s psychosocial status and contributes to improved quality of life. The data from recent studies examining topical estriol therapy in POI demonstrated high efficacy and safety. Finally, we also discuss diverse strategies to support reproductive function in women with POI.

Mohamed F El-Badawy,1,2 Shaymaa W El-Far,1 Shaker S Althobaiti,3 Fatma I Abou- Elazm,2 Mohamed M Shohayeb4 1Division of Pharmaceutical Microbiology, Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Taif, Kingdom of Saudi Arabia; 2Department of Microbiology and Immunology, Faculty of Pharmacy, Misr University for Science and Technology, 6th of October City, Egypt; 3King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia; 4Department of Microbiology and Biotechnology, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa, EgyptCorrespondence: Mohamed F El-BadawyDivision of Pharmaceutical Microbiology, Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Kingdom of Saudi ArabiaTel +20-103-205-9964Email m.elbadawy@tu.edu.saBackground and Objective: The emergence of carbapenem-resistant K. pneumoniae (CRKP) continues to escalate and is alarming because of the emergence of pan drug-resistant strains. The objective of this study was to investigate the existence of 12 carbapenemase genes among CRKP clinical isolates.Methods: Ninety-six Klebsiella spp. clinical isolates were collected. The isolates were identified phenotypically and genotypically. These isolates were screened for susceptibility to 24 different antibiotics. The modified Hodge test (MHT) and the Carba Nordmann/Poirel (NP) test were used to phenotypically screen carbapenem-resistant strains for carbapenemase production. Phenotypic characterization of carbapenemases was performed using the combined disk synergy test (CDST). Additionally, the presence of 12 carbapenemase genes in CRKP isolates was investigated. The DNA sequence of blaNDM and blaGES genes was determined. The BOX-PCR technique was used to determine the clonal relationship between CRKP isolates.Results: All carbapenem-resistant isolates were related to K. pneumoniae. Susceptibility testing showed that 19.79% (19/96) of the collected isolates were carbapenem-resistant. Of the CRKP isolates, 68.42% (13/19) tested positive for the MHT and Carba NP test. CDST showed that 42.11% (8/19), 63.16% (12/19), 47.37% (9/19), and 73.68% (14/19) of the CRKP isolates tested positive for the inhibitory effect of clavulanic acid, sulbactam, phenylboronic acid, and tazobactam, respectively, while 84.21% (16/19) and 68.42% (13/16) tested positive for the inhibitory effect of EDTA and mercaptopropionic acid, respectively. It was found that 10.53% (2/19) of the isolates tested positive for the inhibitory effect of sodium chloride. Molecular investigation of carbapenemases showed that 26.32% (5/19), 73.68% (14/19), 21.05% (4/19), 10.53% (2/19), and 5.26% (1/19) of the isolates tested positive for blaNDM, blaOXA-48, blaOXA-181, blaOXA-51, and blaOXA-23, respectively. None of the isolates tested positive for blaOXA-40 and blaOXA-58. Two allelic variants of blaNDM (blaNDM-1 and blaNDM-25) were detected. BOX-PCR revealed high clonal relatedness between CRKP isolates.Conclusion: MHT was more sensitive than Carba NP test for evaluating carbapenemase production and class D carbapenemase genes were the most prevalent of the 12 carbapenemase genes that were evaluated.Keywords: carbapenemases, CRKP, BOX-PCR, blaNDM-25, MHT, CDST

Spatiotemporal big data are a kind of data that marks time information and geographic location and has been widely applied in various fields. However, there are always security issues with spatiotemporal big data, especially in data collection and authentication. Traditional authentication protocols are less efficient in the face of ultra-large-scale IoT (Internet of Things, IoT) device verification, and the threat of single-point failure is relatively large. Given these complications, a group authentication scheme is proposed in this paper with blockchain spatiotemporal big data. The decentralization of the blockchain is utilized to solve the single point of failure, and the single-point authentication is combined with the group authentication, the authentication efficiency is improved through the group authentication, and the illegal nodes are accurately identified using the single-point authentication. The simulation results demonstrate that using the MHT (Merkel Hash Tree, MHT) algorithm for group authentication can effectively improve the authentication efficiency of the entire system when the number of users exceeds 200. The time overhead is only 4 ms when the number of users is 16,000. It can have a large throughput (400–500 tps) and a low latency (1–2 s) at the same time when the block size is 1500 KB. This study not only verifies the legitimacy of each device and protects the security of spatiotemporal big data, but also significantly reinforces the authentication efficiency compared with similar schemes.

Background and aim Urinary tract infections represent a substantial portion of healthcare-associated infections due to E. coli and Klebsiella . Carbapenems are broad-spectrum antibiotics considered highly effective in treating infections caused by multidrug-resistant bacteria. Carbapenem-resistant  Enterobacteriaceae ( CRE), including carbapenem-producing E. coli and Klebsiella isolates, have become a major concern as they limit treatment options. The study aims to determine the prevalence of carbapenemase-producing E. coli and Klebsiella while also comparing the effectiveness of two detection methods, namely the modified carbapenem inactivation method (mCIM) and modified Hodge test (MHT). Materials and methods A cross-sectional study was conducted from July 2022 to June 2023 in a tertiary care hospital, in Karad, Satara, India. Three hundred urinary isolates of E. coli (150) and Klebsiella (150) were studied. These isolates were tested for antimicrobial susceptibility testing. Two phenotypic methods, the modified carbapenem inactivation method (mCIM) and the modified Hodge test (MHT), were used to study carbapenemase production. Results Out of three hundred isolates, carbapenemase production was detected in 72 isolates (24%) by the modified Hodge test (MHT) and in 111 isolates (37%) by the modified carbapenem inactivation method (mCIM). Among the MHT-positive isolates, 46 (63.8%) were identified as Klebsiella and 26 (36.1%) as E. coli . In contrast, of the mCIM-positive isolates, 68 (61.2%) were Klebsiella , and 43 (38.7%) were E. coli . A total of 41 Klebsiella (27.33%) and 25 E. coli (16.66%) isolates tested positive by both methods, highlighting variability in detection rates between the two methods. Conclusion This study observed MHT and mCIM to be accurate for the detection of carbapenemase among carbapenem-resistant isolates. However, the mCIM demonstrated greater sensitivity compared to the MHT., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee of Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed To Be University), Karad issued approval 231/2023-2024. The authors affirm that this study adhered to ethical standards and received approval from Institutional Ethics Committee of Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed To Be University), Karad, under protocol number 231/2023-2024. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Arumugam et al.)

In this study we used an analytical approach based on complementary techniques that targets all structural levels of collagen in leather to investigate how vegetable-tanned leather deteriorates during soil burial tests. For the first time, a group of deterioration markers specific to molecular, fibrillar and fibrous structure of collagen in leather was associated with the deterioration of buried leather. The application of the second order derivative of FTIR-ATR spectra analysis allowed us to detect loosening of collagen–tannin matrix, de-tanning and gelatin formation based on the behaviour of collagen and tannin spectral components (intensity variation and shifts). Collagen denaturation observed by DSC analysis and its thermo-oxidative behaviour measured by TG/DTG analysis, as well as the altered morphology of collagen (namely melt-like fibres and distorted fibrillar ultrastructure) imaged by SEM confirmed the FTIR-ATR analyis results. These analytical outcomes enabled us to understand the effect of leather hardening/cementing through soil mineral penetration into its fibrous structure and thus correctly interprete the higher-than-expected shrinkage temperatures and intervals determinatd by MHT method. Thus, MHT method proved to be suitable for a quick evaluation method that can direcly support the first conservation decision after excavation. The combination of FTIR-ATR, DSC, TG/DTG and SEM can be particularly useful to provide insights on the deterioration mechanism of archaeological leather and support best decision on its long-term preservation. [ABSTRACT FROM AUTHOR]

Background: The emergence of carbapenem-resistant Pseudomonas aeruginosa is one of the most important challenges in a healthcare setting. The aim of this study is double-locus sequence typing (DLST) typing of blaNDM-1 positive P. aeruginosa isolates. Methods: Twenty-nine blaNDM-1 positive isolates were collected during three years of study from different cities in Iran. Modified hodge test (MHT), double-disk synergy test (DDST) and double-disk potentiation test (DDPT) was performed for detection of carbapenemase and metallo-beta-lactamase (MBL) producing blaNDM-1 positive P. aeruginosa isolates. The antibiotic resistance genes were considered by PCR method. Clonal relationship of blaNDM-1 positive was also characterized using DLST method. Results: Antibiotic susceptibility pattern showed that all isolates were resistant to imipenem and ertapenem. DDST and DDPT revealed that 15/29 (51.8%) and 26 (89.7%) of blaNDM-1 positive isolates were MBL producing isolates, respectively. The presence of blaOXA-10,blaVIM-2, blaIMP-1 and blaSPM genes were detected in 86.2%, 41.4%, 34.5% and 3.5% isolates, respectively. DLST typing results revealed the main cluster were DLST 25-11 with 13 infected or colonized patients. Conclusions: The presence of blaNDM-1 gene with other MBLs encoding genes in P. aeruginosa is a potential challenge in the treatment of microorganism infections. DLST showed partial diversity among 29 blaNDM-1 positive isolates. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is the second most frequently diagnosed cancer in females worldwide. Menopausal hormone therapy (MHT) has been proposed as a potential protective factor for the development of CRC. Yet, the available evidence is controversial. Thus, we aimed at summarizing the current evidence on the effect of MHT on CRC through a systematic review. A systematic literature search identified 1001 potentially relevant articles, out of which 57 original studies and nine meta‐analyses were deemed eligible for the final synthesis. The evidence synthesis showed the following: (1) MHT showed a heterogeneity in findings for CRC risk with a slight tendency to a neutral or protective effect; (2) MHT effect was either neutral or protective on colorectal adenoma; (3) MHT had no impact on tumour grade, subsite and histologic types; (4) MHT was not associated with CRC mortality; and (5) MHT showed heterogeneous effects on CRC stage and invasiveness, respectively. In summary, despite some evidence pointing towards a protective effect of MHT on CRC, MHT is currently not recommended for primary CRC prevention by international guidelines due to several important, potentially harmful effects. [ABSTRACT FROM AUTHOR]

Understanding the arc parallel variation on the geometry of the Main Himalayan Thrust (MHT) is as important as understanding the arc perpendicular variation in the Himalayas. The geometric variability of the MHT holds significant implications for the occurrence of major and great earthquakes. Three-dimensional magnetotelluric (MT) forward modeling enables the investigation of potential crustal models along the MHT in northwest Himalayas. MT impedance tensors were computed utilizing the 3D forward modeling code MTD3FWD. Previously established MT resistivity and seismic velocity models from various sectors of the northwestern Himalayas were employed as inputs for generating the resistivity mesh necessary for 3D forward modeling. The computed impedance tensors by 3D forward computation were cross-referenced with the original published MT data to validate their accuracy. A lateral resistivity cross section is also derived from the 3D forward model along the sub-Himalaya and lesser-Himalaya region to study the lateral heterogeneity. The lateral resistivity cross-section reveals significant heterogeneity within the crust, marked by both high and low-resistive structures and a possible lateral ramp along the MHT. The geometry of the lateral MHT showcases a gradual incline within the Himachal sector and a steep ramp within the Garhwal and Kumaun sectors in the northwestern Himalayas. The crustal architecture exhibits distinct nearly-vertical resistive and conductive features beneath the study area. Consequently, the crust within this region is characterized by considerable heterogeneity, influenced by a network of subsurface faults and ridges. The Delhi Haridwar Ridge, which exhibits high resistivity, plays a significant role in dictating the lateral dip of the MHT and exerting control over seismic activity patterns in the region. [Display omitted] • Lateral resistivity variation in geometry of the Main Himalayan Thrust (MHT) along the strike of the northwest Himalaya. • The MHT, showcases a gradual incline within the Himachal sector and a steep ramp within the Garhwal and Kumaun sectors. • The crust within this region is characterized by considerable heterogeneity, influenced by a network of subsurface faults and ridges. [ABSTRACT FROM AUTHOR]

Abstract Many objects of culture heritage, comprised of leather, need to receive the right treatment to be restored and to elongate their lifespan. Determination of the degradation degree and even better the type of the degradation is a crucial knowledge for the way of subsequent conservation, exhibition and long-term storage. Collagen based materials are very sensitive to the deterioration and undergo, mainly hydrolysis and oxidation. Namely acid hydrolysis and photooxidation are the most often causes of the disintegration of leather. Contrary to the leather investigation, a few studies dedicated to parchment described some typical features of hydrolysis, oxidation and gelatinization observed applying Attenuated Total Reflection Fourier-Transform Infrared spectroscopy (ATR-FTIR) which is widely used in collagen degradation type research. Except of the collagen secondary structure, followed by IR spectroscopy, we determined the shrinkage temperature of the collagen substrate by Micro Hot Table method (MHT) to reach the degradation level. In this paper, artificially degraded leather samples as a theoretical representative of cultural heritage objects were examined. We discuss the use of both techniques (IR and MHT) as potential methods for fast assessment of oxidation and hydrolysis of vegetable tanned leathers and degradation level. New samples of leather tanned by various vegetable tannins were artificially degraded under controlled conditions. We simulated the photooxidation by means of the Xenon arc lamp exposure, oxidation using the soaking in hydrogen peroxide, acid hydrolysis by the soaking in hydrochloric acid and alkaline hydrolysis using the soaking in natrium hydroxide. ATR-FTIR spectra of reference and tested samples were compared. Oxidation causes increase of the distance between amide I (AI) and amide II (AII) wavenumbers (Δν) above 100 cm−1 and the intensity ratio between AI and AII bands (AI/AII) above 1.6. The AI/AII ratio depends on the type of hydrolysis. The increase above 1.8 proves acid hydrolysis while the decrease under 1 demonstrate alkaline hydrolysis. MHT results are not so obvious. Generally, mainly the hydrolysis causes the decrease of the temperatures. We have found out that knowledge of the whole shrinkage interval is important and provides more appropriate information about the leather disintegration.

One of the most common approaches for enhancing network performance is to retrieve data from nearby data holders that have previously obtained the desired data, not only from the original data source itself. In this case, since a data receiver cannot identify a practical data sender, it is necessary to verify both the received data and the data sender. Moreover, a data sender generally fragments the data into several small segments and sends them. Therefore, if these segments are retrieved from multiple unknown senders, the receiver must verify every segment to safely use the data. MHT (Merkle hash tree) is suitable for efficiently verifying the set of segments shared in the network. NDN (named-data networking) and Bitcoin utilize MHT to verify transmitted data. However, a data authentication scheme based on the MHT has an inefficient factor that repeatedly computes the same node values of the MHT and are repeatedly computed. The larger the size of the MHT is, the greater the number of calculation iterations. Therefore, as a result, the authentication scheme’s inefficiency is also more severe. When a sender transmits data consisting of many segments through NDN, the data authentication time may take longer than the data transmission time. Hence, in this paper, the degree of the MHT’s inefficiency and the pattern of the iterated operation of the MHT are analyzed first. The proposed improvement is to find repeatedly used node values, store them internally, and use the stored node values without recalculation when required to reuse them. For that process, a rule to select such node values is given. Additionally, when verifying the leaf node value of the MHT, the MHT-based authentication scheme asks a verifier to compute all node values on the path from the leaf node to the root node of the MHT. This paper demonstrates the proposed shortest path selection for verifying the leaf node value. The proposed scheme, using saved node values and the shortest path, reduces the computational overhead of the MHT and improves service latency. It has been proven from performance evaluations that the proposed scheme decreases the computational overhead by more than one-third if the number of segments is more than 1024.

Introduction: Carbapenems are broad spectrum β Lactam antibiotics & are the last resort to control infections caused by gram negative bacteria. The increasing resistance to these antibiotics is an alarming sign. CRE (Carbapenem resistant Enterobacteriaceae) is reported due to acquisition of carbapenemase genes or association with decreased outer membrane permeability with β lactamases with weak carbapenemase activity. Methods: Total 123 culture positive blood samples from our tertiary care hospital were included in which carbapenem resistance was identified and the resistant strains were assessed for carbapenemase production by Modified Hodge Test (MHT) & Modified Carbapenemase inactivation method (mCIM) simultaneously. Results: Out of total 896 blood samples received, 123 isolates were members of Enterobacteriaceae family. The maximum isolates were Escherichia coli 39(31.70%) next was Klebsiella pneumoniae, Klebsiella oxytoca, Klebsiella aerogenes, Citrobacter freundii. Carbapenem resistance was seen in 19(15.44%) isolates. The positivity rate by MHT was 11 (57.89%) while by mCIM was 17(89.47%). Conclusion: Prevalence of carbapenem resistance was 15.44%.

Background and Objectives: The human brain presents a functional asymmetry for every cognitive function, and it is possible that sexual hormones could have an impact on it. Visual–spatial attention, one of the most lateralized functions and one that is mainly dependent on the right hemisphere, represents a sentinel for functional cerebral asymmetry (FCA). The aim of this study was to evaluate whether menopausal hormone therapy (MHT) or phytoestrogens could modulate FCA in postmenopausal women. Materials and Methods: We enrolled postmenopausal women who were taking MHT or soy isoflavones or receiving no therapy and asked them to perform the line bisection test at study enrollment and after 18 and 36 months. Results: Ninety women completed the follow-up. At zero time, women who had not been subjected to therapy showed a leftward deviation (F = −3.0), whereas, after 36 months, the test results showed a rightward deviation (F = 4.5; p < 0.01). Women taking MHT showed a leftward deviation at the start (F = −3.0) and a persistent leftward deviation after 36 months (F = −4.0; p = 0.08). Conversely, women taking soy isoflavones started with a leftward deviation (F = −3.0) that became rightward (F = 3.0), with a significant difference shown after 36 months (p < 0.01). Conclusions: Our data suggest that hormonal modulation improves the interplay between the two hemispheres and reduces FCA. We propose, therefore, that the functions of the right hemisphere are mainly affected by aging and that this could be one of the reasons why the right hemisphere is more susceptible to the effects of MHT.

The global aging of the population leads to a significant increase in the demographic burden on society, puts a heavy burden on the economy and causes significant structural changes in the sphere of social security. Therefore, the problem of maintaining the health of women in peri- and post-menopause becomes extremely important for public health and health. It is in this period that a number of somatic and mental diseases appear that significantly affect the quality and overall life span of a woman. Inevitably, menopausal manifestations is a change in hormone levels that causes various symptoms, including vasomotor disorders, bone density, hair loss, decreased sexual interest and mood, etc. Therefore, the development of therapeutic and rehabilitative programs for women of menopausal age, based on pathogenetically substantiated complex treatment. Among other things, patients in the phase of the menopausal transition need to take into account several principal provisions: – Clinical deficiency of sex hormones (estrogens, progesterone and testosterone) in women is an indication for the appointment of menopausal hormone therapy (MHT) with appropriate hormones. This should be done as soon as possible (during the menopausal transition) and personified – taking into account the individual characteristics of patients. The purpose of MHT should correspond to the symptomatology and goals of the prevention of various diseases, as well as the history, research results, preferences and expectations of women. – Women who need correction of the symptoms of menopause and adequate control of the endometrium, should be prescribed a combination of estrogen and gestogen. In the presence of risk factors for hyperproliferation, the best choice is the combination of estrogen and progestogens with antiproliferative activity, for example levonorgestrel, which can be prescribed both in combination menopausal therapy and in the form of an intrauterine system with this gestogen. – A special category is patients who have clinical manifestations of androgen deficiency in the clinical situation, in addition to the characteristic symptoms of estrogen deficiency. In such patients, preference should be given to the drug containing levonorgestrel, which has residual androgenic activity, provides adequate control of the endometrium and has additional advantages with regard to the prevention of osteoporosis, premature ovarian failure and cognitive decline.

Background: The rising global emergence of Gram-negative bacteria (GNB) producing ß-lactam hydrolysing enzymes in clinical infections constitutes a growing public health threat. This study investigated the occurrence of co-production of extended spectrum ß-lactamase (ESßL), AmpC ß-lactamases, and carbapenemases among GNB isolated from HIVinfected patients in two tertiary healthcare facilities in southwest Nigeria. Methodology: A total of 115 GNB isolates previously recovered from HIV-infected patients at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, and the State Specialist Hospital, Akure, were investigated. The isolates were characterized to species level with the Microbact 24E kit and screened for ESßL production using the double-disc test (DDT) and combination disc methods, AmpC using modified Hodge test (MHT) and AmpC EDTA disc, and carbapenemase production using the MHT and EDTA disc test. Antibiotic susceptibility testing (AST) was performed by the Kirby-Bauer disc diffusion method. Results: A total of 15 species of GNB were characterized. The AST profile of the isolates revealed high resistance rates to ampicillin (94.5%), tetracycline (74.5%), sulphamethoxazole-trimethoprim (66.3%), and lowest resistance to imipenem (10.9%). Multi-drug resistance (MDR) was observed in 93.6% while 98.8% of ESßL, AmpC, and carbapenemase-producing isolates had multiple antibiotic resistance (MAR) indices = 0.2. ESßL production was detected in 53.9%, AmpC in 20.9% and carbapenemase in 25.2% of the isolates. ESßL, AmpC or carbapenemase or co-production of two or all three enzymes was detected in 80 (69.6%) isolates, while only 10.0% produced all three enzymes. Conclusion: The isolation of MDR bacteria and isolates co-producing ß-lactam hydrolysing enzymes in immunocompromised individuals portend grave consequences. Routine screening for these enzymes in MDR bacteria will be highly essential to guide the institution of appropriate antibiotic therapy and infection control measures. [ABSTRACT FROM AUTHOR]

Aim: To study compliance with menopausal hormonal therapy (MHT) until age ≥ 50 year and health consequences after surgical menopause. Methods: A retrospective cohort study of 1000 consecutive surgically menopausal patients who underwent premenopausal surgery before 50 years of age from benign indications during 1996–2012 was performed. Main outcomes were number in year of MHT compliance and health consequences: hypertension (HT), diabetes mellitus (DM), dyslipidemia (DLP), ischemic heart disease (IHD)/myocardial infarction (MI), venous thromboembolism (VTE), stoke, osteopenia/osteoporosis, cognitive impairment/dementia/Alzheimer's disease (AD) /Parkinsonism and breast/other cancers. The MHT nonuser subgroup served as the control. Results: Of the 1000 patients, 855 cases used MHT. The median overall follow‐up time from surgery for 145 MHT nonuser patients, 435 MHT users until age <50 year and 420 MHT users until age ≥50 year was 12.0 years. Compliance until age ≥50 year was only 49.1%. For MHT users, the overall median age of stopping MHT was 47.0 year with a median MHT use of 6.0 year. After age adjustment at the time of follow‐up of all subgroups by forward stepwise logistic regression analysis, the only significantly different health consequence was osteopenia (32.4%, 10.6% and 21.4% in the MHT nonusers, users until age <50 year and users until age ≥50 year, respectively [P < 0.001]). Prevalence of breast cancer, colon cancer and other cancers were not different among subgroups. Conclusion: The majority of patients used MHT with low compliance until age ≥50 year. In addition, MHT initiation after surgery possibly prevented osteopenia compared with MHT nonusers. [ABSTRACT FROM AUTHOR]

Elméleti háttér: A mentális egészség egyfajta jóllét biológiai, pszichológiai, társadalmi és spirituális szinten, ezen kívül pedig képesség a pozitív állapotok fenntartására és megélésére, amelyhez a hatékony megküzdés és savoring, valamint a reziliencia és a dinamikus önszabályozás jelenléte is társul. A pozitív pszichológia egyik feladata, hogy érvényes teszteket dolgozzon ki a mentális egészség mérésére. Cél: A Mentális Egészség Teszt (MET) legújabb változatának átfogó pszichometriai ellenőrzése. Módszer: Két, online módon lefolytatott kérdőíves keresztmetszeti vizsgálat. I. 1540 fő (391 férfi, 1149 nő; átlagéletkor 52,0 év, SD = 11,3 év) demográfiai, valamint testi és lelki egészségre vonatkozó kérdések mellett kitöltötte az alábbi kérdőíveket: MET, PERMA Kérdőív, Globális Jóllét Kérdőív, Diener-féle Virágzás skála, Rövidített Savoring Hit Kérdőív, Rövidített Pszichológiai Immunrendszer Kérdőív. II. 1083 fő (233 férfi, 847 nő; átlagéletkor 33,9 év, SD = 12,2 év) demográfiai, a vallásosságra, valamint a testi és lelki egészségre vonatkozó kérdések mellett kitöltötte a MET, Aspirációs Index, Rövidített Beck Depresszió, WHO Jól-Lét, Élettel való Elégedettség, valamint Életcél Kérdőíveket. Eredmények: Az I. mintán elvégzett feltáró faktoranalízis megerősítette a MET ötfaktoros szerkezetét 17 tétellel, s az ezt tesztelő konfirmatív faktoranalízis jó illeszkedésű modellt jelzett. A II. mintában ugyanezen a faktorstruktúrán elvégzett konfirmatív faktoranalízis kiváló illeszkedésű (RMSEA = 0,051; pClose = 0,408; CFI = 0,950; TLI = 0,936). Az öt skála Cronbach-a értékei mindkét vizsgálatban 0,70 felettiek, magas belső konzisztenciát mutatva. A diszkriminációs validitást igazolja, hogy minden skálának van egy minimum 44%-os olyan egyedi része, amelyet a többi négy skála nem fed le. A skálák tartalmi validitását a mentális egészség 10 tesztjével, speciális tesztkérdésekkel és szociodemográfiai mutatókkal sikerült igazolni. Fontos eredmény továbbá, hogy a jóllét pozitív irányú kapcsolatot mutat az anyagi helyzettel; az alkotó-végrehajtó hatékonyság a flow-val és az iskolázottsággal; az önreguláció és a reziliencia az életkorral; a savoring pedig a nőknél minden életkorban magasabb, mint a férfiaknál. Következtetés: a MET a jóllét, a savoring, az alkotó-végrehajtó hatékonyság, az önreguláció és a reziliencia konstruktumok megbízható és érvényes mérőeszközének tekinthető. Theoretical background: Beyond that mental health is related to biological, psychological, social, and spiritual well-being, it is a capacity to maintain and experience the positive conditions with effective coping, savoring, resilience and dynamic self-regulation skills. One of the most important responsibility of positive psychology is to construct scales measuring mental health. Aim: the purpose of this study is to present the psychometric characteristics of the new version of the Mental Health Test (MHT) based on five pillars. Method: Two online cross-sectional studies with self-report questionnaires. Study I: 1540 persons (391 men, 1149 women; mean age 52.0 years, SD = 11.3 years) filled in MHT, PERMA Profiler, Global Health, Diener's Flourishing Scale, Shortened Savoring and Shortened Psychological Immune Competence questionnaires along with questions about physical and psychological well-being and demographic data. Study II: 1083 persons (233 men, 847 women; mean age 33.9 years, SD = 12.2 years) filled in MHT, Aspiration Index, Shortened Beck Depression Inventory, WHO Well-Being Scale, Satisfaction with Life Scale, Purpose in Life Test, and Shortened Young Maladaptive Schema Questionnaire, along with questions about demographic data, religiosity, physical and mental health. Results: In Study I exploratory factor analysis identified the five-factor structure of MHT with 17 items, having also good fit measures in confirmative factor analysis. In Study II the five-factor model of the five subscales yielded excellent fit measures in confirmatory factor analysis (RMSEA =.051, pClose =.408, CFI =.950, TLI =.936). In both studies, Cronbach's a values of the five subscales (all above 0.70) indicated a high level of internal consistency. The discriminant validity is proven by the fact that each subscale had a minimum 44% part not covered by the set of other subscales. The content validity of the subscales was confirmed by ten tests about mental health, some special questions and socio-demographic indicators. Subscale of well-being showed a definite positive correlation with financial background. Creative and executing efficiency correlated with flow and education. We found also a positive correlation of self-regulation and resilience subscales with age, and women showed a higher level of savoring than men at all age levels. Conclusion: MHT can be considered a reliable and valid measurement tool for well-being, savoring, creative and executing efficiency, self-regulation and resilience dimensions of mental health. [ABSTRACT FROM AUTHOR]

Background: Carbapenem are a wide range of β-lactam antibiotics exploited as a final resort in the controlling of multidrug-resistant bacterial infections. Carbapenemase producing Gram negative bacteria may reach the wastewater via effluent of untreated hospital wastewater in addition to vital role of drug manufacturing companies that loaded their wastewater with such antibiotics leading to emergence of carbapenem resistance bacteria. The current study aims to investigate the carbapenemase producing Gram negative bacteria among wastewater using three different phenotypic methods. Methodology: During a winter period of 2018, 852 wastewater samples were collected from Basra city and cultured on MacConky agar and then confirm identification by API-20E. The Kirby-Bauer were used for screenings of carbapenem resistance and then the carbapenemase producing confirmed by three different phenotypic methods: MHT, RAPIDEC®.CARBA NP and CHROMID®.CARBA agar. Results: The results of bacterial isolation revealed positive culture for 742 (87.08%) of samples while 110 (12.92%) give no growth. Gram negative bacteria were recovered from 514/852 (60.32%) of samples and 228/852(26.76%) for Gram-positive bacteria. All 514 gram negative isolates were submitted for carbapenem producing using disc diffusion method for imipenem, meropenem and ertapenem. The results showed that only 38/514 (7.39%) of Gram negative isolates were resist at least one of the three used carbapenem antibiotics. 10/38 (26.31%) of Gram negative isolates were resist to meropenem, imipenem and ertapenem. 21/38 (55.26%) were resist to meropenem and imipenem while all isolates 38/38 (100%) were resist to meropenem. The 38 isolates of carbapenem producing Gram negative (CRGN) were 20/38 (52.631%) for E. coli, 11/38 (28.947%) for K. pneumoniae, 5/38 (13.157%) for P. aeruginosa and 2/38 (5.263%) for P. mirabilis. The results of three phenotypic assay to investigate the carbapenemase production showed that RAPIDEC®CARBA NP reveal 36/38 (94.74%), MHT reveal 31/38 (81.58%) and CHROMID®CARBA agar reveal 27/38 (71.05%) of isolates were carbapenemase producer. Conclusion: It is easily to conclude that, the carbapenemase producing Gram negative (CPGN) bacteria may reach the wastewater from hospital effluent and drug manufacturers. RAPIDEC®CARBA NP was rapid, accurate and suitable assay for detecting CPGN bacteria. [ABSTRACT FROM AUTHOR]

Introduction: Resistance to carbapenem in Gram-negative bacteria is attributable to their ability to produce carbapenemase enzymes. The main objective of this study was to detect the presence of blaOXA-48 genes in carbapenem-resistant uropathogenic Escherichia coli and Klebsiella pneumoniae isolated from urine samples from patients attending Alka Hospital, Jawalakhel, Lalitpur, Nepal. Methods: A total of 1013 mid-stream urine samples were collected from patients with suspected urinary tract infection (UTI) between April and September 2018. The identified isolates underwent antibiotic susceptibility testing using the modified Kirby–Bauer disc-diffusion method. Phenotypic carbapenemase production was confirmed by the modified Hodge test, and the blaOXA-48 gene was detected using conventional polymerase chain reaction. Results: Out of 1013 urine samples, 15.2% (154/1013) had bacterial growth. Among the isolates, 91.5% (141/154) were Gram-negative bacteria, and E. coli was the most common bacterial isolate (62.9%; 97/154), followed by K. pneumoniae 15.6% (24/154). Among 121 bacterial isolates (97 E. coli isolates and 24 K. pneumoniae isolates), 70.3% (52/121) were multidrug-resistant E. coli and 29.7% (22/121) were multidrug-resistant K. pneumoniae. In addition, 9.1% (11/121) were carbapenem resistant (both imipenem and meropenem resistant). Development of multidrug resistance and development of carbapenem resistance were significantly associated (p< 0.05). Of the 11 carbapenem-resistant isolates, only seven were carbapenemase producers; of these, 28.6% (2/7) were E. coli, 72.4% (5/7) were K. pneumoniae and 42.8% (3/7) had the blaOXA-48 gene. Of the three bacterial isolates with the blaOXA-48 gene, 33.3% (1/3) were E. coli and 66.7% (2/3) were K. pneumoniae. Conclusion: One in ten isolates of E. coli and K. pneumoniae were carbapenem resistant. Among carbapenem-resistant isolates, one-third of E. coli and two-thirds of K. pneumoniae had the blaOXA-48 gene. OXA-48 serves as a potential agent to map the distribution of resistance among clinical isolates. [ABSTRACT FROM AUTHOR]