Search

Background: Sepsis and septic shock have high mortality rates and often require a prolonged hospital stay. Patient outcomes may vary according to multiple factors. We aim to determine the prevalence of antimicrobial resistance and factors associated with mortality and hospital stay. Methods: Clinical and microbiological data of patients with sepsis or septic shock were retrospectively collected for 15 months. Patients with negative blood cultures and patients that did not meet the SEPSIS 3 criteria were excluded. Results: We included 48 septic shock and 28 septic patients (mean APACHE II 20.32 ± 5.61 and mean SOFA 9.41 ± 3.17), with a mean age of 60.5 ± 16.8 years and 56.6% males. WBCs, neutrophils, INR, and fibrinogen levels were significantly associated with mortality. 59.5% of the cultured bacteria were gram-negative (most common E. coli) and 27.8% were gram-positive (most common S. aureus), while 7.6% were other types of bacteria and 5.1% were fungi. Resistance patterns to gram-negative were varying, and resistance to piperacillin/tazobactam, carbapenems, and aminoglycosides were from 60% to 100% (A. baumanii), while they were highly sensitive to Colistin. E. coli was also resistant to ceftriaxone (77.8%) and sulbactam/cefoperazone (44.4%). Resistance rates for Gram-positives were high, from 86% to 100% for oxacillin, while for vancomycin, teicoplanin, and linezolid, they were often low but arrived up to 42.8%. According to our logistic regression analysis, patients over 65 year-old and those who received corticosteroids had a significantly increased risk of in-hospital mortality (OR: 4.0; OR: 4.8). Conclusion: Sepsis still poses a significant threat to patients’ health, even when positive blood culture results allow the administration of specific antibiotic treatment., Hospital Practice, 50(5), pp.407-415; 2022

Kinesio taping is widely used in musculoskeletal conditions. We performed a systematic review and meta-analysis on the efficacy of kinesio taping in musculoskeletal disorders compared to other interventions. Twelve electronic databases were used for systemic search and data relevant to pain and disability were extracted. The protocol was registered in PROSPERO (CRD42018087606). Meta-analysis was performed to compare the efficacy of kinesio taping to other modalities of musculoskeletal disorders. As a result, 36 studies were included in the quantitative analysis. Kinesio taping was found to provide an improvement of both pain and disability when applied to any region of the body. In the first five days of application, kinesio taping significantly reduced the pain in all body regions (SMD = -0.63, 95%CI: -0.87, -0.39). This was also noted after four-to-six weeks of application (SMD = -0.76, 95%CI: -1.07, -0.45). When kinesio taping was used for disability in low back pain patients, it significantly reduced the disability within five days of application (SMD = -0.70, 95%CI: -1.29, -0.11). Finally, kinesio taping has shown an improvement of the disability in all body regions after four-to-six weeks of application (SMD = -0.59, 95%CI: -0.96, -0.22). Our findings support kinesio taping as an adjuvant to other treatments for musculoskeletal disorders. Abbreviations KT = Kinesio taping; MSK = musculoskeletal; SD = standard deviation; CR = conventional rehabilitation; NDI = Neck Disability Index; NPS = Numerical Pain Scale; CTM = Cervical Thrust Manipulation; PIR = Post-isometric muscle relaxation; NPRS Numerical Pain Rating Scale; OA = osteoarthritis; ROM = Range of motion; VAS = visual analogue scale; VAS-W = visual analogue scale-worst pain; VAS-U = visual analogue scale-usual pain; VAS-R = visual analogue scale-resting pain; VAS-A = visual analogue scale-activity pain; VAS-N = visual analogue scale-night pain; NPDS = Neck Pain Disability Scale; QA = Quality assessment.

Background Kinesio tape is an elastic therapeutic tape used for treating sports injuries and various other disorders. A systematic review and network meta-analysis approach was used to synthesise all related evidence on the clinical effectiveness of kinesio taping for the treatment of shoulder pain. Methods A literature search was performed using 10 major databases. Randomised clinical trials reporting usage of kinesio taping for shoulder pain have been included. Quality and risk of bias were assessed using the Cochrane Collaboration's quality assessment tool. Meta-analysis was conducted to calculate standardised mean differences and corresponding 95% confidence intervals (CI). The corresponding 95% CI of pooled effect size were calculated using a fixed-effects or random-effects model based on the level of heterogeneity. In addition, meta-regression was used to assess the influence of underlying shoulder disease on the efficacy of kinesio taping. Results This systematic review and meta-analysis included 12 studies, with a total of 555 participants. Pairwise comparisons inferred that kinesio taping only showed significant improvement of shoulder pain and disability when combined with exercise. However, kinesio taping did not produce better results than placebo or treatment with steroids. The duration of treatment and underlying shoulder pathology did not influence the efficacy of kinesio taping. Conclusion There is insufficient evidence to support the use of kinesio taping in clinical practice as a treatment for shoulder pain. However, there is limited evidence of its benefit as a complementary treatment in shoulder pain syndromes. Clinical trial registration number PROSPERO CRD42017065881.

Background There is preliminary evidence for lavender as an anxiolytic agent through various routes of administration. Our goal is to elucidate the best route of administration for lavender as a treatment for anxiety. Methods Thirteen electronic search engines were systematically scanned for relevant publications. The relevant articles were included after the title and abstract screening followed by the full-text screening. This study included randomized control trials reporting lavender for the treatment of anxiety. The protocol was registered in PROSPERO (CRD42017076711). Frequentist network meta-analysis and Bayesian meta-regression were conducted to report the best treatment modality and the effect of covariates on the effectiveness as an anxiolytic. Treatment arms were ordered according P-scores, where higher P-score indicates better treatment choice. Results Forty studies were eligible for qualitative analysis, and 32 were included in quantitative analysis. Lavender aromatherapy was the best approach for the treatment of anxiety among other lavender modalities at the first week recording [Standardized Mean Difference (SMD) = −0.57, 95% CI (−1.14–0.01), P-score = 0.72], in addition to achieve at the first time points [SMD = −0, 95% CI (−0.97 -0.16), P-score = 0.69], compared to placebo; however, lavender massage along with foot bath were found to be the most efficacious for anxiety treatment at the study endpoint [SMD = −1.10, 95% CI = (−7.41 5.21), P-score = 0.65]. Furthermore, network meta-regression revealed that the duration of therapy influenced treatment, suggesting Silexan (oral lavender) 80 mg (first rank probability = .116) as the favorable option for anxiety in long-term treatment. Conclusions Lavender aromatherapy is, clinically, superior in short-duration, while Silexan (oral lavender) 80 mg is preferable for long-term treatment of anxiety.

PurposeApplying machine learning in medical statistics offers more accurate prediction models. In this paper, we aimed to compare the performance of the Cox Proportional Hazard model (CPH), Classification and Regression Trees (CART), and Random Survival Forest (RSF) in short-, and long-term prediction in glioblastoma patients.MethodsWe extracted glioblastoma cancer data from the Surveillance, Epidemiology, and End Results database (SEER). We used the CPH, CART, and RSF for the prediction of 1- to 10-year survival probabilities. The Brier Score for each duration was calculated, and the model with the least score was considered the most accurate.ResultsThe cohort included 26473 glioblastoma patients divided into two groups: training (n = 18538) and validation set (n = 7935). The average survival duration was seven months. For the short- and long-term predictions, RSF was the best algorithm followed by CPH and CART.ConclusionFor big data, RSF was found to have the highest accuracy and best performance. Using the accurate statistical model for survival prediction and prognostic factors determination will help the care of cancer patients. However, more developments of the R packages are needed to allow more illustrations of the effect of each covariate on the survival probability.

Dengue is classified as an endemic infectious disease, which is transmitted by Aedes mosquitos. Kinetic studies, which monitor the viral load of the disease, have been the mainstay for several decades in humanity's quest to control this disease. Our study aims to systematically evaluate the usage of different timing systems in dengue kinetic studies. A search in nine electronic databases and manual search of reference and citation lists were conducted to find relevant studies. A quality assessment using the National Institute of Health tools for observational cohort and cross-sectional studies was performed. The protocol was registered in PROSPERO with number CRD42018086435. As results, among included 87 studies, 71 studies (81.6%) use a timing system which is based on the day of illness onset, of which, 11 studies designate the day of illness onset as "day 0″ (type 1A) while 60 studies designate it as "day 1″ (type 1B). Only ten articles (11.5%) designate the day of defervescence as "day 0″, the day before and after defervescence as "day -1″ and "day +1″, respectively. Four articles (4.6%) use a timing system based on the day of hospital admission. Lastly, two studies (2.3%) designate the day of hemorrhagic manifestation as "day 0″ and two studies (2.3%) designate the day of pharmacological treatment as "day 1″. Therefore, the timing system which designates the day of illness onset as "day 1″ (type 1B) was most commonly used. Inconsistent definitions of "day 0″ and "day 1″ may lead to disparities in results across the studies and may have a negative impact on treatment guidelines implementation.

Background Tuberculous meningitis (TBM), manifests as the most severe involvement of the nervous system by Mycobacterium tuberculosis, it has a high mortality rate and a spectrum of systemic and neurological complications that can lead to debilitating or fatal sequelae, whereas hyponatremia is the commonly encountered life-threatening electrolyte disturbance. Thus, our study aimed to determine the prevalence, risk factors and differences in outcomes of hyponatremia in TBM. Methods This systematic review was registered in PROSPERO (CRD42018088089). A comprehensive electronic search was conducted through ten databases to find relevant articles. Results A total of 42 studies were included, 24 case reports and 18 retrospective studies. The prevalence rate of hyponatremia among TBM patients was 52% and the rate of death among those patients was 29%. The meta-regression analysis revealed that there was no significant effect of sodium level on the death rate in TBM patients (P-value = 0.9). Additionally, there was no significant difference in sodium level based on sex, and etiologies of hyponatremia. Conclusions Hyponatremia is commonly present in patient with TBM, but it is not significantly correlated to the rate of death. However, it is necessary to treat this potentially life-threatening condition appropriately according to its etiology, further research is needed on its pathophysiology in TBM, its risk factors, and the most appropriate treatment.

Objectives Neonatal dengue has been reported in the literature with contradictory findings of clinical characteristics and diagnosis; thereby, misdiagnosis of neonatal dengue has been frequently reported. We aim to delve into the epidemiology, clinical features, and outcomes of neonatal dengue, thus avoid misdiagnosis and obtain early intervention. Study design A retrospective study was conducted at Children's Hospital 1, Ho Chi Minh, Vietnam with laboratory-confirmed dengue in neonates by positive viral antigen nonstructural protein one rapid test (NS1) and positive IgM antibody for dengue by MAC-ELISA. Results We have included 32 neonates in this study with 25% cases were misdiagnosed with neonatal sepsis, and 12.5% cases were misdiagnosed with neonatal immune thrombocytopenia at the beginning. The median time between the first day of the mother's onset of fever and childbirth was -1 days (IQR: -2, 2). The patient's clinical manifestation included: petechiae 87.5% (28/32), pharyngeal mucosal hemorrhage 6.3% (2/32), and hepatomegaly occurred 75% (24/32). In the febrile phase (day of illness 1-3), the mean white blood cell (WBC) counts were 7800 ± 800/mm3 and platelets were 97,111 ± 37,826/mm3. In the critical phase (day of illness 4-6), the mean WBC counts were 13,400 ± 2800/mm3, and platelets were 30,100 ± 5749/mm3. All mothers (100%) had laboratory-confirmed dengue by NS1 positive in the perinatal period. Conclusions The findings emphasize that early diagnosis of neonatal dengue should be based on a history of maternal illness, NS1 rapid test, and clinical presentation such as petechiae, hepatomegaly, and low platelet counts in the febrile phase.

In this study, we aim to assess the association of dengue viremia with dengue severity. The study protocol was developed and registered in PROSPERO (CRD42016039864). We searched nine databases to find potential papers. Studies meeting the inclusion criteria were included. We, based our analysis on three outcomes which are disease severity, dengue serotype and disease infection type. Thirty studies with 3316 patients were included. Our analysis revealed that viremia is significantly higher in dengue hemorrhagic fever patients than dengue fever in days 5 to 6. Regarding the serotype of dengue, the maximum viremia titre of serotype 1 was significantly higher than serotype 3 and the viremia in dengue serotype 2 was significantly higher than serotype 4 in days 2 to 4. However, comparison of the daily viremia level between the primary and secondary dengue infection revealed that secondary infection was significantly higher than the primary infection on seventh day and on the eighth day. Viremia is strongly associated with disease severity and type of infection which gave viremia a high indicative power to be used as a clinical predictor. Dengue serotype is also associated with viral load with higher viremia in DENV-2/1.

The secret of educational success and splendid future with prosperous career lies in the constant hard work performed in a smart way. By that way, the change or modification in study methods, exam strategies, and learning techniques is necessity. Deriving from our own experience as medical students from some developing countries from all over the world, authors support some tips and methods to approach the medical field more productive.

Spinal muscular atrophy (SMA) is a neuromuscular disorder classified into four types based on the age of onset of the disease. Early onset is correlated with a higher mortality rate, mainly due to respiratory complications. Valproic acid (VPA) is a histone deacetylase (HDAC) inhibitor that has shown positive results on SMA both in experimental and cohort studies. This systematic review and meta-analysis aimed to investigate the efficacy and safety of VPA in patients with SMA. Eleven databases were systematically searched on 30 May 2017 for clinical trials that reported the efficacy and safety of VPA in SMA patients. The primary outcome was the efficacy of VPA in terms of gross motor function and expression of both full-length spinal motor neuron (SMN) gene (FL-SMN) and exon 7-lacking SMN. The secondary outcome was the safety of VPA in terms of reported adverse effects. The protocol was registered at PROSPERO (CRD42017067203). Five of the ten included studies were used in the meta-analysis (n = 126). The overall effect estimate, comparing pre- and post-VPA treatment, regardless of carnitine co-administration and design of the studies, showed significant improvement in gross motor function (standard mean difference [SMD] = 0.302, 95% confidence interval [CI] 0.048–0.556, P = 0.02) using the Hammersmith Functional Motor Scale (HFMS), Modified Hammersmith Functional Motor Scale (MHFMS), and MHFMS-Extend, with no significant heterogeneity. Similarly, in non-randomized controlled studies, the results indicated that there was a significant improvement detected (SMD = 0.335, 95% CI 0.041–0.628, P = 0.025), with no significant heterogeneity. Meanwhile, our results suggest that there was no significant improvement in treatment with co-administered carnitine (SMD = 0.28, 95% CI − 0.02 to 0.581, P = 0.067). No significant differences were found between pre- and post-VPA treatment co-administered with carnitine, in terms of the change in FL-SMN and exon 7-lacking SMN. Qualitative synthesis showed that other motor functions were not improved, while respiratory function test results were contradictory. Regarding the safety of the treatment, a double-blind, randomized, placebo-controlled trial reported no statistically significant differences for adverse events (AEs) between groups. Moreover, most of the included studies reported no serious AEs related to VPA use, although weight gain, gastrointestinal symptoms and respiratory symptoms were notable problems. Our study suggests that VPA treatment results in an improvement in gross motor functions for SMA patients, but not in other assessments of motor function or, possibly, in respiratory function. Furthermore, VPA appears to be a relatively safe drug, although treatment may be associated with a wide range of AEs (including body weight increase, fatigue, fever, flu-like symptoms, irritability, and pain). Double-blind, randomized, controlled trials are required to confirm these findings.

The pyridinocrownophane derivatives containing 2,6-diaryl-γ-arylpyridine subunit and the aza-14-crown-4 ether ring have been exhibit high cytotoxicity on several tumor cell lines such as Hep- G2, MCF7, FL, RD, Lu. This study continues to develop method of synthesis of new γ-(fur-2-yl)pyridinoaza-14-crown-4-ether (2), γ-(naphthalen-1-yl)pyridinoaza-14-crown-4-ether (3), γ-(thien-2-yl)pyridinoaza-17-crown-5-ether (4) and γ-(2-pyridino)pyridinoaza-17-crown-5-ether (5) based on the 1,5-bis- (2-acetylphenoxy) -3- -oxapentane (1a) and 1,8-bis- (2-acetylphenoxy) -36-dioxaoctane (1b). The structure of these derivatives has determined by 1 H NMR, HPLC-MS.

Having been synthesized successfully heterocyclic system, namely 2-aryl-N-methyl-4,8a-di(α-furyl)perhydro[1,2,3]dioxaborinino-[5,4-c]pyridine contains two piperidine and dioxaborinine rings. This new heterocyclic system was prepared from the reaction of N-methyl-3-(α-hydroxyfuryl)-4-(α-furyl)-γ-piperidol and some derivatives of arylboronic acid. The structure of new substances was confirmed by physical-chemical method including 1Н NMR, IR, MS. Futhermore, PASS online Program investigated that di(α-furyl)perhydro[1,2,3]dioxaborinino-[5,4-c]pyridine derivatives have high potential of bioactivities such as dermatology, spasmology, anticoagulant and antipsoriatic agent … which promote us to develop the new method affording this kind of compounds.

e23095 Background: Infectious diseases are the second leading cause of death in the field of oncology. Around 60% of deaths are infection related to cancer patients, especially with underlying hematological malignancies. This study assesses the changing trends of mortality in cancer patients from infectious causes in the past 40 years. Methods: This is a retrospective analysis on 151440 cancer patients who died from infectious causes between 1973 and 2014, identified in the Surveillance, Epidemiology, and End Results (SEER) Program database. Results: Pneumonia and influenza were the most common infections (n = 72133) followed by parasitic diseases and other infections (n = 47310) and septicemia (n = 31119), respectively. The average survival was 65.31 months, while pneumonia and influenza had the highest survival of all. Prostate cancer was the most common cancer associated with infectious diseases (n = 20068) followed by breast cancer (n = 16676) and Kaposi sarcoma (n = 13046), respectively. During 1998-2001, an overshoot in infection-related mortality was significantly noted (APC = 26.74%; 95%CI = 3.7:54.9). However, since 1973, the greatest reduction in infection-related mortality was recorded during 2012-2014 (APC = -37.15; 95%CI = -48.6: -23.2). Compared to other infectious diseases, ‘parasitic and other infections including HIV’ accounted for the highest incidence (SIR = 1.77; 95% CI = 1.69:1.84), where blood vessel tumors occurred the most in this category (SIR = 88.83; 95%CI = 2.25:494.9). Afterward, septicemia was the second most common infectious disease (SIR = 0.84; 95%CI = 0.81:0.88). Except for leukemia, lymphoma, plasma cell tumors, and mast cell tumors, hematologic tumors revealed the highest incidence of septicemia (SIR = 51.9; 95%CI = 1.31:289.16). Gender, race, marital status, an infectious organism, and tumor characteristics (behavior and grade); all accounted for significant differences in survival (P < 0.0001). The nomogram has outstanding discrimination ability (c-index = 0.85) with very minimal differences from the actual observations of 1-, 3-, and 5-year survival probabilities. Conclusions: Infection-related mortality in cancer patients declined from 1973 to 2014. The most common infections in cancer patients were Pneumonia and influenza, followed by parasitic diseases, other infections, and septicemia. Prostate cancer was the most common cancer associated with infectious diseases, followed by breast cancer and Kaposi sarcoma.

Two novel aza-14-crown-4 ether derivatives bearing fused (∆ 3 -piperideino)[2,3-e]pyrimidine moieties as subunits were unexpectedly obtained as major products of a modified Petrenko-Kritschenko type cascade condensation of 1-benzyl-4ethoxycarbonylpiperidin-3-one with 1,5-bis(2-formylphenoxy)-3-oxapentane and ammonium acetate. X-ray structure study was performed to determine the structure of the compounds.

The crystal structure of a product of the Petrenko–Kritchenko condensation of N-propyl­piperidone with 1,5-bis­(2-formyl­phen­oxy)-3-oxa­pentane and ammonium acetate was studied by X-ray diffraction, The title compound, C26H32N2O4(M)·C2H4O2, (I), is the product of the Petrenko–Kritchenko condensation of N-propyl­piperidinone with 1,5-bis­(2-formyl­phen­oxy)-3-oxa­pentane and ammonium acetate. In M, the aza-14-crown-3-ether ring adopts a bowl conformation, with the configuration of the C—O—C—C —O—C—C—O—C polyether chain being t–g (−)–t–t–g (+)–t (t = trans, 180°; g = gauche, ±60°). The dihedral angle between the planes of the benzene rings fused to the aza-14-crown-4-ether moiety is 62.75 (5)°. The central piperidinone ring has a boat conformation, whereas the terminal piperidinone ring adopts a chair conformation. The boat conformation of the central piperidinone ring is supported by the bifurcated intra­molecular N—H⋯O hydrogen bond. In the crystal, each solvent mol­ecule is linked to mol­ecule M via strong O—H⋯N hydrogen bonding, forming hydrogen-bonded pairs of mol­ecules, which further inter­act through weak C—H⋯O hydrogen bonds, forming layers parallel to the ac plane.

The title compound, C40H41NO8, is a product of the reduction of the cyclic carbonyl group of the γ-piperidone subunit of the aza-14-crown-4 ether with subsequent re-esterification of its dimethyl butenoate substituent into a monoethyl monomethyl group. The azacrown macrocycle exhibits a bowl conformation with a dihedral angle of 70.82 (5)° between the benzene rings fused to it. The piperidine ring adopts a chair conformation and the methyl ethyl ethylenedicarboxylate fragment has a cis conformation, with a dihedral angle of 66.51 (7)° between the two carboxylate groups. The ethyl group is disordered over two sites with occupancies of 0.70 (1):0.30 (1). In the crystal, molecules form inversion dimers, via pairs of O—H...O hydrogen bonds, that stack along the a axis.

The title compound, C39H37NO8, is a product of the Michael addition of the cyclic secondary amine subunit of aza-14-crown-4 ether to dimethyl acetylenedicarboxylate. The piperidinone ring exhibits a distorted chair conformation and the dimethyl acetylenedicarboxylate fragment has a cis configuration with a dihedral angle of 56.61 (5)° between the two carboxylate groups. The crystal packing is stabilized by the weak C—H...O hydrogen bonds.

The title compound, C29H33NO8, is a product of the Michael addition of the cyclic secondary amine subunit of the aza-14-crown-4 ether to dimethyl acetylenedicarboxylate. The piperidinone ring exhibits a distorted chair conformation, and the dimethyl ethylenedicarboxylate fragment has a cis configuration with a dihedral angle of 78.96 (5)° between the two carboxylate groups. The crystal packing is stabilized by weak C—H...O hydrogen bonds.

The title compound, C(36)H(31)N(2)O(3) (+),C(2)H(3)O(2) (-)·2C(2)H(5)OH, the product of a domino condensation of dibenzyl ketone with salicylic aldehyde and ammonium acetate, crystallized as the ethanol disolvate. The cation of the salt comprises a fused tricyclic system containing three six-membered rings (piperidine, dihydro-2H-pyran and benzene). The piperidine ring has the usual chair conformation, while the dihydro-pyran ring adopts a slightly distorted sofa conformation. In the crystal, there are six (one intra- and five inter-molecular) independent hydrogen-bonding inter-actions: the inter-molecular hydrogen bonds link the cations and anions and ethanol solvent mol-ecules into ribbons along [001]. The ribbons are stacked along the a axis.

The title compound crystallizes as a chloroform solvate, C20H23N3O3S·CHCl3, with two crystallographically independent units. The independent units have distinctly different interaction patterns between the azacrown macrocycle and the chloroform solvent molecule. In one of them, the chloroform molecule forms C—H...N and Cl...H—C hydrogen bonds with the azacrown macrocycle (as a proton donor and an acceptor, respectively), whereas in the other, one of the chloroform molecules is bound to the azacrown macrocycle by an attractive Cl...O [3.080 (3) Å] interaction. The azacrown macrocycles of different units are structurally similar; the aza-14-crown-3-ether ring adopts a bowl conformation with dihedral angles between the planes of the fused benzene rings of 60.7 (1) and 68.0 (1)°. The triazinanethione ring in both cases has a sofa conformation. The crystal packing is characterized by N—H...S, N—H...O, C—H...Cl and C—H...S hydrogen bonds.