Background Gram-negative bacteria (GNB) are responsible for about one-third to nearly half of adult bloodstream infections, resulting in higher rates of morbidity and mortality. Difficult-to-treat resistance (DTR), among GNB, is characterised as being intermediate or resistant to all β-lactam classes (including carbapenems) and fluoroquinolones, thus constituting a clinically significant resistant phenotype. This study aims to ascertain the prevalence and antibiotic susceptibility pattern of DTR organisms isolated from Gram-negative bloodstream infections (GNBSIs) at a tertiary-level hospital in eastern India. Methods This retrospective observational study was conducted in the Department of Microbiology of a tertiary care hospital in eastern India from June 2024 to May 2025. Blood samples were collected in age-specific blood culture bottles and incubated at 37°C. Positive blood cultures were subcultured to obtain pure isolates. Identification and antimicrobial susceptibility testing (AST) were performed using the VITEK 2 Compact automated system. The results were interpreted according to Clinical Laboratory and Standards Institute (CLSI) M100, 2026, 36th edition. Demographic characteristics, comorbidities, risk factors, and in-hospital mortality rates were collected from hospital records. Univariate and multivariate analyses were used to test the association of the variables with DTR GNBSIs. Results Among 202 patients with GNBSIs, 67 (33.17%, 95% CI: 26.7-39.7%) exhibited the characteristics of DTR. The most common DTR pathogens were Klebsiella pneumoniae, 27 (40.3%, 95% CI: 28.6-52.0%), followed by Acinetobacter baumannii, 19 (28.36%, 95% CI: 17.6-39.2%), and Escherichia coli, 10 (14.9%, 95% CI: 6.4-23.5%). The majority of the DTR organisms from GNBSIs were isolated from male patients (41, 61.19%) as compared to female patients (26, 38.81%), with maximum occurrence in the age group >60 years (25, 37.3%). Factors such as arterial line, liver disease, dialysis, prior antibiotic use, and prior carbapenem use exhibited statistically significant associations with DTR GNBSIs in univariate analysis. Prior antibiotic use was identified as the independent predictor of DTR GNBSIs in multivariate analysis. AST revealed maximum resistance of DTR isolates to amikacin (39/63, 61.9%) followed by gentamicin (31/59, 52.54%) and co-trimoxazole (29/59, 49.15%). In terms of susceptibility, maximum susceptibility was marked towards tigecycline (37/44, 84.09%), followed by co-trimoxazole (30/59, 50.85%) and gentamicin (28/59, 47.46%), with (63/63, 100%) of the DTR isolates being intermediate to colistin. Conclusion The occurrence of DTR and their non-susceptibility to first-line drugs raises serious concern due to the limited availability of effective treatment options. Therefore, active surveillance, strict infection control practices, and antibiotic stewardship are necessary to tackle this situation in hospitals.
Extraintestinal pathogenic Escherichia coli (ExPEC) can colonize and infect body sites outside the intestines, which can lead to invasive E. coli disease potentially resulting in sepsis or death. We evaluated O-serotype distribution, antimicrobial resistance profiles, and sequence types (STs) of ExPEC bloodstream isolates collected during 17 global surveillance studies conducted from 2011 through 2023. E. coli clinical blood isolates from an adult population were analyzed for O-serotype, ST, and multidrug-resistance (MDR) using data obtained by agglutination, whole-genome sequencing, and determination of minimal inhibitory concentrations of antimicrobial drugs. Globally, 10 098 E. coli isolates were collected; 4925 (48.8%) from men and 5136 (50.9%) from women, median (range) age was 72 (18-104) years. The most prevalent ExPEC O-serotypes were O25 (18.7%), O2 (8.2%), O6 (8.2%), and O1 (7.0%). Highest MDR rates were observed in India (83.3%), Mexico (76.6%), and China (69.4%); lowest rates were in Sweden (10.6%), New Zealand (11.6%), and Netherlands (12.1%). Among MDR isolates (n=3343), serotype O25 was the most prevalent in all countries (range: 11.3% China to 56.2% Mexico). We observed a resistance rate of 1.1% and 0.7% to last-resort carbapenem and colistin antibiotics, respectively, distributed over diverse STs and O-serotypes. Overall, serotypes O25, O2, O6, and O1 were the most prevalent. MDR levels showed large regional variation. O25 was dominant within the subset of MDR isolates across all countries. O153-ST648, O101/O162-ST744, O102-ST405, and O25-ST131 were associated with MDR.
Blood flow restriction (BFR) training involves partial occlusion of limb blood flow during exercise, and it is known to promote gains in skeletal muscle strength and hypertrophy. However, its impact on muscle oxygenation and microvascular function remains unclear, as recent studies and reviews have mainly focused on macrovascular acute and chronic adaptations. This review aimed to examine the effects of BFR exercise on muscle oxygenation and microvascular function in healthy individuals. Research for this narrative review was conducted on PubMed/MEDLINE in January 2026. Randomized and non-randomized trials on healthy adults assessing the effects of acute or long-term BFR exercise on muscle oxygenation and microvascular function via near-infrared spectroscopy (NIRS), compared to non-BFR exercise, were included. Sixteen studies met the inclusion criteria. Acute BFR exercise was associated with significantly elevated skeletal muscle deoxygenated hemoglobin (HHb) and total hemoglobin (tHb) responses, while O2Hb and tissue saturation index (TSI) decreased to a greater extent compared to non-BFR exercise. Evidence on the effects of chronic BFR training on muscle oxygenation is limited but suggests a potential improvement in muscle oxygen extraction, as reflected by higher HHb levels. The few studies that examined BFR effects on microvascular function/reactive hyperemia report a greater TSI reperfusion slope during vascular occlusion tests following a BFR resistance exercise bout. BFR exercise appears to elicit greater muscle deoxygenation responses than traditional free-flow training, suggesting a stronger stimulus for chronic muscular adaptations. However, evidence regarding microvascular function/reactivity is very limited, and further research is warranted to determine the acute and chronic effects of BFR exercise.
Background: Hypertension is a major contributor to cardiovascular morbidity and mortality. While lifestyle modification is central to prevention, evidence on short-term blood pressure (BP) dynamics in relation to behavioural factors remains limited. Objective: To evaluate the influence of diet, physical activity, and psychological stress on systolic blood pressure (SBP) trajectories and to develop a regression-based model for short-term BP prediction. Methods: In this 12-week prospective cohort study, 75 adults attending a preventive cardiology clinic were followed, with BP measured at baseline, 6 weeks, and 12 weeks using validated oscillometric methods. Lifestyle and behavioural factors were assessed using the Food Frequency Questionnaire (sodium intake and DASH adherence), IPAQ-SF (physical activity), and PSS-10 (stress). Linear mixed-effects regression identified predictors of SBP change, and Elastic Net regression predicted 12-week SBP. Results: Sixty-seven participants (mean age 44.6 ± 10.8 years; 52.2% male) completed follow-up. Mean SBP declined from 134.2 ± 12.6 to 131.4 ± 11.5 mmHg. Higher physical activity and DASH adherence were associated with SBP reduction, whereas higher sodium intake and stress predicted SBP elevation (all p < 0.05). The Elastic Net model demonstrated strong predictive performance (R 2 = 0.78; RMSE = 5.9 mmHg). Physical activity had a stronger effect in participants <45 years, and stress amplified sodium-related SBP increases. Conclusions: Short-term SBP trajectories are strongly influenced by modifiable behavioural factors. Predictive models based on lifestyle data may support early risk stratification and personalized hypertension prevention.
This pilot study introduces the first subject‑specific, physiology‑informed neural network approach for accurate estimation of the full blood pressure (BP) waveform. The method builds on a nonlinear autoregressive model with exogenous inputs (NARX), implemented through artificial neural networks trained on subject‑specific electrocardiography (ECG) and photoplethysmography (PPG) signals. Three model configurations are evaluated: (1) a reference NARX model trained on 30 min of data, (2) a reduced‑data NARX model trained on 15 min, and (3) a physiology‑informed model (NARXphysio), also trained on 15 min, which incorporates a personalized four‑parameter BP-PPG sigmoidal layer into the training process through a dual‑output loss function that simultaneously estimates the BP and PPG waveforms. By embedding BP-PPG physiology directly into training, the architecture ensures internal physiological consistency-something not achieved in existing PPG‑based or purely data‑driven machine learning approaches. All three models were assessed on a small (n = 5), but rich dataset, covering over six hours of activities of daily living. Despite using only half the training duration of the baseline NARX model, the physiology‑informed approach maintains accurate BP estimation. Beyond improved accuracy, the sigmoidal layer provides physiologically interpretable parameters, including estimated arterial‑compliance curve width with an average of 36.5 mmHg and an estimated PPG contact pressure with an average of 59 mmHg in this study, offering insights unavailable in standard neural network models. Together, these preliminary results suggest that the NARXphysio model enables effective personalization of cuffless BP waveform estimation with limited training data, highlighting its potential to improve both the reliability and the clinical relevance of continuous cuffless BP monitoring.
Raised inflammatory biomarkers predict an increased short-term risk of recurrent vascular events after stroke or transient ischemic attack, but it is uncertain whether the hazard is maintained thereafter. In the absence of previous population-based studies, we aimed to determine the predictive value of biomarkers for the long-term risk of recurrent stroke in intensively treated patients following transient ischemic attack or stroke. We studied 12 blood biomarkers related to inflammation, neuronal cell damage, and thrombosis soon after transient ischemic attack or stroke in a population-based study (OXVASC [Oxford Vascular Study]; 2002-2011) with follow-up to 2025. We used Cox and negative binomial regressions to assess associations between each log-transformed biomarker (per SD increase) and recurrent stroke (first event and total number), adjusted for age, sex, and baseline vascular risk factors. Of 1292 consecutive patients (mean/SD age, 73.1/13.2 years; 47.8% male), 365 recurrent strokes occurred in 280 patients during 11 336 patient-years. All inflammatory biomarkers were associated with 10-year risk of recurrence, with little impact of adjustment for other risk factors (adjusted incidence rate ratio: IL-6 [interleukin-6], 1.21 [95% CI, 1.04-1.42]; CRP [C-reactive protein], 1.29 [95% CI, 1.11-1.49]; TNFR-1 [tumor necrosis factor receptor-1], 1.24 [95% CI, 1.05-1.46]; and NGAL [neutrophil gelatinase-associated lipocalin], 1.15 [95% CI, 0.99-1.33]). Moreover, number of elevated (top quartile) inflammatory markers was associated with higher burden of recurrence (incidence rate ratio, 1.31 [95% CI, 1.15-1.50]; P<0.001), with no diminution over time (90 days: hazard ratio, 1.24 [95% CI, 0.98-1.57]; 90 days-1 year: 1.24 [95% CI, 0.95-1.62]; 1-5 years: 1.22 [95% CI, 1.01-1.47]; and 5-10 years: 1.34 [95% CI, 1.06-1.68]), and similar associations for transient ischemic attack and minor stroke. Biomarkers related to neuronal cell damage or thrombosis were generally less predictive of recurrent stroke. Inflammatory biomarkers were more predictive of long-term recurrent stroke than neuronal or thrombotic biomarkers, particularly when several inflammatory markers were raised. Predictive value was independent of other vascular risk factors and did not diminish with duration of follow-up, supporting trials of anti-inflammatory strategies for long-term secondary prevention.
Propofol-based total intravenous anesthesia (TIVA) with remifentanil is widely used for general anesthesia but is frequently associated with hypotension and bradycardia. Remimazolam, an ultra-short-acting benzodiazepine, provides rapid onset and offset, with the additional advantage of reversal by flumazenil, and may result in less hemodynamic depression. Previous randomized studies have largely focused on the induction phase or the incidence of hypotension, with limited data on continuous intraoperative hemodynamic changes during laparoscopic gynecologic surgery. The study is designed to compare prospectively the intraoperative hemodynamic profiles of remimazolam-based versus propofol-based TIVA in patients undergoing robotic gynecologic surgery in the Trendelenburg position. This prospective, single-center, randomized, single-blind, parallel-group superiority trial will be conducted at CHA Ilsan Medical Center, a secondary care university-affiliated hospital. In total, 58 adult patients (aged 19-65 years, American Society of Anesthesiologists physical status I-II) scheduled for elective robotic laparoscopic hysterectomy under general anesthesia will be enrolled and randomly assigned (1:1) to receive either remimazolam- or propofol-based total intravenous anesthesia, both in combination with remifentanil. Continuous invasive mean arterial pressure (MAP) will be monitored using a FloTrac™ sensor (Edwards Lifesciences, Irvine, CA, United States). The primary outcome will be the time-weighted average MAP (TWA-MAP), analyzed using analysis of covariance adjusted for baseline MAP. Secondary outcomes will include the area under the curve for hypertensive and hypotensive burden, as well as the incidence of adverse hemodynamic events, including hypotension, hypertension, bradycardia, and tachycardia. Generalized estimating equations (GEE) will be used to evaluate hemodynamic and respiratory parameters across predefined time points. This trial is expected to provide prospective, randomized evidence to compare continuous intraoperative blood-pressure trajectories between remimazolam- and propofol-based TIVA during robotic gynecologic surgery. It is anticipated that the findings will clarify the relative hemodynamic stability of these anesthetic agents under the combined physiological challenges of Trendelenburg positioning and pneumoperitoneum. The findings may inform anesthetic drug selection and intraoperative blood pressure management strategies, enhancing cardiovascular stability and improving postoperative outcomes. ClinicalTrials.gov, identifier NCT07251101.
Scaphoid fractures still have high rate of nonunion, mainly due to the tenuous blood supply and only primary bone healing. Rigid fixation facilitates this kind of bone healing and is considered as vital as protection of the blood supply. The optimal implant (screw) location should meet the requirements for researcher's biomechanical findings on fracture stability. Raw CT-scanned data of eight volunteers' wrists were imported into Mimics. The 3D scaphoid was segmented out and calculated, then opened in Geomagic Studio. Four fracture planes (proximal, oblique waist, horizontal waist and distal) simulating common broken scaphoid were created. Mimicking scaphoid implants (screws), the longest, the sub-longest, and central and eccentric cylinders perpendicular to each fracture plane were created. Whole and inside-fragmental length, and the relative location of each cylinder were measured and analyzed. The longest (28.5 ± 1.6 mm) cylinder was significantly longer than the sub-longest (25.4 ± 1.4 mm). Several eccentric perpendicular cylinders (so short or cutting out of the scaphoid) couldn't be created. Some proximal inside-fragmental lengths ranged from 3.0 to 5.1 mm. Several central perpendicular cylinders intersected with the longest one. Several central and eccentric perpendicular cylinders were outside of the proximal scaphoid non-contact region. The results of this study showed that scaphoid fracture images from CT scan can be calculated and yield the optimal implant location.
Methods: In addition to traditional testing methods, the use of PSMA-directed imaging to guide biopsy procedures using Multiparametric Magnetic Resonance Imaging (mpMRI) allows for better localization and characterization of lesions. Researchers have begun to develop and continue to innovate Molecular & Imaging processes, called Liquid Biopsies, that are now being used to assess health risk factors associated with PC, by sampling macro-molecules from various biological liquids. Recently, the use of Artificial Intelligence (AI) and Machine Learning Models for improving the speed and accuracy of lesion detection and gland segmentation has significantly increased both precision and consistency in these areas. Results: However, there is still great concern regarding overdiagnosis and lack of standardization associated with all types of molecular and imaging techniques currently available. Conclusion: This review provides a comprehensive overview of the currently available diagnostic modalities for prostate cancer, including their weaknesses as well as gaps in clinical translation and standardization, which can assist with providing guidance for future development of diagnostic innovations.. The number of new cases of prostate cancer in global incidence over the next two decades is expected to double worldwide. The need for improved diagnostic tools that are more precise and less invasive is becoming increasingly urgent due to this projected increase.Liquid biopsies (CTCs, cfDNA/ctDNA, ctRNA, and exosomes) provide an opportunity for less-invasive assessment for diagnosis, prognosis, selection of therapy, and follow-up, but there are still significant barriers to their routine use: 1) limited sensitivity of these markers in patients in the early stages of disease; and 2) the absence of standardized protocols or reference materials for performing liquid biopsies.Emerging urine and blood biomarker panels demonstrate utility in distinguishing PC from BPH and for risk stratification according to Gleason score, but most of these are preliminary and require additional validation before they can be integrated into routine patient care.PET scans that look for prostate-specific membrane antigen, MRI images, and PSA blood test results provide key information for accurate diagnosis of and treatment planning for men with prostate cancer. Current imaging methods of differentiating prostate cancer lesions are DWI and PI-RADS, each of which is evaluated for risk, and help physicians determine what treatment options are available to them. Hybrid PET/MRI imaging produces both anatomical and functional imaging modalities, providing information for physicians to make more accurate diagnoses and more collaborative decisions about treatment.Artificial Intelligence (AI) is being used in the diagnosis, detection of lesions, prediction of risk, and treatment decisions based on cancer images, pathology, history, and patient data, but issues surrounding the quality of data, interpretability of models, and generalizability of results continue to restrict full adoption of AI in standard care pathways for prostate cancer.
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) provide significant renoprotection in chronic kidney disease, but their efficacy in autosomal dominant polycystic kidney disease (ADPKD) remains unclear. To systematically assess preclinical and clinical data regarding the effectiveness, safety, and mechanisms of SGLT2i in ADPKD. PubMed, Embase, and Scopus were searched from database inception to May 2026. Preclinical polycystic kidney models and clinical trials/observational studies of ADPKD evaluating any SGLT2i. Two reviewers independently screened studies and extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards. Bias was evaluated using SYRCLE and relevant clinical tools. Eleven studies satisfied the inclusion criteria: 4 preclinical rodent models, 1 current randomized controlled trial, and 6 observational/case-based clinical investigations. Preclinical results consistently showed decreased cyst load, inflammation, and fibrosis while also enhancing renal hemodynamics. Emerging clinical evidence demonstrated advantages in managing blood pressure, decreasing proteinuria, and improving metabolic measures, with slight or inconsistent effects on overall kidney volume. Diverse clinical data prevented quantitative meta-analysis. This review addresses a significant gap by comparing the functional and structural renal outcomes of SGLT2i in ADPKD. It indicates that although SGLT2i provides multi-pathway functional nephroprotection (natriuretic, anti-inflammatory, antifibrotic), structural reduction of cyst growth needs additional clinical validation. These results provide reassurance to clinicians concerning short-term safety and advocate for the use of SGLT2i as effective supplements to control blood pressure, metabolic markers, and proteinuria in ADPKD, regardless of structural kidney alterations. Preclinical findings suggest that SGLT2i provides renal protection in ADPKD through metabolic, anti-inflammatory, and antifibrotic mechanisms. Nevertheless, well-structured randomized controlled trials are necessary to validate long-term clinical effectiveness and safety.
The main cause of decreased or absent female fertility is a complex, heterogeneous condition known as premature ovarian failure (POF). Surprisingly, POF can be effectively treated using traditional Chinese medicine. Si Jun Zi Tang (SJZT) has unique approaches for treating POF, although they have not been thoroughly investigated. This study aims to explore the impact of SJZT on ovarian function. The POF mouse model was induced using the Cyclophosphamide (CTX) method. Throughout the therapy, the mice's body weight was monitored, and ovarian tissue pathology was observed using HE staining. Serum levels of FSH, E2, and LH were quantified using the ELISA method. qRT-PCR was employed to measure ROCK1 and PTEN mRNA levels in the ovaries. Protein expressions of PTEN, PI3K, p-PI3K, Akt, p-Akt, and apoptosis-related proteins Cleaved Caspase3, Caspase3, Bax, and Bcl-2 were assessed via Western blot analysis. Additionally, the TUNEL assay was utilized to quantify apoptotic cells in the ovaries. In a dose-dependent manner, SJZT therapy reversed the CTX-induced decrease in developing follicles and the increase in atretic follicles, maintaining relatively normal blood levels of LH, FSH, and E2. By modulating the mRNA expression of ROCK1 and PTEN, SJZT treatment was associated with reduced activation of PI3K/Akt signaling and mitigated ovarian dysfunction. Additionally, SJZT effectively decreased apoptosis in the ovarian tissues of mice serving as models for POF. These findings suggest that SJZT may protect ovaries from CTX-induced damage, potentially through modulation of the ROCK1/PTEN/PI3K/Akt pathway, providing insights into possible mechanisms of damage and CTX-induced cellular apoptosis. The study indicates a potential role of SJZT in the treatment of POF.
What is this summary about?Transthyretin amyloid cardiomyopathy (ATTR-CM) happens when transthyretin (TTR) protein breaks apart, forming clumps that build up in the heart, making it harder to pump blood.People with ATTR-CM often go to the hospital multiple times due to heart problems and may die from heart-related causes. Repeated hospital visits negatively affect patients and increase medical costs. Examining recurrent (events occurring more than once) and cumulative (total events over time) heart-related events (hospitalizations/death) gives an overview of disease impact.Acoramidis, a medicine taken by mouth, binds tightly to TTR, preventing it from breaking apart and forming clumps.This summary describes acoramidis’ effects on recurrent and cumulative heart-related events in people with ATTR-CM.What is ATTRibute-CM?ATTRibute-CM is a study in which participants with ATTR-CM took acoramidis or placebo (non-medicine pill) for 30 months. After 30 months, everyone who joined the open-label extension took acoramidis.What were the results?Acoramidis reduced recurrent hospitalization or death by 49% versus placebo. Many heart-related events (19% of them) occurred early, within the first 6 months. The benefits of acoramidis versus placebo increased over time, with results suggesting that acoramidis started working within the first month of treatment. In the open-label extension, participants taking acoramidis from the start were 45% less likely to have heart-related deaths than those switching from placebo to acoramidis.Results suggest acoramidis can reduce the cumulative burden of repeated hospital visits and heart-related deaths in people with ATTR-CM, with benefits suggesting an early effect within 1 month.
Mononeuritis multiplex (MM) is a severe and clinically heterogeneous form of peripheral neuropathy, most commonly arising in the context of systemic vasculitis in rheumatology practice. Despite its potential to cause substantial functional impairment, data on its clinical spectrum, management, and outcomes remain limited. This study aimed to comprehensively evaluate the clinical characteristics, underlying etiologies, treatment approaches, and outcomes of MM in a nationwide multicenter rheumatology cohort. Retrospective, multicenter observational study. Adult patients diagnosed with MM by rheumatologists across 27 tertiary referral centers were included. Data were collected using a standardized case report form, encompassing demographic features, clinical presentation, electrophysiological findings, laboratory parameters, treatment modalities, and outcomes. Neurological status was assessed at the final follow-up visit. A total of 72 patients were analyzed (mean age 53.5 ± 14.9 years; 61.1% male). Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis was the most common underlying etiology (68%), with eosinophilic granulomatosis with polyangiitis being the predominant subtype. The typical clinical presentation consisted of acute-onset, asymmetric, distal involvement of the lower extremities, with foot drop as the most frequent manifestation (69.4%). Electrophysiological findings were consistent with a classical MM pattern in the majority of patients. Most patients received high-dose glucocorticoids combined with immunosuppressive therapy. Over a median follow-up of 29 months, 81.9% of patients achieved complete or partial neurological improvement. Outcomes were similar between ANCA-associated and non-ANCA-related diseases. MM represents a clinically diverse but potentially manageable neurological complication of rheumatic diseases. Early recognition supported by electrophysiological assessment, together with timely immunosuppressive treatment, may improve clinical outcomes. A multidisciplinary approach is essential to optimize long-term recovery and functional status. Nerve damage causing weakness in the arms or legs in people with rheumatic diseases: findings from a nationwide study Some people with rheumatic diseases can develop sudden damage to the nerves, which may cause weakness, numbness, or pain in the arms or legs. This condition can lead to problems such as difficulty walking or lifting the foot, commonly known as foot drop. If not recognized early, nerve damage may become permanent and seriously affect daily life. In this study, we looked at people who developed this type of nerve damage while having a rheumatic disease. Information was collected from many hospitals across the country to better understand how these patients present, how they are treated, and how well they recover over time. Most patients developed symptoms suddenly, often affecting one or more nerves in the legs. Many first noticed weakness rather than pain, and foot drop was a common early sign. The nerve problem was often linked to inflammatory rheumatic diseases that affect blood vessels. Treatment usually involved strong anti-inflammatory medicines and drugs that suppress the immune system. Encouragingly, most patients showed partial or complete improvement after treatment, especially when therapy was started early. However, some patients continued to experience long-term nerve symptoms, such as weakness or chronic pain. These findings show that nerve damage in rheumatic diseases, although serious, is often treatable. Recognizing warning signs like sudden weakness or foot drop and starting treatment promptly may greatly improve recovery. Close cooperation between different medical specialists is important to ensure early diagnosis and the best possible outcome for patients.
Eclipsed mitral regurgitation (MR) is a rare, paroxysmal entity with preserved left ventricular ejection fraction, marked by abrupt, severe, but reversible MR that is demonstrable only during episodes. We report the case of an 82-year-old woman with systemic sclerosis and persistent atrial fibrillation who had four admissions for acute heart failure within six months. Transthoracic echocardiography captured massive MR with leaflet malcoaptation, severe pulmonary hypertension, a dagger-shaped MR jet, and a blood pressure drop; between episodes, MR was mild and leaflet coaptation was normal, and provocation testing was negative. Recurrent events during hospitalization prompted urgent surgery. Mitral valve replacement with concomitant tricuspid annuloplasty prevented recurrence, and the postoperative course was uneventful until death from tuberculosis-related sepsis. Operative inspection showed minimal structural change of the mitral valve, and histopathology demonstrated preserved leaflet architecture with mild fibrosis and myxomatous change, indicating no significant intrinsic valvular damage. These findings indicate that eclipsed MR is a unique pathophysiological entity.
Penile fracture coexisting with urethral injury is very rare. We present a 35-year-old businessman with complaints of penile pain and a popping sound during sexual intercourse. Examination revealed a deformed phallus consistent with eggplant deformity, blood at the tip of the meatus and suprapubic swelling. A diagnosis of penile fracture coexisting with urethral injury and acute urinary retention was made. Immediate surgical intervention revealed a 1.5 x 0.5cm ventral transection of the mid-bulbar urethral and the right corpus cavernosum. He subsequently had urine diversion via suprapubic cystostomy, repair of ruptured tunica albuginea covering the corpora and urethroplasty over a size 16-FR silicone urethral catheter. Patient did well postoperatively with normal urination two weeks postop following removal of urethral stent. Penile fracture coexisting with urethral injury is a rare but serious urological emergency. Prompt detection and surgical intervention are crucial for a successful outcome.
Cancer cachexia is associated with poor tolerance to anticancer therapies and reduced survival rates. Anamorelin, a ghrelin receptor agonist, has been introduced for the management of cachexia; however, early discontinuation and variable therapeutic responses are frequently observed in clinical practice. We aimed to identify the real-world predictors of early discontinuation and therapeutic response to anamorelin. We conducted a retrospective cohort study of 90 patients with cancer cachexia who received anamorelin therapy. Early discontinuation was defined as the cessation of treatment within 3 weeks. Therapeutic response was evaluated using changes in the modified Glasgow Prognostic Score (mGPS) in patients who continued treatment and had evaluable laboratory data. Nutritional and inflammatory indices, including the prognostic nutritional index (PNI), were assessed. Multivariate logistic regression analyses were performed to identify independent predictors. 43 (47.8%) patients discontinued anamorelin treatment within 3 weeks. Multivariate analysis showed that high baseline white blood cell count, low baseline PNI, and gastrointestinal tumor type were independently associated with early discontinuation. Among 38 evaluable patients in the continuation group, 14 (36.8%) demonstrated improvement or stabilization of the mGPS. A high baseline PNI and the absence of concomitant nonsteroidal anti-inflammatory drug use were independently associated with a therapeutic response. Baseline nutritional and inflammatory statuses strongly influence both treatment continuation and response to anamorelin. The PNI is a practical predictor for identifying patients who are likely to benefit from therapy. Early intervention before severe nutritional deterioration may optimize the outcomes of patients with cancer cachexia.
BMI is graded differently in Asians, and its association with pulse wave analysis (PWA) based arterial stiffness (AS) parameters are unknown in the Indian population. We studied these AS parameters in relation to BMI grading as per ESI (Endocrine Society of India) for association, if any. This is a secondary pooled analysis of previously published data of normal (n=1186), diabetics (n=328), hypertensives(n=309), and diabetic hypertensives(n=401). Oscillometric PWA (Mobil-o-graph, IEM, Germany) was used to derive aortic BP (aBP), aortic pulse wave velocity (aPWV), augmentation index (AIx), and reflection %. All participants in each group were divided into BMI-based subgroups as per the ESI criteria for Indians. PWA parameters were compared among BMI-based subgroups in each of the four study groups. Aortic pressures, AIx, aPWV, and Ref% were significantly associated with BMI grading only in the normal subgroup and not in the other three groups with at least one of either diabetes or hypertension. In the multivariate linear regression model, BMI-based grading was not associated with aPWV or AIx after adjusting for gender, age, mean blood pressure, heart rate, and presence of diabetes and/or hypertension. It suggests arterial stiffness to be a poorly BMI-dependent parameter and calls for more studies for its consolidation.
Type 2 diabetes mellitus (T2DM) is a significant public health problem, particularly in Nigeria, with increasing prevalence worldwide. Hyperglycemia in T2DM is associated with various metabolic disturbances, including alterations in uric acid metabolism. This study investigates the effect of hyperglycemia on the serum uric acid (SUA) levels in patients with T2DM. This cross-sectional observational study included 100 participants comprising 70 patients with T2DM and 30 age- and sex-matched non-diabetic individuals in the control group. Blood samples were obtained to measure fasting and postprandial plasma glucose and SUA levels. Statistical analyses were conducted to compare the groups. A total of 100 participants were recruited for this study. The results indicated that diabetic patients had significantly higher fasting SUA levels (0.45 ± 0.16 mmol/L) when compared to the control group (0.28 ± 0.05 mmol/L, p = 0.02). Similarly, postprandial SUA levels were elevated in diabetic patients (0.58 ± 0.16 mmol/L) compared to controls (0.30 ± 0.06 mmol/L, p = 0.022). No statistically significant difference was observed between fasting and postprandial SUA levels within the diabetic and control groups (p>0.05). Hyperglycemia in individuals with T2DM is significantly associated with increased serum uric acid levels. These findings show the clinical relevance of monitoring SUA in patients with type 2 diabetes.
A 5-year-old spayed female domestic shorthair cat was referred to the Clinical Nutrition Service at the Ontario Veterinary College (Guelph, Ontario) for management of chronic, nonresponsive enteropathy and recently diagnosed diabetes mellitus. The cat was presented with persistent diarrhea, perianal ulceration, weight loss, and poor glycemic control despite treatment with prednisolone, cobalamin injections, a hydrolyzed diet, and short antimicrobial trials. Once hospitalized, the cat was transitioned to a high-protein, low-carbohydrate commercial veterinary therapeutic diet containing mixed protein sources. Nutritional support was initiated via a nasogastric tube but discontinued after 48 h when voluntary oral intake resumed. Clinical signs improved gradually over 5 d, blood glucose stabilized below the renal threshold, and insulin therapy was discontinued at discharge after 6 d of hospitalization. The commercial veterinary therapeutic diet was maintained, and psyllium husk was later added to improve stool quality. Soft stools persisted for several months, with normalization occurring only after targeted fiber supplementation was introduced alongside ongoing medical management. This case highlights the importance of individualized nutritional management in chronic enteropathy, as clinical response to dietary intervention may evolve over time and long-term stabilization may require alternative strategies beyond hydrolyzed-protein diets. Key clinical message: Dietary responsiveness in feline chronic enteropathy is highly individualized. Hydrolyzed-protein diets are commonly recommended, but responses may vary between cases. Sequential and sustained dietary trials, guided by clinical response, may be necessary to achieve durable remission. Prise en charge nutritionnelle d’entéropathie chronique féline : évolution de la réponse alimentaire et stabilisation à long termeUne chatte domestique à poil court stérilisée de 5 ans a été référée au Service de nutrition clinique du Ontario Veterinary College (Guelph, Ontario) pour la prise en charge d’une entéropathie chronique réfractaire au traitement et d’un diabète sucré récemment diagnostiqué. La chatte a été présentée avec une diarrhée persistante, des ulcérations périanales, une perte de poids et un mauvais contrôle glycémique malgré un traitement par prednisolone, injections de cobalamine, une alimentation hydrolysée et de courts essais d’antibiotiques. Une fois hospitalisée, elle a été mise sous un aliment thérapeutique vétérinaire commercial riche en protéines et pauvre en glucides, contenant des sources de protéines mixtes. Un soutien nutritionnel a été instauré par sonde nasogastrique, mais interrompu après 48 h lorsque la chatte a repris volontairement son alimentation orale. Les signes cliniques se sont progressivement améliorés sur 5 j, la glycémie s’est stabilisée en dessous du seuil rénal et l’insulinothérapie a été arrêtée à la sortie de l’hôpital après 6 j d’hospitalisation. L’alimentation thérapeutique vétérinaire commerciale a été maintenue, et du psyllium a été ajouté ultérieurement pour améliorer la qualité des selles. Les selles molles ont persisté pendant plusieurs mois, la normalisation n’intervenant qu’après l’introduction d’une supplémentation ciblée en fibres, associée au traitement médical en cours. Ce cas souligne l’importance d’une prise en charge nutritionnelle individualisée dans l’entéropathie chronique, car la réponse clinique à l’intervention diététique peut évoluer au fil du temps et une stabilisation à long terme peut nécessiter des stratégies alternatives aux régimes à base de protéines hydrolysées.Message clinique clé :La réponse à l’alimentation dans l’entéropathie chronique féline est très variable d’un individu à l’autre. Les régimes à base de protéines hydrolysées sont couramment recommandés, mais les réponses peuvent différer d’un cas à l’autre. Des essais diététiques séquentiels et prolongés, guidés par la réponse clinique, peuvent être nécessaires pour obtenir une rémission durable.(Traduit par Dr Serge Messier).
Background Universal precautions are essential infection control measures aimed at preventing healthcare-associated infections and occupational exposure among healthcare workers (HCWs). However, compliance remains suboptimal, particularly in resource-limited settings. Objective The aim of this study was to assess the knowledge and compliance regarding universal precautions among the nursing staff at a tertiary care teaching hospital and identify gaps in infection control practices. Methods A hospital-based cross-sectional study was conducted from March to April 2026 among 40 nurses at Government Medical College, Datia, Madhya Pradesh, India. Participants were selected using simple random sampling. Data were collected using a validated structured questionnaire assessing knowledge (15 items) and compliance (20 items on a Likert scale). Statistical analysis was performed using Jamovi, version 2.6.44 (The jamovi Project, Sydney, NSW, Australia). Results Among the 40 nurses included in the study, 31 (77.5%) were aged 24-30 years, and 24 (60.0%) had 1.5-5 years of work experience. Adequate knowledge regarding universal precautions was observed among 31 (77.5%) nurses, while five (12.5%) demonstrated very good knowledge scores. Knowledge regarding key infection control practices was high, with 40 (100%) participants aware of hand hygiene between patients and 39 (97.5%) reporting correct knowledge regarding glove use for blood collection and avoidance of needle recapping. However, 34 (85.0%) nurses correctly recognized that the primary objective of universal precautions is not limited solely to protecting HCWs, while five (12.5%) believed that such precautions were required only for infected patients. Compliance with hand hygiene practices was high, with 36-38 nurses (90.0%-95.0%) consistently adhering to recommended practices. Similarly, adherence to glove use during high-risk procedures was observed among 37-39 nurses (92.5%-97.5%). Lower compliance was observed for glove use during injections among 22 (55.0%) nurses and for apron and cap/shoe-cover use among 26-27 nurses (65.0%-67.5%). Additionally, 4 (10.0%) nurses reported non-adherence to safe needle recapping and post-exposure management practices. Conclusion Despite adequate knowledge, a notable knowledge-practice gap exists among nurses. Strengthening training, ensuring personal protective equipment (PPE) availability, and reinforcing monitoring mechanisms are essential to improve compliance and enhance infection control practices.