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With approximately half a billion events per year, lower respiratory tract infections (LRTIs) represent a major challenge for the global public health. Among LRTI cases, those caused by Gram-negative bacteria (GNB) are associated with a poorer prognostic. Standard-of-care etiologic diagnostics is lengthy and difficult to establish, with more than half of cases remaining microbiologically undocumented. Recently, syndromic molecular diagnostic panels became available, enabling simultaneous detection of tens of pathogen-related and antimicrobial-resistance genetic markers within a few hours. In this narrative review, we summarize the available data on the performance of molecular diagnostics in GNB pneumonia, highlighting the main strengths and limitations of these assays, as well as the main factors influencing their clinical utility. We searched MEDLINE and Web of Science databases for relevant English-language articles. Molecular assays have higher analytical sensitivity than cultural methods, and show good agreement with standard-of-care diagnostics regarding detection of respiratory pathogens, including GNB, and identification of frequent patterns of resistance to antibiotics. Clinical trials reported encouraging results on the usefulness of molecular assays in antibiotic stewardship. By providing early information on the presence of pathogens and their probable resistance phenotypes, these assays assist in the choice of targeted therapy, in shortening the time from sample collection to appropriate antimicrobial treatment, and in reducing unnecessary antibiotic use.

Background: The outbreak of the COVID-19 pandemic caught healthcare systems in many countries unprepared. Shortages of personnel, medicines, disinfectants, and intensive care unit (ICU) capacities, combined with inadvertent use of antibiotics and emergence of drug-resistant secondary infections, led to a surge in COVID-19-related mortality. Objective: We aimed to evaluate the prevalence of secondary bacterial infections and the associated antibiotic resistance in a temporary established ICU dedicated to COVID-19 patients. We also assessed the utility of clinical and routine laboratory data as predictors of secondary infections and mortality in these patients. Methods: We examined the medical records of 243 patients admitted to the COVID-19 Medical Support Unit of Târgu Mures, Romania, between 1 August 2020 and 31 January 2021. Results: Among the 243 patients admitted to the COVID-19 Medical Support Unit of Târgu Mures between 1 August 2020 and 31 January 2021, 59 (24.3%) presented secondary infections. Acinetobacter baumannii and Klebsiella pneumoniae were the most frequent isolates (31.1% and 18.9%, respectively), most of them multidrug resistant. Chronic obstructive pulmonary disease had a higher prevalence in patients who developed secondary infections (p = 0.012). Secondary infections were associated with longer stay in the ICU and with higher mortality (p = 0.006 and p = 0.038, respectively). Conclusions: Early identification of secondary infections and proper use of antibiotics are necessary to limit the spread of multidrug-resistant microorganisms in COVID-19 patients admitted in the ICU. [ABSTRACT FROM AUTHOR]

With approximately half a billion events per year, lower respiratory tract infections (LRTIs) represent a major challenge for the global public health. Among LRTI cases, those caused by Gram-negative bacteria (GNB) are associated with a poorer prognostic. Standard-of-care etiologic diagnostics is lengthy and difficult to establish, with more than half of cases remaining microbiologically undocumented. Recently, syndromic molecular diagnostic panels became available, enabling simultaneous detection of tens of pathogen-related and antimicrobial-resistance genetic markers within a few hours. In this narrative review, we summarize the available data on the performance of molecular diagnostics in GNB pneumonia, highlighting the main strengths and limitations of these assays, as well as the main factors influencing their clinical utility. We searched MEDLINE and Web of Science databases for relevant English-language articles. Molecular assays have higher analytical sensitivity than cultural methods, and show good agreement with standard-of-care diagnostics regarding detection of respiratory pathogens, including GNB, and identification of frequent patterns of resistance to antibiotics. Clinical trials reported encouraging results on the usefulness of molecular assays in antibiotic stewardship. By providing early information on the presence of pathogens and their probable resistance phenotypes, these assays assist in the choice of targeted therapy, in shortening the time from sample collection to appropriate antimicrobial treatment, and in reducing unnecessary antibiotic use. [ABSTRACT FROM AUTHOR]

The article discusses the need for linguists to change their approach to teaching Creole languages in order to rectify historical biases and promote equitable inclusion. The authors developed the Mis/Underrepresented Languages: Teaching and Inclusion (MULTI) Project, which provides pedagogical resources for integrating Creole language data and expertise into linguistics courses. The project aims to amplify the voices of Creole language users and empower educators to incorporate Creole languages into their classrooms. It includes resources such as video clips of interviews with Creole users, contextualized problem sets, and a facilitation guide for incorporating these materials into curricula. The text also emphasizes the importance of diversity and inclusivity in linguistics education, particularly in relation to underrepresented languages and language varieties. [Extracted from the article]

The United Nations Sustainable Development Summit in New York in September 2015 resulted in a tumultuous period for the companies in their quest to support the 17 Sustainable Development Goals (SDGs). The adoption of SDGs by all United Nations member states targets ending poverty and other deprivations, developing strategies to improve health and education, reducing inequality, and spurring economic growth while tackling climate change and working to preserve oceans and forests. This paper aims to assess the influence of countries' governance six dimensions (Voice and Accountability, Political Stability and Absence of Violence/Terrorism, Government Effectiveness, Regulatory Quality, Rule of Law, and Control of Corruption) on European companies' Sustainable Development Goals (SDGs) reporting from 2019 to 2021. To achieve this goal, quantitative research was conducted through linear parametric regressions. The econometric analysis is based on six regression equations, one for each countries' governance dimension, data being collected from Thomson Reuters, World Bank Governance Indicator, and International Monetary Fund databases. The sample includes 2542 companies headquartered in Europe, with 6644 panel data observations highlighted. The results show that the indicators regarding countries' governance negatively influence companies' SDGs reporting. This study fills the gap in countries' governance research in relation to companies' SDGs reporting, which helps develop future research. Therefore, future research should address other methods of quantifying the score of companies' SDGs reporting. Furthermore, this research may be extended to all 193 United Nations member states to investigate the impact of SDGs reporting on country performance. [ABSTRACT FROM AUTHOR]

The growing concern of all UN member states to respond to global challenges, such as ending poverty, developing the health and educational systems, economic growth, reducing the impact of climate change, and preserving oceans and forests, has made ESG disclosure a necessity for companies. This study intends to analyze the relationship between ESG disclosure and company's performance. The overall company's performance was evaluated based on the corporate sustainability performance (CSP) framework, namely economic, environmental, and social (EES) performance. A sample of 80 articles taken from the Web of Science and Scopus databases, published in 50 journals, and reporting 742 effects, was relevant to meta-analyses the correlation between ESG disclosure and company's economic performance. The results support the positive correlation between ESG disclosure and company's economic performance. ESG disclosure is for more than just transparently reporting relevant ESG information, but also contributes to the consolidation of better economic performance through the degree of efficiency and effectiveness of the economic strategies of the business. In terms of practical implications, management of companies should consider ESG information disclosure through a long-term management strategy. These findings being timely especially in the case of companies for which no legislative constraints for ESG disclosure. [ABSTRACT FROM AUTHOR]

Introduction: Toxic megacolon represents one of the most severe complications linked to Clostridioides difficile infection, a life-threatening condition characterized by an acute dilatation of the colon, specifically exceeding 6 cm, contributing to elevated rates of morbidity and mortality. Case Report: This case report presents a 75-year old male patient, previously diagnosed with chronic ischemic heart disease, type 2 diabetes mellitus, with an operated and radiotreated colon tumor. He comes to the Emergency room complaining of affected general state, asthenia, dyspnea, diarrheal stools (2-3 per day) and hypotension. Examination was notable for confusion and diffuse abdominal tenderness, distended abdomen, painful to palpation with tympany. Also, out of laboratory analyses performed, a severe hyponatremia is revealed (Na:114mmol/l), mild hyperkalemia, acute kidney injury, coagulation dysfunction and elevated C-reactive protein (CRP) levels. Biological samples are collected for Clostridioides difficile exotoxin testing with a positive result, which is why targeted antibiotic treatment is initiated. Thoracoabdominal-pelvic computed tomography (CT) is also performed, leading to the discovery of abdominal level diffuse distension of the transverse colon up to 7 cm, as well as of visible hydroaerial levels and ascites. Considering the serious condition of the patient, it is decided to admit him to medical clinic for monitoring and specialized treatment. Discussions : The patient presented in this case is of advanced age, which represents a risk factor itself for the development of a possible complication following the infection with Clostridioides Difficile. In addition, the fact that he is an immunosuppressed, diabetic patient who underwent a surgical intervention on the colon, confirms that his medical history features multiple risk factors for the development of complications. Conclusions: Although it is a rare complication, when it occurs it has a fulminant evolution. In more than 80% of cases, it results in death, as proven by multiple studies, as well as by the facts highlighted in the presented case. [ABSTRACT FROM AUTHOR]

Background: Clostridiodes Difficile, a toxigenic anaerobic bacterium, is an infectious pathogen often associated with severe infectious colitis that causes significant morbidity and mortality globally, especially in the elder patients. Also, Clostridioides Difficile represents one of the main agents that can cause health-care associated infections, making this specifical type of disease a public health issue, requiring a multifaceted approach, including spread control, mindful usage of antibiotics, patient education, also requiring future research to develop more effective treatments and prevention strategies. Material and methods: A retrospective study was carried over a period of 4 years (2020-2023), in which there were included 232 patients hospitalized in the Internal Medicine Clinic of the Emergency County Clinical Hospital of Târgu Mureş.Inclusion criteria consisted of bacteriological confirmed diagnosis of Clostridioides difficile enterocolitis, treated in the clinic, with some of further being transferred to a Infectious Diseases Clinic. Data collection was made by reviewing existing documentation in all discharge notes and clinical observation sheets from admissions and consultations of patients with Clostridioides difficile enterocolitis. Results: With a cohort of 232 patients, aged between 26 and 96 years, analysis revealed that the infection is more common in the elder population, with an average age of affected patients being around 73 years old. Most patients developed the infection during hospitalization. Intravenous antibiotic treatment was strongly associated (87%cases). Another result highlighted is that the use of broad- spectrum antibiotic therapy represents the main risk factor for the development of this condition. Combined pharmacotheraphy was common, with more than half of patients(52%) receiving two or more different classes of antibiotics,particularly cephalosporins. The analysis of the association between the antibiotic therapy combination and the patient's survival rate revealed that cases of death most often occured when the patient received a combination of antibiotics (23%), compared to monotheraphy in those who survived (30%). The analysis of the duration of antibiotic treatment revealed that the deceased individuals received treatment for a longer period. Another noteworthy aspect is that one-fifth of the patients had undergone surgical intervention prior to developing the infection, and a history of pseudomembranous colitis was a significant predictor for the recurrence of the infection (p< 0.05). The mortality rate following Clostridioides difficile infection was 33%, with a positive correlation between the duration of broad-spectrum antibiotic treatment and mortality (p< 0.05). These findings emphasize the relevance of appropriate management of antibiotic therapy and associated pathologies in the prevention and treatment of Clostridioides difficile infection. Conclusions: This study has examined the dynamics and risk factors of Clostridioides difficile infection among a cohort of patients hospitalized in the Internal Medicine department. Most patients originate in rural areas, as low income and socioeconomic status play an important role in the occurence of this infection. Beyond demographic characteristics, the use of broad-spectrum antibiotics was identified as a major risk factor, involved in over 80% of cases. This paper aims to highlight the risk factors associated with Clostridium Difficile, while presenting valuable corelations with the particularities of the affected patients. [ABSTRACT FROM AUTHOR]

Introduction: Colon cancer is a common type of cancer that occurs in older patients. The colon can be affected at any level, often due to the presence of benign polyps that develop into malignant tumors over time. Colorectal cancer is described as having a slow and unfavorable evolution, and there are multiple types of oncological treatments available. Case Report: The 72-year-old patient, known as an alcoholic and a heavy smoker, has chronic obstructive pulmonary disease, hypertension, presents with mucopurulent cough, dyspnea, tachypnea, and diffuse abdominal pain for 3 days. The thoracic radiography doesn't descriebe any pleural fluid, but after the chest CT scan was presented, a 30 mm homogeneous hypodense mass in the left upper lobe was in contact with the aortic arch. The abdominal-pelvic CT scan highlights a liver with nodular contour and inhomogeneous structure due to the presence of numerous sized hypodense formations distributed throughout the entire hepatic parenchyma. Due to the increased values of the carcioembryonic antigen and CA19-9, the presence of a cholangiocarcinoma is suspected, and due to the lack of MRI, contrast ultrasound was performed, describing the presence of a 10x12 cm tumour in the splenic flexure with multiple liver metastases (some necrotic) and hepatomegaly until the right iliac fossa. Discussions : The absence of digestive symptoms in the advanced stage of the disease and the evolution up to acute hepatic insufficiency 4 days after presentation are unique features of the case. The patient refused the lung and liver biopsy. His prognosis is unfavorable because of the agressive form of the descending colon cancer with the presence of remote liver and pulmonary metastases which requires palliative care. Conclusions: The survival rate of patients with colon carcinoma is based on the stage of the illness. Multidisciplinary approaches including surgery, chemotherapy and targeted therapies, play crucial roles in managing this disease. [ABSTRACT FROM AUTHOR]

Common bile duct duplications represent exceptionally rare congenital anomalies of the biliary tract. In this case report we document an unusual variant of common bile duct duplication in a 79-year-old man who underwent a pancreaticoduodenectomy for ampullary cancer. The duplication consisted of two unseparated, completely-layered, common bile ducts which originated above the cystic duct junction and terminated prior to the point of insertion into the pancreas, where the two lumens converged into a single duct. Duplication of the bile duct is rare and often goes undetected. In the present case, the anomaly was found incidentally in a patient who had a pancreaticoduodenectomy for an ampullary carcinoma. However, duplication may be associated with choledocholithiasis, cholangitis, pancreatitis, and pancreaticobiliary malignancies and it is important to be aware of the condition., Competing Interests: None of the authors has a direct conflict of interest to declare. DNL has received an unrestricted educational grant from B. Braun for unrelated work. He has also received speaker’s honoraria for unrelated work from Abbott, Nestlé and Corza.