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Background: Diabetic foot ulcers (DFUs) represent severe complications in diabetic patients, often leading to chronic infections and potentially resulting in nontraumatic lower-limb amputations. The increasing incidence of multidrug-resistant (MDR) bacteria in DFUs complicates treatment strategies and worsens patient prognosis. Among these pathogens, carbapenemase-producing pathogens have emerged as particularly concerning owing to their resistance to β-lactam antibiotics, including carbapenems. Methods: This study evaluated the prevalence of MDR bacteria, specifically carbapenemase-producing pathogens, in DFU infections. A total of 200 clinical isolates from DFU patients were analyzed via phenotypic assays, including the modified Hodge test (MHT) and the Carba NP test, alongside molecular techniques to detect carbapenemase-encoding genes (blaKPC, blaNDM, blaVIM, blaIMP, and blaOXA-48). Results: Among the isolates, 51.7% were confirmed to be carbapenemase producers. The key identified pathogens included Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Escherichia coli. The most commonly detected carbapenemase genes were blaKPC (27.6%) and blaNDM (24.1%). Carbapenemase-producing isolates presented high resistance to β-lactam antibiotics, whereas non-carbapenemase-producing isolates presented resistance through mechanisms such as porin loss and efflux pumps. Conclusions: The findings of this study highlight the significant burden of MDR infections, particularly carbapenemase-producing organisms, in DFUs. MDR infections were strongly associated with critical clinical parameters, including pyrexia (p = 0.017), recent antibiotic use (p = 0.003), and the severity of infections. Notably, the need for minor amputations was much higher in MDR cases (p < 0.001), as was the need for major amputations (p < 0.001). MDR infections were also strongly associated with polymicrobial infections (p < 0.001). Furthermore, Wagner ulcer grade ≥II was more common in MDR cases (p = 0.002). These results emphasize the urgent need for enhanced microbiological surveillance and the development of tailored antimicrobial strategies to combat MDR pathogens effectively. Given the high prevalence of carbapenem resistance, there is an immediate need to explore novel therapeutic options to improve clinical outcomes for diabetic patients with DFUs. [ABSTRACT FROM AUTHOR]

Nosocomial resistance in staphylococci and enterococci is challenging. The aim of this work was to conduct a multipoint study using molecular detections, antimicrobial resistances profiles, patient demographics and disease patterns for objective assessments of Staphilococcus aureus and other Gram-positive pathogens recovered from clinical infections in the Ha’il region. We have surveyed 188 non-duplicate Gram-positives against 22 antimicrobials for molecular-differentiation, resistance, patient demographics, and disease patterns from January–April 2021. According to definitions for acquired resistance, Staphylococcus aureus was the most frequent with multidrug resistant (65.4%), where MRSA was 60% (n = 72 out of 121). In age-identified patients, 43% were seniors ≥50 years, 38% 21–49 years, and 19% 0–20 years. In gender-identified patients, 63% were males, and 37% were females. While 25% of specimens were from the ICU, the majority (60%) of specimens were from surgical infection in other wards. Staphylococcus epidermidis was the second (15.4%) species of infection identified with 81% from bloodstream infections at the ICU and other wards. The majority of S. epidermidis patients (69%) were seniors ≥50 years, while other age groups 0–20 and 21–49 each had 14% isolates. Although S. epidermidis was multidrug-resistant, it was susceptible to many drugs. Enterococcus faecalis (13%) ranked third with two major infections; bloodstream (64%) and urinary-tract infections (36%) in mainly seniors (86%). Its isolates were fully resistant to oxacillin, penicillin, cefoxitin, and cefotaxime but nearly 100% susceptible to seven others. Other Gram-positive bacteria (6%) were susceptible to many antibiotics. The use of combinations of objective criteria is a well thought out approach in infection control. While the low-frequency of Gram-positives is an impressive achievement, future large-scale investigations should include all private hospitals, clinics and other cities over a longer sampling time to gain more insights. Although geriatric susceptibility can be justified by age and comorbidities, the staphylococcal infections in young adults and children is a global concern and warrants more vertical studies.

The possible impact of topiramate against diabetic retinopathy (DREN) and its molecular mechanisms in relation to the nod-like receptor family pyrin domain containing 3 (NLRP3) inflammasome has not been studied before. Thus, in the present study, we aimed to utilize a computational approach to investigate the possible protective effect of topiramate on experimental DREN and explore its impact on NLRP3/interlukin-1β signaling and brain-derived neurotrophic factor (BDNF) expression. Male albino mice were distributed to four experimental groups and assigned the following categorizations: (i) saline, (ii) diabetic, (iii) diabetic + topiramate 10 mg/kg and (iv) diabetic + topiramate 30 mg/kg. We observed shrinkage of total retinal thickness and elevation in retinal glutamate, malondialdehyde, NLRP3 and interlukin-1β but decreased glutathione (GSH) levels in the diabetic mice. Additionally, retinal ultra-structures in the diabetic group showed abnormalities and vacuolations in the pigmented epithelium, the photoreceptor segment, the outer nuclear layer, the inner nuclear layer and the ganglion cell layer (GCL). Mice treated with topiramate 10 or 30 mg/kg showed downregulation in retinal malondialdehyde, NLRP3 and interlukin-1β levels; improvements in the retinal pathologies; enhanced immunostaining for BDNF and improved ultra-structures in different retinal layers. Overall, the current results suggest topiramate as a neuroprotective agent for DREN, and future studies are warranted to further elucidate the mechanism of its protective action.

Women of reproductive age are at nutritional risk due to their need for nutrient-dense diets. Risk is further elevated in resource-poor environments. In one such environment, we evaluated feasibility of meeting micronutrient needs of women of reproductive age using local foods alone or using local foods and supplements, while minimizing cost. Based on dietary recall data from Ouagadougou, we used linear programming to identify the lowest cost options for meeting 10 micronutrient intake recommendations, while also meeting energy needs and following an acceptable macronutrient intake pattern. We modeled scenarios with maximum intake per food item constrained at the 75th percentile of reported intake and also with more liberal maxima based on recommended portions per day, with and without the addition of supplements. Some scenarios allowed only commonly consumed foods (reported on at least 10% of recall days). We modeled separately for pregnant, lactating, and nonpregnant, nonlactating women. With maxima constrained to the 75th percentile, all micronutrient needs could be met with local foods but only when several nutrient-dense but rarely consumed items were included in daily diets. When only commonly consumed foods were allowed, micronutrient needs could not be met without supplements. When larger amounts of common animal-source foods were allowed, all needs could be met for nonpregnant, nonlactating women but not for pregnant or lactating women, without supplements. We conclude that locally available foods could meet micronutrient needs but that to achieve this, strategies would be needed to increase consistent availability in markets, consistent economic access, and demand.

Abstract Many iterative optimization algorithms involve compositions of special cases of Lipschitz continuous operators, namely firmly nonexpansive, averaged, and nonexpansive operators. The structure and properties of the compositions are of particular importance in the proofs of convergence of such algorithms. In this paper, we systematically study the compositions of further special cases of Lipschitz continuous operators. Applications of our results include compositions of scaled conically nonexpansive mappings, as well as the Douglas–Rachford and forward–backward operators, when applied to solve certain structured monotone inclusion and optimization problems. Several examples illustrate and tighten our conclusions.

Abstract Background With the rapid rise in COVID 19 cases incomparable to the number of vaccinations available, there has been a demand to prioritize the older age groups receiving the vaccine as they have more risk of morbidity and mortality and thus better outcome from vaccination. Main body Some studies showed a lower seroconversion rate in older group patients; thus, we discuss the necessity to reprioritize vaccinations to younger age groups who have better seroconversion rates, but we may face some ethical dilemma that could hinder our hypothesis. Decreased seroconversion rates in adults are attributable to immuno-senescence which involves a decrease in humoral and cellular-mediated immunity with age. Despite this fact, there remains some ethical dilemma that can hinder widespread vaccination of younger generations, the most important of which is the unknown long-term effects of COVID-19 vaccines due their fast-tracking under the pressure of the pandemic. Short conclusion Prioritizing children vaccination against COVID-19 seems an interesting strategy that can help in containing the pandemic. Resolving some ethical dilemma needs to be done before implementing such strategy.

Background: The Global Diet Quality Score (GDQS) application is an electronic data collection tool developed to provide a standard, easy-to-use method for collecting low-cost, time-relevant data on diet quality. Objective: To assess the feasibility and ease-of-use of the GDQS application and associated set of 3D cubes used as visual aids to assist the respondent with estimating amounts consumed at the food group level. Methods: The study was conducted in August 2021 in two regions of Ethiopia with varied dietary practices. Face-to-face interviews were conducted in Amharic and Somali by 10 enumerators among 120 women to collect dietary data using the GDQS application. Feedback on each completed interview was collected from both the respondent and enumerator. Enumerators also participated in focus group discussions. Results: Enumerators rated the GDQS application as easy to use after 85.8% of the interviews completed. They identified the automatic provision of food-specific probes to guide the interview, the automatic classification of reported foods, beverages, and ingredients into the corresponding GDQS food groups, and the ability to work offline as the main advantages of the application. Most respondents (78.3%) did not find it difficult to choose the cube that corresponded to the amount of each food group they reported consuming. Respondents' feedback on the open recall of all foods, beverages and mixed dishes consumed the previous day and the use of 3D cubes was mostly positive. Conclusion: The results suggest that the GDQS application and cubes were easy to use and feasible for collecting data on diet quality in a low-income country setting. [ABSTRACT FROM AUTHOR]

Highlights The Drainage Water Recycling (DWR) reservoir stored enough water to meet irrigation demand in three of four growing seasons. Subirrigation raised the groundwater table by an average of 15 cm. On average, DWR increased corn and soybean yields by 0.52 Mg ha-1 (8%) and 0.45 Mg ha-1 (17%), respectively. Subirrigation from the small size DWR reservoir did not protect corn from extended dry conditions during the growing season. Nutrients recycled back to the field via supplemental irrigation were not large enough to reduce fertilizer application rate. Drainage water recycling (DWR) has been proposed as a source of supplemental irrigation to increase crop production resilience to extended and more frequent dry periods during the crop growing season; however, the system’s potential benefits have not been adequately quantified. The main objective of this study was to assess the performance of a DWR system for providing water for supplemental irrigation to corn and soybean at a research site in eastern North Carolina and quantify corn and soybean yield responses during 4 growing seasons (2018-2021) with varying weather conditions. Two treatments were implemented at the study site: DWR and the control (CT) treatment. The CT treatment was a 11.23 ha non-irrigated field that was primarily drained by a surface drainage system. The DWR treatment (11.48 ha) had a subsurface drainage system that provided drainage during the wet periods and subirrigation during the dry periods of the growing season. A small size reservoir (5,458 m3) was used to collect surface runoff and subsurface drainage and subirrigate the DWR treatment. Results showed that the DWR reservoir stored enough water to meet irrigation requirements in 3 of the four growing seasons and provided 5 to 73 mm of irrigation to the DWR treatment. Subirrigation raised the groundwater table by an average of 15 cm, which helped increase the upward movement of soil water to the root zone and meet crop evapotranspiration demand. DWR increased corn yields by 0.13 and 0.91 Mg ha-1 (1% and 79%) and soybean yields by 0.31 and 0.59 Mg ha-1 (9% and 30%). Subirrigation, which is generally less efficient than overhead irrigation methods, did not optimize the use of the limited water stored in the small reservoir and could not provide enough protection to corn against prolonged dry conditions in the 2019 growing season. The amount of nutrients recycled back to the field through subirrigation was not large enough to help reduce fertilizer application rate. Overall, the results demonstrated that DWR is a promising practice for increasing the resilience of crop production in the southeastern U.S. to the uncertainty in precipitation, which is expected to intensify by climate change. Monitoring the performance of DWR for longer periods with varying factors of weather, soil, and system design and management would help guide the design and management of the system to optimize the performance and minimize the implementation cost. [ABSTRACT FROM AUTHOR]

Background/Objectives: One of the most abundant and growing neurodevelopmental disorders in recent decades is attention deficit hyperactivity disorder (ADHD). Many trials have been performed on using drugs for the improvement of ADHD signs. This study aimed to detect the possible interaction of naringin with Wnt/β-catenin signaling and its putative anti-inflammatory and protective effects in the mouse ADHD model based on bioinformatic, behavioral, and molecular investigations. Furthermore, molecular docking was applied to investigate possible interactions with the GSK-3β and HSP90 proteins. Methods: Male Swiss albino mice were divided into four groups, a normal control group, monosodium glutamate (SGL) control, SGL + naringin 50 mg/kg, and SGL + naringin 100 mg/kg. The psychomotor activity of the mice was assessed using the self-grooming test, rope crawling test, and attentional set-shifting task (ASST). In addition, biochemical analyses were performed using brain samples. Results: The results of the SGL group showed prolonged grooming time (2.47-folds), a lower percentage of mice with successful crawling on the rope (only 16.6%), and a higher number of trials for compound discrimination testing in the ASST (12.83 ± 2.04 trials versus 5.5 ± 1.88 trials in the normal group). Treatment with naringin (50 or 100 mg per kg) produced significant shortening in the grooming time (31% and 27% reductions), as well as a higher percentage of mice succeeding in crawling with the rope (50% and 83%, respectively). Moreover, the ELISA assays indicated decreased dopamine levels (0.36-fold) and increased TNF-α (2.85-fold) in the SGL control group compared to the normal mice, but an improvement in dopamine level was observed in the naringin (50 or 100 mg per kg)-treated groups (1.58-fold and 1.97-fold). Similarly, the PCR test showed significant declines in the expression of the Wnt (0.36), and β-catenin (0.33) genes, but increased caspase-3 (3.54-fold) and BAX (5.36-fold) genes in the SGL group; all these parameters were improved in the naringin 50 or 100 mg/kg groups. Furthermore, molecular docking indicated possible inhibition for HSP90 and GSK-3β. Conclusions: Overall, we can conclude that naringin is a promising agent for alleviating ADHD symptoms, and further investigations are required to elucidate its mechanism of action. [ABSTRACT FROM AUTHOR]