Search

ABSTRACT: Objectives: We report the use of IV dalbavancin in Canadian patients using data captured by the national CLEAR registry. Methods: The CLEAR registry uses the web-based data management program, REDCap™ (online survey https://rcsurvey.radyfhs.umanitoba.ca/surveys/?s=TPMWJX98HL) to facilitate clinicians entering details associated with their clinical experiences using IV dalbavancin. Results: Data were available for 40 patients. The most common infections treated were acute bacterial skin and skin structure infection (ABSSSI) (62.5% of patients), bone/joint infection (22.5%), bloodstream/vascular infection (7.5%) and endocarditis (5.0%). Dalbavancin was used as directed (75.0%) and empiric therapy (25.0%). MRSA was the most common identified pathogen (70.0%). Dalbavancin was used both in outpatient (e.g., emergency department) (65.0%), and inpatient treatment settings (e.g., hospital ward) (35.0%). Dalbavancin was used due to the convenience of a single dose treatment (77.5%) as well as to facilitate hospital discharge (7.5%). Dalbavancin was primarily used alone (90.0%), and most commonly using a single 1500 mg dose (77.5%). Microbiological success (pathogen eradicated or presumed eradicated) occurred in 88.2% of known cases, while clinical success (cure and/or improvement) occurred in 93.3% of known cases. No adverse events were reported. Conclusions: In Canada, IV dalbavancin is used as both directed and empiric therapy to treat ABSSSI as well as off-label (bone/joint, bacteremia/vascular, endocarditis, device-related) infections. It is used in both outpatient and inpatient settings due primarily to its convenience as a single-dose treatment regimen and to facilitate early hospital discharge. Dalbavancin use is associated with high microbiological and clinical cure rates along with an excellent safety profile.

Virtual reality (VR) has emerged as an innovative technology in various fields. It transforms how we experience and interact with the world, and it has also developed into physical rehabilitation. Rehabilitation has also evolved from mere exercises to using technology while giving exercises to patients. VR is a technology that can enhance treatment and improve outcomes. VR uses computer-generated three-dimensional interactive simulation models, allowing users to engage in environments resembling real-world objects and events. An extensive literature search was conducted on SCOPUS, PubMed, the Web of Science and relevant rehabilitation databases. The keywords ‘virtual reality’, ‘rehabilitation’ and ‘physical therapy’ were employed to identify pertinent studies. The inclusion criteria encompassed research investigating the use of VR in rehabilitating musculoskeletal, neurological and cardiovascular conditions. VR has been used in various rehabilitation domains. It is effectively used in balance and gait training, cognition and memory training, pain management, muscle strengthening, etc. It has also been shown to improve adherence to exercises. VR training in physical therapy represents a transformative advancement in rehabilitation. Integrating VR technology offers many benefits, including enhanced engagement, customised therapy regimens and a safe environment for patients to practice and improve their physical abilities. The evidence from various studies indicates its potential to improve outcomes for individuals with a wide range of physical impairments.

Targeted drug delivery to specific locations is a significant challenge encountered by researchers. Nanosponges have emerged as a promising solution for delivering drugs to their target sites. Nanosponges are nanoparticles with a large surface area, allowing for enhanced penetration compared to conventional drug delivery systems. This new technology offers controlled drug release and has several advantages over other methods. This project aimed to prepare and evaluate a Tacrolimus-loaded Nanosponges hydrogel. The goal was to create a dermatological gel suitable for local drug delivery after topical application, aiming for improved therapeutic effects, better dispersibility and good storage stability. Tacrolimus-loaded Nanosponge was prepared using beta-cyclodextrin and ethylcellulose as polymers, along with polyvinyl alcohol (PVA) as a surfactant. The solvent emulsion diffusion technique is a method for preparing nanosponges, and the variations in the formulation using different polymers and drug-polymer ratios offer the opportunity to fine-tune the nanosponge’s properties to meet specific requirements for drug delivery applications. A Tacrolimus-loaded nanosponge hydrogel was formulated using carbopol 934. The results of the study indicated that the optimized batch of nanosponges with high entrapment efficiency was chosen for formulating the gel incorporating carbopol 934. The gel that was prepared was subjected to assessments for pH, viscosity, spreadability, in-vitro diffusion, permeation and stability. The findings suggest that Tacrolimus can be effectively formulated in low doses of nanosponges-loaded hydrogel for atopic dermatitis.

Introduction: Langerhans cell histiocytosis (LCH) is a rare hematologic condition which can affect multiple organ systems and has variable presentation. LCH is more commonly seen as a malignancy of childhood. LCH in adulthood can have poor outcomes depending on the involvement of critical organs. Case Presentation: We report a case of a 71-year-old female who presented with progressive weakness, weight loss, diarrhea, and jaundice, and had been undergoing outpatient workup for elevated liver enzymes for the last 2 years. She required admission to the intensive care unit for vasodilatory shock, requiring vasopressor and chronotropic support. Imaging showed an underlying multiorgan process involving the gastrointestinal tract, liver, spleen, and central nervous system. A repeat liver biopsy after a prior inconclusive one revealed the diagnosis of multisystem LCH presenting as secondary sclerosing cholangitis. Conclusion: The uniqueness of this multisystem LCH case lies not only in its rarity but also in the diagnostic journey that necessitated a repeat biopsy for a conclusive diagnosis. Early identification and targeted intervention can help in ensuring better patient outcomes, especially when the presentation can overlap with various other possible conditions.

Abstract Background Colorectal cancer (CRC) is the second most lethal cancer in the United States (U.S.) with the highest incidence and mortality rates among African Americans (AAs) compared to other racial groups. Despite these disparities, AAs are the least likely to undergo CRC screening, have precancerous colorectal polyps removed, and have CRC detected at stages early enough for curative excision. In addition, compelling evidence links inflammatory dietary patterns to increased CRC and cardiovascular disease risk. Studies show that AA churches can successfully engage in health promotion activities including those related to cancer control. The current study seeks to leverage church-placed Community Health Workers (CHWs) to increase CRC screening and reduce CRC risk. Design and methods We aim to (1) increase guideline concordant CRC screening uptake using church-placed CHWs trained in screening with a validated instrument, Brief Intervention using Motivational Interviewing, and Referral to Treatment (SBIRT); and (2) reduce dietary risk factors (inflammatory dietary patterns) linked to CRC. The latter will be addressed by culturally adapting an existing, web-based lifestyle program called Alive!. Using a Hybrid Type 1 Implementation-Effectiveness cluster randomized design, we will randomize 22 AA churches into either the dual intervention arm (CHW-led SBIRT intervention plus Alive!) or a usual care arm comprised of CRC prevention educational pamphlets and a list of CRC screening sites. We will recruit 440 subjects and evaluate the effects of both arms on screening uptake (colonoscopy, fecal DNA) (primary outcome) and dietary inflammation score (secondary outcome) at 6-month follow-up, and Life Simple7 (LS7)—a cardiovascular disease (CVD) risk score—at 6 months and 1 year (secondary outcome). Finally, guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed-methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors. Discussion Church-placed CHWs are trusted influential connectors between communities and health systems. Studies have shown that these CHWs can successfully implement health prevention protocols in churches, including those related to cancer control, making them potentially important community mediators of CRC screening uptake and CRC/CVD risk reduction. Trial registration NCT05174286; clinicaltrials.gov; August 31st, 2023

Treacher Collins Syndrome (TCS), also known as Franceschetti syndrome, is an autosomal dominant condition marked by various developmental anomalies confined to the head and face. It primarily affects craniofacial structures derived from the first and second branchial arches. Patients usually present with down-slanting palpebral fissures, mandibular hypoplasia, lower eyelid colobomas, external ear malformations, and hearing loss. Congenital heart defects and cryptorchidism are two other unusual anomalies. It is typically a bilateral condition. The symptoms and physical features of TCS can vary greatly from person to person. Some individuals may be affected so mildly that their condition goes undiagnosed, whereas others may develop serious, life-threatening complications. Individuals with TCS may require specialised airway management due to a narrow mouth aperture and micrognathia. They are best served by an interprofessional team that can coordinate all aspects of their care. Timely detection and management can improve the quality of life for these patients. The present case report presents the airway challenges in an eight-year-old child with TCS who has congenital malformations and presented with swallowing difficulty, which was later diagnosed as oesophageal atresia.

Introduction: The transmission dynamics of the recent mpox outbreak highlights the lack of infrastructure available to rapidly respond to novel STI outbreaks, of which Asia and Oceania remains particularly susceptible. Here, we simulate outbreaks in this setting and propose the use of pre-emptive vaccination within the men who have sex with men (MSM) community before the arrival and establishment of the virus. Materials and methods: Using data driven heterogeneous sexual contact networks, we simulated outbreaks of mpox in Singapore, Hong Kong, and Sydney. An individual based SEIR compartmental model was used to simulate epidemic trajectories and the impact of different vaccination uptakes was assessed in their ability to avert or suppress outbreaks upon the arrival of mpox within the MSM populations. Results: The highly dense sexual networks of Singapore and Sydney experience rapid outbreaks, with infection peaks occurring at day 41 and 23 respectively, compared to Hong Kong which occurs at day 77. Across the simulations with no vaccination, 68.2%–89.7% of the MSM community will become infected with mpox across the different cities, over a simulation period of 1 year. By implementing vaccination strategies, the infection rate across the cities can be reduced to as low as 3.1% of the population (range: 3.1%–82.2%) depending on the implementation and uptake of the vaccine. Vaccination is also extremely effective in slowing the start of the epidemic, delaying the epidemic peak by 36–50 days in Hong Kong, or even preventing the outbreak of mpox. Discussion: With extremely dense and well-connected sexual contact networks, where 65.2%–83.2% of the population are connected to a super-spreader in the different contact networks, pre-emptive or immediate vaccination upon identification of the first case is strongly recommended to help better manage the outbreak of mpox and prevent potential straining of healthcare systems.

AI has emerged as a revolutionary technology in the pharmaceutical and biomedical fields. This review explores its transformative role, particularly in drug development, the discovery of future interventions in the pharmaceutical sector. By leveraging AI, these processes have become more efficient, cost-effective, and capable of delivering personalized medicine to individual patients. Moreover, AI’s potential in disease prevention and outbreak prediction is promising, as it can analyze vast datasets to identify crucial patterns and trends, leading to targeted interventions for combating diseases. In biomedical research, AI has proven highly beneficial, especially in genomics, proteomics, and metabolomics, where it enables researchers to comprehensively analyze complex biological data, uncovering new insights and accelerating scientific discoveries. The impact of AI is also evident in the patient-physician interface, as it enhances diagnostic accuracy and treatment efficiency, ultimately improving patient care.

Objectives: To date, studies have not provided definitive answers regarding whether previous immune checkpoint inhibitor (ICI) treatment alters outcomes for cancer patients with COVID-19. Methods: The OnCovid registry (NCT04393974) was searched from February 27, 2020, to January 31, 2022, for patients who received systemic anti-cancer therapy in the 4 weeks before laboratory-confirmed COVID-19 diagnosis. Propensity-score matching using country, vaccination status, primary tumor type, sex, age, comorbidity burden, tumor stage, and remission status investigated differences in predefined clinical outcomes comparing those who had or had not received ICIs. Results: Of 3523 patients screened, 137 ICI-only and 1378 non-ICI met inclusion criteria. Before matching, ICI patients were older, male, enrolled at centers in Italy, and had histories of smoking, thoracic cancers, advanced cancer stages, and active malignancies (P ≤0.02). After matching, there were 120 ICI and 322 non-ICI patients. ICI patients had no differences (odds ratio: 95% CI) in presenting COVID-19 symptoms (0.69: 0.37-1.28), receipt of COVID-specific therapy (0.88: 0.54-1.41), 14-day (0.95: 0.56-1.61), or 28-day (0.79: 0.48-1.29) mortalities. However, ICI patients required less COVID-19-related hospitalization (0.37: 0.21-0.67) and oxygen therapy (0.51: 0.31-0.83) and developed fewer complications (0.57: 0.36-0.92). Conclusion: In this propensity-score matched analysis, previous ICI therapy did not worsen and potentially improved COVID-19 outcomes in patients with cancer.

Purpose and Aim: In COVID 19 pandemic, it was essential to document the functioning of the institutional ethics committee (IEC), how the organization adapted and faced challenges posed, thus forming the rationale behind this particular audit. The objectives were to assess the impact of the pandemic on the structure, review process, outcomes, and administration of IEC and to compare the same during its functioning in the prepandemic stage. Subject and Methods: The study was conducted as a retrospective audit. After exemption from ethics review, the data were collected from the IEC office situated in KEM Hospital and were segregated into four domains: structure, review process, outcomes, and administration. The data were analyzed using descriptive statistics. Mann–Whitney U-test was used to compare the turnover time for approval of projects between the two study periods at 5% level of significance. SPSS software version 22 was used to analyze the data. Results: Constitution changed , more protocols pertaining to COVID 19 studies were reviewed, meetings frequency doubled, and Standard Operating Procedures was amended to incorporate the changes faced during pandemic. Significant decrease in turnover time was noticed with respect to submission to query letter and study completion. There were more protocol deviations. Financial burden and expenditure decreased due to less paperwork and meetings being held online. Conclusion: The ethics committee infrastructure and functioning had to undergo a paradigm shift to adapt to the various changes and overcome the various hurdles occurring during the COVID-19 pandemic.

Foods high in phenolics such as prunes have been shown to exert protective effects on bone mineral density (BMD), but only certain individuals experience these benefits. This post-hoc analysis of a 12-month randomized controlled trial aimed to identify the relationship among the gut microbiome, immune responses, and bone protective effects of prunes on postmenopausal women. Subjects who consumed 50–100 g prunes daily were divided into responders (n = 20) and non-responders (n = 32) based on percent change in total hip bone mineral density (BMD, ≥1% or ≤−1% change, respectively). DXA scans were used to determine body composition and BMD. Immune markers were measured using immunoassays and flow cytometry. Targeted phenolic metabolites were analyzed using ultra performance liquid chromatography-tandem mass spectrometry. The fecal microbiota was characterized through 16S rRNA gene PCR amplicon sequencing. After 12 months of prune consumption, anti-inflammatory markers showed responders had significantly lower levels of IL-1β and TNF-α. QIIME2 sequence analysis showed that microbiomes of responders and non-responders differed in alpha (Shannon and Faith PD, Kruskal-Wallis p < 0.05) and beta diversity (unweighted Unifrac, PERMANOVA p < 0.04) metrics both before and after prune treatment. Furthermore, responders had a higher abundance of bacterial families Oscillospiraceae and Lachnospiraceae (ANCOM-BC p < 0.05). These findings provide evidence that postmenopausal women with initial low BMD can benefit from prunes if they host certain gut microbes. These insights can guide precision nutrition strategies to improve BMD tailored to diet and microbiome composition.

Breast cancer has a heavy toll on the world's health, both in terms of morbidity and death. For women aged 35 to 54, it is the primary cause of mortality. In addition, over the preceding 2 decades, the mortality rate has not decreased noticeably. Early diagnosis and detection are still essential for enhancing patient outcomes despite substantial advancements in treatment. Also, possible to use monoclonal antibodies, but they come with a host of drawbacks, including unspecified binding, toxicity, expense, and debated clinical efficacy. Aptamers, which are small nucleic acid molecules that can bind to specific target molecules with high specificity, have instead emerged as potential theranostic treatments for breast cancer. Both for diagnosis and treatment, aptamers can be made to precisely target breast cancer cells or molecules linked to tumor progression. High binding affinity and specificity, low immunogenicity, and ease of modification are just a few of the characteristics that set aptamers apart from other delivery systems and make them desirable options for the delivery of drugs, imaging agents, or both, to breast cancer cells. In this study, we provide a comprehensive overview of the aptamer-based theranostic strategies for treating breast cancer, including aptamer selection, modifications, and imaging and drug delivery applications.We also discussed the SELEX method for picking aptamers and why they are good breast cancer treatments. The toxicity and weak immunogenicity of some antigens do not affect aptamer selection, unlike antibodies. Compared to antibodies, they are more selective and have higher affinities. Therefore, in the future, these therapies may be used as both main therapies and adjuvants to traditional anti-HER2 therapies. We also discussed the difficulties and potential futures of theranostic approaches based on aptamers for treating breast cancer.

Abstract Background Patients living with multimorbidity may require frequent visits to multiple healthcare institutions and to follow diverse medical regimens and advice. Older adults with multimorbidity could face additional challenges because of declining cognitive capability, frailty, increased complexity of diseases, as well as limited social and economic resources. Research on how this population navigates the healthcare system in Singapore also remains unknown. This study investigates the challenges older adults with multimorbidity face in navigating healthcare in Singapore. Methods Twenty older adults with multimorbidity from a public primary care setting were purposively sampled. Interviews conducted inquired into their experiences of navigating the healthcare system with multiple conditions. Inductive thematic analysis was performed by independent coders who resolved differences through discussion. Results Older adults with multimorbidity form a population with specific characteristics and challenges. Their ability to navigate the healthcare system well was influenced by these themes including patient-related factors (autonomy and physical mobility, literacy and technological literacy, social support network), healthcare system-related factors (communication and personal rapport, fragmented system, healthcare staff as advocate) and strategies for navigation (fitting in, asking for help, negotiating to achieve goals, managing the logistics of multimorbidity). Discussion Older adults with multimorbidity should not be treated as a homogenous group but can be stratified according to those with less serious or disruptive conditions (less burden of illness and burden of treatment) and those with more severe conditions (more burden of illness and burden of treatment). Among the latter, some became navigational experts while others struggled to obtain the resources needed. The variations of navigational experiences of the healthcare system show the need for further study of the differential needs of older adults with multimorbidity. To be truly patient-centred, healthcare providers should consider factors such as the existence of family support networks, literacy, technological literacy and the age-related challenges older adults face as they interact with the healthcare system, as well as finding ways to improve healthcare systems through personal rapport and strategies for reducing unnecessary burden of treatment for patients with multimorbidity.

BackgroundEpidemiological studies have observed an increase in the prevalence of obesity in both western and Asian countries. This study aims to compare the distribution of body mass index (BMI) in the general population of Singapore between 2010 and 2016, and to explore the socio-demographic risk factors associated with it.MethodsData for this study were extracted from two national-wise studies in 2010 and 2016, two population-based, cross-sectional epidemiological studies. BMI cut-off scores were used as an indicator to assess obesity in this study, and the data included in the analysis was self-reported by the respondents.ResultsOverall, the study observed decreasing prevalence in underweight and normal weight categories; and an increasing prevalence in overweight and obesity categories in the Singapore adult population between 2010 and 2016. Age, gender, ethnicity, marital status, and educational level were found to be significantly associated with BMI categories.ConclusionThe observed increase in the population’s BMI between 2010 and 2016 may lead to an increase in the incidence of chronic diseases in Singapore. Our study findings add to the existing local literature and provides data for evidence-based policymaking on health-related interventions and program planning.

Abstract Membrane-based organic solvent separations are rapidly emerging as a promising class of technologies for enhancing the energy efficiency of existing separation and purification systems. Polymeric membranes have shown promise in the fractionation or splitting of complex mixtures of organic molecules such as crude oil. Determining the separation performance of a polymer membrane when challenged with a complex mixture has thus far occurred in an ad hoc manner, and methods to predict the performance based on mixture composition and polymer chemistry are unavailable. Here, we combine physics-informed machine learning algorithms (ML) and mass transport simulations to create an integrated predictive model for the separation of complex mixtures containing up to 400 components via any arbitrary linear polymer membrane. We experimentally demonstrate the effectiveness of the model by predicting the separation of two crude oils within 6-7% of the measurements. Integration of ML predictors of diffusion and sorption properties of molecules with transport simulators enables for the rapid screening of polymer membranes prior to physical experimentation for the separation of complex liquid mixtures.