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ObjectiveTo study clinical outcome and risk factors associated with extended-spectrum β-lactamase (ESBL)-producing uropathogenic Escherichia coli (UPEC) in community-onset bloodstream infections (CO-BSI).MethodsThis was a population-based cohort study including patients with pheno- and genotype-matched ESBL-producing E. coli and non-ESBL- E. coli in urine and blood samples collected in 2009-2018 in southeast Sweden. Seventy-seven episodes of ESBL-UPEC satisfying the inclusion criteria were matched 1:1 with 77 non-ESBL-UPEC for age, gender, and year of culture.ResultsThe most common ST-type and ESBL gene was ST131 (55%), and blaCTX-M-15 (47%), respectively. Risk factors for ESBL-UPEC were: previous genitourinary invasive procedure (RR 4.66; p = 0.005) or history of ESBL-producing E. coli (RR 12.14; p = 0.024). There was significant difference between ESBL-UPEC and non-ESBL-UPEC regarding time to microbiologically appropriate antibiotic therapy (27:15 h vs. 02:14 h; p = 0.999) or sepsis within 36 hours (51% vs. 62%; p = 0.623) was observed.ConclusionThe predominant risk factors for ESBL-UPEC were history of ESBL-Ec infection and history of genitourinary invasive procedure. The overall mortality was low and the delay in appropriate antibiotic therapy did not increase the risk for 30-day mortality or risk for sepsis within 36 hours among patients infected with ESBL UPEC. However, these results must be regarded with some degree of caution due to the small sample size.

ObjectivesThe aim of this study was to investigate the epidemiology of bloodstream infections (BSI) in a Swedish setting, with focus on risk factors for BSI-associated mortality.MethodsA 9-year (2008-2016) retrospective cohort study from electronic records of episodes of bacteremia amongst hospitalized patients in the county of Östergötland, Sweden was conducted. Data on episodes of BSI including microorganisms, antibiotic susceptibility, gender, age, hospital admissions, comorbidity, mortality and aggregated antimicrobial consumption (DDD /1,000 inhabitants/day) were collected and analyzed. Multidrug resistance (MDR) was defined as resistance to at least three groups of antibiotics. MDR bacteria and MRSA, ESBL-producing Enterobacteriaceae, vancomycin-resistant enterococci not fulfilling the MDR criteria were all defined as antimicrobial-resistant (AMR) bacteria and included in the statistical analysis of risk factors for mortality.ResultsIn all, 9,268 cases of BSI were found. The overall 30-day all-cause mortality in the group of patients with BSI was 13%. The incidence of BSI and associated 30-day all-cause mortality per 100,000 hospital admissions increased by 66% and 17% respectively during the nine-year study period. The most common species were Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae and Enterococcus faecalis. Independent risk factors for 30-day mortality were age (RR: 1.02 (CI: 1.02-1.03)) and 1, 2 or ≥3 comorbidities RR: 2.06 (CI: 1.68-2.52), 2.79 (CI: 2.27-3.42) and 2.82 (CI: 2.31-3.45) respectively. Almost 3% (n = 245) of all BSIs were caused by AMR bacteria increasing from 12 to 47 per 100,000 hospital admissions 2008-2016 (p = 0.01), but this was not associated with a corresponding increase in mortality risk (RR: 0.89 (CI: 0.81-0.97)).ConclusionComorbidity was the predominant risk factor for 30-day all-cause mortality associated with BSI in this study. The burden of AMR was low and not associated with increased mortality. Patients with BSIs caused by AMR bacteria (MDR, MRSA, ESBL and VRE) were younger, had fewer comorbidities, and the 30-day all-cause mortality was lower in this group.

In this research, we introduce a comprehensive epidemiological model that accounts for multiple strains of an infectious disease and two distinct vaccination options. Vaccination stands out as the most effective means to prevent and manage infectious diseases. However, when there are various vaccines available, each with its costs and effectiveness, the decision-making process for individuals becomes paramount. Furthermore, the factor of waning immunity following vaccination also plays a significant role in influencing these choices. To understand how individuals make decisions in the context of multiple strains and waning immunity, we employ a behavioral model, allowing an epidemiological model to be coupled with the dynamics of a decision-making process. Individuals base their choice of vaccination on factors such as the total number of infected individuals and the cost-effectiveness of the vaccine. Our findings indicate that as waning immunity increases, people tend to prioritize vaccines with higher costs and greater efficacy. Moreover, when more contagious strains are present, the equilibrium in vaccine adoption is reached more rapidly. Finally, we delve into the social dilemma inherent in our model by quantifying the social efficiency deficit (SED) under various parameter combinations.

Purpose: Benign prostate hyperplasia (BPH) is a common age-related chronic condition. Its pathogenesis involves androgen imbalance, inflammation, oxidative stress, and endoplasmic reticulum (ER) stress. This study aims to assess the protective effect of finasteride, a 5α-reductase inhibitor, against testosterone propionate (TP)-induced BPH in rats and explore its potential mechanism of action. Materials and Methods: TP-induced BPH rats received either saline or finasteride (1 mg/kg) orally once a day for 7 weeks. Prior to sacrificing the animals, blood samples were collected. After sacrifice, prostate and tissue around the prostate were dissected from seminal vesical for further analysis. Body weight, prostate weight, dihydrotestosterone (DHT), 5α-reductase type 2 (5-AR2), and prostate-specific antigen (PSA) levels were measured. In addition, HIF-1α, VEGF, MMP-2 expressions in prostate, oxidative stress, inflammation, and ER stress responses were analyzed to understand the mechanism of action of finasteride. Results: Finasteride administration inhibited prostate enlargement, DHT, 5-AR2, and PSA levels in BPH rats. Additionally, finasteride inhibited angiogenesis markers such as HIF-1α, VEGF, and MMP-2. Moreover, components of oxidative stress, inflammation, and ER stress responses were significantly regulated by finasteride treatment. Conclusions: This study suggests that finasteride prevents BPH-associated symptoms by regulating angiogenesis, reactive oxygen species, ER stress responses, and inflammation, another mechanism to explain the effect of the 5α-reductase against BPH.

ABSTRACT Due to the spread of resistance, antibiotic exposure receives increasing attention. Ecological consequences for the different niches of individual microbiomes are, however, largely ignored. Here, we report the effects of widely used antibiotics (clindamycin, ciprofloxacin, amoxicillin, and minocycline) with different modes of action on the ecology of both the gut and the oral microbiomes in 66 healthy adults from the United Kingdom and Sweden in a two-center randomized placebo-controlled clinical trial. Feces and saliva were collected at baseline, immediately after exposure, and 1, 2, 4, and 12 months after administration of antibiotics or placebo. Sequences of 16S rRNA gene amplicons from all samples and metagenomic shotgun sequences from selected baseline and post-antibiotic-treatment sample pairs were analyzed. Additionally, metagenomic predictions based on 16S rRNA gene amplicon data were performed using PICRUSt. The salivary microbiome was found to be significantly more robust, whereas the antibiotics negatively affected the fecal microbiome: in particular, health-associated butyrate-producing species became strongly underrepresented. Additionally, exposure to different antibiotics enriched genes associated with antibiotic resistance. In conclusion, healthy individuals, exposed to a single antibiotic treatment, undergo considerable microbial shifts and enrichment in antibiotic resistance in their feces, while their salivary microbiome composition remains unexpectedly stable. The health-related consequences for the gut microbiome should increase the awareness of the individual risks involved with antibiotic use, especially in a (diseased) population with an already dysregulated microbiome. On the other hand, understanding the mechanisms behind the resilience of the oral microbiome toward ecological collapse might prove useful in combating microbial dysbiosis elsewhere in the body. IMPORTANCE Many health care professionals use antibiotic prophylaxis strategies to prevent infection after surgery. This practice is under debate since it enhances the spread of antibiotic resistance. Another important reason to avoid nonessential use of antibiotics, the impact on our microbiome, has hardly received attention. In this study, we assessed the impact of antibiotics on the human microbial ecology at two niches. We followed the oral and gut microbiomes in 66 individuals from before, immediately after, and up to 12 months after exposure to different antibiotic classes. The salivary microbiome recovered quickly and was surprisingly robust toward antibiotic-induced disturbance. The fecal microbiome was severely affected by most antibiotics: for months, health-associated butyrate-producing species became strongly underrepresented. Additionally, there was an enrichment of genes associated with antibiotic resistance. Clearly, even a single antibiotic treatment in healthy individuals contributes to the risk of resistance development and leads to long-lasting detrimental shifts in the gut microbiome.

Migration of intrauterine fetal death (IUD) products from the uterus to different nearby intra abdominal organ of body especially to urinary bladder is a rare clinical situation to report. Here we are presenting a case , where a woman of 54 years of age presented to us with the history of IUD at 27 weeks of gestation 17 years back with history of passage of hard brittle bony fragment like material with urine and an abdominal lump. Laparotomy was done, some parts of IUD product was found to migrate to urinary bladder cavity, some parts to incompletely invade the intestinal loops & some parts towards the abdominal wall to form the lump. Hysterectomy was done, product was removed and the entire involved organ was repaired successfully and patient cure was uneventful.

In this research, we introduce a comprehensive epidemiological model that accounts for multiple strains of an infectious disease and two distinct vaccination options. Vaccination stands out as the most effective means to prevent and manage infectious diseases. However, when there are various vaccines available, each with its costs and effectiveness, the decision-making process for individuals becomes paramount. Furthermore, the factor of waning immunity following vaccination also plays a significant role in influencing these choices. To understand how individuals make decisions in the context of multiple strains and waning immunity, we employ a behavioral model, allowing an epidemiological model to be coupled with the dynamics of a decision-making process. Individuals base their choice of vaccination on factors such as the total number of infected individuals and the cost-effectiveness of the vaccine. Our findings indicate that as waning immunity increases, people tend to prioritize vaccines with higher costs and greater efficacy. Moreover, when more contagious strains are present, the equilibrium in vaccine adoption is reached more rapidly. Finally, we delve into the social dilemma inherent in our model by quantifying the social efficiency deficit (SED) under various parameter combinations. [ABSTRACT FROM AUTHOR]

Background: Understanding health in daily life can vary from person to person. The concept of health arises from the perspective of an individual's experience. People face several kinds of barriers while seeking healthcare services, where rickshaw pullers are one of the most vulnerable groups to meet their basic health needs. This study aimed to investigate Bangladeshi rural rickshaw pullers’ perception regarding health and what obstacles they face while seeking healthcare services. Methods: This study followed a qualitative approach conducted in-depth interviews involving 20 rickshaw pullers in rural Bangladesh from 4th to 15th December 2020. Participants were selected through purposive and snowball sampling techniques. The verbatim transcription was performed, and the thematic analysis was done through manual coding and NVivo version 12. Results: According to the study’s findings, participants’ perception regarding health were mainly based on physical, nutritional, and social points of view. The financial hardship to convey medical costs, long waiting time in receiving healthcare services, social class inequality, low trustworthiness on diagnostic services, and mastery of broker in the hospital setting were acknowledged as prevailing barriers to seeking healthcare services. Conclusion: Several health perceptions existed among the rural rickshaw pullers. They faced different kinds of barriers while seeking healthcare services, and those obstacles made them hopeless and worried about getting quality healthcare services. Concerned authorities, including government and private organizations, should take effective strategies to ensure that healthcare services are available, reliable, and affordable.

Background: Ischemic heart disease (IHD) is a major cause of death globally. Countries vary in their rates, and changes have occurred over time. Nowadays, developing countries pose new public health challenges. Objectives: The objective of the present study was to appraise the alterations in the levels of serum Zn, Cu, Fe, and Mn that occur in patients with ischemic heart disease and to depict the correlations of the effects of these changes that lead to the pathogenesis of IHD. Methods: Zn, Cu, Fe, and Mn in the IHD patients were determined by Atomic Absorption Spectroscopy (AAS). Results: This study evaluated 52 patients with IHD, and 61 healthy volunteers served as controls. The primary outcomes of interest were explored regarding the correlations of the serum levels of these trace elements in patients with IHD. The secondary outcomes were explored in terms of inter-element relations to connect them with the pathogenesis of IHD. Our study found significantly reduced levels of Zn and Cu (2.50 ± 0.19 mg/L and 2.52 ± 0.17 mg/L, respectively) and an elevated level of Fe (148.97 ± 17.25 mg/L) in the patient group with IHD. The level of Mn (7.32 ± 1.23 mg/L) was elevated in the sera of the patients with ischemic heart disease (IHD) compared to healthy control subjects. Conclusion: Our results indicate strong associations of the pathogenesis of IHD with depleted serum levels of Zn and Cu and elevated Fe and Mn levels, which may provide a prognostic tool for the treatment of this concerning the disease.

Purpose: Globally, many extension professionals and policy-makers are advocating fee based services, in addressing the fund shortage and sustainable provision of agricultural advisory services. Hence, the article attempts to expose the farmers' willingness to pay (WTP) as agricultural extension in Bangladesh is experiencing chronic fund crisis. Methodology: This study used contingent valuation method (CVM) for investigating farmers' WTP. Logit and Tobit model was employed to assess the determinants of WTP and amount willing to pay (AWTP) respectively. Besides, different qualitative methods were employed to have a deeper understanding of the research problems. Findings: WTP was conditioned by providing quality extension services at farm and/or home of the farmers. The study also focused on farmers preferred mode of payment, criteria influencing payment decisions and the type of services for which they are willing to pay. Paid model can contribute to quality extension services, if started with a market oriented commodity based approach accompanied by adequate crop insurance support. Practical implications: The study considered international experiences and national crisis in delivering extension services that provoke actions towards changing the extension policy of Bangladesh. The findings also prompt the factors that influence the paid extension service delivery for the crop farmers of Bangladesh. Originality: Although, many studies have been conducted on privatisation of agricultural extension around the globe, we are not aware of any single study on crop farmers' willingness to pay for the extension services in Bangladesh.

From a residential point of view, home energy management (HEM) is an essential requirement in order to diminish peak demand and utility tariffs. The integration of renewable energy sources (RESs) together with battery energy storage systems (BESSs) and central battery storage system (CBSS) may promote energy and cost minimization. However, proper home appliance scheduling along with energy storage options is essential to significantly decrease the energy consumption profile and overall expenditure in real-time operation. This paper proposes a cost-effective HEM scheme in the microgrid framework to promote curtailing of energy usage and relevant utility tariff considering both energy storage and renewable sources integration. Usually, the household appliances have different runtime preferences and duration of operation based on user demand. This work considers a simulator designed in the C++ platform to address the domestic customer’s HEM issue based on usages priorities. The positive aspects of merging RESs, BESSs, and CBSSs with the proposed optimal power sharing algorithm (OPSA) are evaluated by considering three distinct case scenarios. Comprehensive analysis of each scenario considering the real-time scheduling of home appliances is conducted to substantiate the efficacy of the outlined energy and cost mitigation schemes. The results obtained demonstrate the effectiveness of the proposed algorithm to enable energy and cost savings up to 37.5% and 45% in comparison to the prevailing methodology.

The steady increase in energy demand for residential consumers requires an efficient energy management scheme. Utility organizations encourage household applicants to engage in residential energy management (REM) system. The utility’s primary goal is to reduce system peak load demand while consumer intends to reduce electricity bills. The benefits of REM can be enhanced with renewable energy sources (RESs), backup battery storage system (BBSS), and optimal power-sharing strategies. This paper aims to reduce energy usages and monetary cost for smart grid communities with an efficient home energy management scheme (HEMS). Normally, the residential consumer deals with numerous smart home appliances that have various operating time priorities depending on consumer preferences. In this paper, a cost-efficient power-sharing technique is developed which works based on priorities of appliances’ operating time. The home appliances are sorted on priority basis and the BBSS are charged and discharged based on the energy availability within the smart grid communities and real time energy pricing. The benefits of optimal power-sharing techniques with the RESs and BBSS are analyzed by taking three different scenarios which are simulated by C++ software package. Extensive case studies are carried out to validate the effectiveness of the proposed energy management scheme. It is demonstrated that the proposed method can save energy and reduce electricity cost up to 35% and 45% compared to the existing methods.