Study of the gut microbiome as a novel target for prevention of hospital-associated infections in intensive care unit patients.

BACKGROUND: Hospital-acquired infections (HAIs) are increasing due to the spread of multi-drugresistant organisms. Gut dysbiosis in an intensive care unit (ICU) patients at admission showed an altered abundance of some bacterial genera associated with the occurrence of HAIs and mortality. In the present study, we investigated the pattern of the gut microbiome in ICU patients at admission to correlate it with the development of HAIs during ICU stay. METHODS: Twenty patients admitted to an ICU with a cross-matched control group of 30 healthy subjects of matched age and sex. Quantitative SYBR green real-time polymerase chain reaction was done for the identification and quantitation of selected bacteria. RESULTS: Out of those twenty patients, 35% developed ventilator-associated pneumonia during their ICU stay. Gut microbiome analysis showed a significant decrease in Firmicutes and Firmicutes to Bacteroidetes ratio in ICU patients in comparison to the control and in patients who developed HAIs in comparison to the control group and patients who did not develop HAIs. There was a statistically significant increase in Bacteroides in comparison to the control group. There was a statistically significant decrease in Bifidobacterium and Faecalibacterium prausnitzii and an increase in Lactobacilli in comparison to the control group with a negative correlation between Acute Physiology and Chronic Health Evaluation (APACHE) II score and Firmicutes to Bacteroidetes and Prevotella to Bacteroides ratios. CONCLUSIONS: Gut dysbiosis of patients at the time of admission highlights the importance of identification of the microbiome of patients admitted to the ICU as a target for preventing of HAIs.

Early assessment of aspiration risk in acute stroke by fiberoptic endoscopy in critically ill patients.

BACKGROUND: Fiberoptic endoscopic evaluation of swallowing (FEES) has been recommended to assess aspiration in stroke. This study aimed to determine the diagnostic and prognostic roles of FEES in the early assessment of aspiration, intensive care unit (ICU) stay and mortality in acute stroke patients. METHODS: Fifty-two patients with acute stroke admitted to the Alexandria Main University Hospital were included. Complete examinations and assessment of aspiration using the 8-point penetration-aspiration scale (PAS) with FEES protocol were performed. RESULTS: The patients were classified into three groups: normal with no or low risk of aspiration (n=15, 27.3%; PAS level 1), low to moderate risk (n=8, 14.5%; PAS level 2-4), and high risk (n=32, 58.2%; PAS ≥5). There was high incidence of aspiration pneumonia, prolonged ICU stay, and mortality in both moderate- and high-risk groups (P=0.001, P<0.001, and P<0.001, respectively). The PAS score predicted aspiration pneumonia (hospital-acquired pneumonia) with sensitivity and specificity of 80.0% and 76.0%, respectively (negative predictive value [NPV], 76.0; positive predictive value [PPV], 80.0; 95% confidence interval [CI], 0.706-0.940) and mortality with sensitivity and specificity of 88.46% and 68.97% (NPV, 87.0; PPV, 71.9; 95% CI, 0.749-0.951). The PAS score could predict the length of ICU stay with sensitivity and specificity of 70.21% and 87.50, respectively (NPV, 33.3; PPV, 97.1; 95% CI, 0.605-0.906). CONCLUSIONS: The standard FEES protocol using PAS score is a useful tool to assess aspiration in acute stroke patients and could be used to predict length of ICU stay and mortality.

Cemented versus cementless bipolar hemiarthroplasty for femoral neck fractures in the elderly.

The management of femoral neck fractures remains controversial. Treatment options include a wide variety of internal fixation methods, unipolar or bipolar hemiarthroplasty or total hip replacement.We carried out a systematic review of the available literature to detect differences between cemented and cementless fixation of bipolar prostheses in treating femoral neck fractures in patients aged 60 years or older.Thirteen studies involving a total of 1561 bipolar hemiarthroplasties (770 cemented and 791 uncemented) were identified. Uncemented hemiarthroplasty was associated with significantly lower blood loss (p < 0.0001), shorter operative time (p < 0.0001), less infection (p = 0.03) and lower risk of heterotopic ossification (p = 0.007). On the other hand, patients with cemented hemiarthroplasty suffered significantly less postoperative thigh pain than those with cementless implantation (p < 0.00001).The existing evidence indicates that uncemented bipolar hemiarthroplasty offers shorter operative time, less blood loss, lower local complications and a similar rate of systemic complications and reoperations as compared to cemented implantation. Cite this article: EFORT Open Rev 2021;6:380-386. DOI: 10.1302/2058-5241.6.200057.

Prevalence of Genes Encoding Aminoglycoside-Modifying Enzymes and armA among Acinetobacter baumannii Clinical Isolates in Alexandria, Egypt.

INTRODUCTION: Acinetobacter baumannii (A.baumannii) is a ubiquitous pathogen responsible for serious infections in hospitalized patients with a high propensity to develop resistance to antimicrobial agents. The study aimed to determine the antimicrobial resistance patterns and the prevalence of aminoglycoside resistance genes among A. baumannii clinical isolates from patients in different intensive care units (ICUs) in Alexandria, Egypt. METHODS: A total of 100 A. baumannii isolates collected from ICU patients were confirmed as A. baumannii by VITEK 2 and the presence of the blaOXA-51 gene has been reported. Antimicrobial susceptibility testing was performed and Multiplex PCR was done for the detection of aminoglycoside resistance genes. RESULTS: Most of the isolates (82%) were resistant to all tested aminoglycosides; resistance was higher for kanamycin and neomycin, followed by amikacin. The predominant AMEs were aphA6 and aphA1 in 86% and 67% of the isolates, respectively; aacA4 and aacC1 were detected in 37% and 8%, respectively, while aadA1 and aadB were present in 34% and 4%, respectively. Furthermore, the armA gene was detected in 83% of the isolates. CONCLUSION: The results of this study revealed a high level carriage of armA and AMEs, which limit the usage of aminoglycoside as a treatment option for A. baumannii and make treatment extremely difficult.

Effects of heated and thermoneutral yoga interventions on arterial stiffness in middle-aged adults.

The study investigated the efficacy of 12 weeks of heated and thermoneutral Bikram yoga in reducing arterial stiffness in middle-aged adults. Fifty-four sedentary adults (ages 40-60 years) completed 12 weeks of yoga at 40.5 °C (n = 21), yoga at 23 °C (n = 14) or time control (n = 19). Brachial-ankle pulse wave velocity (PWV) was not significantly altered by hot or thermoneutral yoga interventions.

Effects of yoga interventions practised in heated and thermoneutral conditions on endothelium-dependent vasodilatation: The Bikram yoga heart study.

NEW FINDINGS: What is the central question of this study? Does the heated practice environment enhance the effects of Bikram yoga on endothelium-dependent vasodilatation in healthy, middle-aged adults? What is the main finding and its importance? The primary finding from this investigation is that the hatha yoga postures in the Bikram yoga series produce similar enhancements in endothelium-dependent vasodilatation in healthy, middle-aged adults regardless of environmental temperature. These findings highlight the efficacy of yoga postures in producing improvements in vascular health and downplay the necessity of the heated practice environment in inducing vascular adaptations. ABSTRACT: We have previously documented improvements in endothelium-dependent vasodilatation with a Bikram (hot) yoga intervention in middle-aged adults. At present, the effect of environmental temperature in hot yoga on endothelial function is unknown. The purpose of this investigation was to determine the effects of Bikram yoga interventions performed in heated or thermoneutral conditions on endothelium-dependent vasodilatation. Fifty-two sedentary but apparently healthy adults aged 40-60 years were randomly assigned to one of three groups: Bikram yoga practised at 40.5°C (n = 19), Bikram yoga practised at 23°C (n = 14) or sedentary time control (n = 19). The yoga interventions consisted of 90 min Bikram yoga classes three times a week for 12 weeks. Endothelium-dependent vasodilatation was measured non-invasively using brachial artery flow-mediated dilatation (FMD). Body fat percentage determined via dual-energy X-ray absorptiometry was significantly lower in the hot yoga group after the intervention than in the thermoneutral yoga and control conditions. Brachial artery FMD increased (P < 0.05) in the thermoneutral yoga group and tended to increase in the hot yoga group (P = 0.056). No changes occurred in the control group. There were no significant differences in FMD change scores between groups. We conclude that Bikram yoga practised in thermoneutral conditions improved endothelium-dependent vasodilatation in healthy, middle-aged adults. These new findings highlight the effectiveness of hatha yoga postures alone, in the absence of a heated practice environment, in improving vascular health and are of clinical significance given the increased propensity for heat intolerance in ageing adults.

The effect of Bikram yoga on endothelial function in young and middle-aged and older adults.

The purpose of this investigation was to determine if Bikram yoga, a style of heated hatha yoga, would improve endothelial function in young and middle-aged and older, healthy adults. This trial was performed in 36 young (n = 17) and middle-aged and older adults (n = 19) who completed 3 weekly Bikram yoga classes for 8 weeks. Height, body weight and body composition were determined and endothelial function was measured noninvasively using brachial artery flow-mediated dilation (FMD) before and after the intervention. No changes in body weight, BMI or body fat percentage occurred as a result of the intervention in either group. Brachial artery FMD was significantly increased in middle-aged and older (P < 0.05) but not in young adults as a result of the intervention. The results demonstrate that a relatively short-term Bikram yoga practice might significantly improve vascular endothelial function in middle-aged and older adults. While apparently healthy individuals in this study experienced no adverse events, those with preexisting conditions should take caution and consult with a physician prior to engaging in this style of yoga.

Visceral adiposity predicts subclinical white matter hyperintensities in middle-aged adults.

OBJECTIVE: Growing prevalence of neuropathology and cognitive impairment are emerging consequences of the obesity epidemic. Adiposity indices used in examining the relationships between obesity, neuropathology, and cognition vary substantially in the literature leading to incongruent findings. Our aim was to determine the anthropometric measures most strongly associated with early white matter disease and cognitive function at midlife. METHOD: Multiple adiposity indices were measured in 126 adults aged 40-62 who also completed a magnetic resonance imaging (MRI) scan to quantify white matter disease and a cognitive test battery. Anthropometric indices of obesity were compared to image-based estimates of visceral adipose tissue with dual-energy X-ray absorptiometry (DEXA) as predictors of current white matter disease and cognitive function. We also explored sex as a potential moderator of these relationships. RESULTS: Waist circumference (WC) was most strongly correlated with DEXA estimates of visceral adipose tissue (r=0.871, p<0.001). Increasing WC (ß=0.231, p=0.034), percent body fat (ß=0.230, p=0.045), and VAT (ß=0.247, p=0.027) significantly predicted subclinical white matter hyperintensities in the absence of cognitive impairment after accounting for age, sex, years of education, and cardiovascular risk factors. Sex was not a significant moderator of any of the observed relationships. CONCLUSIONS: Of the anthropometric indices used in this study, WC, BF, and VAT successfully predicted subclinical white matter disease in cognitively normal adults at midlife. Increasing VAT may independently insidiously affect cerebral white matter prior to detectable cognitive changes, necessitating early intervention.

A rise in peak performance age in female athletes.

It was reported in 1980s that ages at which peak performance was observed had remained remarkably stable in the past century, although absolute levels of athletic performance increased dramatically for the same time span. The emergence of older (masters) athletes in the past few decades has changed the demographics and age-spectrum of Olympic athletes. The primary aim of the present study was to determine whether the ages at which peak performance was observed had increased in the recent decades. The data spanning 114 years from the first Olympics (1898) to the most recent Olympics (2014) were collected using the publically available data. In the present study, ages at which Olympic medals (gold, silver, and bronze) were won were used as the indicators of peak performance age. Track and field, swimming, rowing, and ice skating events were analyzed. In men, peak performance age did not change significantly in most of the sporting events (except in 100 m sprint running). In contrast, peak performance ages in women have increased significantly since 1980s and consistently in all the athletic events examined. Interestingly, as women's peak performance age increased, they became similar to men's peak ages in many events. In the last 20-30 years, ages at which peak athletic performance is observed have increased in women but not in men.