Preventing New Gram-negative Resistance Through Beta-lactam De-escalation in Hospitalized Patients With Sepsis: A Retrospective Cohort Study.

BACKGROUND: Whether antibiotic de-escalation reduces the risk of subsequent antibiotic resistance is uncertain. We sought to determine if beta-lactam (BL) antibiotic de-escalation is associated with decreased incidence of new Gram-negative resistance in hospitalized patients with sepsis. METHODS: In a retrospective cohort study, patients with sepsis who were treated with at least 3 consecutive days of BL antibiotics, the first 2 days of which were with a broad-spectrum BL agent defined as a spectrum score (SS) of ≥7 were enrolled. Patients were grouped into three categories: (1) de-escalation of beta-lactam spectrum score (BLSS), (2) no change in BLSS, or (3) escalation of BLSS. The primary outcome was the isolation of a new drug-resistant Gram-negative bacteria from a clinical culture within 60 days of cohort entry. Fine-Gray proportional hazards regression modeling while accounting for in-hospital death as a competing risk was performed. FINDINGS: Six hundred forty-four patients of 7742 (8.3%) patients developed new gram-negative resistance. The mean time to resistance was 23.7 days yielding an incidence rate of 1.85 (95% confidence interval [CI]: 1.71-2.00) per 1000 patient-days. The lowest incidence rate was observed in the de-escalated group 1.42 (95% CI: 1.16-1.68) per 1000 patient-days. Statistically significant reductions in the development of new gram-negative resistance were associated with BL de-escalation compared to no-change (hazards ratio (HR) 0.59 [95% CI: .48-.73]). CONCLUSIONS: De-escalation was associated with a decreased risk of new resistance development compared to no change. This represents the largest study to date showing the utility of de-escalation in the prevention of antimicrobial resistance.

Safety of cardiovascular disease drugs approved between 2014 and 2021 in the US: a pharmacovigilance analysis.

BACKGROUND: Recently FDA-approved drugs for cardiovascular disease (CVD) require robust post-marketing surveillance. The objective of this study was to assess their safety using a large pharmacovigilance database. RESEARCH DESIGN AND METHODS: We analyzed adverse event (AE) reports for 17 drugs approved from 2014 to 2021, utilizing the FDA Adverse Event Reporting System (FAERS). Descriptive and disproportionality analyses were conducted by estimating the reporting odds ratio (ROR) and its 95% confidence interval. RESULTS: Among the 43,664,773 AE reports 97,702 (0.22%) were related to newly approved CVD drugs. No AEs were reported for finerenone and evinacumab. The results from the disproportionality analyses revealed potential risks of acute kidney injury (ROR = 8.24, 95% CI: 6.05-11.22), cardiac failure (ROR = 4.80, 95% CI: 3.82-6.05), and hypotension (ROR = 3.98, 95% CI: 3.44-4.61) among sacubitril/valsartan users. Additionally, ivabradine was found to be associated with tachycardia (ROR = 11.94, 95% CI: 8.35-17.08), abnormal feeling (ROR = 4.40, 95% CI: 2.70-7.18), and dizziness (ROR = 2.56, 95% CI: 1.68-3.90). CONCLUSIONS: This study identified specific safety concerns related to recently approved CVD drugs. Further research is required to understand the underlying mechanisms and clinical implications of these findings.

Subdural Empyema from Streptococcus suis Infection, South Korea.

In Jeju Island, South Korea, a patient who consumed raw pig products had subdural empyema, which led to meningitis, sepsis, and status epilepticus. We identified Streptococcus suis from blood and the subdural empyema. This case illustrates the importance of considering dietary habits in similar clinical assessments to prevent misdiagnosis.

COVID-19 knowledge and mental health impact assessment in Haiti.

Mental health is a significant public health challenge globally, and one anticipated to increase following the COVID-19 pandemic. In many rural regions of developing nations, little is known about the prevalence of mental health conditions and factors that may help mitigate poor outcomes. This study assessed the impact of the COVID-19 pandemic on mental health and social support for residents of rural Haiti. Data were collected from March to May 2020. The Patient Health Questionnaire subscales for anxiety and depression, and the Perceived Stress Scale were utilized in addition to tailored questions specific to COVID-19 knowledge. Half (51.8%) of the 500 survey respondents reported COVID-19-related anxiety and worrying either daily or across a few days. Half (50.2%) also reported experiencing depression daily or across several days. Most (70.4%) did not have any social support, and 28.0% experienced some stress, with 13.4% indicating high perceived stress. Furthermore, 4.6% had suitable plumbing systems in their homes. The results were immediately actionable, informing the implementation of a mental health counseling program for youth following a loss of social support through school closures. Long-term investments must be made as part of public health responses in rural communities in developing nations, which remain under-studied.

Fibrous hamartoma of infancy of the spinal cord resembling conus and filum, with a coexisting sacral dimple.

Fibrous hamartoma of infancy (FHI) is a rare benign soft tissue lesion of infants and young children. It usually occurs within the first 2 years of life at the superficial layer of the axilla, trunk, upper arm, and external genitalia. FHI in the central nervous system (CNS) is extremely rare. So far, only two spinal cord FHI cases have been reported. We present a case of a 1-month-old girl who presented with a skin dimple in the coccygeal area. Her MRI showed a substantial intramedullary mass in the thoracolumbar area with a sacral soft tissue mass and a track between the skin lesion to the coccygeal tip. Her normal neurological status halted immediate surgical resection. A skin lesion biopsy was first performed, revealing limited information with no malignant cells. A short-term follow-up was performed until the intramedullary mass had enlarged on the 5-month follow-up MRI. Based on the frozen biopsy result of benign to low-grade spindle cell mesenchymal tumor, subtotal resection of the mass was done, minimizing damage to the functioning neural tissue. Both the skin lesion and the intramedullary mass were diagnosed as FHI. Postoperative 5.5-year follow-up MRI revealed minimal size change of the residual mass. Despite being diagnosed with a neurogenic bladder, the patient maintained her ability to void spontaneously, managed infrequent UTIs, and continued toilet training, all while demonstrating good mobility and no motor weakness. This case is unique because the lesion resembled the secondary neurulation structures, such as the conus and the filum, along with a related congenital anomaly of the dimple.

Survival and Malignant Transformation of Pineal Parenchymal Tumors: A 30-Year Retrospective Analysis in a Single-Institution.

BACKGROUND: This study aims to elucidate clinical features, therapeutic strategies, and prognosis of pineal parenchymal tumors (PPT) by analyzing a 30-year dataset of a single institution. METHODS: We reviewed data from 43 patients diagnosed with PPT at Seoul National University Hospital between 1990 and 2020. We performed survival analyses and assessed prognostic factors. RESULTS: The cohort included 10 patients with pineocytoma (PC), 13 with pineal parenchymal tumor of intermediate differentiation (PPTID), and 20 with pineoblastoma (PB). Most patients presented with hydrocephalus at diagnosis. Most patients underwent an endoscopic third ventriculostomy and biopsy, with some undergoing additional resection after diagnosis confirmation. Radiotherapy was administered with a high prevalence of gamma knife radiosurgery for PC and PPTID, and craniospinal irradiation for PB. Chemotherapy was essential in the treatment of grade 3 PPTID and PB. The 5-year progression-free survival rates for PC, grade 2 PPTID, grade 3 PPTID, and PB were 100%, 83.3%, 0%, and 40%, respectively, and the 5-year overall survival rates were 100%, 100%, 40%, and 55%, respectively. High-grade tumor histology was associated with lower survival rates. Significant prognostic factors varied among tumor types, with World Health Organization (WHO) grade and leptomeningeal seeding (LMS) for PPTID, and the extent of resection and LMS for PB. Three patients experienced malignant transformations. CONCLUSION: This study underscores the prognostic significance of WHO grades in PPT. It is necessary to provide specific treatment according to tumor grade. Grade 3 PPTID showed a poor prognosis. Potential LMS and malignant transformations necessitate aggressive multimodal treatment and close-interval screening.

Feasibility and acceptability of miracle fruit application prior to the consumption of sour-tasting foods as a weight-loss strategy in adults with diabetes or prediabetes: A randomized crossover trial.

Miracle fruit (MF) has emerged as a promising option for healthy noncaloric sweeteners due to its sour-to-sweet taste-modifying effects and high antioxidant activity. We aimed to examine the feasibility and acceptability of using MF as a weight-loss strategy for individuals with diabetes or prediabetes. Fifty Korean-American men and women (25 participants each) aged 45-75 years with diabetes or prediabetes were recruited in this study. They participated in a randomized placebo-controlled crossover trial where they took the assigned tablet (either an MF tablet or a placebo-sugar candy) 10 min before consuming food. Using a 9-point hedonic scale, participants assessed the likings of overall, flavor, texture, and aftertaste for green apples, goat cheese, lemonade, pickles, and plain fat-free yogurt before and 10 min after taking the assigned tablet. Additionally, overall liking for meals and calorie intake were assessed during subsequent ad libitum meal sessions. An ANOVA for a crossover design, and independent and paired t-tests were used to compare the outcomes. The results revealed that all postintervention liking values for sour-tasting foods were higher than the respective preintervention liking values for both interventions. However, the MF intervention showed significantly higher pre-post differences in liking for all sour-tasting foods and the overall liking values for breakfast and dinner compared to the placebo intervention (P < 0.001). Furthermore, the MF intervention resulted in a significantly lower calorie intake for each meal than the placebo (P < 0.001). These findings suggest that MF intervention can be considered a viable weight-loss strategy for individuals with diabetes.

Information seeking during the COVID-19 pandemic: Application of the risk information seeking and processing model.

BACKGROUND: To limit the risk of contracting the coronavirus, it is crucial for individuals to attain accurate COVID-19 related information. Once equipped with such information, they can engage in risk preventive behaviors. OBJECTIVE: Applying the risk information seeking and processing (RISP) model, this study examined the sociopsychological factors predisposing individuals' information-seeking intentions. METHODS: This study employed a cross-sectional survey design. Using an online survey platform, study participants were recruited from US adults. A total of 510 valid responses were included in the analyses. Multivariate regression analyses were conducted in a hierarchical fashion while controlling for numerous covariates to determine the relationships between the sociopsychological variables and information-seeking intentions. RESULTS: Sociodemographic disparities were found in perceptions of COVID-19 risk. Perceived risk of coronavirus infection was higher among females, individuals with a history of COVID-19 symptoms, and those in a lower health status. Individuals' perceived risk provoked affective responses (e.g., worry and fear), which then increased self-perceived information insufficiency. This finding indicated individuals experienced worry and fear after perceiving the risk of coronavirus. Such affective responses made them realize that their current COVID-19 related knowledge was insufficient. Subjective norms were also found to increase information insufficiency. In other words, individuals who desired to comply with others' expectations to acquire knowledge about the risk recognized that their current knowledge about coronavirus was insufficient. Finally, individuals who acknowledged information insufficiency were motivated to seek information about the coronavirus. The relation between information insufficiency and information-seeking intentions was moderated by perceived information gathering capacity, but not by relevant channel beliefs. CONCLUSIONS: The findings suggest that policy makers and clinicians assist the public in obtaining accurate information from reliable sources.

Harnessing an Integrated Health Communication (IHC) Framework for Campaigns: A Case of Prescription Drug Decision Making.

Drawing on a multiplicity of mass media and health behavior theories, we propose an integrated health communication (IHC) framework to understand and leverage the ways in which mass mediated and interpersonal sources of health information influence the public's health behavior in the context of their prescription drug decisions. Building on the agenda setting theory, two-step flow theory, and the Health Belief Model, we dig into the interrelationships between mass media and interpersonal information sources and information seeking engagement. Employing survey methodology, our framework was tested using a sample of U.S. adults (N = 628). The major results include (a) information gained through interpersonal sources and perceived benefits of the prescription drugs positively and sequentially mediate the association between mass media exposure and intent to seek prescription drug information, (b) interpersonal health information positively moderate the mediation of mass media exposure - perceived benefits - intent to seek prescription drug information, and (c) the inexpert interpersonal information's positive interaction effect with mass media exposure on intent to seek prescription drug information mediated through perceived benefits was greater with high expert interpersonal communication. These results impart valuable theoretical contributions and have the potential to guide integrated health communication (IHC) campaigns.

Interpersonal Communication Influence on Health-Protective Behaviors amid the COVID-19 Crisis.

The 2019 novel coronavirus (COVID-19) has posed substantial threats to global public health. Individuals are extensively exposed to interpersonal sources of health information (e.g., family, friends, colleagues, physicians, and pharmacists). Interpersonal connections often encourage people to question or reinforce other sources of health information, which can affect their perceptions and behaviors. This study integrates research on how exposure to interpersonal health communication affects people's risk perception and affective responses to influence health-protective behaviors such as health information seeking and adherence to protective measures. Findings from an online survey of U.S. adults (n = 488) demonstrated that risk perception and affective responses serve as behavioral motivation factors. The influences of cognitive and affective responses were greater to the extent that individuals believed the health-protective behaviors are beneficial. Our study illuminates how people engage in preventive health behaviors to protect themselves in the COVID-19 context and demonstrates the influence of interpersonal social networks in motivating such behaviors. The theoretical and practical implications of these findings are discussed.

Uptake and Utilization of the COVID-19 Alert App within a University Community in New York.

The rapid onset of the COVID-19 pandemic elicited a swift response to control the virus ubiquitous within the United States. Expanded telehealth and health informatics became critical components of the pandemic response. The aim of this study was to assess the utilization of the COVID-19 New York (NY) Alert App and identify the perceived benefits and limitations of the App. A cross-sectional design was employed to collect data by using questionnaires with closed-ended and open-ended questions. The survey was developed and administered during March through April 2021. The study found that the highest rated benefit from using the COVID-19 NY Alert App was receiving alerts about being in close proximity to individuals diagnosed with COVID-19. Results showed that ineffective (insufficient and inappropriate) usage was the highest rated potential challenge for using the App. Study subjects were likely to download this Alert App when they perceived more benefits and less barriers to using the App. Findings from this study can help improve utilization of the App and inform development of similar tele-education tools. The study illuminated considerations for health information applications in scaling-up traditional COVID-19 tracing efforts and may facilitate the design of similar emergency preparedness health technology.

The acclimatization of Haenyeo to a cold environment and occupational characteristics evaluated by orexin and irisin levels.

Background: Haenyeo is a woman who has the job of collecting seafood in the Jeju Sea at an average temperature of 13°C-14°C. The purpose of this study was to examine the cold acclimatization and occupational characteristics of Haenyeo through biomarkers such as orexin and irisin related to heat generation in the body. Methods: Twenty-one Haenyeo and 25 people with similar age, body type, and body mass index were selected as the control group (Control G). In the cold exposure experiment, a climate chamber was set to 5°C and both feet were immersed in a 15°C water tank for 30 minutes. Tympanic temperature (Tty) and skin temperature (Tsk) were measured, and the mean body temperature (mTb) was calculated. Blood samples were collected before and immediately after the examination. Orexin and irisin levels were analyzed. Results: Orexin levels were elevated after cold stimulation from 12.17 ± 4.44 to 12.95 ± 4.53 ng/mL (Haenyeo group [Haenyeo G], p < 0.01) and 10.37 ± 3.84 to 11.25 ± 4.02 ng/mL (Control G, p < 0.001). Irisin levels were elevated after cold stimulation from 4.83 ± 2.28 to 5.36 ± 2.23 ng/mL (Haenyeo G, p < 0.001) and 3.73 ± 1.59 to 4.18 ± 2.04 ng/mL (Control G, p < 0.001). The difference between Haenyeo G and Control G values in orexin and irisin appears not only in pre-exposure but also in post-exposure (p < 0.05). Conclusions: Our experimental results suggest that Haenyeo G were relatively superior in cold tolerance to Control G under cold exposure conditions. Haenyeo's cold acclimatization is due to the basic differences in pyrogens regarding body temperature control such as orexin and irisin. This means that Haenyeo are advantageous for cold survival.

Development of machine learning models for the screening of potential HSP90 inhibitors.

Heat shock protein 90 (Hsp90) is a molecular chaperone playing a significant role in the folding of client proteins. This cellular protein is linked to the progression of several cancer types, including breast cancer, lung cancer, and gastrointestinal stromal tumors. Several oncogenic kinases are Hsp90 clients and their activity depends on this molecular chaperone. This makes HSP90 a prominent therapeutic target for cancer treatment. Studies have confirmed the inhibition of HSP90 as a striking therapeutic treatment for cancer management. In this study, we have utilized machine learning and different in silico approaches to screen the KCB database to identify the potential HSP90 inhibitors. Further evaluation of these inhibitors on various cancer cell lines showed favorable inhibitory activity. These inhibitors could serve as a basis for future development of effective HSP90 inhibitors.

Propionate Attenuates Growth of Oral Streptococci through Enhancing Methionine Biosynthesis.

Oral streptococci are considered as an opportunistic pathogen associated with initiation and progression of various oral diseases. However, since the currently-available treatments often accompany adverse effects, alternative strategy is demanded to control streptococci. In the current study, we investigated whether short-chain fatty acids (SCFAs), including sodium acetate (NaA), sodium propionate (NaP), and sodium butyrate (NaB), can inhibit the growth of oral streptococci. Among the tested SCFAs, NaP most potently inhibited the growth of laboratory and clinically isolated strains of Streptococcus gordonii under anaerobic culture conditions. However, the growth inhibitory effect of NaP on six different species of other oral streptococci was different depending on their culture conditions. Metabolic changes such as alteration of methionine biosynthesis can affect bacterial growth. Indeed, NaP enhanced intracellular methionine levels of oral streptococci as well as the mRNA expression level of methionine biosynthesis-related genes. Collectively, these results suggest that NaP has an inhibitory effect on the growth of oral streptococci, which might be due to alteration of methionine biosynthesis. Thus, NaP can be used an effective bacteriostatic agent for the prevention of oral infectious diseases caused by oral streptococci.

Economic Evaluation of Pharmacist-Led Digital Health Interventions: A Systematic Review.

There has been growing interest in integrating digital technologies in healthcare. The purpose of this study was to systematically review the economic value of pharmacist-led digital interventions. PubMed, Web of Science, and the Cochrane databases were searched to select studies that had conducted economic evaluations of digital interventions by pharmacists for the period from January 2001 to February 2022. Economic evidence from 14 selected studies was synthesized in our analysis. Pharmacists used telephones, computers, web-based interventions, videotapes, smartphones, and multiple technologies for their digital interventions. Prior studies have reported the results of telephone-based interventions to be cost-effective. Alternatively, these interventions were found to be cost-effective when reevaluated with recently cited willingness-to-pay thresholds. In addition, pharmacist-led interventions based on computers, web-based interventions, smartphones, and multiple technologies have been reported to be cost-effective in previous studies. However, videotape-based intervention was found cost-ineffective because there was no significant difference in outcomes between the intervention and the usual care groups. If this intervention had been intensive enough to improve outcomes in the intervention group, favorable cost-effectiveness results could have been obtained. The economic evidence in the previous studies represented short-term economic values. Economic evaluations of the long-term value of digital interventions are warranted in future studies.

Thermotherapy as an alternative to exercise for metabolic health in obese postmenopausal women: focus on circulating irisin level.

Irisin is a myokine caused by exercise that improves insulin resistance and weight loss. However, under unfavorable conditions such as air pollution, and during the pandemic, outdoor activities are uncomfortable. Therefore, in this study, the effect of heat therapy (half bath 42 ± 0.5°C for 30 min) on irisin circulation levels as an exercise alternative for middle-aged obese women after menopause was investigated. Subjects were 33 women aged 49.54 ± 6.04 years, with parameters of height, 160.12 ± 4.33 cm, weight, 69.71 ± 7.52 kg, body surface area 1.73 ± 0.13 m2, body mass index, 27.19 ± 3.40 kg/m2. The results suggest that circulating irisin levels showed a significant increase after one-time thermotherapy (TH-1). However, the increase in circulating irisin levels after 15 treatments (TH-15, 5 days/week, 3 weeks) was significantly varied. The level of adiponectin, which increases fatty oxidation to reduce fatty deposition, increased significantly at TH-1, but further increased at TH-15, which was significantly different from the level of TH-1. In addition, the basic serum free fatty acid (FFA) level was significantly increased at TH-15 compared to TH-1. Significant differences were also found in the lipid profile (body mass index, waist circumference, and % body fat). Thermotherapy can significantly increase the tympanic temperature and induce changes in circulating irisin and adiponectin levels. Thus, it resulted in positive changes in FFA and lipid profiles. Therefore, repeated thermotherapy is effective in increasing circulating irisin levels in postmenopausal obese women.

Examining the Theory of Motivated Information Management (TMIM) in the COVID-19 Pandemic.

In order to inform understanding of the public's health information management during the COVID-19 pandemic, we applied a modification of TMIM from a serial mediation model to a conditional process model (moderated mediation). In doing so, the current study attempted to refine some of the relational propositions of the original TMIM with a focus on efficacy while addressing the distinction between a mediator and a moderator in a behavioral decision model. Findings from an online survey of U.S. adults (n = 488) demonstrated that anxiety can positively motivate evaluation of information seeking during the COVID-19 pandemic context, a unique context of application for TMIM. Efficacy was found to be qualified as an individual difference variable that moderates the relationships of uncertainty perception and health decision. Our newly proposed conditional process framework of the TMIM opens research directions in health information-seeking and encourages researchers to continuously incorporate updated methodological thought and approach in applying and building communication theory.

Effects of caffeine ingestion and thermotherapy on blood orexin circulation in humans.

Caffeine and orexin can affect awakening, neuroendocrine, and sympathetic nerve function. Our previous study has reported that caffeine intake can increase human body temperature. However, little is known about the combined effects of thermotherapy and caffeine intake on human serum orexin concentrations. Forty-two healthy male subjects with age of 26.72 ± 5.05 years, height of 174.10 ± 7.09 cm, and body weight of 74.68 ± 8.91 kg participated in this study. They were randomly assigned to a control (CON) group (n = 21) and a caffeine (CAFF) group (n = 21). After thermotherapy (half-body immersion in a hot water bath at 42 ± 0.5 °C, circulating orexin level increased more (p < 0.05) in the CAFF group than in the CON group. Positive relationships between mean body temperature and orexin were observed before and after heat stimulation (p < 0.001). Caffeine intake boosted the upregulation of serum orexin concentrations in subjects undergoing thermotherapy.

Digital Health Interventions by Clinical Pharmacists: A Systematic Review.

Integrating digital interventions in healthcare has gained increasing popularity among clinical pharmacists (CPs) due to advances in technology. The purpose of this study was to systematically review CP-led digital interventions to improve patients' health-related clinical outcomes. PubMed and the Cochrane Database were searched to select studies that had conducted a randomized controlled trial to evaluate clinical outcomes in adults following a CP-led digital intervention for the period from January 2005 to August 2021. A total of 19 studies were included in our analysis. In these 19 studies, the most commonly used digital intervention by CPs was telephone use (n = 15), followed by a web-based tool (n = 2) and a mobile app (n = 2). These interventions were provided to serve a wide range of purposes in patients' outcomes: change in lab values (e.g., blood pressure, HbA1c) (n = 23), reduction in health service use (n = 8), enhancing adherence (n = 6), improvement in drug-related outcomes (n = 6), increase in survival (n = 3), and reduction in health-related risk (e.g., CVD risk) (n = 2). Although the impacts of telephone-based interventions on patients' outcomes were decidedly mixed, web-based interventions and mobile apps exerted generally positive influences. To date, little research has investigated the cost-effectiveness of digital interventions. Future studies are warranted.