Combination Effect of Novel Bimetallic Ag-Ni Nanoparticles with Fluconazole against Candida albicans.

The increasing frequency of antifungal drug resistance among pathogenic yeast "Candida" has posed an immense global threat to the public healthcare sector. The most notable species of Candida causing most fungal infections is Candida albicans. Furthermore, recent research has revealed that transition and noble metal combinations can have synergistic antimicrobial effects. Therefore, a one-pot seedless biogenic synthesis of Ag-Ni bimetallic nanoparticles (Ag-Ni NPs) using Salvia officinalis aqueous leaf extract is described. Various techniques, such as UV-vis, FTIR, XRD, SEM, EDX, and TGA, were used to validate the production of Ag-Ni NPs. The antifungal susceptibility of Ag-Ni NPs alone and in combination with fluconazole (FLZ) was tested against FLZ-resistant C. albicans isolate. Furthermore, the impacts of these NPs on membrane integrity, drug efflux pumps, and biofilms formation were evaluated. The MIC (1.56 µg/mL) and MFC (3.12 µg/mL) results indicated potent antifungal activity of Ag-Ni NPs against FLZ-resistant C. albicans. Upon combination, synergistic interaction was observed between Ag-Ni NPs and FLZ against C. albicans 5112 with a fractional inhibitory concentration index (FICI) value of 0.31. In-depth studies revealed that Ag-Ni NPs at higher concentrations (3.12 µg/mL) have anti-biofilm properties and disrupt membrane integrity, as demonstrated by scanning electron microscopy results. In comparison, morphological transition was halted at lower concentrations (0.78 µg/mL). From the results of efflux pump assay using rhodamine 6G (R6G), it was evident that Ag-Ni NPs blocks the efflux pumps in the FLZ-resistant C. albicans 5112. Targeting biofilms and efflux pumps using novel drugs will be an alternate approach for combatting the threat of multi-drug resistant (MDR) stains of C. albicans. Therefore, this study supports the usage of Ag-Ni NPs to avert infections caused by drug resistant strains of C. albicans.

A 66-Year-Old Man Presenting with Port-Site Metastatic Gastric Adenocarcinoma 4 Years After Laparoscopic Resection of a Rectal Adenocarcinoma.

BACKGROUND There is a recognized association between synchronous and metachronous colorectal and gastric adenocarcinoma. This report describes a 66-year-old man presenting with port-site metastatic gastric adenocarcinoma 4 years after laparoscopic resection of a rectal adenocarcinoma. CASE REPORT A 66-year-old male rectal cancer survivor presented to the clinic with a painless mass at the previous laparoscopic anterior resection port site. Physical examination revealed a soft port-site mass measuring 5×4 cm. Abdominal CT revealed enlargement of the right rectus abdominis muscle and thickening of the gastric fundus. A biopsy of the right abdominal wall mass revealed metastatic adenocarcinoma. Immunohistochemistry (IHC) testing was positive for cytokeratin 7 (CK7) and CDx2 and negative for cytokeratin 20 (CK20). The possible primary malignancy was upper gastrointestinal, and it was less likely to be colorectal in origin. Subsequently, the upper endoscopy revealed a friable, erythematous gastric mucosa. Biopsy revealed an invasive moderately differentiated gastric adenocarcinoma with positive IHC for CK7 and CDx2 and negative for CK20. The rectal adenocarcinoma pathology slides were reviewed, and IHC testing showed negative CK7 and positive CK20. Patient was known to have multiple comorbidities with poor functional status. The tumor board decision was made to manage him palliatively with best supportive care for the diagnosis of metastatic gastric cancer. CONCLUSIONS This report has presented a case of possible metachronous gastric adenocarcinoma with port-site metastasis following resection of a rectal adenocarcinoma. Clinicians should be aware of the association between synchronous and metachronous colorectal and gastric adenocarcinoma and the challenges associated with the diagnosis.

How Does the Remaining Single Kidney Cope After Contralateral Nephrectomy of the Kidney Donor? A Single-Center Cohort Study.

Introduction Immediately after kidney donation, the remaining kidney will undergo hyperfiltration and work at a higher level to compensate for the other kidney's loss. It is estimated that 70% of the baseline renal function before the donation is recovered post-donation. However, factors that determine the post-donation renal compensation are not well understood. Methods We conducted a retrospective study of 190 consecutive kidney donors who completed a one-year follow-up in order to predict the factors affecting the function of the remaining kidney post-contralateral nephrectomy. Results We enrolled 190 living kidney donors who had completed at least one year of follow-up after nephrectomy. Among the participants, 149 (78.4%) were males and 41 (21.6%) were females. The mean age of the participants was 31.33 ±7.9 years and the mean body mass index (BMI) was 25.6 ±3.9 kg/m2. Before kidney donation, the mean estimated glomerular filtration rate (eGFR) and serum creatinine were 114.31 ±15.94 ml/min/1.73 m2 and 71.60 ±10.62 mmol/min, respectively. At the one-year follow-up, the mean eGFR was 77.97 ±14.44 ml/min/1.73 m2 and serum creatinine was 100.84 ±20.15 mmol/min. The female gender [odds ratio (OR): 20.6, 95% CI: 3.9-107.7, p: <0.001] and having a higher baseline eGFR (OR: 8.8, 95% CI: 1.6-45.8, p = 0.01) were found to be significant predictors of having a better eGFR at one year post-nephrectomy. Conclusions Female gender and pre-donation low serum creatinine and high eGFR were the significant predictors of better kidney function at one year post-contralateral nephrectomy. However, further studies with longer follow-up durations are needed to better assess the factors that could predict renal compensation and the renal compensation rate's suitability as a prognostic measure for long-term renal outcomes.

The Prediabetes Outcome at National Guard Primary Health Care Centers in Riyadh, Saudi Arabia: Retrospective Chart Review.

Objectives To identify the outcome of prediabetes and the interventions that have been implemented for prediabetic patients at primary healthcare centers (PHCs) affiliated with King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methodology This retrospective chart-review study was carried out using the BestCare electronic health records (EHRs) system. Data from the PHCs of King Abdulaziz Medical City, Riyadh, Saudi Arabia were extracted. Inclusion criteria were patients with prediabetes who were diagnosed between January 2015 and December 2016, with at least one follow-up visit. Variables included demographics, comorbidities, blood sugar lab results, and lipid profile measurements at each visit and intervention at the time of the initial diagnosis. Fisher's Exact test, sign test, and Kruskal-Wallis test were used to assess the differences for non-normally-distributed variables, while a paired t-test was conducted for paired and normally distributed continuous variables. Data were analyzed using the statistical program SAS, version 9.4 (SAS Institute Inc. Cary, NC). Result Of the 92 patients followed up with for three years, 76.08% remained in the prediabetic range, while 16.4% regressed to a normal glycemic state (NGS) and 7.6% progressed to the diabetic range after intervention and follow-up for three years. Metformin use was not significant in the glycemic outcome. In comparison to the baseline, there was a considerable reduction in fasting blood sugar (FBS) and glycosylated hemoglobulin A1c (HbA1c) at the end of the follow-up. Conclusion We found that most of the patients remained in the prediabetic range after the three-year follow-up, with or without intervention. A commonly prescribed pharmacological intervention like metformin showed no regression benefit in most patients. More extensive prospective studies are needed to evaluate the outcome and adherence to different interventions.