Knowledge and Attitudes Toward Pressure Ulcer Prevention Evidence-based Guidelines among Nursing Students at Jazan University, Saudi Arabia.

BACKGROUND: Pressure ulcers (PUs) are a common global problem. They affect health-care costs and patient health because of increased morbidity and mortality rates. Critically ill patients are more prone to acquiring PUs than other patients. As the prevalence of PUs is high in Saudi Arabia, more attention is required for PU prevention. Nurses' knowledge and attitudes toward PU prevention are crucial. AIMS: This study aimed to assess the knowledge and attitudes of nursing students regarding PU prevention evidence-based guidelines. SETTING AND DESIGN: This descriptive, cross-sectional study was conducted among nursing students at Jazan University. MATERIALS AND METHODS: Data were collected using an electronic questionnaire. STATISTICAL ANALYSIS USED: Data were entered, coded, and analyzed using the SPSS version 23. RESULTS: A total of 378 participants were included. The mean age was 22.4 ± 3.4 years, and the mean knowledge score was 7.6 ± 2.64 (range = 0-16). Of the participants, 365 (96.6%) and 13 (3.4%) were considered to have poor and good knowledge about PUs, respectively. Only 72 (19%) correctly identified a lack of oxygen as the cause of PUs; other participants answered malnutrition and moisture. Conversely, 200 (52.9%) participants indicated that recent weight loss below patients' ideal weight increases the risk for PUs. Concerning knowledge about preventive measures, 64 (16.9%) participants correctly answered that a backward sitting position, with both legs resting on a footrest, can reduce the amount of pressure. Meanwhile, 169 (44.7%) participants correctly selected thick air cushion as a means to reduce the magnitude of pressure when patients are sliding down on a chair. Some participants answered that PUs can be reduced if patients are mobilized. Seventy-two (19%) participants indicated that patients laying on a visco-elastic foam mattress should be repositioned every 2 h to reduce the duration of pressure. Age, year of education, training experience, and department were not significantly associated with knowledge about PUs (P = 0.333, P = 0.370, P = 0.700, and P = 0.810, respectively). CONCLUSIONS: The general knowledge and attitudes toward PUs of the nursing students at Jazan University were poor. Nevertheless, they had an average knowledge level regarding PU prevention. Age and training experience were not significantly associated with knowledge about PUs.

Résumé Contexte:Les ulcères de pression (UP) sont un problème mondial courant. Ils affectent les coûts de santé et la santé des patients en raison de l'augmentation des taux de morbidité et de mortalité. Les patients gravement malades sont plus susceptibles de développer des UP que d'autres patients. Comme la prévalence des UP est élevée en Arabie saoudite, une attention accrue est nécessaire pour la prévention des UP. Les connaissances et attitudes des infirmiers en matière de prévention des UP sont cruciales.Objectifs:Cette étude visait à évaluer les connaissances et attitudes des étudiants en soins infirmiers concernant les directives de prévention des UP basées sur des preuves. Cadre et conception : Cette étude descriptive et transversale a été menée auprès des étudiants en soins infirmiers de l'Université de Jazan.Matériels et méthodes:Les données ont été collectées à l'aide d'un questionnaire électronique. Analyse statistique utilisée: Les données ont été saisies, codées et analysées à l'aide de la version 23 du logiciel SPSS.Résultats:Au total, 378 participants ont été inclus. L'âge moyen était de 22,4 ± 3,4 ans et le score moyen de connaissance était de 7,6 ± 2,64 (plage = 0-16). Parmi les participants, 365 (96,6 %) avaient une connaissance médiocre et 13 (3,4 %) une bonne connaissance des UP. Seuls 72 (19 %) ont correctement identifié un manque d'oxygène comme étant la cause des UP; les autres participants ont répondu la malnutrition et l'humidité. En revanche, 200 (52,9 %) participants ont indiqué qu'une perte de poids récente en dessous du poids idéal des patients augmente le risque de UP. En ce qui concerne les connaissances sur les mesures préventives, 64 (16,9 %) participants ont répondu correctement qu'une position assise inclinée vers l'arrière, avec les deux jambes reposant sur un repose-pieds, peut réduire la pression. Pendant ce temps, 169 (44,7 %) participants ont correctement sélectionné un coussin d'air épais comme moyen de réduire l'ampleur de la pression lorsque les patients glissent sur une chaise. Certains participants ont répondu que les UP peuvent être réduits si les patients sont mobilisés. Soixante-douze (19 %) participants ont indiqué que les patients allongés sur un matelas en mousse viscoélastique devraient être repositionnés toutes les 2 heures pour réduire la durée de la pression. L'âge, l'année d'éducation, l'expérience de formation et le département n'étaient pas significativement associés aux connaissances sur les UP (P = 0,333, P = 0,370, P = 0,700 et P = 0,810, respectivement).Conclusions:Les connaissances générales et les attitudes à l'égard des UP des étudiants en soins infirmiers de l'Université de Jazan étaient médiocres. Néanmoins, ils avaient un niveau de connaissance moyen concernant la prévention des UP. L'âge et l'expérience de formation n'étaient pas significativement associés aux connaissances sur les UP.

Dissecting the stability of Atezolizumab with renewable amino acid-based ionic liquids: Colloidal stability and anticancer activity under thermal stress.

Monoclonal antibodies (mAbs) have revolutionised the biopharmaceutical market. Being proteinaceous, mAbs are prone to chemical and physical instabilities. Various approaches were attempted to stabilise proteins against degradation factors. Ionic liquids (ILs) and deep eutectic solvents (DESs) have been established as green solvents for ever-increasing pharmaceutical and biopharmaceutical applications. Hence, amino acid (AA)-based ILs, were used for the first time, for mAb stabilisation. Choline (Ch)-based DESs were also utilised for comparison purposes. The prepared ILs and DESs were utilised to stabilise Atezolizumab (Amab, anti-PDL-1 mAb). The formulations of Amab in ILs and DESs were incubated at room temperature, 45 or 55 °C. Following this, the structural stability of Amab was appraised. Interestingly, Ch-Valine retained favourable structural stability of Amab with minimal detected aggregation or degradation as confirmed by UV-visible spectroscopy and protein Mass Spectroscopy. The measured hydrodynamic diameter of Amab in Ch-Valine ranged from 10.40 to 11.65 nm. More interestingly, the anticancer activity of Amab was evaluated, and Ch-Valine was found to be optimum in retaining the activity of Amab when compared to other formulations, including the control Amab sample. Collectively, this study has spotlighted the advantages of adopting the Ch-AA ILs for the structural and functional stabilising of mAbs.

Numerical and experimental investigation of heat transfer enhancement in double tube heat exchanger using nail rod inserts.

The Double-tube heat exchanger (DTHX) is widely favored across various industries due to its compact size, low maintenance requirements, and ability to operate effectively in high-pressure applications. This study explores methods to enhance heat transfer within a DTHX using both experimental and numerical approaches, specifically by integrating a nail rod insert (NRI). A steel nails rod insert, 1000 mm in length, is introduced into the DTHX, which is subjected to turbulent flows characterized by Reynolds numbers ranging from 3200 to 5700. Three different pitches of NRI (100 mm, 50 mm, and 25 mm) are investigated. The results indicate a significant increase in the Nusselt (Nu) number upon the insertion of nail rods, with further improvements achievable by reducing the pitch length. Particularly noteworthy is the Nu number enhancement ratio for the 25 mm pitch NRI, which is 1.81-1.9 times higher than that for the plain tube. However, it is observed that pressure drop increases in all configurations with NRI due to heightened turbulence and obstruction by the NRI. Among the various pitch lengths, the 25 mm pitch exhibits the highest pressure drop values. Moreover, exergy efficiency is found to improve across all cases with NRI, corresponding to increased heat transfer, with the 25 mm pitch length showing a remarkable 128% improvement. Numerical analysis reveals that the novel insert enhances flow turbulence through the generation of secondary flows, thereby enhancing heat transfer within the DTHX. This study provides a comprehensive analysis, including temperature, velocity, and pressure drop distributions derived from numerical simulations.

Levofloxacin-Fatty Acid Systems: Dual Enhancement Through Deep Eutectic Formation and Solubilization for Pharmaceutical Potential and Antibacterial Activity.

Fatty acids, including medium-chain saturated and polyunsaturated fatty acids, are known for their broad health benefits, including antimicrobial activity. Through their green properties, deep eutectic systems have been heralded as having the potential to be at the forefront of pharmaceutical applications. In this work, capric acid and geranic acid, two examples of medium-chain saturated and polyunsaturated fatty acids, were employed to enhance the pharmaceutical properties and the antibacterial activity of levofloxacin. To this end, levofloxacin formulations with either capric or geranic acid were prepared and characterized using appropriate techniques. Levofloxacin was utilized to create innovative deep eutectic systems in conjunction with capric acid at three different molar ratios: 1:9, 2:8 and 3:7. This was confirmed through a rigorous analysis involving nuclear magnetic resonance, infrared spectroscopy and differential scanning calorimetry. Furthermore, it is noteworthy that geranic acid demonstrated an impressive threefold improvement in levofloxacin's solubility compared to its solubility in aqueous solutions. The antibacterial activity of the novel combinations of levofloxacin with either fatty acid was evaluated using a checkerboard titration assay. Gratifyingly, both formulations exhibited synergistic effects against a panel of levofloxacin-sensitive and resistant Gram-negative bacteria. In conclusion, the observed superior antibacterial activity of levofloxacin illuminates the potential use of fatty acid-based formulations and deep eutectic systems as green and innovative strategies to combat the global antimicrobial resistance problem.

The Diagnostic Utility of Natural Killer Cell Subsets in Deep Vein Thrombosis.

Background: Natural killer (NK) cells are important components of adaptive and innate immune responses. NK cell subsets have different functions and may play a role in vascular disorders. This study aimed to evaluate the proportions of NK cells and their subsets to determine whether they can be used as markers of venous thrombosis and to identify whether there was a link between NK cell proportion and citrullinated histone (H3) levels. Patients and Methods: This study included 100 participants divided into Group I (n=50, patients with deep venous thrombosis (DVT)) and Group II (n=50, age- and sex-matched healthy controls). Group I was further categorized into Group Ia (n=25, patients with acute DVT) and Group Ib (n=25, patients with chronic DVT). The proportions of NK cells and their subsets were evaluated by flow cytometry using CD3/CD16/CD56. The levels of citrullinated histones (H3) were estimated using enzyme-linked immunosorbent assay (ELISA). Results: Compared to the control group, DVT patients had a significantly lower proportion of (CD56 dim/CD16+) NK cells, a significantly higher proportion of (CD56-/CD16+) NK cells and a high level of citrullinated histone (H3). Conclusion: NK cell subsets and citrullinated histone (H3) could be used as markers for DVT and as targets for therapeutic drugs to inhibit the formation or progression of thrombosis.

Psychotropic Medication Adherence and Its Associated Factors Among Schizophrenia Patients: Exploring the Consistency of Adherence Scales.

Background and objective Non-adherence to psychotropic medication can aggravate an individual's illness, diminish treatment efficacy, or make patients less responsive to future therapeutic interventions. There are several scales available to measure non-adherence to medications. In this study, we aimed to measure psychotropic medication adherence and its associated factors among schizophrenic outpatients in Saudi Arabia. Methodology A cross-sectional study was conducted with a view to measuring psychotropic medication adherence and its associated factors. The Medication Adherence Rating Scale (MARS) and the Drug Attitude Inventory-10 (DAI-10) were translated into Arabic, and their internal consistency was measured. The adjusted odds ratios (AOR) were calculated using logistic regression in the IBM SPSS Statistics software version 23 (IBM Corp., Armonk, NY). Results Spearman's rho correlation indicated a negative association between DAI-10 and MARS scores (r = -0.579; p<0.05). The Arabic version of MARS was more reliable than DAI-10, as evidenced by Cronbach's alpha value. Of note, 60.20% (n = 59) of the sample demonstrated high adherence levels. The adherence level based on MARS scoring remained unaffected (p>0.05) in terms of gender, age, employment, marital status, educational level, income level, and duration of sickness. These results were obtained by using the multivariate logistic regression model; 89% of respondents reported not using psychiatric drugs given by someone else, despite the adherence rate not affecting this number. Conclusion The rate of non-adherence to psychotropic treatment was found to be high in our cohort. Hence, it is imperative to develop comprehensive intervention methods targeting the causes of non-adherence to psychiatric medication.

The Correlation Between C-Peptide and Severity of Peripheral Atherosclerosis in Type 2 Diabetes Mellitus.

Background: One of the major issues affecting global health is Diabetes mellitus (DM), not only in terms of the disease itself but also its complications. Macrovascular complications are both common and serious, affecting many patients. This study aimed to assess fasting C-peptide levels and correlate them with the severity of the peripheral arterial disease complicating type 2 DM (T2DM). Patients and Methods: This study included 200 participants who were categorized into two groups: Group I (n=100, patients with T2DM complicated by femoropopliteal arterial atherosclerosis) and Group II (n=100, healthy age- and sex-matched individuals serving as controls). Fasting C-peptide levels were estimated using an immunochemiluminometric assay. Results: Fasting C-peptide levels were significantly higher in Group I than in the control group. Fasting C-peptide levels were positively correlated with the severity of atherosclerosis. In addition, the receiver operating characteristic (ROC) curve analysis revealed that fasting C-peptide levels served as a specific and sensitive marker for detecting the severity of this disease. Conclusion: Fasting C-peptide levels can be used as a sensitive and specific indicator of the severity of femoropopliteal arteriosclerosis that complicates T2DM.

Cancer-related post-treatment pain and its impact on treatment satisfaction with medication in women with breast cancer: a cross-sectional study from Palestine.

BACKGROUND: Pain after therapy is an important clinical problem in patients with breast cancer. Unfortunately, cancer patients have a lower quality of life due to inadequate treatment of posttreatment pain; therefore, improving medication management plans and palliative care has become one of the most important targets of cancer therapy. Therefore, the current study aimed to examine the impact of posttreatment pain on medication satisfaction in patients with various stages of breast cancer in Palestine. METHODS: A cross-sectional analytical study was conducted et al.-Watani Hospital and An-Najah National University Hospital in the Nablus area. Using the Brief Pain Inventory (BPI), the intensity and interference of pain were evaluated. In addition, patients' satisfaction with cancer management medications was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM). RESULTS: Two hundred fifty-four patients were included in this study. All were women, with a mean ± SD age of 53.1 ± 10.7 years. The median score for pain severity was 7.0. Pain in the lower extremities was the most reported location. There was a negative association between the global satisfaction domain and the presence of posttreatment pain (p < 0.001). Furthermore, significant differences and negative correlations were found between global satisfaction and posttreatment pain on the day of the interview (p = 0.001), pain medication (p < 0.001), paracetamol use (p < 0.001), and the presence of side effects (p = 0.003). There were significant negative correlations (p < 0.05) between pain severity and interference with effectiveness (r = -0.258, -0.319, respectively), side effects (r = -0.414, -0.514, respectively), convenience (r = -0.274, -0.307, respectively), and global satisfaction domain scores (r = -0.293, -0.287, respectively). Exposure to chemotherapy was the only significant positive correlation with global satisfaction (p = 0.007). The regression analysis results indicated an independent association between chemotherapy use and a higher global satisfaction score (p = 0.011). CONCLUSIONS: Patients with posttreatment pain, side effects, and greater interference of pain with their functioning had lower satisfaction scores. Therefore, better management of their treatment medications, side effects, and pain medications is recommended to enhance their satisfaction and quality of life. Several aspects of palliative care should be organized to improve the patient's satisfaction and quality of life in addition to conducting longitudinal studies to evaluate the pain and satisfaction of different types of cancers.

Factors Affecting Awareness of Pregnancy Screening for Group B Streptococcus Infection Among Women of Reproductive Age in Jazan Province, Saudi Arabia.

Background: Group B streptococcus (GBS) infection is one of the leading causes of neonatal sepsis and meningitis. GBS screening and intrapartum antibiotic prophylaxis can effectively prevent early-onset GBS disease. This study aimed to assess the awareness of the risks of GBS infection and screening in Jazan Province, Saudi Arabia. Methodology: A cross-sectional study was conducted using a survey of 995 women aged 18-45 in Jazan, Saudi Arabia. Data were collected between January to April 2023 and included information on sociodemographic characteristics, awareness of GBS infection, and perspectives on GBS screening. Results: The response rate was 97.45%, and the mean age of the participants was 31.50 ± 9.80 years. Most were married (60.2%), had a university education (81.11%), and 59% were pregnant or had a pregnancy history. Only 23% had heard of GBS, associated with age, marital status, job, pregnancy status, awareness of GBS risk factors, and pregnancy follow-up (p < 0.05). Women most aware were students (55.9%), married (55.46%), pregnant or had a pregnancy history (51.09%), knew risk factors of GBS (38.86%), and were followed by a specialist (88.14%). Regarding GBS screening preferences, 40% preferred universal screening without consent, 31% with consent, 16% for high-risk pregnancies with consent, and 13% for high-risk pregnancies without consent. Conclusion: The study found low awareness of GBS among women residing in Jazan, Saudi Arabia. Factors related to demographic details and obstetric follow-up were associated with better understanding. Most women preferred universal screening for GBS, with or without consent. Effective health education is needed to raise women's awareness of screening benefits and risks. This education can help women make informed decisions and improve prevention and care. Future studies may evaluate healthcare providers' awareness of GBS.

Non-classical monocytes frequency and serum vitamin D3 levels are linked to diabetic foot ulcer associated with peripheral artery disease.

AIMS/INTRODUCTION: Peripheral artery disease (PAD) serves as a risk factor for diabetic foot ulcers (DFUs). PAD pathology involves atherosclerosis and impaired immunity. Non-classical monocytes are believed to have an anti-inflammatory role. 1,25-Dihydroxy vitamin D (vitamin D3 ) is claimed to have immune-modulating and lipid-regulating roles. Vitamin D receptor is expressed on monocytes. We aimed to investigate if circulating non-classical monocytes and vitamin D3 were implicated in DFUs associated with PAD. MATERIALS AND METHODS: There were two groups of DFU patients: group 1 (n = 40) included patients with first-degree DFUs not associated with PAD, and group 2 (n = 50) included patients with DFU with PAD. The monocyte phenotypes were detected using flow cytometry. Vitamin D3 was assessed by enzyme-linked immunosorbent assay. RESULTS: DFU patients with PAD showed a significant reduction in the frequency of non-classical monocytes and vitamin D3 levels, when compared with DFU patients without PAD. The percentage of non-classical monocytes positively correlated with vitamin D3 level (r = 0.4, P < 0.01) and high-density lipoprotein (r = 0.5, P < 0.001), whereas it was negatively correlated with cholesterol (r = -0.5, P < 0.001). Vitamin D3 was negatively correlated with triglyceride/high-density lipoprotein (r = -0.4, P < 0.01). Regression analysis showed that a high vitamin D3 serum level was a protective factor against PAD occurrence. CONCLUSIONS: Non-classical monocytes frequency and vitamin D3 levels were significantly reduced in DFU patients with PAD. Non-classical monocytes frequency was associated with vitamin D3 in DFUs patients, and both parameters were linked to lipid profile. Vitamin D3 upregulation was a risk-reducing factor for PAD occurrence.

Adherence to oral anticancer hormonal therapy in breast cancer patients and its relationship with treatment satisfaction: an important insight from a developing country.

BACKGROUND: Hormone-positive breast cancer is the most common type and represents a burden in all countries. Treatment satisfaction might be a predictor for adherence, as higher satisfaction with medication encourages patients to adhere appropriately to the medication and, consequently, successfully achieve the treatment goals. The present study evaluated the adherence of women with hormone-positive breast cancer to oral hormonal drugs and correlated it with treatment satisfaction and other sociodemographic and clinical factors. METHODS: A cross-sectional design was applied. This study included two cancer centers. Data were collected from patients through face-to-face interviews and medical record reviews. The Medication Adherence Scale was adapted to assess medication adherence, and the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4 was adopted to measure treatment satisfaction. RESULTS: The final analysis included 106 patients, with a mean age ± SD of 51.9 ± 1.2. Approximately 35% were hospitalized in the past year. Current hormonal therapy among cancer patients included letrozole (38.7%), tamoxifen (31.1%), exemestane (17%), and anastrozole (13.2%). The median adherence score was 5.0 [4.8-6.0], and 62.3% adhered fully to their oral hormonal drugs in the past week. The median scores of effectiveness, side effects, convenience, and global satisfaction were 66.67 [61.11.0-72.22], 75.00 [48.44-100.00], 66.67 [66.67-72.22], and 71.43 [57.14-78.57], respectively. A significantly lower adherence score was identified in patients living in camps (p = 0.020). Patients with comorbidities and those who continued on the same hormonal therapy had higher adherence scores, although they were not statistically significant. Multiple linear regression analysis showed that two domains of treatment satisfaction, side effects (p = 0.013) and global satisfaction (p = 0.018), were predictors of adherence to oral hormonal drugs. CONCLUSIONS: The current study revealed a significant association between treatment satisfaction and adherence to oral hormonal therapy. We recommend creating a specialized scale to measure adherence, considering the psychosocial factors that affect hormonal anticancer medication adherence.

Impact of an antibiotic stewardship program on antibiotic utilization, bacterial susceptibilities, and cost of antibiotics.

Antimicrobial misuse is a worldwide issue, and antimicrobial resistance is considered the most challenging aspect of health care. It has been reported that as much as 30-50% of antimicrobials prescribed in hospitals are deemed unnecessary or inappropriate. Antibiotic stewardship programs (ASPs) include policies that apply continuous management of judicious anti-infectious treatment in the clinical setting. Therefore, the objectives of this study were to evaluate the effect of ASPs on antibiotic consumption, the costs of antibiotic expenditure, and the sensitivity of antimicrobials. A retrospective, quasi-experimental study was performed to assess the effect of ASP at An-Najah National University Hospital, a tertiary care hospital in the West Bank, Palestine, over a period of 20 months before and 17 months after the implementation of the ASP. Data on antibiotic consumption were reported monthly as days of therapy per 1000 patient-days and monthly costs (USD/1000 patient-days). A total of 2367 patients who received one or more of the targeted antibiotics (meropenem, colistin and tigecycline) during their hospital stay were included in the study. They have split into two groups: 1710 patients in the pre-ASP group, and 657 patients in the post ASP group. The most significant reduction in DOT per 1000 patient-days was seen with tigecycline, with a percentage of change of - 62.08%. Furthermore, the mean cost of the three antibiotics decreased significantly by 55.5% in the post-ASP phase compared to the pre-ASP phase. After the implementation of ASP, there was a statistically significant increase in susceptibility to meropenem, piperacillin and piperacillin/tazobactam with respect to Pseudomonas aeruginosa. However, changes in mortality rates were not statistically significant (p = 0.057). ASP positively reduced costs and antimicrobial consumption, with no statistically significant effect on the overall mortality rate. However, a long-term evaluation of the ASP's impact is needed to conclude its lasting impact on infection-related mortality and antimicrobial susceptibility pattern.

Impact of Toll-Like Receptor 2 and 9 Gene Polymorphisms on COVID-19: Susceptibility, Severity, and Thrombosis.

Background: Toll-like receptors (TLRs) play an important role in activation of innate and adaptive immune responses. Aim: We aimed to detect the association between TLR2 rs5743708 G>A and TLR9 rs5743836 C>T variants and COVID-19 disease susceptibility, severity, and thrombosis by using neutrophil extracellular traps (NETs). Subjects and Methods: We included 100 adult COVID-19 patients as well as 100 age- and gender-matched normal controls. Participants were genotyped for TLR2 rs5743708 and TLR9 rs5743836. Citrullinated Histone (H3) was detected as an indicator of NETs. Results: The mutant (G/A and C/C) genotypes and (A and C) alleles of TLR2 rs5743708 and TLR9 rs5743836, respectively, have been significantly related to a higher risk of COVID-19 infection, representing a significant risk factor for the severity of COVID-19. There was no significant association between the two variants and citrullinated histone (H3). Conclusion: TLR2 rs5743708 and TLR9 rs5743836 variants have been significantly related to a higher risk and severity of COVID-19 infection but had no effect on thrombus formation.

Predicting SARS-CoV-2 Variant Spread in a Completely Seropositive Population Using Semi-Quantitative Antibody Measurements in Blood Donors.

SARS-CoV-2 serologic surveys estimate the proportion of the population with antibodies against historical variants, which nears 100% in many settings. New approaches are required to fully exploit serosurvey data. Using a SARS-CoV-2 anti-Spike (S) protein chemiluminescent microparticle assay, we attained a semi-quantitative measurement of population IgG titers in serial cross-sectional monthly samples of blood donations across seven Brazilian state capitals (March 2021−November 2021). Using an ecological analysis, we assessed the contributions of prior attack rate and vaccination to antibody titer. We compared anti-S titer across the seven cities during the growth phase of the Delta variant and used this to predict the resulting age-standardized incidence of severe COVID-19 cases. We tested ~780 samples per month, per location. Seroprevalence rose to >95% across all seven capitals by November 2021. Driven by vaccination, mean antibody titer increased 16-fold over the study, with the greatest increases occurring in cities with the highest prior attack rates. Mean anti-S IgG was strongly correlated (adjusted R2 = 0.89) with the number of severe cases caused by Delta. Semi-quantitative anti-S antibody titers are informative about prior exposure and vaccination coverage and may also indicate the potential impact of future SARS-CoV-2 variants.

SARS-CoV-2 antibody dynamics in blood donors and COVID-19 epidemiology in eight Brazilian state capitals: A serial cross-sectional study.

Background: The COVID-19 situation in Brazil is complex due to large differences in the shape and size of regional epidemics. Understanding these patterns is crucial to understand future outbreaks of SARS-CoV-2 or other respiratory pathogens in the country. Methods: We tested 97,950 blood donation samples for IgG antibodies from March 2020 to March 2021 in 8 of Brazil's most populous cities. Residential postal codes were used to obtain representative samples. Weekly age- and sex-specific seroprevalence were estimated by correcting the crude seroprevalence by test sensitivity, specificity, and antibody waning. Results: The inferred attack rate of SARS-CoV-2 in December 2020, before the Gamma variant of concern (VOC) was dominant, ranged from 19.3% (95% credible interval [CrI] 17.5-21.2%) in Curitiba to 75.0% (95% CrI 70.8-80.3%) in Manaus. Seroprevalence was consistently smaller in women and donors older than 55 years. The age-specific infection fatality rate (IFR) differed between cities and consistently increased with age. The infection hospitalisation rate increased significantly during the Gamma-dominated second wave in Manaus, suggesting increased morbidity of the Gamma VOC compared to previous variants circulating in Manaus. The higher disease penetrance associated with the health system's collapse increased the overall IFR by a minimum factor of 2.91 (95% CrI 2.43-3.53). Conclusions: These results highlight the utility of blood donor serosurveillance to track epidemic maturity and demonstrate demographic and spatial heterogeneity in SARS-CoV-2 spread. Funding: This work was supported by Itaú Unibanco 'Todos pela Saude' program; FAPESP (grants 18/14389-0, 2019/21585-0); Wellcome Trust and Royal Society Sir Henry Dale Fellowship 204311/Z/16/Z; the Gates Foundation (INV- 034540 and INV-034652); REDS-IV-P (grant HHSN268201100007I); the UK Medical Research Council (MR/S0195/1, MR/V038109/1); CAPES; CNPq (304714/2018-6); Fundação Faculdade de Medicina; Programa Inova Fiocruz-CE/Funcap - Edital 01/2020 Number: FIO-0167-00065.01.00/20 SPU N°06531047/2020; JBS - Fazer o bem faz bem.

Admission Levels of Serum P-Selectin and IL-6 Can Predict Development of Deep Venous Thrombosis in Hospitalized Covid-19 Patients.

Background and Aim: Deep venous thrombosis (DVT) of the lower extremities is common in Covid-19 patients. Interleukin (IL)-6 and P-selectin were found to be elevated in Covid-19 patients. The current study aimed to evaluate P-selectin and IL6 in Covid-19 patients with DVT and to explore its relation to clinical and laboratory parameters in those patients. Patients and methods: The present retrospective study included 150 hospitalized COVID-19 patients diagnosed on the basis of a positive result of reverse-transcriptase polymerase chain reaction (RT-PCR) test. Laboratory assessments were included for IL-6 and P selectin assessments via enzyme-linked immunosorbent assay. The primary outcome of the present study was the development of DVT detected by Doppler ultrasound (DU) evaluation of the lower extremities during the admission. Results: The present study included 150 hospitalized Covid-19 patients. DVT was developed in 59 patients (39.3%). DVP patients had significantly higher levels of P selectin [76.0 (63.0-87.0) versus 63.0 (54.3-75.0), p < 0.001] and IL-6 [37.0 (27.0-49.0) versus 18.5 (13.5-31.5), p < 0.001]. ROC curve analysis revealed good performance of P selectin [AUC (95% CI): 0.72 (0.64-0.81)] and IL-6 [AUC (95% CI): 0.79 (0.71-0.86)] in identification of DVT. Logistic regression analysis identified the presence of severe disease [OR (95% CI): 9.016 (3.61-22.49), p < 0.001], elevated P selectin [OR (95% CI): 1.032 (1.005-1.059), p = 0.018] and elevated IL-6 [OR (95% CI): 1.062 (1.033-1.091), p < 0.001] as significant predictors of DVT development in multivariate analysis. Conclusion: The present study identified a probable role of elevated P-selectin and IL-6 levels in the DVT development in hospitalized Covid-19 patients.

Predicting SARS-CoV-2 variant spread in a completely seropositive population using semi-quantitative antibody measurements in blood donors

BackgroundSARS-CoV-2 serologic surveys estimate the proportion of the population with antibodies against historical variants which nears 100% in many settings. New analytic approaches are required to exploit the full information in serosurvey data. MethodUsing a SARS-CoV-2 anti-Spike (S) protein chemiluminescent microparticle assay, we attained a semi-quantitative measurement of population IgG titres in serial cross-sectional monthly samples of routine blood donations across seven Brazilian state capitals (March 2021-November 2021). In an ecological analysis (unit of analysis: age-city-calendar month) we assessed the relative contributions of prior attack rate and vaccination to antibody titre in blood donors. We compared blood donor anti-S titre across the seven cities during the growth phase of the Delta variant of concern (VOC) and use this to predict the resulting age-standardized incidence of severe COVID-19 cases. ResultsOn average we tested 780 samples per month in each location. Seroprevalence rose to >95% across all seven capitals by November 2021. Driven proximally by vaccination, mean antibody titre increased 16-fold over the study. The extent of prior natural infection shaped this process, with the greatest increases in antibody titres occurring in cities with the highest prior attack rates. Mean anti-S IgG was a strong predictor (adjusted R2 =0.89) of the number of severe cases caused by the Delta VOC in the seven cities. ConclusionsSemi-quantitative anti-S antibody titres are informative about prior exposure and vaccination coverage and can inform on the potential impact of future SARS-CoV-2 variants. SummaryIn the face of near 100% SARS-CoV-2 seroprevalence, we show that average semi-quantitative anti-S titre predicted the extent of the Delta variants spread in Brazil. This is a valuable metric for future seroprevalence studies.

Efficacy of clofazimine and nitazoxanide combination in treating intestinal cryptosporidiosis and enhancing intestinal cellular regeneration in immunocompromised mice.

Cryptosporidium is a widely distributed food and water-borne enteric protozoan that affects a wide range of vertebrates, resulting in life-threatening consequences, particularly in immunocompromised hosts. The lack of effective anti-cryptosporidial drugs may be related to the parasite's unique intestinal location, plus the lack of studies on the process by which the protozoan is able to impair intestinal cellular function. The present work aimed to assess the effect of clofazimine (CFZ), an FDA-approved drug for the treatment of leprosy, as an anti-cryptosporidial drug, using transmission electron microscopy (TEM) and an immunocompromised mouse model. The affected intestinal mucosa with parasitic stages in the infected non-treated group showed signs of severe cellular degeneration, including the loss of tight junctions, deformed and damaged microvilli and irregularly distributed nuclei with a severely vacuolated cytoplasm. Comparatively, nitazoxanide (NTZ) monotherapy showed the lowest efficacy as the drug was associated with the lowest rate of oocyst shedding. In addition, NTZ treatment failed to achieve the return of complete cellular function; abnormalities were evident in the microvilli, cytoplasmic organelles and nuclear features. Clofazimine demonstrated an improvement of the mucosal cellular components, including mitochondria and significantly reduced oocyst shedding. Combined treatment with low-dose CFZ and half-dose NTZ resulted in a significant improvement in the enterocyte cellular structures with an absence of intracellular parasitic stages. These results indicate that CFZ, a safe and readily prescribed drug, effectively reduces cryptosporidiosis when used in combination with only half the dose of NTZ. Used in combination, these drugs were shown to be efficient in regaining intestinal cellular activity following Cryptosporidium-induced functional damage in an immunocompromised mouse model.

A comprehensive evaluation of potentially significant drug-drug, drug-herb, and drug-food interactions among cancer patients receiving anticancer drugs.

INTRODUCTION: During the cancer treatment path, cancer patients use numerous drugs, including anticancer, supportive, and other prescribed medications, along with herbs and certain products. This puts them at risk of significant drug interactions (DIs). This study describes DIs in cancer patients and their prevalence and predictors. METHODS: A cross-sectional study design was used to achieve the study objectives. The study was carried out in two centers in the northern West Bank, Palestine. The Lexicomp® Drug Interactions tool (Lexi-Comp, Hudson OH, USA) was applied to check the potential DIs. In addition, the Statistical Package for the Social Sciences (SPSS) was used to show the results and find the associations. RESULTS: The final analysis included 327 patients. Most of the participants were older than 50 years (61.2%), female (68.5%), and had a solid tumor (74.6%). The total number of potential DIs was 1753, including 1510 drug-drug interactions (DDIs), 24 drug-herb interactions, and 219 drug-food interactions. Importantly, the prevalence of DDIs was 88.1%. In multivariate analysis, the number of potential DDIs significantly decreased with the duration of treatment (p = 0.007), while it increased with the number of comorbidities (p < 0.001) and the number of drugs used (p < 0.001). CONCLUSIONS: We found a high prevalence of DIs among cancer patients. This required health care providers to develop a comprehensive protocol to monitor and evaluate DIs by improving doctor-pharmacist communication and supporting the role of clinical pharmacists.

Survival From Ninety-Five Percent Total Body Surface Area Burn: A Case Report and Literature Review.

Burns can be devastating and result in unwanted consequences with prolonged length of hospital stay. The mortality rate increases as the total body surface area increases, so proper management of patients with extensive degrees of burns is crucial for their survival. We present the hospital course, management, and survival of a patient after he sustained a 95% total body surface area, second-degree burn from a gas flame. Furthermore, we present from the literature different cases of patients with large total body surface area burns and survived after being managed in burns specialty centers. Although large total body surface area burns can result in significant morbidity and mortality, early management and intervention by an expert surgical team can result in positive outcomes.