Friend and foe: factors influencing the movement of the bacterium Helicobacter pylori along the parasitism-mutualism continuum.

Understanding the transition of bacterial species from commensal to pathogen, or vice versa, is a key application of evolutionary theory to preventative medicine. This requires working knowledge of the molecular interaction between hosts and bacteria, ecological interactions among microbes, spatial variation in bacterial prevalence or host life history, and evolution in response to these factors. However, there are very few systems for which such broad datasets are available. One exception is the gram-negative bacterium, Helicobacter pylori, which infects upwards of 50% of the global human population. This bacterium is associated with a wide breadth of human gastrointestinal disease, including numerous cancers, inflammatory disorders, and pathogenic infections, but is also known to confer fitness benefits to its host both indirectly, through interactions with other pathogens, and directly. Outstanding questions are therefore why, when, and how this bacterium transitions along the parasitism-mutualism continuum. We examine known virulence factors, genetic predispositions of the host, and environmental contributors that impact progression of clinical disease and help define geographical trends in disease incidence. We also highlight the complexity of the interaction and discuss future therapeutic strategies for disease management and public health in light of the longstanding evolutionary history between the bacterium and its human host

Prognostic Factors of Renal Involvement in Systemic Sclerosis

Background/Aims: Renal involvement is common in systemic sclerosis (SSc), including asymptomatic reduction of glomerular filtration rate (GFR), increased renal resistance indices, scleroderma renal crisis (SRC) and ANCA-associated vasculitis. The aim was to evaluate type and evolution of renal involvement for a period of five years. Methods: 121 SSc patients (100 F, 21 M) with mean age of 54.9 ± 13.8, disease duration of 9 ± 6 years, of which 62 had a diffused form and 59 limited form were enrolled. All patients were screened annually for renal function by laboratory examination, ultrasound and color Doppler ultrasound of renal arteries. Results: Over the five-year observation period, 6 SRC (3 M, 3 F) occurred, four of which required dialysis. One patient developed ANCA-related proliferative glomerulonephritis and the other one acute tubular necrosis. The remaining 113 patients had a preserved renal function (serum creatinine 0.75 ± 0.24 mg/dl, GFR 93.8 ± 20 ml/min, 24h proteinuria 0.20 ± 0.15 g). Doppler indices of intrarenal arterial stiffness increased with progression of capillaroscopic damage and with presence of digital ulcers. A negative correlation was observed between estimated GFR and pulsatile index (p< 0,05, r=-0.198), resistive index(p< 0,01, r=0.267), S/D ratio (p< 0,01, r=-0.237). Conclusion: In SSc patients, renal function was normal for 4.1 years despite the presence of increased intrarenal arterial stiffness. SRC was observed in 4.9% of SSc patients. In SSc patients, a periodic follow-up based on clinical and laboratory evaluation, colorDoppler ultrasound and, in some cases, renal biopsy is required to evaluate renal involvement

Valoración de las heridas crónicas en el adulto: una revisión integrativa

Objetivo: Identificar los principales aspectos a valorar en personas adultas con heridas crónicas. Método: Revisión integrativa de la literatura científica publicada, entre 2010 y principios del año 2015, en las bases de datos PubMed y Web Of Science. Resultados: Existe un número muy limitado de estudios que se centraran exclusivamente en la valoración de las heridas. Sin embargo, se encontraron muchos aspectos a tener en cuenta en la valoración de personas con úlceras. Por lo que, estos aspectos fueron agrupados en: factores que afectaban significativamente a la cicatrización o desarrollo de nuevas heridas (como la edad, el estado nutricional, la capacidad funcional o la presencia de cormobilidades), factores psicosociales y aspectos relacionados con la lesión (localización, tamaño, profundidad, tipo de tejido, tiempo de evolución). Conclusión: En general, no se ha encontrado un aspecto único que se deba contemplar en la valoración de las heridas crónicas, sino una compleja interacción de factores que incluyen tanto aspectos fisiológicos, como sociales y psicológicos. De modo que, los profesionales deben ser conscientes de este enfoque multifactorial; para reconocer tempranamente el desarrollo y la evolución de la úlcera, e intervenir consecuentemente.Objective: To identify the main aspects that should be assessed in adults with chronic wounds. Method: This was an integrative review of the scientific literature published between 2010 and early 2015 in the PubMed and Web of Science databases. Results: Few studies exclusively address wound assessment. However, the review found many aspects to consider when assessing individuals with ulcers, grouped as follows: factors that significantly affect healing or the development of new wounds (age, nutritional status, functional capacity, or comorbidities), pyschosocial factors, and wound characteristics (location, size, depth, type of tissue, time of evolution). Conclusion: The literature search did not result in any one aspect that must be considered when assessing chronic wounds, but a complex interaction of factors that include both physiological and social and psychological elements. Professionals should be aware of this multifactorial approach to achieve early detection of the development and evolution of ulcers and to intervene accordingly.Objetivo: Identificar os principais aspectos a ser avaliados em pessoas adultas com feridas crônicas. Método: Revisão integrativa da literatura científica publicada, entre 2010 e princípios do ano 2015, nas bases de dados PubMed e Web Of Science. Resultados: Existe um número muito limitado de estudos que se centraram exclusivamente na avaliação das feridas. No entanto, foram encontrados muitos aspectos a levar em conta na avaliação de pessoas com úlceras. Portanto, esses aspectos foram agrupados em: fatores que afetavam significativamente a cicatrização ou desenvolvimento de novas feridas (como idade, estado nutricional, capacidade funcional ou presença de comorbidades), fatores psicossociais e aspectos relacionadas à lesão (localização, tamanho, profundidade, tipo de tecido, tempo de evolução). Conclusão: Em geral, não foi encontrado um aspecto único que deva ser contemplado na avaliação das feridas crônicas, mas sim uma complexa interação de fatores que incluem tanto aspectos fisiológicos, quanto sociais e psicológicos. De modo que os profissionais devem ser conscientes desse enfoque multifatorial, para reconhecer precocemente o desenvolvimento e a evolução da úlcera e fazer a consequente intervenção

Pressure Ulcer Risk Factors for Patients with Hospital Versus Community Acquired Pressure Ulcers

Purpose: Pressure ulcers are a major health problem in the United States. Patients who develop pressure ulcers have longer hospital stays, significant increase in morbidity and mortality, added pain and suffering. The purpose of this study was to examine community versus hospital specific pressure ulcer risk factors to identify whether the most severe pressure ulcer stages can be predicted from the knowledge of an individual\u27s risk factors as has been reported in the literature. Methodology: The sample of patients with stageable III-IV and unstageable pressure ulcer patients included in the analysis was extracted from a Microsoft Access database developed by a WOCN Certified Advanced Practice wound care nurse. Results: The sample was predominantly Caucasian, having community acquired and unstageable pressure ulcers. The risk factors examined in the Chi-square model Pearson\u27s correlation calculated for predictor variables length of stay, age, and Braden scale score (which was analyzed as a continuous variable) showed significant positive relationships between hospital acquired pressure ulcer and length of stay. There were statistically significant differences in the incidence of patients admitted from the community with a pressure ulcer (stageable or unstageable) and those with hospital acquired ulcers. Ninety-five percent of patients had unstageable hospital acquired pressure ulcers compared to 72% of community acquired pressure ulcers. Twenty-seven percent of community acquired pressure ulcers were stageable (27.2%) compared to hospitalized acquired PUs (4.9%). Conclusions: This study demonstrated that a wound care practice and quality database can be used to conduct exploratory descriptive research on a patient population with severe pressure ulcers. Findings indicate that most patients have community acquired pressure ulcers and that these ulcers are unstageable, occur in Caucasian patients, and occur equally in men and women. Although the mean age of patients with these severe pressure ulcers is 74.24 years, patients with longer length of stays were associated with a higher risk for hospital acquired pressure ulcers. Diagnostic groups most common in these patients included patients with sepsis, cardiac and circulatory problems and pulmonary diseases. Hospital acquired pressure ulcers were significantly more likely to be unstageable with slough or eschar in the wound bed

Towards an Effective Decision Support System for Diabetic Foot Ulcers Diagnostic and Treatment Assessment

Diabetes mellitus (DM) is a fast-growing metabolic condition that threatens human population quality of living in the overcoming decades. One of its severe consequences is diabetic foot ulcers (DFU), which affect up to a quarter of the DM patients in their lifetime. This consequence leads to high health costs and significant decrease of the patients’ quality of life and self-esteem. In order to cope with the rising demands of heath resources and shortage in clinical human assets intelligent computational tools are required to aid in the decision where a patient is in an early stage of a DFU development and on the appraisal of a DFU treatment. It is aim of this research to provide a critical overview of the existing decision support systems (DSS) and publicly available research datasets for diabetic foot ulcers early diagnosis and treatment assessment, and thus proposing a new infrastructure system to deal with it overcoming the past attempts. The existing DFU DSS failed in being introduced in clinical practice due to total discrepancy with current daily clinical practice with DFU and the publicly available DM research datasets are shorter in data for feeding a new DSS. This research presents the actual and promising future data required for effective decisions and discloses a proposed architecture for a DSS applicable to DFU early diagnosis and treatment evaluation. Implementing the proposed system will take time but it will definitely contribute to cope with the patient demands, associated cost reduction and promotion of patients care.info:eu-repo/semantics/publishedVersio

Advancing Artificial Intelligence in Sensors, Signals, and Imaging Informatics.

ObjectiveTo identify research works that exemplify recent developments in the field of sensors, signals, and imaging informatics.MethodA broad literature search was conducted using PubMed and Web of Science, supplemented with individual papers that were nominated by section editors. A predefined query made from a combination of Medical Subject Heading (MeSH) terms and keywords were used to search both sources. Section editors then filtered the entire set of retrieved papers with each paper having been reviewed by two section editors. Papers were assessed on a three-point Likert scale by two section editors, rated from 0 (do not include) to 2 (should be included). Only papers with a combined score of 2 or above were considered.ResultsA search for papers was executed at the start of January 2019, resulting in a combined set of 1,459 records published in 2018 in 119 unique journals. Section editors jointly filtered the list of candidates down to 14 nominations. The 14 candidate best papers were then ranked by a group of eight external reviewers. Four papers, representing different international groups and journals, were selected as the best papers by consensus of the International Medical Informatics Association (IMIA) Yearbook editorial board.ConclusionsThe fields of sensors, signals, and imaging informatics have rapidly evolved with the application of novel artificial intelligence/machine learning techniques. Studies have been able to discover hidden patterns and integrate different types of data towards improving diagnostic accuracy and patient outcomes. However, the quality of papers varied widely without clear reporting standards for these types of models. Nevertheless, a number of papers have demonstrated useful techniques to improve the generalizability, interpretability, and reproducibility of increasingly sophisticated models

New horizons in the understanding of the causes and management of diabetic foot disease: report from the 2017 Diabetes UK Annual Professional Conference Symposium

Diabetes-related foot disease remains a common problem. For wounds, classic teaching recommends the treatment of any infection, offloading the wound and ensuring a good blood supply, as well as ensuring that the other modifiable risk factors are addressed and optimized. There remain, however, several questions about these and other aspects of the care of diabetes-related foot disease. Some of these questions are addressed in the present report; in particular, the impact of newer technologies in the identification of any organisms present in a wound, as well as the use of novel approaches to treat infections. The use of new remote sensing technology to identify people at risk of developing foot ulceration is also considered, in an attempt to allow early intervention and prevention of foot ulcers. The psychological impact of foot disease is often overlooked, but with an increasing number of publications on the subject, the cause-and-effect role that psychology plays in foot disease, such as ulcers and Charcot neuroarthropathy, is considered. Finally, because of heterogeneity in diabetic foot studies, comparing results is difficult. A recently published document focusing on ensuring a standardized way of reporting foot disease trials is discussed

A Mobile Clinical DSS based on Augmented Reality and Deep Learning for the home cares of patients afflicted by bedsores

Abstract A bedsore, also known as pressure sore, pressure ulcer or decubitus ulcer, is the result of constant pressure on skin occurring in bedridden patients and paraplegics continuously sitting in chair. All patients who are immobile for a long time due to any cause are likely to get bedsores. Effective and efficient management of processes related to the treatment of bedsores is an important issue for healthcare organizations as it heavily affects the quality of life of patients and the costs for such organizations. Therefore organizations need and look for more and more to provide their field workforce with smart mobile tools able to support such processes. In such a context, this paper proposes a mobile app implementing a Clinical Decision Support System (CDSS) to help field operators to measure the bedsore, classify its status, trace its evolution along the timeline and making correct decisions about the course of actions to effectively treat it. The mobile app is mostly based on Augmented Reality supported by Deep Learning, thus it requires an adequate system architecture to be effectively deployed, adopted and used. From the conceptual viewpoint, the defined CDSS model lays on three important considerations: providing automatic support to classify the status of a bedsore does not do all the work but help operators to improve the quality of their decisions, augmented reality allows to build a situated environment for decision-making supporting the operators' cognitive processes, operators should use only one tool to execute all their tasks in order to be more focused on the real problem which is to improve the quality of life of their patients