Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study

Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60\u20131.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14\u20131.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely

Electrode modification using nanocomposites of electropolymerised cobalt phthalocyanines supported on multiwalled carbon nanotubes

A polymer of tetra(4)-(4,6-diaminopyrimidin-2-ylthio) phthalocyaninatocobalt(II) (CoPyPc) has been deposited over a multiwalled carbon nanotube (MWCNT) platform and its electrocatalytic properties investigated side by side with polymerized cobalt tetraamino phthalocyanine (CoTAPc). X-ray photoelectron spectroscopy, scanning electron microscopy and cyclic voltammetry studies were used for characterization of the prepared polymers of cobalt phthalocyanine derivatives and their nanocomposites. L-Cysteine was used as a test analyte for the electrocatalytic activity of the nanocomposites of polymerized cobalt phthalocyanines and multiwalled carbon nanotubes. The electrocatalytic activity of both polymerized cobalt phthalocyanines was found to be superior when polymerization was done on top of MWCNTs compared to bare glassy carbon electrode. A higher sensitivity for L-cysteine detection was obtained on CoTAPc compared to CoPyPc

Lithium attenuated the behavioral despair induced by acute neurogenic stress through blockade of opioid receptors in mice

Major depressive disorder is disease with high rate of morbidity and mortality. Stressful events lead to depression and they can be used as a model of depression in rodents. In this study we aimed to investigate whether lithium modifies the stressed-induced depression through blockade of opioid receptors in mice. We used foot shock stress as stressor and forced swimming test (FST), tail suspension test (TST) and open field test (OFT) to evaluation the behavioral responses in mice. We also used naltrexone hydrochloride (as opioid receptor antagonist), and morphine (as opioid receptor agonist). Our results displayed that foot-shock stress significantly increased the immobility time in TST and FST but it could not change the locomotor behavior in OFT. When we combined the low concentrations of lithium and naltrexone a significant reduction in immobility time was seen in the FST and TST in comparison with control foot-shock stressed group administered saline only. Despite the fact that our data showed low concentrations of lithium, when administered independently did not significantly affect the immobility time. Also our data indicated that concurrent administration of lithium and naltrexone had no effect on open field test. Further we demonstrated that simultaneous administration of morphine and lithium reverses the antidepressant like effect of active doses of lithium. Our data acclaimed that we lithium can augment stressed-induced depression and opioid pathways are involved in this action. © 201

Plastic rotation capacity of high-strength concrete beams

Abstract  This work describes an experimental study on the plastic rotation capacity of high strength beams. Nine simply supported isotatic beams were tested, by applying comprising two symmetrical concentrated loads at approximately one-third and two-third's span. A method of analysis is defined that leads to the development of a parameter that characterizes the plastic rotation capacity at the failure section by means of a plastic analysis of the tested beams. The influence of concrete strength and the longitudinal tensile reinforcement ratio on the capacity for plastic rotation is examined and discussed. The results are discussed and compared with previous studies

Smoking and Diabetes Control in Adults With Type 1 and Type 2 Diabetes: A Nationwide Study From the 2018 National Program for Prevention and Control of Diabetes of Iran

Objectives: Smoking is among the top leading causes of morbidity and mortality worldwide. To date, studies on the association between smoking and diabetes complications and metabolic control have shown conflicting results. In this study, we aimed to assess the association of smoking with micro- and macrovascular complications of diabetes and lipid and glycemic indices. Methods: We used the National Program for Prevention and Control of Diabetes of Iran database of 99,651 adult patients with diabetes across Iran. Multiple logistic regression models were used to examine the association between smoking and diabetes complications including cardiovascular disease, neuropathy, nephropathy and retinopathy. This association was adjusted for age, sex, duration of diabetes, glycated hemoglobin (A1C), hypertension, hyperlipidemia, medication, obesity and type of diabetes. Results: Smoking was associated with cardiovascular disease, nephropathy, retinopathy and neuropathy (odds ratios ORs for patients with type 1 diabetes were 1.51, 2.29, 2.70 and 2.40, respectively; for patients with type 2 diabetes, ORs were 1.27, 1.21, 1.51 and 1.70, respectively; all with p values <0.001). Among patients with type 1 diabetes, smoking was significantly (p<0.05) associated with A1C (OR, 2.12), 2-h postglucose level (OR, 1.30), triglycerides (OR, 1.48) and high-density lipoprotein (HDL) control (OR, 1.34). Among patients with type 2 diabetes, smoking was significantly associated with A1C (OR, 1.09) and HDL control (OR, 1.21). Conclusions: Smoking was associated with multiple diabetes complications including cardiovascular disease, neuropathy, nephropathy and retinopathy and worse A1C and HDL control in both patients with type 1 and type 2 diabetes. It was also associated with worse 2-h postglucose level and triglyceride control among patients with type 1 diabetes. Our findings signify that national programs for smoking prevention and cessation may be beneficial to diabetes control in Iran. © 2019 Canadian Diabetes Associatio

Determinants of glycemic control: Phase 2 analysis from nationwide diabetes report of National Program for Prevention and Control of Diabetes (NPPCD-2018)

Background: Diabetes is one of the leading causes of morbidity and mortality worldwide, especially among middle and low income nations. Many diabetic complications and comorbidities are attributable to poor glycemic control. The aim of this study was to update and extend the national diabetes reports on the status of comorbidities, diabetes care and complications in Iran. Moreover, we investigated the risk factors of poor glycemic control in the Iranian population. Methods: National database of 99,651 patients with diabetes who attended university-affiliated clinics between April 1, 2017 and February 30, 2018 was used to carry out a cross-sectional study. Stepwise backward selection logistic regression model was used to examine the associated factors of glycemic control. Results: In this study 73.0 and 56.5 of the enrolled population with diabetes, had hypertension and hyperlipidemia, respectively. The prevalence of patients who received education for nutrition therapy or diabetes self-management was 16.3 and 23.3 respectively. Poor glycemic control was associated with male gender (OR = 1.06, p = 0.001), obesity (OR = 1.03, p = 0.05), duration of diabetes (OR = 1.018, p < 0.001), smoking (OR = 1.08, p = 0.041), hypertension (OR = 1.53, p < 0.001), hyperlipidemia (OR = 1.15, p < 0.001), insulin therapy (OR = 1.26, p < 0.001) and combination of insulin and oral anti-diabetic agents compared to oral anti-diabetic agents alone (OR = 2.36, p < 0.001). Conclusion: We demonstrated that the prevalence of diabetes comorbidities is high in Iranian population and that a great proportion of Iranian patients with diabetes had not reached the goal of glycemic control. Our findings provide a starting point from which to investigate the obstacles that prevent patients with diabetes from reaching metabolic targets. © 2019 Primary Care Diabetes Europ