Assessing the Effect of Piperacillin/Tazobactam on Hematological Parameters in Patients Admitted with Moderate or Severe Foot Infections

Introduction: Piperacillin/tazobactam is a commonly used antibiotic for the empirical treatment of severe diabetic foot infections. One of the most feared complications of this drug is the development of pancytopenia. The aim of this study was to determine whether the use of piperacillin/tazobactam caused any hematological changes in patients admitted with severe diabetes-related foot infections from a specialist multidisciplinary foot clinic. Specifically, looking at whether it caused anemia, leukopenia, neutropenia, or thrombocytopenia. Methods: A 1-year retrospective analysis of patients admitted to a tertiary care center for treatment of diabetes-related foot infection using piperacillin/tazobactam. Hematological indices, urea and electrolytes, and C-reactive protein (CRP) were recorded pretreatment, during treatment, and posttreatment. HbA1c, vitamin B12, folate, thyroid-stimulating hormone, and free thyroxin were also analyzed to exclude any potential confounders as a cause of pancytopenia. Results: A total of 154 patients were admitted between 1 January 2016 and 31 December 2016 who received piperacillin/tazobactam for severe diabetes-related foot infection. On admission, white cell count and CRP were raised and fell significantly within the first 48 h. Other hematological factors did not change. Five patients developed a mild pancytopenia, of which three were unexplained. Conclusion: In this relatively small cohort, pancytopenia did not occur. As such, piperacillin/tazobactam appeared to have a low risk of adverse hematological outcomes and remains the treatment of choice for severe diabetes-related foot infections

Predictors of loss to follow up among patients with type 2 diabetes mellitus attending a private not for profit urban diabetes clinic in Uganda : a descriptive retrospective study

BACKGROUND: Although the prevalence of type 2 diabetes mellitus is increasing in Uganda, data on loss to follow up (LTFU) of patients in care is scanty. We aimed to estimate proportions of patients LTFU and document associated factors among patients attending a private not for profit urban diabetes clinic in Uganda. METHODS: We conducted a descriptive retrospective study between March and May 2017. We reviewed 1818 out-patient medical records of adults diagnosed with type 2 diabetes mellitus registered between July 2003 and September 2016 at St. Francis Hospital - Nsambya Diabetes clinic in Uganda. Data was extracted on: patients' registration dates, demographics, socioeconomic status, smoking, glycaemic control, type of treatment, diabetes mellitus complications and last follow-up clinic visit. LTFU was defined as missing collecting medication for six months or more from the date of last clinic visit, excluding situations of death or referral to another clinic. We used Kaplan-Meier technique to estimate time to defaulting medical care after initial registration, log-rank test to test the significance of observed differences between groups. Cox proportional hazards regression model was used to determine predictors of patients' LTFU rates in hazard ratios (HRs). RESULTS: Between July 2003 and September 2016, one thousand eight hundred eighteen patients with type 2 diabetes mellitus were followed for 4847.1 person-years. Majority of patients were female 1066/1818 (59%) and 1317/1818 (72%) had poor glycaemic control. Over the 13 years, 1690/1818 (93%) patients were LTFU, giving a LTFU rate of 34.9 patients per 100 person-years (95%CI: 33.2-36.6). LTFU was significantly higher among males, younger patients (< 45 years), smokers, patients on dual therapy, lower socioeconomic status, and those with diabetes complications like neuropathy and nephropathy. CONCLUSION: We found high proportions of patients LTFU in this diabetes clinic which warrants intervention studies targeting the identified risk factors and strengthening follow up of patients

Persistence to Treatment with Novel Antidiabetic Drugs (Dipeptidyl Peptidase-4 Inhibitors, Sodium-Glucose Co-Transporter-2 Inhibitors, and Glucagon-Like Peptide-1 Receptor Agonists) in People with Type 2 Diabetes

INTRODUCTION: Adequate persistence to antidiabetic treatment is highly important to achieve proper glycemic control. In this study we evaluate the persistence to treatment with dipeptidyl peptidase-4 inhibitors, sodium-glucose co-transporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists in a nationwide cohort of patients with type 2 diabetes. METHODS: Using a central database in Hungary, we analyzed the persistence to the treatment with dipeptidyl peptidase-4 inhibitors (n = 59,900), sodium-glucose co-transporter-2 inhibitors (n = 26,052), and glucagon-like peptide-1 receptor agonists (n = 17,332) at treatment intensification between 2014 and 2016. We also compared the persistence of dipeptidyl peptidase-4 inhibitors (n = 9163) and sodium-glucose co-transporter-2 inhibitors (n = 1257) in initial therapy to that of metformin (n = 79,305) or sulfonylureas (n = 29,057). The rates of persistence to treatment and risk of non-persistence are reported. RESULTS: The persistence rates of dipeptidyl peptidase-4 inhibitors, sodium-glucose co-transporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists at treatment intensification were 69.6%, 67.8%, and 66.3% at year 1 which decreased to 57.3%, 56.8%, and 52.1% by year 2, respectively. The risk of non-persistence was higher by 6.6% (95% CI 3.6-9.6) for sodium-glucose co-transporter-2 inhibitors and by 8.3% (95% CI 5.0-11.5) for glucagon-like peptide-1 receptor agonists as compared to dipeptidyl peptidase-4 inhibitors. Novel oral antidiabetic drugs in fixed versus free add-on combinations with metformin had higher persistence. The persistence to treatment with novel oral antidiabetic drugs in initial therapy was better (dipeptidyl peptidase-4 inhibitors, 59.6% and 47.6%; sodium-glucose co-transporter-2 inhibitors, 61.9% and 47.0%) than that of initial monotherapy with metformin (47.0% and 39.1%) or sulfonylureas (52.4% and 41.8%) at years 1 and 2, respectively. CONCLUSION: Analysis of persistence of treatment with novel glucose-lowering medications revealed differences between drug classes, favoring dipeptidyl peptidase-4 inhibitors vs. sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. Persistence data of novel antihyperglycemic agents may be useful for guiding the decision at initiation of antidiabetic treatment. FUNDING: Hungarian Diabetes Association. Plain language summary available for this article

The Activity of the Youth Parliamentary Structures as a Way of Prevention of Youth Extremism

The paper considers the problem of extremism in the youth environment. The concept of extremism. Examines the causes of extremism. Noted that extremism is a destructive form of manifestation of youth subculture, based on the behavioral strategies of extreme character, and is localized in nationalist, terrorist, fascist and criminal movements that threaten to society. It is emphasized that in the light of the objectives of the prevention of extremism must be the formation of an individual citizen having a stable internal position and is able to counter extremist sentiments, i. e. to have a certain worldview, to have a sufficient level of emotional­volitional regulation and practical to implement is in operation.Рассмотрены проблема экстремизма в молодежной среде и причины ее возникновения. Уточняется понятие экстремизма. Отмечено, что экстремизм является деструктивной формой проявления молодежной субкультуры, основанной на поведенческих стратегиях экстремального характера, и локализируется в националистических, террористических, фашистских преступных движениях, создающих угрозу для общества. Подчеркивается, что в свете задач профилактики экстремизма необходимо формирование личности гражданина, имеющего устойчивую внутреннюю позицию и способного противостоять экстремистским настроениям, т. е. иметь определенное мировоззрение, обладать достаточным уровнем эмоционально-волевой регуляции и практически воплощать это в деятельности

EXPRESSION FEATURES OF TOLL-LIKE RECEPTOR 2 AND TOLL-LIKE RECEPTOR 4 IN CHILDREN WITH ASTHMA

Currently actively  discussed  the  role  of innate immunity receptors, in particular TLRs  in the immunopathogenesis of bronchial asthma (BA).The aim of our work was to study the expression of ТLR2 and TLR4 on the nasal mucosal cells and peripheral blood leukocytes  of patients with BA of different  severity.The study included 40 children with asthma (3-12 years) and 10 healthy  children. Methods: real-time PCR, flow cytometry and multiplex immunofluorescence analysis evaluated the levels of pro and anti-inflammatory cytokines (IL-1β, IL-1ra, IL-6, IL-8, IL-10, TNFα) in nasal swabs.The result of the study hyperactivation of the factors of innate immunity at the level of the mucosal  of the nasal cavity in patients with asthma, manifested by increased gene expression  of TLR2, TLR4, and production of proinflammatory as well as anti-inflammatory cytokines. Correlation between cytokine levels and the severity of asthma. In the  peripheral blood  identified a significant  increase  in the  expression  of TLR2  and  TLR4  on circulating CD14+  monocytes in children with BA.Thus,  the  increase  of gene expression  of TLRs  mucosa of the  nasal cavity, increase  surface  expression  of TLR2  and TLR4  on circulating monocytes of patients with bronchial asthma compared to healthy  children. The revealed changes indicate the involvement of the system of TLRs in the immunopathogenesis of bronchial asthma. In the future, TLRs can be used as markers  to predict the course of ad and possible therapeutic targets

Machine Vision for Obstacle Avoidance, Tripwire Detection, and Subsurface Radar Image Correction on a Robotic Vehicle for the Detection and Discrimination of Landmines

In a joint project, research partners across institutions combined specialties to develop a remotely-operable, multi-sensor, robotic device for the detection of land mines, unexploded ordnance (UXO), and improvised explosive devices (IEDs). The robotic detection device uses a novel subsurface radar with imaging and target classification to differentiate between dangerous landmines and harmless clutter. One important aspect of this project has been to develop a system for imaging the terrain and potential obstacles ahead of the moving vehicle. Three important tasks drive the need for this look-ahead imaging: obstacle avoidance, tripwire detection, holographic subsurface radar (HSR) image correction