The importance of genus Candida in human samples

Microbiology is a rapidly changing field. As new researches and experiences broaden our knowledge, changes in the approach to diagnosis and therapy have become necessary and appropriate. Recommended dosage of drugs, method and duration of administration, as well as contraindications to use, evolve over time all drugs. Over the last 2 decades, Candida species have emerged as causes of substantial morbidity and mortality in hospitalized individuals. Isolation of Candida from blood or other sterile sites, excluding the urinary tract, defines invasive candidiasis. Candida species are currently the fourth most common cause of bloodstream infections (that is, candidemia) in U.S. hospitals and occur primarily in the intensive care unit (ICU), where candidemia is recognized in up to 1% of patients and where deep-seated Candida infections are recognized in an additional 1 to 2% of patients. Despite the introduction of newer anti-Candida agents, invasive candidiasis continues to have an attributable mortality rate of 40 to 49%; excess ICU and hospital stays of 12.7 days and 15.5 days, respectively, and increased care costs. Postmortem studies suggest that death rates related to invasive candidiasis might, in fact, be higher than those described because of undiagnosed and therefore untreated infection. The diagnosis of invasive candidiasis remains challenging for both clinicians and microbiologists. Reasons for missed diagnoses include nonspecific risk factors and clinical manifestations, low sensitivity of microbiological culture techniques, and unavailability of deep tissue cultures because of risks associated with the invasive procedures used to obtain them. Thus, a substantial proportion of invasive candidiasis in patients in the ICU is assumed to be undiagnosed and untreated. Yet even when invasive candidiasis is diagnosed, culture diagnosis delays treatment for 2 to 3 days, which contributes to mortality. Interventions that do not rely on a specific diagnosis and are implemented early in the course of Candida infection (that is, empirical therapy) or before Candida infection occurs (that is, prophylaxis) might improve patient survival and may be warranted. Selective and nonselective administration of anti-Candida prophylaxis is practiced in some ICUs. Several trials have tested this, but results were limited by low statistical power and choice of outcomes. Thus, the role of anti-Candida prophylaxis for patients in the ICU remains controversial. Initiating anti-Candida therapy for patients in the ICU who have suspected infection but have not responded to antibacterial therapy (empirical therapy) is practiced in some hospitals. This practice, however, remains a subject of considerable debate. These patients are perceived to be at higher risk from invasive candidiasis and therefore are likely to benefit from empirical therapy. Nonetheless, empirical anti-Candida therapies have not been evaluated in a randomized trial and would share shortcomings that are similar to those described for prophylactic strategies. Current treatment guidelines by the Infectious Diseases Society of America (IDSA) do not specify whether empirical anti-Candida therapy should be provided to immunocompetent patients. If such therapy is given, IDSA recommends that its use should be limited to patients with Candida colonization in multiple sites, patients with several other risk factors, and patients with no uncorrected causes of fever. Without data from clinical trials, determining an optimal anti-Candida strategy for patients in the ICU is challenging. Identifying such a strategy can help guide clinicians in choosing adequate therapy and may improve patient outcomes. In our study, we developed a decision analytic model to evaluate the cost-effectiveness of empirical anti-Candida therapy given to high-risk patients in the ICU, defined as those with altered temperature (fever or hypothermia) or unexplained hypotension despite 3 days of antibacterial therapy in the ICU

Generalized Poincaré plots analysis of heart period dynamics in different physiological conditions: Trained vs. untrained men

Background Recently we proposed a new method called generalized Poincare´ plot (gPp) analysis which gave a new insight into the pattern of neurocaridac control. In this study we examined potential of gPp method to reveal changes in cardiac neural control in young athletes during three conditions: supine rest, running and relaxation, with respect to untrained subjects. Methods This method is based on the quantification of Pearson's correlation coefficients r(j, k), between symmetrical (j = k) and asymmetrical summed j previous and k following RR intervals up to the 100th order (j,k.100). Results Differences between groups were obtained at all levels of this analysis. The main result is the significant difference of NAI, normalized index of asymmetry, between groups in running, which was originated in different positions of local maxima of r(j, k). Compared with untrained subjects, these findings indicate modified neural control and altered intrinsic heart rate behavior in athletes which are related to some kind of memory mechanism between RR intervals. Conclusion Obtained results provide great potential of gPp method analysis in the recognition of changes in neurocardiac control in healthy subjects. Further studies are needed for identification of altered cardiac regulatory mechanisms whose background may be useful in the evaluation of genesis of athletes neurocardiovascular pathology. © 2019 Platiša et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Pulse respiration quotient as a measure sensitive to changes in dynamic behavior of cardiorespiratory coupling such as body posture and breathing regime

In this research we explored the (homeo)dynamic character of cardiorespiratory coupling (CRC) under the influence of different body posture and breathing regimes. Our tool for it was the pulse respiration quotient (PRQ), representing the number of heartbeat intervals per breathing cycle. We obtained non-integer PRQ values using our advanced Matlab® algorithm and applied it on the signals of 20 healthy subjects in four conditions: supine position with spontaneous breathing (Supin), standing with spontaneous breathing (Stand), supine position with slow (0.1 Hz) breathing (Supin01) and standing with slow (0.1 Hz) breathing (Stand01).Main results: Linear features of CRC (in PRQ signals) were dynamically very sensitive to posture and breathing rhythm perturbations. There are obvious increases in PRQ mean level and variability under the separated and joined influence of orthostasis and slow (0.1 Hz) breathing. This increase was most pronounced in Stand01 as the state of joint influences. Importantly, PRQ dynamic modification showed greater sensitivity to body posture and breathing regime changes than mean value and standard deviation of heart rhythm and breathing rhythm. In addition, as a consequence of prolonged supine position, we noticed the tendency to integer quantization of PRQ (especially after 14 min), in which the most common quantization number was 4:1 (demonstrated in other research reports as well). In orthostasis and slow breathing, quantization can also be observed, but shifted to other values. We postulate that these results manifest resonance effects induced by coupling patterns from sympathetic and parasympathetic adjustments (with the second as dominant factor).Significance: Our research confirms that cardiorespiratory coupling adaptability could be profoundly explored by precisely calculated PRQ parameter since cardiorespiratory regulation in healthy subjects is characterized by a high level of autonomic adaptability (responsiveness) to posture and breathing regime, although comparisons with pathological states has yet to be performed. We found Stand01 to be the most provoking state for the dynamic modification of PRQ (cardiorespiratory inducement). As such, Stand01 has the potential of using for PRQ tuning by conditioning the cardiorespiratory autonomic neural networks, e.g., in the cases where PRQ is disturbed by environmental (i.e., microgravity) or pathologic conditions

An Extended Evaluation of Schema Issues Advisor in the Azure SQL Database

The analysis of the telemetry data in Azure SQL database has revealed that most of the problems affecting the customers are due to the schema inconsistency errors. An assumption has been made that direct e-mail notifications sent to the customers about the current problems could significantly shorten time to resolve them. The prospective benefits are first validated by sending e-mail recommendations manually. Then, in an iterative way, the schema issue advisor that detects anomalies and automatically sends the appropriate notifications to the customers is implemented on top of Azure resources. Finally, an extended evaluation has confirmed the expected benefits of direct communications with the customers

Electrochemical synthesis and characterization of basic bismuth nitrate [Bi6O5(OH)3](NO3)5·2H2O: a potential highly efficient sorbent for textile reactive dye removal

A new method of synthesis was developed for the preparation of basic bismuth nitrate [Bi6O5(OH)3](NO3)5·2H2O (ECBBN). Electrochemical synthesis of the material was carried out by galvanostatic electrodeposition from an acidic Bi(III) solution on a Ti substrate and further thermal treatment in air at 200 °C. Characterization of ECBBN was conducted by employing SEM–EDX, N2 adsorption, XRD and FTIR, and its pI was also determined. The analyses showed that the material obtained was pure [Bi6O5(OH)3](NO3)5·2H2O. Morphologically, ECBBN aggregates were composed of crystals, some smaller than 50 nm. Electrochemically synthesized sorbent (ECBBN) was used for the removal of the textile dye Reactive Blue 19 (RB19) from deionized water and model solutions of polluted river water, and it showed considerably superior sorption performance compared to other inorganic sorbents synthesized by conventional methods reported in the literature. A kinetic study suggests that the sorption process is both under reaction and diffusion control. Equilibration of the sorption process was attained in several minutes, i.e. the sorption process is very fast. The sorption equilibrium data were well interpreted by the Langmuir, Redlich–Peterson and Brouers–Sotolongo isotherm. Using Langmuir isotherm, the maximum sorption capacity of ECBBN was reached at pH 2 and was 1049.19 mg g−1

Leaching of chromium from chromium contaminated soil: Speciation study and geochemical modeling

Distribution of chromium between soil and leachate was monitored. A natural process of percolating rainwater through the soil was simulated in the laboratory conditions and studied with column leaching extraction. Migration of chromium in the soil is conditioned by the level of chromium soil contamination, the soil organic matter content, and rainwater acidity. Chromium (III) and chromium(VI) were determined by spectrophotometric method with diphenilcarbazide in acidic media. Comparing the results of chromium speciation in leachate obtained by experimental model systems and geochemical modelling calculations using Visual MINTEQ model, a correlation was observed regarding the influence of the tested parameters. Leachate solutions showed that the concentration of Cr depended on the organic matter content. The influence of pH and soil organic matter content is in compliance after its definition through experimental and theoretical way. The computer model - Stockholm Humic Model used to evaluate the leaching results corresponded rather well with the measured values

Slow 0.1 Hz Breathing and Body Posture Induced Perturbations of RRI and Respiratory Signal Complexity and Cardiorespiratory Coupling

Objective: We explored the physiological background of the non-linear operating mode of cardiorespiratory oscillators as the fundamental question of cardiorespiratory homeodynamics and as a prerequisite for the understanding of neurocardiovascular diseases. We investigated 20 healthy human subjects for changes using electrocardiac RR interval (RRI) and respiratory signal (Resp) Detrended Fluctuation Analysis (DFA, α1RRI, α2RRI, α1Resp, α2Resp), Multiple Scaling Entropy (MSERRI1−4, MSERRI5−10, MSEResp1−4, MSEResp5−10), spectral coherence (CohRRI−Resp), cross DFA (ρ1 and ρ2) and cross MSE (XMSE1−4 and XMSE5−10) indices in four physiological conditions: supine with spontaneous breathing, standing with spontaneous breathing, supine with 0.1 Hz breathing and standing with 0.1 Hz breathing. Main results: Standing is primarily characterized by the change of RRI parameters, insensitivity to change with respiratory parameters, decrease of CohRRI−Resp and insensitivity to change of in ρ1, ρ2, XMSE1−4, and XMSE5−10. Slow breathing in supine position was characterized by the change of the linear and non-linear parameters of both signals, reflecting the dominant vagal RRI modulation and the impact of slow 0.1 Hz breathing on Resp parameters. CohRRI−Resp did not change with respect to supine position, while ρ1 increased. Slow breathing in standing reflected the qualitatively specific state of autonomic regulation with striking impact on both cardiac and respiratory parameters, with specific patterns of cardiorespiratory coupling. Significance: Our results show that cardiac and respiratory short term and long term complexity parameters have different, state dependent patterns. Sympathovagal non-linear interactions are dependent on the pattern of their activation, having different scaling properties when individually activated with respect to the state of their joint activation. All investigated states induced a change of α1 vs. α2 relationship, which can be accurately expressed by the proposed measure—inter-fractal angle θ. Short scale (α1 vs. MSE1−4) and long scale (α2 vs. MSE5−10) complexity measures had reciprocal interrelation in standing with 0.1 Hz breathing, with specific cardiorespiratory coupling pattern (ρ1 vs. XMSE1−4). These results support the hypothesis of hierarchical organization of cardiorespiratory complexity mechanisms and their recruitment in ascendant manner with respect to the increase of behavioral challenge complexity. Specific and comprehensive cardiorespiratory regulation in standing with 0.1 Hz breathing suggests this state as the potentially most beneficial maneuver for cardiorespiratory conditioning. © Copyright © 2020 Matić, Platiša, Kalauzi and Bojić

Generalized Poincare Plots-A New Method for Evaluation of Regimes in Cardiac Neural Control in Atrial Fibrillation and Healthy Subjects

Classical Poincare plot is a standard way to measure nonlinear regulation of cardiovascular control. In our work we propose a generalized form of Poincare plot where we track correlation between the duration of j preceding and k next RR intervals. The investigation was done in healthy subjects and patients with atrial fibrillation, by varying j,k LT = 100. In cases where j = k, in healthy subjects the typical pattern was observed by paths that were substituting scatterplots and that were initiated and ended by loops of Poincare plot points. This was not the case for atrial fibrillation patients where Poincare plot had a simple scattered form. More, a typical matrix of Pearsons correlation coefficients, r(j,k), showed different positions of local maxima, depending on the subjects health condition. In both groups, local maxima were grouped into four clusters which probably determined specific regulatory mechanisms according to correlations between the duration of symmetric and asymmetric observed RR intervals. We quantified matrices degrees of asymmetry and found that they were significantly different: distributed around zero in healthy, while being negative in atrial fibrillation. Also, Pearsons coefficients were higher in healthy than in atrial fibrillation or in signals with reshuffled intervals. Our hypothesis is that by this novel method we can observe heart rate regimes typical for baseline conditions and defense reaction in healthy subjects. These data indicate that neural control mechanisms of heart rate are operating in healthy subjects in contrast with atrial fibrillation, identifying it as the state of risk for stress-dependent pathologies. Regulatory regimes of heart rate can be further quantified and explored by the proposed novel method

Influence of War Circumstances on Tumor Morphological Characteristics in Patients with Breast Cancer

The influence of war circumstances on tumor morphological characteristics in patients with breast cancer has not been studied up to now. The aim of this study is to investigate if war circumstances have influenced breast cancer incidence. The study covered both the patients in which during a period of observation a breast cancer was diagnosed as well as those who died of the same disease in the same period. Three sources of data were used: 1) The archives of the Oncology and Radiotherapy Center of the University Hospital »Split« (UHS): hospital data of 768 patients were reviewed. The war sample consisted of 380 patients aged 59.4±12.1 (31 to 86) (including 5 males), whereas the pre-war sample was made up of 388 patients aged 58.4±12.7 (19 to 88) (including 3 males); 2) Register of death of the Pathology Department of UHS with 162 analyzed persons whose death was caused by breast cancer in the six-year period between 1988 and 1993. The list of 162 dead patients included 79 people who died from breast cancer diagnosed in that period (1988–1993) and another 83 people that had been diagnosed before that period; 3) The biopsy register of the Pathology Department of UHS with 851 breast biopsies performed between 1988 and 1993. Breast cancer is predominantly a female illness (99.1%). The war circumstances influenced the of T, N and M rate. The rate of N2, N3, M1 were conspicuously higher in the war period. There were significantly more malignant histological diagnoses found in new patients and also significantly more patients died due to breast cancer. Stress and other war circumstances undoubtedly have a negative impact on the numerous markers of breast cancer which we have proved in this study