Interactions Between Clostridioides difficile and Fecal Microbiota in in Vitro Batch Model: Growth, Sporulation, and Microbiota Changes

Disturbance in gut microbiota is crucial for the development of Clostridioides difficile infection (CDI). Different mechanisms through which gut microbiota influences C. difficile colonization are known. However, C. difficile could also affect gut microbiota balance as previously demonstrated by cultivation of fecal microbiota in C. difficile conditioned medium. In current study, the interactions of C. difficile cells with gut microbiota were addressed. Three different strains (ribotypes 027, 014/020, and 010) were co-cultivated with two types of fecal microbiota (healthy and dysbiotic) using in vitro batch model. While all strains showed higher sporulation frequency in the presence of dysbiotic fecal microbiota, the growth was strain dependent. C. difficile either proliferated to comparable levels in the presence of dysbiotic and healthy fecal microbiota or grew better in co-culture with dysbiotic microbiota. In co-cultures with any C. difficile strain fecal microbiota showed decreased richness and diversity. Dysbiotic fecal microbiota was more affected after co-culture with C. difficile than healthy microbiota. Altogether, 62 OTUs were significantly changed in co-cultures of dysbiotic microbiota/C. difficile and 45 OTUs in co-cultures of healthy microbiota/C. difficile. However, the majority of significantly changed OTUs in both types of microbiota belonged to the phylum Firmicutes with Lachnospiraceae and Ruminococcaceae origin

CREATIVE PSYCHOPHARMACOTHERAPY IN CHILD AND ADOLESCENT PSYCHIATRY AND EXPERIENCES FROM BOSNIA AND HERZEGOVINA

Introduction: Paediatric psychopharmacology involves the application of psychotropic agents to the treatment of children and adolescents with mental disorders and gathered knowledge from child and adolescent psychiatry (CAP), neurology, paediatrics and pharmacology. Defining elements of this discipline are: the metabolism of drugs is different in children than in adults (pharmacokinetics), the developing brain reacts specifically to the drug (pharmaco dynamics), and psychopathology itself is not differentiated yet. To make and overview of specifics in psychopharmacological use in CAP and emphasize some experiences from Bosnia and Herzegovina in that field. Methods: Through insight in current literature, we presented comprehensive findings and compare it with situation in Bosnia and Herzegovina. Results: The most common conditions in which psycho pharmaceuticals are used in CAP were attention deficit hyperactivity disorders (ADHD), depressive and bipolar disorder, obsessive compulsive disorder and the treatment of early psychosis. Psycho pharmaceuticals were also used to treat agitated conditions in various causes. We made an overview of psycho pharmaceuticals use in Bosnia and Herzegovina CAP and emphasized the fact that psycho stimulants are not approved for the use yet, although they are mostly prescribed medicament in CAP over the world. That limits us in the effectiveness of the treatment in ADHD and put us in the situations to use other medicaments instead (anxiolytics, antipsychotics, mood stabilizers) which are not approved for that condition. Conclusion: The use of psycho pharmacotherapy in CAP is justified in cases where it is necessary to reduce the suffering of children and to improve their functionality at the time when cognitive, social and emotional advancement is most pronounced. Further research and clinical monitoring of efficacy and safety in the use of psycho pharmaceuticals in youngsters are necessary

Coulomb dissociation of O-16 into He-4 and C-12

We measured the Coulomb dissociation of O-16 into He-4 and C-12 within the FAIR Phase-0 program at GSI Helmholtzzentrum fur Schwerionenforschung Darmstadt, Germany. From this we will extract the photon dissociation cross section O-16(alpha,gamma)C-12, which is the time reversed reaction to C-12(alpha,gamma)O-16. With this indirect method, we aim to improve on the accuracy of the experimental data at lower energies than measured so far. The expected low cross section for the Coulomb dissociation reaction and close magnetic rigidity of beam and fragments demand a high precision measurement. Hence, new detector systems were built and radical changes to the (RB)-B-3 setup were necessary to cope with the high-intensity O-16 beam. All tracking detectors were designed to let the unreacted O-16 ions pass, while detecting the C-12 and He-4

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Kako in zakaj analiziramo mikrobioto

Mikrobno združbo, ki naseljuje določen del človeškega telesa, imenujemo mikrobiota. Najbolj poznana je črevesna mikrobiota, vendar se zmeraj več raziskav izvaja tudi na področju mikrobiote ust, vagine in kože. Danes vemo, da imajo tudi številna področja, ki so nekoč veljala za sterilna, svojo specifično mikrobioto. Mikrobiote igrajo pomembno vlogo pri delovanju organov ter pri zdravju in razvoju bolezni in so zato predmet obsežnih raziskav, katerih namen je ugotavljanje možnih označevalcev zdravja oziroma bolezni ali možnosti uporabe mikrobiote v terapevtske namene. Skupaj z razvojem metod za analizo mikrobiote literatura na tem področju eksponentno narašča. Razumevanje osnovnih načel in izrazov, ki se uporabljajo v raziskavah mikrobiote, bo zato postalo pomemben del splošnega znanja zdravnikov

STATE SOVEREIGNITY

Suverenost je pojem, ki je od svojega nastanka v 17. stoletju pa vse do danes doživel veliko sprememb, na kar nakazujejo tudi številne teorije, ki se med seboj pomembno razlikujejo. Na mestu je celo trditev, da je suverenost zašla v neke vrste krizo, saj o tradicionalni suverenosti, ki naj bi bila vzpostavljena z vestfalskim mirom leta 1648, ne moremo več govoriti. Na to so vplivale številne spremembe, med drugim tudi globalizacija, ki se največkrat omenja v povezavi s spremembami. Ta je namreč med drugim tudi povzročila, da so države čedalje bolj povezane, s tem pa posledično tudi manj avtonomne. Povezave držav v različne mednarodne, regionalne in druge organizacije so vse pogostejše, prav tako pa tudi sklepanje raznoraznih pogodb z namenom pridobitve določenih pravic. Interes držav je torej poglavitni razlog, da se le-te odločijo za omejitev svoje suverenosti, saj s pravicami posledično pridejo tudi določene obveznosti. Te pa je potrebno spoštovati, sicer lahko pride do ustreznih sankcij.Sovereignty is a concept that has undergone several changes since its inception in the 17th century until today. There are numerous theories about sovereignty which implicate those changes. It can be argued that sovereignty is in some kind of crisis, because we can no longer speak of a traditional concept of sovereignty, which has been supposedly established by the Peace of Westphalia in 1648. This is a result of changes that include globalisation as well. As a result of numerous changes and globalisation over the past decades, states are now more connected than ever and consequently have less autonomy than before. States are also parts of various international, regional and other organisations and parts of different treaties as well. A state’s interest is therefore the main reason a state decides to limit its sovereignty. However, rights also include certain obligations which must be respectedotherwise it may lead to appropriate sanctions

CONCEPTION OF SUSTAINABLE FAMILY HOUSES IN SUBURBAN AREA

V diplomskem delu smo obravnavali trajnostni razvoj v obmestnem prostoru, kjer model za preurejanje in razvoj sodobnih naselij predstavljajo strnjene skupine stavb v obliki samooskrbnega naselja. Za oblikovanje takšnega naselja smo na podlagi teoretičnih izhodišč zbrali vidike, ki jih moramo upoštevati za doseganje ˝trajnosti˝. Vidike smo razdelili glede na njihov vpliv na različnih nivojih načrtovanja in sicer na lokalni nivo, nivo strnjenega naselja in nivo stavb. Pri tem smo izpostavili nivo naselja. S pomočjo teoretičnih izhodišč, spoznanj, referenčnih primerov in analiz lokacije smo zasnovali vzorčni model trajnostnega naselja družinskih hiš.In this thesis we deal with sustainable development in the suburban area, where a model, for the reorganization and development of sustainable neighbourhood, are compact groups of buildings in form of self-sufficiency settlement. In order to create such neighbourhood gathered from certain aspects on tha basis of the principles, which we have to consider in order to achieve ˝sustainability˝. Those aspects were divided on different levels of planning according to their impact: on the local level, the level of density and the level of buildings. In doing so, we pointed out the density of the neighbourhood. With the help of theoretical principles, insights, reference examples and location analysis, we designed a model of sustainable neighbourhood of family houses