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The Role of Nutrition and Nutritional Supplements in the Prevention and Treatment of Malnutrition in Chronic Obstructive Pulmonary Disease: Current Approaches in Nutrition Therapy
No full textPurpose of ReviewMalnutrition is a significant comorbidity in Chronic Obstructive Pulmonary Disease (COPD), contributing to disease progression and reduced quality of life. This narrative review examines the role of nutritional therapy in the prevention and management of malnutrition in COPD, emphasizing evidence-based approaches and their clinical implications.Recent FindingsCOPD patients face increased metabolic demands, systemic inflammation, and reduced dietary intake, resulting in muscle wasting, sarcopenia, and cachexia. Recent evidence highlights the efficacy of targeted nutritional strategies, including essential amino acid supplementation, omega-3 fatty acids, vitamin D, and antioxidants, in improving respiratory function, muscle strength, and patient well-being. Comprehensive nutritional assessments and personalized interventions are increasingly recognized as critical components of COPD care. However, long-term efficacy data remain limited.SummaryNutritional therapy plays a pivotal role in managing malnutrition and improving clinical outcomes in COPD. This review synthesizes the latest evidence, identifies gaps in current research, and proposes strategies for integrating personalized nutrition into COPD care. Future studies are needed to establish the long-term benefits of these interventions and to develop tailored nutritional guidelines for COPD patients
Adult outcomes of childhood kidney replacement therapy in Europe from 2008 to 2019: an ERA Registry study
No full textBackground Young adults starting kidney replacement therapy (KRT) during childhood and reaching their 18th birthday (i.e. adult survivors of childhood KRT) form a challenging population of interest to nephrologists treating adults, as during this period there will be a transition to adult renal centres. Nonetheless, few studies have focused on the epidemiology of KRT in this group. We aimed to provide an update on these patients' characteristics, treatment history, and graft and patient survival, to report their 5-year prognosis and expected remaining lifetime.Methods Data on KRT patients reaching their 18th birthday in 2008-19 were collected from 21 European countries/regions providing individual patient data to the European Renal Association (ERA) Registry. Patient characteristics and treatment trajectories were examined before and after turning 18 years old. Kaplan-Meier and Cox proportional hazards regression were used for patient and graft survival analyses.Results In total, 2944 patients were included. The proportion of adult survivors initiating KRT at a very young age (0-4 years) and undergoing pre-emptive kidney transplantation increased. Unadjusted 5-year patient survival was 96.9% [95% confidence interval (CI) 96.2-97.5]. Dialysis patients had a higher risk of death than kidney transplant recipients [adjusted hazard ratio 5.44 (95% CI 3.34-8.86)]. Between ages 18 and 23 years, about 21% of the adult survivors lost their kidney transplant and 34% of the dialysis patients continued this treatment. Compared with the general population, life expectancy for 18-year-old kidney transplant and dialysis patients was 17 and 40 years shorter, respectively.Conclusion Life expectancy of 18-year-old kidney transplant recipients was lower compared with the general population, yet having a functioning kidney graft at age 18 years resulted in better outcomes than being on dialysis. Nevertheless, between ages 18 and 23 years, about one-fifth of the kidney grafts failed and one-third of the patients remained on dialysis. Graphical Abstract 10.1093/ndt/gfae189 Video Abstract Watch the video of this contribution at https://academic.oup.com/ndt/pages/author_videos gfae189Media1 636187728011
Rapid bacterial detection through microfluidic integration with a glucometer
No full textWe present a novel approach for sensitive and portable detection of pathogenic bacteria, which is crucial for household and clinical practice. Our method employs immunoliposomes, antibodies, and microchip to detect specific pathogens quantitatively. Gold and metal metal-organic nanoparticles and liposomes were characterized using high-resolution techniques like TEM and SEM. Utilizing a commercial, personal glucose meter (PGM), we initially detected released glucose from antibody-modified liposomes and microchips with MOF-NPs. Detection on the microchip was achieved within 30 min, while the PGM analysis took only one minute for targeted bacteria, yielding glucose signals of 66 mg/dL and 69 mg/dL, respectively. Serial dilutions with group A-Streptococcus pyogenes (GAS) (1.4 x 104-1.4 x 108 CFU/mL) demonstrated quantitative measurement applicability. This innovative approach and a portable PGM hold promise for various industries, including physician labs, hospitals, and households
Comparative evaluation of ChatGPT-4, ChatGPT-3.5 and Google Gemini on PCOS assessment and management based on recommendations from the 2023 guideline
No full textContext Artificial intelligence (AI) is increasingly utilized in healthcare, with models like ChatGPT and Google Gemini gaining global popularity. Polycystic ovary syndrome (PCOS) is a prevalent condition that requires both lifestyle modifications and medical treatment, highlighting the critical need for effective patient education. This study compares the responses of ChatGPT-4, ChatGPT-3.5 and Gemini to PCOS-related questions using the latest guideline. Evaluating AI's integration into patient education necessitates assessing response quality, reliability, readability and effectiveness in managing PCOS. Purpose To evaluate the accuracy, quality, readability and tendency to hallucinate of ChatGPT-4, ChatGPT-3.5 and Gemini's responses to questions about PCOS, its assessment and management based on recommendations from the current international PCOS guideline. Methods This cross-sectional study assessed ChatGPT-4, ChatGPT-3.5, and Gemini's responses to PCOS-related questions created by endocrinologists using the latest guidelines and common patient queries. Experts evaluated the responses for accuracy, quality and tendency to hallucinate using Likert scales, while readability was analyzed using standard formulas. Results ChatGPT-4 and ChatGPT-3.5 attained higher scores in accuracy and quality compared to Gemini (p = 0.001, p < 0.001 and p = 0.007, p < 0.001 respectively). However, Gemini obtained a higher readability score compared to the other chatbots (p < 0.001). There was a significant difference between the tendency to hallucinate scores, which were due to the lower scores in Gemini (p = 0.003). Conclusion The high accuracy and quality of responses provided by ChatGPT-4 and 3.5 to questions about PCOS suggest that they could be supportive in clinical practice. Future technological advancements may facilitate the use of artificial intelligence in both educating patients with PCOS and supporting the management of the disorder
New polymorph of<i> N</i>-benzoyl-morpholine-4-carbothioamide with ten crystallographically independent molecules in the asymmetric unit: Crystal structure, Hirshfeld surface analysis and Density functional theory calculations
No full textHerein, facile synthesis, single crystal X-ray diffraction (SC-XRD) structure, Hirshfeld surface (HS) analysis and Density functional theory (DFT) calculations of N-benzoyl-morpholine-4-carbothioamide 5(a) are presented. Hence, the synthesized compound, C12H14N2O2S 5(a), crystallizes in monoclinic crystal system having space group of P 2(1) with a = 22.2226 (9) & Aring;, b = 11.7520 (3) & Aring;, c = 24.9361 (8) & Aring;, alpha = 90 degrees, beta = 111.054 (4)degrees, gamma = 90 degrees, Z = 20 and V = 6077.6 (4) & Aring;(3). The asymmetric unit of 5(a) contains ten crystallographically independent molecules, where the morpholine and benzene rings are in respective chair and planar conformations. In the crystal structure, some of the intermolecular, N-HO, C-HO and C-HS, hydrogen bonds link the molecules into a 2D-network parallel to (010), enclosing R-2(2)(10) and R-2(2)(24) ring motifs, when viewed down the b-axis direction. Furthermore, contribution of the remaining hydrogen bonds consolidates a 3D-architecture. Similarly, HS analysis clarified the importance of hydrogen atom contacts with the major contributions of H & mldr;H (46.7 %), H & mldr;S/S & mldr;H (21.1 %), H & mldr;C/C & mldr;H (16.5 %), and H & mldr;O/O & mldr;H (12.5 %). Thus, hydrogen bond and van der Waals interactions play major role in the crystal packing. Finally, optimum molecular structure of compound 5(a) was related to the experimentally determined one employing DFT at B3LYP/6-311++G(d,p) level. Subsequently, the geometry of the optimized and most stable conformation turned out to be complementary with the crystal structure. The computational calculation of compound 5(a) revealed the molecule to be chemically hard in nature with high energy intrinsic reaction pathway. The associated band gap predicted compound 5(a) to be a wide band gap material. The intrinsic reaction pathway predicts hard-core behavior of the molecule
Extracorporeal Blood Purification in European Pediatric Intensive Care Units A Consensus Statement
No full textImportanceImportant advances have been made in extracorporeal blood purification therapies (EBPTs) due to new technologies and biomaterials; however, the lack of established guidelines is a factor in great variability in clinical practice. This aspect is accentuated in pediatric intensive care given the small number of patients with diverse diagnoses treated with EBPT and the technical challenges in treating small children, potentiating the risk of adverse events. ObjectiveTo understand what experienced users of EBPT think about its relevant issues, insight that may have implications for the design of future studies, and the application of EBPTs in patient care. Evidence ReviewLiterature search was conducted using the PubMed and Embase databases between January 1, 2020, and July 15, 2024, and a combination of key medical terms. A panel of experts was formed (composed of 15 authors and pediatric intensivists) to develop a consensus statement using a modified Delphi-based model between 2022 and 2024. The panel's core team drafted the initial questionnaire, which explored EBPT use in pediatric intensive care units (PICUs), including clinical indications for initiating and discontinuing use and outcomes for assessing effectiveness and safety. SurveyMonkey was used in the distribution, completion, and revision of the questionnaire, and findings were analyzed. Panelists were asked to rank answer choices. Numerical value for each ranking was translated to a percentage defining the strength of consensus (>90% agreement from panelists signifying strong consensus; <49% signifying no consensus). FindingsA total of 116 survey responses were received from panelists from 8 European countries. Strong consensus was achieved on 6 of 24 questions and consensus (75%-90% agreement) was reached on 18 of 24 questions. According to the panelists, the continuous renal replacement therapy standard or enhanced adsorption hemofilter and plasma exchange were of interest, representing the most applied EBPTs across various applications. While evidence on hemoadsorption is growing, it remains limited. Conclusions and RelevanceThis consensus statement on EBPTs in critically ill pediatric patients was developed by an international panel of experts in areas where clinical evidence is still limited. This consensus statement could support pediatric intensivists in bedside decision-making and guide future research on EBPTs in PICUs
The Konno-Rastan Procedure in the Current Era: Still A Feasible Option?
No full textIntroduction: The Konno-Rastan procedure is a commonly used surgical technique to address complicated subaor tic stenosis and to enlarge the aorta via an anterior route. The objective of this report is to describe the experience of our underwent the Konno-Rastan procedure. Relevant information was retrospectiveThe median follow-up was nine years (4 - 16 years), and there was no operative mortality. All patients had a straightforward recovery, and five patients required reoperation at follow-up, none of which was related to the left ventricular outflow tract. The median echocardiographic indices at the most recent follow-up were not significantly different from the preoperative values, with a median peak gradient across the left ventricular outflow tract of 25 mmHg. In their most recent follow-up, 81% of the patients were New York Heart Association class 1. No bleeding, thromboembolic, or infective complications were encountered. Conclusion: We concluded that the Konno-Rastan procedure can be regarded as a definitive alternative to other surgical interventions for left ventricular outflow tract obstructions. Although reoperations are still necessary, particularly in patients with additional mitral valve disease, the Konno-Rastan procedure is still a viable option in patients with complex left ventricular disease
Proto- posthumanist subject for Swift: Gulliver as a non/human hybrid in Lilliput
No full textFantasy literature breaches the great divide between dualities, making marginalized and disempowered nonhuman beings much more audible, visible, and intelligible. In fantasy, the human gets stripped of its so-called superiority and is guided to attain a more-than-human subjectivity at the end of the fantastic journey. In parallel with the character of fantasy fiction, critical posthumanism interrogates the notion of the human as the zenith of the universe, the reliance on and parameters of rationality, and the agential capabilities of subjects other than the human. Criticizing the liberal humanist notion of anthropocentric subjectivity as continuously structured in the seventeenth and eighteenth centuries, this article combines the discourses of the early example of fantasy fiction, Jonathan Swift's Gulliver's Travels (1726), and contemporary posthumanist theories. In this context, it positions Swift as a proto-posthumanist satirist and scrutinizes the Lilliputian praxes of hybridizing and nonhumanizing Gulliver in Travels. In this scrutiny, I claim that Gulliver experiences a systematic process of nonhumanization and his sense of humanness is undermined to the extent of transforming into a posthumanist subjectivity
Increasing frequency of therapy by software-based treatment of naming ability in people with aphasia: a preliminary study
No full textThis study aimed to explore the effect of new software targeting naming deficits in Turkish-speaking people with aphasia. The study included seven Turkish people with aphasia. These participants took the Aphasia Language Assessment Test (ADD), Turkish Picture-Naming Test (T-RAT), and Technology Familiarity Assessment, and the words for therapy were determined. The selection of categories and words for inclusion in the application was based on the frequency and typicality features. The 12-week speech-language treatment sessions were divided into two sections. During the first six weeks, a speech-language pathologist (SLP) used the software to train people. After the first part, the SLP applied the T-RAT. Participants utilized the software at home in the second part. All participants took the ADD, T-RAT, and Software Evaluation Questionnaire following the second part. Participants' naming abilities improved in all tests. Both therapy sessions with the SLP and those in which participants used the program independently demonstrated this improvement. Participants also reported high levels of treatment satisfaction. Cueing hierarchy approaches used in the software helped to improve naming skills in people with aphasia (PWA), independent of type, stage, or severity of aphasia. The findings of this study indicate that both sessions directed by an SLP and independent use of the software by participants can positively impact the therapy process with the developed software
Ultrasonographic Measurements of Femoral Cartilage Thickness in Women With Symptomatic Joint Hypermobility: A Controlled Study
No full textObjective: The goal of this study was to measure femoral cartilage thickness in patients with symptomatic joint hypermobility (SJH) using ultrasound (US) imaging. Methods: This cross-sectional study comprised 42 female patients diagnosed with SJH (Beighton score > 3) and 42 age-matched healthy controls. Ultrasonographic measurements of bilateral femoral cartilage thickness were conducted in three areas: medial, intercondylar, and lateral, while the patients were in a supine position with their knees fully flexed. The Numeric Pain Rating Scale and the Turkish version of the Knee Injury and Osteoarthritis Outcome Score were used to evaluate pain and functional status in the SJH group. Results: The mean age was 28.0 +/- 7.1 years in the study group and 28.5 +/- 7.2 years in the control group. The right medial, left medial, left intercondylar, and left lateral femoral cartilage thicknesses of patients in the SJH group were significantly thinner than those of patients in the control group (p 0.05). A negative correlation was observed between femoral cartilage thickness and age, which was identified as an independent predictor of femoral cartilage thickness in SJH (p < 0.05). Conclusion: Femoral cartilage thickness was significantly reduced on the right/left medial, left intercondylar, and left lateral sides in women with SJH compared to healthy subjects. Furthermore, age appears to be an important determinant of femoral cartilage thickness