BackgroundThe epidemiology of infective endocarditis (IE) depends on a number of host factors whose prevalence can vary globally. The usual patient population affected by IE is sicker and older, often with many comorbid conditions. The risk is growing in younger populations due to the emerging epidemic of intravenous (IV) drug use. We have performed a temporal trend analysis of various factors of IE in the rural counties covering a major part of central Upstate New York.MethodsWe performed a retrospective analysis of electronic medical records of patients who were admitted in a tertiary care hospital in rural Upstate New York and diagnosed with IE from January 1, 2011 to December 31, 2016. Forty-five patients were identified with definite IE and nine with possible IE.ResultsTotal incidence of IE was 3.5 cases per 100,000 person years in the total population and 4.4 if we consider total population ≥ 18 years in the denominator. A significant (P = 0.022) increase in incidence of IE from 2011 to 2016 was seen by univariate analysis. Incidence was higher in males (P = 0.029) and for those aged 65 or older (P = 0.0003). IV drug use among cases is noted to be more prevalent in 2015 and 2016 compared to previous years.ConclusionIn this study of patients in a rural region of New York, an increase in the incidence of IE was seen over the study period with changes in patient characteristics and etiology over this time. We speculate that an increase in IV drug use could be a leading factor in the recent and future increased incidence of IE in the area.
Aortic dissection is the most catastrophic clinical condition that involves the aorta. It has a high mortality as well as high rate of misdiagnosis due to frequent unusual presentation. Typically, it presents with acute chest, back, and tearing abdominal pain. However, it can present atypically with minimal or no pain, making diagnosis difficult. Physicians should always suspect acute aortic dissection in patients with certain clinical conditions like difficult-to-control hypertension, giant cell arteritis, bicuspid aortic valve, intracranial aneurysms, simple renal cysts, family history of aortic disease, and Marfan syndrome, especially when a patient presents with ischemic symptoms involving multiple organ without an obvious cause.
Synthetic plastics are causing serious environmental and health problems due to which the concept of developing biodegradable food packaging has gained considerable attention. In this study, extraction of gelatin from chicken feet was optimized followed by characterization of gelatin. Chicken feet gelatin was used to develop biodegradable nanocomposite films by the incorporation of chitosan (CS) and zinc oxide (ZnO) nanoparticles (NPs). Gelatin nanocomposite films were used to increase the shelf-life of fresh grapes by determining the browning index, weight loss, and microbial profile of fresh grapes. A high yield (7.5%) of gelatin and Bloom strength (186 g) were obtained at optimized extraction conditions (pretreatment with 4.2% acetic acid and extraction at 66 °C for 4.2 h). Electrophoretic analysis of gelatin revealed the presence of α (130–140 kDa) and β chains (195–200 kDa), whereas a Fourier transformed infrared (FTIR) spectrometer confirmed the presence of amide A and B and amide I, II, and III. Incorporation of ZnO NPs in a gelatin–CS matrix improved the barrier and the mechanical and the thermal properties of films. Gelatin nanocomposite films with 0.3% ZnO NPs significantly reduced the weight loss (23.88%) and the browning index (53.33%) of grapes in comparison to control treatments. The microbial count in artificially inoculated grapes wrapped in gelatin nanocomposite films remained below 4 log CFU/mL until the fifth storage day in comparison to control treatments. The gelatin from poultry byproducts such as chicken feet can serve as an efficient biopolymer to develop biodegradable food packaging to enhance the shelf-life of perishable food products.
Tumor lysis syndrome (TLS) is considered an oncologic emergency which requires early diagnosis and treatment to prevent mortality and morbidity. It refers to the constellation of metabolic disturbances manifested by acute renal failure associated with hyperuricemia, hyperkalemia, hypocalcemia and hyperphosphatemia. Diagnosis is made based on Cairo-Bishop clinical and laboratory criteria. Spontaneous TLS, occurring prior to the initiation of cancer therapy, has been reported in hematologic malignancies like high grade non-Hodgkin's lymphoma (NHL) and acute leukemia, and rarely in solid tumors including colon cancer, hepatocellular carcinoma and in at least two cases of breast cancer. We present a case of spontaneous TLS in breast cancer patient which is rare but interesting disease manifestation.
In patients with diabetes mellitus, cardiovascular (CV) disease is the leading cause of morbidity and mortality. A multitude of contemporary antidiabetic agents presents different CV safety profiles. Metformin forms the cornerstone agent to reduce CV events. Newer agents, such as glucagon‐like peptide‐1 agonists and sodium‐glucose cotransporter‐2 inhibitors, have appealing CV benefits. Insulin, dipeptidyl peptidase‐4 inhibitors, and sulfonylureas have neutral CV effects. Cardiologists should familiarize themselves with these agents to promote comprehensive CV care in patients with diabetes mellitus.
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