Candida endocarditis: Update on management considerations

The rise in incidence rates of invasive candidiasis warrants an increase in attention and efforts toward preventing and treating this virulent infection. Cardiac involvement is one of the most feared sequelae and has a poor prognosis. Despite the introduction of several novel antifungal agents over the past quarter century, complications and mortality rates due to Candida endocarditis have remained high. Although fungal endocarditis has a mechanism similar to bacterial endocarditis, no specific diagnostic criteria or algorithm exists to help guide its management. Furthermore, recent data has questioned the current guidelines recommending a combined approach of antifungal agents with surgical valve or indwelling prostheses removal. With the emergence of multidrug-resistant Candida auris, a focus on improved prophylactic measures and management strategies is necessary.

Impact of corn processing and weaning age on calf performance, blood metabolites, rumen fermentation, and behavior

This study examined the impact of two corn processing methods (steam-flaked (SFC) vs. ground) combined with two weaning ages (50 or 75 days) on calf performance, blood metabolites, rumen fermentation, nutrient digestion, and behavior. The study involved 48 three-day-old Holstein calves, with an average body weight of 41.4 ± 2.2 kg. The experimental design was a 2 × 2 factorial arrangement, resulting in four treatment groups: SFC50 (SFC and weaning at 50 days), SFC75 (SFC and weaning at 75 days), GC50 (ground corn and weaning at 50 days), and GC75 (ground corn and weaning at 75 days). Calves were given whole milk at 4 L/ day from day 3-15 and 7 L/ day from day 16 to either 43 or 68, depending on weaning age. Weaning occurred between days 44 and 50 for early-weaned calves and between days 69 and 75 for late-weaned calves. The study lasted until calves were 93 days old. The starter ration consisted of soybean meal, corn grain, 5% chopped wheat straw and premix. Results indicated that the SFC-based starter feed improved calf performance and nutrient digestion, as evidenced by increased weight gain, dry matter, crude protein, and neutral detergent fiber digestibility. Calves fed the SFC-based starter diet had lower blood albumin and urea N concentrations, while blood total protein and globulin concentrations were higher, especially in early-weaned calves. No significant changes in rumen pH and ammonia-N concentration were observed. In addition, the SFC starter feed resulted in higher volatile fatty acids concentration and longer feeding time in weaned calves compared to ground corn. Overall, these results suggest that an SFC-based starter feed may be beneficial for both early and late weaned calves.

Silicene dynamic optical response in the presence of external electric and exchange fields

We investigate the dynamic optical transition of monolayer silicene in the presence of external electric and exchange fields within the low-energy tight-binding model. Applying external electric and exchange fields breaks the silicene band structure spin and valley degeneracies. Three phases of silicene corresponding to different strengths of perpendicular electric field with respect to the spin-orbit coupling (Δ_z< Δ_so, Δ_z= Δ_soand Δ_z> Δ_so) are considered. We obtain the spin-valley-dependent optical responses to the incoming circularly polarized light using the Kubo formula. We show and discuss how the magnitude and direction of the transverse and longitudinal optical responses of such a system change with the electric and exchange fields. Our calculations suggest that the intraband part of the longitudinal optical response as well as the initial point of the interband part have strong dependencies on the exchange field. Furthermore, we show that one of the spin subbands plays a dominant role in the response to polarized light. Depending on the type of incident light polarization, the dominant subband may change. Our results shed light on the relation between silicene dynamic optical responses and externally applied fields.

Effects of different planes of milk feeding and milk total solids concentration on growth, ruminal fermentation, health, and behavior of late weaned dairy calves during summer

Background

In recent years, there has been an increasing interest in using high quantities of milk or milk replacer (MR) in heat-stressed calves to alleviate the negative effects of high environmental temperatures on their performance. However, observations have indicated a decline in growth performance in the weaning and post-weaning period, which might be optimized with increasing total solids (TS) in milk and weaning age. This study aims to optimize the effects of higher quantities of milk on late weaned calves' performance by increasing TS concentration or delivery route in summer conditions.

Method

Forty-eight newborn Holstein calves were used in a 2 × 2 factorial arrangement with the factors of pre-weaning total plane of milk (PM) intake (low vs. high) and milk TS content (12% vs. 17%). The treatments were (1) low PM (LPM) intake with 12% TS (TS intake = 45.9 kg), (2) LPM intake with 17% TS (TS intake = 65.1 kg), (3) high PM (HPM) intake with 12% TS (TS intake = 63.7 kg); and (4) HPM intake with 17% TS (TS intake = 90.3 kg). Calves were weaned at d 83, and the study was terminated at d 103 of age. Performance data (every 10 day), skeletal growth (d 80 and 100), ruminal fermentation parameters (d 48 and 91), and behavioral measurements (d 69, 70, 93 and 94) were analyzed as repeated measurements with PROC MIXED of SAS 9.4 (SAS Institute Inc., Cary, NC).

Results

Calves receiving HPM consumed less PMR from d 44 to 83 of age, but they had higher ADG from d 24 to 53 of age compared to those fed LPM (PM × age, P < 0.001). In addition, calves receiving milk with 17% TS had lower PMR intake from d 14 to 83 of age, but greater ADG from d 34 to 53 compared to those receiving milk with 12% TS (TS × age, P < 0.001). Calves that received HPM had greater skeletal growth parameters compared to LPM-fed calves, with a similar effect evident for calves fed milk with 17% TS compared with those fed milk with 12% TS. Calves receiving milk with 17% TS had greater fecal scores and diarrhea occurrence than those fed milk with 12% TS in HPM, but not LPM.

Conclusions

Increasing PM and milk TS concentration improved growth in summer-exposed calves as demonstrated by increased pre-weaning ADG, pre- and post-weaning BW, and structural growth.

Synergistic effects of dual antimicrobial combinations of synthesized N-heterocycles or MgO nanoparticles with nisin against the growth of Aspergillus fumigatus: In vitro study

Introduction of new inhibitory agents such as peptides, heterocyclic derivatives and nanoparticles (NPs) along with preventive proceedings are effective ways to deal with standard and drug-resistant strains of microorganisms. In this regard, inhibitory activities of some recently synthesized 4-thiazolylpyrazoles, imidazolidine- and tetrahydropyrimidine-2-thiones and magnesium oxide (MgO) NPs alone and in combination with nisin have been assessed against Aspergillus fumigatus. Antimicrobial susceptibility tests were done via broth microdilution, disk diffusion and streak plate methods according to the modified Clinical and Laboratory Standards Institute (CLSI) guidelines. Synergistic effects were also determined as fractional inhibitory concentration (FIC) and fractional fungicidal concentration (FFC) values. Inhibitory potentials of all heterocycles and NPs against A. fumigatus were proved based on inhibition zone diameter (IZD) values in the range of 7.72 - 16.85 mm, minimum inhibitory concentration (MIC) values in the range of 64.00 - 512 µg mL^-1 and minimum fungicidal concentration (MFC) values in the range of 256 - 2048 µg mL^-1. Tetrahydropyrimidine derivative 3f showed the best inhibitory properties. Inhibitory activity was not significant with nisin. While antifungal effects of major derivatives were improved by combination with it. The results indicated that the combined treatment of heterocycles used in the present study with nisin might be efficient for mold prevention and removal in foodstuffs or other products.

Synergistic promoting effect of ball milling and Fe(ii) catalysis for cross-dehydrogenative-coupling of 1,4-benzoxazinones with indoles

In this work, a novel C(sp3)–C(sp2) cross-dehydrogenative-coupling method is developed to react benzoxazin-2-one derivatives with various indoles. As a result, combined use of ball milling and Fe(ii) catalysis leads to rapid coupling of 1,4-benzoxazinones with derivatives of indole. Under the conditions, derivatives of 1 couple with various indoles at room temperature to produce good yields of the desired compounds within 0.5–2 h time period. Thus, derivatives of both starting materials couple smoothly under relatively mild conditions to give good yields of 3.

Missed Opportunities for Prevention of Sudden Death

BACKGROUND

We assessed patterns of health care utilization to further characterize chronic comorbidities prior to sudden death.

METHOD

From March 1, 2013, through February 28, 2015, all out-of-hospital deaths aged 18-64 reported by emergency medical services in Wake County, North Carolina, were screened to adjudicate 399 sudden death victims. Retrospective analysis of clinical records on victims determined health care utilization. Health care utilization frequency was assessed by latent growth curve analysis.

RESULTS

Medical records were available for 264 victims (aged 53.5 ± 9.2) who were predominantly male (65%) and white (64%). Of these, 210 (80%) victims had at least one visit within two years of death and 73 (28%) had a visit within one month of death. Over the two years prior to death, there was an increasing frequency of doctor visits (P < .001). Victims averaged 3.7 ± 4.6 yearly visits and were categorized into low (0.4 visits/year), medium (3.3 visits/year), and high (11.4 visits/year) tiers of visit frequency. The high visit tier had a greater prevalence of coronary artery disease (38%), hypertension (80%), diabetes (58%), depression (74%), anxiety (64%), and substance misuse (46%) (P < .001).

LIMITATIONS

Those who were non-free-living, minors, without formal medical records, and adults aged 65 and older were excluded from the analysis.

CONCLUSIONS

A majority of sudden death victims utilized health care within two years prior to death and had comorbidities that may have contributed to their unexpected death. The increasing frequency of visits prior to death provided an opportunity for health care providers to address potential victims' chronic medical conditions to potentially prevent death.

Effects of supplemental fat sources and forage feeding levels on growth performance, nutrient digestibility, ruminal fermentation, and nitrogen utilization in dairy calves

Knowledge regarding the potential interactions between supplemental fat source and fiber level in starter diet of dairy calves is lacking. The aim of the present study was to investigate the effects of supplemental saturated fat [palm fat (PLF) containing 86% palmitic acid (C16:0)] vs. unsaturated fat [soybean oil (SBO) containing 51% linoleic acid (C18:2)] and forage level on feed intake, growth performance, ruminal fermentation, nutrient digestibility, and metabolic traits in dairy calves. Forty newborn Holstein female calves (BW = 39.7 ± 1.8 kg) were assigned to 1 of 4 treatment groups (each consisting of 10 animals) in a 2 × 2 factorial arrangement of fat source [soybean oil vs. palm fat; 3% of starter based on DM basis] and alfalfa hay level (0 vs. 15%, on DM basis): SBO or PLF with (AH) or without (NAH) alfalfa hay. Calves had ad libitum access to water and starters throughout the study and a constant amount of milk was offered among experimental calves during the pre-weaning period. All calves were weaned on day 63 of age and remained in the study until day 73 of age. The results showed that the lowest and the highest starter intake and average daily gain during pre-weaning period was observed when calves received SBO-AH and PLF-AH, respectively. Accordingly, the lowest wither and hip heights at weaning time (day 63) and final wither height (day 73) were observed in SBO-AH group across treatments. Calves received PLF-AH had the highest weaning and final BW compared to other groups. Feed efficiency tended to be higher in PLF groups compared with SBO calves. Calves fed SBO-AH had the lowest digestibility of organic matter and neutral detergent fiber and also total short chain fatty acid concentrations in rumen compared with other groups. The SBO calves had lower urinary allantoin, urinary purine derivatives, and microbial protein synthesis than PLF calves; however, urinary nitrogen increased with SBO supplementation. In summary, the supplementation of SBO rich in C18:2 and AH during the pre-weaning period resulted in negative responses on growth performance, digestibility, and ruminal fermentation profile. Therefore, the inclusion SBO rich in C18:2 along with forage in the starter is not recommendable for young dairy calves.

High Prevalence of Diabetes Mellitus and Mental Illness Among Victims of Sudden Death

OBJECTIVES

Diabetes mellitus (DM) increases the risk of cardiovascular disease and is associated with sudden death. Mental illness among individuals with DM may confound medical care. This study assessed the association of mental illness with DM and poorly controlled DM in sudden death victims.

METHODS

We screened out-of-hospital deaths ages 18 to 64 years in Wake County, North Carolina from 2013 to 2015 to adjudicate sudden deaths. We abstracted demographics and clinical characteristics from health records. Mental illness included anxiety, schizophrenia, bipolar disorder, or depression. Poorly controlled DM was defined as a hemoglobin A1c >8 or taking ≥3 medications for glycemic control. Logistic regression assessed the association between DM and mental illness.

RESULTS

Among victims with available records, 109 (29.4%) had DM. Of those, 62 (56.9%) had mental illness. Mental illness was present in 53.42% and 63.89% of victims with mild and poorly controlled DM, respectively. Mental illness was associated with DM (adjusted odds ratio 2.46, 95% confidence interval 1.57-3.91). Victims with poorly controlled DM were more likely to have mental illness (adjusted odds ratio 2.66, 95% confidence interval 1.14-6.18).

CONCLUSIONS

DM is a common comorbid condition in sudden death victims. Among victims, mental illness is associated with the control of DM. Early management of comorbid mental illnesses may improve the care of patients with DM and reduce the incidence of sudden death.

Symptoms prior to sudden death

Background

Sudden death accounts for up to 15% of all deaths among working age adults. A better understanding of victims’ medical care and symptoms reported at their last medical encounter may identify opportunities for interventions to prevent sudden deaths.

Methods

From 2013−15, all out-of-hospital deaths, ages 18–64 reported by Emergency Medical Services (EMS) in Wake County, North Carolina were screened and adjudicated to identify 399 victims of sudden death, 264 of whom had available medical records. Demographic and clinical characteristics and prescribed medications were compared between victims with versus without a medical encounter within one month preceding death with chi-square tests and t-tests, as appropriate. Symptoms reported in medical encounters within one month preceding death were analyzed.

Results

Among the 264 victims with available medical records, 73 (27.7%) had at least one encounter within a month preceding death. These victims were older and more likely to have multiple chronic illnesses, yet most were not prescribed evidence-based medicines. Of these 73 victims, 30 (41.1%) reported cardiac symptoms including dyspnea, edema, and chest pain.

Conclusions

Many victims seek medical care and report cardiac symptoms in the month prior to sudden death. However, medications that might prevent sudden death are under prescribed. These findings suggest that there are opportunities for intervention to prevent sudden death.

Effects of wheat straw particle size as a free-choice provision on growth performance and feeding behaviors of dairy calves

In the dairy calf feeding, supplementation of forage to the starter feed is commonly practiced. However, data are insufficient about how changes in particle size (PS) of forage affect calf performance and behavior in a free-choice forage provision system. This study aimed to assess the effects of supplementing wheat straw varying in PS on performance, skeletal growth characteristics, ruminal pH, nutritional behaviors, and blood metabolites of dairy calves. Forty-eight Holstein calves (43.8 ± 3.2 kg of BW) from d 15 of age were randomly assigned to one of the four treatments (n = 12/treatment; six males and six females): (1) starter without wheat straw supplementation (CON), (2) CON supplemented with wheat straw chopped at 1 mm geometrical mean particle length (GMPL) (fine PS), (3) CON supplemented with wheat straw at 4 mm GMPL (medium PS), and (4) CON supplemented with wheat straw at 7 mm GMPL (long PS). The calves were given ad libitum access to feed and water throughout the study. All calves were weaned on d 56 of age and continued the experiment until d 90. The starter, wheat straw, and total solid feed intakes were not affected by GMPL of wheat straw; however, CON calves had a lower solid feed-, total DM- and NDF-intake than calves offered wheat straw. Further, ADG, weaning, and final BWs as well as feed efficiency were similar between treatments. No difference was observed in growth rate of hip height, hip width, body barrel, wither height, and heart girth among treatments, however, wheat straw supplemented calves tended to have greater body length at weaning. Blood concentration of serum β-hydroxy butyrate was greater in wheat straw supplemented calves compared with CON calves on d 56 and 90. Calves supplemented with wheat straw spent more time eating starter and forage, lying and ruminating and less time for standing and non-nutritional behaviors compared with the CON calves on d 49 and 63 of the study. Moreover, calves offered wheat straw had greater ruminal pH than CON calves at 4 and 8 h after offering starter feed on d 35. In conclusion, supplementing wheat straw as a free-choice increased solid feed intake, rumen pH, and calves' welfare, however, PS of wheat straw had no effect.

Poultry by-product meal as a replacement to xylose-treated soybean meal in diet of early- to mid-lactation Holstein cows

The objectives were to compare the effectiveness of poultry by-product meal (PBM) with xylose-treated soybean meal (x-SBM) as a conventional protein source and rumen-undegraded protein (RUP):rumen-degraded protein (RDP) ratio on nutrient digestibility, nitrogen metabolism, and production of early- to mid-lactation Holsteins. Twelve multiparous cows averaging (mean ± SD) 50 ± 9 days in milk were randomly assigned to a replicated 4 × 4 Latin square design within a 2 × 2 factorial arrangement of treatments. Each period was 28 days in length. Treatments were RUP sources (PBM or x-SBM) with either a high or a low RUP:RDP ratio (high ratio = 40:60 or low ratio = 36:64; based on % of crude protein (CP)). Experimental diets were balanced to be similar in protein and energy contents (CP = 16.7% of DM; NEL = 1.67 Mcal/kg DM). Prior to diet formulation, an in situ pilot experiment was conducted to estimate the RUP fractions of x-SBM and PBM as 63.9% and 54.1% of CP, respectively. Treatments had no effect on ruminal pH and total volatile fatty acid (VFA) and molar percentage of individual VFAs. Treatments had no effect on total tract apparent digestibility of DM, OM, and neutral detergent fiber (NDF), with the exception of N that was greater in diets with a low RUP:RDP ratio (68.2 vs. 70.1% of DM). DM consumption was 0.70 kg/day higher when cows were fed PBM diet compared with x-SBM diet. No treatment effect was observed on milk yield and milk composition; however, milk protein yield and milk urea N were greater in cows fed PBM. Inclusion of PBM in the diet in substitution to x-SBM resulted in increased blood levels of urea N, cholesterol, and non-esterified fatty acid (NEFA). There was no interaction between the RUP source and the RUP:RDP ratio for urinary and fecal N excretion. Efficiency of N utilization expressed as milk N secretion as a proportion of N intake tended to be greater in cows fed PBM. Feeding diets with a low ratio of RUP:RDP increased efficiency of milk production expressed as milk yield as a proportion of total N excretion (fecal and urinary N). Feeding a diet with PBM supported milk production comparable with x-SBM and had positive effects on feed intake, milk protein yield, and milk N efficiency.

Effects of physical forms of starter and milk allowance on growth performance, ruminal fermentation, and blood metabolites of Holstein dairy calves

A 2 × 2 factorial study was conducted to evaluate the effects of milk allowance and physical forms of starter on growth performance, ruminal fermentation, and blood metabolites of Holstein dairy calves. A total of 48 calves [40.4 ± 1.55 kg of body weight (BW), n = 12 per treatment: 6 males and 6 females] were randomly assigned to 1 of the 4 treatments: (1) calves fed low milk allowance and finely ground (FG) starter feed [low-FG; 1.47 ± 2.12-mm geometric mean particle size (GMLP)], (2) calves fed low milk allowance and textured (TS) starter feed [low-TS, includes steam-flaked grains (corn and barley) with a pelleted supplement, GMLP 4.15 ± 1.77 mm], (3) calves fed high milk allowance and FG starter feed (high-FG); and (4) calves fed high milk allowance and TS starter feed (high-TS). The starter diets were blended with 7% of chopped alfalfa hay as a proportion of diet dry matter (DM). No milk refusal was observed in any treatments, and calves on both treatments were weaned from milk by wk 8 of the study using a gradual weaning procedure. We observed no interaction between milk allowance and physical forms of starter on feed intake, average daily gain, feed efficiency, BW, and structural growth. Calves fed high milk allowance had lower starter feed intake but greater feed efficiency and overall BW compared with those fed low allowance. Total DM intake and average daily gain were not different among treatments. Regardless of the physical form of starter feed, hip height, heart girth, the molar proportion of ruminal acetate, acetate to propionate ratio, plasma cholesterol, and high-density lipoprotein were greater, but ruminal total volatile fatty acids, the molar proportion of propionate, and plasma β-hydroxybutyrate were lower in calves fed high milk allowance compared with those fed low allowance. Regardless of the milk allowance, calves fed the FG starter feeds had greater blood urea nitrogen concentrations compared with calves fed the TS starter diets. In conclusion, both forms of the starter feeds can be used when calves are fed high milk allowance with no negative effect on their performance.

Effects of step-down weaning implementation time on growth performance and blood metabolites of dairy calves

The current study evaluated the effects of step-down weaning implementation time on starter feed intake, growth performance, blood metabolites, and ruminal pH in dairy calves. A total of 48 Holstein dairy calves (24 male and 24 female; 3 ± 1 d old; 41.2 ± 1.8 kg of body weight) were assigned (n = 12 per treatment; 6 male and 6 female) to 4 experimental treatments in a completely randomized block design. All calves were fed 6 L/d of milk from d 3 to 10 of age, and the treatments consisted of the following: calves were offered 8 L/d of milk from d 11 to 28 of age and then 4 L/d from d 29 to 63 (Step-28; total milk offered = 326 L); calves were offered 8 L/d of milk from d 11 to 42 of age and then 4 L/d from d 43 to 63 (Step-42; total milk offered = 382 L); calves were offered 8 L/d of milk from d 11 to 56 of age and 4 L/d from d 57 to 63 (Step-56; total milk intake = 438 L); and calves were fed 8 L/d of milk from d 11 to 63 of age and abruptly weaned (control; total milk offered = 466 L). All calves were housed individually in pens and had ad libitum access to water and solid feed throughout the experiment. All calves were completely milk weaned on d 64, and their performance was measured until d 80 of age. During the experiment, the starter intake (kg/d and % of body weight) was greater in calves in the Step-28 group compared with those in the other groups. However, the total metabolizable energy intake was greater in the Step-56 calves compared with the other calves. Overall, the average daily gain (ADG), feed efficiency (ADG/dry matter intake), and ADG/total metabolizable energy intake were similar across the treatments. Circulating glucose, β-hydroxybutyrate, blood urea nitrogen, albumin, total protein, alanine aminotransferase, and aspartate aminotransferase, as well as ruminal pH, were not affected by the treatments. The implementation of step-down weaning in early life (4-6 wk of age) could stimulate solid feed intake compared with weaning at a later age with no negative effect on performance.

Changes in the prevalence of measures associated with hypertension among Iranian adults according to classification by ACC/AHA guideline 2017

Background

Different definitions have been proposed to categorize hypertension. We aimed to investigate the difference in prevalence of measures associated with hypertension according to the American College of Cardiology/American Heart Association (ACC/AHA) criteria versus Joint National Committee 7 (JNC7) criteria.

Methods

We analyzed the data of 10,000 participants of Yazd Health Study (YaHS) aged 20–69 years. Blood pressure was measured three times with standard protocol defined by ACC/AHA. Prevalence of high blood pressure measure was compared in both definitions and absolute differences reported.

Results

The prevalence of high blood pressure in our measurement was 61.0% according to ACC/AHA, and 28.9% according to JNC 7. The prevalence of self-reported hypertension was 18.6%. Age and sex standardized prevalence rates of high blood pressure measure indicates a 2.4-fold increase in the prevalence rate (30.1% absolute difference) by the ACC/AHA guideline. While the prevalence increased in all age groups, the age group of 20–29 showed the highest relative increase by 3.6 times (10.6% vs. 38.1%). High blood pressure measure among people with diabetes increased from 45.8 to 75.3% with the ACC/AHA guideline. Of the people who had no past history of diagnosed hypertension (n = 7887), 55.1 and 22.7% had high blood pressure measure by ACC/AHA and JNC-7 guidelines, respectively. From JNC7 to ACC/AHA, the overall difference in unawareness about HTN increased by 32.4%.

Conclusion

Prevalence of hypertension associated measures increased over two folds by using the ACC/AHA criteria compared to JNC 7. Also, change in the criteria, reduces awareness of the disease and increases uncontrolled hypertension respectively. More research is needed to determine if the new definitions can affect management of hypertension in societies. Considering local priorities and implication of cost effective may improve implementation of new definitions for hypertension in different countries.

Coronary Artery Disease and Atherosclerotic Risk Factors in a Population-Based Study of Sudden Death

BACKGROUND

Sudden death is a public health problem with major impact on society. Coronary artery disease (CAD) is believed to underlie 60-80% of these deaths. While deaths from CAD have decreased in the recent decades, sudden death rates remain unacceptably high.

OBJECTIVE

We aimed to assess the prevalence of CAD and its risk factors among 18-64-year-old adults in a population-based case registry of sudden deaths and compare them to a living population from the same geographical area.

DESIGN

From 2013 to 2015, all sudden deaths among 18-64-year-old adults in Wake County, NC, were identified (n = 371). A comparison group was formed by randomly selecting individuals from an electronic health record repository of a major healthcare system in the area (N = 4218).

MAIN MEASURES

Prevalence of CAD and its risk factors among cases of sudden death and living population across sex and age groups. Odds of sudden death associated with atherosclerotic risk factors and comorbidities.

KEY RESULTS

CAD was present in 14.8% of sudden death cases. Among sudden death victims, most risk factors and comorbidities were more common in the older age group, except for obesity which was more common in younger cases, and diabetes which was equally prevalent in younger and older cases. Compared to living population, sudden death cases had higher prevalence of atherosclerotic risk factors across all gender and age groups. Sudden death cases had a numerically higher number of risk factors compared to living population, regardless of age group or presence of CAD.

CONCLUSIONS

Coronary artery disease is not common among sudden death cases, but risk factors and comorbidities are prevalent. Our findings support the changing etiology of sudden death. In the absence of clinically diagnosed CAD, use of novel imaging modalities and biomarkers may identify high-risk individuals and lead to prevention of sudden death.

Identification and Determination of the Geographical Distribution of Freshwater Snails in Lorestan, Iran

Snails are creatures present in various ecosystems that, in addition to being present in human surroundings, some of them are also important in veterinary medicine and medicine as the intermediate hosts of Digenean trematodes. The present study was conducted to identify and determine the geographical distribution of freshwater snails and investigate the relationship of variables, such as season and geographical region, with snail species and dispersion in Lorestan in the west of Iran. A total of 4400 samples of freshwater snails were collected using the multistage sampling method (i.e., stratified, cluster, and randomized) from 110 points in five geographical regions in four seasons and then identified based on their morphological characteristics by diagnostic keys. The ArcGIS software (version 10.3) was used to evaluate the spatial distribution of the freshwater snails. In this study, seven species of freshwater snails were identified in six families belonging to six genera, namely Melanopsis doriae (6.30% of the variation in species), Theodoxus doriae (5.55%), Bithynia tentaculata (43.22%, the dominant species), Physa acuta (24.98%), Lymnaea truncatula (9.75%), Gyraulus euphraticus (8.18%), and Lymnaea gedrosiana (2.02%). The geographic distribution of freshwater snails was recorded across five regions in 22 points per region for every season. The spatial distribution maps showed that the distribution of freshwater snails varies according to region and season (P&amp;lt;0.001). The obtained results revealed the effects of season and geographical region on the distribution and population density of snails in the province. These data can be used for the implementation of control programs against parasitic diseases in the region, including trematodes.

Reciprocal combinations of alfalfa hay and corn silage in the starter diets of Holstein dairy calves: effects on growth performance, nutrient digestibility, rumen fermentation and selected blood metabolites

Adding corn silage (CS) instead of alfalfa hay (AH) to the finely ground starter diet would improve calf performance if feed intake or feed efficiency is increased. We investigated the effects of replacing AH with CS in the starter diet on nutrient intake, digestibility, growth performance, rumen fermentation and selected blood metabolites in Holstein calves. Newborn male calves (n = 30; 3 days of age; 40.2 ± 1.28 kg BW) were assigned randomly to three groups receiving starter diets containing chopped AH (10% dry matter (DM) basis; AH diet), CS (10% DM, CS diet) or their combination (each at 5% level; AHCS diet). The starter diets had the same nutrient composition but differed in DM content (91.2%, 87.5% and 83.8% for AH, AHCS and CS, respectively). The calves were weaned on day 50, and the study continued until day 70. Nutrient intake, BW (at weaning and at the end of the study) and body measurements were not affected by the diet. During the post-weaning period, average daily gain tended to be greater on CS than on AH diet. Feed efficiency was greater in CS than in AH or AHCS calves during the post-weaning period. Digestibility of neutral detergent fiber was greater in AHCS and CS compared with AH during the post-weaning period. Concentration and profile of volatile fatty acids and ruminal fluid pH were not affected by the diet. Replacing AH with CS in the starter diet had no effect on feed intake, growth performance and general health of the calves. These results indicate that AH and CS can be used interchangeably in dairy calf starter diets until 70 days of age, allowing dairy producers more choices in selecting the feed ingredients.

Can transient resting of the bladder with vesicostomy reduce the need for a major surgery in some patients?

BACKGROUND

Neuropathic bladder, voiding dysfunction, and posterior urethral valves may cause a great challenge in children. Preserving the kidney function is the main aim in all of these patients which can be achieved by cutaneous vesicostomy.

OBJECTIVE

The objective of this study is to evaluate the long-term outcomes of patients who have undergone cutaneous vesicostomy in an 11-year period at the study center.

STUDY DESIGN

In this retrospective study, the authors evaluated the long-term treatment results and complications of cutaneous vesicostomy on children with bilateral severe hydronephrosis, bilateral vesicoureteral reflux (VUR), and urosepsis who were operated at our center from 2007 to 2018.

RESULTS

There were 64 (80%) boys and 16 (20%) girls. Their mean of age was 15.27 months old when they underwent vesicostomy. Twenty-three (28.75%) of them had neurogenic bladder and 17 (21.25%) of them had intact neuronal pathway defined as dysfunctional voiding. Twenty-five (31.25%) boys had posterior urethral valves. Fifteen (18.75%) of them were younger than six months old with primary bilateral high-grade VUR and urosepsis. Mean of follow-up time was 65.34 ± 37.82 months (11.5 months-10.5 years). Cure rate was 95% in urinary tract infection, 80.7% in secondary VUR, and 40% in primary VUR. Creatinine level was significantly reduced after vesicostomy and during follow-up (P < 0.001). Complications after vesicostomy were stoma stenosis (11.25%), mucosal prolapse (7.5%), dermatitis (3.75%), and febrile urinary tract infection (5%). In primary VUR after vesicostomy, 60% of the patients did not require an intervention to correct the reflux (Table).

DISCUSSION

A number of 29 of 66 patients with closed vesicostomy needed another surgery: three modified Gil-Vernet antireflux surgeries, one ureteral reimplantation, two endoscopic Deflux injections, 13 valve ablations, six ileocystoplasties, and four Botox injections. The 37 (56.06%) remaining patients did not require any other surgery after closure of vesicostomy.

CONCLUSION

Vesicostomy should be considered in children with neuropathic bladder or bladder outlet obstruction in case first-line therapies fail. This simple and reversible procedure can reduce febrile urinary tract infections, protect the upper urinary tract, and reduce the need for a major surgery without decreasing the bladder capacity.

Years of Life and Productivity Loss Because of Adult Sudden Unexpected Death in the United States

BACKGROUND

Few studies have evaluated the years of life lost (YLL) and productivity loss due to sudden unexpected death (SUD). The burden of SUD on society is undetermined because of lack of population-based studies and comprehensive adjudication methods.

OBJECTIVE

We estimated YLL and productivity loss from SUD in working-age adults and compared it with the leading causes of death in the United States.

METHODS

We screened all out of hospital deaths among people aged 20-64 in Wake County, NC from 2013 to 2015 to adjudicate SUDs. We extrapolated Wake County incidence to estimate the age-standardized and sex-standardized rate of SUD in the United States. YLL was calculated based on the remaining life expectancy of the victims. Incorporating market and housekeeping value estimated the present value of lifetime productivity loss because of SUD.

RESULTS

SUD incidence rates in the US adults aged 20-64 were 49.3 (95% confidence interval, 41.2-58.3) and 21.7 (95% confidence interval, 16.5-27.8) per 100,000 among men and women, respectively. SUD resulted in the loss of 2 million years of life, accounting for 10.0% of YLL from all causes of death. Among natural causes of death, YLL from SUD was only lower than that from all cancers combined and heart disease. Lifetime productivity loss because of SUD was ~$51 billion, exceeding productivity loss from any individual cancer.

CONCLUSION

SUD is an important source of YLL and productivity loss among adults aged 20-64. Such a high burden on society justifies prioritizing health policies and interventions toward preventing SUD.

Evaluation of an education program based on the theory of planned behavior for salt intake in individuals at risk of hypertension

This study was conducted to evaluate an education program based on the theory of planned behavior (TPB) for salt intake in individuals at risk of hypertension. This randomized controlled trial was conducted from February 2017 to December 2017 in Shahediyeh, Yazd Province, Iran. For this purpose, 140 people were selected and assigned to two groups of 70 each, namely, intervention and control. Data were gathered by a self-administered TPB based questionnaire, and also 24-h urinary sodium and potassium levels and systolic and diastolic blood pressure were measured. The intervention group received TPB based on a training package, while the control group received no intervention. Post-test was administered 2 months after completion of the intervention. Independent and paired t-tests, χ2 and analysis of covariance (ANCOVA) were used for data analysis. All mean scores on TPB constructs increased significantly except motivation to comply and power of control for intervention group. Average salt intake decreased in intervention group compared with the control group (-4.73 g/day �0.73 versus -0.24 g/day �0.94, P < 0.001), but systolic and diastolic blood pressure did not change significantly in intervention group compared with control group. TPB can be implemented along with other approaches in educational programs to reduce salt intake. Code: IRCT201701108803N3.

A Facile Solvent-free One-pot Three-component Mannich Reaction of Aldehydes, Amines and Terminal Alkynes Catalysed by CuCl2

A solventless Mannich condensation of aldehydes, amines, and terminal alkynes catalysed by 10 mol% of CuCl2 was investigated. The components were simply mixed and heated together under vacuum, without any need of solidsupport or solvent. This results in the formation of Mannich products in high yields.

Copper-Catalysed Oxidative Homo-Coupling of Terminal Acetylenes on Alumina Assisted by Microwave Irradiation

A variety of diacetylenes were prepared in a microwave irradiation promoted reaction on alumina in the presence of catalytic amounts of a copper catalyst with up to 90% yields, in short times and under solvent-free conditions.

Immobilization of Lewis acidic ionic liquid on perlite nanoparticle surfaces as a highly efficient solid acid catalyst for the solvent-free synthesis of xanthene derivatives

In this study, perlite nanoparticles were prepared through a simple method and then modified with Lewis acidic ionic liquid (perlite NP@IL/ZrCl₄) through a two step procedure. The prepared solid acid catalyst was characterized by Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), X-ray diffraction (XRD), energy-dispersive X-ray spectroscopy (EDX) and thermo gravimetric analysis (TGA). Perlite NP@IL/ZrCl₄ was used as a new solid acid, reusable and green heterogeneous nanocatalyst for the one-pot synthesis of xanthene derivatives. Synthesis of xanthenes was performed under solvent free conditions using a catalytic amount (0.005 g, 0.4 mol%) of the prepared catalyst with simple work-up and high to excellent yield of products. The reusability and high efficiency of this catalyst makes this method attractive for large scale environment-friendly operations.

Perlite nanoparticles were prepared, modified with Lewis acidic ionic liquid, and used as a highly efficient catalyst for the eco-friendly, solvent free and high yield synthesis of xanthenes via a multicomponent reaction.

Mortality Rate and Years of Life Lost Due to Prostate Cancer in Yazd Province, Iran: A 10-year study

Objectives

Prostate cancer is a leading cause of cancer-related deaths. The number of deaths and years of life lost (YLL) due to a disease can be used to monitor health status, assess healthcare needs and determine the prioritisation and allocation of health resources within a population; in addition, the latter calculation can serve as a baseline indicator of premature mortality. This study aimed to measure prostate cancer-related mortality and YLL in Yazd Province, Iran.

Methods

This study included all prostate cancer-related deaths in Yazd Province reported between March 2001 and March 2010. Mortality data were obtained from a provincial death registration system which integrates data from different sources. YLL was calculated based on an individual's age at death and their life expectancy according to age group.

Results

During the study period, prostate cancer was the fourth most common fatal cancer among men, resulting in 324 deaths or 10.0% of all cancer-related deaths. The crude mortality rate per 100,000 individuals increased from 4.7 in 2001 to 8.8 in 2010. Premature deaths caused 1,358.7 YLL and the YLL caused by prostate cancer deaths more than doubled from 94.7 in 2001 to 196.5 in 2010.

Conclusion

Due to changes in population structure, it is likely that the burden of prostate cancer will continue to increase in Yazd Province. As such, it is necessary that the national health system implements screening programmes and improves public awareness of prostate cancer-associated risk factors.