Outcomes of Clostridioides difficile infection in acute heart failure hospitalizations: insights from the National Inpatient Database

BACKGROUND

Heart failure (HF) patients are at a greater risk for nosocomial infections due to their higher prevalence of comorbidities, readmission rates, and prolonged hospital stays. Clostridioides difficile infection (CDI) remains a common nosocomial infection in hospitalized patients.

AIM

To identify patients with a diagnosis of acute HF and stratified based on the presence of CDI, using the National Inpatient Sample (NIS) database from 2016 to 2020.

METHODS

Adjusted odds ratios (aOR) of in-hospital outcomes were calculated, and a propensity-matched analysis was performed.

FINDINGS

Of 536,595 acute HF hospitalizations in this timeframe, 3030 were also diagnosed with CDI (0.56%). Patients with acute HF and CDI had significantly higher in-hospital mortality (adjusted odds ratio: (aOR): 1.91), cardiac arrest (aOR: 1.66), and use of mechanical circulatory support (MCS) (aOR 2.42). In propensity-matched analysis, in-hospital mortality (13.71 vs 8.44%; P=0.005), septic shock (7.54 vs 3.33%; P=0.002), and use of MCS (7.19 vs 3.68%; P=0.009) were significantly higher in HF patients with CDI than without. Coexisting neurological disease (aOR: 3.74) and liver disease (aOR: 2.97) showed the strongest association as independent predictors of mortality. HF patients with CDI had longer hospital stays (14.45 ± 19.40 vs 5.44 ± 7.10 days; P<0.0001) and higher inflation-adjusted total hospital costs ($186,225 ± 376,485 vs $60,740 ± 153,992; P<0.001) compared to those without CDI.

CONCLUSION

The occurrence of concomitant CDI in patients admitted with acute HF exacerbation is associated with worse in-hospital outcomes and deaths as well as longer hospitalizations and greater financial cost.

Bio-enrichment of phenolics and antioxidant activity of combination of Oryza sativa and Lablab purpureus fermented with GRAS filamentous fungi

Cereal and legumes meet a considerable requirement of protein and carbohydrate of the local population. Most of the foods are cereal based but some cereal/legume or legume based foods are also common in many countries of Asia and Africa. In present study, the effect of fermentation on total phenolics, antioxi- dant activity and α-amylase enzyme activity of ethanolic extracts of each of seeds and flours combination (1:1) of Oryza sativa (rice) and Lablab purpureus (seim) was determined. The percentage inhibition of free radicals formation by DPPH and ABTS assays was found maximum i.e. 80.66 ±0.21, 97.67 ±0.35 on 4th day of incubation of combined sample of rice and seim seeds fermented with Aspergillus oryzae and As- pergillus awamori, respectively. The increased percentage inhibition of free radical formation of fermented samples was found greater than the non-fermented samples (65.88 ±0.15, 42.00 ±0.63). The TPC of sub- strate i.e. rice:seim seeds (1:1) was also found maximum i.e. 47.53 ±0.20 on 5th day of fermentation with A. awamori . α-amylase activity of fermented samples was also found higher than that of non fermented samples. Almost similar results were obtained in combined flour extract of both the substrates. Increase in level of α-amylase enzyme during SSF indicates that enzymes produced by microorganisms were re- sponsible for release of bound phenolics which may be responsible for increase in antoxidant activity of extracts of fermented seeds and flour combination a cereal and a legume.

Nanotechnology: The new perspective in precision agriculture

Nanotechnology is an interdisciplinary research field. In recent past efforts have been made to improve agricultural yield through exhaustive research in nanotechnology. The green revolution resulted in blind usage of pesticides and chemical fertilizers which caused loss of soil biodiversity and developed resistance against pathogens and pests as well. Nanoparticle-mediated material delivery to plants and advanced biosensors for precision farming are possible only by nanoparticles or nanochips. Nanoencapsulated conventional fertilizers, pesticides and herbicides helps in slow and sustained release of nutrients and agrochemicals resulting in precise dosage to the plants. Nanotechnology based plant viral disease detection kits are also becoming popular and are useful in speedy and early detection of viral diseases. In this article, the potential uses and benefits of nanotechnology in precision agriculture are discussed. The modern nanotechnology based tools and techniques have the potential to address the various problems of conventional agriculture and can revolutionize this sector.

Bio-augmentation of antioxidants and phenolic content of Lablab purpureus by solid state fermentation with GRAS filamentous fungi

The present study was conducted to find out the effect of solid state fermentation on release of phenolicsand subsequently on improvement of antioxidant activity of fermented seed and flour of Lablabpurpureus (seim), using GRAS filamentous fungi i.e. Aspergillus awamori and Aspergillus oryzae . Significantincrease in TPC level was observed on 5th day of fermentation of seed and flour with A. awamori and A.oryzae as compared to non-fermented ones. In DPPH and ABTS antioxidant assay, maximum activity wasnoticed in fermented ethanolic extract of seim seed with A . awamori and A . oryzae on 3rd and 4th dayof incubation, respectively. The findings showed higher antioxidant activity formation in fermented seimseed than flour. Significant increase in enzyme activity of α-amylase was also contributed by SSF. Thisstudy demonstrated that fermented seed and flour of seim are better source of phytochemicals comparedto the non-fermented ones.

Atypical Whipple's disease

We report an unusual case of Whipple's disease diagnosed with help from the patient himself. The patient presented with rash resembling dermatitis herpetiformis, constipation, and intermittent diarrhea. A suspicion of celiac disease led to duodenal biopsy, which showed features of Whipple's disease on histology and electron microscopy.

Unicompartmental osteoarthritis of the knee: an innovative osteotomy

Thirty patients with unicompartmental osteoarthritis of the knee and genu varum deformity ranging from 2 degrees to 15 degrees were treated with high tibial osteotomy by using a medial open wedge, stabilized and distracted with our fixator. Pain relief and correction of deformity were achieved in all except two cases.