Non-antibiotic pharmaceuticals are toxic against Escherichia coli with no evolution of cross-resistance to antibiotics.

Antimicrobial resistance can arise in the natural environment via prolonged exposure to the effluent released by manufacturing facilities. In addition to antibiotics, pharmaceutical plants also produce non-antibiotic pharmaceuticals, both the active ingredients and other components of the formulations. The effect of these on the surrounding microbial communities is less clear.

Outcomes of Coccidioides Seropositive Solid Organ Transplant Recipients After Self-discontinuation of Antifungal Prophylaxis: The EIA-IgM-only Conundrum.

Background: Solid organ transplant recipients are at risk of severe coccidioidomycosis and are given prophylaxis to mitigate the risk. Patients with seropositive testing typically receive lifelong prophylaxis; currently, this prophylaxis strategy includes patients who are positive only for IgM by enzyme immunoassay (EIA-IgM-only), although this result may be falsely positive.

Methods: We conducted a retrospective study at a large-volume transplant center in an endemic coccidioidomycosis region to compare outcomes of non-lung transplant recipients who were seropositive for Coccidioides but discontinued prophylaxis (case patients) to outcomes of patients who continued prophylaxis (controls).

Symptomatic glucocorticoid-induced adrenal suppression in the United Kingdom and Ireland: a BPSU study.

Objective: To determine the incidence and describe the presentation and management of unexpected symptomatic glucocorticoid-induced adrenal suppression (AS) in children and young people aged 0-15 years.

Setting And Design: Surveillance study of symptomatic glucocorticoid (GC)-induced AS with supportive biochemical evidence or presenting as an adrenal crisis, reported via the British Paediatric Surveillance Unit (BPSU) from September 2020 to September 2022.

Results: Over a 25-month period, 190 reports of symptomatic GC-induced AS/adrenal crisis were made, of which 22 were confirmed cases: 18 AS and 4 adrenal crises.

Nutritional composition, nitrogen-corrected true metabolizable energy, and standardized amino acid digestibility of palm kernel meal from several countries.

Extensive nutritional analyses were conducted for palm kernel meal (PKM) sourced from 5 countries. Two precision-fed rooster trials were conducted to evaluate the nitrogen-corrected true metabolizable energy (TME) and standardized amino acid (AA) digestibility of 10 PKM samples (PKM 1 to 10). The TME was determined using conventional Single Comb White Leghorn roosters, and standardized AA digestibility was determined using cecectomized roosters.

Evaluating the Performance of ChatGPT 3.5 and 4.0 on StatPearls Oculoplastic Surgery Text- and Image-Based Exam Questions.

Introduction: The emergence of large language models (LLMs) has led to significant interest in their potential use as medical assistive tools. Prior investigations have analyzed the overall comparative performance of LLM versions within different ophthalmology subspecialties. However, limited investigations have characterized LLM performance on image-based questions, a recent advance in LLM capabilities.

How I Do It: Managing Cavitary Coccidioidomycosis Expert Opinions for Improving Patient Outcomes.

Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis (C. immitis) and C. posadasii, is recognized as an increasing threat both nationally and worldwide.

Targeting MarA N-terminal domain dynamics to prevent DNA binding.

Efflux is one of the mechanisms employed by Gram-negative bacteria to become resistant to routinely used antibiotics. The inhibition of efflux by targeting their regulators is a promising strategy to re-sensitize bacterial pathogens to antibiotics. AcrAB-TolC is the main resistance-nodulation-division efflux pump in Enterobacteriaceae.

Creating a plasma coordination center to support COVID-19 outpatient trials across a national network of hospital blood banks.

Introduction: In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.

Methods: A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.

Chlorine dioxide is a broad-spectrum disinfectant against Shiga toxin-producing and in agricultural water.

Agricultural water is commonly treated with chlorine-based disinfectants, which are impacted by water quality. Understanding how water quality influences disinfectants such as chlorine dioxide (ClO) against pathogenic bacteria is important for creating efficacious sanitation regimens. In this study, the minimum inhibitory concentration (MIC) of ClO needed to achieve a 3-Log reduction against Shiga toxin-producing (STEC) and was compared across agricultural water samples.

Massive Tibial Defect Treated with Plate-assisted Bone Segment Transport and A Novel Internal Cable-Pulley System.

Aim: The treatment of massive diaphyseal tibial bone defects remains challenging with poor results seen from treatment modalities other than bone transport (BT). Current methods of BT require lengthy periods in a circular external fixator. Despite recent modifications in BT techniques via circular external fixator such as multifocal transport and immediate intramedullary nailing after docking, circular external fixation remains poorly tolerated with a high complication profile.

Reduction of RAD23A extends lifespan and mitigates pathology in TDP-43 mice.

Protein misfolding and aggregation are cardinal features of neurodegenerative disease (NDD) and they contribute to pathophysiology by both loss-of-function (LOF) and gain-of-function (GOF) mechanisms. This is well exemplified by TDP-43 which aggregates and mislocalizes in several NDDs. The depletion of nuclear TDP-43 leads to reduction in its normal function in RNA metabolism and the cytoplasmic accumulation of TDP-43 leads to aberrant protein homeostasis.

Association of Adherence to a MIND-Style Diet With the Risk of Cognitive Impairment and Decline in the REGARDS Cohort.

Background And Objectives: Diet may influence the development of cognitive impairment and affect cognitive decline, but whether this relationship varies between Black American and White American people is unclear. This study examined the association of Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) and incident cognitive impairment and cognitive trajectories in a biracial prospective cohort study.

Methods: Using data derived from the Food Frequency Questionnaire in the REasons for Geographic and Racial Differences in Stroke study, we compared MIND diet adherence with incident cognitive impairment and cognitive trajectory in Black participants and White participants.

Robotic Totally Endoscopic Off-Pump Unroofing of Myocardial Bridge: Early Experience and Midterm Outcomes.

Objective: Myocardial bridging (MB) occurs when a coronary artery, commonly the left anterior descending (LAD), has an intramyocardial course. In symptomatic patients who fail medical therapy, surgical unroofing can provide symptomatic relief by improving coronary blood flow. We present a series of patients undergoing robotic totally endoscopic beating-heart MB unroofing.

Efflux pumps mediate changes to fundamental bacterial physiology via membrane potential.

Efflux pumps are well known to be an important mechanism for removing noxious substances such as antibiotics from bacteria. Given that many antibiotics function by accumulating inside bacteria, efflux pumps contribute to resistance. Efflux pump inactivation is a potential strategy to combat antimicrobial resistance, as bacteria would not be able to pump out antibiotics.

Improving Coccidioidomycosis Testing for Emergency Department Patients With Suspect Community-Acquired Pneumonia: Analysis of Provider Attitudes and the Effect of a Targeted Intervention.

Coccidioidomycosis is a common cause of community-acquired pneumonia in endemic regions. Approximately 20 000 cases of coccidioidomycosis occur annually; however, this statistic is limited by a widespread lack of testing. Here, we analyze emergency medicine provider attitudes toward coccidioidal testing and assess the effect of an intervention to improve testing rates.

Robotic unroofing of myocardial bridge of the left anterior descending coronary artery in a patient with hypertrophic obstructive cardiomyopathy and previous septal myectomy.

Unlabelled: A 56-year-old female diagnosed with hypertrophic obstructive cardiomyopathy and myocardial bridge (MB) of the left anterior descending (LAD) coronary artery underwent septal myectomy with resolution of her left ventricular outflow tract gradient. She had ongoing refractory symptoms of exertional angina and fatigue for over a decade and finally presented to our clinic to be re-evaluated for treatment. Provocative angiographic testing confirmed significant ischemia secondary to LAD MB.