Search Results (7,144)

Urinary tract infections (UTIs) are among the most common pathologies, with a high incidence in women and hospitalized patients. Their diagnosis is based on the presence of clinical symptoms and signs in addition to the detection of microorganisms in urine trough urine cultures, a time-consuming and resource-intensive test. The goal was to optimize UTI detection through artificial intelligence (machine learning) using non-microbiological laboratory parameters, thereby reducing unnecessary cultures and expediting diagnosis. A total of 4283 urine cultures from patients with suspected UTIs were analyzed in the Microbiology Laboratory of the University Hospital Virgen de las Nieves (Granada, Spain) between 2016 and 2020. Various machine learning algorithms were applied to predict positive urine cultures and the type of isolated microorganism. Random Forest demonstrated the best performance, achieving an accuracy (percentage of correct positive and negative classifications) of 82.2% and an area under the ROC curve of 87.1%. Moreover, the Tree algorithm successfully predicted the presence of Gram-negative bacilli in urine cultures with an accuracy of 79.0%. Among the most relevant predictive variables were the presence of leukocytes and nitrites in the urine dipstick test, along with elevated white cells count, monocyte count, lymphocyte percentage in blood and creatinine levels. The integration of AI algorithms and non-microbiological parameters within the diagnostic and management pathways of UTI holds considerable promise. However, further validation with clinical data is required for integration into hospital practice. Full article

Saline–alkaline soils are becoming prevalent across the globe, decreasing the availability of forage for animals and threatening sustainable animal production. This study evaluated the effects of a NaCl-supplemented alfalfa-based total mixed ration, simulating saline–alkaline soil conditions, on intake, the utilization of nutrients, antioxidant levels, and rumen fermentation. A 60-day feeding trial with 24 AOHU lambs (Australian White × Hu) compared a control diet (0.43% NaCl) with the NaCl-supplemented group (1.71% NaCl). Digestibility trials were conducted in metabolic cages for the collection of total feces and urine. Blood samples were taken at 0, 30, and 60 days for serum analysis, and slaughter samples (liver, kidney, rumen tissue, and rumen fluid) were taken for physiological, biochemical, and histological evaluation. The NaCl alfalfa-based TMR markedly increased liver and kidney weights. The rumen muscle layer thickened in the NaCl group. The ruminal ammonia nitrogen (NH₃-N), ruminal microbial crude protein (MCP) synthesis, and glucogenic/branched-chain VFAs increased, indicating enhanced proteolysis, microbial protein synthesis, and energetically efficient fermentation. Serum total protein and albumin also rose over time in the NaCl group, reflecting increased nitrogen retention, while superoxide dismutase and glutathione peroxidase activity rose considerably by day 60, reflecting increased antioxidant defense. Furthermore, nitrogen intake, digestibility, and retention were improved in the NaCl group along with augmented digestible and metabolizable energy (28.47 vs. 13.93 MJ/d and 24.68 vs. 11.58 MJ/d, respectively) and gross energy digestibility (78.13% vs. 67.10%). Although NaCl-based alfalfa TMR cannot fully emulate naturally salt-stressed forages, these results indicate that the NaCl alfalfa-based diets improved rumen fermentation, energy yields, and antioxidant enzyme activity without impairing electrolyte balance. These findings suggest that NaCl-supplemented alfalfa-based TMRs, with a salt content comparable to that of alfalfa hay grown under saline–alkaline conditions, could support environmentally sustainable meat production in salt-stressed regions. Full article

A nanoliter-scale fabrication method was applied to construct a colorimetric lateral flow strip for urea detection (Urea-CLFS). The device involves two main papers: a nitrocellulose membrane (NC-Mb) for urease enzyme immobilization and chromatography paper (CH-PP) containing a phenol red indicator. Urea-CLFS is a tool for detecting urea that is based on enzyme catalysis and the change in color of phenol red when urea is present. The Urea-CLFS fabrication was made possible by the minimal amount of nanoliters used in reagent consumption. The use of small arrays of phenol red dots provides a higher response result compared to single dots applied on CH-PP. To find the most effective design, it analyzed how urease was aligned on NC-Mb horizontally and vertically. According to our findings, the vertical alignment of the urease enzyme on NC-Mb leads to a prolonged reaction time, which leads to higher product production. The optimization process included optimizing various parameters, including the layer number of phenol red on CH-PP, phenol red concentration, urease concentration, reaction time, and sample volume. Under optimal conditions, the Urea-CLFS provided a linear range of 0.25–8.0 mmol L⁻¹ with an LOD of 0.34 mmol L⁻¹, which is sufficient for human health diagnostics. The accuracy of the Urea-CLFS was demonstrated by the recovery of the human urine sample between 95 ± 3% and 103 ± 3% (n = 3). Full article

Mycotoxins are toxic secondary metabolites produced by fungi, frequently present in food and representing significant health hazards. Exposure occurs through the consumption of contaminated foods or animal-derived products from livestock fed with contaminated feed. This study evaluated internal exposure to twelve mycotoxins in 492 first-morning urine samples from adults, aged 18–65 years, in the Valencian Community, Spain. Samples were analysed using a “dilute-and-shoot” approach followed by UHPLC-MS/MS. Aflatoxins (AFs) were the most frequently detected, with a geometric mean (GM) of 1.17 ng/mL and a 95th percentile (P95) of 6.04 ng/mL. Alternariol (AOH), present in 63% of samples, showed high concentrations (GM: 0.98 ng/mL; P95: 4.74 ng/mL). Emerging mycotoxins such as alternariol monomethyl ether (AME), citrinin (CIT), and sterigmatocystin (STER) were also considered due to their potential health impacts. Exposure levels correlated with variables including sex, age, annual income, smoking status, and recent consumption of meat and cereals. Probable daily intakes (PDIs) were estimated from urinary concentrations to support risk assessment. Hazard Quotients (HQs), Margins of Exposure (MOEs), the Hazard Index (HI) and the total Margin of Exposure (MOET) were calculated to evaluate the risk associated with mycotoxin exposure. Findings suggest that potential health risks cannot be excluded. Full article

Background and Clinical Significance: Inherited metabolic disorders can result in fatal metabolic decompensation if not promptly recognized and treated. These conditions are common in Plain communities due to founder effects and the high prevalence of consanguinity. Case Presentation: We present the case of an adult Amish male with maple syrup urine disorder who sustained traumatic injuries and delayed metabolic intervention that contributed to a fatal outcome. Conclusions: This case highlights the critical need for increased awareness among emergency and adult care providers, especially in Plain communities, and emphasizes the importance of early multidisciplinary coordination and preparedness with metabolic resources to ensure timely, life-saving management in adult metabolic emergencies. Full article

Obstructive nephropathy is a common clinical condition caused by urinary retention. After urine flow is restored, kidney function is recovered. However, the effectiveness of this process can be influenced by many factors, including the age of the patient. In this study, we analyzed the following parameters in young and old rats subjected to a 3-day reversible unilateral ureteral obstruction (R-UUO): AKI severity, renal tissue proliferation and histology, inflammatory and fibrosis marker expression, as well as autophagosomal-lysosomal and mitochondrial function. Compared to old rats, young animals exhibited more pronounced renal tissue proliferation and higher expression of profibrotic markers (Col1a1, Fn1, Tgfb1, MMP2), but diminished expression of pro-inflammatory markers (Il1b, Tnfa, Cd32) in response to R-UUO. Additionally, young rats showed more pronounced activity of autophagy, as indicated by increased beclin-1 levels. R-UUO induced severe damage to the mitochondrial respiratory chain in old animals, as indicated by reduced complex I, IV, cytochrome c, VDAC protein levels, and impaired mitochondrial biogenesis (associated with decreased Pgc1a mRNA expression). Thus, we demonstrated that despite restored urine outflow, kidneys exhibited autophagy activation, inflammatory response, and mitochondrial dysfunction after R-UUO. Negative alterations in the kidney were age-dependent indicating necessity for therapeutic strategies optimization for patients of different ages. Full article

Objectives: The study aimed to determine the effect of manganese (Mn) exclusion from the dietary mineral mixture and the dietary replacement of the recommended level of MnCO₃ with Mn₂O₃ nanoparticles (Mn₂O₃NPs) on the Mn biodistribution and the femur histology. Methods: The experiment was conducted on twenty seven Wistar rats divided into three groups (n = 9): a control group receiving the recommended level of Mn (65 mg/kg) in standard form (MnCO₃); a manganese deficient group (Mn deprived from dietary mineral mixture), and a group receiving diet supplemented Mn₂O₃NPs (65 mg/kg) instead of MnCO₃. During the 12-week experiment, a balance test was performed. After the experiment period, blood and femur were collected from sacrificed rats. The content of Mn in water, diet, urine, feces, plasma, and femur was measured. Results: In the Mn-deficient rats, a reduction in Mn intake and excretion, Mn retention index, and blood Mn level, but an increase in Mn digestibility index was noted. In rats supplemented with Mn₂O₃NPs, Mn intake and excretion and blood Mn levels were decreased, while Mn retention and digestibility indexes were increased. In both experimental groups, deterioration of femur morphology was noted, but these changes were more severe in the Mn-deficient group. Conclusions: The obtained research results indicate that manganese deficiency significantly disturbed the biodistribution of this element and led to the deterioration of the architecture and histological parameters of the femur, emphasizing the key role of manganese in maintaining bone homeostasis. It has also been shown that replacing MnCO₃ with Mn₂O₃NPs allows the maintenance of the correct Mn level in the femur but causes unfavorable changes in its morphology. Full article

Antimicrobial resistance (AMR) remains a public health problem in European Union countries, and elderly patients represent a vulnerable category due to aging and its associated risk factors. In this research, we investigated the trend of the antimicrobial resistance pattern of Gram-negative pathogens isolated in samples collected from elderly patients (over 65 years) hospitalized in the intensive care unit (ICU) between 2022 and 2024. A total of 2510 samples, including blood, tracheal aspirate, sputum, urine, pus/wound swabs, exudates, intravascular catheters, cerebrospinal fluid, and sterile fluids, were collected from 1864 elderly patients. Almost two-thirds of clinical specimens were harvested from the respiratory tract. The most frequently reported pathogens from 3094 Gram-negative bacterial isolates were Klebsiella spp., Acinetobacter spp., and Escherichia coli. During the studied period, almost 40% of all the Klebsiella spp. strains were multidrug-resistant (MDR)/extensively drug-resistant (XDR), with a significant increase in the resistance to cephalosporins (p ≤ 0.05), fluoroquinolones (p ≤ 0.05), and carbapenems (imipenem—(p ≤ 0.05), ertapenem—p < 0.001). The proportion of carbapenem-non susceptible Klebsiella spp. rose from 24.41% in 2023 to 32.48% in 2024, p = 0.01. Two-thirds of Acinetobacter spp. isolates were MDR/XDR, and over 80% were carbapenem-non-susceptible in 2023–2024. The results draw attention to the need to quickly adopt measures to reduce the prevalence, limit the transmission of MDR/XDR pathogens, and improve therapeutic protocols in this age category. Full article

Background and Objectives: Albuminuria is a key clinical marker for early detection of diabetic kidney disease (DKD) in individuals with type 2 diabetes mellitus (T2DM). The triglyceride-glucose (TyG) index, a simple surrogate of insulin resistance, has been increasingly investigated for its potential association with renal complications. This study aimed to evaluate the relationship between the TyG index and albuminuria in patients with T2DM and assess its clinical utility as an accessible metabolic marker reflecting early renal involvement. Materials and Methods: This retrospective cross-sectional study included 570 adult patients with confirmed T2DM who were followed at a tertiary internal medicine outpatient clinic between January and December 2024. Participants were classified as albuminuric or non-albuminuric based on spot urine albumin-to-creatinine ratio (ACR) values. Clinical and biochemical parameters were collected from medical records, and the TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Logistic regression models were used to identify independent factors associated with albuminuria. ROC analysis was performed to evaluate the discriminatory accuracy of the TyG index. Results: The median TyG index was significantly higher in the albuminuric group compared to the non-albuminuric group (10.0 vs. 9.1; p < 0.001) and increased progressively with albuminuria severity (p < 0.001). In multivariate logistic regression analysis, elevated TyG index, hyperlipidemia, and reduced estimated glomerular filtration rate were independently associated with albuminuria. When evaluated as a continuous variable, the TyG index showed strong discriminatory ability (area under curve (AUC) = 0.949; 95% confidence interval (CI): 0.933–0.964). Using the optimal cut-off threshold of 9.6, the TyG index maintained high diagnostic performance (AUC = 0.870; 95% CI: 0.839–0.902; sensitivity 87.7%, specificity 86.3%). Subgroup analyses confirmed the robustness of this association across clinical and demographic variables. Conclusions: In this study, higher TyG index values were significantly associated with the presence and severity of albuminuria in individuals with T2DM. While causality cannot be inferred, the findings suggest that the TyG index may serve as a practical, cost-effective tool for identifying patients at increased risk for early diabetic kidney involvement. Prospective longitudinal studies are needed to confirm its predictive value and clinical applicability. Full article

Background/Objectives: A variant of autism spectrum disorder (ASD) known as Asperger syndrome (AS) shows increasing incidence worldwide, affecting between 0.02% and 0.03% of children. Patients display abnormal conduct, are limited in social interaction and communication, and are more often affected by micturition disorders, incontinence, and voiding symptoms than typically developing children. Methods: The present study aimed to review the literature related to the current management of lower urinary tract conditions in children with Asperger syndrome and to present a case of a 14-year-old girl with ASD, with characteristic impairments, including communication challenges, stereotyped, repetitive behaviors, and chronic constipation with concomitant bladder dysfunction, presenting recurrent urinary tract infections (UTIs) and lower urinary tract symptoms (LUTS), including voiding and filling storage symptoms. For the AS, she was treated with a selective serotonin reuptake inhibitor (Sertraline). An abdominal ultrasound, PLUTTS—pediatric lower urinary symptoms scoring (21); QL-quality of life (3); voiding diary; and uroflowmetry were performed, revealing an incomplete urinary retention (incomplete bladder emptying of 120 mL), a prolonged and interrupted curve, a maximum urinary flow rate (Qmax) 7 mL/s, and a UTI with Enterococcus. Results: Besides psychiatric reevaluation and antibiotic therapy, functional magnetic stimulation (FMS) sessions were performed. After eight sessions (20 min, 35 MHz, every second day), the ultrasound control and the uroflowmetry showed no residual urine, and the Qmax was 17 mL/s. The curve continued to be interrupted: PLUTSS-11, QL-1. FMS was continued at two sessions per week. At the 3-month follow-up, no residual urine was detected, and Qmax reached 24 mL/s. Conclusions: ASD is an incapacitating/debilitating condition that significantly impairs social functioning. In many cases, in addition to psychological symptoms, other conditions such as LUTS and constipation may coexist. Antipsychotics and antidepressants are frequently prescribed for these patients, often leading to various side effects, including micturition disorders. Therefore, screening for LUTS is recommended, and, if indicated, treatment—especially non-pharmacological and non-invasive approaches, such as FMS—should be considered. Full article

Background: Zoonotic fascioliasis and schistosomiasis, caused by trematode parasites transmitted by freshwater snails, are neglected tropical diseases of both medical and veterinary importance. There are critical knowledge gaps regarding the transmission dynamics of these infections in humans and animals, particularly in endemic African communities. Therefore, the current study aimed to determine the burden of human zoonotic schistosomiasis and fascioliasis among different age groups, focusing on the Lake Victoria zone and the Southern Highlands of Tanzania. Methods: A cross-sectional study was conducted among preschool-aged children, school-aged children, and adults. A total of 1557 stool and urine samples were collected, 400 from preschool children, 804 from school-aged children, and 353 from adults. Stool samples were processed using the Kato–Katz technique and the formol-ether concentration method to detect Schistosoma mansoni and Fasciola spp., respectively. Urine samples were examined for Schistosoma haematobium infection using the urine filtration method. Data were analyzed using Stata version 17. The t-tests or one-way ANOVA were used to assess statistical differences in the mean egg counts of S. mansoni and S. haematobium between exposure groups. Results: The overall prevalence of S. haematobium was 4.9%, S. mansoni was 1.2% with no significant differences across age groups, but with a statistically significant difference between sexes 1.8%. Males had a higher prevalence of both S. haematobium and S. mansoni infections compared to females. The prevalence of Fasciola infection was 0.9%, with the highest prevalence found in adults (≥18 years). Conclusions: Zoonotic schistosomiasis and fascioliasis are prevalent in the study area, affecting individuals across all age groups. This is the first study to report the presence of Fasciola infection in both the Lake Victoria zone and the Southern Highlands of Tanzania. These findings call for the Ministry of Health, through the Tanzania NTD Control Program, to recognize fascioliasis as a high-priority disease and include it in the national master plan. Full article

Background: Maple syrup urine disease (MSUD) is a genetic disorder caused by mutations in the branched-chain α-ketoacid dehydrogenase (BCKDH) complex, leading to toxic buildup of branched-chain amino acids (BCAAs) and their ketoacid derivatives. While newborn screening (NBS) and molecular testing are standard diagnostic tools, they face challenges such as delayed results and false positives. Untargeted metabolomics has emerged as a complementary approach, offering comprehensive metabolic profiling and potential for novel biomarker discovery. We previously applied untargeted metabolomics to neonates with MSUD, identifying distinct metabolic signatures. Objective: This follow-up study investigates metabolic changes and biomarkers in pediatric MSUD patients and explores shared dysregulated metabolites between neonatal and pediatric MSUD. Methods: Dried blood spot (DBS) samples from pediatric MSUD patients (n = 14) and matched healthy controls (n = 14) were analyzed using LC/MS-based untargeted metabolomics. Results: In pediatric MSUD, 3716 metabolites were upregulated and 4038 downregulated relative to controls. Among 1080 dysregulated endogenous metabolites, notable biomarkers included uric acid, hypoxanthine, and bilirubin diglucuronide. Affected pathways included sphingolipid, glycerophospholipid, purine, pyrimidine, nicotinate, and nicotinamide metabolism, and steroid hormone biosynthesis. Seventy-two metabolites overlapped with neonatal MSUD cases, some exhibiting inverse trends between age groups. Conclusion: Untargeted metabolomics reveals that the metabolic profiling of MCUD pediatric patients different from that of their controls. Also, there are valuable age-specific and shared metabolic alterations in MSUD, enhancing the understanding of disease progression in MSUD patients. This supports its utility in improving diagnostic precision and developing personalized treatment strategies across developmental stages. Full article

Biomarkers are important for the diagnosis and follow-up of neuromuscular diseases. Creatine kinase (CK) is a widely used marker of active muscle damage; however, it is not suitable for assessing muscle mass loss. Therefore, additional biomarkers are required to monitor skeletal muscle damage and loss. Titin plays an essential role in the structure and function of muscle fibers. It provides stability and elasticity to the sarcomeres. During sarcomere damage, fragments of titin and other proteins are released from muscle fibers and can be detected in blood and urine. Urinary titin-N fragment (UTN) detection is a noninvasive method for assessing and monitoring the extent of muscle damage. In addition to muscular dystrophies, elevated UTN levels have been observed in patients with sarcopenia. The UTN level increased significantly during eccentric muscle strain, indicating muscle damage, whereas the concentric load was associated with only a minimal increase in UTN. As titin is also present in the heart muscle, UTN can help diagnose cardiomyopathies and predict disease prognosis. In summary, the detection of urinary titin fragments is a promising tool for diagnosing and monitoring neuromuscular and cardiac diseases. While both CK and UTN rise and are related in acute conditions, their relationship is less clear in chronic diseases where muscle tissue damage and muscle mass loss are combined. Full article

This study used Rosa roxburghii Tratt. crude extract (RR) as a reducing, stabilizing, and modifying agent for the green synthesis of gold nanoparticles (RR-AuNPs) via the one-pot method for the first time and established a novel colorimetric sensor for detecting tiopronin. Initially, RR-AuNPs with a uniform particle size and stable dispersion were prepared using the reducing property of RR. Upon the introduction of tiopronin, the drug binds to the surface of RR-AuNPs through Au-S bonds and hydrogen bonds, inducing a significant aggregation of RR-AuNPs. The absorbance of the RR-AuNP solution exhibited a linear relationship with the tiopronin concentration in the range of 0.17 μM to 16.67 μM (y = 1.9157 − 0.0972x), with a detection limit of 0.19 μM. The colorimetric sensor was successfully applied to detect tiopronin in urine samples. Compared with other detection methods, this approach is simple to operate and has a high sensitivity, a wide linear range, and a low detection limit. Full article

Background/Objectives: The attainment of a stone-free (SF) condition is a fundamental indicator of successful outcomes after flexible ureteroscopy (fURS) for urinary stone disease. External confirmations of preoperative scores remain limited. We externally validated the T.O.HO. and S.T.O.N.E. scores in an independent Japanese cohort and examined calibration, decision curve utility, and threshold-guided use to support personalized planning. Methods: We retrospectively analyzed 361 consecutive patients treated with fURS from March 2018 to August 2023. Postoperative SF status was defined as the absence of residual calculi greater than 2 mm on non-contrast computed tomography performed within three months of surgery. Independent determinants of SF were identified using multivariable logistic regression, predictive performance was quantified by receiver operating characteristic analyses with DeLong’s test, and model calibration and decision curve analysis were additionally assessed. Results: Among the 361 patients, 255 (70.6%) achieved an SF state. A larger stone diameter, the presence of lower-pole calculi, and preoperative pyuria (positive urine WBC) were significant independent predictors of residual fragments. T.O.HO. demonstrated superior discrimination (AUC 0.86) compared with S.T.O.N.E. (AUC 0.77; p < 0.01) and surpassed individual predictors. Both scores showed acceptable calibration. Decision curve analysis demonstrated higher net benefit for T.O.HO. across clinically relevant thresholds. We provide clinically useful cut-offs (e.g., T.O.HO. ≤5: high SF probability; 6: trade-off discussion; ≥7: higher residual risk) to align actions with patient priorities. Conclusions: Beyond discrimination, a calibrated, threshold-aware use of T.O.HO. enables personalized preoperative counseling and shared decision-making, potentially reducing unnecessary staging and enhancing routine fURS planning. Full article