Search Results (452)

The rise in antimicrobial resistance and strict milk withdrawal regulations drive the search for safe, non-antibiotic intramammary therapies. This pilot field study focused on clinical parameters, including the somatic cell count (SCC) and the assessment of changes, as well as overall safety, which together enabled a prospective evaluation of whether the substance exerted any therapeutic effect. In this study, 48 Holstein–Friesian cows with naturally occurring clinical mastitis (somatic cell count > 400,000 cells/mL; single quarter) were randomized to receive either seven daily infusions of 10% pectin (n = 24) or two standard intramammary doses of a licensed multi-component antibiotic formulation (n = 24). The clinical severity scores (0–3) and SCC were monitored from 72 h before to 168 h after treatment initiation; the bacteriological cultures, milk TNF-α, milk yield, and blood hematology/biochemistry were also assessed. Both groups exhibited comparable and significant reductions in the mastitis scores and log₂-transformed SCC by 48 h post-treatment, with equivalent bacteriological cure rates and pathogen profiles (predominantly Streptococcus uberis, coagulase-negative staphylococci, and Escherichia coli) and no local irritation, systemic adverse effects, or alterations in the milk yield, TNF-α, or blood parameters. These findings indicate that intramammary pectin at a 10% concentration is safe and well tolerated and that it provides efficacy equivalent to standard antibiotic therapy, supporting its potential as an alternative mastitis treatment that avoids antibiotic residues and contributes to antimicrobial stewardship. Full article

Background: Stroke-related deaths often follow rapid deterioration, making end-of-life (EOL) care decisions particularly challenging in acute settings. Although national guidelines support structured approaches to end-of-life care, there is limited evidence of how these pathways are applied in routine stroke practice. Objective: To evaluate the use of structured end-of-life care pathways, including the AMBER Care Bundle and Dying Adults in the Last Days of Life (DALDL), in stroke patients who died during admission at a general hospital stroke center. Methods: This retrospective, single-center cohort study included 123 patients with confirmed stroke (73.2% ischemic, 26.8% hemorrhagic) who died in hospital during 2023. Clinical characteristics, the timing of care pathway decisions, palliative care involvement, withdrawing of medical procedures, and outcomes were analyzed. Descriptive statistics, Mann–Whitney U tests, Spearman correlations, chi-square tests, and a multivariate regression model were performed. Results: Of 123 patients, 101 (82.1%) entered the DALDL pathway a median of 14.8 days after admission, with a subsequent median survival of 2.9 days. Anticipatory medications were prescribed in 100% of DALDL patients versus 0% of non-DALDL. Do Not Attempt Cardiopulmonary Resuscitation orders were documented in 99%, and 67.3% received specialist palliative care input. Nasogastric tube insertion correlated with a higher National Institutes of Health Stroke Scale (NIHSS) and higher rate of infections. Conclusions: Most patients had access to structured EOL care, but variability in timing and interventions highlights the need for earlier palliative engagement and consistent implementation of pathways to improve the quality of EOL care in stroke patients. We detected areas that could be improved, such as access to a palliative care team and the anticipatory medication use in dying stroke patients. Full article

This study investigated the potential of hazelnut wood (Corylus avellana L.) as an alternative raw material in the production of single-layer structural particleboards. Boards with a target density of 700 kg m⁻³ and thickness of 13 mm were manufactured using varying substitution levels (5%, 10%, 25%, 50% and 100%) of hazel wood particles relative to industrial pine (Pinus sylvestris L.) particles. Phenol-formaldehyde (PF) resin was used as the adhesive at a 15% resination rate. Mechanical and physical properties, including modulus of rupture (MOR), modulus of elasticity (MOE), internal bond (IB), screw withdrawal resistance (SWR), water absorption (WA), and thickness swelling (TS), were evaluated according to relevant European standards. Density profiles (DP) were also assessed. The results showed that while higher hazel content reduced bending strength (from 23.3 N mm⁻² for reference to 18.7 N mm⁻² for 100% hazel wood board) and stiffness (from 3515 N mm⁻² for reference to 2520 N mm⁻² for 100% hazel wood board), most boards met standard mechanical requirements of EN 312 for P3 and P5 boards. Notably, IB strength improved significantly at higher hazel content, with the 100% variant (2.07 N mm⁻²) exceeding the reference board (1.57 N mm⁻²). Screw withdrawal resistance also increased with hazel wood addition (from 235 N mm⁻¹ for reference to 262 N mm⁻¹ for 100% hazel wood board), linked to its higher density. However, water resistance and dimensional stability worsened with increasing hazel content, particularly in bark-containing particles, leading to excessive thickness swelling after prolonged water exposure. Thickness swelling after 24 h of soaking rose from 16.36% for the reference board to 20.13% for the 100% hazel wood board. Density profiles revealed a more uniform internal structure in boards with higher hazel content. Overall, hazelnut wood shows promise as a partial substitute for pine in particleboard production, especially at moderate substitution levels, though limitations in moisture resistance must be addressed for broader industrial application. Full article

This article aims to analyze the conditions that contribute to the sustainability of violence against women in Bulgaria, an EU member state with high rates of this phenomenon. The analysis is based on data obtained through qualitative and quantitative methods, including in-depth interviews and focus groups with experts from state institutions (the police, prosecutors, courts, and social services), politicians, journalists, and from non-governmental organizations working with victims, as well as a nationwide sample survey of the adult population of Bulgaria. The qualitative data were analyzed through thematic analysis. The article demonstrates that cultural, ideological, and structural conditions in Bulgarian society facilitate the sustainability of violence against women. These include patriarchal norms prevailing in the family, specific characteristics of the popular culture, the neoliberal ideology of extreme individualism, the withdrawal of the state from its obligations, and ineffective institutional response. These conclusions point to the need to enhance the state’s capacity to counteract the phenomenon as well as the need to address ingrained cultural norms of conduct. Full article

Environmental protection is one of the key challenges facing mankind today. Finding out what young people, referred to as Generation Z, think about this issue is extremely important, as they will be the first to experience the negative effects of environmental degradation. Research has shown that Generation Z has the greatest hope for solutions from the technological sphere. Thus, the economic and political spheres should support the development of technology in this area. The social sphere is rated lowest, which may reflect young people’s personal withdrawal and the delegation of responsibility for the environment’s future to engineers, entrepreneurs, and politicians. It is equally important to learn what constitutes an environmental imperative for Generation Z. It is based on new energy sources, energy producers, and the state’s pursuit of a policy of international cooperation in this area, supported by national legislative activity toward entrepreneurs and citizens. Research has demonstrated the need to raise awareness among young people, with a focus on individuals treated as subjects in their interaction with modern technology. Full article

Background and Aim: Long-term treatment with biologic therapy alongside immunomAfodulators in patients with inflammatory bowel disease (IBD) can be associated with severe side effects. The objective of this study was to determine whether discontinuing anti-TNF treatment after two years in patients who have achieved mucosal healing is associated with lower relapse rates. Materials and Methods: A total of 67 patients with IBD from a single tertiary IBD Center who had achieved mucosal healing were enrolled in this retrospective study. In this single-center retrospective study (January 2014–December 2022), we screened 67 IBD patients in deep remission (endoscopic mucosal healing after ≥2 years of anti-TNF therapy). After excluding three patients without histologic data, 64 patients (25 ulcerative colitis, 39 Crohn’s disease) were analyzed. Mayo endoscopic sub-score and SES-CD were used to evaluate endoscopic activity after two years of anti-TNF therapy. Histological activity was assessed using the GHAS (for CD) and Nancy index (for UC). Results: A total of 67 patients were screened, of whom 3 were excluded due to a lack of biopsies. Of the 64 included patients, 39.06% (25/64) had UC and 60.9% (39/64) had CD, with a mean disease duration of 11.6 ± 8.0 years. All patients were in endoscopic remission at the time of therapy de-escalation, and 60.9% (39/64) also achieved histological remission (“deep remission”). In the follow-up of 38.6 months (IQR 30–48) after biologic therapy was stopped, 57.8% (37/64) relapsed with a median time to relapse of 13.5 months (IQR 8–24) off anti-TNF—a total of 34 patients required a restarting of biologic therapy. Using Spearman’s correlation, a moderate connection was observed between histological activity at withdrawal and subsequent relapse (rho = 0.467, p < 0.001). The probability of relapsing within 4 years after anti-TNF cessation was significantly higher (OR 2.72) in patients with histologically active disease at the time of de-escalation. Conclusions: Achieving ‘deep remission’ (clinical, endoscopic, and histological healing) may be a suitable parameter for making decisions on when to de-escalate therapy; however, given that over half of patients in endoscopic remission relapse after discontinuation, any de-escalation should be approached with caution and individualized patient assessment. Full article

Antibiotic residues in poultry pose health and resistance risks, necessitating breed-specific WDTs. In this study, the residue elimination patterns of seven antibiotics in Taihang chicken tissues under free-range conditions were studied and the appropriate WDT was formulated. A total of 240 healthy Taihang chickens aged 100 days were randomly divided into 8 groups, each comprising 30 chickens. Chickens in groups 1 to 7 were administered oxytetracycline, chlortetracycline, erythromycin, tylosin, tylvalosin, lincomycin, and tiamulin, respectively. Regarding the administration method, we adopted the highest dose and maximum course of treatment recommended by the Veterinary Pharmacopoeia of the People’s Republic of China. Group 8 served as the control group. Muscle, sebum, liver, and kidney samples were collected at 4 h, 1 d, 2 d, 3 d, 5 d, 7 d, 10 d, 13 d, and 16 d after drug withdrawal. Our results demonstrated that the drug residues after drug withdrawal gradually decreased with the increase in drug withdrawal days, and the elimination rate in the early stage of drug withdrawal was significantly faster than that in the later stage. At 4 h after drug withdrawal, the drug residues in various tissues reached their highest values. In most cases, the drug concentrations in the kidney and liver were higher than those in the muscles and sebum; however, some drugs also exhibited concentration peaks in the sebum. On the first day of drug withdrawal, the amount of residues in various tissues decreased rapidly. In general, the elimination rate of various drugs in the muscles, liver, and kidneys is faster but slower in the sebum. Based on the WDT calculation software WT1.4, the recommended WDTs for oxytetracycline, chlortetracycline, erythromycin, tylosin, tylvalosin, lincomycin, and tiamulin chickens are 4 d, 5 d, 11 d, 8 d, 13 d, 13 d, and 7 d, respectively. These findings support food safety and industry development. Full article

Four entire male sugar gliders (Petaurus breviceps) belonging to the same colony were presented for elective orchiectomy. After clinical examination, dexmedetomidine (120 μg/kg) in combination with ketamine (5 mg/kg) were administered subcutaneously (SC). Once righting and pedal withdrawal reflexes were lost, ringer lactate solution, enrofloxacin and meloxicam were administered SC and a bilateral intratesticular block with lidocaine 0.25% was performed. Heart, respiratory rates and pulse oximetry values were recorded every minute. Onset of sedation, additional use of isoflurane, duration of anaesthesia, duration of surgery, time of recovery after atipamezole administration, quality of recovery and time of food intake were recorded. Postoperative assessment (posture, level of activity, vocalisation, response to manipulation, attention to the surgical wound) was performed hourly until discharge, five hours after surgery. Dexmedetomidine in combination with ketamine provided adequate short-lasting anaesthesia for castration in 3 out of 4 sugar gliders. One sugar glider needed additional isoflurane administration to perform orchiectomy. No perioperative additional analgesia was needed in any sugar glider. Full article

Background/objectives: In 9/2020, the United States Food and Drug Administration )FDA( posted a black box warning for all benzodiazepines, addressing their association with serious risks of abuse, addiction, physical dependence, and withdrawal reactions. We evaluated changes in benzodiazepine dispensing rate trends after this warning. Methods: The dataset of Clalit Health Services (Israel’s largest insurer, with 5 million members) was used to identify and collect benzodiazepine dispensing data for all patients who were dispensed these drugs at least once during the study period (1/2017–12/2021). The dispensing rate (number of patients who were dispensed benzodiazepines per month divided by the number of patients alive during that month) was calculated for each month in the study period. Linear regression and change point regression were used to review the change in trend before and after the black box warning. New users of benzodiazepines after the black box warning were analyzed by age. Results: A total of 639,515 patients using benzodiazepines were reviewed. The mean benzodiazepine dispensing rate per month was 0.21 and ranged from 0.17 (in 2/2017) to 0.24 (in 3/2020). No significant change in trend was observed before vs. after the black box warning (slopes of 0.00675 percentage points per month and 0.00001 percentage points per month, respectively; p = 0.38). The change point regression analysis identified a change point in 4/2019, which is prior to the black box warning. New users were younger after the black box warning compared to before this warning. Conclusions: The FDA black box warning did not affect the dispensing rate of benzodiazepines. Full article

Background: Belantamab mafodotin (belamaf) is a BCMA-targeting antibody–drug conjugate used in triple-class refractory multiple myeloma. Despite its efficacy, keratopathy remains a significant dose-limiting toxicity. Following its withdrawal from the U.S. market in 2022, its use in Austria is limited to clinical trials or compassionate use. Methods: In this real-world, retrospective study, we analyzed 36 relapsed/refractory, BCMA-naïve multiple myeloma patients treated at the University Hospital of Vienna (January 2020–June 2024); 42% received a reduced dose (1.9 mg/kg) throughout all treatment cycles. The primary objective was to assess adverse events, particularly keratopathy, and the impact of dose modifications on toxicity and efficacy. Results: The overall response rate was 64%, with responders having significantly fewer prior therapy lines (median 3 vs. 4.5, p = 0.015). Median PFS was 7.3 months, significantly longer in responders (11.1 vs. 1.6 months, p < 0.0001); median OS was 20.1 months, also longer in responders (not reached vs. 18 months, p = 0.031). Keratopathy occurred in 75% of patients; 33% experienced grade 3–4 events. Dose reduction significantly decreased grade 3–4 keratopathy (7% vs. 52%, p = 0.004) and thrombocytopenia (33% vs. 67%, p = 0.048) without compromising efficacy. Conclusions: Belamaf dose reductions improved tolerability without loss of efficacy, supporting reduced dosing in practice. Full article

Background: Alcohol withdrawal syndrome is a common clinical challenge that may lead to significant complications if not properly managed. Symptom-triggered therapy (STT) represents a promising alternative to fixed-dose regimens (FDRs) providing benzodiazepine prescriptions based on objectively quantified withdrawal symptoms. This study aimed to evaluate the effectiveness and safety of STT using the Hamburg Alcohol Withdrawal Scale (HAES) compared to FDRs in the management of inpatient alcohol detoxification. Methods: In a retrospective case–control study, alcohol detoxification treatment in STT was compared with FDRs. During a twelve-month observation period, a total of 123 patients in the STT group were recruited and compared with 123 controls in the FDR group (matched according to sex, age, and current amount of alcohol consumption) treated in the same hospital before the implementation of STT. The study outcomes included the total benzodiazepine dosage, duration of acute detoxification phase, length of inpatient stay, and occurrence of complications such as epileptic seizures and delirium tremens. Results: STT showed a significantly lower total benzodiazepine dosage (22.50 mg vs. 115.00 mg, p < 0.001), a shorter duration of the detoxification phase (48.00 h vs. 201.75 h, p < 0.001), and a reduced length of inpatient stay (23.00 days vs. 28.00 days, p = 0.003) compared to FDRs. There were no significant differences in the rates of complications between the two settings. Linear mixed model analysis revealed that the differences remained highly significant even after adjusting for various explanatory variables (i.e., age, sex, standard units of alcohol, psychiatric comorbidities, treatment discontinuation, and occurrence of any complication). Conclusions: STT appears to be as effective and safe as traditional fixed-dose regimens of benzodiazepines for the management of inpatient alcohol detoxification. This approach may thereby minimize unnecessary pharmacological exposure, facilitate the earlier integration of patients into psychoeducational and psychosocial interventions, and reduce healthcare costs. Full article

Background: Polysubstance use, particularly combining opioids with stimulants such as cocaine, is rising among individuals with substance use disorders. This practice aims to balance cocaine’s stimulant effects with opioids’ sedative effect, potentially decreasing adverse outcomes. We hypothesized that concurrent exposure to cocaine and opioids would reduce the risk of neonatal opioid withdrawal syndrome (NOWS) compared to opioid use alone. Methods: This analysis draws from an ongoing prospective study of maternal substance use (SUD) at Regional One Health’s perinatal center in Memphis, TN, and included mothers and their infants born between 2018 and 2022. Maternal SUD was identified via screening questionnaires, urine toxicology, or umbilical cord tissue analysis. Participants were grouped into using (a) opioids with cocaine (OwC) and (b) opioids without cocaine (OwoC). Univariate and regression analyses were conducted to assess the risk of NOWS. Results: A total of 353 infants were born to 342 mothers, with 31% (110/353) of the infants born to women who used cocaine along with opioids. While maternal demographics were similar, the OwC group had significantly lower rates of prenatal care, chronic pain history, and MOUD enrollment (p = 0.03). Infants in the OwC group had significantly higher rates of NOWS (p < 0.01), longer hospital stays (p < 0.01), and 6.5 times greater odds of developing NOWS (p < 0.001). NOWS was associated with an average 15-day increase in the length of stay for term infants (95% CI: 11.2, 18.8; p < 0.001). Conclusions: Contrary to our hypothesis, our study highlights the significant impact of maternal cocaine use on the increased likelihood of NOWS and extended hospital stays for affected infants. Full article

Introduction: Chronic alcohol use is a complex condition influenced by psychological, behavioral, and socio-demographic factors. This study aimed to develop a comprehensive psychosocial profile of individuals with alcohol use disorder (AUD) by examining associations between psychometric variables and relapse risk including repeated psychiatric hospitalizations. Methodology: A cross-sectional observational analytical study was conducted on a sample of 104 patients admitted for alcohol withdrawal management at the “Prof. Dr. Al. Obregia” Psychiatric Clinical Hospital in Bucharest between March 2023 and September 2024. Participants completed a set of validated psychometric tools: the Drinker Inventory of Consequences—Lifetime Version (DrInC), Readiness to Change Questionnaire—Treatment Version (RTCQ), Drinking Expectancy Questionnaire (DEQ), and Drinking Refusal Self-Efficacy Questionnaire (DRSEQ). Additional data were collected on the socio-demographic (education level, socio-professional category), genetic (family history of alcohol use), and behavioral factors (length of abstinence, tobacco use, co-occurring substance use disorders). Results: Higher alcohol-related consequence scores (DrInC) were significantly associated with lower education (p < 0.001, η² = 0.483), disadvantaged socio-professional status (p < 0.001, η² = 0.514), and family history of alcohol use (p < 0.001, η² = 0.226). Self-efficacy (DRSEQ) was significantly lower among individuals with co-occurring substance use (p < 0.001) and nicotine dependence (p < 0.001). Logistic regression showed that the DrInC scores significantly predicted readmission within three months (OR = 1.09, p = 0.001). Conclusions: Psychometric tools are effective in identifying individuals at high risk. Personalized, evidence-based interventions tailored to both psychological and socio-professional profiles, combined with structured post-discharge support, are essential for improving long-term recovery and reducing the readmission rates. Full article

Background and Objectives: The worldwide prevalence of chronic kidney disease (CKD) continues to increase, representing a major concern for public health systems. CKD is associated with gut microbiota dysbiosis, which may exacerbate disease progression by increasing the levels of uremic toxins, systemic inflammation, and oxidative stress. Modulation of the gut microbiota through biotic supplementation has been proposed as a potential therapeutic strategy to slow CKD progression and mitigate its complications. This study aimed to evaluate the effect of 10-month synbiotic supplementation on estimated glomerular filtration rate (eGFR), circulating concentrations of indoxyl sulfate (IS), p-cresyl sulfate (p-CS), interleukin-6 (IL-6), and malondialdehyde (MDA) in patients with stage IV–V CKD not receiving dialysis, in comparison to placebo. Materials and Methods: Fifty non-dialysis CKD IV–V patients were assigned (n = 25 each) via matched, non-randomized allocation (age, sex, and primary disease) to synbiotic or placebo. This single-blind, placebo-controlled trial blinded participants and laboratory personnel. The synbiotic group received daily capsules containing Lactobacillus acidophilus La-14 (2 × 10¹¹ CFU/g) + fructooligosaccharides; controls received identical placebo. Adherence was monitored monthly (pill counts, diaries), with < 80% over two visits resulting in withdrawal. The eGFR, IS, p-CS, IL-6, and MDA were measured at baseline and month 10. Results: Forty-two patients (21/arm) completed the study; eight withdrew (4 per arm). At 10 months, the change in eGFR was −1.2 ± 2.5 mL/min/1.73 m² (synbiotic) vs. −3.5 ± 3.0 mL/min/1.73 m² (placebo); between-group difference in change was 2.3 mL/min/1.73 m² (95% CI: 0.5–4.1; p = 0.014; adjusted p = 0.07). IS decreased by −15.4 ± 8.2 ng/L vs. −3.1 ± 6.5 ng/L; between-group difference in change was −12.3 ng/L (95% CI: −17.8 to −6.8; p < 0.001; adjusted p = 0.005). No significant differences were observed for p-CS, IL-6, or MDA after correction. Conclusions: Synbiotic supplementation over a 10-month period resulted in a trend toward decreased serum IS levels in patients with advanced CKD, suggesting potential benefits of microbiota-targeted therapies. However, no significant effects were observed on renal function, inflammatory, or oxidative stress markers. Further large-scale studies are warranted to confirm these findings and explore the long-term impact of synbiotics in CKD management. Full article

Background/Objectives: This retrospective cohort study compared well-child visits (WCVs) and immunization encounters from birth to age three among rural and urban South Carolina (SC) Medicaid-enrolled children with neonatal opioid withdrawal syndrome (NOWS). Methods: We applied logistic and Poisson regression models to examine associations between rural status and the number of WCVs, WCV adherence, and immunization encounters. Results: The sample included 833 urban and 161 rural children with NOWS born between 2006 and 2014. Significant differences existed between groups in the number of WCVs and immunization encounters each year from birth to age three (p = < 0.01 for all the comparisons). After covariate adjustment, rural compared to urban status was associated with decreased WCVs from birth to 11 months (incidence rate ratio (IRR): 0.85; 95% CI: 0.77–0.93) and 12 to 23 months (IRR: 0.80; 95% CI: 0.69–0.93). Rural status was not significantly associated with decreased WCVs from 24 to 35 months (IRR: 0.81; 95% CI: 0.63–1.03). Rural compared to urban status was associated with a 34% lower odds of WCV adherence from 12 to 23 months (odds ratio (OR): 0.66; 95% CI: 0.44–0.99). Furthermore, rural compared to urban status was associated with decreased immunization encounters from birth to 11 months (IRR: 0.60; 95% CI: 0.52–0.69), 12 to 23 months (IRR: 0.61; 95% CI: 0.50–0.71), and 24 to 35 months (IRR: 0.55; 95% CI: 0.40–0.76). Conclusions: Rurality was associated with decreased WCVs and immunization encounters among children with a history of NOWS residing in SC. Policy interventions, including telehealth services and expanded Medicaid access, could improve WCV and immunization rates among these children. Full article