Tangefalkenberg5753

New series of hybrids were synthesized by combination of 4-hydroxycoumarin with spiro[indol-indazole-thiazolidine]-diones and spiro[indol-pyrazole-thiazolidine]-diones, via hitherto unknown Schiff bases. The effects of substituents, such as -F, -Br and -CH3, on the crucial characteristics pertaining to the hybrids were investigated through computational studies. In silico or virtual screening through molecular docking studies on the library of 22 compounds, including reference compounds, precursors, non-hybrid and hybrid derivatives, was performed on DNA G-quadruplex of the human genome. All six freshly synthesized hybrids showed high binding energy as compared to non-hybrids as well as reference compounds. The presence of substituents at 5-position of indole enhanced the binding tendency of the ligand. ADME studies indicated good oral bioavailability and absorption of these compounds. Density Functional Theory (DFT) calculations of hybrids were done at B3LYP/6-311G++(d,p) level of computation. Their HOMO and LUMO energy plots reflected the presence of high charge transfer and chemical potential. Natural bond order (NBO) calculations predicted hyperconjugative interactions. The Molecular Electrostatic Potential (MEP) surface plots showed possible electrophilic and nucleophilic attacking sites of the hybrids. Compound 10 a (5-fluoro-spiro[indol-indazole-thiazolidine]-dione-coumarin hybrid), on the basis of global reactivity descriptors, was filtered to be chemically most reactive with the highest binding energy of -8.23 kcal/mol with DNA G-quadruplex. The synthesized hybrid coumarin derivatives in correlation with theoretical docking studies validate that hybrid derivatives are more reactive compared to their non-hybrid counterparts. © 2020 Wiley‐VCH Verlag GmbH & Co. KGaA, Weinheim.The COVID-19 pandemic has prompted rapid restructuring of the healthcare system in an effort to stop the spread of the virus and to treat patients who are acutely ill with COVID-19, while continuing to provide outpatient care for the remainder of patients. To help control spread of this pandemic, many centers have boosted telemedicine capability to care for patients who would typically be seen in person in outpatient settings, including total joint arthroplasty clinics. We review key components relevant to the establishment and effective use of telemedicine, focused on patient education, practice logistics, technological considerations, and sensitive patient health information-associated compliance factors, which are necessary to provide care remotely for total joint arthroplasty patients. © 2020 Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons.Background The value of follow-up blood cultures (FUBCs) to document clearance of bacteremia due to Gram-negative bacilli (GNB) has not been well established. Although previous studies suggested that the yield of FUBCs for GNB bacteremia is low, it remains to be elucidated for whom FUBC may be beneficial and for whom it is unnecessary. Methods A retrospective cohort study was performed at 4 acute care hospitals to identify risk factors for positive FUBCs with GNB bacteremia and to better guide clinicians' decisions as to which patients may or may not benefit from FUBCs. Participants included adult patients with GNB bacteremia who had FUBCs and were admitted between January 2017 and December 2018. The primary outcomes were the factors associated with positive FUBCs and the yield of FUBCs with and without the factors. Results Of 306 patients with GNB bacteremia who had FUBCs, 9.2% (95% confidence interval, 6.2%-13.0%) had the same GNB in FUBCs. In the multivariate logistic regression analysis, end-stage renal disease on hemodialysis, intravascular device, and bacteremia due to extended-spectrum β-lactamase or carbapenemase-producing organism were identified as independent predictors of positive FUBCs with GNB bacteremia. Approximately 7 FUBCs and 30 FUBCs were needed for patients with ≥1 or no risk factors, respectively, to yield 1 positive result.SummaryThis multi-site retrospective cohort study found that among patients with gram-negative bacilli (GNB) bacteremia, having ESRD on hemodialysis, intravascular devices, or bacteremia due to multi-drug resistant GNB were each independently associated with having a positive follow-up blood culture. Conclusions Follow-up blood culture may not be necessary for all patients with GNB bacteremia and has the highest yield in patients with 1 or more risk factors. © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.Background Understanding the link between tuberculosis (TB) and diabetes is increasingly important as public health responds to the growing global burden of noncommunicable diseases. Genetic association studies have identified numerous host genetic variants linked to TB; however, potential host genetic mechanisms linking TB and diabetes remain unexplored. Methods We used genetic and phenotypic data from the UK Biobank to evaluate the association of 6 previously reported TB-related host genetic variants (genome-wide significant associations from published studies) with diabetes. The study included 409 692 adults of European ancestry including 2177 with type 1 diabetes mellitus (T1DM) and 13 976 with type 2 diabetes mellitus (T2DM), defined by ICD-10 diagnosis codes. Results Of the 6 TB-associated single nucleotide polymorphisms (SNPs), 2 were associated with T1DM and 3 with T2DM, after adjusting for age, sex, body mass index, smoking, alcohol use, and population structure. After correction for multiple testing, SNPs rs2894257 and rs3135359 (HLA-DRA-DQA1) were associated with T1DM (rs2894257 odds ratio [OR], 1.32; 95% confidence interval [CI], 1.21-1.45; rs3135359 OR, 1.72; 95% CI, 1.57-1.88) and T2DM (rs2894257 OR, 1.11; 95% CI, 1.08-1.15; rs3135359 OR, 1.06; 95% CI, 1.025-1.096). The associations with T2DM weakened for rs2894257 and rs3135359 after further exclusion of probable T1DM cases defined by International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. SNP rs4733781 on chromosome 8 (ASAP1 gene) was associated with T2DM after exclusion of T1DM cases. Conclusions Our findings suggest that common host genetic effects may play a role in the molecular mechanism linking TB and diabetes. Future large genetic studies of TB and diabetes should focus on developing countries with high burdens of infectious and chronic diseases. © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.We launched Infectious Disease electronic consultations (eConsults) in 2018. During the first 15.5 months, primary care practitioners submitted 328 eConsults; the most frequent reasons were a positive culture or polymerase chain reaction (PCR) result, syphilis, and latent tuberculosis. Practitioners commonly requested advice on antimicrobial choice, clinical evaluation, and indications for treatment. Internal phone consultations decreased after eConsult implementation. © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.Background Overtesting and overdiagnosis of Clostridioides difficile infection are suspected to be common. Reducing inappropriate testing through interventions designed to promote evidence-based diagnostic testing (ie, diagnostic stewardship) may improve C. difficile test utilization. However, the safety of these interventions is not well understood despite the potential risk for missed or delayed diagnoses. Methods This retrospective case-control study examined the outcomes of patients admitted to the University of Virginia Medical Center following introduction of a computerized clinical decision support tool without hard-stops designed to reduce inappropriate tests. Outcomes were compared between patients with a prevented C. difficile nucleic acid amplification test and those with a negative result. Chart reviews were performed for patients with a subsequent positive within 7 days, as well as those patients who received C. difficile-active antibiotics after implementation of the computerized clinical decision support tool. Results Multivariate analysis of 637 cases (490 negative, 147 prevented) showed that a prevented test was not significantly associated with the primary composite outcome (inpatient mortality or intensive care unit transfer) compared with a negative test (adjusted odds ratio, 0.912; P = .747). Fifty-four of 147 (37%) prevented tests were followed by a completed test within 7 days; 11 of these results were positive, resulting in a potential delay in diagnosis. Individual case reviews found that either clinical changes warranted the delay in testing or no adverse events occurred attributable to C. difficile infection. C. difficile treatment without a positive test was not identified. Conclusions Diagnostic stewardship of C. difficile testing using computerized clinical decision support may be both safe and effective for reducing inappropriate inpatient testing. © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.Background Hypertension is a growing public health problem in many developing countries including Ethiopia. Determining the prevalence of hypertension and identifying the associated factors is crucial. Objective To assess the prevalence of hypertension and associated factors, among adult population of Arba Minch town, Gamo Zone, Southern Nations, Nationalities and Peoples Region, Ethiopia. Methods A cross-sectional study design was conducted from December 1 to 30, 2017 among adults. Study participants were selected using a multistage systematic sampling method. Data were collected by face-to-face interview after getting written informed consent by using a structured questionnaire. Additionally, weight, height, and blood pressure of participants were measured following standard procedures. Data were entered into a computer using EPI INFO 7 and exported into SPSS version 20 for analysis. Bivariate and multivariable analyses were performed to explore the association between hypertension and associated factors. Multivariable logistic regressions were fitted to control the effect of confounders. Results A total of 784 study participants were included in this study. The overall prevalence of hypertension in Arba Minch Town was 35.2%, (95% CI 32.4%, 38.4%). this website Nearly 90% of hypertensive patients were screened for the first time. Age ≥55 years [AOR = 7.74; 95% CI 2.19, 27.23], income level which is greater than 2501 Ethiopian Birr [AOR = 9.5; 95% CI 4.5, 20.20], working hour less than seven hours per day [AOR = 12.5; 95% CI 4.3, 36.1], and chewing "khat" [AOR = 11.06 95% CI 4.3, 27.7] were the independently associated factors with hypertension. Conclusion The prevalence of hypertension is found to be high. Increasing awareness on control use of "khat," increasing physical activity, and strengthening community-based periodic screening programs of high-risk populations are recommended. Copyright © 2020 Belachew Kebede et al.Background Diabetes mellitus and depression are very common diseases worldwide, and the prevalence rates of both conditions are increasing rapidly. Depression among patients with diabetes mellitus results in poor glycemic control through different mechanisms. Besides, the coexistence of a chronic medical illness with depression reduces the probability of recognizing and treating depression. The study is aimed at assessing the prevalence and factors associated with depression among adults with diabetes mellitus. Methods A hospital-based cross-sectional study was conducted among adult diabetes mellitus patients on follow-up in Mizan-Tepi University Teaching Hospital and Tepi General Hospital. A consecutive sampling technique was employed to recruit the study participants, and data were collected through face-to-face interview and medical chart review. Depression was measured using Patient Health Questionnaire-nine (PHQ-9). Binary logistic regression analysis was done and a p value of less than 0.05 was used as a level of significance.