Biochemistry Behind Protein Adaptations in Extremophiles

Extremophiles are the mortals that tolerate in the most limiting and aggravating conditions to life. Because of these fantastic ecological criticisms, extremophiles have substituted innumerable intriguing transformations to cell films, proteins, and extracellular metabolites. These stimulatingly regulated usual particles and frameworks as of now play parts in numerous biotechnological fields. Compounds from extremophilic microorganisms as a rule catalyse synthetic responses in non-standard conditions. Such conditions advance accumulation, precipitation, and denaturation, diminishing the movement of most non-extremophilic catalysts, regularly because of the shortfall of adequate hydration. Extremophilic catalysts can go after hydration by means of modifications particularly to their surface through more noteworthy surface charges and expanded sub-atomic movement. These assets have permitted few extremophilic compounds to work within the sight of non-fluid natural solvents, with potential for plan of valuable impetuses.

Dermatoses due to Personal Protective Equipment and other protective/preventive measures in COVID-19 pandemic- A study on frontline Health care workers

<p><strong>Background: </strong>The use of personal protective equipment (PPE) around the world in view of COVID-19 pandemic has led to high incidence of occupational dermatoses amongst healthcare workers (HCWs). Amongst all staff members visiting dermatology services, irritant dermatitis (body, hand) and acne form eruption remained the most common concerns. Apart from improving staff morale and quality of life, prevention and management of these conditions will also minimize the risk of breaching stringent PPE protocol. Preventive strategies including frequent breaks from PPE and less than 6 hours of continuous PPE usage can make the working environment more conducive for HCWs.<strong></strong></p><p><strong>Methods: </strong>A quantitative descriptive research-based study is utilized, in which participants who fulfilled the required criteria were selected and were asked to fill the questionnaire. Results were analysed.</p><p><strong>Results: </strong>Redness and itching are the commonest complaints encountered followed by skin rash and acne. Facial occupational dermatoses due to PPE revealed that allergic and irritant contact dermatitis are most common, followed by acne form eruptions and contact urticaria.</p><p><strong>Conclusions: </strong>With adequate hydration, workplace modifications, taking regular breaks from wearing PPE gear may help in alleviation of dermatoses and motivate HCWs in their fight against pandemic.</p><p><strong> </strong></p>

Recurrent Takotsubo syndrome complicated with ischemic enteritis successfully treated by hydration: a case report

Background Takotsubo syndrome is a sudden and an acute form of transient cardiac dysfunction, triggered by mental and physical stress. The treatment for Takotsubo syndrome is not well understood and is incompletely established. Takotsubo syndrome is partly thought to be caused by coronary ischemia under sympathetic nerve activation. Case presentation We report the case of an 80-year-old Japanese woman with recurrent Takotsubo syndrome complicated with ischemic enteritis. In this case, abdominal pain and dehydration due to ischemic enteritis is thought to have triggered Takotsubo syndrome. Her life was saved with rapid, adequate intravenous hydration. She was diagnosed with coronary vasospastic angina using coronary angiography on her second admission. This case highlights the potential of adequate intravenous hydration in increasing coronary blood flow. In our case, it should be noted that pulmonary congestion was mild and may have improved Takotsubo syndrome without the use of diuretics. Conclusion Adequate hydration must be considered for prompt improvement of cardiac function in Takotsubo syndrome. Replenishment of fluid to increase coronary blood flow, improvement of heart load without exacerbating heart failure, and stabilization of circulation dynamics can help treat patients with Takotsubo syndrome without using diuretics.

DIETARY GUIDELINES FOR PROTECTION OF THE OCCUPATIONAL HEALTH OF WORKERS IN FORESTRY

Introduction: Healthy and safe working conditions in the Bulgarian forest economy are associated with a lower incidence of labor abuses and occupational diseases among forest workers. Strategic management in this area includes actions to improve the working environment, part of which is the organization of pre-occupational nutrition. Purpose of the study is to support the occupational health of forest workers with specific dietary guidelines. Methods: The object of the study is 105 workers employed in the forestry of Northern Bulgaria. A documentary method was used - a study of the medical documentation from preventive examinations conducted in the period from 2015 to 2019. The results were analyzed with statistical software SPSS v.20. Results: Dietary recommendations in forestry aim to reduce the occupational health risk from contact with biological hazards, cold and hot microclimate, noise, dust and forced working posture. Dietary guidelines include adequate hydration, recommended eating frequency with a mandatory snacks, consumption of animal foods, fruits and vegetables, which increase the intake of essential amino acids, dietary fiber, vitamins (A, C, B1, B2, B6,), calcium, magnesium and trace elements, limiting the intake of saturated fatty acids and sodium, provision of dining facilities, clean food and clean drinking water. The training of forest workers to regulate energy intake is also being discussed. Conclusion: The implementation of dietary recommendations based on leading occupational hazards in forestry will help to protect occupational health and safety at work.

Left Ventricular End-Diastolic Pressure and B-Type Natriuretic Peptide Levels Guidance of Low-Dose Furosemide Treatment to Prevent Contrast-Induced Nephropathy in Patients with Percutaneous Coronary Intervention: A Randomized Controlled Trial

Objective. We aimed to explore the preventive effect of low-dose furosemide administration guided by left ventricular end-diastolic pressure (LVEDP) and B-type natriuretic peptide (BNP) based on adequate hydration on contrast-induced nephropathy (CIN) in patients with percutaneous coronary intervention (PCI). Methods. This parallel randomized clinical trial was conducted at a tertiary hospital in China. A total of 1053 consecutive patients (71.98% men) who underwent PCI at our hospital were enrolled. Pre-PCI plasma BNP levels were recorded. Patients enrolled received a continuous intravenous infusion of normal saline starting 4 h before PCI until 24 h after surgery. LVEDP was measured immediately after surgery. Patients in the control group received intravenous furosemide injection (20 mg). Patients in the experimental group received furosemide if they showed LVEDP ≥15 mmHg, a post-PCI BNP level ≥100 pg/mL, and/or a post-PCI BNP value > 150% of the pre-PCI value. The primary and secondary outcome measures were serum creatinine levels, glomerular filtration rate, and creatinine clearance rate measured before and after PCI. CIN incidence was compared between the two groups. Logistic regression analysis was used to study the risk factors for CIN. Results. CIN incidence was significantly higher in the control group than in the experimental group ( P < 0.05 ). Logistic regression analysis showed that elevated LVEDP and BNP levels were risk factors. As LVEDP increased, the CIN incidence also increased (odds ratio (OR) 1.038, 95% confidence interval (CI) 1.006–1.070). The OR of BNP was 1.001 (95% CI 1.000–1.002). Conclusions. Low-dose furosemide administration guided by LVEDP or BNP is superior to direct low-dose administration on the basis of adequate hydration during PCI. This trial is registered with ChiCTR-IOR-14005250

An exploration of hydration practices in Maltese residential care homes for older people

Background/aims The integral relationship between adequate hydration and good health is widely recognised. Older people with complex needs and frailty can struggle to maintain adequate hydration, with residents in care home settings being at an increased risk of dehydration. The aim of this study was to explore current hydration practices in residential care homes in Malta. Methods An exploratory qualitative approach was adopted to explore staff's views and approaches in supporting residents' hydration. Data was collected via semi-structured, individual and small group interviews with staff from two care homes from the central and southern region of Malta. A process of open coding, followed by axial coding, was used to analyse the data. Peer debriefing was performed throughout, until agreement was reached among the research team about the final themes and sub-themes. Results Three themes emerged from the data: culture of promoting fluid intake; challenges in supporting older people to achieve optimum hydration; hydration practices and approaches. Conclusions A hydration promotion culture was demonstrated through various practices adopted in the care homes. The strong focus on water intake, in response to concerns about consuming sugary beverages, has implications for the promotion of a person-centred approach to hydration care. Inconsistencies in monitoring of fluids and daily recommended targets highlights the importance of policies or guidelines to guide hydration practice. Challenges related to refusal of fluids and language barriers among non-native staff were evident and justify further research is this area.

O20 Approach to parotid swelling

Case report - Introduction The rarity of paediatric salivary gland disease and the lack of pathognomonic signs are likely to contribute to delay in diagnosis and make a structured approach to parotid swelling particularly important. Here we discuss a case of a 4-year-old girl with recurrent parotid swelling and some features to suggest multisystem involvement. Case report - Case description A partially immunised, 4-year-old girl with a history of eczema and vitiligo presented with a 3-month history of intermittent painless pre-auricular swelling. She had 2 days of fever at onset but was otherwise afebrile. She reported intermittent joint pain without swelling. There was no cough, coryza, sore throat, dryness of the mouth or eyes, rash, systemic upset, and no other evidence of multisystem involvement on systems review. She had no unwell contacts and no family history of autoimmune disease. On examination she had bilateral pre-auricular swelling which was non-tender, not fluctuant, and had no overlying skin changes. No calculi were identified on bimanual palpation of the parotid ducts and no pus was visible at the opening. Respiratory, cardiovascular, abdominal, musculoskeletal, and skin examination were unremarkable. Her bloods showed microcytic anaemia, raised ESR (peak 97mm/hr), CRP (peak 30mg/l), CK (peak 628 IU/l), and LDH (peak 512 IU/l), but normal ferritin and ACE. Serology showed ANA 1/10240, RNP Ab positive, negative myositis specific ENA, dsDNA, and rheumatoid factor, and normal complement. Infection screen, including TSpot, and screening for immunodeficiency were negative. Her urine dipstick was normal. Interferon signature was abnormal with very high levels. Parotid ultrasound scan showed heterogenous enlargement of all major salivary glands and lacrimal glands with reactive cervical lymph nodes. CT chest demonstrated basal ground-glass change and hilar, mediastinal, and axillary lymphadenopathy. Parotid biopsy was normal on two occasions, with no evidence of lymphoma or granulomatous disease. At this stage she was treated for undifferentiated autoimmune connective tissue disease with steroids and mycophenolate mofetil. Due to the lack of improvement and persistently mildly elevated CK and LDH, MRI thighs was subsequently performed. This demonstrated mild myositis prompting a muscle biopsy which showed typical features of juvenile dermatomyositis. She was therefore commenced on intravenous immunoglobulin and subcutaneous methotrexate. Case report - Discussion This is an unusual presentation of juvenile dermatomyositis with no typical clinical features of skin or muscle involvement, negative myositis ENA, and only mildly elevated CK, where parotitis was the main presenting feature. Despite a dramatic reduction in mumps following routine immunisation, viral adenitis remains the most common cause of parotid swelling. The most prominent features are unilateral or bilateral parotid swelling with fever and headache and, unlike this case, typically resolve in 1—2 weeks. Bacterial adenitis may be suggested by erythema and purulent secretions and may be precipitated by preceding viral sialadenitis, dehydration, or damage by calculi. Obstruction and inflammation caused by calculi, sialolithiasis, are suggested by pain with meals and almost complete resolution in between. A single short episode of parotid swelling without multisystem involvement will most commonly be caused by one of the above and would not require extensive investigation. Management consists of one or more of: ensuring adequate hydration, warm compresses, analgesia, salivary gland massage, sialagogues, antibiotics, and safety netting advice. More prolonged painful swelling despite sialagogues and antibiotics would warrant sialography to look for calculi, and prolonged painless swelling, particularly with the presence of any red flags, should prompt investigation for tumours or haematological malignancy. Only in recurrent, treatment refractory episodes, or, in cases such as this, where a thorough history and examination suggest multisystem involvement, would more extensive investigation be warranted to look for inflammatory causes of parotitis. Case report - Key learning points The differential diagnosis for parotid swelling is broad so a structured approach is essential. Extent of investigation should be guided by the history, particularly the clinical course and the evidence of multisystem involvement. It may be reasonable not to investigate at all in cases of isolated resolved or resolving parotid gland swelling without systemic upset and normal systems review. Where there are features to suggest multisystem disease, early referral to rheumatology for further investigation and treatment is needed.

Evaluation of Capillary Blood Gases in Medical Personnel Caring for Patients Isolated Due to SARS-CoV-2 in Intensive Care Units before and after Using Enhanced Filtration Masks: A Prospective Cohort Study

The dynamically changing epidemiological situation caused by the SARS-CoV-2 virus is associated with the increased burden and fatigue of medical personnel. The aim of the study was to evaluate: (1) oxygen and carbon dioxide blood pressure and saturation levels in medical personnel caring for patients isolated due to SARS-CoV-2 in ICUs; (2) adverse symptoms reported by medical personnel after leaving the isolation zone. Design: A Prospective Cohort Study. Methods: The project was implemented in the first quarter of 2021. Medical personnel working with patients isolated due to SARS-CoV-2 in the ICU of three hospitals were eligible for the study. The participants of the study were subjected to two analyses of capillary blood by a laboratory diagnostician. Results: In the studied group of medical personnel (n = 110) using FFP2/FFP3 masks, no significant differences (p > 0.05) were found between the parameters of geometric examination performed before and after leaving the isolation ward of the hospital. After working in the isolation ward, nurses reported malaise (somnolence, fatigue, sweating, dizziness) more often than paramedics (44% vs. 9%; p = 0.00002). The risk of ill-being in nurses was approximately nine times higher than in paramedics (OR = 8.6; Cl 95%: 2.7 to 26.8) and increased with the age of the subjects (OR = 1.05; Cl 95%: 1.01 to 1.08). Conclusion: FFP2/FFP3 filter masks did not worsen blood oxygenation in medical staff caring for patients isolated due to SARS-CoV-2 in the ICU. The presence of subjective symptoms such as fatigue may be due to lack of adequate hydration.

The therapeutic features of acute kidney injury in the elderly

The incidence of acute kidney injury (AKI) is increasing in people of all ages, but patients over the age of 65 are more likely to develop AKI due to structural and functional renal failure associated with aging, comorbidities, and reduced ability to recover. For this reason, the functionality of many organs tends to decrease. Older patients with AKI have an increased risk of mortality in both the short and long term, and survivors are patients with chronic kidney disease (CKD) who eventually progress to end-stage renal disease (ESRD). This paper aims at the therapeutic management of the elderly suffering from AKI. Maintaining adequate hydration and avoiding nephrotoxic agents are helpful in preventing AKI in the elderly. There are no proven treatment measures for AKI in the elderly, except for supportive therapy.

Huge cutaneous abscess and severe symptomatic hypercalcaemia secondary to Mycobacterium kansasii infection in an immunocompetent patient

Mycobacterium kansasii is among the most common non-tuberculous mycobacteria causing human infections. Apart from pulmonary infection, the most common infection caused by M. kansasii is skin and soft tissue infection, and it is very rare in immunocompetent people. In this report, we present a case of a huge cutaneous abscess caused by M. kansasii. A 63-year-old man living in Bangkok presented with progressive pain at the left lateral chest wall for 3 weeks and altered mentation for a few days. Examination revealed a non-tender fluctuated cutaneous mass 20×10 cm in size. An aspiration of the mass yielded 50 mL pus with many positive acid-fast bacilli. Mycobacterial PCR was positive for M. kansasii with culture confirmation. There was severe hypercalcaemia. The treatment included surgical drainage, and medical treatment consisted of isoniazid, rifampicin, ethambutol and levofloxacin, along with adequate hydration and calcitonin for hypercalcaemia. The patient gradually improved and was discharged 12 days after hospitalisation.