Background: Emerging evidence suggests that gut microbiota plays a significant role in the regulation of blood pressure and cardiovascular health. Dysbiosis an imbalance in the gut microbial composition has been implicated in the pathophysiology of hypertension, potentially via pathways involving systemic inflammation, altered short-chain fatty acid (SCFA) production, and gut barrier dysfunction. Objective: To investigate the association between gut microbiota dysbiosis and hypertension in adult patients. Methods: A cross-sectional analytical study enrolling 181 adult patients, including hypertensive individuals and age-matched normotensive controls, using non-probability consecutive sampling. Results: Out of 181 participants, hypertensive patients (n=110) had significantly higher BMI (29.8 ± 4.5 vs. 27.3 ± 3.9; p=0.002), CRP levels, and blood pressure values compared to normotensive controls. Alpha diversity indices, including Shannon index (3.10 ± 0.6 vs. 3.75 ± 0.5; p<0.001), Simpson index, and observed OTUs, were significantly lower in hypertensive individuals. Relative abundance analysis revealed a notable reduction in Faecalibacterium (8.4% vs. 12.1%) and Roseburia (5.6% vs. 8.7%), while Enterobacter and Klebsiella levels were markedly higher (6.8% vs. 3.3% and 4.9% vs. 2.1%, respectively; all p<0.001). Correlation analysis showed inverse relationships between microbial diversity and systolic BP (r = -0.41) and CRP (r = -0.35). In multivariate regression, low Shannon index (OR = 2.85; p<0.001) and high Enterobacter abundance (OR = 2.41; p=0.004) emerged as independent predictors of hypertension. Conclusion: Gut microbiota dysbiosis is strongly associated with hypertension, characterized by decreased microbial diversity and increased pro-inflammatory taxa. These findings underscore the potential of targeting gut microbiota as a novel strategy in managing hypertension.

Introduction: The most frequent medical issue that arises during pregnancy is hypertension, which continues to be a critical contributor in both maternal and fetal morbidity and mortality. Almost 10% of all pregnancies are complicated by this cardiovascular pathology. Preterm birth, intrauterine growth restriction, perinatal death, acute renal or hepatic failure, antepartum hemorrhage, postpartum hemorrhage, and maternal death are all correlated with a heightened risk in pregnancies complicated by hypertension Materials and Methods: This is an Institutional based cross sectional study design was conducted among women whose age was greater or equal to eighteen from March to April 2019. Selected pregnant women who gave at least one child birth and those who were above 20 weeks of gestation for current pregnancy were included. First, we obtained the annual report of the pregnant mothers with gestational age of greater than 20 weeks in ANC then we divide by 12 to get the flow of pregnant mothers per month. Then finally we found about 139 pregnant mothers who come for ANC follow up. Then the total sample size required was collected consecutively within the given period. Results The predominant age group was ≤25 years, and more than half of the subjects (64.0%) were from urban areas. A high percentage of middle- (n=48, 48.0%) and low-income (n=45, 45.0%) patients were observed to have preeclampsia as compared to patients of high economic status (n=7, 7.0%). In this study, 38 (38.0%) women had a family history of preeclampsia. Severe preeclampsia was diagnosed in 24 (24.0%) patients, and 36 (36.0%) had mild stage, while 40 (40.0%) subjects were at the normal stage of preeclampsia. Conclusion This study highlights the significant impact of hypertension on both maternal and neonatal health. The high prevalence of hypertensive disorders, associated complications, and increased rates of cesarean delivery and preterm births emphasize the urgent need for comprehensive prenatal care and improved management strategies. Further research should focus on long-term maternal and neonatal outcomes, as well as effective interventions to reduce the risks associated with hypertensive disorders in pregnancy.

Background: Psychological stress adversely affects immune function, potentially influencing cancer progression and patient outcomes globally. Objective: This study aims to evaluate the impact of stress on the immune system of cancer patients in Al-Ahsa, Saudi Arabia, and its correlation with disease progression and treatment response. Methods: A cross-sectional study was conducted in Al-Ahsa during 2019, enrolling 1,000 cancer patients. Stress levels were assessed using the Perceived Stress Scale (PSS). Immune parameters, including cortisol levels, natural killer (NK) cell activity, and cytokine profiles (e.g., IL-6, TNF-α), were measured through blood samples. Statistical analysis was performed using SPSS version 26.0, employing descriptive statistics, Pearson correlation, and multivariate regression to examine relationships between stress and immune markers. Additionally, Receiver Operating Characteristic (ROC) curve analysis was utilized to determine the predictive accuracy of stress on immune dysfunction and clinical outcomes. Results: High stress levels were reported by 68% of patients. Elevated cortisol was observed in 72% of highly stressed patients compared to 28% in low-stress groups (p < 0.001). NK cell activity was significantly reduced in stressed patients, with a mean decrease of 35% (p < 0.001). IL-6 and TNF-α levels were elevated in 65% and 60% of patients experiencing high stress, respectively (p < 0.001). Multivariate analysis revealed that stress independently predicted reduced NK activity (β = -0.45, p < 0.001) and increased pro-inflammatory cytokines (β = 0.50, p < 0.001). Additionally, stress was associated with a 20% higher rate of disease progression (OR = 1.20, 95% CI: 1.05-1.37) and a 15% poorer treatment response (OR = 0.85, 95% CI: 0.78-0.93). ROC analysis demonstrated that the PSS score had an area under the curve (AUC) of 0.82 (95% CI: 0.78-0.86) for predicting immune dysfunction. The combined effect of high stress and immune dysregulation contributed to a 25% increase in overall mortality risk (p < 0.05). Furthermore, subgroup analysis indicated that females exhibited a higher prevalence of stress-induced immune alterations compared to males (75% vs. 62%, p = 0.004). Conclusions: Stress significantly impairs immune function in cancer patients in Al-Ahsa, Saudi Arabia, correlating with increased disease progression and diminished treatment efficacy. These findings underscore the necessity for integrating stress management interventions in oncology care to enhance patient outcomes.

Introduction Febrile neutropenia is a clinical emergency that can develop as a result of multiple mechanisms. The evolution of neutropenia is highly dependent on that of the underlying disease, and identification of comorbidities is essential. In cases of Gram-negative bacteremia, the mortality rate can reach 18%. Case report We report the case of a patient with myelodysplastic syndrome and neutropenia among multiple comorbidities, hospitalized for fever, chills and altered clinical state two weeks after having been discharged from the hospital following the resolution of sepsis with P. aeruginosa. The clinical exam revealed active intestinal bleeding and discrete wet rales in the middle one-third of the right pulmonary lung field. An initial diagnosis was neutropenic fever, and empirical intravenous treatment with meropenem, vancomycin and caspofungin was started. A comprehensive laboratory evaluation revealed liver and kidney impairment of recent onset, blood cultures came back positive for P. aeruginosa, and the diagnosis of recurrent sepsis with P. aeruginosa was established. Antimicrobial treatment was de-escalated from meropenem to piperacillin-tazobactam, levofloxacin was added, vancomycin was stopped, and caspofungin was replaced with fluconazole, with favorable evolution, remission of fever within three days, marked reduction of the inflammatory syndrome, and remission of organ impairment. Treatment was continued for 10 days before the patient was discharged with the recommendation to continue prophylaxis with levofloxacin and fluconazole for the duration of severe neutropenia and to return for periodic evaluation in our clinic. Conclusions The recurrent sepsis episodes in this patient reflect primarily the neutropenic status, but comorbidities could also contribute to a certain degree of immunodeficiency. The long-term management of the infectious risk is a complex issue, including antibiotic and antifungal prophylaxis, due to the anticipated persistent neutropenia.

Introduction Eosinophilic fasciitis is asclerodermiform syndromewith the histopathologic hallmark of fascial fibrosis. The following have been suggested as potential triggers: physical exercise, trauma, Lyme disease, hematologic malignancies, thyroid diseases, hemodialysis, systemic lupus erythematosus and exposure to certain medications such as: statins, L-tryptophan, phenytoin, ramipril or subcutaneous heparin. Case report We report the case of a 75-year-old man with sclero-indurative, alopecic and shiny skin affecting almost the entire body (with the exception of face, perigenital area, hands and feet), "groove sign”at the upper extremities and impaired mobility of ankles, knees and elbows,evolving for almost 8 months. At the thigh level he presented a net-like vascular pattern suggestive for livedo reticularis. Clinical evaluation, laboratory studies and pathological examination established the diagnosis of eosinophilic fasciitis associated with factor V Leiden. Discussion Eosinophilic fasciitis is a rare disease that needs to be differentiated from localized and systemic sclerosis, scleroderma-like disorders such as nephrogenic systemic fibrosis, scleromyxedema, scleredema and eosinophilia myalgia syndrome. Early diagnosing enables screening for diseases commonly reported as being associated. Up to 10 percent of patients with eosinophilic fasciitis associate hematologic abnormalities and prompt treatment can prevent long lasting sequelae. Conclusion We have presented a case of eosinophilic fasciitis and livedo reticularis caused by mutated factor V of coagulation, an association that has not been described before.

Introduction Disseminated granuloma annulare, one of the rare clinical forms of granuloma annulare, is characterized by a prolonged evolution, frequent relapses and difficulty in finding the best therapeutic approach for the accompanying skin lesions. Case report We report the case of a female patient with disseminated granuloma annulare resistant to standard therapy, in evolution for more than 5 years, whose cutaneous lesions began to respond to topical treatment with calcineurin inhibitors only after the underlying systemic conditions (autoimmune thyroiditis and diabetes) were properly treated. Discussion The pathogenesis of the disease is not totally elucidated, various hypotheses of immunological origin are taken into consideration. The association and causal interaction between granuloma annulare and various systemic and autoimmune diseases has been brought to attention. Conclusion Granuloma annulare may be associated with various systemic diseases, such as diabetes mellitus and autoimmune thyroiditis, which interfere with the natural course of the skin lesions.

Introduction Early identification and determination of antimicrobial susceptibilities of microorganisms growing in blood cultures is crucial as delay can lead to increased mortality, morbidity and cost. This study was done to evaluate the usefulness of the FilmArray blood culture identification (FA-BCID) in comparison with conventional techniques in early identification and antimicrobial initiation. MethodsThis was a single centre, prospective study conducted in a 24-bed critical care unit (CCU) of a tertiary care hospital at Chennai, India between October 2016 and December 2016. Patients whose blood culture bottles were flagged using the BACTEC-FX system were included. The blood culture was processed by FA-BCID and by conventional method and the results were compared. ResultsA total of 36 positive blood cultures were analyzed by both FA-BCID and conventional method from patients admitted in the CCU. FA-BCID accurately identified 80% of the organisms. Of 32 isolates identified by FA-BCID, 50% (16/32) showed isolated growth of Gram negative bacteria (GNB), 37.5% (12/32) showed isolated growth of Gram positive (GP) bacteria, whereas 12.5% (4/32) showed >1 micro-organism in the same culture bottle. Overall, sensitivity, specificity, positive predictive value and negative predictive value were 100% for the identification of GP bacteria, and 69%, 100%, 100% and 76.4% for GNB, respectively. FA-BCID identified oxacillin resistance (mec A) accurately, whereas resistance mechanisms could not be predicted at all in cases of Gram negatives as the kit only has KPC gene identification system. The turnaround time of FA-BCID was a median of 2 hours compared to 2 days for the conventional method. Antibiotics were de-escalated or escalated in 47.2% of patients based on FA-BCID within a median time of 3 hours. Conclusion FA-BCID is a significant advance in the early identification and escalation or de-escalation of treatment for bacteremia in critically ill patients, with a high sensitivity for Gram positive bacteria as compared to Gram negative bacteria. Incorporation of probes for prevalent pathogens and resistance genes would make this panel more useful in Indian settings.

Introduction This article describes how relationship marketing is defined and generally perceived, how important it is for business and how it applies to the healthcare system. There are three major categories of relationship marketing strategies that successful healthcare units practice: attracting new patients, patient retention and patient loyalty. A study was conducted in order to observe if there are any differences between the physician-patient relationship in the private and public healthcare sectors in Bucharest, Romania. Methods A qualitative research was performed using the questionnaire method. Data from 41 physicians (21 from the private healthcare sector and 20 from the public healthcare sector) was obtained by answering the same questions regarding the physician-patient relationship, patient retention and loyalty. The statistical analysis was performed using Pearson’s Chi-squared test. Results The general characteristics of the two groups were balanced in terms of gender distribution and experience in healthcare, but a significant difference was identified concerning the type of diseases that the respondents generally worked with. Practitioners from the public sector reported that they more often worked with patients with acute and chronic diseases alike, while healthcare practitioners from the private sector stated that they worked mostly with chronic diseases. In terms of the physician-patient relationship, the two study groups responded similarly to the questions regarding patient satisfaction and retention, feedback, social statute importance and general communication with patients. However, differences were identified concerning patient loyalty strategies and benefits offered to patients, which were considerably more important in the private sector, and also the average duration of consultation was higher in the private healthcare sector (21-30 minutes) than in the public healthcare sector (11-20 minutes). Conclusions Practitioners from the private and public healthcare sectors alike are aware of the importance of the physician-patient relationship. The private healthcare sector has a greater emphasis on patient loyalty strategies by offering various benefits to make the patients return.

Introduction Emerging strains of Klebsiella pneumoniae resistant to different antibiotics, especially metallo-beta-lactamase-(MBL)-producing isolates, are major therapeutic problems worldwide. The aim of this study was to determine the prevalence of MBL-producing K. pneumoniae and their antimicrobial pattern. MethodsThis descriptive study included 100 K. pneumoniae isolates recovered from inpatients and outpatients, which were referred to 3 hospitals in Hamadan, Iran. In this study antibiotic susceptibility was determined using disk diffusion and E-test. MBL-producing isolates were detected by the double disk synergy test (DDS test). Furthermore, the frequency of blaVIM-1, blaVIM-2 and blaIPM-1genes was investigated using PCR. Results The highest resistance rate was observed to cefixime (48%), followed by ceftriaxone (47%) and cefotaxime (46%). In contrast, the most active antibiotic agents against K. pneumoniae were meropenem (95%) and imipenem (88%). The frequency of MBL and multidrug-resistant isolates were 5% and 43%, respectively. Also, only blaVIM-1was detected in 5% of the isolates. Conclusion In summary, our results showed that the most effective antibiotic agents for the treatment of infections caused by K. pneumoniaestrains in this region are meropenem and imipenem.

Many things have changed since I started my medical training but at least one of them is as valid today as it was 30 years ago: being a doctor is a lifetime commitment to learning. During my medical training the transfer of knowledge was almost exclusively one-directional: from professors to students. Limitations in technology, the characteristics of the students and of the socio-cultural environment made the professor the center of the education. Knowledge was important, but mentorship even more: even in those times, mentorship was essential for obtaining the ability to integrate theory into practice and for developing the skills and experience for the ever-changing challenge that is meeting the patient. By providing a model, the good professors were able to plant the seed of continual self-education, and, reconsidering it now, with my lifetime experience, I believe that seed gradually sprouted to the current student-centered education concept.