Baseline Health Research Articles

Air pollution is associated with increased risk of venous thromboembolism: the Multi-Ethnic Study of Atherosclerosis.

Air pollution exposure may induce procoagulant effects, and chronic exposure may be linked to greater risk of venous thromboembolism (VTE). We tested the hypothesis that air pollution is associated with increased VTE risk in the prospective Multi-Ethnic Study of Atherosclerosis (MESA), which has well-characterized air pollution measures and information on potential confounding factors. We included 6,651 participants recruited in 2000-2002 (baseline age range: 45-84 yrs; 53% female). Air pollution was assessed with a validated spatio-temporal model that incorporates cohort-specific monitoring. Four indices of air pollution updated each fortnight over follow-up were averaged to estimate participant-level chronic exposure: fine particulate matter ≤2.5 micrometers in aerodynamic diameter (PM2.5), oxides of nitrogen (NOx), nitrogen dioxide (NO2), and ozone (O3). Mean±SD PM2.5 was 13.5±3.0 µg/m3, NO2 17.9±8.2 ppb, NOx 36.1±19.6 ppb, and O3 22.2±3.7 ppb. Incident VTE was identified using hospitalization discharge codes through 2018. A total of 248 VTE events accrued over a median follow-up of 16.7 years. After adjustment for baseline demographics, health behaviors and body mass index, the hazard ratio (95% CI) for incident VTE associated per 3.6 µg/m3 higher PM2.5 was 1.39 (1.04-1.86); per 13.3 ppb higher NO2 concentration was 2.74 (1.57-4.77); and per 30 ppb higher NOx was 2.21 (1.42-3.44). O3 was not related. In this prospective community-based cohort with individual-level estimation of chronic air pollution exposure, higher average ambient concentrations of PM2.5, NO2 and NOX were associated with greater risk of developing VTE. Findings add to accumulating evidence of adverse health effects attributed to air pollution exposure.

Co-prescription of low-dose methotrexate and trimethoprim-sulfamethoxazole and the 30-day risk of death among older adults: A cohort study.

The aim of this study was to characterize the risk of death in older adults co-prescribed low-dose methotrexate and TMP-SMX vs. low-dose methotrexate and a cephalosporin. We conducted a retrospective, population-based, new-user cohort study in Ontario, Canada (April 1, 2002-August 1, 2022) using linked administrative healthcare data. Older adults taking low-dose methotrexate who were newly co-prescribed TMP-SMX (n = 1602) were matched 1:1 with those who were newly co-prescribed a cephalosporin. The primary outcome was death within 30 days of the antibiotic dispensing date. Secondary outcomes included all-cause hospitalization, a hospital visit with myelosuppression and a hospitalization with persistent infection defined as the main diagnosis. Propensity score matching was used to balance comparison groups on indicators of baseline health. Risk ratios (RR) were obtained using modified Poisson regression. In a propensity-score matched cohort of 3204 adults taking low-dose methotrexate, the 30-day risk of death was similar in adults co-prescribed TMP-SMX vs. a cephalosporin (14/1602 [0.87%] vs. 15/1602 [0.94%]; RR 0.93 [95% CI 0.45-1.93]). The risk of all-cause hospitalization (RR 1.49 [95% CI 1.13-1.97]) and infection (RR 2.78 [95% CI 1.30-5.95]) was higher in adults treated with TMP-SMX than those treated with cephalosporins. In older adults taking low-dose methotrexate, co-prescription of TMP-SMX vs. a cephalosporin was not associated with a higher 30-day risk of death but was associated with a higher 30-day risk of all-cause hospitalization and hospital admission with persistent infection. If verified, these risks should be balanced against the benefits of co-prescribing TMP-SMX and low-dose methotrexate.

Estimated Reduction in Health Care Spending Associated With Weight Loss in Adults

Recent data from federal surveys show that more than 70% of adults have either overweight or obesity. Overweight and obesity are associated with several expensive chronic conditions, such as type 2 diabetes, heart disease, hypertension, and hyperlipidemia. The prevalence of chronic disease is a key driver of rising health care spending among employers and the Medicare program. To estimate health care spending among adults with overweight or obesity and have employer-sponsored insurance or Medicare and examine the association of higher and lower body mass index (BMI). This cross-sectional study included privately insured adults and adult Medicare beneficiaries with a BMI of 25 and higher. Data from the Medical Expenditure Panel Survey-Household Component were used to tabulate total annual health care spending. Data were analyzed from April 1 to June 20, 2024. The primary intended measures were total annual health care spending, controlling for patient demographics, income, education, and BMI. The baseline health care spending as a percentage reduction in BMI. An instrumental variable regression model with estimated total spending at various levels of BMI was used. This study included 3774 adults who were insured with Medicare (mean [SD] age, 63.1 [11.1] years; mean [SD] percentage female, 50.4% [49.7%]; mean [SD] percentage non-Hispanic Black adults, 17.4% [37.7%]; mean [SD] percentage non-Hispanic White adults, 61.3% [48.4%]). The study also included 13 435 adults who had employer-sponsored insurance (mean [SD] age, 46.3 [6.9] years; mean [SD] percentage female, 47.6% [48.9%]; mean [SD] percentage non-Hispanic Black adults, 11.1% [30.7%]; mean [SD] percentage non-Hispanic White adults, 73.1% [43.4%]). Overall, adults with employer-sponsored insurance with a weight loss of 5% were estimated to spend a mean of $670 (95% CI, $654-$686) less on health care (8% less), and those with a weight loss of 25% spent an estimated mean of $2849 (95% CI, $2783-$2916) less on health care (34% less). Among adults with Medicare who had 1 or more comorbid conditions, a 5% weight loss was estimated to reduce spending by $1262 (95% CI, $1217-$1306) (7% less) and a 25% weight loss was estimated to reduce health care spending by a mean of $5442 (95% CI, $5254-$5629) (31% less). In this cross-sectional study, projected annual savings from weight loss among US adults with obesity were substantial for both Medicare and employer-based insurance.

Participant-reported neurological events following immunization in the Canadian National Vaccine Safety Network-COVID-19 vaccine (CANVAS-COVID) study

IntroductionThe Canadian National Vaccine Safety Network (CANVAS) conducted active participant-based surveillance for adverse events following immunization during the COVID-19 vaccine campaign. This study evaluated the association between COVID-19 vaccination and neurological adverse events. MethodsParticipants were invited to complete online surveys to report health events that prevented daily activities and/or required medical attention within 7 days after COVID-19 vaccination or 7 days prior to the survey (unvaccinated controls); follow-up surveys were sent 7 months later. Neurological events were health events where the most severe symptom reported was ≥1 of: numbness/tingling, loss of taste or smell, vision loss, facial weakness/paralysis, seizure, weakness/paralysis of arms or legs, confusion, change in personality or behavior, or difficulty with urination or defecation. Data were extracted from the CANVAS-COVID database for analysis. ResultsCompleted survey responses were received from 15,273 unvaccinated controls, 758,619 dose 1 recipients, 406,884 dose 2 recipients, and 126,586 dose 3 recipients. Rates of neurological events ranged from 15.9 (95 % CI 13.6–18.4) per 10,000 dose 1 ChAdOx1 recipients to 8.4 (6.5–10.8) and 7.9 (5.7–11.0) per 10,000 dose 3 mRNA-1273 and BNT162b2 recipients, respectively. Multivariable regression adjusted for age, sex, previous SARS-CoV-2 infection, and baseline health status showed an increased risk of neurological event among ChAdOx1 dose 1 recipients versus controls (adjusted OR 2.3, 95 % CI 1.2–4.3), but not among mRNA vaccine recipients after any dose. Risk of anaesthesia/paresthesia were increased following ChAdOx1 dose 1 (aOR 4.7, 1.7–13.1), and consistently but not statistically significantly higher following any dose of either mRNA vaccine. Risk of loss of smell/taste was decreased among recipients of any dose of either mRNA vaccine versus controls. ConclusionsThe results support the safety of COVID-19 vaccines while confirming reported associations between ChAdOx1 dose 1 and neurological events. Participant-based AEFI surveillance is a useful component of post-market surveillance programs.

Leveraging Deep Learning of Chest Radiograph Images to Identify Individuals at High Risk for Chronic Obstructive Pulmonary Disease.

This study assessed whether deep learning applied to routine outpatient chest X-rays (CXRs) can identify individuals at high risk for incident chronic obstructive pulmonary disease (COPD). Using cancer screening trial data, we previously developed a convolutional neural network (CXR-Lung-Risk) to predict lung-related mortality from a CXR image. In this study, we externally validated CXR-Lung-Risk to predict incident COPD from routine CXRs. We identified outpatients without lung cancer, COPD, or emphysema who had a CXR taken from 2013-2014 at a Mass General Brigham site in Boston, Massachusetts. The primary outcome was 6-year incident COPD. Discrimination was assessed using AUC compared to the TargetCOPD clinical risk score. All analyses were stratified by smoking status. A secondary analysis was conducted in the Project Baseline Health Study (PBHS) to test associations between CXR-Lung-Risk with pulmonary function and protein abundance. The primary analysis consisted of 12,550 ever-smokers (mean age 62·4±6·8 years, 48.9% male, 12.4% rate of 6-year COPD) and 15,298 never-smokers (mean age 63·0±8·1 years, 42.8% male, 3.8% rate of 6-year COPD). CXR-Lung-Risk had additive predictive value beyond the TargetCOPD score for 6-year incident COPD in both ever-smokers (CXR-Lung-Risk + TargetCOPD AUC: 0·73 [95% CI: 0·72-0·74] vs. TargetCOPD alone AUC: 0·66 [0·65-0·68], p<0·01) and never-smokers (CXR-Lung-Risk + TargetCOPD AUC: 0·70 [0·67-0·72] vs. TargetCOPD AUC: 0·60 [0·57-0·62], p<0·01). In secondary analyses of 2,097 individuals in the PBHS, CXR-Lung-Risk was associated with worse pulmonary function and with abundance of SCGB3A2 (secretoglobin family 3A member 2) and LYZ (lysozyme), proteins involved in pulmonary physiology. In external validation, a deep learning model applied to a routine CXR image identified individuals at high risk for incident COPD, beyond known risk factors. The Project Baseline Health Study and this analysis were funded by Verily Life Sciences, San Francisco, California. NCT03154346.

Abstract 4138672: Blood Pressure and Cardiovascular Outcomes in Adults with Diabetes and Chronic Kidney Disease

Background: Most international guidelines recommend intensive blood pressure (BP) targets (e.g., &lt;130/80 mm Hg) for patients with chronic kidney disease (CKD). However, the data supporting these recommendations are limited, particularly for those with concomitant diabetes. Hypothesis: Systolic BP (SBP) &lt;130 mm Hg and diastolic BP (DBP) &lt;80 mm Hg are associated with a reduced risk of cardiovascular disease (CVD) in adults with diabetes and CKD. Aims: To determine the association of BP with incident CVD risk among adults with diabetes and CKD. Methods: From a Korean nationwide health screening database, we identified 373,966 adults aged 20-79 with both diabetes and CKD who: (1) underwent baseline health examinations in 2009-2013; (2) had ≥3 BP measurements; and (3) did not have CVD at baseline. The associations of baseline average SBP and DBP with CVD risk were assessed using multivariable-adjusted cause-specific Cox models. The primary outcome was CVD event, defined as a composite of myocardial infarction, stroke, heart failure, or death from CVD. Results: The median (Q1-Q3) age of the participants was 62 (53-70) years; 40.8% were female. Over a median follow-up of 10.2 years, a total of 40,781 incident CVD events occurred. Compared with SBP 130 to &lt;140 mm Hg as the referent group, the multivariable-adjusted HRs (95% CIs) for CVD event in the SBP ≥150 mm Hg, 140 to &lt;150 mm Hg, 120 to &lt;130 mm Hg, and &lt;120 mm Hg groups were 1.34 (1.29-1.39), 1.11 (1.08-1.14), 0.89 (0.87-0.91), and 0.77 (0.74-0.80), respectively. Compared with DBP 80 to &lt;90 mm Hg as the referent group, the HRs (95% CIs) in the DBP ≥100 mm Hg, 90 to &lt;100 mm Hg, 70 to &lt;80 mm Hg, and &lt;70 mm Hg groups were 1.70 (1.56-1.85), 1.19 (1.15-1.24), 0.88 (0.86-0.90), and 0.83 (0.80-0.87), respectively (Figure A). SBP &lt;130 mm Hg and DBP &lt;80 mm Hg were each associated with a reduced CVD risk in a log-linear manner (Figure B, Figure C). The findings were consistent when examining kidney instead of cardiovascular outcomes. Conclusion: Among patients with diabetes and CKD, SBP below 130 mm Hg and DBP below 80 mm Hg were associated with a reduced risk of CVD.

Abstract 4138647: Opportunistic Screening for Cardiovascular Risk Using Chest X-Rays and Deep Learning: Associations with Coronary Artery Disease in the Project Baseline Health Study and Mass General Brigham Biobank

Introduction/Background: We previously demonstrated that an open-source deep learning model (CXR-CVD Risk) can predict 10-year major adverse cardiovascular events (myocardial infarction&amp;stroke), based on a chest radiograph image (CXR). As deep learning models are black boxes, establishing the biological processes the model captures to predict risk may help build understanding and trust in the model. Research Questions/Hypothesis: To test associations between deep-learning derived CXR-CVD Risk and markers of cardiovascular disease including coronary artery calcium (CAC) and stenosis ≥50% on CT, systolic blood pressure (SBP), ankle brachial index (ABI), and prevalent myocardial infarction and stroke. Methods/Approach: We conducted external validation of CXR-CVD-Risk in two cohorts: 1) 2,097 volunteers in the Project Baseline Health Study (PBHS) and 2) 1,644 Mass General Brigham Biobank (MGBB) patients. The CXR-CVD-Risk model estimated 10-year cardiovascular event risk (probability between 0 and 1) from a CXR image. We calculated linear associations with SBP, ABI, and the logarithm of coronary artery calcium and odds ratios for prevalent hypertension, myocardial infarction, stroke, and, in the MGBB, coronary artery stenosis ≥50%. Analyses were adjusted for age, BMI, sex, smoking status, and enrolling site. Results/Data: CXR-CVD-Risk was associated with CAC in both populations (PBHS: 1.11-fold increase, 95% CI: [1.07-1.16]; MGBB: 1.03-fold increase [1.01-1.05] in CAC per 1% increase in CXR-CV-Risk). CXR-CVD-Risk was also associated with SBP (0.59 mmHg increase [0.24-0.93] in SBP per 1% increase in CXR-CV-Risk), history of hypertension, history of myocardial infarction, and stroke. There was an inverse association with ABI (0.010 decrease [0.005-0.014] in ABI) in the PBHS. In the MGBB, CXR-CVD-Risk was associated with coronary artery stenosis ≥50% (OR = 1.004 [1.002-1.007]). All estimates are after covariate adjustment. Conclusion: This deep learning CXR risk score was associated with coronary artery disease (calcium score and stenosis ≥50%), CVD risk factors, and prevalent CVD. Opportunistic screening using CXRs in the electronic record can identify patients at high risk of CVD who may benefit from prevention.

NCOG-41. COMPARATIVE ANALYSIS OF MORTALITY AND SHORT-TERM SIDE EFFECTS IN PATIENTS WITH GLIOBLASTOMA MULTIFORME TREATED WITH TEMOZOLOMIDE VERSUS TEMOZOLOMIDE PLUS BEVACIZUMAB CHEMOTHERAPY

Abstract INTRODUCTION Glioblastoma multiforme (GBM) is a highly aggressive primary brain tumor in adults with limited treatment options and poor prognosis. Temozolomide (TMZ) chemotherapy is the standard treatment for GBM, but alternative therapies have shown limited success. Bevacizumab (BEV), a monoclonal antibody targeting vascular endothelial growth factor (VEGF), is used to restrict GBM growth and spread. This study evaluates the efficacy of combining TMZ with BEV compared to TMZ alone in managing GBM. METHODS A retrospective cohort study was conducted using TriNetX database data, focusing on patients diagnosed with GBM and receiving chemotherapy. Cohorts were defined by treatment: TMZ plus BEV versus TMZ alone. Propensity-score matching balanced baseline characteristics, including demographics and health conditions. Primary outcomes included mortality rates and short-term side effects within the first year of treatment, such as cognitive communication deficits, headache, dizziness, insomnia, and nausea/vomiting. RESULTS After matching, 922 patients were included in each cohort. There were no significant demographic differences post-matching. The mortality rate was higher in the TMZ plus BEV group compared to TMZ alone (51.30% vs. 36.98%, RR: 1.387, 95% CI: 1.249-1.541). However, TMZ plus BEV was associated with a lower incidence of cognitive communication deficits (1.95% vs. 4.34%, RR: 0.45, 95% CI: 0.26-0.779) and dizziness (7.27% vs. 10.52%, RR: 0.691, 95% CI: 0.513-0.93). No significant differences were found in headache, insomnia, or nausea/vomiting rates between the groups. CONCLUSION This study indicates that combining bevacizumab with temozolomide may increase mortality in GBM patients but reduce certain side effects such as cognitive deficits and dizziness. These findings emphasize the need to carefully consider the benefits and risks of different chemotherapy regimens for GBM and highlight the necessity for further research to optimize treatment strategies and improve patient outcomes.

Insomnia symptoms predict systemic inflammation in women, but not in men with inflammatory bowel disease.

Insomnia has been suggested as a potential modulator of systemic inflammation. However, few studies have examined the longitudinal association between insomnia and inflammation as well as the role of sex differences, despite accumulating evidence of the vulnerability of women to immune consequences of disturbed sleep. In this study, we tested the association between self-reported insomnia symptoms and serum C-reactive protein, a marker of systemic inflammation, at 1-year follow-up, in 54 outpatients with inflammatory bowel disease (52.81 ± 16.09, 40.7% women). Insomnia symptoms were measured using the Insomnia Severity Index. After controlling for baseline inflammation and health variables, longitudinal moderated regression analysis showed that baseline insomnia symptoms predicted C-reactive protein levels at follow-up in women (β = 0.416, p = 0.014), but not in men (β = -0.179, p = 0.212). Results were not influenced by sex differences in insomnia severity or C-reactive protein levels. This study suggests insomnia symptoms may partially influence systemic inflammation in women with inflammatory bowel disease. Sex-specific psychological, immune and neuroendocrine pathways linking sleep to inflammation should be further elucidated.

Data management practice of health extension workers and associated factors in Central Gondar Zone, northwest Ethiopia.

Generating quality data for decision-making at all levels of a health system is a global imperative. The assessment of the Ethiopian National Health Information System revealed that health information system resources, data management, dissemination, and their use were rated as "not adequate" among the six major components of the health system. Health extension workers are the frontline health workforce where baseline health data are generated in theEthiopian health system. However, the data collected, compiled, and reported by health extension workers are unreliable and of low quality. Despite huge problems in data management practices, there is a lack of sound evidence on how to overcome these health data management challenges, particularly among health extension workers. Thus, this study aimed to assess data management practices and their associated factors among health extension workers in theCentral Gondar Zone. An institution-based cross-sectional study was conducted among 383 health extension workers. A simple random sampling method was used to select districts, all health extension workers were surveyed in the selected districts, and a structured self-administered questionnaire was used for data collection. The data was entered using EpiData version 4.6 and analyzed using STATA, version 16. Bivariable and multivariable binary logistic regression analyses were executed. An odds ratio with a 95% confidence interval and a p-value of <0.05 was calculated to determine the strength of theassociation and to evaluate statistical significance, respectively. Of the 383 health extension workers enrolled, all responded to the questionnaire with a response rate of 100%. Furthermore, 54.7% ofthe respondents had good data management practices. In the multivariable logistic regression analysis, being a married woman, having good data management knowledge, having agood attitude toward data management, having 1-5 years of working experience, and havingasalary ranging from 5,358 to 8,013 Ethiopian Birr were the factors significantly associated with good data management practices among health extension workers. The overall data management practice was poor with only five health extension workers out of ten having good data management practices.

Predictors of the effectiveness to first-line CTLA4-Ig in patients with rheumatoid arthritis: the FIRST registry.

This study aimed to elucidate which bio-naïve patients with rheumatoid arthritis (RA) are suitable for treatment with CTLA4-Ig. This study enrolled 953 patients with RA who were administered their first biological disease-modifying antirheumatic drug (CTLA4-Ig, n = 328; tumour necrosis factor inhibitor [TNFi], n = 625) from July 2013 to August 2022. The primary outcome was the Clinical Disease Activity Index (CDAI) remission rate at week 24 in each group, adjusted using Propensity Score-based Inverse Probability of Treatment Weighting (PS-IPTW). After minimizing selection bias using PS-IPTW, the CDAI remission showed no significant difference between the CTLA4-Ig and TNFi groups (p= 0.464). Multivariable logistic regression analysis identified low baseline Health Assessment Questionnaire-Disability Index (HAQ-DI) scores as a contributing factor to the CDAI remission rate at week 24 in both groups, along with high baseline anti-citrullinated peptide antibody (ACPA) levels in the CTLA4-Ig group. However, among patients with high baseline HAQ-DI scores and low baseline ACPA levels (≦57.2), the CDAI remission rate was significantly higher in the TNFi group (29.8%) compared with the CTLA4-Ig group (5.9%, p< 0.0001). Among patients with high baseline HAQ-DI scores and ACPA levels (>57.2), the CDAI remission rate was significantly higher in the CTLA4-Ig group (35.6%) compared with the TNFi group (22.1%, p= 0.0057). Bio-naive RA patients with low HAQ-DI scores showed high treatment efficacy with no significant difference between CTLA4-Ig and TNFi. Among patients with high baseline HAQ-DI scores, TNFi and CTLA4-Ig were more likely to be effective in those with lower and higher baseline ACPA levels, respectively.

Do we need urine drug screens in opioid addiction treatment: An observational study on self-report versus urine drug screens

BackgroundThe substance use crisis continues to progress. Medication for Opioid Use Disorder (MOUD) are prescribed to reduce opioid use and related harms; however, many individuals continue to use substances while on treatment. The objective of this study was to describe the temporal and demographic trends of the agreement between self-reported and urine tested substances. MethodsThe current study is a retrospective secondary analysis of three phases of a prospective cohort study (Pilot 2011, Genetics of opioid addiction (GENOA) 2013–2017, and Pharmacogenetics of opioid substitution treatment (POST)) 2018–2022) spanning 2011–2022. We compared the self-reported substance use data for opioids, benzodiazepines, amphetamine/methamphetamine (AMP/MET), and cocaine with urine drug results. We compared the positive predictive value (PPV), false omission rate (FOR), sensitivity, and specificity between (i) different drugs; (ii) by sex, and (iii) age group at enrollment in each phase of the study using self-reported substance use at baseline and retrospective electronic health record data on urine drug screenings collected over the same time period. ResultsOverall, the average PPV and FOR for any drug across all phases was 80.7 % and 37.9 %, respectively. Sensitivity and specificity were highest for cocaine and lowest for benzodiazepines. We found no specific trend by sex. Lastly, we found a higher sensitivity for opioids and AMP/MET in those under 25 years of age compared to other age groups. PPV increased over time for benzodiazepines, AMP/MET and cocaine and FOR was higher during the pilot and POST phases than the GENOA phase. ConclusionOur study highlights the unique challenges associated with ascertaining substance use behaviour for individuals receiving MOUD, indicating many patients will accurately report substance use while others do not. It is therefore important to consider the context of the patient, and the type of the co-substance used to select patient-centred testing as indicated. Therefore, the answer to the question of do we need urine drug screen is yes in some cases.

Post-Neutralisation Activated Clotting Time and Postoperative Transfusions in Cardiac Surgery Outcome.

To assess the impact of post-protamine neutralisation activated clotting time (ACT) values on postoperative outcomes including chest drain output, transfusion requirements, and CICU stay, in patients undergoing cardiac surgery. Observational comparative study. Place and Duration of the Study: Department of Anaesthesiology, The Aga Khan University Hospital, Karachi, Pakistan, from February to August 2023. Ethical approval was obtained to collect data from elective cardiac surgery patients' charts. A sequential sampling approach analysed the baseline and post-protamine neutralisation ACT values, categorising patients into two groups. Group A maintained ACT within 10% of baseline, while Group B deviated. The outcomes measured included transfusion needs, chest drain output, additional protamine, cardiac intensive care unit (CICU) stay, and postoperative reopening. Statistical analysis included mean, median, frequency, t-test / Mann-Whitney U test, and Chi-square test. The study comprised 101 patients (39 in Group A, 62 in Group B), with similar baseline health. No significant differences were found in tranexamic acid use, CICU stay, chest drain output, or transfusion rates between the groups (p >0.05). Maintaining ACT within 10% of baseline post-protamine neutralisation results in similar intraoperative and postoperative outcomes, suggesting potential benefits in avoiding the aggressive protamine therapy and ensuring haemostasis in cardiac surgery. Coronary Artery bypass grafting, Cardiopulmonary bypass, Activated clotting time (ACT), Heparin, Postoperative bleeding, Blood transfusions.

Post-Neutralisation Activated Clotting Time and Postoperative Transfusions in Cardiac Surgery Outcome.

To assess the impact of post-protamine neutralisation activated clotting time (ACT) values on postoperative outcomes including chest drain output, transfusion requirements, and CICU stay, in patients undergoing cardiac surgery. Observational comparative study. Place and Duration of the Study: Department of Anaesthesiology, The Aga Khan University Hospital, Karachi, Pakistan, from February to August 2023. Ethical approval was obtained to collect data from elective cardiac surgery patients' charts. A sequential sampling approach analysed the baseline and post-protamine neutralisation ACT values, categorising patients into two groups. Group A maintained ACT within 10% of baseline, while Group B deviated. The outcomes measured included transfusion needs, chest drain output, additional protamine, cardiac intensive care unit (CICU) stay, and postoperative reopening. Statistical analysis included mean, median, frequency, t-test / Mann-Whitney U test, and Chi-square test. The study comprised 101 patients (39 in Group A, 62 in Group B), with similar baseline health. No significant differences were found in tranexamic acid use, CICU stay, chest drain output, or transfusion rates between the groups (p >0.05). Maintaining ACT within 10% of baseline post-protamine neutralisation results in similar intraoperative and postoperative outcomes, suggesting potential benefits in avoiding the aggressive protamine therapy and ensuring haemostasis in cardiac surgery. Coronary Artery bypass grafting, Cardiopulmonary bypass, Activated clotting time (ACT), Heparin, Postoperative bleeding, Blood transfusions.

Functional outcome after infectious encephalitis: a longitudinal multicenter prospective cohort study.

ObjectivesWe aimed to describe longitudinal functional outcome among survivors after an infectious encephalitis (IE) and to analyze risk factors for poor functional outcome. MethodsPatients included in the prospective ENCEIF cohort (France, 2016-2019) were followed-up at 6 months and one year after hospital discharge for assessment of i) functional outcome using modified Rankin scale (mRS); ii) cognitive function and abilities to perform activities of daily living. Risk factors for poor outcome on the full distribution of mRS were estimated using multivariable mixed ordinal regression analysis with time between hospital discharge and follow-up as a covariate. ResultsOur follow-up study included 322 patients with 896 mRS evaluations. Median age was 66 [50-74] years, 197/322 were male (61%) and 35/322 were immunocompromised (11%). Causative agents were herpes simplex virus 1 (HSV-1) in 95/322 cases (30%), varicella zoster virus (VZV) in 46/322 cases (14%), others documented IE in 90/322 cases (28%) and unknown in 91/322 cases (28%). Intensive care unit (ICU) admission was necessary for 117/322 patients (36%). Brain imaging was abnormal in 180/311 (58%) of patients.At 6 months, 95/287 (33%) had fully recovered and 181/287 (63%) had persisting symptoms. At 12 months, 124/253 (49%) had fully recovered and 108/253 (43%) had persisting symptoms. The proportion of patients who improved was 41% (117/287) during the first 6 months, and 24% (52/218) between 6 and 12 months. Factors significantly associated with poor functional outcome were age, immunosuppression, ICU admission, abnormal brain imaging and causative agents, notably HSV-1. Follow-up visit during the first 120 days did not detect significant change in functional outcome, but was strongly associated with better outcome at the subsequent evaluation. ConclusionsAfter IE, improvement may take several months. Functional outcome is associated with baseline health status (age, immunosuppression), abnormal brain imaging, ICU admission, and causative agent.

Effects of Social Determinants of Health and Social Support on Surgical Outcomes Among Patients Undergoing Hysterectomy.

To describe composite 30-day postoperative complication rates among patients undergoing hysterectomy during the coronavirus disease 2019 (COVID-19) pandemic and to determine baseline and postoperative mental health symptoms, levels of social support, and socioeconomic status and their association with hysterectomy outcomes. This multicenter prospective cohort study at eight centers across the United States enrolled patients who underwent minimally invasive hysterectomy for benign indications during the COVID-19 pandemic. Patients completed preoperative and postoperative surveys assessing mental health (PHQ-9 [Patient Health Questionnaire]), social support (MOS-SS [Medical Outcomes Study Social Support Survey]), and socioeconomic status (Hollingshead Index [Hollingshead Four Factor Index of Socioeconomic Status]). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and 30-day composite complication rates were measured and categorized by Clavien-Dindo Grade. Bivariate associations of survey data on complications were assessed. Logistic regression analyses were used to identify independent predictors of 30-day complications and complication severity. Postoperative complications within 30 days occurred in 67 of 273 (24.5%) patients. Most (88.1%) complications were mild, but eight (11.9%) experienced severe complications. Only three patients (1.1%) tested positive for SARS-CoV-2 infection. There were no differences in complication rates when comparing race and ethnicity, age, or socioeconomic status. Survey responses that indicated more depression and worse support from preoperative to postoperative were seen in patients with severe complications (P=.008 and P=.09, respectively). Multivariate analysis demonstrated that an increase in support scores was protective against severe complications (P=.02). Worsening depression scores were associated with more severe complications (P=.03). This study showed a high rate of complications (24.5%) among patients who underwent hysterectomy during the COVID-19 pandemic. Lower social support and worse mental health status are associated with worse postoperative outcomes after hysterectomy.

Novel R package to quantify and monetize burden of disease attributable to air pollution and noise

Abstract Background Ambient air pollution and noise substantially impact public health and the economy. Different methods to quantify these impacts are described in the literature. Objectives Within the European project BEST-COST (Burden of disease-based methods for estimating the socio-economic cost of environmental stressors), we aim to develop an open-source R package to quantify and monetise the disease burden attributable to air pollution and noise, including the impact of social inequalities. Methods The developed code will allow for different calculation pathways including: single baseline health data vs. age-specific estimates from life tables; relative and absolute risk; scenario comparison based on the population attributable fraction vs. population impact fraction; single-pollutant vs. correlated exposures; and outdoor vs. indoor air pollution. Moreover, the package can digest a variety of input data formats for the exposure-response function (e.g. relative risk with fixed shape vs. user-defined function) and exposure data (e.g. population-weighted mean vs. categorical distribution, spatial data). Eligible impact metrics will include morbidity incidence and prevalence, number of deaths, years of life lost, and years lived with disability. Finally, the R package will enable quantifying social inequities (using a novel multiple deprivation index) and monetising the attributable disease burden (using a state-of-the-art approach). Results During development, the R package will be tested in BEST-COST case studies in 5 European countries (BE, EE, FR, NO, PT), compared with existing tools, and discussed with key users in a workshop. The final R package will be available on GitHub in 2026. Conclusions This tool will allow the quantification and monetisation of the health impact of air pollution and noise. The R package will be a flexible programming resource that can be used as a standalone or combined with existing tools to build a more solid basis for evidence-based policy making. Key messages • This open-source tool will allow the quantification and monetisation of the health impact of air pollution and noise, including the impact of social inequalities. • The R package will be a flexible programming resource that can be used as a standalone or combined with existing tools to build a more solid basis for evidence-based policy making.

Impact of age on health status after TAVI or SAVR in low risk patients with severe aortic stenosis: results from the PARTNER 3 Trial

Abstract Background Transcatheter aortic valve implantation (TAVI) results in similar 5-year survival and quality of life compared with surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) and low surgical risk. Whether participants’ age at the time of intervention influences the health status benefit of TAVI vs. SAVR is unknown. Purpose To assess the relationship between age and both the short- and long-term health status outcomes of TAVI vs. SAVR among patients enrolled in the PARTNER 3 trial. Methods We used data from the PARTNER 3 randomized trial to compare health status outcomes between TAVI and SAVR, stratified by age (&amp;lt;70, 70-74, 75-79, ≥80 years). Health status was assessed at baseline, 1 month, 6 months, 12 months and annually through 5 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ). The primary endpoint was the KCCQ overall summary score (KCCQ-OS) over the 5-year follow-up period (range 0-100; higher=better). The key secondary endpoint was an excellent outcome, defined as a KCCQ-OS&amp;gt;75 at 5-year follow-up without a decline of &amp;gt;10 points from baseline. Results Between March 2016 and October 2017, 1000 low-risk patients with severe AS were randomized in a 1:1 fashion to transfemoral TAVR using the balloon-expandable Sapien 3 valve or surgery in the PARTNER 3 trial. Among patients who underwent TAVI or SAVR (and had baseline health status available; TAVI: 494, SAVR: 449), 228 (24%) were &amp;lt;70, 284 (30%) were 70-74, 287 (31%) were 75-79, and 144 (15%) were ≥80 years old. Baseline health status was similar between the TAVI and SAVR groups as well as across age strata. At 30-day follow-up, health status was substantially better with TAVI than SAVR with similar differences across age strata (mean difference 13-18 points; Figure 1). At all other timepoints, there were no significant differences between TAVI and SAVR in any age group. The proportion of TAVI patients with an excellent outcome at 5-year follow-up ranged from 86% in the youngest subgroup to 73% in the oldest subgroup, with no significant differences compared with SAVR. Conclusions Among patients with severe AS at low surgical risk, TAVI using the SAPIEN 3 balloon-expandable valve resulted in substantially better health status in the early post-procedure period compared with SAVR across all age strata. Beyond the early recovery period, intermediate- and longer-term health status outcomes were similar with TAVI and SAVR, with no evidence of heterogeneity by age. Although longer term follow-up is necessary (and ongoing), these 5-year outcomes suggest that over the age range included in the PARTNER 3 trial, age alone should not play a dominant role in determining treatment recommendations for patients with severe AS.Health status by treatment and age group

Race in heart failure: a pooled participant-level analysis of the global PARADIGM-HF and PARAGON-HF trials

Abstract Background Mechanisms of disease pathobiology, prognosis, and potentially treatment responses might vary by race in patients with heart failure (HF). Early experiences with neprilysin inhibition suggested possible increased risks of angioedema, especially among Black individuals. We aimed to examine the safety and efficacy profile of sacubitril/valsartan in a pooled participant-level dataset of 2 large cohorts of patients with HF by self-reported race. Methods PARADIGM-HF and PARAGON-HF were multicenter, randomized clinical trials testing sacubitril/valsartan against a renin-angiotensin system inhibitor (RASi, enalapril or valsartan, respectively) in patients with HF and LVEF ≤40% (PARADIGM-HF) or LVEF ≥45% (PARAGON-HF). We included all patients with available data on self-reported race and categorized patients as White, Asian, or Black. We assessed adjudicated outcomes including the composite of first HF hospitalization (HFH) or cardiovascular (CV) death, its components, and angioedema by racial group. Results Among 12,097 included participants, 9,451 (78.1%) were White, 2,116 (17.5%) were Asian, and 530 (4.4%) were Black. Asian participants were from 19 countries, with highest enrollment from India, China, and the Philippines. Black participants were from 18 countries, with highest enrollment from the US, South Africa, and Brazil. Black patients had the worst baseline health status (adjusted KCCQ-OSS mean 70.3), while White (71.4) and Asian patients (76.4) had better health status; P&amp;lt;0.001. Over 2.4-years of median follow-up, Black (adjusted HR 1.67; 95% CI 1.37-1.89; P&amp;lt;0.001) and Asian patients (adjusted HR 1.32; 95% CI 1.16-1.50; P&amp;lt;0.001) experienced higher risks of the primary outcome compared with White patients (Figure 1). The treatment effects of sacubitril/valsartan vs. RASi on the primary endpoint were consistent among White (HR 0.84; 95% CI: 0.77-0.91), Asian (HR 0.92; 95% CI: 0.78-1.10), and Black patients (HR 0.79; 95% CI: 0.58-1.07; Pinteraction = 0.39). In light of higher baseline risks, Black patients accrued the greatest absolute risk reduction with sacubitril/valsartan (Figure 2). Consistent treatment benefits by race were also observed for the individual components (CV death alone and first HFH alone). Rates of any adjudicated angioedema were numerically higher with sacubitril/valsartan vs. RASi across race groups (White 0.4% vs. 0.2%; Asian 0.6% vs. 0.2%; Black 2.3% vs. 0.8%), however no patient in either trial experienced airway compromise or required mechanical airway protection. Conclusions In a pooled experience of over 12,000 participants enrolled in 2 trials conducted across 56 countries, Black and Asian patients exhibited a higher risk of CV events than White patients. Rates of non-serious angioedema were numerically higher with sacubitril/valsartan across race groups. The relative CV benefits of sacubitril/valsartan were consistent across races, with greatest absolute benefits observed in Black patients.

Clinical epidemiology and impact of Haemophilus influenzae airway infections in adults with cystic fibrosis

BackgroundHaemophilus influenzae is prevalent within the airways of persons with cystic fibrosis (pwCF). H. influenzae is often associated with pulmonary exacerbations (PEx) in pediatric cohorts, but in adults, studies have yielded conflicting reports around the impact(s) on clinical outcomes such as lung function decline. Accordingly, we sought to discern the prevalence, natural history, and clinical impact of H. influenzae in adult pwCF.MethodsThis single-centre retrospective cohort study reviewed all adult pwCF with H. influenzae sputum cultures between 2002 and 2016. From this cohort, persistently infected subjects (defined as: ≥2 samples with the same pulsotype and > 50% sputum culture-positive for H. influenzae in each year) were matched (1:2) to controls without H. influenzae. Demographic and clinical status (baseline health or during periods of PEx) were obtained at each visit that H. influenzae was cultured. Yearly biobank isolates were typed using pulsed-field gel electrophoresis (PFGE) to assess relatedness.ResultsOver the study period, 30% (n = 70/240) of pwCF were culture positive for H. influenzae, of which 38 (54%) were culture-positive on multiple occasions and 12 (17%) had persistent infection. One hundred and thirty-seven isolates underwent PFGE, with 94 unique pulsotypes identified. Two (1.5%) were serotype f with the rest non-typeable (98.5%). H. influenzae isolation was associated with an increased risk of PEx (RR = 1.61 [1.14–2.27], p = 0.006), however, this association was lost when we excluded those who irregularly produced sputum (i.e. only during a PEx). Annual lung function decline did not differ across cohorts.ConclusionsIsolation of H. influenzae was common amongst adult pwCF but often transient. H. influenzae infection was not associated with acute PEx or chronic lung function decline.