Concomitant Risk Factors Research Articles

Epicardial adipose tissue volumes for long-term risk stratification in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

Abstract Background Accurate risk stratification is important to improve patient selection and outcome of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). As epicardial adipose tissue (EAT) is discussed to be involved in cardiovascular disease, it could be useful as a marker of poor prognosis in patients with severe AS undergoing TAVR. Purpose We hypothesized that EAT impacts long-term outcome of patients with severe AS undergoing TAVR independently from subtype and other risk factors. Methods A total of 416 patients diagnosed with severe AS by transthoracic echocardiography were assigned for TAVR and enrolled for systematic assessment. Patients underwent clinical surveys and 5-year long-term follow-up, with all-cause mortality as the primary endpoint. EAT volume was quantified on pre-TAVR planning CTs. Patients were retrospectively dichotomized at the median of 74cm3 of EAT into groups with low-EAT and high-EAT volumes. Mortality rates were compared using Kaplan-Meyer plots and uni- and multivariable cox regression analyses. Results A total number of 341 of 416 patients (median age 80.9years, 45% female) was included in the final analysis. Patients with high-EAT volumes had similar short-term outcome (p=0.794) but significantly worse long-term prognosis (p=0.023) compared to patients with low-EAT volumes. Increased EAT volumes were associated with worse long-term outcome (HR1.59;p=0.031) independently from concomitant cardiovascular risk factors, general type of AS and functional echocardiography parameters of AS severity (HR1.69;p=0.013). Conclusion Increased EAT volume is an independent predictor of all-cause mortality in patients with severe AS undergoing TAVR. It can be easily obtained from pre-TAVR planning CTs and may thus qualify as a novel marker to improve prognostication and management of patient with severe AS.Graphical Abstract

Frequency of Asymptomatic Deep Vein Thrombosis in Hospitalized Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD).

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are always associated with high mortality. Because of the presence of some concomitant risk factors such as immobilization and bronchial superinfection, patients who are admitted for acute exacerbations of COPD are generally considered to be at moderate risk for the development of venous thromboembolism. Thromboembolism is a cause of unexplained dyspnea, exacerbations, and mortality in COPD. This study aims to determine the frequency of asymptomatic deep vein thrombosis (DVT) in patients with acute exacerbations of COPD presented at a tertiary care hospital. This is a descriptive cross-sectional study conducted at the Department of Chest Medicine, Jinnah Postgraduate Medical Center (JPMC), Karachi. A duplex ultrasound study of both lower limbs was performed by a sonologist to assess asymptomatic DVT in patients with acute exacerbations of COPD. The mean age of the sample was 59.64 ± 9.711 years. Out of 106 patients, 95 (90%) were male and 11 (10%) were female. Asymptomatic DVT was found in 16 (15%) patients with acute exacerbations of COPD. Male patients exhibited a higher incidence of DVT, with 12 cases versus four in females, a statistically significant finding (p=0.03). Additionally, DVT was significantly more prevalent among patients with restricted mobility, with all 16 cases occurring in this group (p=0.006). Age did not show a statistically significant difference in DVT occurrence between patients above and below 59 years. Deep venous thrombosis is a common occurrence in COPD exacerbations. It is a risk factor for pulmonary embolism that carries a high mortality. All patients with COPD exacerbations may need to be assessed for thromboembolic events. COPD morbidity and mortality are continually rising despite efforts to recognize new phenotypes and treatments. The cause may be the association of unrecognized and untreated thromboembolism. Prompt diagnosis and treatment with anticoagulants in COPD patients may lead to a better prognosis.

Evaluation of pharmacokinetic target attainment and hematological toxicity of linezolid in pediatric patients.

Linezolid is commonly used to treat severe and/or resistant Gram-positive infections. Few studies have assessed its pharmacokinetic (PK) target attainment in pediatrics. To evaluate the percentage of pediatrics achieving the PK targets of linezolid with standard dosing regimens and to assess the incidence and risk factors associated with its hematologic toxicity. This prospective observational study included pediatric patients aged 0-14 who received linezolid for suspected or proven Gram-positive infections. Linezolid trough concentrations and the 24-h area under the curve (AUC24) were estimated, and hematologic toxicity was assessed. Seventeen pediatric patients (5 neonates and 12 older pediatrics) were included. A wide variability was observed in linezolid's trough and AUC24 (ranging from 0.5 to 14.4mg/L and from 86 to 700mg.h/L, respectively). The median AUC24 was significantly higher in neonates than older pediatrics (436 [350-574] vs. 200 [134-272] mg,h/L, P = 0.01). Out of all patients, only 41% achieved adequate drug exposure (AUC24 160-300mg.h/L and trough 2-7mg/L), with 24% having subtherapeutic, and 35% having higher-than-optimal exposures. Hematological toxicity was observed in 53% of cases. Identified risk factors include treatment duration over 7days, baseline platelet counts below 150 × 109/L, sepsis/septic shock, and concomitant use of meropenem. Linezolid's standard dosing failed to achieve its PK targets in approximately half of our pediatric cohort. Our findings highlight the complex interplay between the risk factors of linezolid-associated hematological toxicity and underscore the importance of its vigilant use and monitoring, particularly in pediatrics with concomitant multiple risk factors.

Optimizing metformin therapy in practice: Tailoring therapy in specific patient groups to improve tolerability, efficacy and outcomes.

Metformin is the first-line medication for type 2 diabetes. It is effective and safe, provided some caution is taken in specific populations. In patients with chronic kidney disease, metformin may provide long-term benefits, and it is a first-line therapy for diabetes, but the estimated glomerular filtration rate (eGFR) must be assessed regularly, to minimize the risk for metformin accumulation. When eGFR is 30-60 mL/min/1.73m2, the dose should be reconsidered, and sick-days education provided. Metformin should be discontinued when eGFR falls below 30 mL/min/1.73m2. Metformin accumulation may increase the risk for lactic acidosis if concomitant risk factors for hyperlactataemia (liver or respiratory insufficiency, sepsis, acute heart failure) are present; in these conditions, metformin is contraindicated, even although the available evidence is reassuring. Patients on metformin often complain of gastrointestinal side effects (mainly diarrhoea and nausea) during therapy initiation, but they may sometimes occur after years of stable therapy. These usually resolve if the dose is carefully titrated, or by switching to the extended-release formulation. Patients with obesity may benefit from the significant, although modest, metformin-associated weight loss and appetite reduction. During pregnancy, metformin is associated with a reduction of pregnancy complications, especially in obese women, but some concern remains, because metformin crosses the placenta, and it is associated with a significantly lower mean birth weight than insulin. In the elderly, gastrointestinal tolerability and renal function must be reassessed more often. Vitamin B-12 should be screened regularly in long-time metformin users because metformin may induce clinical vitamin B-12 deficiency.

Predictors for poor daily weight gain in preterm neonates exposed to different dose regimens of caffeine in ICU- a retrospective cohort study

BackgroundWith a wide therapeutic index, efficacy, ease of use, and other neuroprotective and respiratory benefits, caffeine citrate(CC) is currently the drug of choice for preterm neonates (PTNs). Caffeine-induced excessive energy expenditure, diuresis, natriuresis, and other CC-associated potential side-effects (CC-APSEs) result in lower daily-weight gain (WG) in premature neonates. This study aimed to evaluate the risk factors for daily-WG in neonates exposed to different dose regimens of caffeine in ICU.MethodThis retrospective cohort study included neonates of ≤ 36weeks gestational age (GA) and received CC-therapy. The same participants were followed for data analysis in two postnatal phases: 15–28 and 29–42 days of life (DOL). Based on daily CC-dose, formed group-I (received; standard-doses = 5 mg/kg/day), group-II (received;>5-7 mg/kg/day), and group-III (received;>7 mg/kg/day). Prenatal and postnatal clinical characteristics, CC-regimen, daily-WG, CC-APSEs, and concomitant risk-factors, including daily-caloric intake, Parenteral-Nutrition duration, steroids, diuretics, and ibuprofen exposure, were analyzed separately for group-II and group-III using group-I as standard. Regression analysis was performed to evaluate the risk factors for daily-WG.ResultsIncluded 314 PTNs. During 15–28 DOL, the mean-daily-WG(MD-WG) was significantly higher in group-I than group-II [19.9 ± 0.70 g/kg/d vs. 17.7 ± 0.52 p = 0.036] and group-III [19.9 ± 0.70 g/kg/d vs. 16.8 ± 0.73 p < 0.001]. During 29–42 DOL the MD-WG of group-I was only significantly higher than group-III [21.7 ± 0.44 g/kg/d vs. 18.3 ± 0.41 g/kg/d p = 0.003] and comparable with group-II. During 15–28 DOL, observed CC-APSEs was significantly higher in group-II and III but during 29–42 DOL it was only significant in group-III. In the adjusted regression analysis for daily-WG during 15-28DOL, with respect to standard-dose, 5-7 mg/kg/day (β=-1.04; 95%CI:-1.62,-0.93) and > 7-10 mg/kg/day (β=-1.36; 95%CI:-1.56,-1.02) were associated with a lower daily-WG. However, during 29-42DOL, this association was present only for > 7-10 mg/kg/day (β=-1.54; 95%CI:-1.66,-1.42). The GA ≤ 27weeks (β=-1.03 95%CI:-1.24, -0.88) was associated with lower daily-WG only during 15-28DOL. During both periods of therapy, higher cumulative-caffeine dose and presence of culture proven sepsis, tachypnea, hyponatremia, and feeding intolerance were significantly associated with lower daily-WG. Conversely, daily kcal intake was found to be linked with an increase in daily-WG in both periods.ConclusionIn this study cohort exposure to higher caffeine daily and cumulative doses is associated with lower postnatal daily-WG in PTNs than standard-daily doses, which may be due to its catabolic effects and CC-APSEs.

Geographic and sociodemographic variations in disease burden, epidemiological trends, and risk factors of early-onset lung cancer: A global analysis.

11169 Background: Exploring the emerging trend of early-onset lung cancer (EOLC) burden is pivotal for guiding the implementation of preventive strategies among young adults. We aimed to provide a comprehensive examination of the geographic and sociodemographic variations in the disease burden, along with epidemiological trends and risk factors associated with EOLC over the past three decades. Methods: EOLC refers to lung cancer diagnosed in individuals aged 20-49 years. Utilizing the GBD 2019 data, we estimated the age-standardised incidence, mortality, and disability-adjusted life years (DALYs) rates for EOLC by sex, socio-demographic index (SDI) quintiles, and geographical location for the period from 1990 to 2019. We investigated the relationships between concomitant risk factors and EOLC incidence at national level, and calculated the DALYs attributable to risk factors. The relative contribution of population growth, population ageing, and epidemiological changes to the variations in burden of EOLC over study period was measured using the decomposition analysis. Incidence was forecast to 2040 using the Bayesian age-period-cohort model. Results: A total of 135,704 EOLC cases, equating to a age-standardised incidence rate of 4.0 (95% UI 3.6 to 4.3) per 100,000, were estimated in 2019 worldwide and was the second leading cause of cancer death among young adults, with higher disease burden occurred in males and those from middle and high-middle SDI regions. An overall decreasing trend in burden of EOLC was observed globally; such trends were more pronounced among males and followed a gradient across SDI levels, with the greater decrease observed in high and high-middle SDI regions. Sex, tobacco smoking prevalence, per capita cigarette-equivalent estimates, average age of smoking initiation, ambient ozone pollution, and GDP per capita were independently and significantly associated with EOLC incidence at the population level. Smoking remained the top contributor to burden of EOLC, with the exception of Andean Latin America, North Africa, and the low SDI regions, where ambient particulate matter pollution and household air pollution from solid fuels ranked as the foremost attributable risk factors. Population growth was the primary driver behind the global increase in EOLC cases in low and low-middle SDI regions, while epidemiological changes accounted for the most substantial reduction in EOLC cases across most regions. The global incidental cases of EOLC was projected to increase by 31.1% in 2040, with a more pronounced increase in females and those from high-middle and middle SDI locations. Conclusions: Our findings underscore significant geographic and sociodemographic disparities in the epidemiological burden of EOLC, emphasizing the necessity for policymakers to devise and apply region-specific, evidence-driven preventive strategies.

The hidden nature of sibling sexual abuse: when sexually harmful behaviour masquerades as consensual sexual experimentation

Whilst the majority of sibling relationships are generally benign in providing an additional secure attachment figure and source of comfort in which they can grow and flour- ish, some are highly competitive, full of envy, rivalry, and resentment, which can lead to physical and sexual violence. It is estimated that sibling sexual abuse (SSA) is three to four times more common than adult to child sexual abuse (CSA) in the family. Lack of knowl- edge, research, and discourse on psychosexual development in children and the nature of SSA has led both parents, child protection professionals, and clinicians to normalise sexual interactions between siblings, and to minimise these as less harmful than generational CSA. To ensure that sibling sexual interactions, their impact, and long-term effects are fully understood, it is essential that parents and practitioners understand what constitutes harmful sexual behaviour (HSB) between siblings and be able to distinguish between developmentally typical sexual behaviour and developmentally atypical sexual behaviour in children. In recognising the nature, concomitant risk factors, impact, and long-term effects of SSA, parents and professionals will be more able to bear witness to the lived experience of SSA and facilitate the healing process.

COMPLICAÇÕES NEONATAIS CONCERNENTE A MORBIDADE MATERNA: DIABETES GESTACIONAL

The monitoring of this morbidity brings with it the need at public health level to emphasize regular monitoring through prenatal care, aiming at early diagnosis and treatment for Obstetric Diabetes (OD) or gestational diabetes mellitus (GDM), thus being able to reduce complications for the mother and fetus binomial. The aim of this study is to analyze these results among fetal or neonatal complications in women with GDM, bringing in the outcomes of premature birth, birth weight, neonatal morbidity and mortality, and the synergistic effect of concomitant risk factors and poor obstetric outcomes. A literature review was carried out using the following databases: Online Medical Literature Search and Analysis System (MEDLINE/PUBMED), Nursing Database - Brazilian Bibliography (BDENF), Web of Science and Cochrane Library (SCOPUS), CAPES Journals and Latin American and Caribbean Health Sciences Literature (LILACS). The search was carried out using descriptors combined with the Boolean operator “and”. From the searches, it was possible to see that the authors corroborate each other in relation to the main neonatal outcomes: Complications include fetal macrosomia, birth injuries, increased caesarean section rates, neonatal hospitalizations, neonatal hypoglycemia, neonatal respiratory distress syndrome (RDS), prematurity and fetal death. It can be concluded that for the mother the impacts, such as the risk of urinary system infections, are high, as well as bleeding in the postpartum period and tearing of the vaginal canal. For the child, hypoglycemia, prematurity and fetal macrosomia are some of the complications resulting from diabetes.

Descemet's membrane endothelial keratoplasty rejection after SARS-COV2 infection or vaccination: 2-year retrospective study

To assess the incidence of Descemet's membrane endothelial keratoplasty (DMEK) rejection potentially associated with coronavirus disease 2019 (COVID-19) infection or vaccination, and its association with known rejection risk factors during the first two years of the pandemic. This retrospective study included patients with DMEK rejection between January 2020 and December 2021. Diagnostic criteria were based on symptoms, visual acuity, and other clinical assessments. Risk factors for graft rejection were considered, and a telephone survey was conducted to identify possible preceding COVID-19 infection or vaccination. Of 58 patients, 44 were included. Six patients (14%) reported COVID-19 infection, with one immediate endothelial graft rejection (EGR) post-infection. After vaccine availability, 13 of 36 patients had EGR at an average of 2.7 months post-vaccination. Five (38%) had immediate EGR following vaccination, four of which had concomitant risk factors for rejection. Although the risk of endothelial graft rejection (EGR) associated with COVID-19 infection or vaccination appears to be extremely low, there may be a causative relationship, especially in patients with pre-existing risk factors for EGR. A temporary increase in anti-rejection treatment following COVID-19 infection or vaccination is recommended, especially in patients with pre-existing risk factors, along with closer monitoring during the subsequent 4 to 8 weeks.

Psychostimulants and social behaviors.

Mounting evidence from animal models and human studies indicates that psychostimulants can significantly affect social behaviors. This is not surprising considering that the neural circuits underlying the regulation and expression of social behaviors are highly overlapped with those targeted by psychostimulants, which in most cases have strong rewarding and, consequently, addictive properties. In the present work, we provide an overview regarding the effects of illicit and prescription psychostimulants, such as cocaine, amphetamine-type stimulants, methylphenidate or modafinil, upon social behaviors such as social play, maternal behavior, aggression, pair bonding and social cognition and how psychostimulants in both animals and humans alter them. Finally, we discuss why these effects can vary depending on numerous variables such as the type of drug considered, acute versus long-term use, clinical versus recreational consumption, or the presence or absence of concomitant risk factors.

Elevated cardiovascular risk and acute events in hospitalized colon cancer survivors: A decade-apart study of two nationwide cohorts.

Over the years, strides in colon cancer detection and treatment have boosted survival rates; yet, post-colon cancer survival entails cardiovascular disease (CVD) risks. Research on CVD risks and acute cardiovascular events in colorectal cancer survivors has been limited. To compare the CVD risk and adverse cardiovascular outcomes in current colon cancer survivors compared to a decade ago. We analyzed 2007 and 2017 hospitalization data from the National Inpatient Sample, studying two colon cancer survivor groups for CVD risk factors, mortality rates, and major adverse events like pulmonary embolism, arrhythmia, cardiac arrest, and stroke, adjusting for confounders via multivariable regression analysis. Of total colon cancer survivors hospitalized in 2007 (n = 177542) and 2017 (n = 178325), the 2017 cohort often consisted of younger (76 vs 77 years), male, African-American, and Hispanic patients admitted non-electively vs the 2007 cohort. Furthermore, the 2017 cohort had higher rates of smoking, alcohol abuse, drug abuse, coagulopathy, liver disease, weight loss, and renal failure. Patients in the 2017 cohort also had higher rates of cardiovascular comorbidities, including hypertension, hyperlipidemia, diabetes, obesity, peripheral vascular disease, congestive heart failure, and at least one traditional CVD (P < 0.001) vs the 2007 cohort. On adjusted multivariable analysis, the 2017 cohort had a significantly higher risk of pulmonary embolism (PE) (OR: 1.47, 95%CI: 1.37-1.48), arrhythmia (OR: 1.41, 95%CI: 1.38-1.43), atrial fibrillation/flutter (OR: 1.61, 95%CI: 1.58-1.64), cardiac arrest including ventricular tachyarrhythmia (OR: 1.63, 95%CI: 1.46-1.82), and stroke (OR: 1.28, 95%CI: 1.22-1.34) with comparable all-cause mortality and fewer routine discharges (48.4% vs 55.0%) (P < 0.001) vs the 2007 cohort. Colon cancer survivors hospitalized 10 years apart in the United States showed an increased CVD risk with an increased risk of acute cardiovascular events (stroke 28%, PE 47%, arrhythmia 41%, and cardiac arrest 63%). It is vital to regularly screen colon cancer survivors with concomitant CVD risk factors to curtail long-term cardiovascular complications.

Unraveling the Paradox: Can Anticoagulation Improve Outcomes in Patients With Heart Failure and Increased Bleeding Risk?

Heart failure (HF) patients frequently present with comorbidities such as atrial fibrillation (AF) or other cardiovascular conditions, elevating their risk of thromboembolic events. Consequently, anticoagulation therapy is often considered for thromboprophylaxis, although its initiation in HF patients is complicated by concomitant bleeding risk factors. This review explores the paradoxical relationship between HF, increased bleeding risk, and the potential benefits of anticoagulation. Through an examination of existing evidence from clinical trials, observational studies, and meta-analyses, we aim to elucidate the role of anticoagulation in HF patients with increased bleeding risk. Despite guidelines recommending anticoagulation for certain HF patients with AF or other thromboembolic risk factors, uncertainty persists regarding the optimal management strategy for those at heightened risk of bleeding. The review discusses the pathophysiological mechanisms linking HF and thrombosis, challenges in bleeding risk assessment, and strategies to minimize bleeding risk while optimizing thromboprophylaxis.Shared decision-making between clinicians and patients is emphasized as essential for individualized treatment plans that balance the potential benefits of anticoagulation against the risk of bleeding complications. Furthermore, it examines emerging anticoagulant agents and their potential role in HF management, highlighting the need for further research to delineate optimal management strategies and inform evidence-based practice. In conclusion, while anticoagulation holds promise for improving outcomes in HF patients, careful consideration of patient-specific factors and ongoing research efforts are essential to optimize therapeutic strategies in this population.

Severe Conjunctival and Corneal Epithelial Dysplasia: A Case Series

Ocular surface squamous neoplasia (OSSN) are among the most frequent non-pigmented malignancies of the ocular surface. They have a wide range of histological characteristics - ranging from mild epithelial dysplasia to invasive carcinoma of the squamous cells of the cornea. They may be restricted to the conjunctiva or also involve the cornea. As there are no leading symptoms in the early stages, diagnosis may be very delayed in patients who do not receive regular ophthalmological treatment. The present case series describes clinical and histological data on OSSN and includes clinical and histological data on OSSN, including possible clinical presentations, important risk factors, special histological and cytological features and therapeutic options. Retrospective case series of patients with histologically confirmed severe epithelial dysplasia of the conjunctiva and cornea consistent with OSSN who presented to the Department of Ophthalmology in Basel University Hospital. The analysis covered demographic data, symptoms, diagnostic testing (photo documentation, brush biopsy), treatment and cytological and/or histological material and findings. We report on five patients aged between 41 and 92years at the time of diagnosis. The histological findings in all patients included severe epithelial dysplasia, but with a heterogenous clinical presentation. In all cases, the lesion started in the conjunctiva, but traversed the limbus and extended to the cornea. The primary treatment was always surgical removal. In one patient, this had to be repeated several times due to recurrent metaplasia and was complemented by subsequent mitomycin C therapy. The clinical outcome ranged between total restitution of the original state to inevitable enucleation. The clinical presentation of OSSN is highly heterogenous, so that the initial diagnosis is difficult. There are no official guidelines for treatment, so that the treatment of choice varied between clinics. Regular ophthalmological follow-ups are recommended, even after complete surgical excision. Possible relevant concomitant diseases and risk factors must be identified before therapy.

Both HFpEF and HFmrEF should be included in calculating CHA2DS2-VASc score: A Taiwanese longitudinal cohort

BackgroundCongestive heart failure (CHF) as a risk of stroke in patients with atrial fibrillation (AF) mainly referred to patients with left ventricular systolic dysfunction. Whether this should include patients with preserved ejection fraction is debatable. ObjectiveThe study aimed to investigate the variation in stroke risk of AF patients with heart failure with preserved ejection fraction (HFpEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF) for enhancing risk assessment and subsequent management strategies. MethodsIn a longitudinal study using the National Taiwan University Hospital integrated Medical Database, 8358 patients with AF were observed for 10 years (mean follow-up, 3.76 years). The study evaluated the risk of ischemic stroke in patients with differing ejection fractions and CHA2DS2-VASc score, further using Cox models adjusted for risk factors of AF-related stroke. ResultsPatients with HFpEF and HFmrEF had a higher mean CHA2DS2-VASc score compared with patients with HFrEF (4.30 ± 1.729 vs 4.15 ± 1.736 vs 3.73 ± 1.712; P < .001) and higher risk of stroke during follow-up (hazard ratio [HR], 1.40 [1.161–1.688; P < .001] for HFmrEF; HR, 1.184 [1.075–1.303; P = .001] for HFpEF vs no CHF) after multivariate adjustment). In patients with lower CHA2DS2-VASc score (0–4), presence of any type of CHF increased ischemic stroke risk (HFrEF HR, 1.568 [1.189–2.068; P = .001]; HFmrEF HR, 1.890 [1.372–2.603; P < .001]; HFpEF HR, 1.800 [1.526–2.123; P < .001] vs no CHF). ConclusionAfter multivariate adjustment, HFpEF and HFmrEF showed a similar risk of stroke in AF patients. Therefore, it is important to extend the criteria for C in the CHA2DS2-VASc score to include patients with HFpEF and HFmrEF. In patients with fewer concomitant stroke risk factors, the presence of any subtype of CHF increases risk for ischemic stroke.

Epicardial adipose tissue as an independent predictor of long-term outcome in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.

Accurate risk stratification is important to improve patient selection and outcome of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). As epicardial adipose tissue (EAT) is discussed to be involved in cardiovascular disease, it could be useful as a marker of poor prognosis in patients with severe AS undergoing TAVR. A total of 416 patients diagnosed with severe AS by transthoracic echocardiography were assigned for TAVR and enrolled for systematic assessment. Patients underwent clinical surveys and 5-year long-term follow-up, with all-cause mortality as the primary endpoint. EAT volume was quantified on pre-TAVR planning CTs. Patients were retrospectively dichotomized at the median of 74 cm3 of EAT into groups with low EAT and high EAT volumes. Mortality rates were compared using Kaplan-Meyer plots and uni- and multivariable cox regression analyses. A total number of 341 of 416 patients (median age 80.9years, 45% female) were included in the final analysis. Patients with high EAT volumes had similar short-term outcome (p = 0.794) but significantly worse long-term prognosis (p = 0.023) compared to patients with low EAT volumes. Increased EAT volumes were associated with worse long-term outcome (HR1.59; p = 0.031) independently from concomitant cardiovascular risk factors, general type of AS, and functional echocardiography parameters of AS severity (HR1.69; p = 0.013). Increased EAT volume is an independent predictor of all-cause mortality in patients with severe AS undergoing TAVR. It can be easily obtained from pre-TAVR planning CTs and may thus qualify as a novel marker to improve prognostication and management of patient with severe AS. DRKS, DRKS00024479.

Abstract TMP87: Thrombus Age in Ischemic Stroke With Atrial Fibrillation

Background and purpose: Because the biochemical composition of thrombus changes after formation over time, thrombus maturation in the left atrium may affect clot compositions in ischemic stroke with atrial fibrillation (AF). We aimed to investigate the association of the age of retrieved thrombi with clinical features and outcomes after MT for ischemic stroke with AF. Methods: We retrospectively reviewed consecutive patients with ischemic stroke with known AF or AF diagnosed after stroke onset who underwent MT and whose retrieved thrombi were pathologically analyzed. Thrombi were classified as fresh (&lt;1 day) and older (1-5 days) based on the areas (≤20 % or &gt;20 %) of lytic features of granulocytes in the section. Components of thrombi were quantified using immunostaining. Outcomes included first pass effect (FPE, extended Thrombolysis in Cerebral Infarction [eTICI] 2c/3 after first pass) and favorable outcome (3-month modified Rankin Scale score of 0 to 2 or equal to premorbid mRS score). Results: Of 168 patients, 62 patients (37%) had older thrombi. The presence of older thrombi was independently associated with the higher CHADS 2 score (adjusted OR [aOR], 1.46; 95% confidence interval [CI], 1.07-1.99). Older thrombi had the higher proportion of fibrin, platelets, von Willebrand factor, and neutrophil extracellular traps than fresh thrombi. FPE was less frequently achieved in patients with older thrombi than those with fresh thrombi (21% versus 43%; aOR, 0.36; 95% CI, 0.17-0.77). Favorable outcomes were fewer in patients with older thrombi than those with fresh thrombi (40% versus 73%; aOR, 0.37; 95% CI, 0.16-0.85). Conclusions: In patients with ischemic stroke with AF, older thrombi was associated with cardiovascular risk factors and included abundant amounts of components associated with the thrombectomy resistance. Patients with older thrombi had poorer functional outcomes presumably due to concomitant risk factors and worse revascularization outcomes.

Coronary Artery Calcification: Current Concepts and Clinical Implications.

Coronary artery calcification (CAC) accompanies the development of advanced atherosclerosis. Its role in atherosclerosis holds great interest because the presence and burden of coronary calcification provide direct evidence of the presence and extent of coronary artery disease; furthermore, CAC predicts future events independently of concomitant conventional cardiovascular risk factors and to a greater extent than any other noninvasive biomarker of this disease. Nevertheless, the relationship between CAC and the susceptibility of a plaque to provoke a thrombotic event remains incompletely understood. This review summarizes the current understanding and literature on CAC. It outlines the pathophysiology of CAC and reviews laboratory, histopathological, and genetic studies, as well as imaging findings, to characterize different types of calcification and to elucidate their implications. Some patterns of calcification such as microcalcification portend increased risk of rupture and cardiovascular events and may improve prognosis assessment noninvasively. However, contemporary computed tomography cannot assess early microcalcification. Limited spatial resolution and blooming artifacts may hinder estimation of degree of coronary artery stenosis. Technical advances such as photon counting detectors and combination with nuclear approaches (eg, NaF imaging) promise to improve the performance of cardiac computed tomography. These innovations may speed achieving the ultimate goal of providing noninvasively specific and clinically actionable information.

Depression in Medical Academia: A Study on Prevalence and Risk Factors among Undergraduate Students in Jammu, India

Background and Aim Medical students endure elevated stress levels. Contemporary data on the epidemiology of depression and its concomitant risk factors in this demographic is pivotal in comprehending its ubiquity and for instituting preventative strategies. This research endeavors to scrutinize the prevalence of depression in undergraduate medical students and identify the diverse risk factors implicated.Methods In February 2023 a cross-sectional investigation was undertaken at a private medical institution in North India. A cohort of 302 medical students underwent depression screening and evaluation of related factors through the utilization of the 9-Item-Patient Health Questionnaire PHQ-9.Results A substantial proportion 71.2 215302 exhibited varying degrees of depression. The PHQ-9 responses facilitated the categorization of students into distinct severity brackets 28.8 mild 19.9 moderate 11.6 moderately severe and 10.9 severe depression. Implementing a PHQ-9 score threshold of ge10 delineated an overarching depression prevalence of 42.38. Univariate logistic regression identified numerous significant correlates of depressive symptoms including urban habitation having a limited number of siblings engaging in moderate physical activity and enrollment in specific professional academic years. Nevertheless multivariable logistic regression affirmed only urban dwelling and the academic duress experienced in the first third or fourth professional years as persistent significant correlates.Conclusion The study unveiled a high prevalence 42.38 of moderate to severe depression among medical students advocating for meticulous surveillance and further assessment of the affected individuals. It is imperative to devise and implement robust strategies to mitigate academic stressors and forestall the descent into depressive states.

Surgical Trends and Complications in Partial and Radical Nephrectomy: Results from the GRAND Study.

We aimed to evaluate the current trends in renal cancer surgery, as well as to compare the perioperative outcomes of partial versus radical nephrectomy. We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005-2021). We report the largest study in the field, with 317,843 patients and multiple patient-level analyses. Overall, 123,924 (39%) patients underwent partial and 193,919 (61%) underwent radical nephrectomy in Germany from 2005 to 2021. Of them, 57,308 (18%) were operated on in low-, 142,702 (45%) in intermediate-, and 117,833 (37%) in high-volume centers. A total of 249,333 (78%) patients underwent open, 44,994 (14%) laparoscopic, and 23,516 (8%) robotic nephrectomy. The number of patients undergoing renal surgery remained relatively stable from 2005 to 2021. Over the study period, the utilization of partial nephrectomy increased threefold, while radical nephrectomy decreased by about 40%. After adjusting for major risk factors in the multivariate regression analysis, radical nephrectomy was associated with 3.2-fold higher odds (95% CI: 3.2 to 3.9, p < 0.001) of 30-day mortality, longer hospitalization by 1.9 days (95% CI: 1.9 to 2, p < 0.001), and higher inpatient costs by EUR 1778 (95% CI: 1694 to 1862, p < 0.001) compared to partial nephrectomy. Furthermore, radical nephrectomy had a higher risk of in-hospital transfusion (p < 0.001), sepsis (p < 0.001), acute respiratory failure (p < 0.001), acute kidney disease (p < 0.001), acute thromboembolism (p < 0.001), surgical wound infection (p < 0.001), ileus (p < 0.001), intensive care unit admission (p < 0.001), and pancreatitis (p < 0.001). More patients are offered partial nephrectomy in Germany. Patients undergoing radical nephrectomy present with a higher rate of concomitant risk factors and have increased perioperative morbidity and mortality, prolonged hospitalization, and increased in-hospital costs.

Современные методы профилактики пролиферативной витреоретинопатии при обширных проникающих ранениях склеры

Relevance. Currently, there is no single algorithm for the management of patients with extensive penetrating wounds of the sclera, and the frequency of proliferative vitreoretinopathy, leading to adverse outcomes, is very high. Purpose. To present relevant data about prevention of proliferative vitreoretinopathy with extensive penetrating wounds of the sclera, as well as to identify the most effective methods. Material and methods. To complete this review, a literature search was carried out on the databases CyberLeninka, eLIBRARY, PubMed, using the keywords «proliferative vitreoretinopathy», «penetrating wounds of the sclera», «eye injury», «vitrectomy». Preference was given to scientific papers over the past 15 years. Results. There are various approaches in the treatment of severe penetrating wounds. Classical primary microsurgical treatment involves external treatment, suturing of the sclera wound, and delayed optical-reconstructive surgery (including vitrectomy) are performed 1–2 weeks after the acute inflammation reduces. As a rule, in the case of extensive wounds with a whole set of concomitant risk factors, this time is sufficient to trigger pathological proliferation, which aggravates the course of the wound process. This review presents publications proving that the treatment of severe complicated penetrating wounds of the sclera should go beyond the classical treatment and be aimed at early warning and prevention of proliferative vitreoretinopathy. Conclusion. Modern data prove the indisputable advantage of early vitrectomy performed with extensive penetrating scleral and corneoscleral wounds. Vitrectomy in combination with other methods of prevention of proliferative vitreoretinopathy is the most promising direction for the future research. Key words: proliferative vitreoretinopathy, penetrating wounds of the sclera, eye injury, vitrectomy