Deterioration Of Status Research Articles

Profiling the persistent and episodic nature of long COVID symptoms and the impact on quality of life and functional status: a cohort observation study.

Post-viral issues following acute infection with coronavirus disease 2019 (COVID-19), referred to widely as long COVID, are associated with episodic, persistent, and disabling symptoms affecting quality of life and functional status. Evidence demonstrates a significant impairment and long disease course, but there remains limited empirical data to profile and determine the fluctuating symptom profile of long COVID. We devised a 16-week, multicentre prospective cohort observation study to profile changes in patient-reported outcomes, and biological, physiological, psychological, and cognitive parameters following diagnosis and/or referral to an established long COVID clinic. Following baseline assessments, participants completed four face-to-face visits interspersed with telephone consultations. Face-to-face visits included physiological assessment, patient-reported outcome measures (PROMs), functional status, and respiratory function. Telephone consultations involved PROMs and symptom profiling. Patient-reported outcomes improved from baseline to week sixteen, but demonstrated between visit fluctuations in frequency and severity. Further findings highlight the severity and frequency of long COVID symptom profiles and the extent of quality of life and functional status impairment. The data presented here highlight the episodic and relapsing nature and should be used to help characterise long COVID disability. They can inform the development of long COVID-specific guidelines and support services that can adequately respond to the reductions in patient well-being.

Correlation between blood pressure control status and cognitive impairment in older adults: A national cross-sectional study.

Hypertension is closely related to cognitive impairment; however, the correlation between blood pressure control and cognitive impairment in the hypertensive population is unclear. We aimed to explore the relationship between blood pressure control and cognitive impairment in older adults with hypertension. Using the cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey, 5,860 people with self-reported history of hypertension were divided into the hypotension, intermediate blood pressure, and hypertension groups. Cognitive impairment was defined as a score of < 18 on the Chinese version of the Mini-Mental State Examination. Demographics of the population were also collected. Bivariate Logistic regression analysis and restricted cubic spline (RCS) model were used to analyze the relationship between blood pressure control and cognitive impairment. After adjusting for confounding factors, binary logistic regression analysis showed that the intermediate group was significantly associated with an increased risk of cognitive impairment than the hypotension group, whereas the hypertension group was significantly correlated with a reduced risk of cognitive impairment. No significant correlation was found between blood pressure control and cognitive impairment in patients aged <80 years, with hearing impairment, or with cerebrovascular diseases, whether in the hypotension or hypertension groups. There was a significant correlation between hypotension and cognitive impairment, and no correlation between hypertension and cognitive impairment in people aged ≥ 80 years, Han ethnicity and those who used antihypertensive drugs. Furthermore, RCS model analysis showed that there was a non-linear relationship between systolic blood pressure and cognitive impairment in individuals aged ≥ 80 years and those using antihypertensive drugs. There was a linear relationship between diastolic blood pressure and cognitive impairment. Blood pressure control in the hypertensive group was significantly associated with a lower risk of cognitive impairment.

Factors Related to Self-Rated Health Among Community-Dwelling Older Adults

Abstract: Background/Objectives: This study explored factors influencing self-rated health (SRH) among community-dwelling older adults to better support its use in health screening and provide an alternative for older adults who may have difficulty working with lengthy assessment scales. Methods: The participants were 8379 individuals aged 65 years or older from the 2020 Elderly Survey. Data were collected in South Korea between September and November 2020. Descriptive statistics were calculated, and independent samples t-tests, a Kruskal–Wallis test, and weighted multiple regression analysis were conducted using IBM SPSS for Windows ver. 23.0. SRH factors, such as illness, daily living performance, nutritional status, depression, and cognitive impairment, were analyzed. Results: The greater the number of chronic conditions (β = −0.21, p &lt; 0.001), the higher the dependence on activities of daily living and instrumental activities of daily living (β = −0.05, p = 0.002; β = −0.13, p &lt; 0.001), the higher the depression score (β = −0.22, p &lt; 0.001), the more severe the cognitive impairment (β = −0.04, p &lt; 0.001), and the worse the SRH. Conclusions: Participants with high-risk medical conditions, such as cancer, stroke, and depression, thought their health was poor. However, they did not consider hypertension, malnutrition, and abnormal BMI as significantly affecting their health status. Therefore, these factors should be considered when measuring SRH in older adults.

Role of cognitive impairment in predicting the long-term risk of all-cause mortality: a 20-year prospective cohort study in China.

There is limited evidence of the relationship between cognitive changes and all-cause mortality. And it has no report of population-attributable fraction (PAF) of mortality due to cognitive impairment in Chinese elderly. In light of this, we comprehensively examined the relationship between cognitive impairment and all-cause mortality after 20-year follow-up among the elderly Chinese. This is an epidemiological survey with a 20-year prospective cohort study design. A total of 9093 participants came from the Chinese Longitudinal Healthy Longevity Survey 1998-2018 waves. Cox proportional hazards regressions were performed to analyze the relationship between baseline cognitive impairment status, the rate of change in the MMSE scores over two years and subsequent all-cause mortality. We observed a dose-response relationship between cognition and mortality. Compared to those with no impairment, elderly with mild (AHR = 1.11, 95% CI 1.05-1.18), moderate (AHR = 1.22, 95% CI 1.13-1.33) and severe (AHR = 1.30, 95% CI 1.19-1.42) cognitive impairment showed increased mortality risk. Elderly with rapid cognitive decline had 24% higher mortality risk than those with stable cognitive (AHR = 1.24, 95%CI 1.10-1.39). The PAF of mortality due to severe cognitive impairment was 3.69% (95%CI:2.36-5.25%). Impairment in the subdomain of naming foods (AHR = 1.12, 95% CI 1.04-1.21), registration (AHR = 1.18, 95% CI 1.11-1.26), attention and calculation (AHR = 1.13, 95% CI 1.07-1.21), copy figure (AHR = 1.13, 95% CI 1.06-1.20), delayed recall (AHR = 1.14, 95% CI 1.07-1.20) and language (AHR = 1.14, 95% CI 1.05-1.24) were independently associated with increased mortality risk among participants. Baseline cognitive impairment was inversely associated with longevity among the elderly Chinese. The rapid cognitive decline increased all-cause mortality, and this risk would continue for 20 years. These findings underscore the crucial role of early detection and management of cognitive impairment in the elderly.

Revealing equity gaps in pedestrian crash data through explainable artificial intelligence clustering

Pedestrian crashes represent a critical traffic safety issue, often resulting in fatal outcomes and raising significant equity concerns. This study analyzed detailed records of pedestrian-involved crashes in California from 2018 to 2021, employing a novel clustering framework enhanced by the SHapley Additive exPlanations approach. The proposed method significantly enhanced interpretability by effectively capturing complex non-linear relationships and interactions among features. The results indicate that impairment status and lighting conditions are pivotal in severe crash outcomes, while broader societal and demographic factors are more substantially associated with less severe cases. Non-injury pedestrian crashes tend to occur in less underserved, more resilient communities, whereas fatal crashes are more common in underserved communities with poor lighting and incomplete pedestrian infrastructure, particularly when pedestrians are under the influence of drugs or alcohol. The findings underscore the necessity for developing comprehensive safety measures that not only address situational risks but also consider broader societal conditions.

Differential effect of cerium nanoparticles on the viability, redox-status and Ca2+-signaling system of cancer cells of various origins.

The present study aims to understand the molecular mechanism underlying the therapeutic effect of cerium nanoparticles (CeNPs) in oncology. Cancer cells were treated with different concentrations of pure nanocerium of different sizes synthesized by laser ablation. Due to the not insignificant influence of surface defects and oxygen species on the ROS-modulating properties of cerium nanoparticles, the nanoparticles were not coated with surfactants or organic molecules during synthesis, which could potentially inhibit a number of pro-oxidative effects. Reactive oxygen species (ROS) production, expression of genes encoding redox-status proteins, selenoproteins and proteins regulating cell death and endoplasmic reticulum stress (ER-stress) were investigated as indicators of the molecular mechanism of cancer cell death. Studies were conducted on the effects of cerium nanoparticles on the Ca2+ signaling system of cancer cells of different origins. Mouse fibroblasts (L-929cell line) were used as non-cancerous ("normal") cells for which a whole series of experiments were performed, and a comparative analysis of the effects of nanoceria. It was found that 75nm-sized cerium nanoparticles did not affect the redox-status and ROS production of cancer cells. In fibroblast cells, however, this nanoparticle diameter led to a deterioration of the cellular redox status and ROS production in a wide range of nanoparticle concentrations. Larger nanoparticles (100nm-sized and 160nm-sized), on the other hand, showed a different effect on cancer cells of different origins. In mouse fibroblast L-929cells, however, 100nm-sized or 160nm-sized CeNPs acted in a high concentration range to disrupt mitochondrial membrane potential and activate early apoptosis. High concentrations of CeNPs were required to increase ROS production, reduce redox-status and induce apoptosis in human A-172 glioblastoma cells compared to the hepatocellular carcinoma cell line HepG2 and the breast cancer cell line MCF-7. In the A-172 glioblastoma cells, ER-stress was also not activated and their Ca2+ signaling system was activated by a significantly higher concentration of CeNPs, which could also contribute to the formation of tolerance of this cancer cell line to nanoceria. The Ca2+ signaling system of mouse fibroblasts was found to be highly sensitive to activation by nanoceria and the cells produced Ca2+ signals with higher amplitude compared to A-172 and MCF-7cells.

Assessment of clinical prognosis in autoimmune encephalitis: Girona score

BackgroundThe assessment of clinical prognosis in autoimmune encephalitis: Girona (ACPE-Gi) score is a scale for evaluating the severity in the acute phase of autoimmune encephalitis (AE) and predicting the risk of disability at 3 months, measured by modified Rankin scale (mRS).MethodsPatients were strictly diagnosed with AE according to the current criteria between 1 January 2009 to 31 March 2023 at the University Hospital Dr. Josep Trueta of Girona, Catalonia, Spain. ACPE-Gi score included 14 items, and every item was scored from 0 to 3, depending on their severity with a sum ranging from 0 to 41.ResultsACPE-Gi score measured the severity in the acute phase and grouped the patients into three groups: mild (&amp;lt;8; 32%), moderate (8 to 15; 60%), and severe (&amp;gt;15; 8%). We found that the third group had a higher risk of disability compared with the first group (p = 0.035). We identified that the mean initial score was significantly higher in the group of patients who had higher mRS at 3 months compared to that in the group of patients who had a mild to moderate disability level (mRS ≤ 2) at 3 months (p = 0.023). In addition, autonomic symptoms and mental status impairment demonstrated to be independent risk factors to predict disability (p &amp;lt; 0.05).ConclusionsThe ACPE-Gi score seems to be a reliable scale for comprehensively evaluating the severity of AE in the acute phase and predicting the risk of disability at 3 months. Dysautonomia and altered mental status predict a poorer prognosis in patients with AE.

The use of ultrasound to determine volume status and identify sites of edema in patients with heart failure

The management of patients with congestive heart failure requires an accurate working diagnosis and frequent assessment of responses to treatment. In addition, the prediction of short-term and long-term outcomes is important to both the clinician and the patient. The development of pulmonary edema usually represents an acute deterioration of cardiac status and requires immediate attention. The development of peripheral edema usually represents chronic heart failure and warrants evaluation and possibly therapeutic adjustments. Noninvasive tests to identify sites of extravascular fluid formation can help the clinician manage his or her patients. Lung ultrasound can identify B-lines that usually represent pulmonary edema. Ultrasound studies of the inferior vena cava and its dimensions can help determine volume status and make decisions regarding fluid management. This review outlines the use of ultrasound to determine sites of edema formation in patients with heart failure. Key words: ultrasound, inferior vena cava, pulmonary edema, congestive heart failure

Lactobacillus extracellular vesicles alleviate alcohol-induced liver injury in mice by regulating gut microbiota and activating the Nrf-2 signaling pathway.

Lactobacillus derived extracellular vesicles (LAB-EVs) are nanosized particles secreted from Lactobacillus during fermentation, and therefore exist universally in fermented foods such as yogurt, pickles, and fermented beverages. In this study, three LAB-EVs were prepared using a simple scalable method, and then their structures, compositions, and biosafety properties were characterized. The protective properties and potential mechanisms of action of the LAB-EVs against alcoholic liver disease were studied. All three LAB-EVs alleviated alcohol-induced liver injury. It was shown by reduction of liver index, histological damage, liver function impairment, inflammation, and liver oxidative status. The results showed that three LAB-EVs positively promoted the diversity of intestinal flora in mice. Additionally, the relative hepatic protein level of Nrf-2, HO-1, and CYP2E1 was also regulated by LAB-EVs. In summary, these facts suggest that the three LAB-EVs can alleviate alcohol-induced liver damage, by positively modulating the intestinal flora and activation of the Nrf-2 signaling pathway. These results may facilitate the understanding of the composition and function of Lactobacillus fermented food and also the development of Lactobacillus fermented functional food.

Effectiveness and Safety of Dupilumab for Prurigo Nodularis in China: A Multicentric and Observational Study.

The efficacy and safety of dupilumab in patients with refractory prurigo nodularis (PN) is well established in clinical trials, but there is a lack of multicenter data regarding its effectiveness and safety in real-world settings. Patients with moderate-to-severe PN who initiated dupilumab treatment between July 2023 and January 2024, with a follow-up period of at least 16 weeks at 10 hospitals in China were included. We used peak pruritus numeric rating scale (PP-NRS), investigator global assessment (IGA) for PN, and dermatology life quality index for adults or children (DLQI/CDLQI) to assess disease control status and quality of life impairment, and monitored adverse events to assess the safety. A total of 73 PN patients (33 female, 40 male; mean age 45.9 ± 21.5 years) were included. A clinically meaningful improvement of ≥ 4 points in PP-NRS (PP-NRS4) was achieved in 84.9% of patients at Week 12. The percentage of patients achieving IGA 0/1 significantly increasing from 0% to 37.0% and 46.6% at Week 12 and 16, respectively. Patient-reported quality of life outcomes showed substantial improvement, with decreasing from 16.6 ± 6.8 at baseline to 7.2 ± 4.9 at Week 12, 6.4 ± 4.5 at Week 16. The safety profile of dupilumab was favorable, with one patient reporting dry eyes. Dupilumab can effectively improve the pruritus, nodular lesions and quality of life for PN in real-world settings.

Health-Related Quality of Life in a Real-World Cohort of Patients with Advanced Urothelial Carcinoma Treated with Immune Checkpoint Inhibitors.

Health-related quality of life (HRQOL) has been reported in clinical trials of pembrolizumab and avelumab treatment of locally advanced or metastatic urothelial carcinoma. However, few studies have investigated the effect of immune checkpoint inhibitors (ICIs) on HRQOL in patients with urothelial carcinoma in a real-world setting. We included 44 patients with advanced urothelial cancer who were treated with pembrolizumab or avelumab from January 2018 to November 2023. When patients visited our hospital for treatment, we evaluated their HRQOL using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care. We retrospectively reviewed the interview sheets. The median time to deterioration in global health status was 19.1 weeks. The mean scores of emotional functioning were improved in weeks 18 and 36 compared with baseline. The mean scores for fatigue and appetite loss were also improved in weeks 18 and 36. ICI treatment for advanced urothelial carcinoma did not worsen HRQOL over time in a real-world setting. Tolerability of ICIs for advanced urothelial carcinoma appears good in those who received long-term treatment.

Sleep fragmentation and hypoxaemia as key indicators of cognitive impairment in patients with obstructive sleep apnoea

BackgroundThis study aimed to identify characteristics associated with cognitive impairment in older individuals with obstructive sleep apnoea (OSA) using the Addenbrooke’s Cognitive Examination-Revised (ACE-R) that could aid in stratifying those at higher risk for impairment.MethodsWe analysed existing cross-sectional datasets that measured the performance of 89 adult patients (aged 50–85 years) with OSA on the ACE-R cognitive test. Receiver operating characteristic curves and logistic regression analysis were utilised to identify associations between impairment status and various factors, including demographic characteristics, self-reported sleepiness, cognitive complaints, and OSA severity.ResultsAccording to established thresholds (ACE-R ≤ 88), 36% of participants were cognitively impaired. When adjusted for age and education, the strongest factors associated with impairment status were prior measures of arousal index (cut-off: ≥28events/hr, OR: 5.67, p < 0.01), sleep mean SpO2 (cut-off: ≤92%, OR: 3.52, p < 0.05), 3% oxygen desaturation index (cut-off: ≥27events/hr, OR: 3.75, p < 0.05), and sleep time spent under 90% SpO2 (cut-off: ≥9%, OR: 3.16, p < 0.05). Combining these factors achieved a high sensitivity (≥ 93%) of detecting impairment within this cohort. Conversely, the apnoea-hypopnoea index, daytime sleepiness, and cognitive complaints were not associated with impairment status.ConclusionsThe ACE-R identified a significant proportion of patients with OSA as having cognitive impairment. Traditional indices of sleep fragmentation and hypoxaemia may allow clinicians to identify at-risk patients for cognitive evaluation, however further studies are needed to validate these findings and explore whether poor cognitive performance can be remediated via OSA treatment.

Measuring trends in extinction risk: a review of two decades of development and application of the Red List Index.

The Red List Index (RLI) is an indicator of the average extinction risk of groups of species and reflects trends in this through time. It is calculated from the number of species in each category on the IUCN Red List of Threatened Species, with trends influenced by the number moving between categories when reassessed owing to genuine improvement or deterioration in status. The global RLI is aggregated across multiple taxonomic groups and can be disaggregated to show trends for subsets of species (e.g. migratory species), or driven by particular factors (e.g. international trade). National RLIs have been generated through either repeated assessments of national extinction risk in each country or through disaggregating the global index and weighting each species by the proportion of its range in each country. The RLI has achieved wide policy uptake, including by the Convention on Biological Diversity and the United Nations Sustainable Development Goals. Future priorities include expanding its taxonomic coverage, applying the RLI to the goals and targets of the Kunming-Montreal Global Biodiversity Framework, incorporating uncertainty in the underlying Red List assessments, integrating into national RLIs the impact of a country on species' extinction risk abroad, and improving analysis of the factors driving trends.This article is part of the discussion theme issue 'Bending the curve towards nature recovery: building on Georgina Mace's legacy for a biodiverse future'.

Illicit drug use among adolescents and young adults with impairments in the US: A cross-sectional analysis of the National Survey on Drug Use And Health.

The purpose of this cross-sectional analysis is to compare the degree to which adolescents and adults with and without impairments in the US engage in illicit drug use. This cross-sectional study utilized data from the 2022 National Survey of Drug Use and Health. Impairment status (mobility, cognitive, hearing, vision, self-care, and communication impairments), illicit drug use (cocaine, crack, heroin, hallucinogens, LSD, ecstasy and molly, inhalants, and methamphetamine), and demographic variables were measured using self-report. Weighted prevalence estimates for illicit drug use across each category were provided. Group differences in drug prevalence between individuals with and without impairments were examined, then logistic regressions estimated crude and adjusted odds of drug use among impairment groups by age. Prevalence of use and age of first time use for illicit drugs were explored across impairment type. The sample comprised of 35,921 individuals, with an estimate of 12.9 % experiencing at least one impairment. Among emerging adults, hallucinogens were the highest reported used drug in the past year, with a significantly higher percentage of those with impairments (12.8 %, 95 % CI: 1.5, 9.6), compared to adults without impairments (7.1 %, 95 % CI: 6.3, 8.0), reporting recent use. Individuals with impairments (mean = 16.2 years) were significantly younger when they first tried an illicit drug compared to peers (mean = 18.1 years). Overall, individuals with impairments were more than twice as likely to engage in illicit drug use compared to counterparts. People with impairments were younger, on average, when they first tried any illicit drugs.

Nursing knowledge and professional practice in enteral nutrition by nasogastric tube in hospitalized adults

Introduction: The critically ill patient presents a deterioration of nutritional status that requires life support for recovery. Enteral nutrition (EN) is considered the first choice for nutritional support due to its ability to maintain the physiological processes of digestive function and preserve the intestinal barrier. This study focused on assessing the level of knowledge and performance of procedures related to the administration of EN by nasogastric tube (NGT) in nurses in an intensive care unit (ICU).Methods: An analysis was conducted on a population of 27 nurses working in an ICU. The sample was characterized by a female majority at the technical level, with an average age slightly over 36 years. Professional seniority averaged more than 10 years, while ICU seniority averaged more than 6 years. General knowledge of EN administered by NGLS was assessed, as well as the procedures performed before, during and after administration. Previous training in EN and willingness to undertake future training were also considered.Results: Almost 60% of the nurses had received some type of education or training in EN, and 100% expressed interest in continuing to participate in this type of activity. The general level of knowledge about the administration of EN by NGUS was 41.85% of correct answers. As for the appropriate mode of administration, the overall level reached 46.67%. The procedures performed before administration obtained a better performance (52.31%) compared to those observed during administration (39.51%) and at the end of administration (40.74%). Strengths in knowledge were evident in four key items: recommendations on medication administration, knowledge of the economic benefits of nutritional intervention, prevention of NE-drug incompatibilities, and benefits of NE in the hospitalized patient. Procedures highlighted included proper feeding bottle height and correct patient positioning prior to administration.Conclusions: The study revealed that although nurses showed interest in improving their knowledge and skills, the overall level of knowledge and execution of procedures related to NE administration by NGNS was low. The identified strengths and highlighted procedures prior to administration reflect areas of opportunity for improvement through ongoing training. Specific education and training in NE are essential to optimize nutritional care of critically ill patients.

Deterioration of the Defecation Status after Hospitalization in Patients with Type 2 Diabetes is Associated with Albuminuria Rather than Diabetic Neuropathy

Objective To determine the clinical background factors of patients with type 2 diabetes who showed deterioration of defecation status after hospitalization. Methods The defecation status of 128 patients with type 2 diabetes who were admitted to our department for diabetes education was evaluated for 7 days after hospitalization. New-onset constipation was diagnosed when patients without constipation before hospitalization met the criteria for constipation after hospitalization. Worsening constipation was diagnosed when patients with constipation required a larger laxative dose than that before hospitalization. New-onset constipation and worsening constipation were defined as the deterioration of defecation status. The major outcome was the incidence of deterioration of defecation status after hospitalization. Results After hospitalization, 23 of 99 patients who had no constipation before hospitalization developed new-onset constipation. Among the 29 patients with constipation before hospitalization, 9 showed worsening constipation. Overall, 52 patients (41% of all subjects) had constipation, and 32 (25% of all subjects) were diagnosed with deterioration in defecation status. In univariate logistic regression analyses, patient age, albuminuria, diabetic peripheral neuropathy, AST, eGFR, HbA1c, and baPWV were significantly associated with deterioration in defecation status. In the multivariate logistic regression analyses, albuminuria was the only factor that showed a significant association with the deterioration of defecation status after hospitalization. Conclusion Constipation is highly prevalent among hospitalized patients with type 2 diabetes. Paying attention to albuminuria is useful for facilitating an appropriate response to the deterioration of defecation status in patients with type 2 diabetes after hospitalization.

Safety of ceftobiprole in patients with impaired renal, hepatic or immune function: a multinational retrospective hospital chart review (RETRACE study).

Ceftobiprole, an advanced-generation cephalosporin with broad bactericidal activity, is approved for community-acquired and hospital-acquired pneumonia (excluding ventilator-associated pneumonia). We aimed to evaluate, in a real-world setting, the safety profile of ceftobiprole in patients with risk conditions (severe renal impairment, hepatic impairment, and immunocompromised status), groups excluded from clinical trials. In this retrospective study (NCT04170309), 396 consecutive charts of patients treated with ceftobiprole during 2016-2022 in 15 centers in France, Italy, and Spain were analyzed: 62 had severe renal impairment, 51 had hepatic impairment, 120 were immunocompromised, and 203 had no predefined risk condition (controls). Ceftobiprole was used for off-label indications in 110/396 (27.8%) patients; 46/396 (11.6%) patients received a higher-than-recommended dose. Treatment-emergent adverse events (TEAEs) considered as ceftobiprole-related occurred in 44 patients, more frequently in the risk groups compared to controls (severe renal impairment: 8/62 [12.9%]; hepatic impairment: 7/51 [13.7%]; immunocompromised: 19/120 [15.8%]; controls: 15/203, [7.4%]); in 7/44 patients, these events were serious. Compared to controls, liver-related AEs occurred more frequently in the impaired hepatic function (17/51 [33.3%] vs 22/203 [10.8%], odds ratio [OR:]: 4.11; 95% confidence interval [CI]: 1.98-8.55) and immunocompromised (30/120 [25.0%] vs 22/203 [10.8%], OR: 2.74; 95%CI: 1.50-5.02) groups. Hyponatremia was also more frequent in immunocompromised patients than controls (14/120 [11.7%] vs 9/203 [4.4%], OR: 2.85; 95%CI: 1.19-6.80). Underlying disease, concomitant medications and the poor health status of the patients likely affected these imbalances. Overall, no new safety concerns related to ceftobiprole use in real-world patients with severe renal impairment, hepatic impairment or immunocompromised status were identified.

Primary hyperoxaluria type 2 with relentlessly progressive retinal ischemia

A 55-year-old, nondiabetic patient with stage 4 chronic kidney disease (CKD) and secondary hypertension was undergoing hemodialysis (HD) and complained of an acute decrease in right eye (RE) vision, with best corrected vision of 6/18 in RE and 6/12 in LE. Fundus examination revealed crystalline retinopathy, arteriolar narrowing with intra-arterial crystalline deposits, and multiple soft exudates. Genetic testing confirmed a diagnosis of primary hyperoxaluria type 2 (PH 2). Despite adequate intervention, there was a relentless deterioration of renal status, hypertension, and retinal ischemia. The patient subsequently underwent a renal transplant to stabilize the systemic condition and arrest the progression of retinal ischemia. Although the patient remained stable for 4 months, he later presented with cardiopulmonary complications and LE vitreous hemorrhage, indicating progressive retinal ischemia. PH 2 is considered a milder variant, with the retinal phenotype typically characterized by crystalline retinopathy. However, in cases with cardiopulmonary complications associated with CKD, retinal ischemia can progress rapidly despite adequate interventions.

Digital screening tool for the assessment of cognitive impairment in unsupervised setting—digiDEM-SCREEN: study protocol for a validation study

IntroductionDementia is one of the most relevant widespread diseases, with a prevalence of currently 55 million people with dementia worldwide. However, about 60–75% of people with dementia have not yet...

Acquired hypothyroidism, iodine status and hearing impairment in adults: A pilot study.

Hearing impairment can have major impacts on behavior, educational attainment, social status, and quality of life. In congenital hypothyroidism, the incidence of hearing impairment reaches 35-50%, while in acquired hypothyroidism there is a reported incidence of 25%. Despite this, knowledge of the pathogenesis, incidence and severity of hearing impairment remains greatly lacking. The aim of our study was to evaluate hearing in patients with acquired hypothyroidism. 30 patients with untreated and newly diagnosed peripheral hypothyroidism (H) and a control group of 30 healthy probands (C) were enrolled in the study. Biochemical markers were measured, including median iodine urine concentrations (IUC) µg/L. The hearing examination included a subjective complaint assessment, otomicroscopy, tympanometry, transitory otoacoustic emission (TOAE), tone audiometry, and brainstem auditory evoked potential (BERA) examinations. The Mann-Whitney U test, Fisher's Exact test and multivariate regression were used for statistical analysis. The H and C groups had significantly different thyroid hormone levels (medians with 95% CI) TSH mU/L 13.3 (8.1, 19.3) vs. 1.97 (1.21, 2.25) p = 0 and fT4 pmol/L 10.4 (9.51, 11.1) vs. 15 (13.8, 16.7) p = 0. The groups did not significantly differ in age 39 (34, 43) vs. 41 (36,44) p = 0.767 and IUC 142 (113, 159) vs. 123 (101, 157) p = 0.814. None of the hearing examinations showed differences between the H and C groups: otomicroscopy (p = 1), tympanometry (p = 1), TOAE (p = 1), audiometry (p = 0.179), and BERA (p = 0.505). We did not observe any hearing impairment in adults with acquired hypothyroidism, and there were no associations found between hearing impairment and the severity of hypothyroidism or iodine status. However, some forms of hearing impairment, mostly mild, were very common in both studied groups.