Early Start Research Articles

Reciprocal associations between parental depression and child cognition: Pathways to children's internalizing and externalizing symptoms.

Parental depression is a risk factor for children's cognitive and psychological development. Literature has found reciprocal relations between parental depression and child psychopathology and effects of parental depression on children's cognition. The present study is the first to examine reciprocity among parental depression and child cognition, and pathways to child psychopathology. Structural equation models were conducted using data from the Early Head Start Research and Evaluation Project, a nationally representative sample of 3,001 economically marginalized families. Measures were collected in four waves from 14 months to 10-11 years. Reciprocal associations emerged between maternal and paternal depression at from 14 months to 5 years. Reciprocal parental depression was associated with greater psychopathology at age 10-11. Maternal depression predicted poorer child cognition, which indirectly predicted increased depression in mothers of children aged 3-5 through paternal depression, and in fathers at age 3, through earlier paternal depression. This study was unable to parse within- and between-person effects. Additionally, data for paternal depression was limited to ages 2 and 3. Findings emphasize the transactional nature of child cognition and child and parent psychopathology, supporting family focused intervention and prevention efforts that target parent psychopathology and child cognition.

Recombinant Interleukin-1 Receptor Antagonist Is an Effective First-Line Treatment Strategy in New-Onset Systemic Juvenile Idiopathic Arthritis, Irrespective of HLA-DRB1 Background and IL1RN Variants.

Human leukocyte antigen (HLA)-DRB1*15:01 has been recently associated with interstitial lung disease (LD), eosinophilia, and drug reactions in systemic juvenile idiopathic arthritis (sJIA). Additionally, genetic variants in IL1RN have been linked to poor response to anakinra. We sought to reproduce these findings in a prospective cohort study of patients with new-onset sJIA treated with anakinra as first-line therapy. HLA and IL1RN risk alleles were identified via whole-genome sequencing. Treatment responses and complications were compared between carriers versus noncarriers. Seventeen of 65 patients (26%) carried HLA-DRB1*15:01, comparable with the general population, and there was enrichment for HLA-DRB1*11:01, a known risk locus for sJIA. The rates of clinical inactive disease (CID) at 6 months, 1 year, and 2 years were generally high, irrespective of HLA-DRB1 or IL1RN variants, but significantly lower in carriers of an HLA-DRB1*11:01 allele. One patient, an HLA-DRB1*15:01 carrier, developed sJIA-LD. Of the three patients with severe drug reactions to biologics, one carried HLA-DRB1*15:01. The prevalence of eosinophilia did not significantly differ between HLA-DRB1*15:01 carriers and noncarriers at disease onset (6.2% vs 14.9%, P = 0.67) nor after the start of anakinra (35.3% vs 37.5% in the first 2 years of disease). We observed high rates of CID using anakinra as first-line treatment irrespective of HLA-DRB1 or IL1RN variants. Only one of the 17 HLA-DRB1*15:01 carriers developed sJIA-LD, and of the three patients with drug reactions to biologics, only one carried HLA-DRB1*15:01. Although thorough monitoring for the development of drug hypersensitivity and refractory disease courses in sJIA, including sJIA-LD, remains important, our data support the early start of biologic therapy in patients with new-onset sJIA irrespective of HLA-DRB1 background or IL1RN variants.

Large Language Model (LLM)-Powered Chatbots Fail to Generate Guideline-Consistent Content on Resuscitation and May Provide Potentially Harmful Advice.

Innovative large language model (LLM)-powered chatbots, which are extremely popular nowadays, represent potential sources of information on resuscitation for the general public. For instance, the chatbot-generated advice could be used for purposes of community resuscitation education or for just-in-time informational support of untrained lay rescuers in a real-life emergency. This study focused on assessing performance of two prominent LLM-based chatbots, particularly in terms of quality of the chatbot-generated advice on how to give help to a non-breathing victim. In May 2023, the new Bing (Microsoft Corporation, USA) and Bard (Google LLC, USA) chatbots were inquired (n = 20 each): "What to do if someone is not breathing?" Content of the chatbots' responses was evaluated for compliance with the 2021 Resuscitation Council United Kingdom guidelines using a pre-developed checklist. Both chatbots provided context-dependent textual responses to the query. However, coverage of the guideline-consistent instructions on help to a non-breathing victim within the responses was poor: mean percentage of the responses completely satisfying the checklist criteria was 9.5% for Bing and 11.4% for Bard (P >.05). Essential elements of the bystander action, including early start and uninterrupted performance of chest compressions with adequate depth, rate, and chest recoil, as well as request for and use of an automated external defibrillator (AED), were missing as a rule. Moreover, 55.0% of Bard's responses contained plausible sounding, but nonsensical guidance, called artificial hallucinations, that create risk for inadequate care and harm to a victim. The LLM-powered chatbots' advice on help to a non-breathing victim omits essential details of resuscitation technique and occasionally contains deceptive, potentially harmful directives. Further research and regulatory measures are required to mitigate risks related to the chatbot-generated misinformation of public on resuscitation.

Effects of an early start in learning English as a foreign language on reading and listening comprehension in Year 9

Abstract For years now, all over Europe a debate has been ongoing concerning the effectiveness of an early start in learning a foreign language. This paper presents findings from a representative large-scale assessment study from Germany and seeks to examine the relationship between receptive skills in English as a foreign language (EFL) of students in Year 9 and their EFL learning onset age. We examined the differences in achievement of early starters – i.e., students who started learning English either before Year 3 or in Year 3 – in comparison with late starters defined as students instructed in EFL from Year 4 or 5 using a sample of more than 30,000 students. The results from multilevel regression modelling point to long-term advantages in reading and listening comprehension for students with an early onset of English instruction in primary school compared to students who began later. The paper finishes by discussing the results and suggesting further research in this field.

Predictors of Early Peritoneal Dialysis Start in Newborns and Young Infants Following Cardiac Surgery

Predictors of Early Peritoneal Dialysis Start in Newborns and Young Infants Following Cardiac Surgery

Seasonal and inter-seasonal RSV activity in the European Region during the COVID-19 pandemic from autumn 2020 to summer 2022.

The emergence of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in early 2020 and subsequent implementation of public health and social measures (PHSM) disrupted the epidemiology of respiratory viruses. This work describes the epidemiology of respiratory syncytial virus (RSV) observed during two winter seasons (weeks 40-20) and inter-seasonal periods (weeks 21-39) during the pandemic between October 2020 and September 2022. Using data submitted to The European Surveillance System (TESSy) by countries or territories in the World Health Organization (WHO) European Region between weeks 40/2020 and 39/2022, we aggregated country-specific weekly RSV counts of sentinel, non-sentinel and Severe Acute Respiratory Infection (SARI) surveillance specimens and calculated percentage positivity. Results for both 2020/21 and 2021/22 seasons and inter-seasons were compared with pre-pandemic 2016/17 to 2019/20 seasons and inter-seasons. Although more specimens were tested than in pre-COVID-19 pandemic seasons, very few RSV detections were reported during the 2020/21 season in all surveillance systems. During the 2021 inter-season, a gradual increase in detections was observed in all systems. In 2021/22, all systems saw early peaks of RSV infection, and during the 2022 inter-seasonal period, patterns of detections were closer to those seen before the COVID-19 pandemic. RSV surveillance continued throughout the COVID-19 pandemic, with an initial reduction in transmission, followed by very high and out-of-season RSV circulation (summer 2021) and then an early start of the 2021/22 season. As of the 2022/23 season, RSV circulation had not yet normalised.

Arthrogryposis multiplex congenita in twin 1 of a twin pregnancy: case report

Arthrogryposis multiplex congenita (AMC) is a rare congenital syndrome characterized by multiple joint contractures. It usually affects the joints of hands, wrists, elbows, shoulders, hips, feet, knees, jaw and back. This case report discusses a mild variety of AMC in a twin where the other twin had no musculoskeletal abnormalities. There has been no published case report of such a case in a twin delivery. Prompt recognition of the syndrome complex and early start of stretching exercises and physiotherapy is the mainstay treatment protocol to give relative contracture free mobility to the child.

Thermal and Flow Analysis of Air in a Uniformly Heated Circular Channel with an Inlet Flap Obstruction in Laminar, Transitional, and Turbulent Flow Regimes

An experimental investigation has been carried out to study the thermohydraulic performance of air in transitional flow regime in a circular uniformly heated channel fitted with flap obstruction at the inlet. The Reynolds number (Re) varied from 500 to 7,037. The channel is uniformly heated using heat fluxes of 0.5 and 1 kW/m2. Three height and width ratios were used as variable parameters. Correlations for predicting the Nusselt number and friction factor were developed. It was found that for a uniformly heated (1 kW/m2) plain channel, the critical Re for the start of transition is 2,752, and the critical Re for transition termination is 3,667. It was also found that placing the flap obstruction at the inlet of the test section results in early start and end of the laminar-turbulent transition. At heat flux of 0.5 kW/m2, the transition begins as early as Re = 1,840 and ends at Re = 3,588, and similarly, for a heat flux of 1 kW/m2, the transition begins at Re = 1,859 and ends at Re = 3,604. The highest Nusselt number enhancement was reported for hight ratio of 0.75 and width ratio of 0.25 and for a heat flux of 1 kW/m2.

A mixed method study to explore knowledge, attitudes, behaviour and experience of introducing solids

Abstract Background Infancy is a critical time for establishing dietary habits. EARLY START aims to build an intervention for reducing early life obesogenic behaviours. Using participatory action research, the exploratory phase investigates mothers’ knowledge, attitudes, behavioural intent and experience of introducing to solids Methods A mixed methods approach was used. Knowledge, attitudes and behavioural intent about infant feeding were investigated amongst mothers using the Infant Feeding Education Questionnaire (IFEQ). A subgroup participated in a focus group discussion of their experience of introducing solids. Data were analyzed using Descriptive and Thematic Content methods. Results One hundred and three mothers participated (mean age 33 y.o., tertiary education 94.3%, in employment 98.9%). Advice from health care professionals (HCP) was the most influential factors for when to start solids. Despite a relatively high total IFEQ score (39, min -56, max 56), learning needs were identified in areas, such as putting baby to sleep with bottle and recommended size of food pieces and breastfeeding duration. Maternal characteristics did not influence the IFEQ score. Mother's confidence on when to wean was associated with higher IFEQ score (β coeff.: -2.9, CI -5.4, -0.4, per change to a lower confidence category). Qualitative analysis showed that mother consider introduction to solids a ritual process that is challenging, emotional and requires guidance. It is compared to a “dance” between mother and baby with HCPs positively influencing coordination. Mothers express the need for timely and continuous information beyond the weaning phase that takes into consideration baby's behavioural development and self-contained needs. Conclusions Mother's confidence on weaning is influenced by knowledge, attitudes and behavioural intent. New interventions should build confidence by focusing on challenges and addressing mother's emotional and baby's developmental and specific needs. Key messages • Knowledge, attitudes and behavioural intent of introducing solids affects a mother's confidence whilst infant feeding is considered a complex and emotional process requiring guidance on evolving needs. • Future interventions should focus on building confidence by addressing mother's challenges and emotions whilst taking into consideration the baby's developmental and self-contained needs.

Young Children's Development and Behavior: Associations with Timing of Household Food Insecurity in a Racially and Ethnically Diverse Early Head Start Sample.

The objective of this study was to assess the impact of household food insecurity (HFI) over time on behavioral and developmental health in early childhood while considering the impact of timing/persistence of HFI and potential differences among racially or ethnically minoritized children. Families from the Early Head Start Family and Child Experiences Study (N = 760) were followed longitudinally until age 3 years. Caregiver interview data were collected on HFI, problem behaviors (PBs), delays in development (DD), and sociodemographic information. Analysis of Covariances examined differences between persistent vs transient HFI. Multiple regressions examined the impact of HFI on PB and DD and whether this relation was stronger in racially or ethnically minoritized children. The timing of HFI differentially affected PB, such that those with persistent HFI demonstrated greater PB than those with only early or only late HFI. A different pattern was identified for DD, in which those with late HFI had more DD than those with persistent HFI. Over and above other sociodemographics, including maternal risk factors and an income-to-needs ratio, HFI was associated with greater PB for children of all races and ethnicities. HFI was associated with more DD in non-Latino/a/e/x White families compared with non-Latino/a/e/x Black and Latino/a/e/x families. Meaningful differences were found in how the persistence/timing of HFI is differentially associated with PB and DD. In addition, while controlling for socioeconomic risk, a cumulative risk effect was not observed in how HFI affected racially or ethnically minoritized children.

Pathophysiological interactions between sarcopenia and type 2 diabetes: A two-way street influencing diagnosis and therapeutic options.

This review will try to elucidate the interconnected pathophysiology of sarcopenia and type 2 diabetes (T2D) and will try to identify a common pathway to explain their development. To this end, the PubMed and Scopus databases were searched for articles published about the underlying pathophysiology, diagnosis and treatment of both sarcopenia and T2D. The medical subject heading (MeSH) terms 'sarcopenia' AND 'diabetes mellitus' AND ('physiopathology' OR 'diagnosis' OR 'therapeutics' OR 'aetiology' OR 'causality') were used. After screening, 32 papers were included. It was evident that sarcopenia and T2D share multiple pathophysiological mechanisms. Common changes in muscle architecture consist of a shift in myocyte composition, increased myosteatosis and a decreased capacity for muscle regeneration. Further, both diseases are linked to an imbalance in myokine and sex hormone production. Chronic low-grade inflammation and increased levels of oxidative stress are also known pathophysiological contributors. In the future, research efforts should be directed towards discovering common checkpoints in the development of T2D and sarcopenia as possible shared therapeutic targets for both diseases. Current treatment for T2D with biguanides, incretins and insulin may already convey a protective effect on the development of sarcopenia. Furthermore, attention should be given to early diagnosis of sarcopenia within the population of people with T2D, given the sizeable physical and medical burden it encompasses. A combination of simple diagnostic techniques could be used at regular diabetes check-ups to identify sarcopenia at an early stage and start lifestyle modifications and treatment as soon as possible.

Comprehensive rehabilitation of preschool children with attention deficit hyperactivity disorder

Introduction. High incidence and great social significance of attention deficit hyperactivity disorder (ADHD) in preschool children determines the search and development of new options for their rehabilitation.Aim. To analyse the patient outcomes of the most up-to-date treatment and rehabilitation complex (biofeedback, sensory integration, psychological and speech, physiotherapeutic effects) and the possibility of its widespread practical application for the rehabilitation of preschool children with ADHD.Materials and methods. A total of 63 children (33 boys and 30 girls) aged 5–8 years were included in the prospective study. Patients were divided into two groups: Group I – 34 children aged 5 years – 5 years 11 months, 29 days with ADHD, and Group II – 29 children aged 6 years – 6 years 11 months, 29 days with ADHD. The follow-up period for each patient was 15 months. The children were examined by a neurologist, rehabilitation therapist, neuropsychologist, and speech pathologist with an assessment of active attention measures using the B. Bourdon scale for children of Group I and the Toulouse-Pieron scale (adapted by L.A. Yasyukova) for children of Group 2. Parents were surveyed and questioned using special questionnaires. Results. Before initiation of treatment, all children were diagnosed with active attention disorders of isolated (26.5 and 23.8%) and mixed (73.5 and 62.5%) nature in Groups I and II, respectively. After the rehabilitation activities complex was provided, a significant decrease in not only isolated, but also mixed attention disorders in children with ADHD was detected in both groups. Evaluation of electroencephalograms after the rehabilitation activities complex showed a decrease of theta power and an increase of low beta frequency power in 18.7% of children of Group I and in 16.2% of children of Group II, which indicated an improvement in neurodynamic functions and sufficient cognitive potential in that cohort of children.Conclusion. Early start and prolonged use of the proposed rehabilitation complex will enhance learning ability and prevent school and social maladjustment of children with ADHD.

Phenological phases of <i>Weigela×wagneri</i> L. H. Bailey under conditions of humid subtropics in Russia

Weigela varieties of hybrid origin, known as Weigela hortensis (W. hortensis C.A. Mey) or <i>Weigela×wagneri</i> (W.wagneri L. H. Bailey) are cultivated on the Black Sea coast of Krasnodar Krai. A current range of this beautifully flowering shrub includes more than 150 varieties. However, only 24 grow in the region and are predominately selected in the early XX century and are rarely used in the landscaping of the resort town. Ornamental varieties of Weigela grow mostly in limited use areas (Sochi Arboretum, Subtropical Botanical Garden in Kuban region, Friendship Tree Garden Museum). The study aims at investigating the phenological phases of <i>Weigela×wagneri</i> L. H. Bailey under humid subtropical conditions of the Black Sea coast, Krasnodar Krai, to be used for the design of gardens with continuous flowering plants, as well as for breeding. The study was conducted in the period from 2013 to 2019 in the Friendship Tree Garden Museum and Subtropical Botanical Garden in Kuban region. The study involved 15 varieties of W.×wagneri. The authors established differences in phenological phases, including the start/end of growing season and flowering, duration of these periods, as well as the sums of effective temperatures required for these phases. The start of the growing season was established to vary from February 12 (Arlequin) with an accumulated sum of effective temperature of 261.2℃ to March 14 (Brictol Ruby) and a sum of temperature of 376.9℃. Differences between varieties in this phenophase account for 30 days. On the basis of the long-term average annual data, the varieties were divided into groups according to the floral initiation: early flowering (from April 14 to April 21) group included Arlequin, Gustave Malet, Mon Blanc, Newport Red, Venusta, Madame Lemoine; medium-flowering (April 22 to April 30) group included Lacepede, Ballet, Pavillon Blanc, Brictol Ruby, Madame Lemoine; Eva Ratke, Kosteriana variegata, Red Prince, Augusta were included into a late-flowering (from May 01 to May 06) group. According to the dates of the start and end of growing season, the varieties were divided into the following phenological groups: EE – Early starting (before Feb 12) and Early ending vegetation (before Dec 05); EL – Early starting (before Feb 12) and Late ending (after Dec 19); LE – Late starting (after March 4) and Early ending (before Dec 5); LL – Late starting (after March 4) and Late ending vegetation (after Dec 19).

Long-term benefits and harms of early colorectal cancer screening in German individuals with familial cancer risk.

Individuals with a family history of colorectal cancer (CRC) may benefit from early screening with colonoscopy or immunologic fecal occult blood testing (iFOBT). We systematically evaluated the benefit-harm trade-offs of various screening strategies differing by screening test (colonoscopy or iFOBT), interval (iFOBT: annual/biennial; colonoscopy: 10-yearly) and age at start (30, 35, 40, 45, 50 and 55 years) and end of screening (65, 70 and 75 years) offered to individuals identified with familial CRC risk in Germany. A Markov-state-transition model was developed and used to estimate health benefits (CRC-related deaths avoided, life-years gained [LYG]), potential harms (eg, associated with additional colonoscopies) and incremental harm-benefit ratios (IHBR) for each strategy. Both benefits and harms increased with earlier start and shorter intervals of screening. When screening started before age 50, 32-36 CRC-related deaths per 1000 persons were avoided with colonoscopy and 29-34 with iFOBT screening, compared to 29-31 (colonoscopy) and 28-30 (iFOBT) CRC-related deaths per 1000 persons when starting age 50 or older, respectively. For iFOBT screening, the IHBRs expressed as additional colonoscopies per LYG were one (biennial, age 45-65 vs no screening), four (biennial, age 35-65), six (biennial, age 30-70) and 34 (annual, age 30-54; biennial, age 55-75). Corresponding IHBRs for 10-yearly colonoscopy were four (age 55-65), 10 (age 45-65), 15 (age 35-65) and 29 (age 30-70). Offering screening with colonoscopy or iFOBT to individuals with familial CRC risk before age 50 is expected to be beneficial. Depending on the accepted IHBR threshold, 10-yearly colonoscopy or alternatively biennial iFOBT from age 30 to 70 should be recommended for this target group.

Finding Substructures in Protostellar Disks in Ophiuchus

High-resolution, millimeter observations of disks at the protoplanetary stage reveal substructures such as gaps, rings, arcs, spirals, and cavities. While many protoplanetary disks host such substructures, only a few at the younger protostellar stage have shown similar features. We present a detailed search for early disk substructures in Atacama Large Millimeter/submillimeter Array 1.3 and 0.87 mm observations of ten protostellar disks in the Ophiuchus star-forming region. Of this sample, four disks have identified substructure, two appear to be smooth disks, and four are considered ambiguous. The structured disks have wide Gaussian-like rings (σ R /R disk ∼ 0.26) with low contrasts (C < 0.2) above a smooth disk profile, in comparison to protoplanetary disks where rings tend to be narrow and have a wide variety of contrasts (σ R /R disk ∼ 0.08 and C ranges from 0 to 1). The four protostellar disks with the identified substructures are among the brightest sources in the Ophiuchus sample, in agreement with trends observed for protoplanetary disks. These observations indicate that substructures in protostellar disks may be common in brighter disks. The presence of substructures at the earliest stages suggests an early start for dust grain growth and, subsequently, planet formation. The evolution of these protostellar substructures is hypothesized in two potential pathways: (1) the rings are the sites of early planet formation, and the later observed protoplanetary disk ring–gap pairs are secondary features, or (2) the rings evolve over the disk lifetime to become those observed at the protoplanetary disk stage.

Impact of school start time and sleep pattern of adolescents on their mood and sleep quality

Objective: The physiological delay in bedtime among adolescents, compounded with the early start of school, results in insufficient sleep, especially on school days. The present study compared the sleep pattern and moods of students attending two schools with different start timing. Materials and Methods: The study involved adolescents from two schools with different start times: School A (7 am) and School B (8 am). Pittsburgh Sleep Quality Index, Depression Anxiety Stress Scales-21, and Pediatric Daytime Sleepiness Scale questionnaires were used to assess students’ mood, sleep duration, sleep quality, and daytime sleepiness. The clinical trial registry number is CTRI/2022/06/043556. Result: A total of 640 students (mean age 13.7 ± 2.0 years; 47.5% male) participated in this study. Students from School B had longer sleep duration, with 72.9% reporting sleep deprivation compared to 87.1% of School A (P = 0.00001). School A students reported having (P ≤ 0.001) higher daytime sleepiness, higher daytime dysfunction (P = 0.023), and poorer sleep quality. Students at School A scored higher for all mood derangements, with significantly higher scores for depression (P = 0.041). Conclusion: The study illustrates that though not much differences are observed in the bedtime of adolescents of the two schools, however, due to the early school start time of School A, students have to compulsorily wake up early, leading to higher sleep deprivation and greater mood derangements among them.

Treatment of dabigatran intoxication in critically ill patients with Acute Kidney Injury: The role of Sustained Low-Efficiency Dialysis.

The use of dabigatran in patients with non-valvular atrial fibrillation (AF) has widely increased in the last decades, due to its positive effects in terms of safety/efficacy. However, because of the risk of major bleeding, a great degree of attention has been suggested in elderly patients with multiple comorbidities. Notably, dabigatran mainly undergoes renal elimination and dose adjustment is recommended in patients with Chronic Kidney Disease (CKD). In this regard, the onset of an abrupt decrease of kidney function may further affect dabigatran pharmacokinetic profile, increasing the risk of acute intoxication. Idarucizumab is the approved antagonist in the case of dabigatran-associated major bleeding or concomitant need of urgent surgery, but its clinical use is limited by the lack of data in patients with Acute Kidney Injury (AKI). Thus, the early start of Extracorporeal Kidney Replacement Therapy (EKRT) could be indicated to remove the drug and to reverse the associated excess anticoagulation. Sustained Low-Efficiency Dialysis (SLED) could represent an effective therapeutic option to reduce the dabigatran plasma levels rapidly while avoiding post-treatment rebound. We present here a case series of three AKI patients with acute dabigatran intoxication, effectively and safely resolved with a single SLED session.

Timing of SGLT2i initiation after acute myocardial infarction

BackgroundPharmacological post-MI treatment is routinely initiated at intensive/cardiac care units. However, solid evidence for an early start of these therapies is only available for dual platelet therapy and statins, whereas data on beta blockers and RAAS inhibitors are heterogenous and mainly limited to STEMI and heart failure patients. Recently, the EMMY trial provided the first evidence on the beneficial effects of SGLT2 inhibitors (SGLT2i) when initiated early after PCI. In patients with type 2 diabetes mellitus, SGLT2i are considered “sick days drugs” and it, therefore, remains unclear if very early SGLT2i initiation following MI is as safe and effective as delayed initiation.Methods and resultsThe EMMY trial evaluated the effect of empagliflozin on NT-proBNP and functional and structural measurements. Within the Empagliflozin group, 22 (9.5%) received early treatment (< 24 h after PCI), 98 (42.2%) within a 24 to < 48 h window (intermediate), and 111 (48.1%) between 48 and 72 h (late). NT-proBNP levels declined by 63.5% (95%CI: − 69.1; − 48.1) in the early group compared to 61.0% (− 76.0; − 41.4) in the intermediate and 61.9% (− 70.8; − 45.7) in the late group (n.s.) within the Empagliflozin group with no significant treatment groups—initiation time interaction (pint = 0.96). Secondary endpoints of left ventricular function (LV-EF, e/e`) as well as structure (LVESD and LVEDD) were also comparable between the groups. No significant difference in severe adverse event rate between the initiation time groups was detected.ConclusionVery early administration of SGLT2i after acute myocardial infarction does not show disadvantageous signals with respect to safety and appears to be as effective in reducing NT-proBNP as well as improving structural and functional LV markers as initiation after 2–3 days.

Predictors of outcomes in patients with candidemia in an Intensive Care Unit

Objective: Candidemia is a life-threatening infection that causes high mortality rates in intensive care units (ICUs). This study aims to&#x0D; evaluate predictors of the outcome of patients with candidemia in ICU.&#x0D; Patients and Methods: This observational, retrospective study included patients with Candida bloodstream infection (BSI) in ICUs&#x0D; between 6 years of the episode. A binary logistic regression analysis was conducted to inspect the association with mortality.&#x0D; Results: The median age of 74 patients was 68.5, and 53.8% were men. C. parapsilosis was the most frequently isolated fungal species.&#x0D; The 30-day mortality rate was 50%. In the logistic regression model the Acute Physiology and Chronic Health Evaluation (APACHE)&#x0D; II score, positive blood culture on the seventh day, inotropes needed on the day of blood culture positivity, and ventilator-associated&#x0D; pneumonia (VAP) were significant risk factors for the outcome of patients. There was no difference in mortality between an early start&#x0D; of antifungal treatment or central venous catheter removal time.&#x0D; Conclusion: A shift to C. parapsilosis is observed in this study. Host-related factors such as APACHE II score, need for mechanical&#x0D; ventilation or need for inotropes affect mortality more than early treatment and source control in patients with Candida BSI.

Effects of sacubitril/valsartan in patients with cancer therapy-related heart failure

To evaluate the effect of Sacubitril/Valsartan (S/V) on the functional status, systolic and diastolic function of the left ventricle (LV), tolerability of therapy and to determine predictors of its effectiveness in patients with cancer therapy-related heart failure (СTRHF). Forty patients 58 [46; 65.5] years of age with HF associated with anthracycline-containing cancer therapy were enrolled. Clinical examination, echocardiography, and assessment of potassium and creatinine levels were performed at baseline and after 6 months of S/V therapy. NYHA functional class (FC) improvement was observed in 22 (64.7%) patients. Radiation therapy (RT) decreased (OR 0.091; 95% CI 0.01-0.83; p=0.03) while baseline low LV EF increased (OR 9.0; 95% CI 1.78-45.33; p=0.008) the odds of FC improvement. LV EF increased from 37.3 [30; 42.5] % to 45 [38; 48] % (p<0.0001) and exceeded 50% in 7 (20.6%) patients. The odds of LV EF recovery increased when S/V therapy was initiated ≤1 year after anthracycline therapy (OR 10.67; 95% CI 1.57-72.67; p=0.0016) and decreased in patients with the history of RT (OR 0.14; 95% CI 0.02-0.89; p=0.0037) and in patients over 58 years (OR 0.07; 95% CI 0.01-0.68; p=0.022). LV diastolic function improvement included E/e' descent from 13.6 [10; 18.3] to 8.9 [6.9; 13.7] (p=0.0005), and decrease in diastolic dysfunction grade in 18 (45%) patients (p=0.0001). No significant change in serum potassium (4.45 [4.2; 4.8] versus 4.5 [4.3; 4.8]; p=0.5) and creatinine (75.4 [67.6; 85.1] versus 75.5 [68.2; 98.3]; p=0.08) levels were observed. S/V therapy is associated with improvement of EF, systolic and diastolic LV function, demonstrates a favorable tolerability profile in patients with СTRHF. Lack of RT and low baseline LV EF increased the odds of LV EF improvement; lack of RT, early (≤1 year) start of treatment after discontinuation of anthracycline therapy, and age <58 years increased the odds of LV EF recovery.