Personal History Research Articles

Assessment of cognition: dementia and delirium : In consideration of the AWMF guidelines 038-013 and 084-002LG

Cognitive disorders are multifaceted and the range of neuropsychological instruments is correspondingly extensive; however, most examiners have to limit themselves to asmall selection in order to master them safely. In geriatric patients the various forms and stages of dementia dominate. Delirium must be distinguished from these as an acute life-threatening event. The personal and external medical history as well as clinical observation are the first steps in the assessment of cognition; the selection of test procedures is graduated and bears the patient's benefit in mind. When compiling atoolbox for use in one's own field of work, in addition to instruments focusing on different degrees of severity, alternatives should also be considered for use in the presence of comorbidities that reduce the validity (visual, hearing and fine motor disorders) and the examination situation should be taken into account.

Insights into Knowledge and Attitudes About Autoantibody Screening from People Affected by Type1 Diabetes: A Brief Report.

Screening for islet-specific autoantibodies can identify individuals at risk for type1 diabetes (T1D). Despite calls for increased nationwide autoantibody screening efforts, it is unclear how many individuals have participated in screening among people who may benefit from it. Moreover, knowledge and perceptions of autoantibody screening in real-world samples are not well understood. We surveyed a sample of individuals (aged 18+years old) from T1D Exchange Registry with a personal or family history of T1D to assess their self-reported T1D autoantibody knowledge, experiences, and attitudes. Participants belonged to one of three groups: adults with T1D who had a biological child without T1D or future plans for a child (PWD); parents without T1D who had a biological child with T1D and one or more biological children without T1D (Caregivers); and first-degree adult children or siblings to a person with T1D (Relatives). Descriptive analyses (means, standard deviations, frequencies) are presented by participant groups. A total of 510 participants enrolled in the study. Across groups, participants reported feeling a little to somewhat knowledgeable about autoantibody screening and positive perceptions of autoantibody screening in general. However, few participants had screened their child without T1D (PWDs, 21.94%; Caregivers, 46.30%) or themselves (Relatives, 19.23%). Among those who had screened, participants reported generally positive experiences. Among those who had not screened, many participants were "undecided" about autoantibody screening (PWD, 38.46%; Caregivers, 40.52%; Relatives, 44.44%). Influences reported for participants' decisions to screen, not screen, or their current indecision differed by group: PWDs (21.70%) and Caregivers (26.87%) most often reported self-initiated research as an influence and Relatives reported they had not previously considered screening (48.28%). Results highlight the need for more accessible information about screening, including real experiences from those who have screened.

Suppurative Cervicomediastinitis From the Perspective of the Head and Neck Surgeon in a Tertiary Treatment Unit.

Introduction Cervical suppurations represent an emergency pathology, with a dramatic evolution in the absence of adequate treatment. It frequently affects young people, hence the medico-legal implications of these cases. The anatomical substrate for the development of these deep cervical suppurations is represented by the cervical fascia and spaces. A distinct and extremely serious sub-chapter within diffuse cervical suppurations is necrotic cervical fasciitis, a polymicrobial infection with the most common oropharyngeal or odontogenic starting point, with rapidly progressive, destructive evolution in the deep fascial planes of the neck. Materials and method We will present a retrospective clinical study carried out on 26 cases diagnosed and treated between September 2013 and September 2018 in the ENT Clinic Department of the Bucharest University Emergency Hospital. Results Our retrospective analysis of a cohort of 26 patients in a tertiary referral center showed that deep cervical suppurations are slightly more common in men than in women. The most affected age groups were 50-59 years, followed by 20-29 years, representing a percentage of 53.84% of all cases. Also, 53.84% of the studied patients with deep cervical suppurations had a precarious and modest status. The most common clinical signs at presentation were malaise, cervical swelling, neck pain, dysphagia, fever, dysphonia, dyspnea, and cervical erythema. More than 60% of suppurations were odontogenic and 23% were caused by a traumatic element. Diabetes mellitus represents a comorbidity in 30.8% of patients, while 42.3% of patients had no personal pathological history, and thus this pathology has a lethal potential also in a patient in full health. In the study group, 46 (15%) had cervicomediastinitis, and 61.53% developed necrotizing fasciitis. One-third (34.61%) of our patients had undergone previous drainage surgery. Bacteriological examinations of the wound were with group C, D, G betahemolytic streptococcus, while 61.53% of the cultures were negative. Most patients required at least two cervicotomies. The average duration of hospitalization was 28.26 days, and the mortality rate was 23.07%; therefore, practically, one out of four cases resulted in death. In the studied group, no direct relationship can be established between the length of hospitalization and the favorable and unfavorable evolution of the patient. We propose a 10-step management protocol for the management of a cervical suppuration. Conclusion The multidisciplinary approach to these suppurations by the head and neck surgeon, the thoracic surgeon, the oromaxillofacial surgeon, anesthetist, imagist, specialist in infectious diseases, pathologist, psychologist, and so on, is the key to success in a patient who presents not only a suppuration in the throat but also a disease with systemic resonance and significant lethal potential.

Burden and Predictors of Anemia Among Pregnant and Lactating Females in a Rural Area in India With a High Tribal Population.

Introduction Nutritional anemia is a silent emergency particularly rampant in developing countries, especially among women of reproductive age group. This study was done with the objective to determine the prevalence and predictors of anemia among pregnant and lactating females in the Ormanjhi block of Ranchi district, Jharkhand. Methodology A community-based cross-sectional study was done on 388 pregnant and lactating females from July 2022 to June 2024 using a multi-stage cluster sampling technique. A pre-designed, pre-tested, semi-structured, interviewer-administered questionnaire containing different sections namely socio-demographic details, dietary history, menstrual history, obstetric history, antenatal history, medical history, behavioral history, and personal history was used. House-to-house visits were done for the collection of data. To estimate the prevalence, hemoglobin levels were analyzed using adigital hemoglobinometer. Results The overall prevalence of anemia among pregnant and lactating females was found to be 361 (93%) among 388 participants. Prevalence among pregnant females was 295 (92.76%) out of 318, and among lactating females, it was 66(94.28%) out of 70. The prevalence of anemia in the first trimester was 80 (80.45%) out of 87, 112 (94.91%) in the second trimester among 118, and 103 (91.15%) among113females in the third trimester. Conclusion There are concerns about stagnancy in the prevalence of anemia in pregnancy despite strong political commitments. A baseline data is generated from this study giving a clear picture of the exact prevalence and the predictors of anemia among pregnant and lactating females. This would help the policymakers to make warranted modifications imperative to improve the nutritional status of pregnant and lactating women and hence the children.

Screening for common mental disorders in people with epilepsy in Goma, in the Democratic Republic of the Congo: A cross-sectional study

Objectives: Epilepsy is a chronic neurological disease that is highly susceptible to a variety of mental health problems due to its enormous biological, social, and psychological burdens. The purpose of this study was to determine the prevalence and identify risk factors for common mental disorders (CMDs) in people with epilepsy (PWEs) in Goma, in the Democratic Republic of the Congo (DRC). Material and Methods: This is an analytical cross-sectional study conducted at the Neuropsychiatric Hospital Center in Goma (DRC) from March to April 2022, involving 302 PWEs. A questionnaire was administered to collect socio-demographic data, personal and family history, clinical features, and management of epilepsy. CMDs were assessed using the self-report questionnaire-20. Bivariate analysis was performed, followed by multivariate analysis, and variables with P < 0.05 in the final model were considered as risk factors associated with CMDs. Results: The study included 302 PWEs, of which 56.9% were men, and the mean age was 28.4 ± 11.0 years. CMDs were present in 39.1% of the participants. The presence of CMDs was significantly associated with having five or more seizures in the month preceding the survey (adjusted odds ratio [aOR] = 3.8; 95% confidence interval [CI]: 1.7–8.3) and having medical co-morbidities (aOR = 3.1; 95% CI: 1.5–6.4). Conclusion: The prevalence of CMDs in PWEs was high (39.1%), suggesting that this is a public health issue. Therefore, early detection and recognition of CMD symptoms should be a routine activity when managing PWEs.

Influencers y reputación: Chiara Ferragni,Instagram y el escándalo Pandoro Gate

Chiara Ferragni is one of the most important fashion influencers in the world. A pioneer in the profession, with the creation of her blog The Blonde Salad, she has reached more than 29 million followers on her Instagram account. At the end of 2023, her image and reputation suffered a serious deterioration after thePandoro gate scandal. This article analyses the evolution of its content creation routines before and after this crisis. The main objective is to analyse the evolution in the behaviour of the influencer, her followersand the brands with which she collaborated. The results show a significant transformation in her digital behaviour, characterized by a month of silence followed by a notable decrease in her publications. This trendcontinues after her separation and the agreement with her husband not to show the faces of their children. It is striking how the engagement of her Instagram account, despite the lack of content published by theinfluencer, increases. However, there has been a rise in critical and controversial comments. Despite the decrease in content, the activity of her community intensifies, suggesting that the interest of her followers isfocused more on Ferragni’s personal and professional history than on her controlled posts.

Facilitating return of actionable genetic research results from a biobank repository: Participant uptake and utilization of digital interventions

Research participants report interest in receiving genetic research results. How best to return results remains unclear. In this randomized pilot study, we sought to assess the feasibility of returning actionable research results through a two-step process including a patient-centered digital intervention as compared to a genetic counselor (GC) in the Penn Medicine biobank. In Step 1, participants with an actionable result and procedural controls (no actionable result) were invited to digital pre-disclosure education and provided options for opting out of results. In Step 2, those with actionable results who had not opted out were randomized to receive results via a digital disclosure intervention or with a GC. Five participants (2%) opted out of results after Step 1. After both steps, 52/113 (46.0%) of eligible cases received results, 5 (4.4%) actively declined results, 34 (30.1%) passively declined and 22 (19.5%) could not be reached. Receiving results was associated with younger age (p<0.001), completing pre-disclosure education (p<0.001) and being in the GC arm (p=0.06). Being older, female, and of Black race were associated with being unable to reach. Older age and Black race were associated with passively declining. 47% of those who received results did not have personal or family history to suggest the mutation, and 55.1% completed clinical confirmation testing. The use of digital tools may be acceptable to participants and could reduce costs of returning results. Low uptake, disparities in uptake, and barriers to confirmation testing will be important to address to realize the benefit of returning actionable research results.

„Térjetek meg...” : Az akkor és a most idő-anomáliájának feloldása

Jesus’ radicalism is based on the fact that the pious religious image we have of Jesus is fundamentally different from the image Jesus Christ had as a historical person. Radicalism was never strange to the Old Testament prophets and is thus intrinsic to Jesus’ prophetic role. It is also fundamental that prophetic radicalism should manifest itself towards the internal institutions of religion: priests, Levites, Pharisees, etc. The question is how to highlight parallels between the religious conditions of that current age and those of days. Understanding the Greek language’s duality of tempus and actio brings us closer to the message of Jesus two thousand years ago, which is still relevant today.

A Screening Strategy to Mitigate Vision Impairment by Engaging Adults Who Underuse Eye Care Services

Underuse of eye care services leads to underdiagnosed and undertreated eye disease. To assess the reasons for underuse of eye care and whether a novel, free eye disease screening program is engaging adults who are both at high risk of eye disease and were underusing eye care services. In a population-based cross-sectional study, adult participants from the first year of the Michigan Screening and Intervention for Glaucoma and Eye Health Through Telemedicine (MI-SIGHT) Program were included. The participants were recruited from primary care clinics serving 2 low-income communities. Recruitment occurred between June 28, 2020 and June 27, 2021 at the free clinic, and between January 27, 2021 and January 26, 2022 at a federally qualified health clinic. Data were analyzed from December 7, 2022, to May 29, 2024. Participants received comprehensive eye disease screening and completed surveys assessing health and prior eye care use. Risk factors for eye disease included age 65 years and older, diabetes, personal or family history of eye disease, and self-identifying as Black or African American individuals who were aged 50 years or older. Underuse of eye care was defined as no eye examination in 2 or more years. Percentage of participants who were at high risk of eye disease and underused eye care services before accessing this program. A total of 1171 MI-SIGHT participants were a mean (SD) age of 55 (14.5) years; 437 (38%) identified as male; 591 (54%) self-identified as Black or African American, 101 (10%) as Hispanic or Latino, and 371 (34%) as White; 492 (43%) had high school education or less, and 696 (70%) reported an annual household income of less than $30 000. Characteristics of participants reporting not having had an eye examination in 2 years or more included 23% (n = 151) of participants 65 years and over, 33% (n = 214) of participants who self-reported diabetes, 25% (n = 130) of participants reporting a family history of glaucoma, 3% (n = 14) of those with self-reported glaucoma; and 33% (n = 202) of Black or African-American participants aged 50 years and older. In participants who reported not having had an eye examination in 2 or more years, 21% (n = 137) screened positive for glaucoma, 20% (n = 129) for cataract, 6% (n = 38) for diabetic retinopathy, and 1% (n = 9) for age-related macular degeneration. Reported reasons for why participants had not had an eye examination included no insurance (175 of 627 [28%]), no reason to go (no problem) (135 of 627 [22%]), and cost of eye examination (101 of 627 [16%]). The findings of this study suggest that placing eye disease detection programs in primary care clinics in underserved areas may improve eye disease detection and treatment, possibly mitigating needless vision loss in the US.

Development of a comprehensive risk prediction model for arterial stiffness assessment in individuals with obesity.

Obesity in adults is a known risk factor for cardiovascular events and is associated with a decline in arterial elasticity. This study aims to evaluate the utility of pulse wave analysis (PWA) parameters in routine clinical practice for the primary prevention of cardiovascular events by developing a prediction model for arterial stiffness among obese and overweight individuals. The study enrolled 84 adult patients, aged 18 to 85 years, with varying degrees of weight status, including optimal weight, overweight, and obesity. The lifestyle habits, the personal and family history of cardiometabolic diseases, as well the clinical evaluation that included BMI (body mass index), WHR (waist-to-hip ratio), WC (waist circumferance) were performed. PWA evaluation was conducted using the Mobil-O-Graph device, assessing the following parameters: pulse wave velocity (PWV), augmentation index (AIx), heart rate (HR), central pulse pressure (cPP), peripheral and central blood pressure (SBP, DBP, cSBP, cDBP). Body composition analysis was performed using the TANITA BC-418 body analyzer. Laboratory results from the past 3 months were also collected during initial nutritional consultations for each patient. Family history of cardiovascular events showed positive correlations with all PWA parameters, while diabetes history only with PWV and family history of obesity with PWV, DBP, and cSBP. Insufficient sleep duration showed positive associations with all arterial stiffness parameters except cDBP. Smoking status correlated with significantly elevated PWV and Aix values, while insufficient physical activity was associated solely with PWV. Positive correlations were showed between current weight and PWV, while WC demonstrated positive associations with PWV, SBP, and cSBP. Body composition analysis revealed significant associations between trunk adipose tissue mass (%) and PWV, SBP, and cSBP. Hydration status (%) emerged as an independent predictor for PWV, exhibiting an inverse relationship. HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) showed a strong positive correlation with PWV. Negative associations were observed with HDL-c and vitamin D. Threshold values for age, cDBP and Cardiac Index providing positive diagnostic for vascular impairment. The assessment of arterial stiffness can be considered a reliable approach to prevent obesity-related cardiovascular events and facilitate the comprehensive management of such pathologies.

Hepatitis B Prevalence and Referral Rates in Vulnerable Populations Undergoing Community-Based Screening-Results from the LIVE(RO)2 Program.

Background: Hepatitis B Virus (HBV) remains a major global health challenge, with significant morbidity and mortality associated with chronic infections. Methods: This study examines the epidemiology, screening, and risk factors associated with HBV in Romania, focusing on a comprehensive national screening program, LIVE(RO)2, involving 320,000 individuals (majority of them considered vulnerable population). A questionnaire was used to collect information on the potential risk factors for HBV transmission. Results: The overall prevalence rate of HBV chronic infection among all the participants tested was 1.67% (confidence interval: 1.63-1.72%), with significant differences (p = 0.0001) between participants from the main geographical regions of residence (North-East 1.89%, South 1.38%, South-East 2.06%, and South-West 1.54%). Male persons aged 30-49 or 60-69 years old, from the rural and Eastern parts of Romania and non-Romanian ethnia, with a low level of education, unvaccinated, not married, unemployed, with family members with hepatitis, with personal histories of blood or blood product transfusion, surgical interventions, tattooing, hospitalizations, imprisonment, haemodialysis, unsafe sexual contacts, or with sexual transmitted infectious diseases were risk factors associated with HBsAg seropositivity. Conclusions: Our findings highlight significant demographic and epidemiological patterns of reduced HBV prevalence even in vulnerable persons, as well as modified risk factors and the impact of socio-economic factors.

On being a scholar/activist: Personal history and acquired wisdom

Requests to publicly think about what one has learned over time are always interesting to me. They require that authors reflect back on a trajectory that may not be totally clear even to the writers themselves. They ask writers to construct an historical narrative that is simultaneously both personal and intellectual/political. In this “acquired wisdom” essay, I want to engage with this combined task, to reflect on some of the political/intellectual/educational history of the development of my work over time, on some of the most important things I have learned, and on the situations and processes that made this more likely. At the same time, I want to situate this development in some of the more personal groundings that might explain how and why the work I’ve done came about. Let me begin with some general points that bear on my later comments about my grounding in politically engaged educational efforts. There are two fundamental motivations behind such critical work. The first is understanding the complex dynamics of exploitation, domination, and subordination that all too often structure our societies and their constitutive relations inside and outside of education. Yet, while understanding is absolutely crucial, it is not sufficient. Emerging out of such understandings is a commitment to interruption. Both understanding and interruption have their basis in a set of ethical and political commitments that are simultaneously collective and personal (Bourdieu, 2003). And both are crucial to me.

A pilot study of diet lifestyle on complete blood picture, elements, and biological profile in females

Obesity, a prevalent global health issue, is characterized by elevated lipid levels, altered hematological parameters, inflammation, and other related symptoms. A biological profile and complete blood count (CBC) are essential tools for assessing overall health and detecting various dysfunctions, including anemia, infections, leukemia, and heart diseases. In obese patients of both sexes, a high white blood cell count is a reliable indicator of leukemia risk, coronary complications, and inflammation. Notably, dietary and lifestyle changes can significantly improve obesity-related conditions and hematological disorders. This study examines the effects of a six-month dietary program on anthropometric measurements, biological profiles, elemental composition, and complete blood counts in 43 obese females with white blood cell counts above the normal range. Participants underwent comprehensive hematological, biochemical, and anthropometric assessments at the beginning and end of the diet program. The findings revealed a significant weight loss and substantial improvements in laboratory parameters and blood profiles. These improvements are likely due to the nutrient composition of the diet program. The investigation confirmed that modifying dietary intake by reducing consumption of high-acidic foods, fast foods, animal-derived lipids, refined carbohydrates, red meats, and non-seasonal produce, in favor of a nutrient-dense regimen comprising fruits, vegetables (consumed raw or steamed), fish, poultry, and whole grains, resulted in significant enhancements in hematological indices and biological markers. These enhancements substantially surpassed baseline measurements for complete blood count and biological profiles. However, alterations in the elemental profile were not statistically significant. Further studies are being conducted to examine these outcomes with greater specificity. Ongoing research aims to further understand these effects according to personal medical history, age, and sex.

Strategies for management of patients with elevated lipoprotein(a).

There is growing literature that supports the testing of Lp(a). However, few patients are tested, including those with a personal or family history of cardiovascular disease (CVD). One often noted barrier to more widespread testing is uncertainty regarding what to do with an elevated Lp(a) level. Although guidelines vary, there is agreement on the use of Lp(a) as a risk enhancer to guide medical care and shared decision-making. This review will discuss a clinical approach with supporting evidence for management of patients with elevated Lp(a). At the minimum, elevated Lp(a) increases cardiovascular risk and can be incorporated into existing risk stratification paradigms. The cornerstone of management is aggressive management of traditional cardiovascular risk factors, including LDL-cholesterol (LDL-C). More recent studies have highlighted the potential role for proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), aspirin in primary prevention, and prolonged dual antiplatelet therapy in secondary prevention. Although there is optimism for Lp(a)-targeted therapies in the near future, an elevated Lp(a) level is actionable today, and uncertainty regarding the management of patients with elevated Lp(a) should not be a barrier to more widespread testing.

Polyp detection with colonoscopy assisted by the GI Genius artificial intelligence endoscopy module compared with standard colonoscopy in routine colonoscopy practice (COLO-DETECT): a multicentre, open-label, parallel-arm, pragmatic randomised controlled trial

Increased polyp detection during colonoscopy is associated with decreased post-colonoscopy colorectal cancer incidence and mortality. The COLO-DETECT trial aimed to assess the clinical effectiveness of the GI Genius intelligent endoscopy module for polyp detection, comparing colonoscopy assisted by GI Genius (computer-aided detection [CADe]-assisted colonoscopy) with standard colonoscopy in routine practice. We did a multicentre, open-label, parallel-arm, pragmatic randomised controlled trial in 12 National Health Service (NHS) hospitals (ten NHS Trusts) in England, among adults (aged ≥18 years) undergoing planned colonoscopy for gastrointestinal symptoms or for surveillance due to personal or family history (ie, symptomatic indications), or colorectal cancer screening. Randomisation (1:1) to CADe-assisted colonoscopy or standard colonoscopy was done with a web-based dynamic adaptive algorithm, immediately before colonoscopy, with stratification by age group, sex, colonoscopy indication (screening or symptomatic), and NHS Trust. Recruiting staff, participants, and colonoscopists were unmasked to trial allocation; histopathologists, co-chief investigators, and trial statisticians were masked. CADe-assisted colonoscopy consisted of standard colonoscopy plus the GI Genius module active for at least the entire inspection phase of colonoscope withdrawal. The primary outcome was mean adenomas per procedure (total number of adenomas detected divided by total number of procedures); the key secondary outcome was adenoma detection rate (proportion of colonoscopies with at least one adenoma). Analysis was by intention to treat (ITT), with outcomes compared between groups by mixed-effects regression modelling, in which effect estimates were adjusted for randomisation stratification variables. Data were imputed for outcome measures with more than 5% missing values. All participants who underwent colonoscopy were assessed for safety. The trial is registered on ISRCTN (ISRCTN10451355) and ClinicalTrials.gov (NCT04723758), and is complete. Between March 29, 2021, and April 6, 2023, 2032 participants (1132 [55·7%] male, 900 [44·3%] female; mean age 62·4 years [SD 10·8]) were recruited and randomly assigned: 1015 to CADe-assisted colonoscopy and 1017 to standard colonoscopy. 1231 (60·6%) participants were undergoing screening and 801 (39·4%) had symptomatic indications. Mean adenomas per procedure was 1·56 (SD 2·82; n=1001 participants with available data) in the CADe-assisted colonoscopy group versus 1·21 (1·91; n=1009) in the standard colonoscopy group, representing an adjusted mean difference of 0·36 (95% CI 0·14-0·57; adjusted incidence rate ratio 1·30 [95% CI 1·15-1·47], p<0·0001). Adenomas were detected in 555 (56·6%) of 980 participants in the CADe-assisted colonoscopy group versus 477 (48·4%) of 986 in the standard colonoscopy group, representing a proportion difference of 8·3% (95% CI 3·9-12·7; adjusted odds ratio 1·47 [95% CI 1·21-1·78], p<0·0001). Numbers of adverse events were similar between the CADe-assisted colonoscopy and standard colonoscopy groups (adverse events: 25 vs 19; serious adverse events: four vs six), and no adverse events in the CADe-assisted colonoscopy group were deemed to be related to GI Genius use on independent review. Results of the COLO-DETECT trial support the use of GI Genius to increase detection of premalignant colorectal polyps in routine colonoscopy practice. Medtronic.

The arrhythmic substrate of hypertrophic cardiomyopathy using ECG imaging.

Introduction: Patients with hypertrophic cardiomyopathy (HCM) are at risk for lethal ventricular arrhythmia, but the electrophysiological substrate behind this is not well-understood. We used non-invasive electrocardiographic imaging to characterize patients with HCM, including cardiac arrest survivors. Methods: HCM patients surviving ventricular fibrillation or hemodynamically unstable ventricular tachycardia (n = 17) were compared to HCM patients without a personal history of potentially lethal arrhythmia (n = 20) and a pooled control group with structurally normal hearts. Subjects underwent exercise testing by non-invasive electrocardiographic imaging to estimate epicardial electrophysiology. Results: Visual inspection of reconstructed epicardial HCM maps revealed isolated patches of late activation time (AT), prolonged activation-recovery intervals (ARIs), as well as reversal of apico-basal trends in T-wave inversion and ARI compared to controls (p < 0.005 for all). AT and ARI were compared between groups. The pooled HCM group had longer mean AT (60.1ms vs. 52.2ms, p < 0.001), activation dispersion (55.2ms vs. 48.6ms, p = 0.026), and mean ARI (227ms vs. 217ms, p = 0.016) than structurally normal heart controls. HCM ventricular arrhythmia survivors could be differentiated from HCM patients without a personal history of life-threatening arrhythmia by longer mean AT (63.2ms vs. 57.4ms, p = 0.007), steeper activation gradients (0.45ms/mm vs. 0.36ms/mm, p = 0.011), and longer mean ARI (234.0ms vs. 221.4ms, p = 0.026). A logistic regression model including whole heart mean activation time and activation recovery interval could identify ventricular arrhythmia survivors from the HCM cohort, producing a C statistic of 0.76 (95% confidence interval 0.72-0.81), with an optimal sensitivity of 78.6% and a specificity of 79.8%. Discussion: The HCM epicardial electrotype is characterized by delayed, dispersed conduction and prolonged, dispersed activation-recovery intervals. Combination of electrophysiologic measures with logistic regression can improve differentiation over single variables. Future studies could test such models prospectively for risk stratification of sudden death due to HCM.

Use of Neutrophil-to-Lymphocyte Ratio to Predict In-Hospital Mortality in Patients Admitted with Acute Decompensation of Atrial Fibrillation.

Background/Objectives: The prevalence of atrial fibrillation (AF) has been on the rise over the last 20 years. It is considered to be the most common cardiac arrhythmia and is associated with significant morbidity and mortality. The need for in-hospital management of patients having AF is increasing. Acute decompensation of cardiac rhythm is an indication for hospital admission. In the existing literature, several studies on different pathologies have observed that the risk of death was greater for patients with an increased neutrophil-to-lymphocyte ratio (NLR) and suggested that the NLR can be a useful biomarker to predict in-hospital mortality. This study aims to evaluate the link between the neutrophil-to-lymphocyte ratio at admission and death among the patients admitted to the medical ward for the acute manifestation of AF, and to gain a better understanding of how we can predict in-hospital all-cause death based on the NLR for these patients. Methods: A single-center retrospective study in an academic medical clinic was conducted. We analyzed if the NLR at in-hospital admission can be related to in-hospital mortality among the patients admitted for AF at the Medical Ward of Municipal Emergency University Hospital Timisoara between 2015 and 2016. After identifying a total of 1111 patients, we divided them into two groups: in-hospital death patients and surviving patients. We analyzed the NLR in both groups to determine if it is related to in-hospital mortality or not. One patient was excluded because of missing data. Results: Our analysis showed that patients who died during in-hospital admission had a significantly higher NLR compared to those who survived (p < 0.0001, 95% CI (1.54 to 3.48)). The NLR was found to be an independent predictor of in-hospital death among patients with AF, even for the patients with no raised level of blood leukocytes (p < 0.0001, 95% CI (0.6174 to 3.0440)). Additionally, there was a significant correlation between the NLR and the risk of in-hospital death for patients admitted with decompensated AF (p < 0.0001), with an area under the ROC curve of 0.745. Other factors can increase the risk of death for these patients (such as the personal history of stroke, HAS-BLED score, and age). Conclusions: The NLR is a useful biomarker to predict in-hospital mortality in patients with AF and can predict the risk of death with a sensitivity of 72.8% and a specificity of 70.4%. Further studies are needed to determine the clinical utility of the NLR in risk stratification and management of patients with AF.

Predicting Unfavorable Pregnancy Outcomes in Polycystic Ovary Syndrome (PCOS) Patients Using Machine Learning Algorithms.

Background and Objectives: Polycystic ovary syndrome (PCOS) is a complex disorder that can negatively impact the obstetrical outcomes. The aim of this study was to determine the predictive performance of four machine learning (ML)-based algorithms for the prediction of adverse pregnancy outcomes in pregnant patients diagnosed with PCOS. Materials and Methods: A total of 174 patients equally divided into 2 groups depending on the PCOS diagnosis were included in this prospective study. We used the Mantel-Haenszel test to evaluate the risk of adverse pregnancy outcomes for the PCOS patients and reported the results as a crude and adjusted odds ratio (OR) with a 95% confidence interval (CI). A generalized linear model was used to identify the predictors of adverse pregnancy outcomes in PCOS patients, quantifying their impact as risk ratios (RR) with 95% CIs. Significant predictors were included in four machine learning-based algorithms and a sensitivity analysis was employed to quantify their performance. Results: Our crude estimates suggested that PCOS patients had a higher risk of developing gestational diabetes and had a higher chance of giving birth prematurely or through cesarean section in comparison to patients without PCOS. When adjusting for confounders, only the odds of delivery via cesarean section remained significantly higher for PCOS patients. Obesity was outlined as a significant predictor for gestational diabetes and fetal macrosomia, while a personal history of diabetes demonstrated a significant impact on the occurrence of all evaluated outcomes. Random forest (RF) performed the best when used to predict the occurrence of gestational diabetes (area under the curve, AUC value: 0.782), fetal macrosomia (AUC value: 0.897), and preterm birth (AUC value: 0.901) in PCOS patients. Conclusions: Complex ML algorithms could be used to predict adverse obstetrical outcomes in PCOS patients, but larger datasets should be analyzed for their validation.

A human centred innovative approach based on persona in hereditary angioedema

BackgroundHereditary Angioedema (HAE) due to C1-inhibitor deficiency (C1INH) is a rare condition, clinically characterised by recurrent swelling. The unpredictability of attacks affects the patients’ quality of life (QoL). HAE patients and their families have vast unmet physical, psychological, and social needs. A human-centred design (HCD) approach to describing the needs of different user types is to utilise personas, a data-driven narrative tool for communicating user archetypes that capture the individuals’ attitudes, goals, and behaviours. The aim of this study was to create and analyse personas based on HAE patients’ and their caregivers’ interviews. Semi-structured interviews were conducted through anthropological conversations with patients, patient-caregivers (double role of patient and caregiver), and non-affected caregivers. Qualitative and quantitative insights from analyses formed the basis to create personas.ResultsWe enrolled 17 subjects: 15 patients (6 of them were patient-caregivers) and 2 non-affected caregivers. The mean age of participants was 50.3 ± 14.4 years. Eight patients were on treatment with prophylactic therapy. The mean percentage score of Angioedema Quality of Life (AE-QoL) for HAE patients was 19.8 ± 12.0. Six personas were identified describing the participants’ personal history, disease management, and needs: four personas referred to patients, one to patient-caregivers, and one non-affected caregiver personas were identified. Across patient personas, the most expressed needs were psychological support and better awareness amongst healthcare professionals. Caregivers, on their side, desired better information about the disease, including the latest therapies, and higher awareness within the community.ConclusionA Human Centred Innovative Approach Based on Persona extends beyond the physical symptoms to encompass the psychological and social aspects of the individual's well-being also including the family in the evaluation.

SOME SAMPLES OF ASHYG ALESKER'S CREATIVITY, BASED ON LOGIC AND REALITY

İn the article, the material and spiritual existence of the world is divicled into positive and negative poles according to the low of the unity of opposites, and it is shown chat the Turks belong to the positive pole and have active gene carriers. Turks with deep knowledge have had great historical personalities in literature as well as in many areas. One of them is the art of ashıq, which belongs to the spiritual pole and is the food of our soul, and one of those who stand at its peak is Ashıq Alasgar. They did not make a mistake in calling Ashıq Alasgar the real ashiq. By giving logical explanations on selected examples from his work, the authors reveal Ashıq Alasgar knowledge based on sleep logic. This is considered also novelty among the opinions about Ashıq Alasgar based on numerous (any) analyses.