Major Intervention Research Articles

P205 HYPERTENSION AWARENESS, TREATMENT, AND CONTROL RATE IN NEPAL: AN EFFECTIVENESS OF WHO-PEN PACKAGE INTEGRATION THROUGH PRIMARY CARE TO ADDRESS THE NCDs

WHO-PEN, the essential NCD services even in resource constraint settings through PHC approach has been implemented in Nepal since 2017. PEN approach consists of set of protocols for the management of listed major diseases and behavioral interventions to address the associated major modifiable risk factors. The major focused diseases in PEN includes cardiovascular diseases, diabetes, cancer and chronic respiratory diseases. By 2021 it has been expanded across all 77 districts of Nepal. The aim of this analysis is to assess the before and after PEN package changes in hypertension prevalence, awareness, treatment and control rate in Nepal. This analysis used the 2016 Nepal demographic and health survey (NDHS) data as a baseline(N=14,823) and 2022 NDHS data as an Edline(N=10,022). Awareness, treatment and control rate was calculated from the population aged 15 years and above along with the concentration Index (CI) to assess the changes in magnitude and inequalities before and after the intervention. Cluster sampling design was considered for all the inferential statistics and sample weight was used to obtain the population estimates. P<0.05 were considered statistically significant. The study revealed a non-significant change in the hypertension prevalence before and after the intervention (19.6% vs 20.1%;p>0.05). However, a significant change was observed in the awareness rate (40% vs 50.2%,p<0.05) and treatment rate (20.2% vs 31.7%,p<0.05). A significant wealth inequality was observed in awareness ((CI:0.12,p<0.001 in 2016) and (CI:0.13,p<0.001 in 2022)) and treatment rate ((CI:0.24,p<0.001 in 2016) and (CI:0.21,p<0.001 in 2022)) over the period of time. We did not find a significant change (51.7% vs 56.7%, p>0.05) and wealth inequalities in control rate (figure 1). The improvement in awareness and treatment rate over the period entails the integration of WHO-PEN package through primary care is effective, however, the persistent wealth inequalities indicate next level community-based intervention should be instrumental to address the NCDs burden targeted to ultra-poor/poor and marginalized population of Nepal.

Clinical Characteristics and Outcomes of Patients Suffering Acute Decompensated Heart Failure Complicated by Cardiogenic Shock.

Cardiogenic shock (CS) can stem from multiple causes and portends poor prognosis. Prior studies have focused on acute myocardial infarction-CS; however, acute decompensated heart failure (ADHF)-CS accounts for most cases. We studied patients suffering ADHF-CS to identify clinical factors, early in their trajectory, associated with a higher probability of successful outcomes. Consecutive patients with CS were evaluated (N=1162). We studied patients who developed ADHF-CS at our hospital (N=562). Primary end point was native heart survival (NHS), defined as survival to discharge without receiving advanced HF therapies. Secondary end points were adverse events, survival, major cardiac interventions, and hospital readmissions within 1 year following index hospitalization discharge. Association of clinical data with NHS was analyzed using logistic regression. Overall, 357 (63.5%) patients achieved NHS, 165 (29.2%) died, and 41 (7.3%) were discharged post advanced HF therapies. Of 398 discharged patients (70.8%), 303 (53.9%) were alive at 1 year. Patients with NHS less commonly suffered cardiac arrest, underwent intubation or pulmonary artery catheter placement, or received temporary mechanical circulatory support, had better hemodynamic and echocardiographic profiles, and had a lower vasoactive-inotropic score at shock onset. Bleeding, hemorrhagic stroke, hemolysis in patients with mechanical circulatory support, and acute kidney injury requiring renal replacement therapy were less common compared with patients who died or received advanced HF therapies. After multivariable adjustments, clinical variables associated with NHS likelihood included younger age, history of systemic hypertension, absence of cardiac arrest or acute kidney injury requiring renal replacement therapy, lower pulmonary capillary wedge pressure and vasoactive-inotropic score, and higher tricuspid annular plane systolic excursion at shock onset (all P<0.05). By studying contemporary patients with ADHF-CS, we identified clinical factors that can inform clinical management and provide future research targets. Right ventricular function, renal function, pulmonary artery catheter placement, and type and timing of temporary mechanical circulatory support warrant further investigation to improve outcomes of this devastating condition.

Current developments in prehabilitation in urologic oncology.

Prehabilitation describes interventions that are undertaken prior to a major surgical or medical intervention with the objective of improving functional capability with the goal of improving candidacy for therapy, bolstering one's ability to withstand treatment-associated toxicity, functional decline, and facilitating accelerated recovery. The objective of this review is to detail the key tenets of prehabilitation, synthesize contemporary advances in prehabilitation science within Urologic Oncology, and discuss key methodologic trial design considerations salient to future prehabilitation investigations. Contemporary prehabilitation clinical trials have primarily evaluated unimodal interventions aiming to improve functional capacity across the domains of physical exercise, nutrition, and cognition with heightened interest in evaluating multimodal interventions addressing two or more domains. Recent investigations have have demonstrated variable improvements in strength, balance, physical function, and quality of life with preoperative exercise. Although presurgical immunonutrition showed promise in other fields, initial results in uro-oncology have not demonstrated reductions in complications nor improvements in early survival. Emerging data supports the potential of multimodal prehabilitation programs to offer more comprehensive benefits, improving functional outcomes, reducing length of stay, and supporting improved recovery. To date, early prehabilitation studies in patients undergoing surgery for genitourinary malignancies have demonstrated variable ability to facilitate gains in functional capacity and perioperative outcomes. Key issues have arisen including the need to ensure that interventions are pragmatic, scalable, feasible, and acceptable in these populations that often also have a high prevalence of coincident multimorbidity, frailty, and mental health concerns that can increase risk of adverse outcomes after surgery. The integration of personalized prehabilitation strategies as extensions of perioperative enhanced recovery after surgery protocols, supportive care and survivorship paradigms offers of promise to further engage patients in their care, enhance patient resilience and outcomes, while reducing treatment burden in urologic oncology.

Investigating the Prognostic Potential of Plasma ST2 in Patients with Peripheral Artery Disease: Identification and Evaluation.

Soluble interleukin 1 receptor-like 1 (ST2) is a circulating protein demonstrated to be associated with cardiovascular diseases; however, it has not been studied as a biomarker for peripheral artery disease (PAD). Using a prospectively recruited cohort of 476 patients (312 with PAD and 164 without PAD), we conducted a prognostic study of PAD using clinical/biomarker data. Plasma concentrations of three circulating proteins [ST2, cytokine-responsive gene-2 (CRG-2), vascular endothelial growth factor (VEGF)] were measured at baseline and the cohort was followed for 2 years. The outcome of interest was a 2-year major adverse limb event (MALE; composite of major amputation, vascular intervention, or acute limb ischemia). Using 10-fold cross-validation, a random forest model was trained using clinical characteristics and plasma ST2 levels. The primary model evaluation metric was the F1 score. Out of the three circulating proteins analyzed, ST2 was the only one that was statistically significantly higher in individuals with PAD compared to patients without PAD (mean concentration in plasma of 9.57 [SD 5.86] vs. 11.39 [SD 6.43] pg/mL, p < 0.001). Over a 2-year period, 28 (9%) patients with PAD experienced MALE. Our predictive model, incorporating clinical features and plasma ST2 levels, achieved an F1 score of 0.713 for forecasting 2-year MALE outcomes. Patients identified as high-risk by this model showed a significantly increased likelihood of developing MALE (HR 1.06, 95% CI 1.02-1.13, p = 0.003). By combining clinical characteristics and plasma ST2 levels, our proposed predictive model offers accurate risk assessment for 2-year MALE in PAD patients. This algorithm supports risk stratification in PAD, guiding clinical decisions regarding further vascular evaluation, specialist referrals, and appropriate medical or surgical interventions, thereby potentially enhancing patient outcomes.

Postoperative Respiratory Complications After Adenotonsillectomy in Children With High-Risk Obstructive Sleep Apnea.

Identify patient characteristics and polysomnogram (PSG) parameters associated with postoperative respiratory complications after adenotonsillectomy (AT) among children with high-risk obstructive sleep apnea (OSA). Case series with chart review. Tertiary care children's hospital. Pediatric patients (<18 years) with high-risk OSA (any 1 of: apnea-hypopnea index [AHI] >30, O2 nadir <80% and peak CO2 >60 mm Hg) on overnight PSG from 2019 to 2021 were included. Primary outcomes were major respiratory intervention during the postoperative admission, prolonged hospitalization, and intensive care unit (ICU) stay. A total of 307 patients met inclusion criteria. Median age was 6.5 years and 63% were male. Twenty-five (8.1%) required major respiratory intervention and 29 (9.7%) required ICU admission after AT. Major interventions and ICU admissions were significantly associated with neuromuscular disease (P < .01), higher obstructive apnea-hypopnea index (oAHI), higher CO2 peak, and lower O2 nadir. Prolonged admission had similar findings except oAHI was not significantly associated. Younger children were significant more likely to require ICU admission or prolonged admission. Increased oAHI and worsening O2 and CO2 parameters on preoperative PSG were associated with postoperative respiratory complications in children with high-risk OSA. Children with neuromuscular disease and age 0 to 2 had higher risk of ICU stay and prolonged hospitalization. Clinicians should recognize the importance of parameters beyond oAHI when anticipating postoperative monitoring.

Comparison of direct intrahepatic portosystemic shunt and other major radiological interventions in patients with Budd Chiari syndrome

Comparison of direct intrahepatic portosystemic shunt and other major radiological interventions in patients with Budd Chiari syndrome

Impact of the thresholds of surgical volume on mortality in oncological digestive surgery: A French National Cohort

ObjectiveTo report the 90-day mortality benefit associated with the implementation of the new regulatory reform on oncological surgical digestive authorizations. Summary background dataNew thresholds in digestive cancer surgery were applied in 2023, accrediting centers for major interventions. No evidence has been provided to support their justification. MethodsAny French adult operated for digestive cancer from January 1, 2019 to December 31, 2021 was included from the PMSI. A 90-day mortality logistic regression was performed by adjusting by age, sex, Charlson score, Frailty index, hospital-volume (<5 or ≥5 interventions/year), emergency intervention, specialty. Results143,582 patients were identified. Of these, 64,268 underwent surgery of one of the subspecialties subject to the new thresholds (stomach N = 8283, liver N = 18,668, pancreas N = 11,220, esophagus N = 3704, rectum N = 22,393).4808 (7.5 %) patients underwent surgery in low-volume centers, distributed as follows: stomach 1757/8283 (22.94 %), liver 970/18,668 (5.19 %), pancreas 895/11,220 (7.98 %), esophagus 672/3704 (18.14 %) and rectum 514/22,393 (2.29 %).In univariate analysis, the 90-day mortality rate was significantly lower in high-volume centers, for all subspecialties, gastric: 127/1757 (7.23 %) vs 330/6526 (5.06 %), p = 0.0004, hepatic: 64/970 (6.6 %) vs 824/17,698 (4.66 %), p = 0.006, pancreatic: 74/895 (8, 27 %) vs 608/10,325 (5.89 %), p = 0.004, esophageal: 58/672 (8.63 %) vs 195/3032 (6.43 %), p = 0.04, rectal 26/514 (5.06 %) vs 639/21,879 (2.92 %), p = 0.005.The multivariate analysis, showed a mortality reduction for high-volume centers: OR = 0.78 CI95[0.71–0.87], p < 0.001. ConclusionThe recent implementation of regulatory decrees appears to be justified. The enforcement of these hospital volume thresholds is likely to contribute to a reduction in postoperative mortality following digestive cancer surgery.

Studying the Impact of European Union Regulatory Interventions for Minimising Risks From Medicines: Lessons Learnt and Recommendations.

The European Medicines Agency's (EMA) Pharmacovigilance Risk Assessment Committee (PRAC) launched a strategy to examine the public health impact of major regulatory interventions aimed at minimising risks of medicinal products. We conducted a lessons learnt analysis of impact studies completed between 2015 and 2023. We surveyed PRAC Sponsors and (Co-)Rapporteurs involved in the evaluation of 12 impact studies (10 commissioned by EMA and 2 conducted collaboratively by Member States) to explore how these support regulatory decision-making. Questions covered achievement of study objectives, risk minimisation effectiveness, added value for regulatory decision-making, and recommendations for future impact studies. Themes were generated using thematic content analysis. Survey responses from 15 PRAC Sponsors and (Co-)Rapporteurs from 10 European Union Member States were included in the analysis. Among four cross-sectional surveys and eight drug utilisation studies, 50% achieved all objectives, the other studies partially due to limitations. Two studies concluded that risk minimisation measures were overall effective, two were effective with variation across countries, two were partially effective and four studies showed limited effectiveness. Two studies were deemed inconclusive due to limitations. The reasons for the limited effectiveness of risk minimisation may be explored using mixed-method approaches. Assessment of study feasibility and a priori discussion of effectiveness measurements is important. Despite limitations, impact research adds value to regulatory decision-making by addressing knowledge gaps and providing additional information on unintended consequences of regulatory interventions. Our recommendations will help to improve planning, conducting and interpretating future impact studies.

Design and Life Cycle Assessment (LCA)-based Sustainability Evaluation of a Novel Microbial Fuel Cell (MFC)-Integrated Sequencing Batch Reactor (SBR) System

Although sewage treatment plants form one of the major environmental interventions for eco-friendly and sustainable management of domestic sanitary wastes, yet their own overall sustainability enhancement, rather than process performance assessment are seldom addressed. The sustainability study of a standard sewage treatment plant, namely Sequencing Batch Reactor (SBR) is addressed in the present research work through Life Cycle Assessment (LCA) tools using SimaPro. Following this, an attempt was made herewith to integrate a potential, yet much lesser commercially explored, wastewater management strategy, namely Microbial Fuel Cell (MFC) unto the SBR chamber, with suitable design-modification. The sustainability parameters of the resultant MFC-augment SBR system were also analysed using LCA to compare the effect of this intervention unto the said parameters. The study shows similar normalized trends of overall damage unto sewage as well as sludge, with global warming being the dominant damage cause. Human health was found to be most vulnerable category for both types of SBR’s (namely, with and without MFC), with relatively lower effect in case of MFC-augmented SBR, particularly with regard to infrastructural and short-term domains, in addition to improved water quality and lower water-footprint.

Type 2 Diabetes Mellitus and Cardiometabolic Prospects: A Rapid Narrative Review.

Cardiometabolic syndrome (CMS), type 2 diabetes mellitus (T2DM), and cardiovascular diseases are among the major altruists to the international liability of disease. The lifestyle and dietary changes attributable to economic growth have resulted in an epidemiological transition towards non-communicable diseases (NCDs) as the leading causes of death. Low- and middle-income countries (LMICs) bear a more substantial disease burden due to limited healthcare sector capacities to address the rapidly growing number of chronic disease patients. The purpose of this narrative review paper was to explore the interrelationships between CMS, T2DM, and cardiovascular impairments in the context of NCDs, as well as major preventative and control interventions. The role of insulin resistance, hyperglycemia, and dyslipidemia in the pathogenesis of T2DM and the development of severe cardiovascular impairments was highlighted. This paper elaborated on the pivotal role of lifestyle modifications, such as healthy diets and physical activity, as cornerstones of addressing the epidemics of metabolic diseases. Foods high in calories, refined sugar, red meat, and processed and ready-to-eat meals were associated with an amplified risk of CMS and T2DM. In contrast, diets based on fruits, legumes, vegetables, and whole grain, home-cooked foods demonstrated protective effects against metabolic diseases. Additionally, the role of a psychological and behavioral approach in addressing metabolic diseases was highlighted, especially regarding its impact on patient empowerment and the patient-centered approach to preventative and therapeutic interventions.

Growing burden of gamma-hydroxybutyrate intoxication on emergency department resource utilisation.

Recreational gamma-hydroxybutyrate (GHB) use is rising in Australia. We aimed to describe ED presentation patterns related to GHB over time and the impact this has on ED resource use. Retrospective review of prospective data collection from two clinical toxicology units based in Queensland and New South Wales. There were 751 GHB-related presentations to the two units (Newcastle, 127; Princess Alexandria, 624), with marked increases in presentations occurring in 2019 and 2023. The major intervention was intubation, with 95 (13%) patients intubated. GHB presentations to ED are rising and the impact on acute bed space and clinical resources is significant.

E-learning Interventions for Quality Improvement Continuing Medical Education-A Scoping Review.

Improving health care quality and patient safety are top priorities for the medical field. Robust continuing medical education (CME) programs represent major interventions to effectively teach quality improvement (QI) principles to practicing physicians. In particular, eLearning, a term describing online and distance learning interventions using digital tools, provides a means for CME interventions to reach broader audiences. Although there has been a focus on CME addressing QI, no knowledge synthesis has focused specifically on eLearning interventions. The purpose of this review was to examine the current landscape of eLearning interventions in QI-focused CME. We conducted a scoping review using the framework developed by Arksey and O'Malley as revised by Levac. We searched five databases and identified 2467 prospective publications, which two authors independently screened for inclusion. From each included article, two authors independently extracted data on the instructional modalities and QI tools used and met regularly to achieve consensus. Twenty-one studies were included. Most studies used blended instruction (n = 12) rather than solely eLearning interventions. Salient findings included the importance of coaching from QI experts and institutional support for planning and implementing eLearning interventions. Lack of protected time and resources for participants were identified as barriers to participation in CME activities, with small practices being disproportionately affected. Partnerships between CME developers and sponsoring organizations are vital in creating sustainable eLearning interventions for QI-focused CME. Remote coaching can be an effective strategy to provide ongoing support to geographically separated learners.

Low-cost, portable, easy-to-use kiosks to facilitate home-cage testing of nonhuman primates during vision-based behavioral tasks.

Nonhuman primates (NHPs), especially rhesus macaques, have significantly contributed to our understanding of the neural computations underlying human vision. Besides the established homologies in the visual brain areas between these species and our ability to probe detailed neural mechanisms in monkeys at multiple scales, NHPs' ability to perform human-like visual behavior makes them an extremely appealing animal model of human vision. Traditionally, such behavioral studies have been conducted in controlled laboratory settings, offering experimenters tight control over variables like luminance, eye movements, and auditory interference. However, in-lab experiments have several constraints, including limited experimental time, the need for dedicated human experimenters, additional lab space requirements, invasive surgeries for headpost implants, and extra time and training for chairing and head restraints. To overcome these limitations, we propose adopting home-cage behavioral training and testing of NHPs, enabling the administration of many vision-based behavioral tasks simultaneously across multiple monkeys with reduced human personnel requirements, no NHP head restraint, and monkeys' unrestricted access to experiments. In this article, we present a portable, low-cost, easy-to-use kiosk system developed to conduct home-cage vision-based behavioral tasks in NHPs. We provide details of its operation and build to enable more open-source development of this technology. Furthermore, we present validation results using behavioral measurements performed in the lab and in NHP home cages, demonstrating the system's reliability and potential to enhance the efficiency and flexibility of NHP behavioral research.NEW & NOTEWORTHY Training nonhuman primates (NHPs) for vision-based behavioral tasks in a laboratory setting is a time-consuming process and comes with many limitations. To overcome these challenges, we have developed an affordable, open-source, wireless, touchscreen training system that can be placed in the NHPs' housing environment. This system enables NHPs to work at their own pace. It provides a platform to implement continuous behavioral training protocols without major experimenter intervention and eliminates the need for other standard practices like NHP chair training, collar placement, and head restraints. Hence, these kiosks ultimately contribute to animal welfare and therefore better-quality neuroscience in the long run. In addition, NHPs quickly learn complex behavioral tasks using this system, making it a promising tool for wireless electrophysiological research in naturalistic, unrestricted environments to probe the relation between brain and behavior.

Teacher’s Mindset and Mathematical Competencies Development: An Appraisal of Intervention Actions for Curriculum Change Adoption

Teacher’s mindset effects on curriculum implementation. A competency-based curriculum focuses on developing competencies in learners rather than transferring knowledge from teacher. There is concern why changed competence-based mathematics curriculum is not implementing well in school. This study, thus, explores the teachers' mindset and their classroom practices for mathematical competencies development in students. This is an action research based on a qualitative study was planned to intervene some tools expecting to bring changes in teachers’ mindset and influence on classroom practice while implementing the curriculum. The major intervention tools were: a learning outcome log, theme-wise result of learning, and a portfolio. Data were collected using the daily logbook for observation and interview data were kept in written notes. Intervention prior and post changes activities was analyzed based on the seven steps of the Concern Adoption Model (CBAM) as a theoretical base. The results of the study showed the changes in teachers’ mindset and classroom teaching and assessment practices after the intervention justifies the application of concern adoption model for the implementation of the new curriculum as desired.

Balloon-expandable cobalt chromium stent versus self-expandable nitinol stent for the Atherosclerotic Iliac Arterial Disease (SENS-ILIAC Trial) Trial: a randomized controlled trial.

Iliac artery angioplasty with stenting is an effective alternative treatment modality for aortoiliac occlusive diseases. Few randomized controlled trials have compared the efficacy and safety between self-expandable stent (SES) and balloon-expandable stent (BES) in atherosclerotic iliac artery disease. In this randomized, multicenter study, patients with common or external iliac artery occlusive disease were randomly assigned in a 1:1 ratio to either BES or SES. The primary end point was the 1-year clinical patency, defined as freedom from any surgical or percutaneous intervention due to restenosis of the target lesion after the index procedure. The secondary end point was a composite event from major adverse clinical events at 1year. A total of 201 patients were enrolled from 17 major cardiovascular intervention centers in South Korea. The mean age of the enrolled patients was 66.8 ± 8.5years and 86.2% of the participants were male. The frequency of critical limb ischemia was 15.4%, and the most common target lesion was in the common iliac artery (75.1%). As the primary end point, the 1-year clinical patency as primary end point was 99% in the BES group and 99% in the SES group (p > 0.99). The rate of repeat revascularization at 1year was 7.8% in the BES group and 7.0% in the SES group (p = 0.985; confidence interval, 1.011 [0.341-2.995]). In our randomized study, the treatment of iliac artery occlusive disease with self-expandable versus balloon-expandable stent was comparable in 12-month clinical outcomes without differences in the procedural success or geographic miss rate regardless of the deployment method in the distal aortoiliac occlusive lesion (ClinicalTrials.gov, NCT01834495).

Ongoing and Future Clinical Trials of Pharmacotherapy for Heart Failure.

Increasing knowledge of the processes leading to heart failure (HF) has allowed significant developments in therapies for HF over the past few decades. Despite the evolution of HF treatment, it still places a large burden on patients and health care systems across the world.We used clinicaltrials.gov to gather information about clinical trials as of August 2023 studying pharmacotherapy for HF. We included interventional trials that were "active, not recruiting", "recruiting", or looking for participants but "not yet recruiting". In total, 119 studies met our criteria of ongoing clinical trials studying novel as well as currently approved HF pharmacotherapies. The major interventions were novel medications/already approved medications for other diseases 29 % (34 trials), sodium-glucose co-transporter inhibitors 21 % (25 trials), angiotensin receptor blocker-neprilysin inhibitors 10 % (12 trials), diuretics 14 % (17 trials) and mineralocorticoid receptor antagonists 5 % (6 trials). Ongoing research will aid in reducing the impact of HF and we summarize clinical trials leading the way to better HF treatment in this review.

The Minimally Important Difference (MID) in Visual Acuity That Represents Changes in Patients' Quality of Life.

To assess the minimal change in visual acuity perceived by patients as important in different eye-related interventions. PubMed was utilized to search articles on each of the four major interventions: cataract surgery, keratoplasty, different glaucoma treatments, and refractive eye surgery, each combined with quality of life (QoL) and visual acuity keywords. The search was narrowed to articles between 2000 and 2023. Seventy-four major articles were thus reviewed. Of these, 27 studies reviewed the results of cataract surgery, 20 studies discussed the effect of keratoplasty interventions on the vision-related QoL (VRQoL), most showing that VRQoL improved significantly after keratoplasty, 11 studies investigated the effect of different glaucoma interventions on patients' visual acuity and the QoL, 16 studies reviewed refractive surgery, where they showed an improved QoL in most of the cases, although some of the studies showed a slight superiority of one intervention over the other in the short term. The minimally important difference (MID) perceived in visual acuity depends mainly on the type of surgical intervention (keratoplasty, glaucoma, or refractive surgery), and the impact on QoL on improved visual acuity differs depending on the intervention.

Prediction of Peripheral Artery Disease Prognosis Using Clinical and Inflammatory Biomarker Data.

Inflammatory biomarkers associated with peripheral artery disease (PAD) have been examined separately; however, an algorithm that includes a panel of inflammatory proteins to inform prognosis of PAD could improve predictive accuracy. We developed predictive models for 2-year PAD-related major adverse limb events (MALE) using clinical/inflammatory biomarker data. We conducted a prognostic study using 2 phases (discovery/validation models). The discovery cohort included 100 PAD patients that were propensity-score matched to 100 non-PAD patients. The validation cohort included 365 patients with PAD and 144 patients without PAD (non-matched). Plasma concentrations of 29 inflammatory proteins were determined at recruitment and the cohorts were followed for 2 years. The outcome of interest was 2-year MALE (composite of major amputation, vascular intervention, or acute limb ischemia). A random forest model was trained with 10-fold cross-validation to predict 2-year MALE using the following input features: 1) clinical characteristics, 2) inflammatory biomarkers that were expressed differentially in PAD vs non-PAD patients, and 3) clinical characteristics and inflammatory biomarkers. The model discovery cohort was well-matched on age, sex, and comorbidities. Of the 29 proteins tested, 5 were elevated in PAD vs non-PAD patients (MMP-7, MMP-10, IL-6, CCL2/MCP-1, and TFPI). For prognosis of 2-year MALE on the validation cohort, our model achieved AUROC 0.63 using clinical features alone and adding inflammatory biomarker levels improved performance to AUROC 0.84. Using clinical characteristics and inflammatory biomarker data, we developed an accurate predictive model for PAD prognosis.

Relationship Between Body Mass Index, Occlusion, and Dental Caries among School Children in Riyadh

ABSTRACT Background: Malocclusion and lifestyle diseases like obesity can lead to poor oral hygiene and food stagnation, resulting in increased caries incidence. Objectives: To evaluate the interrelationship of age, body mass index (BMI), occlusion, and dental decay in children aged between 5 and 14. Methodology: Our study included 423 school students aged 5-14 visiting dental clinics. Correlation between BMI and DMFT index using Spearman’s correlation coefficient and the association of BMI with gender, age group, and occlusion using the Chi-square test were assessed. Results: The study comprised a larger sample of students aged above 10 years (n = 217) and between 6 and 10 years (n = 183), with Angle’s Class I and II malocclusion being predominant. A weak positive correlation was found between BMI and the missing component of the DMFT index, while significant statistical associations were observed between underweight students below 5 years (8.5%) and obesity in those between 6 and 8 years (53.3%) (P &lt; 0.05). Conclusion: Dental practitioners must pay attention to the BMI of children and consider diet as a major intervention for dental caries prophylaxis.

Evaluation of Pediatric Early Warning Score (PEWS) in Unintentional Childhood Injuries Admitted to the Critical Care Unit.

Pediatric Early Warning Score (PEWS), also known as Brighton PEWS or Monaghan PEWS, was developed to identify children at risk for clinical deterioration in hospitals. We designed this study to describe the epidemiology of unintentional injuries in children admitted to the critical care unit in a tertiary healthcare setting, and to determine the predictive properties of PEWSin these injuries. This is a cross-sectional study. Injury-related data were based on Haddon's matrix of agent, host, and environment factors. Each child was evaluated using PEWS on admission. We noted the following outcomes: duration of stay in the intensive unit; major intervention required; and death. We analyzed data from 157 children. Most of the children were in the age group of one to five years (57.7%), followed by more than five to 12 years old (37.6%). The most common injuries were bites (35.7%), falls (24.2%), and poisoning (21.7%). These injuries occurred at home (52.7%) and in the presence of a caretaker (40.0%). On admission, 11% of children were classified as green, 40% as yellow, 36% as orange, and 13% as red by PEWS. Classification of red versus the rest (orange/yellow/green) had a high sensitivity (100%), specificity (88.3%), and negative predictive value (100%) for "death" as an outcome. Most of the injuries occurred at home and at a time when the caretaker was around. Thus, it will be useful to develop "safe home interventions" and train parents in first aid to take care of these injuries on-site. Baseline PEWS was a good predictor of "poor"as well as "positive" outcomes. It may be worthwhile to implement this score regularly in the management of childhood injuries in hospitals.