Morbidity In Adults Research Articles

Consensus Statement of Cardiac Society of Nepal on Diagnosis, Management and Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Nepal

The prevalence of rheumatic heart disease is still significant in Nepal, especially in rural areas. It is an important preventable cause of morbidity and mortality in children and young adults. Diagnosis of rheumatic heart disease and acute rheumatic fever is based on clinical, laboratory, and echocardiographic criteria. Diagnosis and management criteria need to be locally relevant and practical to our context for implementation at the national level. The Cardiac Society of Nepal initiated the development of consensus document with aim of providing a reasonable and practical format of diagnostic and management. We hope this document will be helpful for physicians, pediatricians and cardiologists of the country to diagnose and treat acute rheumatic fever and RHD.

Prevalence of multidrug-resistant Escherichia coli in household drinking water in rural Ghana

Abstract Even in the 21st century, households in rural Ghana still rely on drinking water sources that are contaminated with pathogenic Escherichia coli, the consumption of which results in morbidity and mortality of children and adults. The present study sought to determine the prevalence and antimicrobial susceptibility profile of E. coli isolated from household drinking water. A total of 49 water samples were analyzed. E. coli was isolated and confirmed from the water samples using the spread plate and biochemical tests, respectively. The Kirby–Bauer method was used for antimicrobial susceptibility testing. E. coli was isolated from 79.6% of the water samples with a mean colony growth of 15 cfu/100 μl. The isolates were absolutely resistant to ceftazidime, cefixime, augmentin, and cefuroxime. In contrast, the isolates were most susceptible to ciprofloxacin, ofloxacin, gentamicin, and nitrofurantoin. Multidrug resistance was registered in 48.7% of the isolates. E. coli isolates from each water sample had a Multiple Antibiotic Resistance (MAR) index greater than 0.2, indicating increased use or misuse of antibiotics in the study area. This study revealed a high occurrence of multidrug-resistant E. coli and a record-high reduction in the efficacy of important antimicrobials.

Urinary C-Telopeptide of Type II Collagen As a Marker of Avascular Necrosis in Younger and Older Adults with Sickle Cell Disease

Background Avascular necrosis (AVN) is a common cause of morbidity and impaired mobility in adults with sickle cell disease (SCD). Repeated episodes of vaso-occlusion cause bone infarctions that lead to AVN. The early detection of AVN in adults with SCD requires expensive imaging modalities (CT, MRI) as it is often not detected on plain radiographs until advanced stages. Type II collagen is an abundant protein of the cartilage matrix and its degradation product, urinary type II collagen C-telopeptide (UCTX II) is a specific biomarker used to measure degradation of articular cartilage in adults with osteoarthritis (OA). UCTX II is easily measured in urine samples and may facilitate early detection of AVN and other bone diseases seen in SCD. The primary objective of this study is to assess the relationship between concentrations of UCTX II and avascular necrosis in adults with SCD. Methods We included adults (≥ 18 years) with a laboratory confirmed diagnosis of SCD in this cross-sectional study. We collected sociodemographic data by patient survey and extracted medical history and routine laboratory data from the electronic health record including history of AVN and joint surgery which were confirmed by participant survey. History of arthritis included in the participant survey. We collected urine and blood specimens and administered physical performance measures on the same day during the participant's usual state of health. We defined usual health as no hospitalizations in the last 6 weeks and no emergency room or Sickle Cell Day Hospital visits in the 2 weeks prior to the assessment and specimen collection. We quantified UCTX II by ELISA and corrected for creatinine excretion. We used descriptive statistics and visual displays to summarize the data and compared UCTX II levels between participants with and without AVN using Wilcoxon rank sum test. We evaluated relationships between UCTX II and physical performance measures using Spearman's correlation coefficients. Results We measured UCTX II in 34 participants. The median age of participants was 48.5 years (range 20-71). Most (62%) participants were ≥ 40 and 38% were between 18-39 years old. SCD genotypes included HbSS (56%), HbSβ0 (3%) and HbSβ+-thalassemia (12%), and HbSC (29%). Most participants (59%) had a diagnosis of AVN, 24% had a history of joint surgery, and 29% had reported a history of arthritis. The median UCTX II level was 348 ng/mmol creatinine (IQR 229-534; range 89 - 78230). Younger adults had significantly higher median UCTX II levels compared to older adults with a median UCTX II of 536 (IQR 358 - 999) in young adults versus 242 (IQR 180 - 357) in older adults; p-value = 0.001. There was not a statistically significant difference in median UCTX II level between participants with and without AVN, history of joint surgery, and self-reported history of arthritis. When we controlled for age using a rank-based nonparametric ANCOVA, there remained no difference in UCTX II levels between participants with and without AVN (p-value = 0.68). Participants with a history of AVN had a median UCTX II level of 311 (IQR 209 - 426) compared to a median of 384 (IQR 248 - 704) in participants without AVN; p-value = 0.22. Participants with a history of joint surgery had a median UCTX II level of 283 (IQR 139 - 371) compared to participants with no history of joint surgery with a median of 357 (IQR 233 - 620); p-value = 0.27. Participants with a history of self-reported arthritis had a median UCTX II level of 312 (IQR 245 - 353) compared to patients without arthritis who had a median of UCTX II of 382 (IQR 217 - 673); p-value = 0.27. Conclusion This preliminary data showed no significant difference in UCTX II levels between adults with and without AVN, history of joint surgery, or self-reported history of arthritis; however, the small sample size limited statistical power to detect differences. We found that younger adults with SCD had higher UCTX II levels than older adults with SCD. The increased UTCXII in younger adults with SCD is consistent with prior studies that demonstrate higher UCTXII in young adults and a gradual decline with age due growth plate activity that contributes to the higher UCTXII levels seen in young adults. The role of UCTXII will need to be explored further in a larger sample and compared to radiographic staging of AVN that includes evaluation of joint damage. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Development of the Home-Based Fall Prevention Knowledge (HFPK) questionnaire to assess home-based fall prevention knowledge levels among older adults in China

BackgroundFalls are one of the main reasons for mortality and morbidity in older adults. However, despite adoption of prevention strategies, the number of falls in older adults has not declined. This study aimed to develop a questionnaire to assess fall prevention knowledge and explore associated factors among Chinese community-dwelling older adults.MethodsThe Home-Based Fall Prevention Knowledge (HFPK) questionnaire was developed by Delphi expert consultation. We tested the internal consistency, reliability, and content validity of the HFPK. A total of 374 community-dwelling older adults participated in this study. The HFPK was used to assess their fall prevention knowledge.ResultsAfter being evaluated by 15 experts, the item content validity index ranged from 0.867 to 1, and the scale content validity index was 0.985, which met the criterion for content validity. Cronbach’s α coefficient was 0.933, which satisfied the reliability criterion. Stepwise linear regression analysis showed that fall prevention knowledge was significantly associated with having higher education, being female, having a higher monthly income, people who were public officials before retirement, and having fewer children (p < 0.05).ConclusionFall prevention knowledge should be improved among older males and those with lower education, lower monthly income, people who were not public officials before retirement, and more children.

Impact of Respiratory Syncytial Virus and Influenza Virus Infection in the Adult Population in Spain between 2012 and 2020.

Respiratory syncytial virus (RSV) infection is increasingly recognized as a cause of significant morbidity and mortality in adults. We aimed to estimate the rates of age-specific hospitalization and in-hospital mortality caused by acute lower respiratory tract infections (ALRTIs) in Spain between 2012 and 2020 and to compare the relative impact of RSV and influenza virus infection in adults. We used the discharge reports from the Minimum Basic Data Set to retrospectively analyze hospital discharge data on the basis of the ICD-9-CM and ICD-10-CM diagnosis codes. A total of 1,518,244 patients were hospitalized for ALRTIs, of whom 137,794 (9.1%) were admitted for RSV-related infections and 46,288 (3.0%) for influenza-related infections. In patients aged 60 years or older, the hospitalization rates (per 100,000 population) were estimated at 1.69 (95% CI 1.68-1.70) and 2.72 (95% CI 2.71-2.73) for RSV and influenza patients, respectively. However, in-hospital mortality rates were significantly higher among RSV patients than among influenza patients, 7.91% (95% CI 7.89-7.93) (83.0% of all RSV-related deaths) versus 6.91% (95% CI 6.89-6.93) (85.6% of all influenza-related deaths), respectively (p = 0.007). RSV-associated in-hospital mortality increases exponentially with age, posing a greater risk for older adults, particularly frail and high-risk patients.

In utero exposure to the Great Depression is reflected in late-life epigenetic aging signatures

Research on maternal-fetal epigenetic programming argues that adverse exposures to the intrauterine environment can have long-term effects on adult morbidity and mortality. However, causal research on epigenetic programming in humans at a population level is rare and is often unable to separate intrauterine effects from conditions in the postnatal period that may continue to impact child development. In this study, we used a quasi-natural experiment that leverages state-year variation in economic shocks during the Great Depression to examine the causal effect of environmental exposures in early life on late-life accelerated epigenetic aging for 832 participants in the US Health and Retirement Study (HRS). HRS is the first population-representative study to collect epigenome-wide DNA methylation data that has the sample size and geographic variation necessary to exploit quasi-random variation in state environments, which expands possibilities for causal research in epigenetics. Our findings suggest that exposure to changing economic conditions in the 1930s had lasting impacts on next-generation epigenetic aging signatures that were developed to predict mortality risk (GrimAge) and physiological decline (DunedinPoAm). We show that these effects are localized to the in utero period specifically as opposed to the preconception, postnatal, childhood, or early adolescent periods. After evaluating endogenous shifts in mortality and fertility related to Depression-era birth cohorts, we conclude that these effects likely represent lower bound estimates of the true impacts of the economic shock on long-term epigenetic aging.

Severity of neonatal influenza infection is driven by type I interferon and oxidative stress

Neonates exhibit increased susceptibility to respiratory viral infections, attributed to inflammation at the developing pulmonary air-blood interface. IFN I are antiviral cytokines critical to control viral replication, but also promote inflammation. Previously, we established a neonatal murine influenza virus (IV) model, which demonstrates increased mortality. Here, we sought to determine the role of IFN I in this increased mortality. We found that three-day-old IFNAR-deficient mice are highly protected from IV-induced mortality. In addition, exposure to IFNβ 24 h post IV infection accelerated death in WT neonatal animals but did not impact adult mortality. In contrast, IFN IIIs are protective to neonatal mice. IFNβ induced an oxidative stress imbalance specifically in primary neonatal IV-infected pulmonary type II epithelial cells (TIIEC), not in adult TIIECs. Moreover, neonates did not have an infection-induced increase in antioxidants, including a key antioxidant, superoxide dismutase 3, as compared to adults. Importantly, antioxidant treatment rescued IV-infected neonatal mice, but had no impact on adult morbidity. We propose that IFN I exacerbate an oxidative stress imbalance in the neonate because of IFN I-induced pulmonary TIIEC ROS production coupled with developmentally regulated, defective antioxidant production in response to IV infection. This age-specific imbalance contributes to mortality after respiratory infections in this vulnerable population.

OR13-6 Deep learning-based voice screening technique for cystic fibrosis related diabetes

Abstract Background Cystic fibrosis-related diabetes (CFRD) is a unique type of diabetes that is associated with significantly increased morbidity and mortality in both children and adults with cystic fibrosis (CF). The prevalence of CFRD progressively increases with age such that more than half of adults with CF develop CFRD. Early diagnosis and treatment are associated with improvements in body weight and pulmonary function, reduction in the frequency of pulmonary exacerbations, and improved overall survival. Since patients with CFRD may present with no symptoms, screening is recommended starting from the age of 10 years with an annual oral glucose tolerance test (OGTT). Especially during the COVID-19 pandemic, requiring an in-person clinic visit can be challenging, which may lead to a delayed diagnosis of CFRD. Objectives The purpose of this project was to develop a state-of-the-art technique to detect changes in glucose levels of patients with CF by developing a deep learning-based audio classification tool. Preliminary work by our group suggested that voice characteristics could distinguish between patients with CFRD patients and patients with CF but without CFRD. We hypothesize that high blood glucose levels may cause laryngeal soft tissue swelling leading to changes in voice characteristics. Methods We performed a prospective cross-sectional study in adult patients with CF recruited from Emory CF Clinic from March to December 2021. We recorded 5-second voice samples of a sustained /a/ vowel via a portable digital microphone. The spectrogram was extracted via the Mel frequency cepstral coefficient. The training to test the dataset ratio was 80: 20. 20% of the training dataset were randomly selected to serve as a validation dataset. We designed a convolutional neural network (CNN) architecture for CFRD patients’ voice classification. Results There were a total of 100 subjects consisting of 43 patients with CFRD and 57 patients with CF without diabetes. The male to female ratio was approximately 60: 40 in both groups. Patients with CFRD had similar mean age and mean BMI to patients without CFRD. There was a significantly higher point of care glucose level in CFRD patients. The mean duration of a CFRD diagnosis was 9 years and the mean HbA1c level was 7.26 in the CFRD group. The performance of the VGG model CNN classifier achieved 98.7% and 94.92% accuracy on training and validation datasets, respectively. On the test dataset, the model achieved 73.53% sensitivity 69.77% specificity and 71.43% accuracy. Conclusions We found a deep learning-based audio screening tool for CFRD could be potentially used as an alternative tool for screening in the CF community. A convolutional neural network algorithm demonstrated high sensitivity and specificity to adequately differentiate between patients with and without CFRD. Larger prospective studies are required to test this technology in patients with every form of diabetes. Presentation: Sunday, June 12, 2022 12:15 p.m. - 12:30 p.m.

Atrial Fibrillation and Hemodialysis – Should we Anticoagulate These Patients? Ischemic Versus Hemorrhagic Risk

Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide, and it is a very frequent cause of increased morbidity and mortality in adults. This arrhythmia favors the formation of thrombi, which can lead to systemic embolism, such as ischemic stroke. To identify patients with thromboembolic risk, the most used score is the CHA2DS2VASC, which takes the following factors in consideration: heart failure, arterial hypertension, age, diabetes, previous stroke, vascular disease, and sex. It is worth emphasizing that this score [...]

Transitioning from Pediatric to Adult Care in Sickle Cell Disease: Patient and Caregiver Feedback

Introduction: Advances in pediatric sickle cell disease (SCD) care have resulted in children surviving into adulthood. Transition is a time when continuity of care is essential to prevent high rates of morbidity and mortality in adolescents and young adults (AYA). This descriptive study evaluated patients and caregivers’ experience with transition. Methods: Survey was conducted with AYA 20-21 years of age who transitioned from pediatric to adult care using Feedback and Post-assessment surveys. Results: Fifty-seven AYA attended transition and 15 did not from January 2018-January 2021. Eighty-seven percent who attended felt prepared to change to adult providers with 89% having seen their adult provider since leaving pediatric care. Discussion: The preparation received promoted self-efficacy for AYA to manage their own health care. AYA who did not attend clinic also did very well. The transition process should start early so AYA have the confidence needed to transition from pediatric to adult health care.

Effect of vitamin and mineral supplementation on nutritional status in children with chronic kidney disease: Protocol for a systematic review and meta-analysis.

Persistent kidney illness in children and those on dialysis therapy, risk of vitamin and mineral deficiencies due to abnormal renal metabolism, anorexia, inadequate intake, poor gastrointestinal absorption, drug-nutrient interaction, and dialysis-related losses. Adequate nutritional management is essential to achieve and maintain an optimal nutritional status for the usual pattern of growth, sexual and neurocognitive development, metabolic abnormalities, and ultimately reducing the risk of chronic mortality and morbidity in adulthood. The purpose of this paper is to describe a protocol for a systematic review to assess the effects of vitamin and mineral supplementation in children with chronic renal disease. This systematic review protocol is developed according to the Preferred Reporting Item for Systematic Review and Meta-Analysis Protocols (PRISMA-P) as well as the Cochrane group guidelines. Comprehensive searching for all possible relevant works of literature- such as PubMed, Google Scholar, MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Science-Direct, Scopus, Research-Gate, Clinical Trials for all randomized controlled studies, full paper articles, and articles written in English will be considered. The primary outcome of this review will be measuring any changes (such as changes in body mass, BMI, and overall Z-score) in the nutritional status of the children (age < 18 years) with chronic kidney disease following vitamin and mineral supplementations. This review will help better understand the effects of vitamin and mineral supplementation to improve nutritional status in CKD children and will create a guideline to determine the applicability of these interventions in different feasible settings. The systematic review protocol has been evaluated and approved by the institutional review board of North South University. Finding will be shared using traditional approaches, including scientific presentations, open-access peer-reviewed platforms. CRD42022341339.

Non-Invasive Vascular Elastography as a One-Step Imaging Technique to Evaluate Early Vascular Changes in Children Compared to B-Mode-Based Intima-Media Thickness Technique : A Validation Study Using Inter- and Intra-Rater Reliability.

Background: Childhood obesity is linked to higher adult mortality and morbidity from atherosclerosis. It is primordial to detect at-risk children earlier-on to prevent disease progression. Carotid intima-media thickness (IMT) is a subclinical radiological marker for early atherosclerosis. B-mode ultrasound is a known technique to assess IMT, but no gold standard technique exists in children. Non-invasive vascular elastography (NIVE) using speckle statistics is an innovative alternative to evaluate IMT and adds by providing translation, strain and shear strain measurements. Validation studies for both techniques lack in children. Purpose: Validate the reproducibility of the 2 techniques in Canadian children. Methods: We conducted a prospective study where anthropometry, blood pressure, IMT and elastography were measured. Six operators obtained 2 measurements for both carotid arteries using both techniques, for a total of 720 measurements. Inter- and intra-class correlation coefficients (ICC) were calculated for each measurement technique and elastography parameters. Results: 30 participants (13.0 ± 1.26years, 17 girls) were recruited. Twelve were overweight. No significant difference was found in mean IMT between weight groups for either technique (P = .15 and P = .60). We found excellent inter- (ICC = .98 [95% Confidence Interval (CI): .97; .99]) and intra- (ICC = .90-.93) operator reliability for the B-mode technique, and good inter (ICC = .70 [95% CI: .47; .85]) and intra- (ICC = .71-.91) operator reliability for the NIVE-based technique. Poor reliability was found between techniques (ICC = .30 [95% CI: -.31; .65). For elastography parameters, translation was the most reliable (ICC = .94-.95). Conclusion: IMT measurement is reproducible in children but not between techniques. NIVE gives the advantage of evaluating elastography.

Deferiprone attenuates neuropathology and improves outcome following traumatic brain injury.

Traumatic brain injury (TBI) remains a leading cause of mortality and morbidity in young adults. The role of iron in potentiating neurodegeneration following TBI has gained recent interest as iron deposition has been detected in the injured brain in the weeks to months post-TBI, in both the preclinical and clinical setting. A failure in iron homeostasis can lead to oxidative stress, inflammation and excitotoxicity; and whether this is a cause or consequence of the long-term effects of TBI remains unknown. We investigated the role of iron and the effect of therapeutic intervention using a brain-permeable iron chelator, deferiprone, in a controlled cortical impact mouse model of TBI. An extensive assessment of cognitive, motor and anxiety/depressive outcome measures were examined, and neuropathological and biochemical changes, over a 3-month period post-TBI. Lesion volume was significantly reduced at 3 months, which was preceded by a reduction in astrogliosis, microglia/macrophages and preservation of neurons in the injured brain at 2 weeks and/or 1 month post-TBI in mice receiving oral deferiprone. Deferiprone treatment showed significant improvements in neurological severity scores, locomotor/gait performance and cognitive function, and attenuated anxiety-like symptoms post-TBI. Deferiprone reduced iron levels, lipid peroxidation/oxidative stress and altered expression of neurotrophins in the injured brain over this period. Our findings support a detrimental role of iron in the injured brain and suggest that deferiprone (or similar iron chelators) may be promising therapeutic approaches to improve survival, functional outcomes and quality of life following TBI.

A novel integrated angioscope-laser system for atherosclerotic carotid artery occlusion: Feasibility and techniques.

IntroductionAtherosclerotic extracranial carotid artery stenosis accounts for about 20%–30% of all strokes, which is one of the leading causes of adult morbidity and mortality. Although carotid endarterectomy (CEA) is still the mainly operational manner for atherosclerotic carotid artery stenosis/occlusion (ACAS/ACAO), and carotid angioplasty and stenting (CAS) have been used as an alternative, both CEA and CAS have limitations of their own, such as extensive invasiveness and in-stent restenosis.MethodsIn this study we established a novel interventional system in vitro to take advantage of both CEA and CAS. Twenty consecutive carotid atherosclerotic plaques were harvested from the patients who underwent CEA. The plaques were randomized into two groups and inserted into the pruned and sutured descending aortas of the swine in vitro. The ZebraScope™ was modified with a protective device on its flexible tip, so that the plaque could be dissected from the wall of parent carotid artery and ablated completely without damage to the carotid artery. The holmium:YAG (Ho:YAG) and thulium fiber laser (TFL) generators were alternately used when needed.ResultsAll the carotid atherosclerotic plaques were completely ablated by Ho:YAG laser and/or TFL. The Ho:YAG laser was more effective for the atherosclerotic plaques with severe calcification, while the TFL was more suitable for those with moderate calcification. There were still some thermal injury spots on the inner wall of the parent carotid artery caused by the laser in the non-protected group B. In the protected group A, on the contrary, there was no even a thermal injury spot was found on the relevant location except for one sample. The difference of ablating duration was statistically significant between group A (36.5 ± 4.79 min) and group B (63.4 ± 6.55 min) (P < 0.01).ConclusionAccording to our knowledge, this is the first attempt to ablate carotid atherosclerotic plaques assisted by the ZebraScope™ in vitro. The protective and dissecting device on the tip of the angioscope makes it safe and visible when the ablation is performed to carotid atherosclerotic plaques. The Ho:YAG laser and TFL are effective and safe for ablating the plaque in vitro.

Seasonal challenges of tropical bats in temperate zones

To examine the challenges faced by free-ranging Rousettus aegyptiacus living at the northern edge of their distribution, we performed a retrospective analysis of 2196 clinical cases reported by a bat rescue NGO over a period of 36 months, from throughout Israel. All cases of injured bats were evaluated and categorized according to date, place, sex, age, and etiology of the morbidity. The data analysis revealed an increase in all types of morbidity during the wintertime, with more than two-fold the number of cases per week compared to in the summer, over three consecutive years. Moreover, we found that the number of abandoned pups peaked during spring and summer, when adult morbidity is minimal. We characterized two prominent types of previously undescribed morbidities in R. aegyptiacus. We also employed GPS tracking to monitor the movement and foraging of dozens of bats, and to examine the potential correlates of elevated winter morbidity. Our results suggest that it is mainly harsh weather that drives the observed winter morbidity, with food limitations playing a minor-role. We hypothesize that R. aegyptiacus, of tropical origin, is facing major seasonal survival difficulties near the northern edge of its distribution, probably limiting its spread further northwards still.

Impact of left atrial size and strain on new atrial arrhythmias during a 5-year follow-up in adults with congenital heart disease

Abstract Introduction Atrial arrhythmias are a common and important cause of morbidity and mortality in adults with congenital heart disease (ACHD). In acquired heart disease, left atrial (LA) strain has been shown to predict supraventricular tachyarrhythmias (SVT). This study sought to investigate if LA strain is also a reliable predictor of SVT in the ACHD population. Method We retrospectively obtained baseline clinical and echocardiographic data, including LA function parameters and strain, in 206 ACHD patients. Only patients with sinus rhythm at baseline and 5-years follow-up were included (median age 29, IQR 22–41 years). 157 participants had a left heart defect (aortic stenosis or aortic coarctation, with or without correction) and 49 a right heart defect (Fallot physiology). Diagnosis of sustained SVT was determined from clinical reports during the follow-up period (standard 12-lead ECG, ECG Holter). Results During a median follow-up of 6.2 years, a new or recurrent sustained SVT occurred in 16 patients (7.8%). Patients baseline characteristics are depicted in Table 1. Patients who developed SVT were older, had larger LA dimensions and left ventricular mass, more likely diastolic dysfunction on echo, and a lower peak LA longitudinal strain (PALS). PALS was a good predictor of SVT risk in patients with left and right heart defects with an area under the receiver-operating-curve of 0.857. By Cox regression analysis, patient in the lowest quartile for PALS had a 16.7-fold higher hazard ratio of SVT (95% confidence interval, 4.7 to 59.0, p&amp;lt;0.001) in comparison with the top three quartiles. Overall freedom from arrhythmia after 1, 3 and 5 years of follow-up was 98.1%, 96.1% and 94.2%, respectively. The freedom from SVT as a function of PALS quartiles is shown in Figure 1. Conclusion PALS provides predictive information about the occurrence of SVT in the ACHD population, regardless of the type of the lesion. Including the measurement of LA strain in the follow-up of these patients may permit to better identify patients at risk of future atrial arrhythmias. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Universitätsklinik für Kardiologie, Inselspital Bern

Does arterial stiffness progression temporally precede higher low-grade inflammation in adolescents? Causal longitudinal evidence using auto-regressive cross-lagged structural equation models

Abstract Background Arterial stiffness, a precursor of arteriosclerosis, measured using carotid-femoral pulse wave velocity (cfPWV) is a strong predictor of cardiovascular morbidity and mortality in adults. Emerging evidence among adolescents, young adults, and middle-aged adults suggest that arterial stiffness may predict the risk of hypertension, obesity, insulin resistance, and the onset of type 2 diabetes and could be a causal risk factor for these diseases. However, it is unknown whether higher arterial stiffness temporally precedes elevated inflammation in the young population or if there is a bi-directional relationship. This evidence is crucial to developing interventions for attenuating arterial stiffness in early life. Purpose To examine the temporal causal longitudinal associations between repeated measures of cfPWV and high sensitivity C-reactive protein (hsCRP). Methods We studied 3862 adolescents, aged 17.7 years, followed-up for 7 years, from Avon Longitudinal Study of Parents and Children, birth cohort, UK. Fasting plasma hsCRP was assessed at 17.7 and 24.5-year clinic visits. In the same clinic visits, cfPWV was computed from pressure waveforms obtained using the Vicorder device (Skidmore Medical, Bristol, UK), 5 minutes after participants rested in a semi-prone position, with 2 blood pressure measurement channels and 2 Velcro pressure sensor cuffs applied over each of the carotid and femoral arteries. The assessment was repeated until three readings that were within 0.5 m/s of each other were recorded. We conducted autoregressive cross-lagged structural equation model path analyses to untangle temporal associations. We adjusted for sex, time in years between ages 17.7 and 24.5 years, age, low-density lipoprotein cholesterol, insulin, triglyceride, high-density lipoprotein cholesterol, fasting blood glucose, systolic blood pressure, heart rate, dual-energy Xray absorptiometry measured total fat mass and lean mass, ActiGraph measured moderate to vigorous physical activity at 15.5 years, smoking status, and family history of cardiovascular and metabolic diseases. Results Among 3862 adolescents (55.5% female), median (IQR) hsCRP at 17.7 and 24.5 years were 0.56 (0.98) mg/L and 0.84 (1.62) mg/L, respectively. The median (IQR) cfPWV at 17.7 and 24.5 years were 5.79 (0.66) m/s and 6.12 (1.12) m/s, respectively. Higher hsCRP at age 17.7 years was associated with higher cfPWV [Standardized β = 0.058, standard error = 0.004, p=0.037] at age 24.5 years. However, higher cfPWV at age 17.7 years was not associated with higher hsCRP [β = 0.023, standard error = 0.243, p=0.341] at 24.5 years. Conclusion We observed that elevated low-grade inflammation in adolescence may temporally cause higher arterial stiffness 7 years later, but not vice versa. Clinical and public health interventions targeted at reducing low-grade inflammation to regress the development of arteriosclerotic cardiovascular disease before mid-adulthood are needed. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Finnish Cultural Foundation

3.77 COVID-19 Positivity Rates and COVID-19 Morbidity in Children and Adolescents With Mental Illness

COVID-19 positivity rates and COVID-19 morbidity in adults with mental illness (mental health disorders and substance-related disorders) have been mixed, with more severe morbidity being associated with bipolar disorder, psychotic disorders, and substance-related disorders. In children and adolescents with pre-existing mental illness, COVID-19 positivity and morbidity have been understudied. Thus, this study addresses this dearth and examined factors associated with COVID-19 positivity and morbidity (measured by hospital admission status and discharge status) in children and adolescents with mental illness.

Volume sweep imaging lung teleultrasound for detection of COVID-19 in Peru: a multicentre pilot study

ObjectivesPulmonary disease is a significant cause of morbidity and mortality in adults and children, but most of the world lacks diagnostic imaging for its assessment. Lung ultrasound is a portable,...

ROLE OF DEBULKING FOR BENIGN ENDOBRONCHIAL LESIONS: A CASE OF CHRONICALLY ASPIRATED FOREIGN BODY PRESENTING AS NECROTIZING PNEUMONIA

ROLE OF DEBULKING FOR BENIGN ENDOBRONCHIAL LESIONS: A CASE OF CHRONICALLY ASPIRATED FOREIGN BODY PRESENTING AS NECROTIZING PNEUMONIA