Nine-month Follow-up Research Articles

Aesthetic Rehabilitation with Veneers Using Digital Precision: A Case Report

Smiling is an essential aspect of daily life, and a confident smile can greatly impact an individual's self-esteem. Aesthetic correction of the anterior teeth poses a challenge in dentistry, particularly in cases where there is spacing between the teeth. This can lead to a lack of confidence and negatively affect a person's self-image. Laminate veneers, a cosmetic dental procedure, involve attaching a thin layer of porcelain or resin composite material to the surface of a tooth. Compared to conventional methods, digital technology offers greater precision and efficiency in placing laminate veneers. Computerised templates guide the teeth preparation process, ensuring minimal tooth structure removal and accurate fitting of the veneers. The present report presents a case (43-year-old female patient) of spacing in the maxillary anterior that was corrected using a minimally invasive technique with laminate veneers and a fully digital workflow using lithium disilicate. The use of this material enhances the aesthetics of the patient's smile, requiring minimal tooth reduction and providing a natural appearance. The paper also includes a nine-month follow-up. Incorporating digital technology in the creation and placement of laminate veneers offers numerous benefits, including improved accuracy, reduced turnaround time, and the ability for patients to preview their enhanced smile.

Effects on secondary outcomes of the Brazilian version of the European unplugged drug use prevention program: drug knowledge, intention predictors, and life skill competencies

The drug use prevention program #Tamojunto2.0, a Brazilian version of the European Unplugged, showed effectiveness in preventing the alcohol use onset at short term. However, we aimed to evaluate the program effects on its secondary outcomes, such as drug knowledge, behavioral beliefs, attitudes, decision-making skills, and refusal skills. A cluster-randomized controlled trial (registration: RBR-8cnkwq) was conducted in 73 public middle schools in three Brazilian cities (N = 5,208 students; 49.4% girls; M age= 13.2 years). The intervention group attended twelve #Tamojunto2.0 lessons conducted by their own teachers previously trained. The control group received no intervention. Data were collected pre-intervention (February/March 2019) and at nine-month follow-up (November/December 2019). We used multiple imputation to handle missing data and performed multilevel mixed-effect regression models, adjusted for sex, age, socioeconomic status, and city. The #Tamojunto2.0 program seems to have increased drug knowledge (Coef.= 0.26, 95%CI = 0.17–0.36), and negative and non-positive alcohol beliefs (Coef.= 0.24, 95%CI= 0.05–0.42), according to its logical framework. Nevertheless, it was found no evidence regarding the program’s effect on marijuana beliefs, attitudes, decision-making skills, and refusal skills. These findings could explain the effectiveness of the program in preventing the onset of alcohol consumption in adolescent participants. More research is needed to observe the long-term effects of the program on primary and secondary outcomes.

New graduate registered nurses’ professional competence and the impact of preceptors’ education intervention: a quasi-experimental longitudinal intervention study

Aims and objectivesThe aim of this quasi-experimental longitudinal intervention study was to investigate new graduate nurses’ professional competence development after preceptors’ participation in an education intervention.BackgroundNew graduate registered nurses are expected to be competent in many areas of nursing. Expectations that are sometimes unrealistic may cause a sense of inadequacy and stress, and this may in turn prevent them from fully deploying their competencies. Competence development is related to practice environment, occupational commitment, empowerment, and work experience. Orientation or transition programs have been designed to ensure new graduate nurses’ competence, and preceptors and preceptorship could also have significant influence on their competence development.DesignA quasi-experimental longitudinal intervention study.MethodsThe data was collected from October 2015 to November 2017. Participating wards were randomized into intervention and control groups. The intervention group preceptors had an eight-hour education intervention that focused on new employees’ orientation, particularly from new graduates’ point of view. Wards in the control group continued to precept as before. The Nurse Competence Scale was used for new graduates’ self-assessment at baseline and at three-month and nine-month follow-up. This study is reported in accordance with the TREND Statement Checklist.ResultsThe education intervention aimed at preceptors did not have impact on the intervention group NGRNs’ competence development. There were no statistically significant differences between the groups and effect size remained small.ConclusionsThe preceptors’ education intervention was not effective enough to develop new graduates’ professional competence so that it would have differed from that of the graduates receiving conventional orientation at the university hospital. This study confirmed that competence development is a complex and multidimensional phenomenon and organizations should invest in new graduate registered nurses’ competence development during their early career. Preceptors’ education and development of preceptorship and transition programs are an important part of overall competence development in complex health care environments.Trial registrationRetrospectively registered

Abstract 13540: Characteristics of Home-Based Walking Exercise Interventions Associated With Greater Improvement in Walking Performance in Peripheral Artery Disease: A Post-Hoc Analysis of the HONOR Randomized Clinical Trial Results

Introduction: Benefits of home-based exercise (HBE) interventions in lower extremity peripheral artery disease (PAD) are variable. This post-hoc analysis of the HONOR randomized trial studied characteristics of a home-based exercise intervention associated with greater 6-minute walk improvement in PAD. Methods: HONOR was a multi-centered randomized trial. PAD participants were randomized to either a HBE intervention or usual care for 9 months. The intervention consisted of four weekly in-person visits with an exercise coach followed by 16 telephone coaching calls over the next eight months. Participants were asked to walk for exercise five days/week, wear a Fitbit to monitor activity, upload their Fitbit on the study website, and visit the website at least weekly to view their exercise goals and monitor their progress toward exercise goals. The primary outcome was change in 6-minute walk distance at 9-month follow-up. Results: Of 200 people randomized (age 70 yrs. ±10.4, 52.5% female, 50% Black), 182 (91%) completed nine-month follow-up. Overall, the exercise intervention did not improve 6-minute walk compared to usual care [+5.5 vs. +14.4 m respectively (Mean diff: –8.9 m, 95% CI, –26.0, +8.2 m, P = .31)]. Among the 99 people randomized to HBE, change in 6-minute walk ranged from -239.2-233.7. See table for characteristics associated with greater six-minute walk improvement. Conclusion: In a home-based exercise intervention for PAD, more frequent use of the intervention website and greater exercise sessions/week, but not more time wearing a Fitbit, were associated with greater 6-minute walk improvement. Future home-based exercise interventions for PAD should help patients self-monitor exercise behavior and increase exercise sessions per week.

How do high ambient temperatures affect infant feeding practices? A prospective cohort study of postpartum women in Bobo-Dioulasso, Burkina Faso

ObjectiveTo examine the effects of high ambient temperature on infant feeding practices and childcare.DesignSecondary analysis of quantitative data from a prospective cohort study.SettingCommunity-based interviews in the commune of Bobo-Dioulasso, Burkina...

Improving multimorbidity measurement using individualized disease-specific quality of life impact assessments: predictive validity of a new comorbidity index

BackgroundInterpretation of health-related quality of life (QOL) outcomes requires improved methods to control for the effects of multiple chronic conditions (MCC). This study systematically compared legacy and improved method effects of aggregating MCC on the accuracy of predictions of QOL outcomes.MethodsOnline surveys administered generic physical (PCS) and mental (MCS) QOL outcome measures, the Charlson Comorbidity Index (CCI), an expanded chronic condition checklist (CCC), and individualized QOL Disease-specific Impact Scale (QDIS) ratings in a developmental sample (N = 5490) of US adults. Controlling for sociodemographic variables, regression models compared 12- and 35-condition checklists, mortality vs. population QOL-weighting, and population vs. individualized QOL weighting methods. Analyses were cross-validated in an independent sample (N = 1220) representing the adult general population. Models compared estimates of variance explained (adjusted R2) and model fit (AIC) for generic PCS and MCS across aggregation methods at baseline and nine-month follow-up.ResultsIn comparison with sociodemographic-only regression models (MCS R2 = 0.08, PCS = 0.09) and Charlson CCI models (MCS R2 = 0.12, PCS = 0.16), increased variance was accounted for using the 35-item CCC (MCS R2 = 0.22, PCS = 0.31), population MCS/PCS QOL weighting (R2 = 0.31–0.38, respectively) and individualized QDIS weighting (R2 = 0.33 & 0.42). Model R2 and fit were replicated upon cross-validation.ConclusionsPhysical and mental outcomes were more accurately predicted using an expanded MCC checklist, population QOL rather than mortality CCI weighting, and individualized rather than population QOL weighting for each reported condition. The 3-min combination of CCC and QDIS ratings (QDIS-MCC) warrant further testing for purposes of predicting and interpreting QOL outcomes affected by MCC.

A prospective, multicentre first-in-man study of the polymer-free ultrathin-strut BIOrapid stent (BIOVITESSE).

Polymer-free drug-coated stents aim to avoid the inflammatory potential of durable polymers, thereby improving the long-term safety profile, and allowing a shorter duration of dual antiplatelet therapy. The BIOVITESSE study was conducted to assess the safety and clinical performance of the BIOrapid polymer-free coronary stent system coated with a novel highly lipophilic sirolimus derivate. BIOVITESSE was a prospective, multicentre, first-in-man study that enrolled subjects with de novo coronary lesions in two cohorts of 33 patients each. The primary endpoint of the first cohort was strut coverage at one month as assessed by optical coherence tomography. The primary endpoint of the second cohort was late lumen loss at nine-month follow-up. Patients were on average 63 years old (range: 42-87) and 12% had diabetes. The 66 patients had 70 lesions with an average lesion length of 12.5±5.4 mm. Predilatation was performed in 91.4% and post-dilatation in 87.1% lesions; device success was obtained in 97.4%. At one month, 95.2±5.6% (95% CI: 93.2-97.2) of struts were covered and at nine months, in-stent late lumen loss was 0.31±0.30 mm (95% CI: 0.20-0.42) and in-segment late lumen loss was 0.20±0.29 mm. Two target lesion failures occurred (3.1%): one at day 1 (to cover an asymptomatic stent edge dissection), and one at day 288 post-procedure for restenosis. No stent thrombosis was reported during the 12-month study duration. The BIOrapid stent system exhibited an excellent safety profile, high strut coverage at one-month, and moderate angiographic efficacy according to the late lumen loss at nine-month angiographic follow-up.

Hair safe study: Effects of scalp cooling on hair preservation and hair regrowth in breast cancer patients receiving chemotherapy - A prospective interventional study

Hair safe study: Effects of scalp cooling on hair preservation and hair regrowth in breast cancer patients receiving chemotherapy - A prospective interventional study

Associations of intensity and emotional connection related to online social networking use on the risk of incident depression among Chinese adolescents: A prospective cohort study

ObjectiveTo investigate the longitudinal prediction of intensity and emotional connection (EC) related to online social networking use at baseline on the risk of incident depression at nine-month follow-up among adolescents. MethodsA total of 3196 secondary school students, who were online social networking users and free of depression at baseline, were included in this study. Multilevel logistic regression models were applied to investigate the longitudinal prediction of two dimensions of online social networking use intensity (social function use intensity (SFUI), entertainment function use intensity (EFUI)) and EC scores at baseline on incident depression at follow-up. ResultsThe incidence of depression was 23.37 per 100-person-years during a nine-month follow-up period. Baseline SFUI and EFUI scores were significantly associated with higher level of incident depression (adjusted OR = 1.017, 95% CI: 1.004–1.029 for SFUI, p = 0.010; adjusted OR = 1.046, 95% CI: 1.012–1.080 for EFUI, p = 0.007), after adjustment of significant background factors and baseline depressive symptom score. The associations of EC at baseline and its interaction with SFUI and EFUI on incident depression were statistically non-significant. ConclusionOnline social networking use seems be a risk factor of depression among adolescents, regardless of its specific functions. Early intervention is recommended to reduce the level of online social networking use intensity as a means of preventing depression among adolescents.

Discharge planning from hospital.

Discharge planning is a routine feature of health systems in many countries that aims to reduce delayed discharge from hospital, and improve the co-ordination of services following discharge from hospital and reduce the risk of hospital readmission. This is the fifth update of the original review. To assess the effectiveness of planning the discharge of individual patients moving from hospital. We searched CENTRAL, MEDLINE, Embase and two trials registers on 20 April 2021. We searched two other databases up to 31 March 2020. We also conducted reference checking, citation searching and contact with study authors to identify additional studies. Randomised trials that compared an individualised discharge plan with routine discharge that was not tailored to individual participants. Participants were hospital inpatients. Two review authors independently undertook data analysis and quality assessment using a pre-designed data extraction sheet. We grouped studies by older people with a medical condition, people recovering from surgery, and studies that recruited participants with a mix of conditions. We calculated risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous data using fixed-effect meta-analysis. When combining outcome data it was not possible because of differences in the reporting of outcomes, we summarised the reported results for each trial in the text. We included 33 trials (12,242 participants), four new trials included in this update. The majority of trials (N = 30) recruited participants with a medical diagnosis, average age range 60 to 84 years; four of these trials also recruited participants who were in hospital for a surgical procedure. Participants allocated to discharge planning and who were in hospital for a medical condition had a small reduction in the initial hospital length of stay (MD - 0.73, 95% confidence interval (CI) - 1.33 to - 0.12; 11 trials, 2113 participants; moderate-certainty evidence), and a relative reduction in readmission to hospital over an average of three months follow-up (RR 0.89, 95% CI 0.81 to 0.97; 17 trials, 5126 participants; moderate-certainty evidence). There was little or no difference in participant's health status (mortality at three- to nine-month follow-up: RR 1.05, 95% CI 0.85 to 1.29; 8 trials, 2721 participants; moderate certainty) functional status and psychological health measured by a range of measures, 12 studies, 2927 participants; low certainty evidence). There was some evidence that satisfaction might be increased for patients (7 trials), caregivers (1 trial) or healthcare professionals (2 trials) (very low certainty evidence). The cost of a structured discharge plan compared with routine discharge is uncertain (7 trials recruiting 7873 participants with a medical condition; very low certainty evidence). A structured discharge plan that is tailored to the individual patient probably brings about a small reduction in the initial hospital length of stay and readmissions to hospital for older people with a medical condition, may slightly increase patient satisfaction with healthcare received. The impact on patient health status and healthcare resource use or cost to the health service is uncertain.

Case management aftercare service provision to homeless people who use drugs in Iran; a nine-month post-treatment follow-up

ABSTRACT The aim of study was to assessing the provision of case management services to homeless people who use drugs. 4358 people were recruited and followed up for nine months after discharge. The average age of the participants were 37.8 ± 5.71. In the first month, 15.9% of the total participants had a job, about half abstained from illegal drug use, about 38% reunited with their families, 51.1% accommodated and 39.1% had identity documents. In the ninth month (N = 136), the variables of abstinence from illegal substances, family reunification and accommodation had the highest rates compared to previous months.

ПОШУКОВЕ ДОСЛІДЖЕННЯ ПРЕДИКТОРІВ ПІЗНІХ РЕЦИДИВІВ АРИТМІЇ У ПАЦІЄНТІВ З ПЕРСИСТУЮЧОЮ ФІБРИЛЯЦІЄЮ ПЕРЕДСЕРДЬ ПІСЛЯ КАРДІОВЕРСІЇ

Introduction. The existing guidelines do not contain a clear algorithm for predicting the late recurrences of atrial fibrillation (AFib). Objectives. We have studied the predictors of late recurrence of arrhythmia in patients with persistent AFib after the restoration of sinus rhythm (SR). Research methods. A prospective single-center study included 120 hospitalized patients with persistent AFib who underwent successful cardioversion. The recurrence of AFib was assessed in the early period after cardioversion by recording 12-channel ECG, Holter ECG monitoring and event ECG monitoring. After a nine-month period follow-up visit was performed. Baseline demographic, clinical-functional features and comorbidities were compared in group with (n = 87) and without (n = 33) late recurrences of Afib. Results. There were no differences in demographic, anthropometric data and comorbidities. Patients with late recurrence of AFib had a lower heart rate (HR) after SR recovery (p <0.001). Early recurrences of AFib were found in 43 (49.4%) patients with late recurrences of arrhythmia and only in two (6.0%) without late recurrences (p <0.001). Patients with late recurrences of arrhythmia had a lower average daily HR (p <0.001), a higher number of single atrial extrasystoles (p = 0.001), atrial pairs and runs (p = 0.01) recorded by Holter ECG monitoring. Conclusions. Late recurrences of arrhythmia during the nine-month follow-up period were reported in 72.5% of patients. Groups of patients with and without late recurrence of arrhythmia had significant differences in the incidence of early recurrences, mean HR on SR, and the presence of atrial extrasystoles after rhythm recovery.

Sleep, Distressed Appearance, and Quality of Life Relate to Satisfaction with Orthognathic Surgery.

Background: In this study, we aimed to identify factors correlating with satisfaction with orthognathic surgery in order to improve its outcome. Methods: We recruited 77 participants who had received orthognathic surgery and 32 age- and gender-matched normal-controls. Questionnaires that included devised questions for family support, Big Five Inventory, Derriford Appearance Score, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, 36-Item Short-Form Health Survey, and a visual analogy scale for satisfaction, were completed before and one month and nine months after the surgery. The statistical analysis methods included descriptive statistics, t-test, and Pearson correlation. Results: All participants received the preoperative and one-month follow-up, while 28 also completed the nine-month follow-up. Satisfaction was not significantly related to demographic data, but long-term satisfaction was related to an extraverted personality. The preoperative and postoperative results of the Derriford Appearance Scale were related to short-term and long-term satisfaction. Furthermore, both the preoperative and one-month postoperative Pittsburgh Sleep Quality Index findings were significantly related to short-term satisfaction. The postoperative 36-Item Short-Form Health Survey was significantly related to short-term and long-term satisfaction. Conclusions: Not only subjective distress and dysfunction of appearance but also sleep problems and quality of life were correlated to satisfaction with orthognathic surgery. In the future, relevant interventions can be developed to further improve patient’s satisfaction and their physical and mental health.

Physical Activity After Covid-19 Part 2: Symptoms Relating To Decreases In Physical Activity

PURPOSE: We have reported significant reductions in physical activity [PA] 9 months following COVID-19 infection. In this same cohort of patients, we determined symptoms experienced during acute illness and during recovery to determine which were associated with significant reductions in PA. METHODS: 8,000 patients who had tested positive for the COVID-19 virus between March and May 2020 within a large healthcare system in the greater New York City area were contacted. Participants completed a 13-item Physical Activity History [PAH] regarding their PA during the 3-months prior to infection and for the current month [December 2020]. They also indicated symptoms they had during their acute illness, and those they were currently experiencing. Patients whose pre-infection PA score was >0 [346: 158 men, 188 women, age 53 ± 14 yr, BMI 28.9 ± 6.5] were stratified into two groups: those who had less than 80% recovery of PA at follow-up [174] and those who had greater than 80% [172]. Differences in the number of patients in each PA grouping were assessed using Fisher’s Exact test for each symptom experienced during acute illness and for current symptoms. RESULTS: Only 11 patients reported no symptoms at the time of acute illness. Surprisingly, none of the symptoms experienced during infection were associated with reduced PA 9 months later. At 264 ± 7 days follow-up, 142 subjects still reported symptoms related to COVID-19. Those reporting lingering symptoms had greater reductions in PA at follow-up compared to those reporting none [p < 0.001]. Results for the most-commonly reported symptoms at nine-month follow-up are shown in the table. CONCLUSIONS: In our cohort, 41% had lingering symptoms nine months after diagnosis. No symptoms experienced during acute illness were associated with poorer return of PA. Fatigue, shortness of breath, difficulty concentrating and body aches were more commonly seen in those with <80% PA recovery, illustrating the systemic, chronic nature of the disease.

Thin- versus thick-strut polymer-free biolimus-eluting stents: the BioFreedom QCA randomised trial.

The BioFreedom drug-coated stent with a stainless steel platform (BF-SS) has been demonstrated to be efficacious in patients at high bleeding risk and receiv-ing only one-month dual antiplatelet therapy. The aim of this study was to evaluate the efficacy of the new BioFreedom Ultra drug-coated stent with a thin-strut cobalt-chromium platform (BF-CoCr) compared to the BF-SS in an all-comers population undergoing percutaneous coronary intervention (PCI). This was a prospective, multicentre, non-inferiority trial. The primary endpoint was in-stent late lumen loss (LLL) as determined by quantitative coronary angiography at nine-month follow-up. Clinical evaluation was performed at one year. A total of 200 patients were randomised (1:1) to either the BF-CoCr or the BF-SS stent at eight centres in Spain and Denmark. Baseline clinical and lesion characteristics were similar between the groups. Mean age was 66 years and 23% were female. The mean number of stents implanted per patient was 1.5. At nine-month follow-up, mean in-stent LLL was 0.34±0.49 mm in the BF-CoCr group versus 0.29±0.37 mm in the BF-SS group, p=0.005 for non-inferiority. At one year, target lesion failure was similar between the groups (7.3% in BF-CoCr vs 9.3% in the BF-SS group; p=0.60). The BF-CoCr was non-inferior to the BF-SS in terms of in-stent LLL at nine months. Larger studies powered for clinical endpoints are warranted to compare the efficacy of this new platform with currently available DES.

Education of patients with prosthetic heart valves using Internet technologies

Aim. To evaluate the effectiveness of education in patients with heart valve prostheses using online technologies. Material and Methods. Two groups of patients were examined. Patients in group 1 ( n = 122) underwent the standard education program; patients in group 2 ( n = 86) underwent distant education using the online technologies (video teleconferencing). The quality of life, adherence to treatment, and time in therapeutic range (TTR) of international normalized ratio (INR) were assessed. Results . The quality of life and adherence to treatment did not differ between groups of patients at baseline. At nine-month follow-up, mental health improved by 30% in patients undergoing their education using the online technologies ( p = 0.0040). Similarly, their adherence to treatment increased by 1.4 times ( p = 0.0002) and TTR expanded by 20% ( p = 0.014). Conclusion . Patient education using the online technologies demonstrated its beneficial potential and represents the priority area in rehabilitation of patients after cardiac surgery.

The Effectiveness of Probiotic Lactobacillus rhamnosus and Lactobacillus casei Strains in Children with Atopic Dermatitis and Cow's Milk Protein Allergy: A Multicenter, Randomized, Double Blind, Placebo Controlled Study.

Probiotics seem to have promising effects in the prevention and treatment of allergic conditions including atopic dermatitis (AD) and food allergy. The purpose of this multicenter randomized placebo-controlled trial was to evaluate the effectiveness of a probiotic preparation comprising Lactobacillus rhamnosus ŁOCK 0900, Lactobacillus rhamnosus ŁOCK 0908, and Lactobacillus casei ŁOCK 0918 in children under 2 years of age with AD and a cow’s milk protein (CMP) allergy. The study enrolled 151 children, who—apart from being treated with a CMP elimination diet—were randomized to receive the probiotic preparation at a daily dose of 109 bacteria or a placebo for three months, with a subsequent nine-month follow-up. The primary outcomes included changes in AD symptom severity assessed with the scoring AD (SCORAD) index and in the proportion of children with symptom improvement (a SCORAD score decreased by at least 30% in comparison with that at baseline). After the three-month intervention, both the probiotic and placebo groups showed a significant (p < 0.0001) decrease in SCORAD scores, which was maintained nine months later. The percentage of children who showed improvement was significantly higher in the probiotic than in the placebo group (odds ratio (OR) 2.56; 95% confidence interval (CI) 1.13–5.8; p = 0.012) after three months. Probiotics induced SCORAD improvement mainly in allergen sensitized patients (OR 6.03; 95% CI 1.85–19.67, p = 0.001), but this positive effect was not observed after nine months. The results showed that the mixture of probiotic ŁOCK strains offers benefits for children with AD and CMP allergy. Further research is necessary to assess the effect of probiotic supplementation on the development of immune tolerance (NCT04738565).

Sustained benefits of cognitive training in children with inattention, three-year follow-up.

The goal of this study was to test for long-term benefits three years after the completion of a cognitive training intervention (Project: EVO™) in a subset of children with Sensory Processing Dysfunction (SPD). Our initial findings revealed that children with SPD who also met research criteria for Attention Deficit Hyperactivity Disorder (SPD+IA) showed a significant decrease in parent-observed inattentive behaviors, which remained stable in a nine-month follow-up assessment. Forty nine caregivers of participants who completed the Project: EVO™ training were contacted to be included in this follow up study. Each was emailed an invitation to complete the Vanderbilt ADHD Diagnostic Parent Rating Scale, which yielded a completion rate of 39/49 (80%). A Generalized Estimating Equations analysis was used to assess changes in symptoms over time, specifically to determine whether the initial improvements were retained. The SPD+IA cohort continued to show sustained benefits on their parent-reported scores of inattention, with 54% of SPD+IA individuals no longer meeting criteria for ADHD three years following intervention. These findings provide initial insights into the potential long-term benefits of a digital health intervention for children with attention-based issues.

32. Risk Factors for Vertical Transmission of t. Cruzi infection in an Endemic Setting

Members of the Chagas Disease Working Group in Peru and Bolivia includeEdith Hinojosa, Clariza Chavez, Jean Karla Velarde, Carla Chavarria, Victoria Serrudo, Roberto Araya, Alcides Buitron, Rita Mendieta, Holger Mayta, Maritza Calderon, Holger Mayta and Yagahira Castro.BackgroundVertical transmission of Trypanosoma cruzi infection accounts for a growing proportion of new cases of Chagas disease. Congenital infection is curable if treated promptly, but the majority of infected infants do not receive timely diagnosis or treatment. Better risk stratification is needed to predict which women are more likely to transmit the infection.MethodsThis study enrolled women who presented for delivery and their infants at the Percy Boland Women’s Hospital in Santa Cruz, Bolivia. Pregnant women were screened for Chagas disease by rapid test. The infants of seropositive mothers underwent diagnostic testing with microscopy (“micromethod”) and quantitative polymerase chain reaction (qPCR) as newborns and at one- and nine-month follow-up. Mothers completed surveys about demographics and medical history.ResultsAmong 5,828 enrolled women, 1,271 (21.8%) screened positive for Chagas disease. Of the 1,325 infants of seropositive mothers, 113 (8.5%) were diagnosed with congenital Chagas disease by microscopy or qPCR. Cesarean delivery was significantly associated with lower odds of vertical transmission (adjusted OR: 0.63, 95% CI: 0.41–0.98, p=0.040). Congenital infection was more common in twins (adjusted OR: 3.30, 95% CI: 1.97–5.54, p< 0.001) and male infants (adjusted OR: 1.50, 95% CI: 1.01–1.22, p=0.045).ConclusionOur findings suggest that Cesarean delivery may be protective against vertical transmission of T. cruzi, while twins and male infants may have an increased risk. A better understanding of risk stratification for congenital Chagas disease may help improve regional initiatives to reduce disease burden.Disclosures All Authors: No reported disclosures

Multicenter experiences with levosimendan therapy and its safety in patients with decompensated advanced heart failure.

Advanced heart failure (AdvHF) is associated with high morbidity and mortality. Patients with this clinical condition are potential candidates for heart transplantation or mechanical circulatory support. Initially, however, they are usually supported with inotropic drugs. Recent studies have suggested that levosimendan, independently of hemodynamic improvements, may lead to outcome benefits. To present clinical experiences concerning the indications, effectiveness, tolerance, and safety of levosimendan in the real-life therapy of patients with decompensated AdvHF in 3 cardiac centers in Poland. This is a prospective, observational, three-center study. Forty-nine patients with AdvHF admitted with decompensation were included (88% men, mean age 58 years, 65% ischemic etiology, left ventricular ejection fraction (LVEF) in median 20%) and followed up for an early (3 months) and prolonged period (1 year) after infusion of levosimendan. Patients were analyzed in relation to death. Levosimendan therapy was associated with reduced HF symptoms and signs, New York Heart Association (NYHA) class and level of B-type natriuretic peptide (BNP) at discharge. Five patients died during hospitalization, a further 10 during the three-month follow-up and 3 died during the next nine-month follow-up. During the three-month follow-up, 22 patients were re-hospitalized due to HF and in the next nine-month follow-up 8 were re-hospitalized. A multivariate analysis indicated the QRS duration at discharge (hazard ratio (HR) = 1.02; 95% confidence interval (95% CI) = 1.003-1.03; p = 0.018), high-sensitivity C-reactive protein (hsCRP) (HR = 1.01; 95% CI = 1.004-1.02; p = 0.002), and simultaneous dobutamine infusion (HR = 6.54; 95% CI = 1.4-30.5; p = 0.017) were independent risk factors for death in the one-year follow-up. There were no side effects leading to the interruption of the levosimendan infusion. The use of levosimendan was safe and associated with clinical improvement and reduction in BNP level in AdvHF patients hospitalized due to HF decompensation, although the mortality and re-hospitalization rate during the one-year follow-up remains high.