Optimal Prevention Strategies Research Articles

Low-dose colchicine for stroke prevention: a systematic overview of systematic reviews and meta-analyses.

Stroke incidence remains a significant concern despite optimized prevention strategies. Colchicine shows potential for improving stroke prevention globally. To summarize efficacy and safety estimates from systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs) comparing colchicine to usual care or placebo for stroke prevention. We conducted an overview of SRMAs according to the Preferred Reporting Items for Overviews of Reviews guidelines through a systematic search in Pubmed, Embase, and the Cochrane Library. Statistical analysis was performed using RevMan Web. Heterogeneity was assessed with I² statistics. Thirty-two studies were included. Colchicine significantly reduced stroke recurrence (RR 0.46; 95% CI 0.41-0.52; p < 0.0001; I² = 0%; OR 0.44, 95% CI 0.36-0.55; p < 0.0001; I² = 0%) but increased gastrointestinal adverse events (RR 1.54, 95% CI 1.33-1.79; p < 0.0001; I² = 63%; OR 1.60, 95% CI 1.08-2.38; p = 0.0007; I² = 82%). Most SRMAs (93.75%) showed reduced stroke incidence (RR 0.26-0.54), while 65.22% reported increased gastrointestinal events (RR 1.05-2.66). No significant differences were observed in mortality, infection or cancer rates. Overall quality was appraised as high in 28.12%, moderate in 6.25%, low in 40.06%, and critically low in 25% of SRMAs. Data were primarily derived from seven RCTs with low risk of bias. Moderate-quality evidence supports colchicine's benefits and reasonable safety for preventing stroke among high-risk populations. However, stroke was not the primary endpoint in analyzed studies. RCTs directly assessing colchicine for stroke prevention are warranted.

Abstract TP122: Impact of 2021 Seconary Stroke Prevention Guidelines on Post Stroke Care Plans for Patients Transferred to Long Term Acute Care Facilities

Background: Classification of etiologic ischemic stroke subtype guides post-stroke care and secondary prevention. Etiologic ischemic stroke subtypes are often not clearly documented in post-stroke care plans especially when transferring from one facility to another. In 2021, AHA/ASA published updated secondary stroke prevention guidelines recommending identifying etiologic ischemic stroke subtypes when possible. The impact of this on post-stroke care is unknown. Methods: Charts of all patients ages 18 and up, admitted from 1/1/20 to 5/23/21 and from 1/1/22 to 5/23/23 to 3 long-term acute care (LTAC) facilities, on antiplatelet therapy, and with an ascertainable history of stroke within 90 days of admission, were retrospectively reviewed to assess for documentation of ischemic stroke subtype at discharge/transfer to an LTAC facility and to assess for appropriateness of secondary stroke prevention therapies. Care plans from those two time periods were compared to assess for any impact the 2021 guidelines may have had on discharge practices. Results: Subtypes were not defined for the majority of ischemic strokes. Classification by etiologic subtype was observed in 33% of cases. Classification by territory or location was more common (Fig. 1). One-quarter of patients were on dual antiplatelet therapy (DAPT) and 75% of patients were on single antiplatelet therapy (SAPT) with more patients on DAPT in the latter time period (Fig. 2A). Rationale for DAPT were not provided for the majority of patients and NIHSS and ABCD2 scored were also not commonly provided for patients on DAPT (Fig. 2B). Close to 90% of patients were treated with antihypertensives and statin therapy at discharge to LTAC; 71% of patients were treated with diabetic therapies at discharge; stroke education at discharge to LTAC was documented for 43% of patients; and LDL was documented in 56% of patients (Fig. 3). Conclusions: Etiologic ischemic stroke subtypes were not documented for the majority of patients transferred to LTACs. Despite recent guideline revisions, an increase in documentation of stroke subtype was not observed. Optimal secondary stroke prevention strategies were difficult to assess without this information including appropriate antiplatelet regimens. Our findings highlight the importance of the need to improve post-stroke care plans at discharge and transfer including documentation of etiologic ischemic stroke subtypes to facilitate optimal post-stroke care across all transitions.

Clinical-pathological characteristics, follow-up, and survival of patients with early-onset vs late-onset colorectal cancer: Institutional experience in Argentina.

82 Background: The incidence of colorectal cancer (CRC) in young adults aged 50 or younger (Early Onset - EO) is increasing worldwide, while in patients over 50 years old (Late Onset - LO), it is declining. The objective is to compare the clinicopathological characteristics, time to diagnosis, and survival between Early Onset (EO) and Late Onset (LO) patients diagnosed with colorectal cancer (CRC). Methods: The sample was described using measures of central tendency and dispersion for continuous numerical variables and percentages for categorical variables. Clinical characteristics between Early Onset (EO) and Late Onset (LO) groups were compared using the Student’s t-test or Chi-square test. Kaplan-Meier curves and the Log-Rank Test were utilized to analyze mortality time. For multivariable analysis, a Cox regression model was applied. A p-value of less than 0.05 was considered statistically significant. The analysis was performed using RStudio. Results: A total of 460 patients were evaluated, with 343 diagnosed with colon adenocarcinoma and 117 with rectal cancer. Patients were grouped into two categories: the LO group with 408 (88.6%) patients and a mean age of 69.3 (8.60 SD) years, and the EO group with 52 (11.3%) patients and a mean age of 41.9 (6.23 SD) years. The EO group presented a higher percentage of patients with a PS of 0 compared to the LO group. In the EO group, there was a predominance of left-sided colon cancer (40.4% vs. 40.0%) and rectal cancer, especially in the middle and lower regions (30% vs. 18.8%), with disease diagnosed at stage III (26.9% vs. 26.5%) and IV (5.8% vs. 4.4%) compared to the LO group. Molecular testing for KRAS, NRAS, and BRAF mutations was more frequent in the EO group (19.2%, 3.8%, and 3.8%, respectively) compared to the LO group, as well as mismatch repair (MMR) status at 9.6% in the EO group vs. 6.9% in the LO group. The median time to diagnosis was 186 days in the LO group and 341 days in the EO group (p=0.21). Follow-up was 858 days in the LO group and 725 days in the EO group (p=0.18); while mortality was 200 (49.0%) in the LO group and 24 (46.2%) in the EO group, with a median survival of 1193 days for the LO group and 1414 days for the EO group, respectively (p=0.7). PS and stage were the most influential prognostic factors for mortality. Conclusions: In the comparison, the EO group showed a higher incidence of left-sided colon and rectal cancers, more advanced stages, better PS, and a greater number of molecular alterations, with a longer time to diagnosis and shorter follow-up. Although these differences were not statistically significant, they highlight the need to optimize prevention strategies and genetic counseling. Additional studies with a larger number of EO patients in real-life contexts are needed to generate more evidence that can improve clinical decision-making.

SPECTRUM OF FATTY LIVER AT TERTIARY CARE CENTRE OF NORTHEREN INDIA

Introduction: It isimportant to determinethe epidemiological factors like etiology, age, sex, mode of clinical presentation of fatty liver and development of complications like chronic liver disease, so as to design optimal and cost effective preventive and treatment strategies for the same. Aim: To determine spectrumof Fatty Liver at tertiary care centerof Northern India. Material and Methods:This was a prospective study conducted at Medical Gastroenterology Department, PGIMS,Rohtak , over a period of seven years i.e. 01.11.2017 to 31.10.2024, on 582confirmed patients of Fatty Liver. Results:The most common etiology seen was Non-Alcoholic Fatty liver disease (82.47%), followed by Chronic HBV infection (11.37%), Chronic Hepatitis C (3.60%) and Alcoholic Liver Disease (2.57%), Conclusion:The present study reveals that Nonalcoholic Fatty liver disease is most common causeof Fatty liver in Northern India.

P-2259. Incidence, Treatment, and Outcomes of Urinary Tract Infections Caused by Extended-Spectrum Beta-Lactamase Producing Bacteria in Kidney Transplant Recipients

Abstract Background Urinary tract infections (UTI) are the most common bacterial infection in kidney transplant recipients (KTR) during the first year post transplant. The objective of this study was to determine the incidence of UTI caused by extended-spectrum beta-lactamase (ESBL) producing bacteria in KTR and compare their outcomes to KTR with UTI caused by non-ESBL producing pathogens. Index Urinary Tract Infections (2013-2022) Methods This was a single-center, retrospective, chart review including adults who received their first, kidney-alone transplant from January 2013 through December 2022 and had a UTI within the first year post-transplant. A UTI was defined as a positive urine culture treated with antibiotics and presence of ESBL-producing bacteria was confirmed by susceptibility patterns. Patients were excluded if they had a rejection or received augmented immunosuppression prior to index UTI, received treatment for positive donor cultures, or were dialysis-dependent at 90 days post-transplant. Primary outcomes: incidence of index UTI caused by ESBL producing bacteria, location of treatment, and length of stay. Key secondary outcomes: patient and allograft survival, incidence of biopsy-proven rejection after treatment of index UTI, and number of UTI in the first year post-transplant. Primary Outcome: Hospitalizations Results Of 178 patients included, 21 (11.8%) had a UTI due to ESBL-producing bacteria and 157 (88.2%) had a UTI caused by a non-ESBL producing organism. The incidence of ESBL-UTIs increased from 0 to 18.5% during the observation period. No differences were identified in baseline characteristics except for receipt of a donation-after-cardiac-death kidney, 8 (38.1%) in the ESBL-UTI group and 28 (17.8%) in the non-ESBL UTI group, p = 0.03. Compared to the non-ESBL-UTI group, the ESBL-UTI group was more likely to be admitted for treatment 11/21 (52.2%) vs 40/157 (25.5%), p = 0.01, and had more UTIs in the first post-transplant year, mean (range) 2.7 (1-6) vs 1.8 (1-7), p = 0.003. No differences were identified in other outcomes. Empiric Therapy in Patients with Extended-Spectrum β-lactamase Urinary Tract Infections Conclusion The incidence of index UTI due to ESBL-producing bacteria is increasing while the UTI rate remains consistent, creating the need to identify optimal treatment and prevention strategies in KTR. Secondary Outcome: Total Urinary Tract Infections in the First Year Post-Transplant Disclosures All Authors: No reported disclosures

Incidence and Presentation of Periprosthetic Joint Infection After Primary Metacarpophalangeal and Proximal Interphalangeal Arthroplasty.

Periprosthetic joint infection (PJI) is a devastating complication that has been extensively investigated in large joint arthroplasty. However, this has been inconsistently reported after metacarpophalangeal (MCP) and proximal interphalangeal (PIP) arthroplasty. The objective of the study was to report the presentation and treatment of patients with PJI after MCP or PIP joint arthroplasty. We performed a retrospective review of 1418 primary MCP or PIP arthroplasties in 642 patients with a minimum of 180 days of follow-up (mean 9.0 years) at a single institution from 1991 to 2020. We also analyzed the association of patient (body mass index, smoking, diabetes, and immunocompromised status) and surgical (digit, implant, operative time, and reoperation) factors with infection. There were six joints, all in separate patients, that developed PJI (0.4%). The median time to PJI was 91.5 days. Of the six patients with PJI, five had no systemic symptoms and a normal leukocyte count. The most common cultured organism was Staphylococcus aureus. PJI was most commonly treated with hardware removal and antibiotics. PJI is uncommon after MCP or PIP arthroplasties. It commonly presents without systemic symptoms or leukocyte count and is most frequently caused by Staphylococcus aureus. More studies are needed to identify the optimal diagnostic criteria, treatment, and preventive strategies of PJI of the MCP and PIP joints. Therapeutic IV.

The future of personalized medicine in Saudi Arabia: Opportunities and challenges.

Personalized medicine is a healthcare approach that designs treatment plans of each patient, considering genetic, environmental, and lifestyle factors. This model leverages genomic information, advanced diagnostics, and data analytics to predict disease risk, optimize prevention strategies, and provide customized treatments. In Saudi Arabia, personalized medicine is gaining momentum, driven by the country's Vision 2030 initiative, which aims to transform the healthcare sector by integrating advanced medical technologies and improving healthcare delivery. The Kingdom has made significant strides in genomics and bioinformatics, with initiatives such as the Saudi Human Genome Program and advancements in institutions i.e.,King Faisal Specialist Hospital and Research Centre. Continued investment in research, education, and technology, alongside international collaborations, will be crucial in overcoming these challenges and realizing the full potential of personalized medicine. This review explores the current state, challenges, and future prospects of personalized medicine in Saudi Arabia, highlighting its transformative impact on healthcare delivery and patient outcomes.

Optimal control of production and maintenance: A cost-efficient approach through inventory and preventive strategies

&lt;p&gt;Using an optimal control framework, the optimization of production and maintenance processes is investigated in this paper. We focused on analyzing system behavior, managing costs, and controlling quality. Differential equations are utilized to model the relationship between inventory level, production, and maintenance strategies. A cost function is built combining different cost elements, and the optimal production and maintenance rates were obtained. A sensitivity analysis is performed to assess the impact of different parameters on the total cost and on the optimal solution. The key findings demonstrated that higher initial inventory levels significantly decreased long-term costs and improved production efficiency. The optimal preventive maintenance strategy emphasized the importance of early investments in quality and maintenance, leading to sustained operational stability.&lt;/p&gt;

What is the optimal strategy for secondary prevention after venous thromboembolism in polycythemia vera?

What is the optimal strategy for secondary prevention after venous thromboembolism in polycythemia vera?

Cost-effectiveness of human papillomavirus (HPV) vaccination in Tunisia: a modelling study

ObjectivesThe objective of this study is to assess the cost utility of the implementation of the human papillomavirus (HPV) vaccination programme in Tunisia in addition to the current cytology screening...

Efficacy and safety of edoxaban in patients with cardioembolic stroke

Ischemic strokes due to cardiogenic embolism are associated with an increased risk of death or permanent disability, which emphasizes the importance of their prevention. Edoxaban is a Xa inhibitor that is widely used globally as a new oral anticoagulant to prevent thromboembolic complications in patients with atrial fibrillation and an increased risk of stroke. The purpose of this review is to summarize data on the efficacy and safety of edoxaban in the secondary stroke prevention. The literature review was conducted using PubMed and Medscape databases to search for publications on clinical trials and clinical guidelines on oral anticoagulant treatment for stroke prevention. The results of clinical trials show that in patients with atrial fibrillation, edoxaban is non-inferior to warfarin in efficacy for primary and secondary stroke prevention, but compared to warfarin, edoxaban treatment is much safer (significantly reduces the risk of serious bleedings, including intracranial ones). The safety profile of edoxaban makes it one of the best drugs for the treatment of elderly patients and those with chronic kidney disease. In general, the results of recent clinical trials indicate that in cardioembolic stroke due to atrial fibrillation, the early initiation of treatment with direct oral anticoagulants is safe and reduces the risk of recurrent embolic events. Timely determination of the etiological subtype of ischemic stroke, in particular the detection of paroxysmal atrial fibrillation, and consideration of individual patient characteristics are the key to an optimal secondary prevention strategy that minimizes the risk of recurrent brain damage and improves the quality of life after stroke.

Interplaying Role of Epigenetic, Exercise and Nutrition in Metabolic Diseases

It is important to understand the interplay of epigenetic changes, exercise and nutrition associated with the development of obesity and type-2 diabetes because it offers insights into how environment and lifestyle factors can influence gene expression without altering the genetic code. This knowledge can lead to the development of optimal interventions and preventive strategies that could potentially decrease the rising rates of obesity and type-2 diabetes. The purpose of this review is to examine the interplay of epigenetic, exercise and nutrition on inflammation and metabolic diseases including obesity and type-2 diabetes, and to acquaint the clinicians and researchers with the current advancing and evolving field of exercise and epigenetics. The proposed mechanisms involved pertain to the development of insulin resistance in peripheral tissues and type-2 diabetes including inflammation. The benefits with regular exercise include improvement in metabolic health occurring through adaptative mechanisms in the adipose tissue, skeletal muscle, and liver as well as improvement in insulin resistance. Physical activity is defined by providing physiological characteristics of physical fitness that includes aerobic or cardiorespiratory fitness, and muscular strength and muscular endurance via regular aerobic exercise or resistance training. Exercise training encompasses training modality, exercise frequency and duration. We discuss the interplay of epigenetic mechanisms in inflammation that may contribute to the current worldwide obesity and type-2 diabetes. Specifically, epigenetic induces a change in phenotype without changes in genotype and thus the epigenome can modify the genome outcome through several processes that include DNA methylation, post-translational histone modification and gene regulation mediated by non-coding RNA (ncRNA) mechanisms that have been correlated with various metabolic and inflammatory diseases.

Clinical impact of the use of chronic suppressive antibiotics against recurrent ventricular assist device infections.

Ventricular assist device infections (VADIs) are a significant complication leading to hospital readmissions. However, the risk factors and optimal preventive strategies for VADI remain unclear. This study investigated the effectiveness of chronic suppressive antibiotic therapy in patients with VADI. We found that the use of chronic suppressive antibiotic therapy was associated with a reduction in the risk of VADI recurrence with few adverse reactions. Our findings suggest the potential benefit of chronic suppressive antibiotics in preventing infections in selected cases. Our findings are relevant for the management of patients with ventricular assist devices awaiting heart transplantation, providing valuable insights for clinical practice.

Time-Trend Analysis and Risk Factors for Niraparib-Induced Nausea and Vomiting in Ovarian Cancer: A Prospective Study.

Nausea and vomiting are major non-hematological adverse events associated with niraparib maintenance therapy. This study aimed to investigate the time-trend patterns of niraparib-induced nausea and vomiting (NINV) and the associated risk factors in patients with ovarian cancer. In this prospective study, we enrolled patients with stage III-IV epithelial ovarian cancer who received niraparib as frontline maintenance therapy. The clinicopathological characteristics and time-trend patterns of patients with NINV were collected through in-person surveys and electronic medical records from the National Cancer Center. Of 53 patients, 50 (94.3%) were diagnosed with high-grade serous ovarian carcinoma. BRCA mutations and homologous recombination deficiency (HRD) were identified in 23 (43.4%) and 32 (60.4%) patients, respectively. Thirty-one patients (58.5%) had NINV. Time-trend analyses revealed that the first peak intensity of NINV was reached at 3 h post-dose, and the second peak intensity was reached at 11 h post-dose. NINV significantly decreased from week 1 to weeks 8 and 12. In multivariate analyses of risk factors for NINV, HRD-positive tumors (p<0.001) and prior experience of chemotherapy-induced nausea and vomiting (p=0.004) were associated with the occurrence of NINV. Pre-emptive treatment with antiemetics are required to manage early-phase NINV during niraparib maintenance therapy in patients with risk factors. Additional larger studies are needed to confirm these findings and to develop optimal preventive strategies for NINV.

The most optimal school recruitment strategies for school-based obesity prevention and health promotion research in the United States: A systematic review with Delphi study.

This systematic review with the Delphi study aimed to identify effective and resource-efficient (optimal) strategies for recruiting schools into health promotion interventions in the United States. A literature search was conducted in PubMed, Cochrane Library, and CINAHL (EBSCO). A total of 116 interventions reported in 160 articles were included. Most school-based interventions did not report data regarding school recruitment duration (81%), target school size (63%), and school recruitment strategies (78%). Further, no details were provided regarding the reasons for declining to participate despite being eligible. For the Delphi, responses from 23 researchers in school-based clinical trials were collected. A qualitative descriptive approach was used for coding responses and collapsed into higher-order categories based on school recruitment strategies. Delphi participants reported that (1) creating new or leveraging pre-existing partnerships, (2) intervention champion, (3) minimal school disruptions, (4) working with open mind/flexibility, and (5) transparent communication are the most optimal school recruitment strategies. Staff time and travel were the most frequently reported costs for implementing those strategies. The overall trend in school-based obesity prevention intervention studies illustrates the importance of a better understanding school recruitment. Improved reporting can allow researchers to budget their time and resources better and provide greater confidence in reaching their target school size.

Antithrombotic treatment in univentricular heart

Abstract Background Univentricular heart (UVH) corrected with Fontan surgery may be associated with an increased risk of thrombosis. Data regarding optimal thrombotic prevention strategy after Fontan surgery in patients with UVH is scarce, and guidelines for antithrombotic treatment are not yet available. Purpose The aim was to evaluate the prevalence of antithrombotic treatments and their relation to mortality in patients with Fontan circulation. Methods A total of 5,075 patients with UVH were identified using data from the Swedish National Patient Register, the Cause of Death Register, and the National Prescribed Drug Register. Patients with UVH born in Sweden between 1970 and 2017 who underwent Fontan surgery were included. The study population was divided into three groups based on medication: anticoagulation therapy, antiplatelet therapy, and no therapy. Incidence rate (IR) was reported per 1000 person-years and calculated as the total number of deaths divided by total follow-up time. Confidence interval (CIs) for IR was estimated with Poisson regression. Kaplain-Meier was used to estimate the survival probability of 95% for UVH. The Stratified Cox proportional hazards model was used to estimate hazard ratios (HR) with 95% CI. Results The total cohort consisted of 864 patients of which 280 individuals (32%) had hypoplastic left heart syndrome (HLHS). The median follow-up time was 14.4 (IQR 3.9;24.9) years, maximum follow-up time was 47 years. Out of all the patients, 36% received no anticoagulation or antiplatelet therapy. Among those who did receive therapy, 75% were treated with antiplatelets. The patients who had no therapy had a higher mortality rate. During long-term follow-up, patients with UVH had higher survival rates when treated with antiplatelets. Conclusion Antithrombotic therapy, in particular antiplatelet therapy, was associated with the highest survival in patients with UVH as compared to no treatment. Our data suggest that antithrombotic treatment, and in particular antiplatelet treatment, could be considered in patients with UVH.Survival with Antithrombotic treatment

Use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation across five stages of chronic kidney diseases

Abstract Background Although non-vitamin K antagonist oral anticoagulants (NOACs) were more and more commonly prescribed in the daily practice, data about the use of NOACs in atrial fibrillation (AF) patients with stage 4 and 5 chronic kidney diseases (CKD) are limited. In the present study, we compared the clinical outcomes of AF patients receiving NOACs and those receiving warfarin or non-OACs in different stages of CKD. Methods A total of 39217 AF patients aged &amp;gt;20 years whose data about creatinine clearance (CCr) were available were identified from the electronic health record database of a multi-center healthcare system in Taiwan. Patients were categorized into stage 1 to stage 5 CKDs, and the composite risks of ischemic stroke/systemic embolism, major bleeding and mortality were compared between non-OACs, warfarin and NOACs. Results Around 12.7% and 9.4% of study patients had a stage 4 and stage 5 CKD, respectively. Compared to non-OACs, the use of OACs (either warfarin or NOACs) were consistently associated with a lower risk of composite events from stage 1 to stage 4 CKD, but not for stage 5 CKD (warfarin: aHR 0.912, 95%CI 0.742-1.121; NOACs: aHR 0.993, 95%CI 0.653-1.537)(Figure 1). Compared to warfarin, NOACs were associated with a lower risk of adverse events for patients with stage 2 (aHR 0.630), stage 3 (aHR 0.712) and stage 4 CKD (aHR 0.749). However, the risk did not differ between warfarin and NOACs for stage 1 and stage 5 CKD (Figure 2). Conclusions Although data of the clinical trials for AF patients with stage 4 CKD were relatively lacking, NOACs should still be considered for this AF population. More data are necessary to guide optimal stroke prevention strategy for patients with stage 5 CKD.

Cardiovascular events and consequent risk of death in hematopoietic stem cell transplant recipients

Abstract Background Hematopoietic stem cell transplant (HSCT) represents a potentially curative approach for various hematologic cancers and bone marrow disorders. Advancements in safety and efficacy have broadened the application of HSCT to older individuals and those with concurrent medical conditions predisposing them to cardiovascular (CV) issues. Despite the significant survival benefits offered by HSCT, it is accompanied by both short- and long-term complications, leading to considerable morbidity and mortality. CV complications, including heart failure, arrhythmias, acute thrombosis, pulmonary hypertension, and pericardial effusions, are among the potential adverse events following HSCT. Aim for the present registry is to determine how much CV complications are related to short-term survival in patients after HSCT. Methods Observational, monocentric cohort study consecutively enrolling all patients undergoing HSCT from 2019 to 2023. Inclusion criteria was &amp;gt;18 years, autologous or allogeneic HSCT, and written informed consent for the participation in the study. All patients underwent a complete cardiological examination, including 12-lead ECG, echocardiography, and cardiac biomarkers, before HSCT, and after 2,6 and 12-months. CV-related adverse events were defined as systolic dysfunction (even asymptomatic), thromboembolism (both VTE and PE), stroke, arrhythmias, pericarditis and hypertensive crises. Results 91 patients (34% female; mean age 54 +/- 12 years) were followed-up for a median of 2 years after HSCT. Major risk factors' prevalence was overall low (hypertension 28%, dyslipidaemia 33%, diabetes 9%, and only 11 patients (12%) had a positive history for CV events (6 atrial fibrillation, 4 coronary heart disease, 1 stroke) before HSCT. During follow-up, 26 patients (29%) experienced at least one CV-related adverse event, of which 7 (8%) were serious enough to require an hospital admission. CV adverse events included 5 new heart failure diagnosis, 5 new atrial fibrillation diagnosis, 10 episodes of VTE/PE, 4 pericarditis, one stroke and one hypertensive crisis. Twenty of all CV-related adverse events were reported within the first six months after HSCT (77%). Having a CV-related AE within the first six months after HSCT is associated with an increased risk of all-cause death (39% vs. 17%; log-rank p=.01; Figure 1). Conclusions CV-related adverse events are common in patients undergoing HSCT and strikes an overall young and healthy population. Having a CV-related adverse event in the six months following HSCT is a heavy prognostic factor for all-cause mortality. Therefore, an optimal prevention strategy including arrhythmia monitoring, echocardiographic follow-up and guideline-driven thromboembolic prophilaxis could improve patients' survival after HSCT.Figure 1

Association of modifiable risk factors with progression to dementia in relation to amyloid and tau pathology

BackgroundDementia preventive interventions targeting multiple modifiable risk factors are a promising approach. However, the impact of modifiable risk factors in the presence of beta-amyloid or phosphorylated-tau (p-tau) pathology is unclear.MethodsThe objective of the study was to examine the role of modifiable risk factors (vascular factors, depression, and smoking) in the progression to mild cognitive impairment (MCI) or dementia among 434 cognitively unimpaired (CU) and 611 individuals with MCI from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Vascular risk factors were summarized with the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) score, dichotomized into higher versus lower risk. Depression and smoking (yes/no) were categorised according to medical history or current symptoms. Analyses were stratified by beta-amyloid negative (A-) and positive (A +), p-tau negative (T-) and positive (T +), or beta-amyloid and p-tau negative (A-T-) and positive (A + T +) biomarker status. Cox proportional hazard models were adjusted for age, sex, education, baseline MMSE score, baseline hippocampal volume and ApoE4 carrier status.ResultsHigher CAIDE score was associated with increased risk of progression to all-cause dementia in most MCI subgroups: adjusted hazard ratios (aHR) [95% CI] were 3.1 [1.43; 6.53] in the A- subgroup, 1.7 [1.20–2.27] in T + , 2.6 [1.06–6.59] in A-T-, and 1.6 [1.15–2.22] in the A + T + subgroup. Smoking (yes/no) was associated with increased dementia aHR in the A + MCI subgroup: 1.6 [1.07–2.34]. Depression increased dementia aHR in the T + MCI subgroup: 1.5 [1.06–2.02]. No significant associations were found in the CU biomarker subgroups.ConclusionAddressing modifiable risk factors carries an important potential for reducing the risk of dementia even after the onset of Alzheimer's pathology. Knowledge of biomarker status can further optimize prevention strategies.

Bone health in childhood cancer survivors, is there really a problem? Pitfalls of assessment, calculating risk, and suggested surveillance and management for osteonecrosis and low and very low bone mineral density.

Childhood cancer survivors are at increased risk of developing (long-term) skeletal adverse effects, such as osteonecrosis, impaired bone mineral density, and fractures. This paper provides an overview of the current understanding of bone health in these survivors, examining whether it represents a significant concern. It focusses on the challenges of assessing and managing bone health in childhood cancer survivors, highlighting diagnostic pitfalls, methods for accurately identifying those at high risk, and suggested strategies for the surveillance and management of osteonecrosis and impaired bone mineral density. The need for improved surveillance strategies, particularly for high-risk survivors, alongside potential prevention and management options, including pharmacological and lifestyle interventions, is emphasised. Given the lack of consensus on optimal prevention and treatment strategies, the paper emphasises the need for further research to optimise care and improve long-term outcomes for childhood cancer survivors with bone health impairments.