Presence Of Adverse Outcomes Research Articles

Velocity-selective arterial spin labeling perfusion measurements in 2nd trimester human placenta with varying BMI

IntroductionProper placental development is crucial to fetal health but is challenging to functionally assess non-invasively and is thus poorly characterized in populations. Body mass index (BMI) has been linked with adverse outcomes, but the causative mechanism is uncertain. Velocity-selective arterial spin labeling (VS-ASL) MRI provides a method to non-invasively measure placental perfusion with robustness to confounding transit time delays. In this study, we report on the measurement of perfusion in the human placenta in early pregnancy using velocity-selective arterial spin labeling (VS-ASL) MRI, comparing non-obese and obese participants. MethodsParticipants (N = 97) undergoing routine prenatal care were recruited and imaged with structural and VS-ASL perfusion MRI at 15 and 21 weeks gestation. Resulting perfusion images were analyzed with respect to obesity based on BMI, gestational age, and the presence of adverse outcomes. ResultsAt 15 weeks gestation BMI was not associated with placental perfusion or perfusion heterogeneity. However, at 21 weeks gestation BMI was associated with higher placental perfusion (p < 0.01) and a decrease in perfusion heterogeneity (p < 0.05). In alignment with past studies, perfusion values were also higher at 21 weeks compared to 15 weeks gestation. In a small cohort of participants with adverse outcomes, at 21 weeks lower perfusion was observed compared to participants with uncomplicated pregnancies. DiscussionThese results suggest low placental perfusion in the early second trimester may not be the culpable factor driving associations of obesity with adverse outcomes.

ПРИМЕНЕНИЕ КСЕНОГЕННОГО КОЛЛАГЕНОВОГО ГЕЛЯ И ЛАЗЕРНОГО ИЗЛУЧЕНИЯ ПРИ ПРОФИЛАКТИКЕ И ЛЕЧЕНИИ ПЕРИИМПЛАНТИТА: ПИЛОТНОЕ ИССЛЕДОВАНИЕ

Subject. The periimplantitis management and prophylaxis technique using xenogenic collagen gel and laser technique, analysis of their results.&#x0D; Aim. To evaluate the effect of periimplantitis management and prophylaxis with xenogenic collagen gel and laser technique. &#x0D; Methodology. The study was conducted on the basis of Sechenov University from 2020 to 2022. The study included ten patients with diagnosed peri-implantitis (age range 28–45 years, median is 35 years). All patients underwent professional hygiene followed by division into 2 groups by random sampling: patients of group 1 were injected with xenogenic collagen gel in the area of the peri-implant pocket and in the soft tissues around the dental implant in the area of alveolar bone resorption, patients of group 2 were subjected to laser bactericidal treatment of peri-implant pockets. The results were evaluated by the depth of probing of the peri-implant pocket and the clinical symptoms of the disease, the presence of adverse outcomes after the application of the techniques.&#x0D; Results. During 12 months of observation, a decrease in the depth of the peri-implant pocket during probing was noted by an average of 3 mm from the initial depth in both groups (p &lt; 0.05), an increase in the volume of soft tissues around the implants, mainly when xenogenic gel was used (p &lt; 0.05).&#x0D; Conclusions. Xenogenic collagen gel and laser microbiocidal treatment of peri-implant pockets may be an alternative treatment for peri-implantitis after full-fledged randomized clinical multicenter trials.

Hospital outcomes in patients evaluated by rheumatology in a Colombian historical cohort

IntroductionHospitalized patients with systemic autoimmune rheumatic diseases (SARDs) generate high impact in clinical terms. ObjectivesTo characterize the study population and estimate risk factors associated with the presence of adverse outcomes in hospitalized patients consulting rheumatology at Clínica Imbanaco between January 2013 and December 2019. MethodsWe analyzed a historical cohort of hospitalized patients who were evaluated by rheumatology. The population was classified as follows: group 1, patients with new onset diagnosed SARDs; group 2, patients with known diagnosed SARDs; group 3, patients without diagnosed SARDs; and group 4, patients with unconfirmed suspicion of SARDs. A composite adverse outcome was defined if at least one of the following occurred: (1) hospital mortality, (2) admission to the intensive care unit, (3) hospital infection, or (4) readmission. ResultsInformation was collected from 327 hospitalization events (307 patients). The median age was 48 (34−63) years and 222 (72.3%) were women. The composite adverse outcome occurred in 136 (41.5%) hospitalization events. Group 2 had the highest number of adverse outcomes (61/128; 47.6%). The variables associated with the worst outcomes were cardiovascular diagnosis at admission (OR = 4.63; CI: 1.60−13.43; p = 0.005), longer hospital stay (OR = 1.04; CI: 1.01−1.07; p = 0.005), and a treating specialty other than internal medicine (OR = 2.79; CI: 1.26−6.17; p = 0.011). Male sex (OR = 0.29; CI: 0.12–0.66; p = 0.004), having special health coverage (OR = 0.39; CI: 0.15–.099; p = 0.047), and hemoglobin > 11.4 g/dL (OR = 0.82; CI: 0.69–0.99; p = 0.039) were the factors associated with lower odds of developing the composite outcome. ConclusionsIn this historical cohort, the group of patients with known diagnosed SARDs presented a higher number in percentage terms of adverse outcomes. The most frequent adverse outcomes were admission to the ICU and hospital readmission.

Evaluation of Procalcitonin Levels in Patients with Various Forms of Acute Coronary Syndrome, Depending on the Presence of Adverse Hospital Outcomes

Aim. to study the levels of procalcitonin in patients with various forms of acute coronary syndrome (ACS), depending on the presence of adverse hospital outcomes.Materials and Methods. The study included 222 patients admitted to the emergency cardiology department with a diagnosis of ACS in the period from March 2014. until January 2017. Of these, 106 (47.7 %) patients were diagnosed with unstable angina (NS) and 116 (52.3%) with myocardial infarction (MI). Non ST segment elevation MI (NSTEMI) was diagnosed in 47 (40.5%) patients with MI, and ST elevation MI (STEMI) – in 69 (59.5%) patients with MI. After the assessment of the patient's compliance with the criteria for inclusion/exclusion in the study, the procedure for signing the patient's informed consent form was carried out. The protocol of the study was approved by the local Ethics committee of the M. E. Zhadkevich State Clinical Hospital. In each study subgroup, the presence of adverse outcomes during the current hospitalization was assessed: cardiovascular death, nonfatal MI, nonfatal acute cerebrovascular accident, acute heart failure, as well as a combined endpoint, including all of the listed adverse outcomes. All patients, in addition to routine laboratory methods of investigation, were examined for the level of procalcitonin at admission to the hospital, on 2-3 and 4-5 days.Results. Patients with MI compared to patients with NS were characterized by a large number of registered endpoints in general (24.1% vs. 6.6%, p&lt;0.001), while in the group of patients with MI, cardiovascular death was more often recorded (10.3% vs. 0.9%, p&lt;0.001) and acute heart failure (12.9% vs. 5.6%, p=0.009). Patients with MI, in particular with STEMI, who had adverse hospital outcomes, were characterized by statistically significantly higher levels of procalcitonin compared to patients without adverse hospital outcomes. Patients with STEMI showed significantly higher levels of procalcitonin at all stages of the disease, and patients with MI-only at 2-3 and 4-5 days. There were no statistically significant differences in the level of procalcitonin at all stages of the disease in patients with NSTEMI and with unstable angina, depending on the hospital outcomes.Conclusion. Elevated procalcitonin levels in patients with MI, in particular with STEMI, are associated with adverse hospital outcomes; for other forms of ACS, no statistically significant differences were observed with different hospital outcomes.

Desenlaces hospitalarios en pacientes evaluados por reumatología en una cohorte histórica colombiana

IntroductionHospitalized patients with systemic autoimmune rheumatic diseases (SARDs) generate high impact in clinical terms. ObjectivesTo characterize the study population and estimate risk factors associated with the presence of adverse outcomes in hospitalized patients consulting rheumatology at Clínica Imbanaco between January 2013 and December 2019. MethodsWe analysed a historical cohort of hospitalized patients who were evaluated by rheumatology. The population was classified as follows: group 1, patients with new onset diagnosed SARDs; group 2, patients with known diagnosed SARDs; group 3, patients without diagnosed SARDs; and group 4, patients with unconfirmed suspicion of SARDs. A composite adverse outcome was defined if at least one of the following occurred: 1) hospital mortality, 2) admission to the intensive care unit, 3) hospital infection, or 4) readmission. ResultsInformation was collected from 327 hospitalization events (307 patients). The median age was 48 (34-63) years and 222 (72.3%) were women. The composite adverse outcome occurred in 136 (41.5%) hospitalization events. Group 2 had the highest number of adverse outcomes (61/128; 47.6%). The variables associated with the worst outcomes were cardiovascular diagnosis at admission (OR=4.63; CI: 1.60-13.43; p=.005), longer hospital stay (OR=1.04; CI: 1.01-1.07; p=.005), and atreating specialty other than internal medicine (OR=2.79; CI: 1.26-6.17; p=.011). Male sex (OR=.29; CI: .12-.66; p=.004), having special health coverage (OR=.39; CI: .15-.99; p=.047), and haemoglobin>11.4g/dL (OR=.82; CI: .69-.99; p=.039) were the factors associated with lower odds of developing the composite outcome. ConclusionsIn this historical cohort, the group of patients with known diagnosed SARDs presented a higher number in percentage terms of adverse outcomes. The most frequent adverse outcomes were admission to the ICU and hospital readmission.

Gender differences in hereditary hemorrhagic telangiectasia severity

BackgroundGender differences in organ involvement and clinical severity have been poorly described in hereditary hemorrhagic telangiectasia (HHT). The aim of this study was to describe differences in the severity of HHT manifestations according to gender.MethodsSeverity was measured according to Epistaxis Severity Score (ESS), Simple Clinical Scoring Index for hepatic involvement, a general HHT-score, needing for invasive treatment (pulmonary or brain arteriovenous malformations -AVMs- embolization, liver transplantation or Young’s surgery) or the presence of adverse outcomes (severe anemia, emergency department -ED- or hospital admissions and mortality).ResultsOne hundred forty-two (58.7%) women and 100 (41.3%) men were included with a mean age of 48.9 ± 16.6 and 49 ± 16.5 years, respectively. Women presented hepatic manifestations (7.1% vs 0%) and hepatic involvement (59.8% vs 47%), hepatic AVMs (28.2% vs 13%) and bile duct dilatation (4.9% vs 0%) at abdominal CT, and pulmonary AVMs at thoracic CT (35.2% vs 23%) more often than men. The Simple Clinical Scoring Index was higher in women (3.38 ± 1.2 vs 2.03 ± 1.2), and more men were considered at low risk of harboring clinically significant liver disease than women (61% vs 25.3%). These differences were mantained when considering HHT1 and HHT2 patients separetely. Duodenal telangiectasia were more frequent in men than women (21% vs 9.8%). Invasive treatments were more frequently needed in women (28.2% vs 16%) but men needed attention at the ED more often than women (48% vs 28.2%), with no differences in ESS, HHT-score, anemia hospital admissions or mortality.ConclusionsHHT women showed more severe hepatic involvement than men, also among HHT1 and HHT2 patients. Women had higher prevalence of pulmonary AVMs and needed invasive procedures more frequently, while men needed attention at the ED more often. These data might help physicians to individualize HHT patients follow-up.

Influence of Time Interval from Bariatric Surgery to Conception on Pregnancy and Perinatal Outcomes.

Pregnancy in women submitted to bariatric surgery is increasing. Recommendations for surveillance of these pregnancies have been suggested, but an adequate time interval from surgery to conception, to avoid perinatal negative outcomes, is still controversial. Medical records of pregnancies in women with previous bariatric surgery were retrieved and outcomes were assessed according to three different time thresholds (12, 18 and 24months). The association between time from surgery to conception and the presence of adverse outcomes was analysed. Eighty-six pregnancies were assessed. Weight gain was higher (p = 0.014) and more adequate (p = 0.041) when pregnancy occurred more than 12months after surgery. Foetal growth percentile was lower when pregnancy was achieved before 24months following surgery (p = 0.021). No differences among groups were found in other assessed outcomes (BMI, gestational age at delivery, type of delivery, gestational diabetes, pregnancy hypertensive disease, anaemia, preterm delivery, foetal weight, foetal growth restriction, Apgar score, admission to neonatal intensive unit) in all considered thresholds. No association between time from surgery to conception and the presence of adverse outcomes was found. Despite differences found in maternal weight gain and foetal growth percentile, our study does not support the recommendation to delay pregnancy based on a fixed deadline. Other factors, including a more individualised approach, need to be considered.