Retrospective Longitudinal Study Research Articles

A predictive score for atrial fibrillation in poststroke patients.

Atrial fibrillation (AF) is a risk factor for cerebral ischemia. Identifying the presence of AF, especially in paroxysmal cases, may take time and lacks clear support in the literature regarding the optimal investigative approach; in resource-limited settings, identifying a higher-risk group for AF can assist in planning further investigation. To develop a scoring tool to predict the risk of incident AF in the poststroke follow-up. A retrospective longitudinal study with data collected from electronic medical records of patients hospitalized and followed up for cerebral ischemia from 2014 to 2021 at a tertiary stroke center. Demographic, clinical, laboratory, electrocardiogram, and echocardiogram data, as well as neuroimaging data, were collected. Stepwise logistic regression was employed to identify associated variables. A score with integer numbers was created based on beta coefficients. Calibration and validation were performed to evaluate accuracy. We included 872 patients in the final analysis. The score was created with left atrial diameter ≥ 42 mm (2 points), age ≥ 70 years (1 point), presence of septal aneurysm (2 points), and score ≥ 6 points at admission on the National Institutes of Health Stroke Scale (NIHSS; 1 point). The score ranges from 0 to 6. Patients with a score ≥ 2 points had a fivefold increased risk of having AF detected in the follow-up. The area under the curve (AUC) was of 0.77 (0.72-0.85). We were able structure an accurate risk score tool for incident AF, which could be validated in multicenter samples in future studies.

Cardiac manifestations and outcomes of COVID-19 vaccine-associated myocarditis in the young in the USA: longitudinal results from the Myocarditis After COVID Vaccination (MACiV) multicenter study

We aimed to study the clinical characteristics, myocardial injury, and longitudinal outcomes of COVID-19 vaccine-associated myocarditis (C-VAM). In this longitudinal retrospective observational cohort multicenter study across 38 hospitals in the United States, 333 patients with C-VAM were compared with 100 patients with multisystem inflammatory syndrome inchildren (MIS-C). We included patients ≤30 years of age with a clinical diagnosis of acute myocarditis after COVID-19 vaccination based on clinical presentation, abnormal biomarkers and/or cardiovascular imaging findings. Demographics, past medical history, hospital course, biochemistry results, cardiovascular imaging, and follow-up information from April 2021 to November 2022 were collected. The primary outcome was presence of myocardial injury as evidenced by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging. Patients with C-VAM were predominantly white (67%) adolescent males (91%, 15.7±2.8 years). Their initial clinical course was more likely to be mild (80% vs. 23%, p<0.001) and cardiac dysfunction was less common (17% vs. 68%, p<0.0001), compared to MIS-C. In contrast, LGE on CMR was more prevalent in C-VAM (82% vs. 16%, p<0.001). The probability of LGE was higher in males (OR 3.28 [95% CI: 0.99, 10.6, p=0.052]), in older patients (>15 years, OR 2.74 [95% CI: 1.28, 5.83, p=0.009]) and when C-VAM occurred after the first or second dose as compared to the third dose of mRNA vaccine. Mid-term clinical outcomes of C-VAM at a median follow-up of 178days (IQR 114-285 days) were reassuring. No cardiac deaths or heart transplantations were reported until the time of submission of this report. LGE persisted in 60% of the patients at follow up. Myocardial injury at initial presentation and its persistence at follow up, despite a mild initial course and favorable mid-term clinical outcome, warrants continued clinical surveillance and long-term studies in affected patients with C-VAM. The U.S. Food and Drug Administration.

RETICULAR PSEUDODRUSEN DISAPPEARANCE AFTER DEVELOPMENT OF MACULAR NEOVASCULARIZATION.

To explore changes in reticular pseudodrusen (RPD) number and location after the development of macular neovascularization (MNV) in eyes with prior intermediate age-related macular degeneration, focusing on different retinal regions differently affected by MNV. This retrospective longitudinal study included intermediate age-related macular degeneration eyes with RPD that developed MNV. Reticular pseudodrusen were assessed at baseline when MNV was diagnosed (MNV stage) and after anti-vascular endothelial growth factor treatment. Three regions of interest were considered: MNV area, subretinal fluid (SRF) area, and a marginal area of 1,000 µm around SRF (marginal zone). Reticular pseudodrusen counts were compared with age- and sex-matched control eyes with RPD that did not develop MNV. Reticular pseudodrusen number exhibited a significant decrease after MNV development in the MNV area (P = 0.048) and in the area with SRF (P = 0.078). A statistically significant decrease was also disclosed in the marginal area around SRF (P = 0.002), associated with larger SRF areas. Control eyes did not show any significant change in the RPD count. Reticular pseudodrusen reduction after MNV development suggests a complex interplay involving the MNV itself, the presence of SRF, and trophic changes. The results of this study highlight the role of MNV in retinal nutritional balance and provide intriguing results in the RPD life cycle.

Discharge Follow-Up of Patients in Primary Care Does Not Meet Their Care Needs: Results of a Longitudinal Multicentre Study

Adequate coordination between healthcare levels has been proven to improve clinical indicators, care costs, and user satisfaction. This is more relevant to complex or vulnerable patients, who often require increased care. This study aims to evaluate the differences between hospital discharge follow-up indicators, including number of general practitioners’ (GPs) and community nurses’ (CNs) consultations, presentiality of consultations, type of first post-discharge consultation, and time between hospital discharge and first consultation. Vulnerable and non-vulnerable patients were compared. A longitudinal retrospective study was carried out in the north of Tenerife on the post-discharge care of patients discharged from the Canary Islands University Hospital (Spanish acronym HUC) between 1 January 2018 and 31 December 2022. The results obtained show deficiencies in the care provided to patients by primary care (PC) after being discharged from the hospital, including delayed first visits, low presentiality of those visits that were less frequent even with increased patient complexity, scarce first home visits to functionally impaired patients and delays in such visits, and a lack of priority visits to patients with increased follow-up needs. Addressing these deficiencies could help those most in need of care to receive PC, thus reducing inequalities and granting equal access to healthcare services in Spain.

Neonatal Markers of Prematurity as Predictors of Permanent Childhood Hearing Loss and Neurodevelopmental Impairment in Children Admitted to the Neonatal Intensive Care Unit

Need for admission to the neonatal intensive care unit (NICU) confers an increased risk of hearing loss in the newborn and of later neurodevelopmental impairment. In this retrospective longitudinal case-controlled study, we assess how the degree of prematurity, measured via gestational age, birth weight, and z-scores, in 138 infants admitted to the NICU are associated with permanent childhood hearing loss (PCHI) and 2-year developmental outcomes. Logistic regression analyses, Kruskal–Wallis analysis of variance, and Chi-squared tests were used. Independent of prematurity, PCHI and NICU admission were predictive of poor developmental outcomes. Twenty-one (47%) children with PCHI had a moderate-to-severe developmental delay, compared to three (7%) matched controls. Days in the NICU but not z-scores predicted PCHI. Z-score was not prognostic of moderate or severe developmental impairment in children with PCHI. The odds ratio of moderate-to-severe neurodevelopmental impairment with PCHI was high, at 12.48 [95% CI = 3.37–46.40]. Children with PCHI were significantly more likely to have cerebral palsy than their matched counterparts (30% vs. 2%). These findings challenge the conventional focus on gestational age and birth weight on neurodevelopmental outcomes for children with PCHI and NICU admission. A more nuanced approach to monitoring and intervention is needed.

Biomonitoring and determinants of mycotoxin exposures from pregnancy until post-lactation in HIV-infected and HIV-uninfected women from Harare, Zimbabwe

The human immunodeficiency virus (HIV) heavily affects women from resource-limited settings who are vulnerable to potentially harmful mycotoxins including aflatoxin B1 (AFB1), fumonisin B1 (FB1) and ochratoxin A (OTA). We aimed to conduct biomonitoring and ascertain the determinants of maternal mycotoxin exposure in pregnancy, lactation and post-lactation periods. We conducted a retrospective longitudinal study in HIV-infected and HIV-uninfected women from Harare, Zimbabwe. 175 and 125 random urine samples in pregnancy and 24 months after delivery (post-lactation) respectively were analysed for aflatoxin M1 (AFM1) and FB1 by ELISA. 6 weeks after delivery (lactation), 226 and 262 breast milk (BM) samples were analysed for AFM1 and OTA respectively by ELISA. The association of demographics and food consumption with mycotoxins was evaluated using multivariable logistic regression. In HIV-infected, urinary AFM1 was detected in 46/94 (Median: 0.05; Range: 0.04–0.46 ng mL−1) in pregnancy and 47/66 (Median: 0.05; Range: 0.04–1.01 ng mL−1) post-lactation. Urinary FB1 was detected in 86/94 (Median: 1.39; Range: 0.17–6.02 ng mL−1) in pregnancy and 56/66 (Median: 0.72; Range: 0.20–3.81 ng mL−1) post-lactation. BM AFM1 was detected in 28/110 (Median: 7.24; Range: 5.96–29.80 pg mL−1) and OTA in 11/129 (Median: 0.20; Range: 0.14–0.65 ng mL−1). In HIV-uninfected, urinary AFM1 was detected in 48/81 (Median: 0.05; Range: 0.04–1.06 ng mL−1) in pregnancy and 41/59 (Median: 0.05; Range: 0.04–0.52 ng mL−1) post-lactation. Urinary FB1 was detected in 74/81 (Median: 1.15; Range: 0.17–6.16 ng mL−1) in pregnancy and 55/59 (Median: 0.96; Range: 0.20–2.82 ng mL−1) post-lactation. BM AFM1 was detected in 38/116 (Median: 7.70; Range: 6.07–31.75 pg mL−1) and OTA in 4/133 (Median: 0.24; Range: 0.18–0.83 ng mL−1). Location, wealth, and peanut butter consumption were determinants of AFB1 exposure. HIV infection, BMI, location, rainy season, unemployment, and age were determinants of FB1 exposure. Women especially those pregnant and/or HIV-infected are at risk of adverse effects of mycotoxins.

325 Longitudinal retrospective study of performance and biomarkers of energy balance and gastrointestinal functionality in unweaned calves subjected to transport or entire commercialization at arrival

Abstract Data from 347 unweaned male dairy beef calves enrolled in 3 studies from 2021 to 2023 were used to evaluate the impact of transport or entire commercialization (marketing and transport) on performance recovery [average daily gain (ADG) and concentrate intake (CI)] and biomarkers of energy balance [non-esterified fatty acids (NEFA), beta-hydroxybutyrate (BHB), and glucose] and gastrointestinal functionality [gut permeability (Cr-EDTA) and enterocyte mass (citrulline)] at farm arrival. Calves were distributed in 3 treatments according to the different managements subjected in the previous studies: calves from a sole dairy farm that were not fasted neither transported (CTR), calves from a sole dairy farm that were transported and fasted for 19 h (TRA), and multi-origin calves commercially marketed and transported for 9 h (COM). On arrival at the rearing farm (d 0), calves were allocated individually, and body weight (BW) was recorded. Calves were fed milk replacer twice daily, and they had ad libitum access to concentrate and water. Concentrate (CI) and milk replacer intake were recorded daily, and BW and the biomarkers of energy balance and gut dysfunction were obtained on d 0 (arrival), 1, 2, and 7. Data were analyzed with mixed models. An interaction (P &amp;lt; 0.01) between treatment and time was observed for CI. On d 0 CTR and TRA had similar CI, while COM had the least CI. On d 1, all treatments decreased CI except CTR. While TRA recovered CI to CTR levels, COM had 50% less CI compared with the other calves on d 7. The COM calves had the least (P &amp;lt; 0.01) ADG compared with CTR and TRA calves. On d 0, COM calves had greater (P &amp;lt; 0.01) concentrations of NEFA and BHB compared with TRA and CTR, and TRA greater (P &amp;lt; 0.01) than CTR calves. The COM calves did not recover NEFA and BHB basal concentrations by d 7 as observed in TRA calves. Concentration of Cr-EDTA was greater on d 0 for TRA calves compared with CTR and COM calves, however concentration of Cr-EDTA was greater during the first 7 d in COM calves compared with CTR and TRA calves. Finally, citrulline concentration was less in COM calves compared with CTR and TRA calves independently of the sampling day. The entire commercialization process, marketing and transportation, of unweaned dairy beef calves impairs intake recovery and growth, and these results are aligned with negative energy balance and comprised gastrointestinal functionality at farm arrival.

The hidden impact of alcohol on young victims: an analysis of police-related alcohol offences resulting in hospitalisation

BackgroundAlcohol-related harm (ARH) remains a significant public health concern, particularly affecting young individuals who are disproportionately impacted. This study focuses on the often-overlooked impact of alcohol on young victims involved in alcohol-related police incidents resulting in hospitalisation. While existing research often centres on the drinker, this study explores the characteristics of both offenders and victims, analysing offence types and investigating the under-ascertainment of ARH in hospital records. MethodsOur research, conducted as a retrospective longitudinal study in Western Australia, utilises linked data from hospital admissions, emergency department (ED) presentations, and police incident records. The study includes 22,747 individuals aged 12–24 involved in alcohol-related police incidents between 2004 and 2015. ResultsFemale victims were 10 times more likely than males to be involved in alcohol-related police incidents, while women had a 2 times higher likelihood of undiagnosed alcohol-related hospital admissions than men. Aboriginal people were overrepresented as both offenders and victims. ED presentations and hospital admissions were prevalent, with head injuries being the most common outcome. Notably, 71% of victims hospitalised did not receive an ARH diagnosis. Conclusions A noticeable gap exists between hospital admissions associated with alcohol-related incidents and cases officially classified as ARH in the hospital system. This difference points to a more significant issue of substantial under-ascertainment or insufficient identification of ARH than previously acknowledged. Our study emphasises the need for targeted interventions, collaborative efforts between health and justice agencies, and ongoing research to address the hidden impact of alcohol on young victims.

Proteomics profiling and machine learning in nusinersen-treated patients with spinal muscular atrophy

AimThe availability of disease-modifying therapies and newborn screening programs for spinal muscular atrophy (SMA) has generated an urgent need for reliable prognostic biomarkers to classify patients according to disease severity. We aim to identify cerebrospinal fluid (CSF) prognostic protein biomarkers in CSF samples of SMA patients collected at baseline (T0), and to describe proteomic profile changes and biological pathways influenced by nusinersen before the sixth nusinersen infusion (T302).MethodsIn this multicenter retrospective longitudinal study, we employed an untargeted liquid chromatography mass spectrometry (LC-MS)-based proteomic approach on CSF samples collected from 61 SMA patients treated with nusinersen (SMA1 n=19, SMA2 n=19, SMA3 n=23) at T0 at T302. The Random Forest (RF) machine learning algorithm and pathway enrichment analysis were applied for analysis.ResultsThe RF algorithm, applied to the protein expression profile of naïve patients, revealed several proteins that could classify the different types of SMA according to their differential abundance at T0. Analysis of changes in proteomic profiles identified a total of 147 differentially expressed proteins after nusinersen treatment in SMA1, 135 in SMA2, and 289 in SMA3.Overall, nusinersen-induced changes on proteomic profile were consistent with i) common effects observed in allSMA types (i.e. regulation of axonogenesis), and ii) disease severity-specific changes, namely regulation of glucose metabolism in SMA1, of coagulation processes in SMA2, and of complement cascade in SMA3.ConclusionsThis untargeted LC-MS proteomic profiling in the CSF of SMA patients revealed differences in protein expression in naïve patients and showed nusinersen-related modulation in several biological processes after 10 months of treatment. Further confirmatory studies are needed to validate these results in larger number of patients and over abroader timeframe.

Longitudinal observation of distal tibial degeneration in varus ankle osteoarthritis using plain radiograph

BackgroundThis study aimed to explore the natural history of distal tibial deformity in varus ankle osteoarthritis and to identify risk factors for its progression. Methods: This retrospective longitudinal observational study included 97 ankles with moderate to severe varus ankle osteoarthritis, monitored for > 2 years. Radiographic assessments were conducted on weightbearing plain radiographs at the initial and final visit. Results: Significant tibial anterior surface angle reduction (p = 0.008), talus center medial migration (p = 0.038), and tibial lateral surface angle increase (p = 0.034) occurred. Multiple logistic analysis revealed an association between progression and coronal talar tilt angle at the first visit (odds ratio 1.17, p = 0.015). Conclusion: The progression of radiographic distal tibial deformity in varus ankle osteoarthritis was clarified, identifying the coronal talar tilt angle as a risk factor. Level of EvidenceLevel IV, retrospective longitudinal observation study

O60 SURVIVAL DISPARITIES AMONG INDIGENOUS GROUPS WITH HTN LINKED TO THEIR POPULATION CONCENTRATION

Background and objective: The indigenous groups are considered minority populations, primarily residing in rural areas. Cardiovascular disease stands as the leading cause of mortality, affecting native populations as well. This study aims to compare the overall survival (OS) rates among patients diagnosed with hypertension (HTN) in four Colombian departments where the population concentration of indigenous groups is over 10% compared to departments where it is less than 1%. Methods: Longitudinal retrospective cohort study. Population: Indigenous adults diagnosed with HTN from July 1st, 2014, to June 30 th, 2015, from the National Registry of Chronic Kidney Disease (NRCKD). The follow-up period was until July 30, 2023. We grouped indigenous communities according to their population concentration calculated by the Observatory of the Colombian Presidential Program for Human Rights. The probability of global survival from the date of diagnosis was estimated using Kaplan-Meier analysis. An unadjusted Royston Parmar flexible regression model was fitted. Right-censoring was defined as abandonment or completion of follow-up without death occurring. Results: 67,353 indigenous prevalent cases were identified from July 1st, 2022 to June 30th, 2023, representing an HTN prevalence of 2.76%. Among them, 48.90% are in Cauca, Nariño, La Guajira, and Córdoba. Natives of Nariño registered a higher proportion of GFR stages 3 and 4, calculated using the CKD-EPI formula, compared to departments with a concentration of less than 1% (48.30% and 3.15% vs. 8.08% and 0.45% respectively). 2.600 cases were included in the survival analysis. Natives residents from Nariño and Cauca had the highest risk of all-cause mortality (HR = 7.66; 95% CI 3.33 – 17.59 and HR = 7.36; 95% CI 3.26 – 16.61) compared to groups living in departments with &lt;1% concentration. Conclusions: In the Colombian health system, the hazard of all-cause mortality is higher for indigenous individuals with HTN living in Nariño and Cauca compared to those living in departments with less than 1% of the indigenous population.

O61 HYPERTENSION IN COLOMBIA: ETHNIC GROUP COMPARISONS IN CHARACTERIZATION AND SURVIVAL

Background and objective: Research has shown that ethnic minorities may be disproportionately affected by arterial hypertension. The aim of this study is to compare the overall survival (OS) HTN patients within the Colombian health system, by their ethnic group. Methods: Design: Longitudinal retrospective cohort study. Population: Adults diagnosed with HTN from June 1, 2014, to July 30, 2015, from the National Registry of Chronic Kidney Disease (NRCKD). The follow-up period was until July 30, 2023. Analysis: The probability of global survival from the date of diagnosis was estimated using Kaplan-Meier analysis. An unadjusted Royston Parmar flexible regression model was fitted. Right-censoring was defined as abandonment or completion of follow-up without death occurring. Results: 5,634,812 cases were identified from june 1st 2022 to july 30th 2023, and 299,161 incident cases were included in the survival analysis. 95.29% had no ethnic group, 1.20% were indigenous, 3.47% were Afro-descendant and 0.03% were Gypsy (ROMA). ROMA group had a higher proportion of residents in Bogotá, D.C. compared to other groups (13.96% vs ∼3%). Afro-descendant group had a higher proportion of obesity (30.61% vs. 27.86%) and diagnosis of Chronic Kidney Disease (27.31% vs. 15.69%) compared to cases with no ethnic group, while ROMA group had a higher occurrence of DM cases (23.46% vs. 21.66%). 9 years OS was higher in ROMA group (OS = 0.85; CI 95% 0.71 – 0.93) compared to indigenous (OS = 0.83; CI 95% 0.81 – 0.84) and afro-descendants (OS = 0.83; CI 95% 0.83 – 0.84). The probability of all-cause mortality was approximately 20% higher among afro-descendants and indigenous people (HR = 1.20; 95% CI 1.14 – 1.25 and HR = 1.22; 95% CI 1.12 – 1.32, respectively) compared to the non-ethnic group. In contrast, the ROMA did not present differences (p = 0.712). Conclusions: In the Colombian health system, differences in OS among afro-descendant and indigenous groups are observed compared to non-ethnic population.

P034 THE INFLUENCE OF SOCIODEMOGRAPHICAL CHARACTERISTICS AND COMORBIDITIES ON SURVIVAL IN ADULTS WITH HTN IN COLOMBIA

Background and objective: Awareness of the impact of hypertension (HTN) on health enables the implementation of effective measures to control the disease. This study characterizes the survival of the Colombian adult population with hypertension. Methods: This longitudinal retrospective cohort study included adults diagnosed with HTN from July 1, 2013, to june 30, 2014, from the National Registry of Chronic Kidney Disease (NRCKD). The primary outcome was the time from diagnosis to all-cause mortality. The probability of from the date of diagnosis was estimated using Kaplan-Meier analysis. Log-rank test evaluated differences in survivor functions. Patients were followed from baseline until death, abandonment, or the end of follow-up on July 30, 2023. Results: Baseline characteristics: The analysis included 285,418 cases. The mean age at diagnosis was 59.17 ± 14.58 years. 61.25% were females, 67.13% were affiliated with third-payer insurance, and 28.81% resided in the Central region. At baseline, 36.77% of the study population had comorbidities, including diabetes mellitus (DM) or chronic kidney disease (CKD) or both. 36,110 all-cause deaths were recorded during the follow-up period. Survival analysis: The 10-year overall survival (OS) rate was 0.84 (95% CI 0.84–0.84). The unadjusted log-rank comparisons revealed a lower probability of survival for men compared to women (0.81 vs. 0.86, respectively) and for individuals with state insurance compared to those with third-party insurance (0.80 vs. 0.86, respectively). The survival rates were found to be lower in individuals with HTA, DM, and HTN at baseline (0.68) compared to those with HTN and CKD (0.78), HTN and DM (0.81), or only HTN (0.88) (p &lt; 0.001). Conclusions: The survival of individuals with HTN is influenced by a variety of sociodemographic characteristics and can be further complicated by the presence of other comorbidities, which can potentially amplify the negative effects on an individual's health. These findings may be useful for decision-makers to focus on the identification of patients with different characteristics of risk.

Association between paediatric eye injuries, later aca-demic success and social performance

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;To investigate an association between eye injury and later academic and social performance.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;A retrospective longitudinal study of taking measurements multiple times was conducted including all severe eye injuries admitted during 2011-2017 at the main regional clinic to investigate changes in academic success and social inclusion before and after an injury. Parents/caregivers were surveyed asking questions on academic performance, and community/social involvement. In 2023 data on employment status were obtained. Kappa (ĸ) and non-parametric Wilcox-on signed-rank test for multiple comparisons were used. For association of employment status and post-injury visual acuity Fisher score was tested.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;The total sample for assessing social inclusion and academic success was 36 and 25 children, respectively. In the following academic year ĸ agreements decreased from 0.88 (p&amp;amp;lt;0.001) comparing pre-injury with a one-year post to 0.5106 (p&amp;amp;lt;.0001) in the second year and 0.4750 (p=0.003) in the third, suggesting a deteriorating trend. A comparison of academic success before injury to two and three years after injury showed the trend significantly worsening with time (p=0.005, and 0.003, respectively). No association between an eye injury and social inclusion, as well as between employment and final visual acuity was noticed.&amp;amp;nbsp;&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Our findings suggest no association between social inclusion, employment, and eye trauma, while in later years academic success may be more impacted by the eye injury. Due to eye injury unpredictability in childhood age, both an informed and supportive climate environment at home and school is essential to minimize deleterious responses to eye trauma.&amp;lt;/p&amp;gt;

Social determinants of health and somatic growth in preterm infants and children with chronic lung disease.

Bronchopulmonary dysplasia (BPD), a common complication of prematurity, is associated with impaired lung function and increased morbidity in childhood. These children display heterogeneous somatic growth patterns which may ultimately impact their risk for later respiratory disease. We aim to understand the relationship between socioenvironmental exposures and growth in this population. A retrospective longitudinal cohort study was conducted using participants (n = 616) enrolled in the Johns Hopkins Outpatient BPD Registry. Growth measurements between 0 and 36 months of age were obtained. Somatic growth measurements, both corrected and uncorrected for gestational age, were converted to z-scores using Center for Disease Control and Prevention normative data. Using a participant's residential zip code, we utilized the 2019 Area Deprivation Index (ADI), the Childhood Opportunity Index (COI) 2.0, and neighborhood food insecurity data from the Maryland Food Bank. Linear regression analysis was performed employing individual socioenvironmental measures as independent variables and growth z-scores as dependent variables in univariate analysis. Univariate analysis was repeated adjusting for gestational age, BPD severity, and the presence of a gastrostomy tube (GT). Of the three measures analyzed, national COI (nCOI) showed a significant association with mean weight z-scores, mean ADI showed some association with mean weight z-scores, and the percentage of a community experiencing food insecurity showed no association with mean weight z-scores. After adjusting for gestational age, BPD severity, and presence of a GT, children living in areas of greater opportunity (higher nCOI values), had significantly lower weight z-scores at 12 months corrected and at 24 and 36 months uncorrected CONCLUSIONS: Our findings suggest that the COI 2.0, a multidimensional measure, captures more facets of an individual's social environment, as compared to the singular nature of a measure of food insecurity. There are several potential explanations for the phenomenon seen, and further understanding of this dynamic is crucial for designing effective interventions and policies to better address inequities in outcomes.

Body Mass Index Changes Among Adolescents and Young Adults Using the Etonogestrel Contraceptive Implant.

To evaluate body mass index (BMI) over 36 months among adolescents and young adults using the etonogestrel implant compared with those using depot medroxyprogesterone acetate (DMPA) and a control group. We conducted a retrospective longitudinal cohort study of postmenarchal adolescents and young adults assigned female at birth. The etonogestrel implant and DMPA groups initiated etonogestrel or DMPA between January 1, 2010, and December 31, 2017. Adolescents and young adults in the control group were prescribed a weight-neutral contraceptive or no contraceptive during the same timeframe. The primary outcome of BMI over time was estimated and compared between study groups with inverse probability of treatment weighting linear mixed-effects modeling. Changes in BMI weight category (underweight or normal weight, overweight, obesity) at 12, 24, and 36 months were also explored. Among the 20,409 eligible patients, 860 initiated etonogestrel, 1,817 initiated DMPA, and 17,732 made up the control group. Compared with individuals in the control group, those in the etonogestrel group had a significantly higher mean BMI difference at 9 months (+0.5, P<.01); at 36 months, the mean BMI difference was +1.0 (P<.01). Compared with individuals in the control group, those in the DMPA group had higher mean BMI at 6 months (+0.3, P<.01); at 36 months, the mean BMI difference was +1.3 (P<.01). Regardless of weight changes, increases in BMI weight categories were rare in all groups. Adolescent and young adult patients who initiated the etonogestrel implant demonstrated BMI changes like those on DMPA and higher than control patients; however, these differences may not be clinically concerning. This study provides important information that can help in counseling adolescent and young adult patients about expectations when starting and using etonogestrel.

Audiological outcome of bimodal CI users over time and depending on different influencing factors

Hearing-impaired persons with asymmetric hearing loss and aunilateral indication for acochlear implant (CI) generally benefit from abimodal hearing solution. The influence of bimodal fitting on speech comprehension (SC) over time has not yet been sufficiently investigated. The present study examines the influence of bimodal fitting on SC in bimodally fitted CI users with postlingual deafness at least 36months after implantation and analyzes possible influencing factors. Included in this retrospective longitudinal study were 54bimodally fitted speech-competent CI users with at least 36months of CI experience. Audiometric data of these CI users at predefined timepoints were compared. The change in the results of the Freiburg monosyllabic test (FT) over 36months was significant (p < 5%) for the deafness group at <10years for both the 65 dB sound pressure level (SPL) and at 80 dB SPL and also significant for the deafness group ≥10years for 65 dB SPL. In the Oldenburg sentence test (OlSa) there was ahighly significant change (p < 0.1%) for S0, S0N0, and S0NCI configurations and avery significant change (p < 1%) for S0NHA (HA: hearing aid). Age at implantation as apossible influencing factor could not be confirmed in the FT. In contrast, the duration of deafness was anegative influencing factor for SC with CI in the FT, whereas alonger duration of deafness was associated with worse results in the FT. The degree of hearing loss in the ear fitted with an HA did not influence SC. The median bimodal benefit (here: difference in SC with bimodal fitting compared to unilateral HA fitting for FT at 65 dB SPL) was 10% over the total study period. For amedian of 79% of the test subjects, the bimodal benefit was found over the entire period of 36months. Over time, SC improves significantly with aCI for the bimodal test subjects. The investigated influencing factors (age, duration of deafness, and degree of hearing loss in the contralateral ear) support the indication for bimodal provision in accordance with the guideline in Germany for cochlear implantation-regardless of age, duration of deafness, and hearing ability of the contralateral ear.

Phosphatidylserine-Dependent Anti-prothrombin Antibodies as a Key Predictor for Systemic Lupus Erythematosus in Patients with Primary Antiphospholipid Syndrome: A retrospective longitudinal cohort study.

Primary antiphospholipid syndrome (PAPS) is an autoimmune disorder characterized by thrombosis and pregnancy morbidity. Although PAPS is distinct from systemic lupus erythematosus (SLE), the two conditions share clinical features and susceptibility genes. Progression from PAPS to SLE is well-recognized. However, risk factors for this transition are poorly understood. We aimed to identify predictors of progression to SLE in patients with PAPS. A longitudinal single-center study was conducted at Hokkaido University Hospital from 1990 to 2021. Baseline characteristics including clinical features, laboratory data, aPL profiles were compared between patients who progressed to SLE (SLE group) and those who did not (non-SLE group). Among 64 patients diagnosed with PAPS at baseline, nine (13.8%) progressed to SLE over a mean follow-up of 9 years (incidence rate, 1.61 per 100 person-years). At the diagnosis of PAPS, the SLE group had a higher prevalence of anti-phosphatidylserine/prothrombin antibodies (aPS/PT) and anti-dsDNA antibodies compared to the non-SLE group. Other clinical findings, autoantibody profiles, and serum complement levels were similar between the two groups. Multivariate Cox analysis showed that IgG aPS/PT was significantly associated with SLE development (Hazard ratio: 10.3, 95% CI: 1.13-92.6, p=0.04). IgG aPS/PT may be a predictive factor for new-onset SLE in patients with PAPS, suggesting its utility in guiding risk stratification and monitoring strategies for these patients.

Validation of histopathological chronicity scores in native kidney biopsies using light microscopy and digital morphometry for predicting renal outcome

Quantitative assessment of chronicity changes in native kidney biopsies offer valuable insights in to disease prognosis, despite the strength of qualitative information. Yet, standardization and reproducibility remain challenging. The present study aims to assess and compare the prognostic utility and reproducibility of two chronicity scoring systems based on light microscopy and whole slide imaging with morphometry and also to evaluate the prognostic utility of structural measurements: cortical non-sclerotic glomerular (NSG) density and NSG area/volume. We designed a retrospective longitudinal study involving 101 adult and paediatric patients who underwent native kidney biopsies. Chronicity scoring was performed using two semi-quantitative methods: Method 1 (method proposed in PMID: 28314581) and Method 2 (method proposed in PMID: 32516862), under light microscopy as well as on whole-slide scanned images, and assessed for prognostic utility. Kidney-Failure-Risk-Equation (KFRE) was employed in combination with chronicity-scoring-methods and assessed for predictive capability. Interobserver reproducibility for the two chronicity methods was studied among three renal pathologists. Structural measurements were performed on whole-slide- scanned-images. Both the chronicity scoring methods significantly predicted decline in estimated glomerular filtration rate (eGFR) and persistent need for renal replacement therapy in follow-up. Method 1 combined with KFRE, outperformed Method 2 in predicting renal survival. Method 2 however showed higher interobserver reproducibility. Combined KFRE plus histopathological scoring methods showed better predictive accuracy. The study validates the precision of chronicity scoring using whole slide scanned images. The morphometric structural measurements showed significant correlations with follow-up eGFR, thereby providing supplementary prognostic information.

Accuracy of MSBase criteria to diagnose secondary progressive multiple sclerosis in large German real-world patient cohort

Background and ObjectivesAccurate diagnosis of secondary progression in multiple sclerosis (MS) remains a challenge since standardized criteria are missing. In 2016, the MSBase registry presented an algorithm that enabled the diagnosis of secondary progressive multiple sclerosis (SPMS) more than three years earlier compared to diagnosis by neurologists. This work aimed to test whether this approach is equally effective in a real-world cohort of MS patients. MethodsThis longitudinal retrospective study analyzed clinical data of outpatients with MS recorded until October 2020 in the NeuroTransData registry, a Germany-wide network of 153 certified neurologists. Patient data had been captured in time during clinical visits employing a defined standardized clinical data set in the webbased NeuroTransData patient management platform DESTINY®. The time between the diagnosis of relapsing-remitting multiple sclerosis (RRMS) to SPMS onset was compared with one determined using MSBase criteria (MSBC). Group 1 consisted of patients diagnosed with SPMS during the observation period, whereas group 2 included RRMS patients who did not convert to SPMS during the observation period. ResultsOf 21,281 patients with MS included in our registry, 194 and 9506 patients were allocated to groups 1 and 2, respectively. 10.3% of patients with RRMS were diagnosed with SPMS simultaneously, whereas 60.8% were diagnosed with SPMS at least 3 months earlier by treating neurologists compared to the MSBC. In group 1, the MSBC showed a low sensitivity of 32.0% and an accuracy of 61.4% but a high specificity of 89.6%. In group 2, the MSBC identified 7.8% of patients with SPMS at some point during the observation time. Moreover, test-retest variability remains a challenge since 29.4% of patients diagnosed with SPMS by treating physicians did not fulfil the MSBC at a later point in time. DiscussionThese results are inconsistent with earlier SPMS diagnosis using the MSBC compared to clinical diagnosis by treating physicians. Therefore, there remains a need for an operational, structured, and validated approach to SPMS diagnosis.