Severe Impairment Research Articles

Aberrant Lipid Metabolism and Complement Activation in Age-Related Macular Degeneration.

Age-related macular degeneration (AMD) stands as a leading cause of severe visual impairment and blindness among the elderly globally. As a multifactorial disease, AMD's pathogenesis is influenced by genetic, environmental, and age-related factors, with lipid metabolism abnormalities and complement system dysregulation playing critical roles. This review delves into recent advancements in understanding the intricate interaction between these two crucial pathways, highlighting their contribution to the disease's progression through chronic inflammation, drusen formation, and retinal pigment epithelium dysfunction. Importantly, emerging evidence points to dysregulated lipid profiles, particularly alterations in high-density lipoprotein levels, oxidized lipid deposits, and intracellular lipofuscin accumulation, as exacerbating factors that enhance complement activation and subsequently amplify tissue damage in AMD. Furthermore, genetic studies have revealed significant associations between AMD and specific genes involved in lipid transport and complement regulation, shedding light on disease susceptibility and underlying mechanisms. The review further explores the clinical implications of these findings, advocating for a novel therapeutic approach that integrates lipid metabolism modulators with complement inhibitors. By concurrently targeting these pathways, the dual-targeted approach holds promise in significantly improving outcomes for AMD patients, heralding a new horizon in AMD management and treatment.

Inherited PURA Pathogenic Variant Associated With a Mild Neurodevelopmental Disorder.

Purine-rich element-binding protein alpha (PURA) regulates gene expression and is ubiquitously expressed with an enrichment in neural tissues. Pathogenic variants in PURA cause the neurodevelopmental disorder PURA syndrome that has a variable phenotype but typically comprises moderate-to-severe global developmental delay, intellectual disability, early-onset hypotonia and hypothermia, epilepsy, feeding difficulties, movement disorders, and subtle facial dysmorphism. Speech is reportedly absent in most, but the specific linguistic phenotype is not well described. We used genome sequencing to identify a pathogenic gene variant as part of a study of children ascertained for severe primary speech disorder in the absence of moderate or severe ID. The novel PURA c.296G>T (p.Arg99Leu) pathogenic missense variant segregated in the female proband and her affected mother. The proband had dysarthria; phonological disorder; and severe receptive and expressive language impairment, borderline intellect, attention difficulties, oropharyngeal dysmotility, and dysmorphic facial features. Her mother had dysarthria, moderate receptive language impairment, and borderline intellect. Both the proband and her mother completed mainstream schooling with classroom support. This is the first inherited PURA pathogenic germline variant in over 600 unrelated families documented on ClinVar or reported in the literature. PURA testing should be considered in families with primary speech disorder and borderline intellectual disability, given the specific genetic counseling implications.

Acute Retinal Necrosis: A Review of Diagnosis and Management

Acute retinal necrosis (ARN) is a profound infection of the retina, marked by acute panuveitis, retinal periarteritis, and widespread necrotizing retinitis. The etiology of ARN involves human herpesviruses, such as herpes simplex virus (HSV) and varicella-zoster virus (VZV), which can lead to severe visual impairment or even blindness. A diagnosis of ARN is based on clinical characteristics and disease progression according to the standard diagnostic criteria established by the American Uveitis Society (AUS) in 1994. The polymerase chain reaction(PCR) of aqueous specimens can enable identification of the type of virus. Early initiation of antiviral medication is essential for treatment efficacy to stop lesion progression, accelerate the healing process, and prevent contralateral eye involvement. Ocular complications of ARN include atrophic retina, multiple retinal breaks, rhegmatogenous retinal detachment (RRD), tractional retinal detachment (TRD), optic atrophy, macular edema, epiretinal membrane (ERM), and retinal and optic disc neovascularization. This review summarizes the clinical features, diagnostic criteria, and recently recommended ARN management.

Identification and characterization of NMNAT1 gene mutations in an Iranian patient with Leber congenital amaurosis 9.

The discovery of compound heterozygous NMNAT1 mutations (c.245T>C; p.Val82Ala and c.575A>G; p.Asp192Gly) provides a genetic explanation for Leber congenital amaurosis 9 in an Iranian patient. The proband's symptoms-including severe visual impairment, nystagmus, night blindness, and retinal degeneration-align with Leber congenital amaurosis 9 clinical features. This case underscores the value of exome-sequencing in diagnosing rare genetic disorders and highlights its role in guiding personalized genetic counseling and potential treatments. Leber congenital amaurosis is a severe early-onset inherited retinal dystrophy. This study delves into the genetic basis of Leber congenital amaurosis, pinpointing compound heterozygous mutations in the NMNAT1 gene as significant causative factors. While one mutation validates previous findings (c.245T>C; p.Val82Ala), the second (c.575A>G; p.Asp192Gly) proves novel, expanding the genetic landscape of Leber congenital amaurosis 9. Both mutations, inherited independently from nonconsanguineous parents, contribute to the intricate genetic basis of light on Leber congenital amaurosis 9 in this case. The identified mutations shed light on Leber congenital amaurosis genetics in the Iranian population, showcasing the efficacy of exome-sequencing for molecular diagnoses in hereditary retinal degeneration. These findings provide valuable insights for tailored genetic counseling and potential therapeutic interventions.

Nutritional screening on hospital admission and one-year clinical outcomes in a prospective cohort of older patients

Background & AimsMalnutrition negatively affects the prognosis and quality of life of hospitalized patients. However, there are several gaps between evidence-based knowledge and current clinical practice. Our primary aim was to describe the prevalence of malnutrition risk in a cohort of in a cohort of older inpatients; secondly, we explored its predictors and its independent impact on 12-month survival. MethodsProspective study focused on patients aged 65 years and older consecutively admitted for any reason to the acute geriatric and general medical units of an Italian university hospital. Comprehensive geriatric assessment data, including the short form of the Mini Nutritional Assessment (MNA-SF), were collected within 48 hours of admission. The prevalence of malnutrition and risk of malnutrition according to the MNA-SF represented the main outcome. Correlations among clinical variables, nutritional status, and one-year survival were analyzed using multivariable and Cox models. ResultsAmong 594 patients (median age: 84 years, 49.5% female), mostly living at home with moderate functional autonomy, 82.3% were identified as probably malnourished or at risk of malnutrition according to MNA-SF (39.9% and 42.4%, respectively). Malnutrition and the risk of malnutrition were positively associated with living alone at home (OR 2.803, 95%CI 1.567-5.177, p<0.001), and negatively associated with autonomy in IADL (OR 0.765, 95%CI 0.688-0.846, p<0.001) and the best performance at HST (OR 0.901, 95%CI 0.865-0.936; p<0.001). After 12 months, 31.8% of patients was dead and mortality was positively correlated with malnutrition according to MNA-SF (OR 2.493, 95%CI 1.345-4.751, p=0.004), institutionalization (OR 2.815, 95%CI 1.423-5.693, p=0.003) and severe cognitive impairment (OR 1.701, 95%CI 1.031-2.803, p=0.036). ConclusionMalnutrition is common among older inpatients upon admission, primarily influenced by their functional and cognitive status, and it is linked to a worse prognosis. Early incorporation of thorough nutritional and functional assessments into clinical practice is crucial to improve prognosis prediction and enable timely, focused interventions targeting modifiable causal factors in a patient-centered approach.

The Role of a Biothesiometer in Early Detection and Management of Diabetic Neuropathy.

Diabetic foot ulcers (DFUs)have become a common and serious outcome of diabetes mellitus (DM). Diabetic peripheral neuropathy (DPN) is often underdiagnosed, which impairs the capacity to prevent foot ulceration. The clinical manifestations typically include sensory complaints, which leavepatients vulnerable to increased risk of injury without their awareness. The current study aims to assess the viability of VPT (vibration perception threshold) testing using a biothesiometer as an early diagnostic tool for detecting diabetic neuropathy and reducing the burden of diabetic foot disease. This prospective study was conducted in Dr. D. Y. Patil Medical College, Pimpri, Pune from August 2022 to July 2024 among 50 patients with DFUs. Ethical approval was taken from the Institutional Ethical Committee. An informed consent was obtained from all the study participants. VPT testing using a biothesiometer was done to assess the neurological status of the patient's limbs. A significant difference between the symptomatic and asymptomatic cases was also calculated to evaluate the co-relation of symptoms compared to VPT. The largest age group among those surveyed is 41-50 with a mean age of 50.72. Males form a slightly larger proportionthan females. A total of 22 (44%) ulcers are present over the plantar aspect of the foot. Out of the entire study, 37 (74%)individuals reported Grade II or III neuropathy, and 29 (58%)individuals reported no symptoms of diabetic neuropathy. The majority portion ofindividuals in the study had an HbA1c ranging from 6.5% to 8%. After an intervention, 44 (88%) patients did not experience a change in their VPT grading after six months. The chi-square test results suggest that the onset period of diabetes in years or the type of treatment history for diabetes does not significantly influence VPT grading among the surveyed individuals. However, individuals with higher HbA1c levels tend to exhibit more severe VPT impairments. Regular monitoring of VPT grading is crucial for early diagnosis of neuropathy, tracking disease progression, and assessing intervention effectiveness. Hence, we recommend all diabetic patientsregularly undergo biothesiometry as part of their routine diabetic check-ups to help prevent disease progressionand complications like amputations and improve their overall quality of life.

Assessment of the quality of life of cats affected by paraparesis/paraplegia and urinary retention, and their impact on caregivers.

In cats affected by severe thoracolumbar spinal cord pathologies, paraplegia and paraparesis, often accompanied by urinary retention, pose significant challenges, impacting both the cats' welfare and owners' lives. This study aimed to assess the quality of life (QoL) of cats affected by these conditions, and to evaluate the social and familial implications for caregivers. The study was structured into two parts. The first part comprised direct observations of aspects of QoL in cats both in household and shelter settings, while the second part involved the distribution of questionnaires to cat owners and shelter operators. Cats with paraplegia/paraparesis and urinary retention can maintain a good QoL, with hindlimb mobility significantly influencing QoL scores. Shelter cats showed a comparable QoL to household cats, challenging the anecdotal beliefs that shelter cats with severe neurological impairments are destined to lead substandard lives. Operator surveys highlighted the feasibility of managing these cats in shelter environments, emphasising the importance of collaboration between caregivers and veterinary professionals. Likewise, owner surveys revealed a manageable time commitment for care, with most owners achieving proficiency in manual bladder expression within 1 month. Despite challenges, most of the owners reported positive experiences and did not contemplate euthanasia for their cats. Regular veterinary visits and occasional physiotherapy were common practices among caregivers. Owners who respond to the questionnaire and shelter operators have a high commitment to cats with paraplegia/paraparesis. Although the study acknowledges this potential bias, it suggests that dedicated care can ensure a good QoL for cats with severe spinal injuries, both in shelter and household settings. Effective communication between caregivers and veterinary professionals is essential for accurate information dissemination and optimal care provision. This research contributes to raising awareness of managing these conditions and emphasises the importance of collaborative care approaches in veterinary medicine.

TCT-824 Transcatheter Aortic Valve Implantation on Coronary Guidewires: Free-Contrast Technique in Patients With Moderate to Severe Renal Impairment

TCT-824 Transcatheter Aortic Valve Implantation on Coronary Guidewires: Free-Contrast Technique in Patients With Moderate to Severe Renal Impairment

Psychological and physiological benefits of horticultural therapy for Chinese older adults.

Gardening as a leisure activity has been shown to be potentially beneficial for older adults, this study aimed to assess the physiological and psychological impacts of a specific horticultural activity, watering indoor plants, compared with playing a computer game - the Klondike Solitaire Card Game. This crossover study included 100 older adults recruited from a nursing care facility for older people in Shanghai, China. They were allocated to either engage in watering indoor plants (horticultural group) or playing a computer game (control group). For the inclusion criteria, screening for cognitive function was conducted to exclude those with severe cognitive impairments, thereby focusing on those capable of participating fully in the study activities. Brainwave activities, blood pressure, and psychological states were measured through pre- and post-test questionnaires to evaluate the physiological and psychological effects. The activity of watering indoor plants was associated with significant reductions in both systolic and diastolic blood pressure, in contrast to the computer game activity. Additionally, participants in the horticultural group showed increased brainwave mean values, indicating heightened relaxation and focus, while decreases were observed in the control group. The experimental group reported reduced anxiety scores, along with increased feelings of comfort and relaxation, and also exhibited significantly higher meditation levels, which indicates a profound mental relaxation effect. Our findings suggest that engaging in indoor horticultural activities, such as watering houseplants for 10minutes, can reduce mental and physical stress levels in older adults.

Homogeneity and reliability of the Behaviour observation scale for Psychomotor Therapy for elderly people with dementia

The Behaviour observation scale for Psychomotor Therapy for elderly people with dementia (BPMT-dem) was developed to (1) evaluate the cognitive, emotional and social functioning of people with dementia in psychomotor therapy, and (2) to facilitate the interdisciplinary communication in treatment of behavioural and mood disruptions. The objective was to investigate the homogeneity and reliability of the BPMT-dem73. The Mokken scaling procedure was used on items and 10 a-priori determined subscales in a sample of 105 people with dementia or severe cognitive impairments.68 items demonstrated sufficient scalability (item-scalability coefficient Hi ranged from .30 to .81). 6 subscales had strong, and 4 had moderate homogeneity. The 68-item version of BPMT-dem has satisfactory reliability (Rho ranged from .65 to .89 for the subscales). Researchers and psychomotor therapists are recommended to use BPMT-dem68 to gain insight into the efficacy of psychomotor therapy on the cognitive, emotional and social functioning of people with dementia.

Prehabilitation for delirium prevention in elderly patients with chronic limb threatening ischemia

Elderly patients with Chronic Limb Threatening Ischemia (CLTI) undergoing revascularization are prone to delirium and prolonged hospitalization. Preoperative prehabilitation may prevent delirium and reduce the length of stay. This study investigates the effect of multimodal prehabilitation on delirium incidence in elderly CLTI patients undergoing revascularization. A comparative observational cohort study conducted in a large teaching hospital (intervention cohort n=101, retrospective control cohort n=207) and a university hospital (prospective control cohort n=48) from 2020 to 2023. Patients aged ≥ 65 years undergoing revascularization were included, with acute treatment or severe cognitive impairment as exclusion criteria. The three-week prehabilitation program included screening of general health and presence of delirium risk factors by a vascular nurse practitioner, screening and provision of personalized, home-based exercises by a physiotherapist, provision of nutritional advice by a dietician, and if indicated comprehensive geriatric assessment by a geriatrician, assessment of self-reliance and home situation by a prearranged homecare nurse, guidance and support for smoking cessation by a quit smoking coach, and anaemia treatment. Primary outcome was 30-day delirium incidence, analysed using regression models adjusting for potential confounders (age, physical impairment, history of delirium, preoperative anaemia and revascularization type). Secondary outcomes were length of stay, postoperative complications, 30-day mortality, and patient experiences. Median age (IQR) was 76 years (71-82). Delirium incidence was lower in the prehabilitation cohort (n=2/101, 2%) compared to controls (n=23/255, 9%; OR=0.21, 95%CI 0.05-0.89, p=.04). Adjusted analysis showed a non-significant delirium reduction (OR=0.28, 95%CI 0.06-1.3, p=.097). The prehabilitation cohort had a significantly shorter length of stay (2 [1-5] vs 4 [2-9] days; p=<.001), and fewer minor complications (14% vs 26%, p=.01). No differences were present in major complications and 30-day mortality. Patients reported high compliance and satisfaction (median score 8/10, IQR 7-9). Prehabilitation among elderly CLTI patients is safe and has the potential to yield multiple beneficial effects on general outcomes following revascularization, while also achieving high levels of patient satisfaction. Further validation and considering implementation in surgical settings is recommended.

A phase 1, open-label, single-dose study to evaluate the pharmacokinetics (PK), safety and tolerability of HM15912 in subjects with severe renal impairment (RI) and normal renal function

A phase 1, open-label, single-dose study to evaluate the pharmacokinetics (PK), safety and tolerability of HM15912 in subjects with severe renal impairment (RI) and normal renal function

A novel dual-split layout for transcritical CO2 power cycle adapted to variable heat sources

Transcritical CO2 power cycle is widely used as the bottom cycle of natural gas engine to recover waste heat. However, owing to the large variation in waste heat sources caused by changes in engine operating conditions, the adaptability of the CO2 power cycle is poor, reflected in severe performance deterioration in thermal match, components and system power output. Hence, to improve the adaptability of the CO2 power cycle to wide-range fluctuation in heat sources, a novel dual-split configuration is proposed in this paper. The freedom of regulation is effectively enhanced by the supplementary split branches, and the mass flow rate through different heat exchangers can be actively adjusted with high flexibility. Furthermore, off-design performance models and a calculation procedure are built to present the off-design performance of the different cycles under the engine operational profile. The results indicate that the proposed configuration can improves the adaptability of the CO2 cycle to fluctuating heat sources effectively. Specifically, for all engine operational conditions, the invalidated operating region was contracted from eight to four points, with the engine coolant and exhaust gas utilisation rates exceeding 90 % and 97.4 % respectively. In addition, under low engine operating conditions, the cycle pressure ratio and mass flow rate were maintained at relatively high values, contributing to enhanced pump and turbine efficiencies. The maximum net power output increased by 8.3 kW, and the minimum brake-specific fuel consumption decreased by 16.9 %.

Late Holocene extraordinary palaeoflood events and their climatological context in the Shahe River, Huaihe River Basin, China

Palaeoflood events represent immediate hydrological responses to extreme climate change. A loess-paleosol sedimentary profile containing three overbank flood deposits (OFD1, OFD2, and OFD3) layers that recorded palaeoflood events was discovered on the platform scarp of the Shahe River, a tributary of the Huaihe River through a field investigation. Sediment samples were collected, and their physicochemical properties, as well as optically stimulated luminescence (OSL) dating, were analyzed. The results indicated that OFD1, OFD2, and OFD3 were indeed overbank flood deposits influenced by hydrodynamic forces. However, OFD3 and OFD1 consisted primarily of sand (>60 %) in terms of particle size composition, whereas paleosol (S0), transitional loess (Lt), and Malan loess (L1) mainly comprised silt (>70 %). Moreover, the magnetic susceptibility values of OFD3 and OFD1 exceeded those of S0, Lt, and L1. The contents of Na2O, K2O, and SiO2 were higher, while their contents of Al2O3 and Fe2O3 were lower in OFD3 and OFD1. These suggested that OFD3 and OFD1 may originate from weathered bedrock materials transported from the upper reaches of the Shahe River under significant hydrodynamic forces. The particle size composition, magnetic susceptibility value, and geochemical element composition of OFD2 were similar to those of S0, Lt, and L1 but diverged significantly from those of OFD1 and OFD3, indicating that OFD2 originated from loess and soil sediments widely distributed on both sides of the valley. Through OSL dating and stratigraphic chronological framework of the sedimentary profile, these three extraordinary palaeoflood events in the Huaihe River Basin occurred during the late Holocene, ∼1470 a. The analysis of high-resolution climate proxy indicators, atmospheric circulation factors, and global mean temperature demonstrated a direct correlation between these extreme flood events and abrupt climate changes during ∼ 1470 a. This period corresponded to severe climate deterioration during the Northern and Southern Dynasties (589–420 CE) in China. These findings are crucial for enhancing our understanding of regional hydrological climate responses to global changes.

Denosumab stimulates spermatogenesis in infertile men with preserved Sertoli cell capacity

Sperm production depends on proper Sertoli-germ cell interaction, and we hypothesized that receptor activator of nuclear factor κB ligand (RANKL) activity in Sertoli cells may influence spermatogenesis. Treatment with the RANKL inhibitor denosumab, normally used to treat osteoporosis, increased testicular weight, inhibin B, and germ cell proliferation in exvivo testis cultures and invivo in a humanized RANKL mouse. The effect on germ cell proliferation was positively associated with baseline serum concentrations of anti-müllerian hormone (AMH). In accordance, denosumab increased germ cell proliferation in exvivo human testis cultures with low/moderate but not severe impairment of Sertoli cell function. In a placebo-controlled randomized clinical trial, denosumab had no effect on semen quality but increased sperm concentration in a subgroup of infertile men with serum AMH ≥38 pmol/L at baseline. In conclusion, high serum AMH may increase the probability of a beneficial response to denosumab treatment in infertile men, thus suggesting a possible venue for precision medicine in male infertility.

Effects of Sulfuric Acid-Water Immersion on the Properties of Ethylene Propylene Diene Monomer, Thermoplastic Vulcanizates, and Eco-Friendly Thermoplastic Vulcanizates

Abstract This research investigates the impact of sulfuric acid-water solutions on the physico-chemical characteristics of ethylene propylene diene monomer rubber (EPDM), thermoplastic vulcanizates (TPV), and ECO TPV materials. We evaluated the deterioration of these materials by subjecting them to acidic environments and using methods such as differential scanning calorimetry (DSC), volume and weight measurements, hardness measures, and scanning electron microscopy (SEM). The samples were submerged in solutions of H2SO4 with concentrations of 1M, 0.1M, and 0.001M at a temperature of 90°C for a duration of 1000 h. The results indicated that EPDM had superior chemical and thermal stability, accompanied by negligible changes in weight and volume. The TPV exhibited moderate stability, however the ECO TPV showed severe deterioration, as seen by major increases in weight and volume, as well as notable changes in DSC profiles. Surface degradation and cracking, especially in ECO TPV samples, were observed using SEM investigation. The hardness results indicated little changes in hardness after exposure to the various chemical aging techniques. The results indicate that EPDM and TPV are better suited for use in acidic conditions, such as fuel-cell systems. However, ECO TPV may need extra stabilization in order to enhance its endurance.

MANUAL OROFACIAL STIMULATION AND ITS IMPACT ON CHILDREN WITH CEREBRAL PALSY

Orofacial education of children with cerebral palsy is a long-lasting process that requires perseverance especially from their families. The main methods based on active orofacial exercises and those from speech therapy continue to question the effectiveness of oral motor treatment, leaving a gap in the literature concerning the feeding skills improvements of the children diagnosed with cerebral palsy. Based on this concern, we ask ourselves the question: are there other better methods of oral motor rehabilitation for these children with special needs? In this study we aimed to investigate, within the complex rehabilitation programme for CP, the impact of manual orofacial stimulation in order to reduce sialorrhea and improve mandibular movements, which play an important role in the feeding process. The study included 10 participants (5 girls and 5 boys), aged 8-10 years, diagnosed with cerebral palsy, spastic tetraplegia form with severe orofacial impairment and the intervention protocol consisted of a manual orofacial stimulation programme 4 times a week. Statistical results revealed that the application of the proposed orofacial stimulation programme was highly effective for the 10 research participants, whose scores improved significantly at the final assessment compared to those achieved at the beginning of the study, reaching almost normal values even in the case of mandibular parameters.

The relationship between Hearing Handicap Inventory for The Elderly – Screening Version (HHIE-S) Questionnaire Scores and Hearing Loss in The Elderly in Sukawati Village, Gianyar Regency

Background: Age-related hearing loss, or presbycusis, significantly impacts communication, social interaction, and cognitive function. This study examined the relationship between Hearing Handicap Inventory for the Elderly – Screening Version (HHIE-S) scores and hearing loss severity among the elderly in Sukawati Village, Gianyar. Methods: A cross-sectional study of 50 elderly participants aged 60 years and older was conducted. Data were collected using the HHIE-S questionnaire and pure-tone audiometry, and analyzed using Pearson’s correlation. Results: A strong positive correlation was found between HHIE-S scores and hearing loss severity (r = 0.896, p &lt; 0.001), indicating that higher scores correspond to more severe hearing impairment. Conclusion: The HHIE-S questionnaire is an effective tool for early detection of hearing loss in the elderly and is recommended for use in primary healthcare settings to enhance timely management and improve quality of life.

КАЧЕСТВО ЖИЗНИ И КОГНИТИВНЫЕ НАРУШЕНИЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

Abstract. Вackground. Chronic heart failure (CHF) has a high prevalence in the Russian population. It is one of the main causes of reduced quality of life in cardiology patients due to the gradual progression of the disease and the development of complications, as well as the development of cognitive impairment. Early recognition of these disorders will optimize the management of patients with CHF. Purpose of the study. To evaluate the quality of life and cognitive functions in patients with different severity of chronic heart failure. Characterization of patients and methods of the study. 105 patients with confirmed diagnosis of CHF with different functional classes according to NYHA were included in the open cross-sectional non-randomized cohort study. Cognitive screening was performed using the Montreal Cognitive Assessment (MoCA), and quality of life was assessed by the Quality of Life Questionnaire (EQ-5D). Statistical Analysis Methods. Excel data analysis package and SPSS 23.0 data analysis package were used. Results and Conclusion. A pilot study was conducted to detect mild or severe cognitive impairment using the Montreal Cognitive Scale and quality of life using the EQ-5D questionnaire in patients with different functional classes of CHF. A significant correlation was found between cognitive function and left ventricular ejection fraction. Quality of life did not depend on the severity of CHF, sex, age, concomitant pathology. The obtained data should be taken into account in personalized management of patients with CHF.

Clinical characteristics and visual outcomes of animal-induced ocular injuries: a prospective multicenter study in Iran.

Animal-induced ocular injuries represent an under-documented health problem that may pose significant visual complications. This study aimed to investigate the clinical characteristics and outcomes of ocular injuries caused by animals. This multicenter prospective study enrolled patients with a history of animal-induced ocular injuries presenting to the ophthalmology departments of two tertiary hospitals over a one-year period. All participants underwent comprehensive assessments by ophthalmologists, and the following data were collected: demographic information, animal species involved, injury details, pre- and post-treatment visual data, management strategies, and follow-up outcomes. Seventy-two patients (62.5% male) were included in the study. Insects were the most common species, causing 37.5% of ocular injuries. The type of animal involved was significantly associated with injury patterns (p < 0.0001), visual impairments at presentation (p < 0.05), and need for surgery (p < 0.001). Insects predominantly caused periorbital soft tissue injuries; birds primarily affected the anterior segment; dogs and cats mainly led to adnexal injuries; and equines often involved both anterior and posterior segments. Equine-related injuries resulted in the most severe visual impairments, requiring surgical interventions in all cases. At the same time, the majority of cases involved with other animal species experienced no visual impairment. The number of patients without visual impairment increased from 46 cases (63.9%) at the time of presentation to 58 (80.6%) at discharge after treatment. At follow-up, eight patients (11.1%) experienced complications, including traumatic cataract (n = 6, 8.3%), endophthalmitis (n = 3, 4.2%), corneal scarring (n = 1, 1.4%), and retinal detachment (n = 1, 1.4%). Rooster pecking was the leading cause of complications, including endophthalmitis and traumatic cataract. This study revealed that depending on the type of animal causing the injury, animal-induced ocular injuries present with diverse characteristics, requiring appropriate treatment approaches and potentially resulting in different outcomes. These findings may promote public awareness and improve preventive strategies and clinical guidelines development.