Severe Stage Research Articles

Performance of perimetric glaucoma staging systems and their preference patterns among the Indian eye care practitioners.

Various systems are available to stage glaucomatous field defects into different severity grades. Still, the preference for such systems among Indian eye care practitioners (ECPs) and the consensus between them are not explored. To compare the clinical performance of perimetric glaucoma staging systems and to assess their preference patterns among Indian ECPs. Retro-prospective cross-sectional study. Three investigators stratified 400 perimetry reports using four systems: Hodapp Anderson Parrish (HAP), enhanced Glaucoma Severity Staging (eGSS), Advanced Glaucoma Intervention Study (AGIS), and Collaborative Initial Glaucoma Treatment Study (CIGTS). Their performance was compared in terms of agreement and association. Following this, 30 ECPs from across the country segregated a subset of reports (n = 20) into different stages based on their system of choice, and their preferences/perceptions about the available perimetry staging systems were enquired and documented. Descriptive statistics, Kruskal-Wallis, Cohen's kappa, and Spearman's correlation. For the consolidated severity stages, substantial agreements (K ranging from 0.61 to 0.75) were found between all the systems, except for HAP-CIGTS (K = 0.58) and AGIS-CIGTS (K = 0.51). All ECPs were aware of perimetry staging systems, and a high preference was reported for HAP (97%) due to ease of implementation and interpretation. Among the four staging systems, the highest agreement was found between HAP and eGSS. A majority of ECPs proposed the need for a uniform classification system across the practices for clinical comparisons and patient education.

Profile of malnourished COPD patients: A comparative study

Introduction: Malnutrition is frequently associated with chronic obstructive pulmonary disease (COPD) especially in severe stages. It is correlated with a poor prognosis. The aim of this study was to determine malnutrition prevalence in COPD patients and to compare the profile of malnourished COPD versus not-malnourished COPD patients. Patients and methods: Stable COPD patients benefited from nutritional evaluation by measuring body mass index (BMI). Subsequently, a comparative study was used to compare disease severity, number of acute exacerbations, modified Medical Research Council (mMRC) dyspnea scale score and exercise capacity by the 6 min walk test (6MWT) between malnourished and not malnourished COPD patients. Results: 175 COPD patients were recruited (9F; 166M) aged between 40 and 86 with an average age of 67.95 years. The mean smoke load of the patients was 35(20) packs/year, FEV1: 52(21) % pred, m MRC dyspnea scale: 2 (1). 41.14% of COPD patients were malnourished (BMI < 20 Kg/m2). Two groups were individualized. · Group A: COPD with BMI < 20 Kg/m2:72 patients, (4F; 68M), age: 67(9) years, FEV1: 48.5(21.44) % pred. · Group B: COPD with BMI≥ 20 Kg/m2: 103 patients, (5F, 98M), age: 68(9) years, FEV1: 55.25(21.42) % pred. Using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, the functional stages found in group A patients were GOLD I: 12%, GOLD II: 23%, GOLD III: 42%, GOLD IV: 23%. While for group B were GOLD I:25% GOLD II%:35%, GOLD III:28%, GOLD IV:12%. 72% of group A patients have an m MRC ≥ 2 Vs 63% of group B. 77.8% of group A patients have a history of hospitalization for at least one acute exacerbation in the last 12-month vs 63.1% of Group B patients. The 6-min walk average distance (6MWD) was 423.58 m in Group A vs 438.33 m in Group B. Conclusion: Nutritional assessment and appropriate management of undernutrition should be integrated into the treatment of COPD patients.

Defining the Role of Frailty in the Transition from Mild Cognitive Impairment to Dementia and in Dementia Progression

Plain Language SummaryThis study focuses on understanding the transition and progression of dementia by investigating the role of frailty, a state of increased vulnerability typically associated with aging. The research involves an analysis of more than 1,200 participants who attended a specialized dementia unit over a span of 2 years. The authors utilized the clinical frailty scale (CFS) to assess the frailty of these individuals, to discern if there is an association between frailty and the progression of dementia, particularly from the initial stage known as mild cognitive impairment (MCI) to more advanced stages of the disease. The results indicate a significant link between the increase in frailty, as quantified by the CFS, and the severity of dementia. The findings also reveal that age, frailty level, and scores from a cognitive assessment test known as the mini-mental state examination (MMSE) were pivotal in predicting the transition from MCI to full-blown dementia and the advancement to more severe dementia stages. In conclusion, the study underscores the critical role of frailty in the progression of dementia. The CFS emerges as a valuable tool for routine frailty assessments, which can aid in the early detection and management of dementia. The research offers vital insights into the progression of dementia and can significantly influence care strategies for affected individuals.

Research on tool wear state identification method driven by multi-source information fusion and multi-dimension attention mechanism

Cutting tool wear condition monitoring technology is the key technology of advanced manufacturing system and a crucial component of machining. The stage of the tool wear has a direct impact on performance of the workpiece and efficacy of machine tool. However, the duplication and lack of wear information and the fuzzy area of the tool wear transition stage are the key factors contributing to the incorrect estimation of the tool wear state when extracting cutting tool wear feature information. As a consequence, this study presents a data fusion from several sources-based intelligent tool wear state detection technique. The fusion of data from several sources can effectively realize the complementarity of machining information. This provides the model with more comprehensive identification data. The mapping between wear state and wear characteristics is precisely established. To address these issues, the attention mechanism of channel and spatial latitude is integrated into the feature extraction. The model that was constructed in the present investigation has a comprehensive identification accuracy of 0.982. The F1 score of initial, normal and severe wear stage of tool wear are 0.977, 0.968 and 0.993, which are better than other models. Experiments show that the identification method proposed in this study may provide accurate tool wear condition identification based on machining process data, allowing for more flexible and precise cutting tool change decisions in machining.

Behavior of Hypertrophied Right Ventricle during the Development of Left Ventricular Failure Due to Myocardial Infarction.

In order to determine the behavior of the right ventricle, we have reviewed the existing literature in the area of cardiac remodeling, signal transduction pathways, subcellular mechanisms, β-adrenoreceptor-adenylyl cyclase system and myocardial catecholamine content during the development of left ventricular failure due to myocardial infarction. The right ventricle exhibited adaptive cardiac hypertrophy due to increases in different signal transduction pathways involving the activation of protein kinase C, phospholipase C and protein kinase A systems by elevated levels of vasoactive hormones such as catecholamines and angiotensin II in the circulation at early and moderate stages of heart failure. An increase in the sarcoplasmic reticulum Ca2+ transport without any changes in myofibrillar Ca2+-stimulated ATPase was observed in the right ventricle at early and moderate stages of heart failure. On the other hand, the right ventricle showed maladaptive cardiac hypertrophy at the severe stages of heart failure due to myocardial infarction. The upregulation and downregulation of β-adrenoreceptor-mediated signal transduction pathways were observed in the right ventricle at moderate and late stages of heart failure, respectively. The catalytic activity of adenylate cyclase, as well as the regulation of this enzyme by Gs proteins, were seen to be augmented in the hypertrophied right ventricle at early, moderate and severe stages of heart failure. Furthermore, catecholamine stores and catecholamine uptake in the right ventricle were also affected as a consequence of changes in the sympathetic nervous system at different stages of heart failure. It is suggested that the hypertrophied right ventricle may serve as a compensatory mechanism to the left ventricle during the development of early and moderate stages of heart failure.

Effects of full-thickness wedge resection on ocular surface and in vivo confocal microscopy findings in floppy eyelid syndrome patients.

To evaluate the effect of full-thickness wedge resection (FTWR) on ocular surface and in vivo confocal microscopy (IVCM) findings in patients with floppy eyelid syndrome (FES). The study included two groups: a surgical treatment (ST) group (26 eyes) consisting of patients who underwent FTWR surgery, and a conservative treatment (CT) group (30 eyes). Pre-treatment and post-treatment ocular surface disease index (OSDI), tear break-up time (TBUT), corneal fluorescein staining (CFS), IVCM findings along with the body mass index (BMI), FES grade, the presence and the treatment of obstructive sleep apnea syndrome (OSAS) were recorded and compared between the groups. The groups were comparable in terms of BMI, FES grade, and OSAS data. After six months, TBUT in the ST group significantly increased to 12.92 ± 1.15, compared to 8.10 ± 1.60 in the CT group (p = 0.000). The CFS and OSDI scores were significantly lower in the ST group (0.15 ± 0.37, 18.0 ± 8.3, respectively) compared to the CT group (0.90 ± 0.61, 27.3 ± 9.3, respectively) (p = 0.000). IVCM analysis revealed a significant decrease in dendritic cell count (ST: 22.0 ± 12.4, CT: 39.5 ± 15.1, p = 0.000) and nerve tortuosity (ST: 1.38 ± 0.64, CT: 2.00 ± 0.59, p = 0.000), with a significant increase in total nerve density (ST: 4.27 ± 0.83, CT: 3.57 ± 0.90, p = 0.002) in the ST group compared to the CT group after six months. In our retrospective cohort, FTWR surgery was shown to be an effective and reliable surgical treatment for FES, improving both ocular surface and IVCM findings. Patients with moderate to severe stages of FES not responding to conservative treatment may benefit from eyelid tightening.

The Role of Fibrin Monomer Compared to D-dimer and CRP in Determining COVID-19 Severity

Fibrin Monomer (FM), as a product of thrombin activity in cleaving fibrinogen, can be used as an early marker of thrombotic events in COVID-19 patients. D-dimer is a commonly used marker of hemostasis as a product of plasmin activity in cleaving polymeric fibrin. D-dimer is often used to help decide whether to initiate anticoagulant administration. This study aims to know whether FM can be used as a marker for thrombotic events such as D-dimer in COVID-19 patients; CRP levels were also examined to determine how inflammation affected the two hemostatic indicators. A total of 93 patients were confirmed with COVID-19 by PCR. The median (min-max) FM in the severe stage was 4.53 (2.26-58.20)ug/mL, whereas, in the mild-moderate stage, it was 4.21 (2.19-32.35 ug/mL. There are significant differences in median D-dimer levels in severe stages to mild-moderate, respectively 0.46 (0.14–7.58) and 0.7890, and ages. The level of FM that can be used to differentiate the severe stage is > 4.46 ug/mL (sensitivity 56.3%, specificity 58.0%) as in the D-dimer level is > 0.58 ug/mL ((sensitivity 75.0%, specificity 65.2%). There is a moderate positive correlation between fibrin monomer and D-dimer, a weak positive correlation between D-dimer and CRP, and no correlation between FM and CRP. This study concludes that the FM median level is higher in severe COVID-19 than in D-dimer. Fibrin monomer levels have a positive correlation with D-dimer. Fibrin Monomer levels are not affected by CRP.

Ruxolitinib in patients with graft versus host disease (GvHD): findings from a compassionate use program

The ruxolitinib compassionate use (CU) program offered ruxolitinib to patients ≥2 years of age with confirmed steroid-resistant acute or chronic graft-versus-host disease (aGvHD and cGvHD, respectively). Data from 1180 patients (n = 775, 370 and 35 with cGvHD, aGvHD, and non-specified GvHD, respectively) were analyzed. Most patients had severe cGvHD (56%) or stage III/IV aGvHD (70%) disease and had previously received corticosteroids ( > 80%); ruxolitinib was requested primarily as a second-/third-line option. Patients <12 and ≥12 years old most often received the recommended ruxolitinib doses (5 mg twice daily [BID] and 10 mg BID, respectively); however, 23% and 30% of ≥12 year olds with cGvHD and aGvHD, respectively, received the lower dose of 5 mg BID. Notably, corticosteroid usage decreased with ruxolitinib treatment; at the initial ruxolitinib request, 81% and 91% of patients with cGvHD and aGvHD, respectively, were receiving corticosteroids whereas at resupply, 62% and 64%, respectively, were receiving corticosteroids. Eighty two percent of evaluable patients with cGvHD had a complete or partial response to treatment and 56% of evaluable patients with aGvHD had a best response of grade 0/I. These findings demonstrate the rapid and positive effects of ruxolitinib in patients with GvHD in a real-world setting.

Patient With Parkinson Disease and Care Partner Perceptions of Key Domains Affecting Health-Related Quality of Life: Systematic Review

To effectively customize Parkinson disease (PD) programs, it is important to incorporate the "individual's voice" and have a thorough understanding of the symptom priorities of people with PD (PwP) and care partners (CP). In this convergent integrated mixed-method systematic review, we aimed to analyze qualitative and quantitative evidence of PD motor and nonmotor symptoms affecting health-related quality of life (HRQOL) in PwP and CP, comparing priorities across different levels of disease severity. We searched MEDLINE, PsycINFO, Web of Science, Embase, and Scopus; ProQuest Dissertations and Theses Global; and the Michael J. Fox Foundation Data Resources for studies published up to June 29, 2022. We included qualitative, quantitative, and mixed-method studies investigating PD symptom priorities among PwP and CP. We critically appraised eligible studies for methodological quality using the Mixed-Methods Appraisal Tool. Derived terms were mapped and coded according to thematic attribution. Independent syntheses of qualitative and quantitative evidence and transformation of quantitative data into qualitative formats were performed. Of the 7,716 identified studies, we included 70 that provided qualitative (n = 13), quantitative (n = 53), and mixed (n = 4) evidence. We included 604 mapped terms representing 11 PwP-identified and CP-identified motor and nonmotor symptom categories. Across all PD stages, both PwP and CP considered 5 domains more affecting their HRQOL, namely: "motor functionality," "mood," "cognition," "gait, balance, posture, and falls," and "nighttime sleep disorders." In early disease, PwP and CP considered "mood" the domain that most affected their HRQOL. In advanced PD, PwP considered "pain" the domain that most affects their HRQOL, while CP considered "psychiatric symptoms." The domain "gait, balance, posture, and falls" was equally considered by both PwP and CP as the second domain that most affects their HRQOL in the advanced stage of PD. The ranking of the priority of symptoms is largely shared by PwP and CP, and motor symptom priorities dominate the full disease spectrum. However, the nonmotor symptom priorities shift according to the disease severity stage. Tailored care and research require that providers consider these shifting priorities and incorporate the "individual's voice" into treatment decisions.

Cost-utility analysis of treating mild stage normal tension glaucoma by surgery in China: a decision-analytic Markov model

BackgroundMany individuals suffer from normal tension glaucoma (NTG) in China. This study utilized Markov models to evaluate the cost-utility of applying many medications and surgery for mild-stage NTG when disease progression occurred at a mild stage.MethodsA 10-year decision-analytic Markov model was developed for the cost-utility analysis of treating mild-stage NTG with surgery and increased application of medication. We hypothesized that all 100,000 samples with a mean age of 64 were in mild stages of NTG. Transitional probabilities from the mild to moderate to severe stages and the basic parameters acquired from the CNTGS were calculated. Incremental cost-utility ratios (ICUR) were calculated for treating all patients with NTG by probabilistic sensitivity analysis (PSA) and Monte Carlo simulation. One-way sensitivity analysis were conducted by adjusting the progression rate, cost of medications or trabeculectomy, cost of follow-up, and surgical acceptance rate.ResultsThe ICUR of treating mild stage NTG with medication over 10 years was $12743.93 per quality-adjusted life years (QALYs). The ICUR for treating mild stage NTG patients with a 25% and 50% surgery rate with medication were $8798.93 and $4851.93 per QALYs, respectively. In this model, the cost-utility of treating NTG was sensitive to disease progression rate, surgical treatment rate, and medication costs.ConclusionsAccording to the results of the cost-utility analysis, it was a reasonable and advantageous strategy to administer a lot of medication and surgery for NTG in the mild stages of the disease. In the model, the greater the probability of patients undergoing surgery, the strategy becomes more valuable.

The importance of multimodal diagnostic methods for therapeutic decision making for overactive bladder in women

Background and aim. Despite overactive bladder (OAB) being a symptomatic diagnosis, all patients require a basic assessment to confirm the diagnosis, as well as to exclude any other underlying cause for lower urinary tract dysfunction. While guidelines clearly define different methods of investigations for OAB, there are reasons to believe that these guidelines reflect more of a “one size fits all” model that may not be appropriate for use in all patients. The study aimed to elucidate the complex and advanced multidisciplinary methods of investigation of OAB patients.&#x0D; Methods. PubMed, ScienceDirect, Cochrane Library, and Google Scholar databases were used to search for scientific publications from 2013 to 2023 using relevant keywords and phrases.&#x0D; Results. Data from 708 publications were researched and synthesized, a systematic review was carried out and the detailed and coherent results presented the diagnostic aspects of overactive bladder in women. Relevant citations from selected articles were included, and a synthesis of key information was provided.&#x0D; Conclusion. These discoveries may assist in detecting OAB earlier, allowing for prompt intervention and potentially preventing the condition from progressing to more severe stages and providing healthcare professionals with valuable tools to enhance the diagnosis and treatment of OAB, potentially improving the quality of life for patients affected by this condition.

Cross-sectional study of the prevalence of hyperextension of the first metatarsophalangeal joint and its relationshipto onycholysis in women with hallux valgus.

Hallux Valgus (HV) deformity is associated with misalignment in the sagittal plane that affects the first toe. However, the repercussions of the first toe hyperextension in HV have been scarcely considered. The purpose of this study was to provide evidence of the association between first-toe hyperextension and the risk of first toenail onycholysis in HV. A total of 248 HV from 129 females were included. The extension of 1st MTP joint was measured while the patient was in the neutral position of the hallux using a two-branch goniometer. The classification of the HV severity stage was determined by the Manchester visual scale, and the height of the first toe in the standing position was measured using a digital meter. An interview and clinical examination were performed to collect information on the presence of onycholysis of the first toe. Of the 248 HV studied, 100 (40.3%) had onycholysis. A neutral extension > 30 degrees was noted in 110 (44.3%) HV. The incidence of onycholysis was higher in HV type C than in type B (p = 0.044). The probability of suffering onycholysis in the right foot was 2.3 times greater when the neutral position was higher than 30 degrees (OR = 2.3; p = 0.004). However, this was not observed in the left foot (p = 0.171). Onycholysis was more frequent in HV with more than 2cm height of the first toe (p < 0.001). For both feet, the probability of suffering onycholysis was greater for each unit increase in hallux height (right foot OR = 9.0402, p = 0.005; left foot OR = 7.6633, p = 0.010). The incidence of onycholysis appears to be significantly associated with HV showing more than 30º extension, and more than 2cm height of the first toe. Height and hyperextension of the first toe together with first toenail pathology should be mandatory in the evaluation of HV.

Bioinformatics to analyze the differentially expressed genes in different degrees of Alzheimer's disease and their roles in progress of the disease.

Employing bioinformatics approaches, this investigation pinpointed pivotal differentially expressed genes (DEGs) across the spectrum of Alzheimer's disease (AD), from incipient to severe stages, using the GSE28146 dataset from the GEO repository. Analytical methods included DEG identification via the limma package in R, coupled with GO and KEGG pathway analyses through clusterProfiler, to discern biological processes and pathway involvements. Key findings spotlighted the roles of proteasome subunits PSMB4, PSMB8, PSMC4, and PSMD6 in the early stage, ribosomal proteins RPS3 and RPL11 during moderate AD, and mitochondrial components COX5B, COX6B2, and COX7A2 in severe AD, underscoring their importance in the disease's pathogenesis. Conclusively, these results not only delineate the dynamic genetic shifts accompanying AD progression but also propose critical biomarkers for potential therapeutic targeting, offering a consolidated basis for future AD research and treatment development. This offered a novel idea for analyzing the pathogenesis and development of AD and investigation of targeted drugs.

Prevalence and Psychosocial Risk Factors Associated with Depression in Older People in A Rural Community

Depression is a multifactorial disease that globally impacts all ages and sectors of the population. In this sense, it has become a public health problem, since it affects 280 million people in the world, according to information from the World Health Organization. Older adults represent 5.7% of the population that experiences this disease, with the moderate to severe stage being the one that most impacts their health, and, therefore, quality of life. For this reason, the objective of the research is to know the prevalence and psychosocial risk factors associated with depression in older people in the community of Santa Cruz, Hecelchakán, Campeche. The methodology used is with a quantitative approach because information was collected, based on the application of the Yesavage scale of geriatric depression, and the sociodemographic registry of 60 older adults of both sexes, in order to measure the percentage of prevalence through its respective epidemiological formula. Likewise, it is cross-sectional because it collected data in a single time: November 2022 – October 2023. Results: 46.7% experienced mild depression, 41.7% moderate depression and 11.6% severe depression. 55% of those interviewed were male and 45% female. The actual prevalence of depression is 100%. Likewise, the psychosocial risk factors identified were: the absence of recreational activities and social support networks, the economy, health services and family disintegration. Finally, it is necessary to design and implement socio-health intervention projects in the locality and with a socio-cultural perspective that impacts this age group, the family and from an intergenerational perspective, with the promotion of mental health being a priority goal in their execution.

An Evaluation of Hemostatic Dysregulation in Canine Multicentric Lymphoma

Multiple hemostatic abnormalities are associated with paraneoplastic syndrome and some malignant tumors. Lymphoma is the most common hematopoietic neoplasm in dogs, sometimes associated with hemostatic changes. The objectives of this study were to evaluate the behavior of coagulation parameters in dogs with multicentric lymphoma compared with diseased dogs without lymphoma, to separately evaluate the effect of immunophenotype (B lymphoma versus T lymphoma) on the variables of interest as well as the effect of disease stage (stage II to IV versus stage V). Specifically, a cross-sectional study was performed with a matched comparison group considering 170 dogs with B or T lymphoma (group 1) and 170 dogs with no lymphoma or other neoplastic processes but other diseases (group 0). Eight coagulation parameters were evaluated: platelet count (Plt), activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT), fibrinogen, fibrin/products of fibrinogen degradation (FDPs), fibrin D-dimers, and antithrombin (AT). Dogs with lymphoma showed prolonged PT and TT, decreased fibrinogen, increased FDP, and decreased Plt compared with group 0. The effect of disease stage was evaluated separately for dogs with stage II to IV lymphoma and dogs with stage V lymphoma; patients with stage II–IV lymphoma showed no significant differences, while in dogs with stage V lymphoma, a prolongation of PT and TT, a decrease in fibrinogen, an increase in FDPs and a decrease in Plt were found compared with the group 0. Finally, the comparison between B lymphoma and T lymphoma showed no significant differences in coagulation parameters between the two groups. Logistic regression analysis demonstrated that low fibrinogen and platelet levels were the most significant predictors of lymphoma in a cohort of canine patients. These hemostatic abnormalities in lymphoma appeared to be associated with the stage of the disease rather than the lymphoma immunophenotype. These findings pave the way for the possible scenario of lymphoma-associated fibrinolysis and the so far undescribed pattern of hyperfibrinolysis associated with the most severe stage of lymphoma.

Pressure injury prevalence in critical care settings: An observational pre-post intervention study.

To explore pressure injury prevention practices and evaluate the impact of an educational intervention on PI prevalence before and after an educational intervention. A multi-centre observational study. Data were collected at two time points in May 2021 and April 2022 using a Qualtrics® online form. Two Registered Nurses at each site collected observational data at each time point by diagnosing and staging any identified pressure injuries as part of a prevalence study. Patients admitted to participating units were included. A total of 181 patients in critical care units were included at the two-time points. Pressure injury prevalence was 60.9% at the outset, with 52.9% hospital-acquired, 37.9% unit-acquired and 23.0% medical device-related. Post-intervention prevalence decreased significantly to 28.7%, including 21.3% hospital-acquired, 14.9% unit-acquired, and 8.5% medical device-related. Pressure injuries were prominent in the sacral region, head area, and heels. Stages I and II pressure injuries were the most common. Increased age and longer ICU stays are linked to a heightened risk of pressure injury development in critically ill patients, whereas higher haemoglobin levels show an inverse relationship with the development of both pressure injury and severe stages in the univariate analysis. The predictive models revealed that increased age and longer ICU stays are predictors for both pressure injury development and progression to severe stages, while Braden scores predict the likelihood of developing severe stages of pressure injuries. This study has identified a benchmark for pressure injury prevalence in critical care units in Saudi Arabia. The results demonstrate that pressure injuries can be prevented in critically ill patients when evidence-based education strategies are implemented. Pressure injuries are an important issue for critically ill patients and can be prevented with proper investments. Strategies to prevent pressure injuries from admission will result in fewer pressure injuries. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and the Template for Intervention Description and Replication (TIDieR) checklist. No patient or public contribution.

Gut microbiota disturbances in hospitalized older adults with malnutrition and clinical outcomes

ObjectiveMalnutrition is one of the most threatening conditions in geriatric populations. The gut microbiota has an important role in the host's metabolic and muscular health: however, its interplay with disease-related malnutrition is not well understood. We aimed to identify the association of malnutrition with the gut microbiota and predict clinical outcomes in hospitalized acutely ill older adults. MethodsWe performed a secondary longitudinal analysis in 108 geriatric patients from a prospective cohort evaluated at admission and 72 h of hospitalization. We collected clinical, demographic, nutritional, and 16S rRNA gene-sequenced gut microbiota data. Microbiota diversity, overall composition, and differential abundance were calculated and compared between patients with and without malnutrition. Microbiota features associated with malnutrition were used to predict clinical outcomes. ResultsPatients with malnutrition (51%) had a different microbiota composition compared to those who were well-nourished during hospitalization (ANOSIM R = 0.079, P = 0.003). Patients with severe malnutrition showed poorer α-diversity at admission (Shannon P = 0.012, Simpson P = 0.018) and follow-up (Shannon P = 0.023, Chao1 P = 0.008). Differential abundance of Lachnospiraceae NK4A136 group, Subdoligranulum, and Faecalibacterium prausnitzii were significantly lower and inversely associated with malnutrition, while Corynebacterium, Ruminococcaceae Incertae Sedis, and Fusobacterium were significantly increased and positively associated with malnutrition. Corynebacterium, Ruminococcaceae Incertae Sedis, and the overall composition were important predictors of critical care in patients with malnutrition during hospitalization. ConclusionOlder adults with malnutrition, especially in a severe stage, may be subject to substantial gut microbial disturbances during hospitalization. The gut microbiota profile of patients with malnutrition might help us to predict worse clinical outcomes.

Abstract TP292: Chronic Kidney Disease Exacerbates Post-Stroke Cell Death and Inflammatory Mechanisms

Chronic kidney disease (CKD) is an important independent risk factor for stroke. To understand the mechanisms of CKD that exacerbates stroke pathogenesis, we developed a rodent CKD model by feeding adult C57BL/6 mice with adenine. There was a gradual progression of CKD from mild to severe stages between days 7 and 28 identified by a combination of hematological (creatinine, blood urea nitrogen, and total protein) and imaging (MRI, μCT, dual-energy X-ray absorptiometry, and ultrasound) markers. The CKD cohort showed significant vascular fibrosis, collagen deposition, microvascular rarefaction, and tubulointerstitial abnormalities in the kidneys compared to the control. Induction of transient focal ischemia (by MCA occlusion) on day 28 of adenine treatment led to bigger infarcts (estimated by MRI on day 1 of reperfusion) and worsened motor function (assessed by rotarod test and beam walk test on days 1, 3, 7 and 14 of reperfusion) compared with non-CKD control cohort. The CKD group also showed twice higher mortality by day 14 of reperfusion after transient MCAO compared to control. Proteomic profiling showed that pro cell death and inflammatory mechanisms were directly induced in the brain by CKD pathogenesis. Overall, these studies conclude that CKD-induced cell death and inflammatory mechanisms in the brain contribute to severe and disabling stroke.

Comparative assessment of the prognostic ability of paediatric Sequential Organ Failure Assessment (pSOFA), paediatric logistic organ dysfunction 2 (PELOD 2) and Vasoactive-Inotropic Score (VIS) in children with septic shock: a retrospective observational study

INTRODUCTION: Septic shock is the most severe stage of sepsis in children accompanied by a highest mortality. OBJECTIVE: The aim of the work is to compare an informative significance of pSOFA, PELOD 2 scales and VIS as predictors of mortality in children with septic shock. MATERIALS AND METHODS: The design of the study is retrospective, observational, single-center trial. The study was performed in the Children's Regional Clinical Hospital of Krasnodar. The inclusion criteria were children with septic shock from 9 months to 17 years old. The endpoint of trial was 28-day mortality. Demographic and clinical characteristic were presented with median and average values, also interquartile intervals were counted. Mann-Whitney U-test was used for comparison data received. The discriminatory power, sensitivity and specificity were defined with receiver operating characteristic (ROC) analysis and determination of area under ROC curve (AUC). RESULTS: No one of this trial’s score provides a prediction of children’s survival with sepsis and shock during first 24 hour PICU stay. PELOD 2 and pSOFA scores allow to estimate a prediction from day 3 from PICU stay. Furthermore PELOD 2 score shows a higher informative significance. The VIS has an ability to predict survival on day 5 from admission. CONCLUSIONS: Only the PELOD 2 score has a good discriminatory power regarding the prognosis of survival in children with septic shock after 48 hours of intensive care. The VIS scale allow to assess a severity of cardiovascular dysfunction in children with refractory septic shock with threshold critical value more than 21 points.

P1216 Oral Health status in Inflammatory Bowel Disease patients

Abstract Background Inflammatory bowel diseases (IBD) affect de gastrointestinal tract primarily as it occurs in oral Crohn´s disease (CD) or as an extraintestinal manifestation (EIM) as aphthous stomatitis either in CD or ulcerative colitis (UC). Moreover, data suggest that IBD patients have a higher prevalence of caries and periodontal disease. The aim of our study was the characterization of oral heath in a cohort of IBD patients compared with a control group without IBD and determine the need of oral health intervention in IBD population. Methods This was a collaborative transversal cohort study between an IBD medical appointment in a tertiary hospital and a faculty of dental medicine. Patients from IBD appointment were invited to participate and gave their informed consent. The only exclusion criteria were the incapacity to open the mouth or give a written informed consent. Data was collected regarding demographics, disease characterization, activity, previous IBD related surgeries and current and previous IBD treatments. The control group were heathy controls matched by age and sex. Oral health assessment was achieved by an intraoral clinical examination with the aid of artificial light, oral mirror and WHO periodontal probe. Periodontal diagnosis was achieved through an online periodontal chart (https://www.periodontalchart-online.com), and classified according to periodontal health, periodontitis (stage and grade) and gingivitis. Oral examination provided the Decayed, Missing due to caries, and Filled Teeth Score (DMFT Score) and need for dental treatment and/or prosthetic rehabilitation. Results Oral health status of IBD patients confirm the high incidence of PD, with a prevalence of 55.3% and 69.4% for CD and UC patients, respectively. It is important to refer most of the patients diagnosed with PD suffer from the most severe stage of the disease (III and IV), which is not observed for the control group. Poor oral health status is also evident due to the need for dental treatment, since 88.1% of IBD patients need dental treatment and 38.1% need prosthetic rehabilitation (table 1). Conclusion IBD affects mainly the digestive system, however there is growing evidence that it also has implications for oral health, namely in periodontitis development, as shown in this study. Thus, good oral hygiene practices, including regular dental check-ups and personalized protocol of periodontal therapy are essential for these patients. Moreover, the collaboration between gastroenterologists and dental professionals is crucial to providing comprehensive care for patients with IBD, addressing both their gastrointestinal and oral health needs.