Significant Predictor Of Adverse Events Research Articles

Exploring Mental Fatigue and Burnout in the Workplace: A Survival Analysis Approach

INTRODUCTION: Employee burnout is a prevalent concern in contemporary workplaces, adversely impacting both individual well-being and organizational productivity.
 OBJECTIVES: In this paper, we conducted a comprehensive analysis of a dataset focusing on mental fatigue and burnout among employees, employing various survival analysis techniques including Kaplan Meier, Nelson-Aalen, and Cox proportional-hazards models, as well as Frailty Models and Competing Risks Analysis.
 METHODS: This research underscored significant associations between mental fatigue, burnout, and adverse outcomes, emphasizing the critical need for early identification and intervention. Kaplan Meier analysis revealed differences in survival probabilities, while Nelson-Aalen analysis depicted cumulative hazard functions over time. Cox proportional-hazards models identified mental fatigue and burnout as significant predictors of adverse events, supported by Frailty Models accounting for individual-level variability. Additionally, Competing Risks Analysis elucidated the simultaneous occurrence of multiple adverse events among employees experiencing burnout.
 RESULTS: This research underscored significant associations between mental fatigue, burnout, and adverse outcomes, emphasizing the critical need for early identification and intervention. Kaplan Meier analysis revealed differences in survival probabilities, while Nelson-Aalen analysis depicted cumulative hazard functions over time. Cox proportional-hazards models identified mental fatigue and burnout as significant predictors of adverse events, supported by Frailty Models accounting for individual-level variability. Additionally, Competing Risks Analysis elucidated the simultaneous occurrence of multiple adverse events among employees experiencing burnout.
 CONCLUSION: This study contributes valuable insights into understanding and addressing mental fatigue in the workplace, highlighting the importance of evidence-based interventions to support employee well-being and organizational resilience. The insights gained from this analysis inform evidence-based strategies for mitigating burnout-related risks and promoting a healthier work environment.

Sarcopenia, Eosinophil-to-Platelet Ratio, and C-reactive Protein as Predictors of Adverse Events in Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study.

Biomarkers such as sarcopenia, eosinopenia, and C-reactive protein (CRP) may predict adverse events in chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to determine their prognostic utility and accuracy versus conventional measures. This was a prospective analysis of COPD patients hospitalized for acute exacerbations for more than one year. Patients with primary diagnoses other than COPD were excluded. A total of 200 participants were screened, and 50 experienced adverse events, including mortality, rehospitalization, prolonged stay, hypoxemia, or hypercapnia. Data on demographics, lung function, symptoms, nutrition, frailty, sarcopenia, the eosinophil-to-platelet ratio (EPR), and CRP were extracted. Differences between groups were analyzed using t-tests and regression modeling. Elevated CRP and a low EPR were significant predictors of adverse events after adjustment, with CRP having an area under the curve (AUC) of 0.71 (0.64-0.80) and EPR having an AUC of 0.76 (0.61-0.79) for composite outcomes. According to the multivariate logistic regression analysis, sarcopenia (adjusted Or (aOR)-1.97 (1.87-4.44)), EPR (aOR-2.33 (1.02-5.32)), and CRP (aOR-2.09 (1.01-3.18)) remained significant. The EPR and CRP levels are useful prognostic markers of in-hospital morbidity and mortality during COPD exacerbations. However, multidimensional assessments incorporating other treatable traits may further optimize risk prediction and reduce adverse outcomes.

Efficacy and safety of praziquantel treatment against Schistosoma mansoni infection among pre-school age children in southern Ethiopia

BackgroundPreventive chemotherapy with a single dose of praziquantel given to an all-at-risk population through mass drug administration is the cornerstone intervention to control and eliminate schistosomiasis as a public health problem. This intervention mainly targets school age children, and pre-school age children (pre-SAC) are excluded from receiving preventive chemotherapy, partly due to scarcity of data on praziquantel treatment outcomes.MethodsWe conducted active efficacy and safety surveillance of praziquantel treatment among 240 Schistosoma mansoni-infected pre-SAC who received a single dose of praziquantel (40 mg/kg) in southern Ethiopia. The study outcomes were egg reduction rates (ERR) and cure rates (CRs) four weeks after treatment using the Kato–Katz technique and treatment-associated adverse events (AEs) that occurred within 8 days post-treatment.ResultsThe overall ERR was 93.3% (WHO reference threshold ≥ 90%), while the CR was 85.2% (95% CI = 80.0–89.5%). Baseline S. mansoni infection intensity was significantly associated with CRs, 100% among light infected than moderate (83.4%) or heavy (29.4%) infected children. An increase of 100 in baseline S. mansoni egg count per gram of stool resulted in a 26% (95% CI: 17%, 34%) reduction in the odds of cure. The incidence of experiencing at least one type of AE was 23.1% (95% CI: 18.0%, 29.0%). Stomachache, diarrhea, and nausea were the most common AEs. AEs were mild-to-moderate grade and transient. Pre-treatment moderate (ARR = 3.2, 95% CI: 1.69, 6.14) or heavy infection intensity (ARR = 6.5, 95% CI: 3.62, 11.52) was a significant predictor of AEs (p < 0.001). Sex, age, or soil-transmitted helminth coinfections were not significant predictors of CR or AEs.ConclusionsSingle-dose praziquantel is tolerable and effective against S. mansoni infection among pre-SAC, and associated AEs are mostly mild-to-moderate and transient. However, the reduced CR in heavily infected and AEs in one-fourth of S. mansoni-infected pre-SAC underscores the need for safety and efficacy monitoring, especially in moderate-to-high infection settings. Integrating pre-SACs in the national deworming programs is recommended to accelerate the elimination of schistosomiasis as a public health problem.

The prognostic role of left atrial strain in young patients after ST elevation myocardial infarction: a 3D echocardiographic study

Abstract Background LA volume previously demonstrated its role as significant predictor of adverse events after AMI. The prognostic value of LA strain is less studied. Left atrial strain has been used as a more accurate alternative to assessing LA performance. 3D echocardiography compared with 2D measurements better reflect the entire atrial myocardium, leading to a more accurate estimation of LA function. Purpose In this study we aimed to assess the prognostic value of LA strain parameters determined by 3D echocardiography in young patients after STEMI. Patients and methods: We enrolled 112 patients in this study - 84 young patients with a first STEMI treated by primary PCI and 28 healthy age and sex matched controls. All patients underwent standard transthoracic echocardiography. In addition to conventional echocardiographic parameters, 3D acquisitions of the left atrium were performed. 3D LA longitudinal strain parameters were determined using the automated function 4D Auto LAQ. Patients were followed up for one year after STEMI, the primary endpoint being the occurrence of MACE. Results Compared to the control group, patients with STEMI had lower values of all LA strain parameters. There were also significant differences between MACE and non-MACE groups. Patients with MACE at follow up had lower reservoir strain (15.16 ± 2.58 vs. 22.71 ± 5.25), lower conduction strain (-8.62 ± 1.77 vs. -10.97 ± 1.44) and lower pumps strain (-9.36 ± 1.51 vs. -12.73 ± 2.53), compared to those from the non-MACE group. All LA strain parameters proved to have very good predictive abilities for MACE in ROC analysis (AUC = 0.894, 95 %CI, P &amp;lt; 0.0001 for LASr 3D, AUC = 0.854, 95 %CI, P &amp;lt; 0.0001 for LASct 3D, and AUC = 0.883, 95%CI, P &amp;lt; 0.0001 for LAScd 3D). For each variable we determined a cut off value as follows: 17.5 (Sb 91.7%, Sp 86.7%) for LASr 3D, -10.5 (Sb 75% Sp 86.7%) for LASct 3D, and -9.05 (Sb 75% Sp 91.7%) for LAScd 3D. LASr 3D under 17, and LASct 3D over -10.5 determined an approximately 2-fold increase in adverse events after STEMI. Univariate COX regression analysis showed that all parameters had a significant effect on MACE, while multivariate analysis identified only reservoir and pump functions as independent predictors for adverse events. LASr 3D values showed a proportional decrease with worsening diastolic dysfunction, demonstrating significant differences between diastolic dysfunction grades. We determined LASr 3D cut-off values for discriminating between different degrees of diastolic dysfunction. Conclusion 3D LA reservoir and pump strain proved to be independent predictors for MACE at one year follow up after STEMI in young patients. Beyond its prognostic role, LASr 3D may be helpful as a complementary method to evaluate diastolic dysfunction in young STEMI patients. Further larger scale studies are needed to validate these findings.

Comparative Safety Surveillance of Triple (IDA) Versus Dual Therapy (DA) in Mass Drug Administration for Elimination of Lymphatic Filariasis in Kenya: A Cohort Event Monitoring Study.

Dual diethylcarbamazine and albendazole (DA) therapy is the standard mass drug administration (MDA) regimen for lymphatic filariasis in Kenya. Following the recent World Health Organization recommendation, Kenya piloted triple therapy with ivermectin, diethylcarbamazine, and albendazole (IDA) in MDA. We conducted a community-based, observational, cohort event monitoring study to compare the types, frequency, severity, and predictors of adverse events following dual versus triple therapy in 20,421 eligible residents. Residents in Kilifi (n = 10,010) and Mombasa counties (n = 10,411) received DA and IDA through MDA campaigns, respectively. Adverse events were actively monitored through house-to-house visits on days 1, 2, and 7 after MDA. Any clinical events reported before and after MDA were cross-checked and verified to differentiate pre-existing events from MDA-associated adverse events. Overall, 5807 and 3102 adverse events were reported by 2839 and 1621 individuals in the IDA and DA groups, respectively. The incidence of experiencing one or more adverse events was significantly higher (p < 0.0001) in the IDA group (27.3%; 95% confidence interval [CI] 26.4-28.2) than in the DA group (16.2%; 95% CI 15.5-16.9). Dizziness (15.9% vs 5.9%) and drowsiness (10.1% vs 2.6%) were the most common adverse events and significantly higher in the IDA group compared with the DA group (p < 0.0001). Most adverse events were mild or moderate with a few severe cases (IDA = 0.05%; 95% CI 0.35-0.78, DA = 0.03%; 95% CI 0.14-0.60). Female sex, obesity, taking three or more diethylcarbamazine or ivermectin tablets, and having pre-existing clinical symptoms were significant predictors of adverse events following IDA treatment. Ivermectin, diethylcarbamazine, and albendazole as a combination is as safe and well tolerated as DA to use in MDA campaigns with no serious life-threatening adverse events. Systemic mild-to-moderate adverse events with a few severe cases and transient adverse events are more common with IDA treatment than with DA treatment. Hence, integrating pharmacovigilance into a MDA program is recommended for the timely detection and management of adverse events.

The association of hyperhomocysteinemia with acute post-operative complications following coronary artery bypass grafting.

Hyperhomocysteinemia is associated with an increased risk for cardiovascular diseases. The influence of hyperhomocysteinemia on post-operative events, after coronary artery bypass surgery graft, is less studied. This cross-sectional study aimed to determine if hyperhomocysteinemia was associated with post-operative complications in patients < 50 years who underwent off-pump coronary artery bypass graft for coronary artery disease. A set of major post-operative complications were considered as primary outcome measures. The independent effect of hyperhomocysteinemia and other risk factors in the incidence of post-operative complications was determined by multivariate analysis. The mean homocysteine levels among the study participants who had post-operative complications were significantly higher than those without post-operative complications (17.37 mmol/L vs. 12.84 mmol/L). On multivariate analysis, hyperhomocysteinemia, diabetes mellitus, and higher body mass index (> 25) were significant predictors of adverse events during the post-operative period. Hyperhomocysteinemia was a significant predictor of immediate post-operative adverse events after coronary artery bypass surgery graft. Necessary precautions and management strategies have to be evolved for these high-risk subsets.

Determining the optimal initial dose for Japanese patients with nocturnal polyuria using an initial dose of desmopressin 50 μg.

There is no consistent opinion on the optimal initial dose of desmopressin for patients with nocturnal polyuria. Over a period of 12 weeks, we investigated the safety and efficacy of an initial dose of 50 μg of desmopressin for elderly men. Eighty patients (mean age: 78.8 years) were started on an initial dose of 50 μg of desmopressin for nocturia associated with nocturnal polyuria. Safety and efficacy were evaluated after 1, 4, and 12 weeks using a frequency-volume chart, Athens Insomnia Scale, Patient Global Impression of Improvement scale, physical examination, blood tests, and a body composition analyzer. Along with reduction in the frequency and volume of night-time urination, improvements in hours of undisturbed sleep, nocturnal polyuria index, and International Prostate Symptom Score, and Overactive Bladder Symptom Scores on quality of life measures were also observed. Hyponatremia was observed in 15 patients (18.7%). However, only 5.0% of patients had hyponatremia after the dose was reduced to 25 μg, and the continuation rate at 12 weeks was high at 87.5%. Age and other physical factors, such as body mass index, body water content, body fat mass, and muscle mass were not significant predictors of adverse events. Our study suggests that an initial dose of 50 μg is more effective than a uniformly minimum dose based on factors such as age and physique. Furthermore, a high continuation rate can be achieved by appropriately reducing the dose, if adverse events occur.

Effect of pharmacogenetic variations on praziquantel plasma concentration and safety outcomes among school children in Rwanda

School-based mass drug administration (MDA) of Praziquantel (PZQ) is the global intervention strategy for elimination of schistosomiasis. Genetic variations in drug metabolizing enzymes and transporter proteins influences drug exposure and treatment outcomes, but data on PZQ pharmacokinetics and safety outcomes are scarce. We investigated the effect of pharmacogenetics variations on PZQ plasma concentrations and safety outcomes among 462 Rwandan schoolchildren who received single dose PZQ and albendazole in MDA. Genotyping for common functional variant alleles CYP3A4*1B, CYP3A5 (*3, *6, *7), CYP2C19 (*2, *3, *17), CYP2C9 (*2, *3) and CYP2J2*7 were done. Plasma concentration of PZQ, cis-4-OH-PZQ and trans-4-OH-PZQ were measured using LC/MS/MS. Active safety monitoring was done on days 1, 2, and 7 post-MDA. CYP2C9 and CYP2C19 genotypes were significantly associated with PZQ plasma concentrations and its cis- and trans-4-OH-PZQ/PZQ metabolic ratios (MR). CYP2C9*2 and CYP2C9*3 carriers had significantly higher PZQ concentration (p = 0.02), lower trans-4-OH-PZQ/PZQ (p < 0.001), and cis-4-OH-PZQ/PZQ (p = 0.02) MR. CYP2C19 (*2, *3) carriers had significantly higher plasma PZQ concentration than CYP2C19 *1/*1 and CYP2C19 *17 carriers (*1/*17 or *17/*17) (p < 0.001). CYP3A4 was significantly associated with cis-4-OH-PZQ MR (p = 0.04). Lower cis-4-OH-PZQ/PZQ MR (p < 0.0001) was a predictor of MDA-associated adverse events, but no significant association with genotypes were found. In conclusion, CYP2C9 and CYP2C19 genotypes significantly influence the plasma PZQ concentration and its MR. Lower cis-4-OH-PZQ/PZQ MR is significant predictor of adverse events following MDA.

Frequency and Intensity of Smoking, Duration of Smoking Cessation, and Risk of Early Postoperative Outcomes after High-risk Arterial Reconstructions

Introduction: The relative influence of smoking and smoking duration/intensity in a co-morbid cohort is uncertain. We examined whether smoking status, duration of cessation, and smoking frequency/intensity significantly affected postoperative morbidity and mortality risk. Methods: We collected single institution, retrospective data from consecutive patients undergoing open operative intervention for carotid, aortoiliac, or infrainguinal aneurysmal or occlusive arterial disease. Smoking cessation duration was calculated as the time between smoking cessation and index surgery. The primary outcome was a composite of 30-day mortality and morbidity. Logistic and Cox regressions estimated associations between the primary outcome and smoking status with interaction terms between cessation duration and intensity (pack-years) for former smokers. Results: Between 2010 and 2019, 1,087 patients underwent 1,523 high-risk surgeries. The mean duration of cessation was 19.3 years (standard deviation [SD] = 16.2). Mean pack-year history was 45.2 pack-years (SD=33.7) among former smokers and 54.8 pack-years (SD=38.5) among current smokers (p < 0.001). Smoking status did not independently predict an increased risk of postoperative mortality or morbidity (Odds Ratio [OR]=0.97, p = 0.85). In the former smoker group, neither smoking cessation duration (OR=0.99, p = 0.23) nor pack-years (OR=1.00, p = 0.99) were statistically significant predictors of adverse events (interaction p = 0.08). Long-term survival probabilities were lower among current smokers (Hazard Ratio [HR] = 1.31, p = 0.002) with no significant effect from either pack-years or cessation duration. Conclusion: Among patients undergoing procedures that represent systemic disease, the adverse effects of continued smoking are better appreciated in long-term survival probability reduction that is observed regardless of smoking frequency or intensity.

Assessing managerial patient safety practices that influence adverse events reporting among nurses in the Savannah Region, Ghana

Introduction Patient safety is a global concern for both health professionals and the public. Studies show that evaluating patient safety culture can help improve patient safety outcomes. Nursing care strategically places nurses at the centre of patient safety promotion and their proximity to patients makes them the drivers of patient safety. Managerial decisions regarding patient safety impact greatly on patient safety outcomes in the healthcare organization. This study aimed to assess the managerial patient safety practices that influence adverse event reporting in three hospitals in the Savannah Region of Ghana. Methods A quantitative cross-sectional design was used to collect data from 210 participants in three hospitals. Data were analysed using descriptive, Pearson's correlation and linear regression. Results It was found that patient safety practices with good positive rating scores were management support (56.6%), managers' expectations (62.8%) and feedback about errors (56.2%). Areas with weak patient safety practices were staffing levels (42.4%), open communication (40.2%) and non-punitive response to errors (36.7%). Again, nurses' attitude towards adverse events reporting was generally low (37.3%). Managerial patient safety practices that had significant associations with adverse events reporting were management support ( r = .18, p &lt; .001), open communication ( r = .19, p &lt; .001), non-punitive to errors ( r = .21, p &lt; .001) and feedback about errors ( r = .37, p &lt; .001). Again, the significant predictors of adverse events reporting were feedback about errors ( β = .36, p &lt; .001) and non-punitive response to errors ( β = .21, p &lt; .01). Conclusion Nurses perceived patient safety culture in their units to be good. Although nurses' attitude towards adverse events reporting was low, the significant predictors of adverse events reporting were feedback about errors and non-punitive response to errors. Therefore, healthcare managers should continually strengthen patient safety to ensure optimal care outcomes. Implications for nursing practice Feedback on errors and non-punitive response to errors had a great influence on adverse events reporting, managerial failure to provide feedback and a non-punitive work environment could result in under-reporting of adverse events. This can be a major threat to patient safety; hence clinical practice should be aware of this and put in strategies to appropriately address them.

Impact of apical and mid-ventricular transmural infarcts in patients with acute myocardial infarction determined by using late gadolinium enhancement combined with feature tracking magnetic resonance.

To analyze the relationship between left ventricular (LV) myocardial strain and transmurality of myocardial infarction at three circular sections (basal, mid-ventricular, apical) by a combined analysis of cardiac magnetic resonance feature tracking (CMR-FT) and late gadolinium enhancement (LGE) information in a cohort of ST-elevation acute myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI). In all, 136 patients with STEMI who underwent PPCI within 12 hours of symptom onset were included. CMR-FT and LGE-MRI were performed 5±2 days after PCI for measuring regional and global myocardial strain indexes and transmural extent. Multivariate regression analysis and Kaplan-Meier survival analysis were performed. Regional radial and circumferential strain decreased with increasing transmurality of myocardial infarction irrespective of basal, mid-ventricular, or apical segments. Segmental longitudinal strain was significantly decreased in the transmural infarcted segments only at the apical and mid-ventricular levels. A significant correlation was found between the number of transmural infarcts and global strain parameters in the apical and mid-ventricular portions. Transmural infarcted segments in apical + mid-ventricular portions >2 was related to an increased risk of cardiac events in patients with STEMI following PPCI than those ≤2. GLS was found to be an independent predictor of cardiac events in these patients. The number of transmural infarcted segments in apical + mid-ventricular portions affects LV global function and prognosis. Global longitudinal strain (GLS) is a significant predictor of adverse events after PPCI for STEMI. Morphologic and functional data fused to study complex pathophysiologic processes of LV early after STEMI may help in risk stratification of patients.

Pre-treatment 18F-RGD Uptake may Predict Adverse Events during Apatinib Antiangiogenic Therapy

AimsThe adverse events during antiangiogenic therapy inevitably influence a patient's quality of life. Therefore, biomarkers to identify patients who will experience adverse events would be very valuable in treatment planning. Materials and methodsBetween September 2016 and December 2019, patients scheduled for single-agent apatinib were prospectively enrolled and underwent 18F-RGD positron emission tomography/computed tomography (PET/CT) pre-treatment. Maximum and mean standard uptake values (SUVmax and SUVmean) were obtained from thyroid, liver, gastric cardia, gastric body, gastric pylorus and spleen. Statistical methods included the independent sample t-test, Mann-Whitney U-test, receiver operating characteristic curve analysis and chi-squared test. ResultsIn total, 60 patients were initially screened and consented for 18F-RGD PET/CT scans. The three most frequent adverse events were fatigue (50%), hypertension (36%) and nausea (36%), accounting for 72% in the 50 patients included in the analysis. SUVmax and SUVmean of thyroid and liver were significantly associated with fatigue, whereas SUVmax and SUVmean of thyroid and spleen were significantly associated with hypertension and SUVmax and SUVmean of thyroid and gastric cardia were significantly associated with nausea (all P < 0.05). The most significant predictors of adverse events were 18F-RGD SUVmax-liver for fatigue (area under the curve [AUC] = 0.682), SUVmax-spleen for hypertension (AUC = 0.688) and SUVmax-gastric cardia for nausea (AUC = 0.698). Classified by the cut-off values for SUVmax-liver (4.57), SUVmax-spleen (6.77) and SUVmax-gastric cardia (2.10), patients with low RGD SUVmax in liver, spleen and gastric cardia had statistically higher incidence of fatigue (67.9% versus 27.3%, P = 0.002), hypertension (55.6% versus 13.0%, P = 0.004) and nausea (61.1% versus 21.9%, P = 0.006). ConclusionsLow pre-treatment 18F-RGD uptake in the liver, spleen and gastric cardia were predictive of the adverse events fatigue, hypertension and nausea during apatinib treatment, respectively.

Glutaredoxin-1 levels in plasma can predict future events in patients with cardiovascular diseases

Reactive oxygen species that increase during cardiovascular disease (CVD) react with protein cysteine residues to form a glutathione adduct by S-glutathionylation, which is selectively removed by glutaredoxin-1 (Glrx). We previously showed that S-glutathionylation and Glrx play important roles in mouse models of CVD, such as heart failure and peripheral artery disease models. However, there are few clinical studies on Glrx in CVD. Although Glrx is a cytosolic protein expressed in various organs, it is detectable in human plasma. Studies have reported that Glrx in plasma is a potential disease maker, such as CVD and chronic kidney disease and diabetes, however, it remains unclear whether Glrx is related to the prognosis of patients with CVD. The purpose of this study was to elucidate whether Glrx levels in plasma are associated with future events in patients with CVD. Plasma levels of Glrx were measured in 555 patients with CVD who underwent cardiac catheterization using enzyme-linked immunosorbent assay. All patients were followed prospectively for ≤36 months or until occurrence of adverse events, including all-cause death, non-fatal myocardial infarction, and worsening heart failure. During a mean follow-up period of 33 months, 54 adverse events occurred. Kaplan-Meier analysis showed that higher levels of Glrx (>0.622 ng/mL, determined by receiver-operating characteristic curve) resulted in a higher probability for adverse events compared with lower levels of Glrx (≤0.622 ng/mL) (P < 0.01, log-rank test). Multivariate Cox proportional hazards analysis showed that Glrx was a significant predictor of adverse events after adjustment for known risk factors. In conclusion, levels of plasma Glrx >0.662 ng/mL can predict future events in patients with CVD.

Endothelial dysfunction and Mid-Regional proAdrenomedullin: What role in SARS-CoV-2 infected Patients?

BackgroundEndothelial dysfunction, a major complication of SARS-CoV-2 infectionplaying a key-role in multi-organ damage, carries high risk of mortality. AimTo investigate the potential role of Mid-Regional pro-Adrenomedullin (MR-proADM) in detecting endothelial damage with a view to stratifying the risk of adverse events (length of stay, death, admission in Intensive Care Unit) and/or disease resolution. Materials and MethodsIn 135 consecutive patients with SARS-CoV-2 infection, MR-proADM was measured in EDTA-K2 plasma samples using B.R.A.H.M.S. KRYPTOR® COMPACT Plus method (Thermo Fisher Scientific, Hennigsdorf, Germany) ResultsPatients were subdivided into three groups based on their MR-proADM value (nmol/L): 1 (n = 20, MR-proADM ≤ 0.55); 2 (n = 82, 0.55 < MR-proADM ≤ 1.50); 3 (n = 33, MR-proADM > 1.50). The higher the MR-proADM value, the greater the patients’ age, the more frequent the occurrence of pneumonia, the requiring of more aggressive treatment, the longer the hospitalization and the more frequent a fatal event. Significant differences were found between the three groups for MR-proADM, White-blood cell count, Neutrophil count, D-dimer, C-reactive Protein, Procalcitonin and hs-Troponin I. At logistic regression,it was found that MR-proADM and Log10D-dimer were the most significant predictors of adverse events. ConclusionThe findings made in the present study highlight the relevance of MR-proADM values in providing clinically useful information, particularly for stratifying COVID-19 patients according to the risk of a more severe form of disease and to the development of adverse events.

Retinopathy of Prematurity Screening Examination and Changes in Vital Signs.

Dilation and examination during retinopathy of prematurity (ROP) screening can cause systemic complications and even life-threatening adverse events (AEs). The main objective of this study is to assess the prevalence and significance of AEs and changes in vital signs during ROP screenings, and to correlate birth weight, gestational age, and length of exam as possible predictors of these changes. This is a prospective, observational study that includes 1,360 screening exams from 680 premature infants in two neonatal intensive care units. Systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and oxygen saturation were monitored from the time that dilating drops were administered until 4 hours after the examination was completed. Any clinical deterioration or complication was documented. Of 1,360 infant screening exams, 153 (11%) screening exams resulted in at least one change in vital sign that alerted the monitor. There was one serious AE requiring bag valve mask resuscitation 30 minutes after dilating drops were placed. Gestational age, birth weight, and length of ROP exam were not significant predictors of AEs. There were statistically significant changes when comparing pre- and post-vital signs following dilation and funduscopy exam. Although ROP screening exams are essential for at-risk neonates, mydriatic drops and retinal exams can result in changes to vital signs and AEs. It is important to closely monitor neonates during these examinations. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:458-463.].

In-Hospital Mortality of COVID-19 Patients Treated with High-Flow Nasal Oxygen: Evaluation of Biomarkers and Development of the Novel Risk Score Model CROW-65.

To replace mechanical ventilation (MV), which represents the cornerstone therapy in severe COVID-19 cases, high-flow nasal oxygen (HFNO) therapy has recently emerged as a less-invasive therapeutic possibility for those patients. Respecting the risk of MV delay as a result of HFNO use, we aimed to evaluate which parameters could determine the risk of in-hospital mortality in HFNO-treated COVID-19 patients. This single-center cohort study included 102 COVID-19-positive patients treated with HFNO. Standard therapeutic methods and up-to-date protocols were used. Patients who underwent a fatal event (41.2%) were significantly older, mostly male patients, and had higher comorbidity burdens measured by CCI. In a univariate analysis, older age, shorter HFNO duration, ventilator initiation, higher CCI and lower ROX index all emerged as significant predictors of adverse events (p < 0.05). Variables were dichotomized and included in the multivariate analysis to define their relative weights in the computed risk score model. Based on this, a risk score model for the prediction of in-hospital mortality in COVID-19 patients treated with HFNO consisting of four variables was defined: CCI > 4, ROX index ≤ 4.11, LDH-to-WBC ratio, age > 65 years (CROW-65). The main purpose of CROW-65 is to address whether HFNO should be initiated in the subgroup of patients with a high risk of in-hospital mortality.

Safety and Tolerability of Mass Diethylcarbamazine and Albendazole Administration for the Elimination of Lymphatic Filariasis in Kenya: An Active Surveillance Study

Preventive chemotherapy with diethylcarbamazine citrate (DEC) and albendazole (ALB) is the core intervention strategy to eliminate lymphatic filariasis (LF). We conducted a large-scale prospective active safety surveillance study to identify the incidence, type, severity, and risk factors for adverse events (AEs) following mass drug administration (MDA) of single-dose DEC and ALB in 10,010 participants from Kilifi County, Kenya. AEs were actively monitored and graded at 24 h, 48 h, and on day 7 Post-MDA. Out of 10,010 enrolled study participants, 1621 participants reported a total of 3102 AEs during a seven-day follow-up. The cumulative incidence of AEs was 16.2% (95% CI, 15.5–16.9%). The proportion of participants who experienced one, two, or ≥three types of AEs was 9.2%, 4.6%, 2.4%, respectively. AEs were mild (87.3%), moderate (12.4%), and severe (0.3%) and resolved within 72 h. The five most common AEs were dizziness (5.9%), headache (5.6%), loss of appetite (3.3%), fever (2.9%), and drowsiness (2.6%). Older age, taking concurrent medications, ≥three tablets of DEC, and type of meal taken before MDA were significant predictors of AEs. One in six participants experienced systemic mild-to-moderate severity grading and transient AEs. DEC and ALB co-administration for the elimination of LF is generally safe and well-tolerated.

Prognostic value of neutrophil gelatinase-associated lipocalin and cystatin C in patients with heart failure and previous myocardial infarction

Aim. To study the prognostic value of neutrophil gelatinase-associated lipocalin (NGAL or lipocalin-2) and cystatin C in patients with heart failure (HF) and myocardial infarction (MI).Material and methods. Baseline plasma concentrations of NGAL and cystatin C were measured in 119 participants (median age, 50-61 years; men, 101) with HF and primary MI (4-6 weeks old) who underwent percutaneous coronary intervention in the acute period. Adverse cardiovascular events within 1 year were considered as the endpoint.Results. Patients with elevated NGAL levels were significantly more likely to have adverse events (p&lt;0,001). The optimal cut-off value for NGAL was 18,75 ng/ml (odds ratio, 10, 95% CI, 3,09-32,45; p=0,0001). Multivariate logistic regression showed that NGAL, N-terminal pro-brain natriuretic peptide, left ventricular aneurysm, and SYNTAX score were significant predictors of adverse events. Cystatin C did not affect prognosis in the study cohort.Conclusion. Increased NGAL levels is a predictor of unfavorable clinical outcome in patients with HF and previous MI.

Predictors of early adverse events after the frozen elephant trunk procedure

The aim of this study was to identify predictors of adverse events after the frozen elephant trunk procedure in the early postoperative period. Between March 2012 and March 2020, a total of 273 patients were operated on for aortic pathology. A retrospective analysis aimed at identifying probable predictors was performed on 83 patients who underwent the FET procedure. Uni- and multivariate logistic regression was used to identify predictors of such adverse events as postoperative delirium, respiratory failure, acute kidney injury, and in-hospital mortality. According to the findings of the optimal multivariate regression model, separate reimplantation of the supra-aortic branches was a significant predictor of postoperative delirium (OR 10.41; 95% CI 1.1-35.45; p=0.05); significant risk factors for prolonged respiratory support were the duration of surgery (OR 1.02; 95% CI 1.01-1.03; p<0.001) and postoperative acute renal injury (OR 8.72; 95% CI 1.67-57.38; p=0.014). Independent risk factors for postoperative renal injury turned out to be the true lumen diameter of the descending aorta (OR 1.3; 95% CI 1.1-1.72; p=0.015) and chronic type A aortic dissection (OR 44.07; 95% CI 3.29-2354.8; p=0.014); statistically significant risk factors for in-hospital mortality were multiple organ dysfunction syndrome (OR 14.34; 95% CI 1.69-155.48; p=0.016) and coronary artery stenosis (OR 3.36; 95% CI 1.19-13.26; p=0.042). Separate reimplantation of the supra-aortic branches, duration of surgery, acute kidney injury, chronic aortic dissection, multiple organ dysfunction syndrome, true lumen diameter of the descending aorta, coronary atherosclerosis and haemoglobin level were statistically significant predictors of adverse events in the early postoperative period.

Pulmonary Artery Systolic Pressure Response to Exercise in Patients with Rheumatic Mitral Stenosis: Determinants and Prognostic Value

Pulmonary hypertension in response to exercise is a marker of the hemodynamic severity of mitral stenosis (MS). However, the factors related to elevated pulmonary pressure with exercise are not well defined. The aim of this study was to assess the parameters associated with the pulmonary pressure response to exercise in patients with pure rheumatic MS. An additional aim was to determine the impact of exercise-induced pulmonary hypertension on clinical outcome. One hundred thirty patients with MS (94% women; mean age, 45±11years) underwent exercise echocardiography. A range of echocardiographic parameters were obtained at rest and at peak exercise. Symptom-limited graded ramp bicycle exercise was performed in the supine position. The primary end point was mitral valve intervention, either percutaneous or surgical. In the overall population, systolic pulmonary artery pressure (SPAP) increased from 38.3±13.4mm Hg at rest to 65.8±20.7mm Hg during exercise. Increases in mean mitral gradient, right ventricular function, left atrial volume, and net atrioventricular compliance were independently associated with SPAP at peak exercise, after adjusting for changes in heart rate. During the follow-up period (median, 17months; range, 1-45months), 46 adverse clinical events were observed. By multivariate Cox proportional-hazards analysis adjusted for age and sex, SPAP achieved at peak exercise was an important predictor of adverse outcome (adjusted hazard ratio, 1.025; 95% CI, 1.010-1.040; P=.001). New York Heart Association functional class (adjusted hazard ratio, 2.459; 95% CI, 1.509-4.006; P<.001) and the interaction between valve area and net atrioventricular compliance (P=.001) were also significant predictors of adverse events. Time-dependent areas under the receiver operating characteristic curve for the model with SPAP during exercise were better than for the model with SPAP at rest, with a significant improvement from 3years onward. In patients with MS, the pulmonary artery pressure response to exercise is determined by a combination of factors, including transmitral mean gradient at exercise, net atrioventricular compliance, left atrial volume, and right ventricular function. Pulmonary artery pressure at peak exercise is a predictor of clinical outcomes and adds incremental prognostic value beyond that provided by standard resting measurements, including valve area.