Signs Of Decompensation Research Articles

Non-compact cardiomyopathy. A case from practic

A retrospective analysis of the statistical data of persons who died in the Tambov region over the past 5 years revealed one case of death from non-compact cardiomyopathy. The incidence of non-compact cardiomyopathy in the population is 0.014 to 1.3 %. Due to the non-proliferation of this pathology, a single recorded case attracted attention for research. This study presents a 10-year-old patient who was admitted to the intensive care unit in the decompensation stage, during which the disease ended in death. After analyzing the medical documentation, it was found that with the development of the disease, the clinical picture was erased, symptoms from the cardiovascular system did not appear, signs of decompensation were not observed until the moment of this hospitalization. Death occurred suddenly, autopsy revealed non-compact cardiomyopathy of the left ventricle, which through its complications led to non-coronary ischemia of the subepicardial myocardium of the left ventricle, which was the cause of death. Since the pathology is quite rare, the purpose of our study is to consider, on the example of a clinical case, the factors contributing to the fatal outcome in non-compact cardiomyopathy.

The nature of gait biomechanics changes with walking speed increase in patients with anterior cruciate ligament injury.

This study on gait biomechanics is based on a functional test (FT) performed at free and fast walking speeds. We investigated the pattern of changes in gait biomechanical parameters and the knee function in patients after anterior cruciate ligament (ACL) injury or its reconstruction. The study included 51 patients (33 males, 18 females) with a confirmed recent or old history of ACL tear, before or after reconstruction (26 patients). Mocap data was obtained using an inertial system. All patients were divided into three groups: 41 patients with physiological response (compensation), 6 patients with signs of decompensation, and 4 non-assessable patients. Increase in gait speed was associated with decrease in the walking cycle duration, stance and double support phases. In the compensation group, the physiological response of the knee was manifested in increased amplitudes. In the decompensation group, the amplitudes remained unchanged or decreased. In the compensation group, there were increases in the symmetrical muscle activity. The decompensation group was characterized by electromyography asymmetry. The observed universal physiological mechanism limiting the load on the damaged joint can be used for accurate assessment of the knee functional state in various periods of rehabilitation.

Rare, but potentially risky, high individual increase of self-reported sexual arousal in men, who have committed sexual offenses against children, while being confronted with experimental sexual stimuli — a retrospective data analysis

AbstractThis data analysis was initiated to further understand the infrequent yet intense instances of sexual arousal and signs of decompensation that emerge after exposing men who have committed sexual offenses against children to experimental sexual stimuli. We analyzed retrospectively and exploratory data of a self-developed sexual arousal questionnaire (“Current-State-of-Emotions-Questionnaire”, CSEQ) with the following objectives: (i) examine subjective sexual arousal changes elicited during confrontation with experimental sexual stimuli, (ii) analyze these sexual arousal changes at an individual level to detect large responses, and (iii) ask for associations between large responses in sexual arousal and individual characteristics of participants, e.g., demographic, clinical, and criminological parameters. The sample consisted of 241 adult, male Germans, comprising four groups: Ten individuals who have committed sexual offenses against children and have been placed in forensic psychiatric facilities (ISOCFP), 31 non-hospitalized individuals with sexual interest in children (ISIC), eight individuals who have committed other offenses and have been placed in forensic psychiatric facilities (IOFP), and 192 individuals without sexual interest in children and offense histories (IWO). We found a significant increase in subjective sexual arousal after confrontation with sexual stimuli (three experiments: initial orientation: Z = −4.819, p < .001, sexual distractor task: Z = −2.954, p = .003, stimulus rating: Z = −6.899, p < .001). Up to 14.3% of participants indicated high sexual arousal values before, but mainly after the experiments, with 20.0% of ISOCFP, 12.9% of ISIC, 12.5% of IOFP, and 14.6% of IWO. ISOCFP and ISIC with high sexual arousal were more likely to be diagnosed with paraphilia (pedophilia) and/or affective disorders, and to receive anti-depressive treatment. We assume a higher emotional lability or/and reduced emotion regulation abilities in those individuals. A careful weighing up of anticipated scientific knowledge gain and a potentially, though rare, increased risk of recidivism or decompensation seems indispensable.

Fever and Leukocytosis Are Poor Predictors of Bacterial Coinfection in Patients With COVID-19 and Influenza Who Are Receiving Extracorporeal Membrane Oxygenation.

Fever and leukocytosis are 2 parameters commonly cited in clinical practice as indications to perform an infectious workup in patients receiving extracorporeal membrane oxygenation (ECMO), but their utility is unknown. All patients who received ECMO between December 2014 and December 2020 with influenza or COVID-19 were included in this retrospective cohort study. Cultures were included if they were drawn from patients without signs of decompensation. Maximum temperature and white blood cell count were recorded on the day of culture collection. Workups with infections were compared with those that were negative. Of the 137 infectious workups in this 45-patient cohort, 86 (63%) were performed in patients with no signs of decompensation, totaling 165 cultures. These workups yielded 10 (12%) true infections. There were no differences in median (IQR) temperature (100.4 °F [100.2-100.8] vs 100.4 °F [99.3-100.9], P = .90) or white blood cell count (18.6 cells/mL [16.8-20.1] vs 16.7 cells/mL [12.8-22.3], P = .90) between those with and without infections. In patients with influenza or COVID-19 who require ECMO, fever and leukocytosis were common indications for infectious workups, yet results were frequently negative. Despite their use in clinical practice, fever and leukocytosis are not reliable indicators of infection in patients who are hemodynamically stable and receiving ECMO.

Changes in the cerebral cortex and thyroid in the simulation of cerebral hypoperfusion and its combination with physical exercise

Cerebral hypoperfusion, as the main mechanism of age-associated diseases, is widespread, which leads to decreased work capacity in the most qualified segment of employees. The study aimed to analyze compensatory and adaptive reactions of the cerebral cortex, thyroid gland, and blood in cerebral hypoperfusion and its combination with short-term physical activity. Chronic cerebral hypoperfusion was modeled by permanent bilateral occlusion of the common carotid arteries. The study included 280 rats, of which 112 were subjected to daily short-term swimming as a model of rehabilitation measures. On days 1, 6, 8, 14, 21, 28, 35, 60, and 90 after surgery, the animals were subjected to the Morris water maze and open field tests. Histological sections of the brain and thyroid gland were examined. The concentrations of the active products of thiobarbituric acid, nitrites, and L-arginine in blood plasma were measured. The results showed that changes in the cerebral cortex and thyroid gland in the cerebral hypoperfusion model were characterized by a general stage: days 18, hypothyroid condition and death of cortical cells, cerebral hemispheres, predominantly neurons; weeks 23, stabilization, transition to the euthyroid condition, accompanied with thyrocyte desquamation, folliculogenesis, perifollicular hemocapillaries fullness, decreased functional activity of neurons, and astrocyte activation; weeks 45, incomplete adaptation, which is characterized by neurons approaching the vessels of the hemocirculatory channel and satellites sinking into the cytoplasm of neurons. Mosaicism of thyroid blood filling was also observed. After 3 months, degenerative changes in the cells of the cerebral cortex of the cerebral hemispheres appear, including a decrease in the numerical density of neurons and immunoreactive cells of glial fibrillar acid protein and a hyperthyroid state with signs of decompensation: plasmorrhagia and desquamation of the thyroid epithelium. Daily 15-min exercise with cerebral hypoperfusion demonstrated a neuroprotective effect, slowed down the progression of hypoxic and neurodegenerative changes, and reduced the concentration of nitrites and malondialdehyde in the blood and the levels of neuronal nitric oxide synthase in immunoreactive neurons.

A vaccine for Beethoven's vulnerable liver.

Dear EJCI Editor, The recent report1 presenting a thorough analysis of Ludwig van Beethoven's genome has made headlines in scientific and non-scientific journals. The famous composer is known to have suffered, among other ailments, from cirrhosis, and the study by Begg et al.1 adds a few exciting new details to this picture. In brief, the authors showed that Beethoven carried a combination of genetic variants (i.e. HFE p.His63Asp and p.Cys282Tyr as well as PNPLA3 p.I148M) that rendered his liver particularly vulnerable to external noxae, here iron, alcohol and caloric overload.2 Hence, regular alcohol consumption, probably combined with rich food over many years is likely to represent the major cause for his chronic liver disease. Interestingly, Begg et al.1 also performed a metagenomic analysis of Beethoven's hair locks and found that in the last months of his life, he might have suffered from hepatitis B virus (HBV) infection. Although the mass media and the authors of the report1 seem to have focused on the analysis of Beethoven's genome, the detection of HBV infection should not be overseen as it might be highly relevant to Beethoven's death, but also to our everyday liver patients. Apparently, the composer experienced a first episode of jaundice 6 years before his death in 1827, possibly a first sign of decompensation. The fact that it took a couple of decades of chronic alcohol consumption on the background of his high-risk genotype to develop clinical liver disease shows the organ's enormous regenerative capacity. This proverbial resilience has been known for a long time and features prominently in the Prometheus saga from 800 BC, which Beethoven refers to in his ballet ‘The Creatures of Prometheus Op. 43’, composed in 1801. One could speculate that during the last months of his life, the composer might have suffered from acute-on-chronic liver failure (ACLF) caused by the HBV infection on top of his alcohol-induced progressive liver damage. This additional insult precipitated the lethal deterioration of liver function (Figure 1). ACLF is a new disease entity,3 defined as acute liver failure in patients with chronic liver diseases. Bajaj et al.4 described ACLF ‘as a potentially reversible condition in patients with chronic liver disease with or without cirrhosis that is associated with the potential for multiple organ failure and mortality within 3 months in the absence of treatment of the underlying liver disease, liver support, or liver transplantation’. The data available in Begg's paper1 are not sufficient to determine if Beethoven suffered from multiple organ failure or only liver failure. Of note, acute viral infections have been identified as precipitating events of ACLF.5, 6 In terms of hepatitis B, acute infection is rare but can result in rapid dysfunction of pre-injured liver, and flares of chronic HBV infection have been described as triggers of ACLF.7 Patients with HBV-ACLF have been reported to suffer from high short-term mortality,8 in line with the data from the metagenomic analyses revealing the viral infection, and Beethoven's rapid demise. Begg's study1 is a major success of molecular genetic analyses. However, we reckon the observation that Beethoven suffered from HBV infection and that ACLF can be triggered by acute viral infections deserves more prominence. This finding might be used as a motivational lever to promote wider acceptance for vaccination against viral infections. Indeed, as highlighted by the pandemic and reviewed recently by Jeng et al.,9 vaccinations represent an effective means to prevent severe viral infections. Regardless of how long Beethoven suffered from HBV infection, one can imagine that prior vaccination against HBV, if it had been available at the time, might have prevented the acute deterioration of his vulnerable liver, which was challenged by the “devil's triangle” of gene variants, environmental toxins, and virus. This represents an important positive message, which is urgently needed in view of the persisting vaccine hesitancy following COVID-19.10 Portrait of Beethoven by Stieler was reproduced in Figure 1 with kind permission of Beethoven Haus Bonn. Open Access funding enabled and organized by Projekt DEAL. The authors have no conflict of interest to declare.

Chronic heart failure with preserved ejection fraction: optimal therapy. Literature review

The literature review discusses approaches to the treatment of patients with chronic heart failure and preserved ejection fraction (EF>50) – HFpEF. The impact of various groups of drugs on the prognosis and quality of life of patients in this cohort was assessed based on the results of randomized trials, systematic reviews and meta-analyses, clinical recommendations of recent years. To date, only sodium-glucose cotransporter-2 inhibitors unequivocally improve the quality of life and prognosis of patients with HFpEF. Angiotensin receptor – neprilysin inhibitors and mineralocorticoid receptor antagonists are effective in terms of prognosis and quality of life only in patients with HFpEF in combination with resistant hypertension. In patients with sinus rhythm, heart rate > 70 beats/min and concomitant coronary artery disease, a combination of bisoprolol and ivabradine may be considered. Diuretics are recommended for patients with HFpEF when there are signs of congestion and signs of decompensation. Other groups of drugs do not significantly affect the quality of life and prognosis of patients with HFpEF and can be prescribed to such patients only as part of planned therapy for the treatment of other concomitant cardiovascular diseases.

335.6: Long-term Outcomes of Living Donor Versus Deceased Donor Liver Transplantation for Acute Liver Failure in United States

Introduction: Acute Liver Failure (ALF) is rarely encountered but often is associated with high morbidity and mortality. Timely Liver Transplantation is universally the only accepted rescue therapy, but not much is known about the usage of Living Donor (LDLT) versus Deceased Donor (DDLT)Liver Transplantation in the United States for this indication. Method: United Network of Organ Sharing/ Organ Procurement and Transplantation Network (UNOS/OPTN) data was reviewed from January 2002 to December 2020. Adult and pediatric recipients with diagnostic codes for ALF and listed as Status 1 were included in the study. Clinical, laboratory, and demographic characteristics were compared between LDLT and DDLT groups. In addition, Post-transplant survival rates were compared between the two groups. Results: There were a total of 246 LDLT (3.8%) and 6153 DDLT (96.2%) recipients with the diagnosis of ALF (Table 1). There was a difference in age and gender between the groups, with 93.5% of LDLT cases being for pediatric ALF cases versus 45.9% of DDLT cases being for pediatric recipients of age less than 18. There were more female gender in the DDLT group. Race was not different between the two groups. The proportion of patients waiting ≥ 3 days was 64.1% in DDLT compared to 77.2% in the LDLT group (P<0.001). There was no statistical difference between the two groups in terms of sodium, bilirubin, and INR. There were more patients with hepatic encephalopathy, and on renal replacement therapy in the DDLT group compared to LDLT group. Overall, 1, 5 and 10 year overall survival among the DDLT and LDLT groups were also similar, 87.7% vs. 85.5%, 81.1% vs. 81.1%, 74.7% vs. 79.3% (p=0.16) (Figure 1) (Log rank P=0.16). Conclusions: In the US, LDLT constitutes of only 3.8% of all liver transplants for ALF. In addition, LDLT was mostly used among pediatric recipients (93.5%), whereas DDLT was mostly used for adult recipients (54.1%). Signs of decompensation with hepatic encephlopathy, ascites, and on renal replacement therapy were more common in DDLT than LDLT group. LDLT can be carefully considered in a select group of adult ALF cases, in early phases, before further progression into renal failure and advanced encephalopathy.

P385 SYNCOPAL VENTRICULAR TACHYCARDIA IN HEALTHY HEART: AN UNUSUAL ORIGIN!

Abstract Torsade de pointes is a particular type of ventricular tachycardia, characterized by QRS complexes that vary progressively in amplitude and morphology, giving the impression of oscillating around the isoelectric line. Causes include long QT syndrome (congenital or drug–induced) or severe hypomagnesemia. We report the case of a 57–year–old woman, a smoker, with a history of weight loss in the last 6 months, hospitalized in Medicine for marked asthenia and an episode of fleeting loss of consciousness, from sitting. She was asymptomatic for chest pain. The physical examination showed a pathological thinness, with BMI 15 kg/m2, rhythmic cardiac activity, no murmurs, no signs of decompensation, flat abdomen, not enlarged liver. Pale, dry skin was observed. On ECG: sinus rhythm, HR 70 bpm, QTc slightly increased 0.47 sec, flat T wave in lateral. Blood exams evidenced: hypokalemia, hypomagnesemia, rise of the amylase. On the MRI abdomen we found large inhomogeneous areas on the head and body of the pancreas, referable to the picture of focal pancreatitis. For syncopal episode during hospitalization in Medicine, she was transferred in Cardiology, where, during electrocardiographic monitoring, paroxysmal ventricular tachycardias torsade de pointes–like, symptomatic, self–resolved was registered. We diagnosed an acute pancreatitis with typical radiological characteristics of an autoimmune form, determining severe electrolyte imbalance and consequent symptomatic paroxysmal ventricular tachycardias. Oral magnesium supplement and corticosteroid therapy allowed the resolution of the arrhythmic problem, monitored over time through the implantation of a loop recorder.

MO332: Acute Kidney Injury is Associated With Poor Long-Term Outcomes in Hospitalized Patients With COVID-19

BACKGROUND AND AIMSThe acute effects of the acute kidney injury (AKI) on short-term mortality in patients with novel coronavirus infection (COVID-19) have been studied, but the long-term outcomes after COVID-19-associated AKI are not well understood. Our aim was to evaluate the impact of AKI in acute COVID-19 in the prediction of long-term mortality in a population of hospitalized patients with COVID-19.METHODWe performed a cohort study on 1000 patients hospitalized from April to July 2020 with laboratory-confirmed COVID-19 and lung injury by computer tomography (CT). We excluded patients with re-hospitalization, acute surgical pathology and a single serum creatinine measurement during hospitalization. Definition of AKI was based on KDIGO criteria. According to the ESC guidelines, the term acute decompensated heart failure (ADHF) is used to describe patients with previously history of chronic stable heart failure with the typical symptoms and/or signs of decompensation of HF during hospitalization. Multivariate Cox regression was conducted to explore the potential predictors for long-term mortality. A P-value < 0.05 was considered statistically significant.RESULTSThe prospective part included 691/792 (87%) surviving patients [47% males, mean age 67 (55;78) years, mean Charlson index 3 (2;5), 69% with hypertension (HTN), 50% with obesity, 26% with diabetes mellitus (DM) and 15% with coronary artery disease (CAD)]. And 12.6% of patients were hospitalized in the intensive care unit (ICU).A total of 137 (20%) patients had AKI in acute COVID-19 and discharged from the hospital. The majority of survival patients with AKI had the 1 stage (77%), 17%—the 2 and 6%–the 3. There were no patients who underwent renal replacement therapy during acute COVID-19 in the survivors’ group. Patients with AKI were older [71 (62;78) versus 64 (52;73) years, P < .0001, compared with patients without AKI], had HTN (83% versus 66%, P < .001), DM (33% versus 24%, P = .03), CAD (25% versus 13%, P < .001) and higher Charlson index [4 (3;5) versus 3 (1;4), P < .0001]. Also, AKI patients had more severe lung injury by CT in acute COVID-19 (lung injuries >50%, 38% versus 26%, P = .004) and more frequently were hospitalized in ICU (23% versus 10%, P < .001). A total of 74% patients recovered from AKI at the discharge time.During 180 days of follow-up, 41 (6%) patients died in the whole study group. The most common cause of death was a heart attack or stroke (29%). In the group without AKI, the mortality rate was 4.5%, among patients with AKI—11.8% (P < .001). In multivariate Cox regression, AKI in the acute phase of COVID-19 [hazard ratio (HR) 2.83, 95% confidence interval (95% CI) 1.28–6.26; P = .01] and the Charlson index (HR 1.46, 95% CI 1.19–1.79; P < .001) were independently associated with higher mortality from all causes within 180 days after discharge after adjusting for age, gender, frequency of obesity, HTN, CAD, DM, ADHF, hospitalization in the ICU and lesions of more than 50% lung volume in the acute phase of COVID-19.CONCLUSIONAKI in the acute phase of COVID-19 and the Charlson index are independently associated with higher mortality within 180 days after discharge.Figure 1:A. Different urinary profiles in UPE. 1: Normal profile, 2: Tubular profile, 3: Glomerular profile, 3: Mixed profile. B. Urine protein assay in COVID ARDS patients with and without AKI KDIGO ≥ 2 in univariate analysis.

LES HEPATHOPATHIES CHRONIQUES ET GROSSESSE A PROPOS DUN CAS

We report the case of a 44-year-old multiparous patient with 3 previous pregnancies during her fourth pregnancy, at 33 WA the patient presented signs of decompensation of a previously unknown chronic liver disease. During her last months of pregnancy the diagnosis was made after the appearance of signs of hepatocellular insufficiency aggravated by hepatic encephalopathy in the immediate postpartum period. Abdominal ultrasound revealed a liver of chronic hepathopathy with abundant ascites and portal hypertension. Further abdominal CT scan confirmed the presence of a dysmorphic liver with bumpy contours associated with collateral perigastric venous circulation and homogeneous splenomegaly. The evolution was favorable marked by the delivery of a healthy female new born baby and the resumption of a normal state of consciousness of the woman.

Hip Fractures in Patients With Liver Cirrhosis: Worsening Liver Function Is Associated with Increased Mortality.

Liver cirrhosis is associated with osteoporosis, imbalance leading to falls, and subsequent fragility fractures. Knowing the prognosis of patients with liver cirrhosis of varying severity at the time of hip fracture would help physicians determine the course of treatment in this complex patient popultaion. (1) Is there an association between liver cirrhosis of varying severity and mortality in patients with hip fractures? (2) Is there an association between liver cirrhosis of varying severity and the in-hospital, 30-day, and 90-day postoperative complications of symptomatic thromboembolism and infections including wound complications, pneumonia, and urinary tract infections? Between 2015 and 2019, we identified 128 patients with liver cirrhosis who were treated for hip fractures at one of two Level I trauma centers. Patients younger than 18 years, those with incomplete medical records, fractures other than hip fractures or periprosthetic hip fractures, noncirrhotic liver disease, status after liver transplantation, and metastatic cancer other than hepatocellular carcinoma were excluded. Based on these exclusions, 77% (99 of 128) of patients were eligible; loss to follow-up was 0% within 1 year and 4% (4 of 99) at 2 years. The median follow-up duration was 750 days (interquartile range 232 to 1000). Ninety-four patients were stratified based on Model for End-stage Liver Disease (MELD) score subgroup (MELD scores of 6-9 [MELD6-9], 10-19 [MELD10-19], and 20-40 [MELD20-40]), and 99 were stratified based on compensation or decompensation status, both measures for liver cirrhosis severity. MELD scores combine laboratory parameters related to liver disease and are used to predict cirrhosis-related mortality based on metabolic abnormalities. Decompensation, however, is the clinical finding of acute deterioration in liver function characterized by ascites, hepatic encephalopathy, and variceal hemorrhage, associated with increased mortality. MELD analyses excluded 5% (5 of 99) of patients due to missing laboratory values. Median age at the time of hip fracture was 69 years (IQR 62 to 78), and 55% (54 of 99) of patients were female. The primary outcome of mortality was determined at 90 days, 1 year, and 2 years after surgery. Secondary outcomes were symptomatic thromboembolism and infections, defined as any documented surgical wound complications, pneumonia, or urinary tract infections requiring treatment. These were determined by chart review at three timepoints: in-hospital and within 30 days or 90 days after discharge. The primary outcome was assessed using a Cox proportional hazard analysis for the MELD score and compensation or decompensation classifications; secondary outcomes were analyzed using the Fisher exact test. Patients in the MELD20-40 group had higher 90-day (hazard ratio 3.95 [95% CI 1.39 to 12.46]; p = 0.01), 1-year (HR 4.12 [95% CI 1.52 to 11.21]; p < 0.001), and 2-year (HR 3.65 [95% CI 1.68 to 7.93]; p < 0.001) mortality than those in the MELD6-9 group. Patients with decompensation had higher in-hospital (9% versus 0%; p = 0.04), 90-day (HR 3.35 [95% CI 1.10 to 10.25]; p = 0.03), 1-year (HR 4.39 [95% CI 2.02 to 9.54]; p < 0.001), and 2-year (HR 3.80 [95% CI 2.02 to 7.15]; p < 0.001) mortality than did patients with compensated disease. All in-hospital deaths were related to liver failure and within 30 days of surgery. The 1-year mortality was 55% for MELD20-40 and 53% for patients with decompensated disease, compared with 16% for patients with MELD6-9 and 15% for patients with compensated disease. In both the MELD and (de)compensation analyses, in-hospital and postdischarge 30-day symptomatic thromboembolic and infectious complications were not different among the groups (all p > 0.05). Ninety-day symptomatic thromboembolism was higher in the MELD20-40 group compared with the other two MELD classifications (13% for MELD20-40 and 0% for both MELD6-9 and MELD10-19; p = 0.02). The mortality of patients with preexisting liver cirrhosis who sustain a hip fracture is high, and it is associated with the degree of cirrhosis and decline in liver function, especially in those with signs of decompensation, defined as ascites, hepatic encephalopathy, and variceal hemmorrhage. Patients with mild-to-moderate cirrhosis (MELD score < 20) and those with compensated disease may undergo routine fracture treatment based on their prognosis. Those with severe (MELD score > 20) or decompensated liver cirrhosis should receive multidisciplinary, individualized treatment, with consideration given to palliative and nonsurgical treatment given their high risk of death within 1 year after surgery. Level III, therapeutic study.

Morphofunctional state of the medulla and the fascicular zone of the adrenal cortex in modeling Alzheimer's disease by excessive administration of sodium nitrite

Background. Nitrates and nitrites are found in soil, water, human food, dyes, and medicines. In the literature, both positive and negative effects from the ingestion of nitrates and nitrites into the body are considered. A nitrite model of Alzheimer's type dementia of vascular origin was used in the work. Objective. The aim of the study was to study the morphofunctional state of the adrenal glands of experimental animals with prolonged administration of sodium nitrite. The study was carried out on male rats of the WAG population, which were divided into 3 groups: gr. N-14 - received injections of a water solution of sodium nitrite at a dose of 50 mg / kg of body weight daily for 14 days; gr. N-28 - Rats received similar injections for 28 days. Injections are intraperitoneal. Control rats were injected with 0.9% sodium chloride solution. Results. In animals of the main groups, the formation of a morphofunctional picture of the development of a stress reaction takes place, which was also confirmed morphometrically, and in group N-28 - with signs of incipient decompensation of the medulla and the fascicular zone of the adrenal cortex. Conclusion. When simulating Alzheimer's disease in laboratory rats by the introduction of a water solution of sodium nitrite at a dose of 50 mg / kg of body weight by daily intraperitoneal injection for 14 and 28 days, a picture of their morphofunctional activation is formed in the medulla and fascicular zone of the adrenal cortex. In the group with a 28-day course of administration of sodium nitrite solution, morphofunctional signs of decompensation of the medulla and the fascicular zone of the adrenal glands (especially the medulla) appear, which indicates the development of severe distress in animals and the impossibility of restoring homeostasis.

Remote Speech Analysis in the Evaluation of Hospitalized Patients With Acute Decompensated Heart Failure

ObjectivesThis study assessed the performance of an automated speech analysis technology in detecting pulmonary fluid overload in patients with acute decompensated heart failure (ADHF). BackgroundPulmonary edema is the main cause of heart failure (HF)-related hospitalizations and a key predictor of poor postdischarge prognosis. Frequent monitoring is often recommended, but signs of decompensation are often missed. Voice and sound analysis technologies have been shown to successfully identify clinical conditions that affect vocal cord vibration mechanics. MethodsAdult patients with ADHF (n = 40) recorded 5 sentences, in 1 of 3 languages, using HearO, a proprietary speech processing and analysis application, upon admission (wet) to and discharge (dry) from the hospital. Recordings were analyzed for 5 distinct speech measures (SMs), each a distinct time, frequency resolution, and linear versus perceptual (ear) model; mean change from baseline SMs was calculated. ResultsIn total, 1,484 recordings were analyzed. Discharge recordings were successfully tagged as distinctly different from baseline (wet) in 94% of cases, with distinct differences shown for all 5 SMs in 87.5% of cases. The largest change from baseline was documented for SM2 (218%). Unsupervised, blinded clustering of untagged admission and discharge recordings of 9 patients was further demonstrated for all 5 SMs. ConclusionsAutomated speech analysis technology can identify voice alterations reflective of HF status. This platform is expected to provide a valuable contribution to in-person and remote follow-up of patients with HF, by alerting to imminent deterioration, thereby reducing hospitalization rates. (Clinical Evaluation of Cordio App in Adult Patients With CHF; NCT03266029)

80. The Utility of Cultures for Isolated Fevers in Patients with Influenza or COVID-19 Receiving Extracorporeal Membrane Oxygenation

BackgroundCritically ill patients receiving extracorporeal membrane oxygenation (ECMO) are at elevated risk for nosocomial infection. Physiological responses to infection on ECMO are difficult to interpret as many clinical characteristics are controlled by the circuit including temperature. This study aimed to determine the culture positivity rates in patients receiving ECMO with influenza or COVID-19.MethodsA single center retrospective study was performed on all patients who received ECMO support at a single institution between December 2014 and December 2020 with influenza or COVID-19. All cultures ordered were reviewed for indication. Patients with fever without specific clinical syndrome or signs of decompensation, such as increasing vasopressor requirement were included. Infections and contaminants were defined by treatment team.ResultsA total of 45 patients received ECMO with an admission diagnosis of influenza or COVID-19 during the study period. This cohort had a median age of 44 (interquartile range (IQR): 36-53) and was predominantly male (84%). The median time on ECMO was 360 hours (IQR: 183-666). 43/137 (31%) of infectious workups were ordered for isolated fever. The most common workup ordered for fever was combination blood cultures (BC) and urine cultures (UC) (13, 30%), followed by combination BC, UC, and respiratory cultures (RC) (11, 26%). Four (9%) infections were identified (3 blood stream, 1 respiratory) and five (12%) cultures grew contaminants (1 blood, 1 respiratory, 2 urine). Culture positivity rate was greatest for BC (3/35, 9%) followed by RC (1/19, 5%), and lowest for UC (0/26, 0%).ConclusionAlthough cultures are commonly ordered for isolated fever in patients with influenza and COVID-19 receiving ECMO, culture positivity rate is low. In particular, no urinary tract infections were identified and the screening for urinary tract infection in patients receiving ECMO with isolated fever is not beneficial. Further work identifying signs and symptoms associated with infection is needed to improve diagnostic stewardship in this population that is high risk for nosocomial infections.Disclosures All Authors: No reported disclosures

Wilson's Disease: An Update on the Diagnostic Workup and Management.

Wilson’s disease (WD) is a rare autosomal recessive disorder of hepatocellular copper deposition. The diagnostic approach to patients with WD may be challenging and is based on a complex set of clinical findings that derive from patient history, physical examination, as well as laboratory and imaging testing. No single examination can unequivocally confirm or exclude the disease. Timely identification of signs and symptoms using novel biomarkers and modern diagnostic tools may help to reduce treatment delays and improve patient prognosis. The proper way of approaching WD management includes, firstly, early diagnosis and prompt treatment introduction; secondly, careful and lifelong monitoring of patient compliance and strict adherence to the treatment; and, last but not least, screening for adverse effects and evaluation of treatment efficacy. Liver transplantation is performed in about 5% of WD patients who present with acute liver failure at first disease presentation or with signs of decompensation in the course of liver cirrhosis. Increasing awareness of this rare inherited disease among health professionals, emphasizing their training to consider early signs and symptoms of the illness, and strict monitoring are vital strategies for the patient safety and efficacy of WD therapy.

Возраст-ассоциированные детерминанты декомпенсации мочевого пузыря в условиях гиперплазии предстательной железы

Introduction. In conditions of long-term infravesical obstruction caused by prostate hyperplasia (РН), 15-30% of patients eventually experience decompensation of detrusor function. At the same time, the details of the adaptive transformation of the vascular bed of the bladder, as well as its correlation with the structural remodeling of this organ, which determine the decompensation of the lower urinary tract in conditions of chronic urinary retention, are still unclear. Aim. To study the role of vascular and age-related factors in the depletion of the compensatory reserve of detrusor in long-term РН in elderly and senile people. Material and methods. Autopsy material from 25 men who did not have urological pathology, from 25 men who had РН without signs of decompensation of the bladder and biopsy material from 25 patients operated on for РН in the decompensation stage were examined. The age of all persons ranged from 60 to 80 years. Control – 10 men aged 20-30 years, who died as a result of injuries. Histological sections of the areas of the bladder were stained with hematoxylin-eosin, according to Mason and Hart. Results. In conditions of long-term РН, the functioning of a locally hypertrophic detrusor occurs against the background of age-related atrophic-sclerotic changes in it, the cause of which is: atherosclerosis of large arteries, as well as hyalinosis of small arteries and arterioles, characteristic of arterial hypertension. The «working capacity» of the bladder under these conditions is provided by the activity of regulatory muscle formations in the arterial and venous basins, with the help of which the necessary level of oxygenation is achieved. However, progressive age-related changes in the cardiovascular system over time lead to an increase in chronic ischemia. Sclerotic changes develop in the regulatory structures of the arteries and veins. As a result, there is a gross diffuse sclerosis of the detrusor with atrophy of the muscle fibers. Conclusions. Decompensation of detrusor in РН is a consequence of earlier vascular decompensation, the morphological markers of which are: arteriosclerosis, phlebosclerosis and sclerosis of regulatory structures.

Heart defects during pregnancy. According to the observations of Wernega and Stiglbauer'a (Arch. F. Gyn., Bd. 115)

According to the observations of Wernega and Stiglbauer'a (Arch. F. Gyn., Bd. 115), in pregnant women with mitral stenosis, it is necessary to terminate the pregnancy at the first signs of decompensation, without wasting time on drug treatment.

Physical activity and deconditioning of heart failure's patients followed at two Yaoundé's hospitals settings : A cross-sectional study in Cameroon

To assess the basic physical condition of chronic heart failure's Cameroonian patients. We carried out a cross-sectional study from February to June 2020 at the Yaoundé Central and General Hospitals, including all consenting adults with stage I or II chronic heart failure of the New York Heart Association without sign of decompensation and received in outpatient consultation. Socio-demographic data and the level of physical activity assessed according to the International Questionnaire on PhysicalActivity were recorded. Quality of Life was evaluated using the "Minnesota Living with Heart Failure Questionnaire". Associated factors were analysed using the Chi-square test, the strength of association expressed by the odds ratio, and its 95% confidence interval. The significance level was 0.05. We recruited 102 participants, including 60 women with a median age of 64 [56,68]. Daily physical activity was moderate in 54% of participants and low in 45%, with no significant difference between the sexes (p=0.3). About 39.2% of patients had an altered physical condition, and the most effective associated factors were obesity (p=0.01), low daily physical activity (p=0.002) and non-compliance to the treatment (p=0.03). The mean Quality of Life score was low (36.7±22.4), and the deterioration in physical condition harmed it (p<0.001). More than a third of the study population had a poor physical condition, which negatively affected their Quality of Life. Therefore, we can suggest that prescribing appropriate physical activity should be an integral part of heart failure management in our context.

C19TM: A nurse practitioner and physician assistant-led telemonitoring initiative ensures timely transfer of critically ill coronavirus disease 2019 patients.

The coronavirus disease 2019 (COVID-19) pandemic has required swift implementation of innovative practices in health care across the globe. We describe a nurse practitioner (NP) and physician assistant (PA)-led initiative to implement telemonitoring (TM) of noncritical patients with COVID-19 by critical care NPs and PAs (C19TM) for early detection of decompensation and early transfer to the intensive care unit (ICU). Every hospitalized patient with suspected or confirmed COVID-19 received an initial telemedicine consult with a critical care NP or PA. Patients were subsequently monitored via electronic health record once every 12-hour shift for the following indicators: oxygen modality and flow, increase in oxygen requirements, sustained tachypnea, and hemodynamic instability. If signs of decompensation were noted, the NP/PA would remotely reassess the patient, provide recommendations to the hospital internal medicine team, and transfer the patient to the ICU. The primary goal was to avoid cardiopulmonary deterioration requiring aerosol-generating procedures outside of the ICU. Over 65 days, 113 patients (86 suspected and 27 confirmed) were enrolled in C19TM. As a result, there were 13 transfers to the ICU, none of which required an aerosol-generating procedure outside of the ICU.