Twofold Risk Research Articles

Reduced fetal movements and COVID-19 infection: a retrospective cohort study

BackgroundFetal movements are an important indicator of fetal well-being; therefore, reduced fetal movements (RFMs) can indicate fetal compromise. RFM is associated with fetal growth restriction (FGR) and intrauterine fetal death (IUFD). Studies have implied that COVID-19 infection increases the risk of adverse fetal outcomes, such as preterm birth and IUFD. It is unclear how COVID-19 infection may aggravate these fetal outcomes among women presenting with RFM.The aims of the study were to (1) determine whether adverse fetal outcomes in women with RFM increased in 2020 compared to 2019, the year before the pandemic, and (2) evaluate whether maternal COVID-19 infection during pregnancy was a risk factor for adverse fetal outcomes in comparison to previously established risk factors among women seeking care for RFM.MethodsAll women who sought care due to RFM and were delivered at Soder Hospital from 2019 to 2020 were included. Fetal composite outcomes were constructed and compared between women with RFM and COVID-19 and women with RFM but without COVID-19.ResultsCOVID-19 infection did not increase the risk of adverse fetal outcomes in women who sought care for RFM. A twofold risk for adverse fetal outcomes was found among all primiparous women vs. multiparous women with RFM (98/788 [12.4%] vs 37/644 [9.8%], AOR = 2.5, 95% CI (1.6–3.7).ConclusionThe proportion of adverse composite outcomes among women with RFM during the first year of the pandemic did not increase compared to the year before. Composite outcomes were marginally higher in the COVID-19-positive group compared to the COVID-19-negative group, but it was not statistically significant.

Melanoma Among Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.

Melanoma as a subsequent malignant neoplasm has been described among childhood cancer survivors; however, the risk factors and long-term survival are not well understood. We assessed incidence, risk factors, and outcomes for melanoma among participants in the Childhood Cancer Survivor Study cohort. Cumulative incidence and standardized incidence ratios (SIRs) were calculated, and multivariable Cox models were used to determine hazard ratios (HRs) and associated 95% CI for melanoma risk factors. Radiation exposure to seven body regions and melanoma status for each of eight regions per survivor were integrated into the Cox model. Among 25,716 participants, 177 melanomas developed in 160 survivors (110 invasive, 62 in situ cutaneous, five ocular). The 40-year melanoma cumulative incidence was 1.1% (95% CI, 0.9 to 1.4) for all participants and 1.5% (95% CI, 1.0 to 2.1) among those receiving a cumulative radiation dose of ≥40 Gy. Compared with the general population, the SIR for invasive skin or ocular melanoma was 2.0 (95% CI, 1.6 to 2.4). A cumulative radiation dose of ≥40 Gy to the corresponding body region(s) of the melanoma (HR, 2.0 [95% CI, 1.1 to 3.7]), a cumulative cyclophosphamide equivalent dose of ≥20,000 mg/m2 (HR, 1.9 [95% CI, 1.1 to 3.6]), and bleomycin exposure (HR, 2.2 [95% CI, 1.2 to 4.1]) were associated with increased cutaneous melanoma. Invasive melanoma at any site was associated with an increased risk of death (HR, 2.4 [95% CI, 1.7 to 3.3]). Childhood cancer survivors have more than a two-fold increased risk of melanoma compared with the general population, and those with an invasive melanoma have more than a two-fold risk of death. High-dose radiation and alkylating agent exposure, and bleomycin are important risk factors for melanoma and should be considered in future patient guidance and screening.

The overlap of diabetic and inflammatory neuropathies: Epidemiology, possible mechanisms, and treatment implications.

Diabetic polyneuropathy is the common neuropathy of diabetes. However, several inflammatory neuropathies may occur during diabetes. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) represents the most treatable example. There has been uncertainty about a higher risk of CIDP in subjects with diabetes. Contradicting earlier reports, subsequent epidemiological studies failed to confirm an association. However, more recent studies from different populations have shown a two-fold relative risk of concurrent diabetes with CIDP. Recognition of CIDP is important in diabetes as treatment response rates have been reported as comparable with or without diabetes. However, with diabetes, the clinical presentation of CIDP and the resulting disability may be more severe due to additional axonal loss from pre-existing diabetic polyneuropathy and delayed diagnosis. An association of nodo-paranodopathy has similarly been described with a three-fold relative risk of concurrent diabetes in seropositive subjects, particularly those harbouring anti-contactin 1 antibodies. Although rare, recognition of nodo-paranodopathy, with characteristic clinical features, in the context of diabetes is likewise important in view of treatment implications. Other inflammatory neuropathies in diabetes are the painful or painless, cervical, or lumbar, radiculoplexus neuropathies. These need distinguishing from variant, multifocal forms of CIDP, as are not treatable, although remit spontaneously over months or years. There are reports of possible association of Guillain-Barré syndrome (GBS), and particularly of greater GBS severity, with diabetes. Finally, vasculitic neuropathy may also occur in diabetes and requires early suspicion, urgent investigations and immunosuppressant treatment. As the worldwide prevalence of diabetes rises, prompt recognition of its concurrent inflammatory neuropathies, is essential.

Vitamin D status in pregnancy and cord blood is associated with symptoms of attention-deficit hyperactivity disorder at age 5 years: Results from Odense Child Cohort.

Vitamin D status in pregnancy may affect offspring neurodevelopment. The objective was to investigate the association between serum 25-hydroxyvitamin D in cord blood and pregnancy and symptoms of attention-deficit hyperactivity disorder in 5-year-old offspring. In Odense Child Cohort, Denmark, 944 mother-child pairs had data on pregnancy or cord serum 25-hydroxyvitamin D and parent-rated attention-deficit hyperactivity disorder symptom score by Child Behavior Checklist for ages 1.5-5 years. Adjusted multiple linear regression and two-stage exposure analyses were performed for serum 25-hydroxyvitamin D associations to the attention-deficit hyperactivity disorder symptom score. The mean (standard deviation) serum 25-hydroxyvitamin D in cord blood was 48.0 (21.8) nmol/L; early pregnancy was 65.5 (20.2) nmol/L and late pregnancy was 79.3 (25.7) nmol/L. The median (interquartile range) age of child at examination was 5.2 (5.1-5.4) years and median (interquartile range) attention-deficit hyperactivity disorder symptom score was 2 (0-3) points. In adjusted analyses, serum 25-hydroxyvitamin D of <25 nmol/L and <32 nmol/L in cord blood and <25 nmol/L in early pregnancy was associated with 0.9 [95% confidence interval: 0.4, 1.3], 0.5 [0.1, 0.9] and 2.1 [0.8, 3.4] points higher attention-deficit hyperactivity disorder symptom score vs reference. In the two-stage exposure analysis, attention-deficit hyperactivity disorder symptom score decreased by 0.4 points per 25 nmol/L increase in serum 25-hydroxyvitamin D. Moreover, serum 25-hydroxyvitamin D of <25 nmol/L in early pregnancy and cord was associated with a five-fold and a two-fold risk of attention-deficit hyperactivity disorder symptom score ⩾90th percentile, adjusted odds ratio [95% confidence interval] = 4.9 [1.3, 19.0] and 2.2 [1.2, 3.9]. In this cohort, serum 25-hydroxyvitamin D <25 nmol/L in cord blood and early pregnancy were risk factors for higher attention-deficit hyperactivity disorder symptom score in 5-year-old children, suggesting a protective effect of vitamin D on attention-deficit hyperactivity disorder traits at preschool age.

Comorbidities and risk of death in atrial fibrillation: a nationwide cohort study

Abstract Background Atrial fibrillation (AF) is associated with increased mortality, cardiovascular morbidity, and risk of stroke. With aging population, the number of AF patients is increasing, and they present with more comorbidities representing a major public health challenge. Purpose The influence of concomitant diseases on survival of patients with AF is not well established. Using data from a comprehensive nationwide cohort study, we studied the influence of several comorbidities on one-year mortality after the diagnosis of new-onset AF. Methods All patients with newly diagnosed AF in Finland 2007-17 were identified from nationwide registries. Individualized data on concomitant diseases were gathered from ICD-10 diagnoses during hospitalizations and outpatient visits in primary and specialist care and from drug reimbursements registries. Patients were followed until the end of 2018 from the causes of death registry, which records every death in the country. All-cause mortality associated with several comorbidities per 1000 person-years was determined, and relative risk (RR) of death was calculated. Results A total of 229,321 patients (mean age 73 ± 13.2 years, 50.0% male) with new-onset AF were identified. Mean age of men and women with new-onset AF was 69.4 ± 13.4 and 77.1 ± 11.8 years, respectively. During the one-year follow-up, 11.6% of men and 13.7% of women died. Heart failure, kidney disease and dementia were the strongest predictors of mortality and were associated with an over threefold risk of death within one year. Cancer, history of bleeding and vascular disease carried over twofold risk of death. In addition, hypertension, diabetes, alcohol abuse and history of stroke predicted mortality. The risk of death associated with these comorbidities is presented in Table. Conclusions Several comorbidities were associated with significantly increased risk of death within one year of the AF diagnosis. Heart failure, kidney disease and dementia were strongest predictors of subsequent mortality with over threefold risk. These data will inform the treatment decisions regarding AF patients with comorbidities.

Relationship between Lipid and Blood Glucose Levels with Stroke Risk in Dupak Surabaya

Background: Stroke is a syndrome characterized by rapidly developing symptoms and/or clinical signs in the form of focal or global brain functional disorders lasting more than 24 hours which are not caused by causes other than vascular. Stroke is the number one cause of disability and the main cause of death in Indonesia (19.42% of total deaths). Dyslipidemia and diabetes mellitus are two-fold risk factors for stroke.This research is to determine the relationship between lipids and blood glucose and a high risk of stroke. Methods: This research uses descriptive analytical methods with a cross sectional approach. The population is residents in Dupak Surabaya. The sampling method is random sampling technique. The total research sample was 53 participants. The statistical test used is Chi Square. Result: Statistical results show that there is no relationship between high cholesterol levels and the risk of stroke and there is a relationship between high triglyceride and blood sugar levels and the risk of stroke.Conclusion:This research concluded that there was a significant relationship between high levels of triglycerides and blood glucose and the risk of stroke and there was no significant relationship between high cholesterol levels and the risk of stroke. This lack of significant association could be due to the heterogeneous population and the presence of previous anti-cholesterol medication.

Nutritional profile and infection-related hospital admissions in children with chronic kidney disease.

Protein energy wasting (PEW) and undernutrition are highly prevalent in children with chronic kidney disease (CKD), but their impact on clinical outcomes is not well described. This prospective longitudinal study in children with CKD assessed the association of nutritional parameters with infection-related hospital admissions (IRHA). Children with CKD2-5D aged 2-18 years and infection-free for 1 month were recruited over 5 years. Evaluation for undernutrition by subjective global nutritional assessment and for PEW using paediatric criteria was undertaken and categorized as mild (>2 criteria), standard (>3 criteria) and modified PEW (>3 criteria with short stature). The IRHA (severe viral, bacterial or fungal infections) were recorded. Among 137 children (45 on dialysis; age 123±46 months; 70% males), undernutrition was seen in 60% and PEW in 52%. In over 38±21 months follow-up, 107 (78%) required hospital admissions (67% IRHA). The incidence rate of IRHA in days per patient-year was higher in those with undernutrition compared to well-nourished children [1.74 (1.27, 2.31) vs. 0.65 (0.44, 0.92) p < 0.0001] and higher in those with PEW compared to no PEW [1.74 (1.30, 2.28) vs. 0.56 (0.36, 0.82) p < 0.0001] respectively. On adjusted analysis, independent risk factors for IRHA were undernutrition, low BMI, hypoalbuminemia and dialysis status with modified PEW [OR 5.34 (2.16, 13.1) p < 0.001] and raised CRP [OR 4.66 (1.56, 13.9) p = 0.006] having the highest risk. Additionally, modified PEW and BMI were noted to have a twofold risk for recurrent infections. In children with CKD2-5D, incidence rate of IRHA was significantly higher in those with undernutrition and PEW. While dialysis, poor nutritional status and inflammation were risk factors for IRHA, modified PEW and BMI were associated with recurrent infections.

Association of Prehypertension with Renin Angiotensin System: A Cross-Sectional Study on Tribal Population of Northern India

Abstract Introduction: Hypertension (HTN), the third risk factor driving death and disability as per Global Burden of Disease 2019, is a major public health concern. Prehypertension, the intermediate stage between HTN and normal blood pressure (BP), is associated with subclinical atherosclerosis and target-organ damage. Evaluating the prevalence of prehypertension is imperative to prevent disease progression. Prehypertension, alike HTN, is a complex disorder that manifests when genes are triggered by the environment. The current study attempts to evaluate the prevalence of prehypertension in a tribal population of Northern India. Further, the association with extensively studied renin–angiotensin system (RAS) pathway genes with prehypertension has been explored. Methods: A cross-sectional study was conducted on adults of 20–60 years old belonging to a tribal community, Rang Bhotia of Northern India. Information on demographic, lifestyle, and anthropometric risk factors was collected. The blood sample was collected for lipid and genetic analysis. DNA extraction and genotyping of five genetic markers of RAS-related pathway were performed. Chi-square and t-tests were used for assessing significant differences between the groups. Logistic regression was used to examine the association of genes with prehypertension and HTN. Results: Among 254 adults participating in the study, 39% and 42% had prehypertension and HTN, respectively. T allele of M235T genetic marker was found to be posing two-fold risk for prehypertension (odds ratio [OR] = 2.9; 95% confidence interval [CI] =1.10–7.72; P = 0.03 in dominant model and OR = 1.83; 95% CI = 1.09-3.09; P = 0.02 in additive model) after adjusting for age and sex. On the other hand, G allele of A6G polymorphism was found to be providing protection toward prehypertension (OR = 0.32; 95% CI = 0.11–0.92; P = 0.03 in recessive model and OR = 0.55; 95% CI = 0.32–0.94; P = 0.03 in additive model). Conclusion: More than one-third of individuals exhibited prehypertension, suggesting an impending burden of HTN and comorbidities among the tribal population in the near future. Moreover, increased genetic susceptibility toward elevated BP commands immediate attention. Effective management strategies including interventions on lifestyle, diet modification, and weight management need to be introduced to combat increasing HTN among the tribal population.

Predictors of mortality by an artificial intelligence enhanced electrocardiogram model for cardiac amyloidosis.

We aim to determine if our previously validated, diagnostic artificial intelligence (AI) electrocardiogram (ECG) model is prognostic for survival among patients with cardiac amyloidosis (CA). A total of 2533 patients with CA (1834 with light chain amyloidosis (AL), 530 with wild-type transthyretin amyloid protein (ATTRwt) and 169 with hereditary transthyretin amyloid (ATTRv)] were included. An amyloid AI ECG (A2E) score was calculated for each patient reflecting the likelihood of CA. CA stage was calculated using the European modification of the Mayo 2004 criteria for AL and Mayo stage for transthyretin amyloid (ATTR). Risk of death was modelled using Cox proportional hazards, and Kaplan-Meier was used to estimate survival. Median age of the cohort was 67 [inter-quartile ratio (IQR) 59, 74], and 71.6% were male. The median overall survival for the cohort was 35.6months [95% confidence interval (CI) 32.3, 39.5]. For AL, ATTRwt and ATTRv, respectively, median survival was 22.9 (95% CI 19.2, 28.2), 47.2 (95% CI 43.4, 52.3) and 61.4 (95% CI 48.7, 75.9) months. On univariate analysis, an increasing A2E score was associated with more than a two-fold risk of all-cause death. On multivariable analysis, the A2E score retained its importance with a risk ratio of 2.0 (95% CI 1.58, 2.55) in the AL group and 2.7 (95% CI 1.81, 4.24) in the ATTR group. Among patients with AL and ATTR amyloidosis, the A2E model helps to stratify risk of CA and adds another dimension of prognostication.

PERIPROSTHETIC JOINT INFECTION AND HETEROTOPIC OSSIFICATION AFTER TOTAL HIP ARTHROPLASTY: A NARRATIVE REVIEW

This meta analysis address the relationship between infection developing after total hip arthroplasty (THA) and heterotopic ossification (HO). To identify the gaps in available knowledge, we screened for full-length peer-reviewed research articles listed in PubMed, Embase, and Web of Science over the past 20 years. The following search terms and Boolean operators were used: heterotopic ossification AND infection AND (hip replacement OR hip arthroplasty). The search resulted in the identification of as few as 14 articles describing periprosthetic joint infection (PJI) and HO after THA. Data summarized from 6 studies suitable for further meta-analysis yielded a cumulative sample size of 753 observations, with 186 recorded events of HO. The pooled RR was estimated at 2.22 (95% CI: 1.00 to 4.91, p = 0.0497), suggesting a more than twofold risk of HO compared to the group without PJI. In conclusion, there is a clear association between a higher risk of HO and PJI. Basic research findings support the hypothesis that bacterial pathogen-associated molecular patterns (PAMPs) can lead to osteogenesis through a toll-like receptor (TLR) and nuclear factor kappa B (NF-κB) pathway in the course of HO development. Together, these results suggest that HO prophylaxis should always be prescribed in PJI after THA. Moreover, during revisions following THA for presumed non-septic reasons, the presence of HO warrants consideration for infection, as there is a potential heightened risk of pathologic ossification induced by PAMPs.Keywords: heterotopic ossification; total hip arthroplasty; total hip replacement; periprosthetic joint infection; bacteriaAuthors Ł. Pulik and P. Łęgosz contributed equally to this work.

Vitamin D affects the risk of disease activity in multiple sclerosis

BackgroundVitamin D (VitD) affects the risk of multiple sclerosis (MS), but the impact on disease activity is controversial. We assessed whether VitD is associated with the No-Evidence of Disease Activity-3...

Extended genome-wide association study employing the African genome resources panel identifies novel susceptibility loci for Alzheimer's disease in individuals of African ancestry.

Despite a two-fold risk, individuals of African ancestry have been underrepresented in Alzheimer's disease (AD) genomics efforts. Genome-wide association studies (GWAS) of 2,903 AD cases and 6,265 controls of African ancestry. Within-dataset results were meta-analyzed, followed by functional genomics analyses. A novel AD-risk locus was identified in MPDZ on chromosome (chr) 9p23 (rs141610415, MAF=0.002, p=3.68×10-9). Two additional novel common and nine rare loci were identified with suggestive associations (P<9×10-7). Comparison of association and linkage disequilibrium (LD) patterns between datasets with higher and lower degrees of African ancestry showed differential association patterns at chr12q23.2 (ASCL1), suggesting that this association is modulated by regional origin of local African ancestry. These analyses identified novel AD-associated loci in individuals of African ancestry and suggest that degree of African ancestry modulates some associations. Increased sample sets covering as much African genetic diversity as possible will be critical to identify additional loci and deconvolute local genetic ancestry effects. Genetic ancestry significantly impacts risk of Alzheimer's Disease (AD). Although individuals of African ancestry are twice as likely to develop AD, they are vastly underrepresented in AD genomics studies. The Alzheimer's Disease Genetics Consortium has previously identified 16 common and rare genetic loci associated with AD in African American individuals. The current analyses significantly expand this effort by increasing the sample size and extending ancestral diversity by including populations from continental Africa. Single variant meta-analysis identified a novel genome-wide significant AD-risk locus in individuals of African ancestry at the MPDZ gene, and 11 additional novel loci with suggestive genome-wide significance at p<9×10-7. Comparison of African American datasets with samples of higher degree of African ancestry demonstrated differing patterns of association and linkage disequilibrium at one of these loci, suggesting that degree and/or geographic origin of African ancestry modulates the effect at this locus. These findings illustrate the importance of increasing number and ancestral diversity of African ancestry samples in AD genomics studies to fully disentangle the genetic architecture underlying AD, and yield more effective ancestry-informed genetic screening tools and therapeutic interventions.

Role of parental educational level as psychosocial factor in a sample of inpatients with anorexia nervosa and bulimia nervosa.

Evidence on parental educational level (PEL) as a risk factor for Eating Disorders (EDs) is mixed, and no study has assessed its role in relation to the compliance and outcomes of treatments in EDs. Further, no study differentiated from the educational level of mothers and fathers, nor considered the possible mediation of perfectionism in fostering EDs. A clinical sample of 242 first-ever admitted inpatients with EDs provided information on PEL and completed the following questionnaires: the Eating Disorder Examination Questionnaire (EDE-Q) and the Frost Multidimensional Perfectionism Scale (F-MPS). Clinicians also provided information on the Hamilton Rating Scale for Anxiety (HAM-A) and the Hamilton Rating Scale for Depression (HAM-D) for each participant. Individuals with high PEL (whether mothers, fathers, or both parents) showed significantly higher scores on depressive symptoms and lower on parental criticism, were younger, had an earlier age of onset, had fewer years of illness, more were students and employed, and fewer had offspring. Individuals with fathers or both parents with high educational levels suffered more from Anorexia Nervosa rather than Bulimia Nervosa, had a longer length of stay during the current hospitalization, had less dietary restraint, and had higher personal standards. Individuals with mothers with high educational levels showed a lower rate of previous substance or alcohol addiction. Personal standards partially mediated the relationship between higher PEL and lower dietary restraint. PEL emerged to be a twofold psychosocial risk factor, being associated with higher depressive symptoms and a longer length of stay, but also with a shorter duration of illness and better scholar and working involvement. Higher PEL was related to higher personal standards but not to global perfectionism. Patterns of eating psychopathology emerged based on the high PEL of mothers or fathers.

Association of leptin–melanocortin gene polymorphisms with the risk of obesity in northwest Indian population

BackgroundObesity, a multifaceted endocrine issue, is adversely affecting all age groups and is posing a significant public health challenge. The genetic polymorphisms of the melanocortin 4 receptor (MC4R) and leptin (LEP) genes likely contribute to the development of obesity. The present study aimed to explore the effects of MC4R and LEP gene polymorphisms on obesity among the northwest Indian population.MethodsThe present study was conducted among 333 obese cases and 338 non-obese controls (aged 18–50 years). All subjects underwent measurements for anthropometric, physiometric, as well as biochemical parameters. Genotyping for MC4R and LEP gene variants was performed using the polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) method. However, 10% of the samples for each variant were confirmed using the Sanger sequencing method.ResultsThe polymorphisms of leptin–melanocortin pathway genes (MC4R-LEP) were found to be significantly associated with various obesity-related parameters like waist circumference: p = 0.017, waist-to-height ratio: p = 0.009, total cholesterol: p = 0.0001 and triglycerides: p = 0.0001. Both the LEP gene variants rs2167270 and rs7799039 conferred 2.4- and 2.2-fold risk toward obesity under the recessive genetic model [OR (95% CI) 2.42 (1.44–4.07), p = 0.001; OR (95% CI) 2.26 (1.41–3.60), p = 0.0001, respectively]. All four polymorphisms of the MC4R and LEP genes demonstrated a strong interaction of 82.1% with the lifestyle factor (p = 0.001). The haplotype combinations A–A for rs571312 and rs12970134 conferred twofold risk [OR (95% CI) 2.61 (1.10–6.20), p = 0.028]. However, the combination A–G for rs2167270 and rs7799039 predicted sixfold risk [OR (95% CI) 6.02 (3.39–10.68), p = 0.0001] toward the obesity development in this population.ConclusionOur study revealed a connection between MC4R (rs571312, rs12970134) and LEP (rs2167270, rs7799039) gene variants with obesity, highlighting their prominent role in assessing the risk of obesity among the northwest Indian population.

Survival of endodontically treated teeth in public dental service in Northern Finland: a practise-based register study.

The aim of this study was to explore the factors associated with the survival of root canal treated teeth in a practise-based study setting in a 5-year period. This retrospective study used data from the electronic patient registration system of the public dental services of the City of Oulu, Finland. The inclusion criteria for this study were patients aged ≥ 20 years who had root canal treatment (RCT) that was initiated in 2014. One RCT per patient was included in the study. A total of 713 patients met the inclusion criteria. The outcome variable for this study was the extraction of the RCT tooth during the 5-year period. Explanatory variables included age, diagnosis, tooth type (incisive, canine, premolar, molar), RCT technique (manual, motorized), time from RCT initiation to final restoration and type of final restoration (composite, glass ionomer, fixed dental prosthesis). To evaluate the association between the outcome variable and explanatory variables, Cox regression analyses were performed. The overall survival rate was 91%. The middle-aged (40-59-years-old) and the oldest (60 and older) patients had a two-fold risk of extraction compared to younger (20-40-years-old) patients. Similarly, a short length of time from RCT initiation to final restoration (0-14 days) resulted in a nearly three times higher risk of extraction compared to a longer period (≥ 90 days). The 5-year survival rate of RCTs seems high. Extractions were more common among patients over 40 years of age and if the RCT was completed shortly after its initiation.

Non-antigen-specific Immunoadsorption Is a Risk Factor for Severe Postoperative Infections in ABO-Incompatible Kidney Transplant Recipients.

ABO-incompatible (ABOi) living kidney transplantation (KTx) is an established procedure to address the demand for kidney transplants with outcomes comparable to ABO-compatible KTx. Desensitization involves the use of immunoadsorption (IA) to eliminate preformed antibodies against the allograft. This monocentric retrospective study compares single-use antigen-selective Glycosorb® ABO columns to reusable non-antigen-specific Immunosorba® immunoglobulin adsorption columns regarding postoperative infectious complications and outcome. It includes all 138 ABOi KTx performed at Freiburg Transplant Center from 2004-2020. We compare 81 patients desensitized using antigen-specific columns (sIA) to 57 patients who received IA using non-antigen-specific columns (nsIA). We describe distribution of infections, mortality and allograft survival in both groups and use Cox proportional hazards regression to test for the association of IA type with severe infections. Desensitization with nsIA tripled the risk of severe postoperative infections (adjusted HR 3.08, 95% CI: 1.3-8.1) compared to sIA. nsIA was associated with significantly more recurring (21.4% vs. 6.2%) and severe infections (28.6% vs. 8.6%), mostly in the form of urosepsis. A significantly higher proportion of patients with sIA suffered from allograft rejection (29.6% vs. 14.0%). However, allograft survival was comparable. nsIA is associated with a two-fold risk of developing a severe postoperative infection after ABOi KTx.

Recurrence of Clostridioides difficile infection and mortality in older inpatients.

The prevalence of Clostridioides difficile infection in older and frail population is extremely high and adverse outcomes, including future recurrences and premature mortality, are common. Nonetheless, the clinical risk profile for Clostridioides difficile recurrence in older people is still controversial. We aimed to investigate: 1) the association between Clostridioides difficile recurrence and 6-month mortality; 2) the risk factors for Clostridioides difficile recurrence after hospital discharge. This is a retrospective study on adults with a first episode of Clostridioides difficile infection admitted to all Internal Medicine and Geriatrics Units of the University Hospital of Ferrara (Italy) between January 2018 and December 2020. For each patient, sociodemographic, clinical and laboratory data were collected through hospital database system. The primary and secondary outcomes were mortality and recurrence within 6months from the first infectious episode, respectively. The mean age of the 386 enrolled patients was 77.8years; 61.7% were females. Twelve percent patients had Clostridioides difficile recurrence and 32.1% patients died during the 6-month follow-up. At Cox analysis, after adjustment for the potential confounders, participants with recurrence reported a twofold risk of death compared to those without recurrence (HR, 95% CI 2.45, 1.59-3.78). Compared to patients treated with metronidazole, those treated with vancomycin showed a lower risk of recurrence (log-rank p < 0.001). Clostridioides difficile recurrence is associated with a higher risk of mortality and it may itself be a marker of frailty and vulnerability. Vancomycin treatment during the infectious episode was associated with lower recurrence rate, as compared to metronidazole.

Prevalence and prognostic impact of bone disease in chronic heart failure with reduced ejection fraction.

Chronic heart failure is associated with a bone-catabolic state and increases the risk of osteoporosis and fractures. Prospective studies investigating the clinical relevance of bone disease in heart failure are lacking. We aimed to assess the prevalence and prognostic impact of osteoporosis and vertebral fractures (VFs) in chronic heart failure with reduced ejection fraction (HFrEF). Symptomatic outpatients with chronic heart failure and a previous diagnosis of overtly reduced left ventricular ejection fraction<40% on stable, optimal HFrEF therapy and left ventricular ejection fraction<50% at enrolment were included into a prospective single-centre study. Osteoporosis was determined with dual-energy X-ray absorptiometry and defined as a T-score≤2.5 at any site. VFs were assessed using X-ray of both thoracic and lumbar spine applying the semiquantitative Genant score. We enrolled 205 patients (22% women), with a median age of 66 (IQR 58-74) years. Median left ventricular ejection fraction was 37 (IQR 30-43) % and median N-terminal pro B-type natriuretic peptide was 964 (IQR 363-2173) pg/mL. Osteoporosis, as defined by bone mineral density, and at least one VF were prevalent in 31 (15%) and 29 patients (14%). Osteoporosis or VF were present in 55 patients (27%) and 5 patients (2%) had both osteoporosis and a VF. During a median follow-up of 4.7 (IQR 4.0-5.3) years, 18 patients (9%) died due to cardiovascular (CV) cause, and 46 patients (22%) had a worsening heart failure (WHF) hospitalization. In multivariate Cox regression analyses, presence of VF independently predicted CV death (HR 2.82, 95% CI 1.04-7.65, P=0.042), WHF hospitalizations (HR 2.39, 95% CI 1.18-4.82, P=0.015), and a composite endpoint of CV death and WHF hospitalizations (HR 2.44, 95% CI 1.23-4.82, P=0.011). Osteoporosis was not significantly associated with CV events. In a prospective study, bone disease affected every fourth patient with HFrEF, and patients with VF at baseline had a two-fold risk of subsequent CV death or WHF hospitalization. Prevalent bone disease, particularly VF, should be considered as a clinically relevant comorbidity in HFrEF.

Prognostic significance of lymphocytic foci composition in minor salivary gland biopsies for severe disease flare and severity in Sjögren's syndrome: a 3-year follow-up cohort study.

This was an ambispective cohort study evaluating the prognostic significance of lymphocytic foci and its lymphoid composition in minor salivary gland biopsy (MSGB) for short-term disease flare and severity in Sjögren's syndrome (SS). The inclusion criteria comprised individuals meeting the ACR/EULAR 2016 criteria who underwent MSGB with an infiltration of more than 50 lymphocytes and received clinical diagnosis between September 2017 and December 2018. Patients with inadequate biopsy samples were excluded. The number of lymphocytic foci and their lymphoid composition in MSGB were assessed using immunofluorescence staining. Major organ damage and improvements in the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) were measured. Statistical analyses, including Cox and linear regressions, were conducted. A total of 78 patients with at least one lymphocytic focus were included in the study. The presence of higher T-cell counts in lymphocytic foci in MSGB was associated with severe disease flare, and a logarithmic transformation of T-cell count indicated increased risk (HR 1.96, 95% CI 0.91-4.21). Improvements in the ESSDAI were associated with higher total lymphocyte count and T- and B-cell numbers in the lymphoid composition of the lymphocytic foci. Seropositive patients exhibited higher T CD4+ cell numbers. Correlation analysis showed negative associations between age and lymphocytic foci and the T-cell count. Positive correlations were observed between antinuclear antibody (ANA) titers and total lymphocyte numbers. Patients with a higher number of T cells in the lymphocytic infiltrates of lymphocytic foci may have a two-fold risk of severe disease flare. The number of B cells and T CD4+ cells in the lymphocytic infiltrates of lymphocytic foci showed a weak but positive relation with the ESSDAI improvement during follow-up. Age and seropositivity appeared to influence the lymphoid composition of the lymphocytic foci.

Religious coping and levels of posttraumatic stress disorder symptomatology after the Beirut explosion.

Religious coping has implications for the development of psychopathology in the aftermath of traumatic events. This study explored the relationship between religious coping (positive and negative) and posttraumatic stress disorder (PTSD) symptomology among survivors of a large industrial explosion that devastated parts of Beirut in August of 2020. Three months after the disaster, 996 residents of Beirut and Lebanon completed validated measures of religious coping (RCOPE) and PTSD symptomatology (Impact of Events Scale-Revised) in either English or Arabic. The majority of participants were young adults aged between 18 and 25 years. Results indicated that higher levels of negative religious coping were a significant predictor of higher levels of PTSD symptomatology and were associated with a two-fold risk of meeting the criteria for probable PTSD. Other significant predictors included female gender, being a resident of Beirut at the time of the explosion, having personally sustained an injury, or knowing a person injured in the explosion. Effects sizes ranged from .34 to .68. Higher scores on measures of negative religious coping were associated with higher levels of PTSD symptomatology. However, negative religious coping may be better construed as a set of religious-based appraisals of event causality and may represent a form of peritraumatic appraisal in the wake of traumatic events. (PsycInfo Database Record (c) 2023 APA, all rights reserved).