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ESC Heart Failure Jun 2024Diagnosing acute heart failure (AHF) remains particularly challenging in older patients. Natriuretic peptides are recommended as valuable diagnostic tools in this...
AIMS
Diagnosing acute heart failure (AHF) remains particularly challenging in older patients. Natriuretic peptides are recommended as valuable diagnostic tools in this context. This study aims to establish the diagnostic thresholds of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for AHF in patients aged over 75 years, both with and without co-morbidities.
METHODS AND RESULTS
In this retrospective longitudinal multicentre cohort study, data were gathered from 12 071 hospitalized patients aged 75 years or older, presenting with acute dyspnoea and undergoing BNP or NT-proBNP measurement within 48 h of admission across 10 Assistance Publique-Hôpitaux de Paris facilities between 2011 and 2022, encompassing geriatrics, cardiology, and pulmonology departments. Final diagnoses were categorized using ICD-10 criteria as either AHF or other acute respiratory conditions such as COPD exacerbation, pulmonary embolism, and pneumonia. The mean (SD) age of the population was 84.0 (80.0, 89.0) years, with 52.7% being female. Out of these, 7946 (65.8%) were diagnosed with AHF upon discharge. For NT-proBNP, the identified 'optimal' threshold for diagnosing AHF was 1748 ng/L, with a positive predictive value (PPV) of 84%. Among patients aged over 85 years, a threshold of 2235 pg/mL for NT-proBNP was associated with an 84% PPV. In patients with atrial fibrillation (AF), a threshold of 2332 pg/mL for NT-proBNP demonstrated a PPV of 90% for AHF diagnosis. Additionally, in patients with an estimated glomerular filtration rate (eGFR) < 30 mL/min, a threshold of 3474 pg/mL for NT-proBNP yielded a 90% PPV for AHF diagnosis. In male patients, a threshold of 1800 pg/mL showed an 85% PPV for AHF diagnosis, while in patients with obesity, a threshold of 1375 pg/mL demonstrated an 85% PPV for AHF diagnosis.
CONCLUSIONS
In older patients, we found significant effects of co-morbidities on natriuretic peptides results, particularly in patients over 85 years old, older patients with abnormal renal function, obesity, and atrial fibrillation. Despite the consideration of those co-morbid conditions, NT-proBNP and BNP level continue to demonstrate utility in the diagnosis of AHF in older patients.
PubMed: 38923835
DOI: 10.1002/ehf2.14894 -
Influenza and Other Respiratory Viruses Jun 2024Respiratory syncytial virus (RSV) and influenza infections cause significant annual morbidity and mortality worldwide in at-risk populations. This study is aimed at... (Comparative Study)
Comparative Study
BACKGROUND
Respiratory syncytial virus (RSV) and influenza infections cause significant annual morbidity and mortality worldwide in at-risk populations. This study is aimed at assessing hospital burden and healthcare resource utilization (HRU) of RSV and influenza in adults in Spain.
METHODS
Data were obtained from the Projected Hospitalisation Database of inpatient episodes (ages: younger adults 18-50 and 51-64 years; older adults 65-74, 75-84, and ≥ 85 years) during 2015, 2017, and 2018 in Spanish public hospitals. Incidence, mean hospitalization, and HRU assessments, including length of stay (LOS), intensive care unit (ICU) usage, and age-standardized mortality rates, were collected and stratified by age group, with analyses focusing on the adult population (≥ 18 years old).
RESULTS
Mean hospitalization rate in the population across all years was lower in individuals with RSV versus influenza (7.2/100,000 vs. 49.7/100,000 individuals). ICU admissions and median LOS were similar by age group for both viruses. Age-standardized mortality was 6.3/100,000 individuals and 6.1/100,000 individuals in patients with RSV and influenza, respectively, and mortality rates were similar in older adults (≥ 65 years) for both viruses.
CONCLUSIONS
RSV and influenza infection were associated with considerable HRU. There is a substantial disease burden for RSV infection in older adults ≥ 65 years. While RSV hospitalization rates in adults reported here appeared lower than influenza, RSV is still underdiagnosed in the hospital setting and its incidence might be similar to, or higher than, influenza.
Topics: Humans; Influenza, Human; Respiratory Syncytial Virus Infections; Middle Aged; Spain; Aged; Adult; Hospitalization; Young Adult; Adolescent; Aged, 80 and over; Male; Female; Incidence; Length of Stay; Cost of Illness; Respiratory Syncytial Virus, Human; Intensive Care Units
PubMed: 38923767
DOI: 10.1111/irv.13341 -
Critical Care Explorations Jul 2024COVID-19 may injure the kidney tubules via activation of inflammatory host responses and/or direct viral infiltration. Most studies of kidney injury in COVID-19 lacked...
IMPORTANCE
COVID-19 may injure the kidney tubules via activation of inflammatory host responses and/or direct viral infiltration. Most studies of kidney injury in COVID-19 lacked contemporaneous controls or measured kidney biomarkers at a single time point.
OBJECTIVES
To better understand mechanisms of acute kidney injury in COVID-19, we compared kidney outcomes and trajectories of tubular injury, viability, and function in prospectively enrolled critically ill adults with and without COVID-19.
DESIGN, SETTING, AND PARTICIPANTS
The COVID-19 Host Response and Outcomes study prospectively enrolled patients admitted to ICUs in Washington State with symptoms of lower respiratory tract infection, determining COVID-19 status by nucleic acid amplification on arrival.
MAIN OUTCOMES AND MEASURES
We evaluated major adverse kidney events (MAKE) defined as a doubling of serum creatinine, kidney replacement therapy, or death, in 330 patients after inverse probability weighting. In the 181 patients with available biosamples, we determined trajectories of urine kidney injury molecule-1 (KIM-1) and epithelial growth factor (EGF), and urine:plasma ratios of endogenous markers of tubular secretory clearance.
RESULTS
At ICU admission, the mean age was 55 ± 16 years; 45% required mechanical ventilation; and the mean serum creatinine concentration was 1.1 mg/dL. COVID-19 was associated with a 70% greater occurrence of MAKE (relative risk 1.70; 95% CI, 1.05-2.74) and a 741% greater occurrence of KRT (relative risk 7.41; 95% CI, 1.69-32.41). The biomarker cohort had a median of three follow-up measurements. Urine EGF, secretory clearance ratios, and estimated glomerular filtration rate (eGFR) increased over time in the COVID-19 negative group but remained unchanged in the COVID-19 positive group. In contrast, urine KIM-1 concentrations did not significantly change over the course of the study in either group.
CONCLUSIONS
Among critically ill adults, COVID-19 is associated with a more protracted course of proximal tubular dysfunction and reduced eGFR despite similar degrees of kidney injury.
Topics: Humans; COVID-19; Middle Aged; Critical Illness; Male; Acute Kidney Injury; Female; Prospective Studies; Aged; Hepatitis A Virus Cellular Receptor 1; SARS-CoV-2; Adult; Biomarkers; Kidney Tubules; Creatinine; Intensive Care Units; Washington; Epidermal Growth Factor; Renal Replacement Therapy
PubMed: 38922318
DOI: 10.1097/CCE.0000000000001109 -
Veterinary Sciences May 2024The objective of this study was to evaluate the thermal comfort of Nelore cattle () managed in silvopastoral and traditional systems associated with rumination behavior...
Thermal Comfort of Nelore Cattle () Managed in Silvopastoral and Traditional Systems Associated with Rumination in a Humid Tropical Environment in the Eastern Amazon, Brazil.
The objective of this study was to evaluate the thermal comfort of Nelore cattle () managed in silvopastoral and traditional systems associated with rumination behavior in a humid tropical environment in the Eastern Amazon, Brazil. The study was carried out on a rural property in Mojuí dos Campos, Pará, Brazil, during the transition period of the year, from June to July 2023. Over these two months, six consecutive data collection days were held. We selected 20 clinically healthy non-castrated male Nelore cattle, aged between 18 and 20 months, with an average weight of 250 kg and body condition score of 3.5 (1-5). These animals were randomly divided into two groups: traditional system (TS) and silvopastoral system (SS). The physiological variables evaluated included RR, RT and BST. The variables were analyzed using the linear mixed model. For agrometeorological variables, higher values were observed between 10:00 a.m. (33 °C) and 6:00 p.m. (30 °C), with the highest temperature observed at 4:00 p.m. (40 °C). The RR showed interactions ( = 0.0214) between systems and times; in general, higher RR were obtained in the Traditional. The animals' RT showed no significant difference ( < 0.05) between the production systems, but there was a statistically significant difference in relation to the time of collection ( < 0.0001). In the BGHI, it was possible to observe that there was mild stress in the period from 22:00 at night to 6:00 in the morning and moderate stress in the period of greatest increase in temperature, from 10:00 in the morning to 18:00 at night. BST showed no statistical difference between the regions studied or between the SP (35.6 °C) and TS (36.25 °C) systems. RT in the TS showed a positive correlation with AT (r = 0.31507; = 0.0477). RT in the SP showed a positive correlation with THI (r = 35583; = 0.0242). On the other hand, RT in the SP (r = 0.42873; = 0.0058) and ST (r = 0.51015; = 0.0008) showed a positive correlation with BGHI. RR in the TS showed a positive correlation with BGHI (r = 0.44908; = 0.0037). The greatest amounts of rumination were carried out by animals in the SP system, generally ruminating lying down ( < 0.05). With regard to rumination behavior in the morning and afternoon, there were higher numbers of WS and LD in the TS ( > 0.05). Most of the time, the cattle were LD during the morning and afternoon shifts, and at night and dawn they were WS in the TS. Therefore, the SP offers more thermal comfort advantages compared to the TS system.
PubMed: 38921983
DOI: 10.3390/vetsci11060236 -
Sports (Basel, Switzerland) Jun 2024This study examined the effect of repeated bouts of level and downhill running on physiological markers of effort and exercise-induced muscle soreness in trained female...
This study examined the effect of repeated bouts of level and downhill running on physiological markers of effort and exercise-induced muscle soreness in trained female distance runners. Ten participants (Age: 24.4 ± 2.0 years; V̇O: 52.9 ± 1.1 mL·kg·min), naïve to downhill running, completed six alternate 5 min trials of level and downhill running (-15%) at a 70% velocity at V̇O on two occasions, three weeks apart. Perceived muscle soreness was measured upon completion and in the 72 h post exercise. V̇O, Heart Rate (HR), Blood Lactate (BLa), and Respiratory Exchange Ratio (RER) were lower running downhill ( < 0.016, ηp > 0.541). For the first downhill run, Rating of Perceived Exertion (RPE) was higher compared to that for level running ( = 0.051; 0.447), but for the remaining trials, RPE was lower when running downhill ( < 0.004; 0.745). V̇O, HR, and RER were not different in the second bout ( > 0.070, ηp < 0.318); however, V̇O was lower in each downhill trial (Δ = 1.6-2.2 mL·kg·min; = 0.382-0.426). In the second bout, BLa was lower ( = 0.005, ηp = 0.602), RPE in the first trial was lower ( = 0.002; 0.923), and post exercise perceived soreness of the gastrocnemius, quadriceps, and hamstrings was attenuated ( < 0.002; ηp > 0.693). Perceived soreness of the gluteal muscles was lower in the second bout immediately post exercise, 24 h, and 48 h post exercise ( < 0.025; 0.922). A repeated bout of downhill running attenuated perceived muscle soreness and may modulate the physiological and perceived physical demand of a second bout of level and downhill running.
PubMed: 38921863
DOI: 10.3390/sports12060169 -
Journal of Fungi (Basel, Switzerland) Jun 2024(1) Background: Only a few studies on histoplasmosis in immunocompetent patients have been reported in French Guiana. Therefore, we conducted a detailed clinical...
(1) Background: Only a few studies on histoplasmosis in immunocompetent patients have been reported in French Guiana. Therefore, we conducted a detailed clinical description of hospitalized patients suffering with histoplasmosis among non-HIV patients. (2) Methods: This is a single-center, retrospective study conducted at Cayenne Hospital Center between 2008 and 2022. (3) Results: Our cohort was composed of 31 (91%) adults (>18 years of age) and 3 (9%) children, with a sex ratio, M:F, of 1:2. The median age was higher among the women than among the men (70 versus 54 years). The collection of respiratory samples constituted the majority of the performed examinations (38%). Fever (>37 °C) was found in 56% of patients. Surprisingly, the histoplasmosis was disseminated in 82% of patients with an overall case fatality rate of 14.7%. However, immunosuppressive conditions were found in 52% (16/31) of the adult patients, including lymphoid hemopathies, diabetes and immunosuppressive drugs. Conclusions: This disease, though rare and usually considered a mostly benign disease in non-HIV patients, presented a relatively high mortality rate in our cohort. Thus, histoplasmosis should be suspected, screened and investigated as a first line of defense in highly endemic areas, even in immunocompetent and non-HIV patients, especially those with fever or chronic respiratory symptoms.
PubMed: 38921386
DOI: 10.3390/jof10060400 -
Healthcare (Basel, Switzerland) Jun 2024Vital signs are crucial for assessing the condition of a patient and detecting early symptom deterioration. Noncontact sensor technology has been developed to take vital...
Vital signs are crucial for assessing the condition of a patient and detecting early symptom deterioration. Noncontact sensor technology has been developed to take vital measurements with minimal burden. This study evaluated the accuracy of a mat-type noncontact sensor in measuring respiratory and pulse rates in patients with cardiovascular diseases compared to conventional methods. Forty-eight hospitalized patients were included; a mat-type sensor was used to measure their respiratory and pulse rates during bed rest. Differences between mat-type sensors and conventional methods were assessed using the Bland-Altman analysis. The mean difference in respiratory rate was 1.9 breaths/min (limits of agreement (LOA): -4.5 to 8.3 breaths/min), and proportional bias existed with significance (r = 0.63, < 0.05). For pulse rate, the mean difference was -2.0 beats/min (LOA: -23.0 to 19.0 beats/min) when compared to blood pressure devices and 0.01 beats/min (LOA: -11.4 to 11.4 beats/min) when compared to 24-h Holter electrocardiography. The proportional bias was significant for both comparisons (r = 0.49, < 0.05; r = 0.52, < 0.05). These were considered clinically acceptable because there was no tendency to misjudge abnormal values as normal. The mat-type noncontact sensor demonstrated sufficient accuracy to serve as an alternative to conventional assessments, providing long-term monitoring of vital signs in clinical settings.
PubMed: 38921307
DOI: 10.3390/healthcare12121193 -
Frontiers in Microbiology 2024Adults with community-acquired pneumonia (CAP) in China suffer high morbidity. CAP is caused by a multitude of pathogens; however, pathogen-directed clinical symptoms...
BACKGROUND
Adults with community-acquired pneumonia (CAP) in China suffer high morbidity. CAP is caused by a multitude of pathogens; however, pathogen-directed clinical symptoms are often lacking. Therefore, patients lacking an accurate microbiological diagnosis are administered with empirical antimicrobials.
METHODS
We collected bronchoalveolar lavage fluid, as well as clinical and laboratory data from 650 adult patients with CAP admitted to three hospitals in Hubei, Sichuan, and Zhejiang provinces in China. Specimens were cultured and tested using real-time reverse transcription qPCR (RT-qPCR) assays for the presence of 42 respiratory bacteria and viruses. CAP was investigated with respect to regions, genders, and age and patterns of infections or co-infections. Employing clinical guidelines adapted for diagnosis, we assessed retrospectively the appropriate pathogen-directed therapy and compared it with the initial empirical therapies.
RESULTS
Our study identified that 21.38% (139/650) of the patients were classified as having Severe CAP (S-CAP), with a higher prevalence among males, older adults, and during the warm season. Bacterial pathogens were detected in 35.53% (231/650) of cases. , , and were the most prevalent bacteria across different demographics and regions. Viral pathogens were found in 48.76% (317/650) of patients Epstein-Barr, Human rhinovirus, and Cytomegalovirus were the most common viruses. Co-infections were present in 24.31% (158/650) of cases, with viral-bacterial co-infections being the most frequent. The RT-qPCR demonstrated significantly higher detection rates for key pathogens compared to standard culture methods. It showed potential in optimizing antimicrobial prescriptions by allowing for de-escalation in 18.30% (95/518) of patients, among which reducing the number of excessive antibiotics mainly comprised decreasing the use of 2nd or 3rd generation cephalosporins (5.79%, 30/518) and β-lactamase inhibitor combinations.
CONCLUSION
The study highlights the significant burden of S-CAP, particularly among specific demographics and seasons. The prevalence of bacterial and viral pathogens, along with the high rate of co-infections, emphasizes the need for comprehensive diagnostic approaches. The RT-qPCR assays emerge as a superior diagnostic tool, offering enhanced pathogen detection capabilities and facilitating more precise antimicrobial therapy. This could lead to improved patient outcomes and contribute to the rational use of antimicrobials, addressing the growing concern of antibiotic resistance.
PubMed: 38919501
DOI: 10.3389/fmicb.2024.1409065 -
Apolipoprotein A-I levels in the survival of patients with colorectal cancer: a retrospective study.Frontiers in Endocrinology 2024Abnormal lipid levels have been associated with cancer incidence and progression. However, limited studies have investigated the relationship between apolipoprotein A-I...
BACKGROUND
Abnormal lipid levels have been associated with cancer incidence and progression. However, limited studies have investigated the relationship between apolipoprotein A-I (ApoA-I) and colorectal cancer (CRC). This study assessed the significance of ApoA-I levels in progression-free survival (PFS) and overall survival (OS) of patients with CRC.
METHODS
Survival curves were compared using Kaplan-Meier analysis, while the predictive values of various lipid indicators in CRC prognosis were evaluated based on receiver operating characteristic curves. The factors influencing PFS and OS in patients with CRC were analyzed using Cox proportional hazards regression models. Finally, the relationship between ApoA-I level and disease recurrence was investigated through logistic regression analysis. The optimal Apo-I level was determined through maximally selected rank statistics.
RESULTS
Using the optimal ApoA-I cutoff value (0.9 g/L), the 1,270 patients with CRC were categorized into low (< 0.9 g/L, 275 cases) and high (≥0.9 g/L, 995 cases) ApoA-I groups. Compared with other lipid indicators, ApoA-I demonstrated superior predictive accuracy. The high ApoA-I group exhibited significantly higher survival rates than the low ApoA-I group (PFS, 64.8% vs. 45.2%, < 0.001; OS, 66.1% vs. 48.6%, < 0.001). Each one-standard-deviation increase in ApoA-I level was related to a 12.0% decrease in PFS risk (hazard ratio [HR] 0.880; 95% confidence interval [CI], 0.801-0.968; = 0.009) and an 11.2% decrease in OS risk (HR 0.888; 95%CI, 0.806-0.978; = 0.015). Logistic regression analysis revealed that patients with low ApoA-I had a 32.5% increased risk of disease recurrence (odds ratio [OR] 0.675; 95%CI, 0.481-0.946; = 0.0225) compared with those with high ApoA-I. PFS/OS nomograms based on ApoA-I demonstrated excellent prognostic prediction accuracy.
CONCLUSIONS
Serum ApoA-I level may be a valuable and non-invasive tool for predicting PFS and OS in patients with CRC.
Topics: Humans; Apolipoprotein A-I; Colorectal Neoplasms; Male; Female; Middle Aged; Retrospective Studies; Aged; Prognosis; Biomarkers, Tumor; Survival Rate; Adult; Kaplan-Meier Estimate
PubMed: 38919478
DOI: 10.3389/fendo.2024.1318416 -
Journal of Anaesthesiology, Clinical... 2024Intra-cuff pressure of Air-Q self-pressurized laryngeal airways (Air-Q SP) balances airway pressure and adapts to patient's pharyngeal and periglottic structures, thus...
BACKGROUND AND AIMS
Intra-cuff pressure of Air-Q self-pressurized laryngeal airways (Air-Q SP) balances airway pressure and adapts to patient's pharyngeal and periglottic structures, thus improves oropharyngeal leak pressure (OLP).This study was performed to compare efficacy of Air-Q SP with Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery.
MATERIAL AND METHODS
The study design was prospective, randomized and controlled. Ninety patients were randomly assigned to Air-Q SP or PLMA group. All patients were premedicated and shifted to operation theatre. Monitoring was instituted. After securing IV-line, induction with inj. Morphine + Propofol, relaxation with inj. Vecuronium was done. Supraglottic was inserted according to group allocation. Outcome measures were OLP, fibreoptic view of larynx, success rate, device insertion parameters, haemodynamic and respiratory parameters and post-operative laryngopharyngeal complications. Neostigmine + glycopyrrolate were given, device was extubated.
RESULTS
All supraglottic airway devices (SADs) were successfully placed in two attempts. The mean initial OLP, OLP at 10 minutes, and device insertion time were significantly lower in Air-Q SP group. Fiber-optic laryngeal view grading was significantly better with Air-Q SP. No significant difference was observed with respect to rate of successful insertion in first attempt, ease of insertion, and manipulations required. The hemodynamic/respiratory parameters and post-operative sore throat in the two both groups were similar.
CONCLUSIONS
Proseal LMA has a higher OLP than Air-Q SP but average insertion time was better, and fiber-optic grading of laryngeal view was shorter with Air-Q SP. However, Air-Q SP and Proseal LMA were both effective for lung ventilation.
PubMed: 38919429
DOI: 10.4103/joacp.joacp_248_22