Application of the REAL-score prognostic index in decision making in rectal cancer surgery.

BACKGROUND: Colorectal anastomosis leak (AL) is the most feared complication of rectal cancer surgery (1-19%) as it increases morbidity and mortality and worsens oncological outcomes in terms of local recurrence and survival. The publication of the REAL-score index makes it possible to predict the risk of AL and compare the expected results with those obtained. METHOD: Observational, descriptive, longitudinal and retrospective study of patients operated on for rectal cancer at the Miguel Servet University Hospital, in Zaragoza, Spain, in 2019. Statistical analysis of morbidity and mortality outcome variables and the REAL-score index using ROC curves. RESULTS: Of 80 patients operated on for rectal cancer, colorectal anastomosis was performed in 52 and temporary ileostomy in 11 (21.2%). Morbidity was high (38.4%), but severe only in 7.7% (Clavien-Dindo IIIb), with no deaths. There were four dehiscences: one type B and three type C. A direct relationship between high risk of AL and the practice of temporary stoma is observed when the cut-off point of the REAL-score exceeds 14.74%. CONCLUSIONS: REAL-score can help in decision-making in rectal cancer surgery. Above a cut-off point, the risk of AL would imply a selective ileostomy.

ANTECEDENTES: La dehiscencia de la anastomosis colorrectal (DA) es la complicación más temida de la cirugía del cáncer de recto (1-19%), pues incrementa la morbimortalidad y empeora los resultados oncológicos en términos de recidiva local y supervivencia. La publicación del índice REAL-score permite predecir el riesgo de DA y comparar los resultados esperados con los obtenidos. MÉTODO: Estudio observacional, descriptivo, longitudinal y retrospectivo, de pacientes intervenidos de cáncer de recto en el Hospital Universitario Miguel Servet, en Zaragoza, España, en 2019. Análisis estadístico de variables resultado de morbimortalidad y del índice REAL-score mediante curvas ROC. RESULTADOS: De 80 pacientes intervenidos de cáncer de recto, se realizó anastomosis colorrectal en 52 e ileostomía temporal en 11 (21.2%). La morbilidad fue alta (38.4%), pero grave solo en el 7.7% (Clavien-Dindo IIIb), sin ningún fallecimiento. Hubo cuatro dehiscencias: una de tipo B y tres de tipo C. Se observa una relación directa entre alto riesgo de DA y la práctica de estoma temporal cuando el punto de corte del REAL-score supera el 14.74%. CONCLUSIONES: El REAL-score puede ayudar en la toma de decisiones en la cirugía del cáncer de recto. Por encima de un punto de corte, el riesgo de DA implicaría ileostomía selectiva.

A prospective observational concordance study to evaluate computational model-driven clinical practice guidelines for Type 2 diabetes mellitus.

BACKGROUND: Clinical Practice Guidelines (CPGs) provide healthcare professionals with performance and decision-making support during the treatment of patients. Sometimes, however, they are poorly implemented. The IDE4ICDS platform was developed and validated with CPGs for type 2 diabetes mellitus (T2DM). OBJECTIVE: The main objective of this paper is to present the results of the clinical validation of the IDE4ICDS platform in a real clinical environment at two health clinics in the Andalusian Public Health System (SSPA) in the southern Spanish region of Andalusia. METHODS: National and international knowledge sources on T2DM were selected and reviewed and used to define a diabetes CPG model on the IDE4ICDS platform. Once the diabetes CPG was configured and deployed, it was validated. A total of 506 patients were identified as meeting the inclusion criteria, of whom 130 could be recruited and 89 attended the appointment. RESULTS: A concordance analysis was performed with the kappa value. Overall agreement between the recommendations provided by the system and those recorded in each patient's EHR was good (0.61 - 0.80) with a total kappa index of 0.701, leading to the conclusion that the system provided appropriate recommendations for each patient and was therefore well-functioning. CONCLUSIONS: A series of possible improvements were identified based on the limitations for the recovery of variables related to the quality of these recolected variables, the detection of duplicate recommendations based on different input variables for the same patient, and clinical usability, such as the capacity to generate reports based on the recommendations generated. Nevertheless, the project resulted in the IDE4ICDS platform: a Clinical Decision Support System (CDSS) capable of providing appropriate recommendations for improving the management and quality of patient care and optimizing health outcomes. The result of this validation is a safe and effective pathway for developing and adopting digital transformation at the regional scale of the use of biomedical knowledge in real healthcare.

Estrategias de afrontamiento en pacientes oncológicos de un hospital público. Corrientes año 2022 / Coping strategies in cancer patients from a public hospital. Corrientes year 2022

Las estrategias de afrontamiento ante el cáncer representan un proceso mediador ante las repercusiones de la enfermedad. Objetivo: Identificar las estrategias de afrontamiento en pacientes oncológicos que asisten a un hospital público de la ciudad de Corrientes en el año 2022. Metodología: Estudio descriptivo, cuantitativo, transversal, observacional. La población fueron pacientes oncológicos que asistieron a un hospital público. Para la recolección de datos se utilizó cuestionario de modos de afrontamiento, desarrollado por Lazarus y Folkman, versión revisada, adaptado y modificado, compuesto por 67 ítems, asociados a las diferentes estrategias de afrontamiento. Resultados: La muestra se integró con 45 pacientes de 52 años en promedio; el 78% del sexo femenino mayoritariamente amas de casa, 64%; casadas/os el 69%. Niveles obtenidos de las estrategias- centradas en el problema- Nivel Bajo de aplicación el confrontamiento (56%) y Nivel Medio el Distanciamiento (51%). -En las estrategias centradas en la emoción- Nivel Medio de aplicación, la reevaluación positiva (67%) y Planificación 60%, el autocontrol (40%), seguidos por la búsqueda de apoyo social (44%), aceptación de la responsabilidad (44%), huida-Evitación (38%). Conclusiones: El confrontamiento fue la estrategia que presentó el porcentaje más destacado en el nivel bajo aplicación y el distanciamiento el nivel alto más frecuente. Es fundamental destacar la importancia de identificar la estrategia de afrontamiento utilizado por los pacientes oncológicos ya que dichos estados emocionales influyen en la salud de manera directa ya sea en el funcionamiento fisiológico, el reconocimiento de síntomas, la búsqueda de atención oportuna[AU]

Cancer coping strategies represent a mediating process in the face of the repercussions of the disease. Objective: Identify coping strategies in cancer patients attending a public hospital in the city of Corrientes in the year 2022. Methodology: Descriptive, quantitative, cross-sectional, observational study. The population were cancer patients who attended a public hospital. For the data collection, a questionnaire of coping modes was used, developed by Lazarus and Folkman, revised, adapted and modified version, composed of 67 items, associated with the different coping strategies. Results: The sample was made up of 45 patients with an average age of 52; 78% of the female sex, mostly housewives, 64%; 69% married. Levels obtained from the strategies - focused on the problem - Low Level of application of confrontation (56%) and Medium Level of Distancing (51%). -In the strategies focused on emotion- Medium level of application, positive reappraisal (67%) and Planning 60%, self-control (40%), followed by the search for social support (44%), acceptance of responsibility (44%), flight-avoidance (38%). Conclusions: The confrontation was the strategy that presented the most outstanding percentage in the low application level and the distancing the most frequent high level. It is essential to highlight the importance of identifying the coping strategy used by cancer patients since these emotional states directly influence health, be it physiological functioning, recognition of symptoms, the search for timely care[AU]

As estratégias de enfrentamento do câncer representam um processo mediador diante das repercussões da doença. Objetivo: Identificar estratégias de enfrentamento em pacientes oncológicos atendidos em um hospital público da cidade de Corrientes no ano de 2022. Metodologia: Estudo descritivo, quantitativo, transversal, observacional. A população foi pacientes oncológicos atendidos em um hospital público. Para a coleta de dados, foi utilizado um questionário de modos de enfrentamento, desenvolvido por Lazarus e Folkman, versão revisada, adaptada e modificada, composto por 67 itens, associados às diferentes estratégias de enfrentamento. Resultados: A amostra foi composta por 45 pacientes com idade média de 52 anos; 78% do sexo feminino, principalmente donas de casa, 64%; 69% casados. Níveis obtidos das estratégias - focadas no problema - Baixo Nível de aplicação de enfrentamento (56%) e Médio Nível de Distanciamento (51%). -Nas estratégias focadas na emoção- Nível médio de aplicação, reavaliação positiva (67%) e Planejamento 60%, autocontrole (40%), seguido da busca de apoio social (44%), aceitação de responsabilidade (44%), evitação de voos (38%). Conclusões: O confronto foi a estratégia que apresentou maior percentual de destaque no nível baixo de aplicação e o distanciamento o nível alto mais frequente. É fundamental destacar a importância da identificação da estratégia de enfrentamento utilizada pelo paciente oncológico, pois esses estados emocionais influenciam diretamente na saúde, seja no funcionamento fisiológico, no reconhecimento de sintomas, na busca por atendimento oportuno[AU]

Mobile Health Requirements for the Occupational Health Assessment of Health Care Professionals: Delphi Study.

BACKGROUND: In recent years, owing to the COVID-19 pandemic, awareness of the high level of stress among health care professionals has increased, and research in this area has intensified. Hospital staff members have historically been known to work in an environment involving high emotional demands, time pressure, and workload. Furthermore, the pandemic has increased the strain experienced by health care professionals owing to the high number of people they need to manage and, on many occasions, the limited available resources with which they must carry out their functions. These psychosocial risks are not always well dealt with by the organization or the professionals themselves. Therefore, it is necessary to have tools to assess these psychosocial risks and to optimize the management of this demand from health care professionals. Digital health, and more specifically, mobile health (mHealth), is presented as a health care modality that can contribute greatly to respond to these unmet needs. OBJECTIVE: We aimed to analyze whether mHealth tools can provide value for the study and management of psychosocial risks in health care professionals, and assess the requirements of these tools. METHODS: A Delphi study was carried out to determine the opinions of experts on the relevance of using mHealth tools to evaluate physiological indicators and psychosocial factors in order to assess occupational health, and specifically, stress and burnout, in health care professionals. The study included 58 experts with knowledge and experience in occupational risk prevention, psychosocial work, and health-related technology, as well as health professionals from private and public sectors. RESULTS: Our data suggested that there is still controversy about the roles that organizations play in occupational risk prevention in general and psychosocial risks in particular. An adequate assessment of the stress levels and psychosocial factors can help improve employees' well-being. Moreover, making occupational health evaluations available to the team would positively affect employees by increasing their feelings of being taken into account by the organization. This assessment can be improved with mHealth tools that identify and quickly highlight the difficulties or problems that occur among staff and work teams. However, to achieve good adherence and participation in occupational health and safety evaluations, experts consider that it is essential to ensure the privacy of professionals and to develop feelings of being supported by their supervisors. CONCLUSIONS: For years, mHealth has been used mainly to propose intervention programs to improve occupational health. Our research highlights the usefulness of these tools for evaluating psychosocial risks in a preliminary and essential phase of approaches to improve the health and well-being of professionals in health care settings. The most urgent requirements these tools must meet are those aimed at protecting the confidentiality and privacy of measurements.

Correction: A Personalized Ontology-Based Decision Support System for Complex Chronic Patients: Retrospective Observational Study.

[This corrects the article DOI: 10.2196/27990.].

Optimized Route for the Fabrication of MnAlC Permanent Magnets by Arc Melting.

The rare-earth-free MnAlC alloy is currently considered a very promising candidate for permanent magnet applications due to its high anisotropy field and relatively high saturation magnetization and Curie temperature, besides being a low-cost material. In this work, we presented a simple fabrication route that allows for obtaining a magnetically enhanced bulk τ-MnAlC magnet. In the fabrication process, an electric arc-melting method was carried out to melt ingots of MnAlC alloys. A two-step solution treatment at 1200 °C and 1100 °C allowed us to synthesize a pure room-temperature ε-MnAlC ingot that completely transformed into τ-MnAlC alloy, free of secondary phases, after an annealing treatment at 550 °C for 30 min. The Rietveld refinements and magnetization measurements demonstrated that the quenched process produces a phase-segregated ε-MnAlC alloy that is formed by two types of ε-phases due to local fluctuation of the Mn. Room-temperature hysteresis loops showed that our improved τ-MnAlC alloy exhibited a remanent magnetization of 42 Am2/kg, a coercive field of 0.2 T and a maximum energy product, (BH)max, of 6.07 kJ/m3, which is higher than those reported in previous works using a similar preparation route. Experimental evidence demonstrated that the synthesis of a pure room-temperature ε-MnAlC played an important role in the suppression of undesirable phases that deteriorate the permanent magnet properties of the τ-MnAlC. Finally, magnetic images recorded by Lorentz microscopy allowed us to observe the microstructure and magnetic domain walls of the optimized τ-MnAlC. The presence of magnetic contrasts in all the observed grains allowed us to confirm the high-quality ferromagnetic behavior of the system.

Characterization of Fe3O4 Nanoparticles for Applications in Catalytic Activity in the Adsorption/Degradation of Methylene Blue and Esterification.

The aim of this study is to evaluate the applicability of the catalytic activity (CA) of the Fe3O4 magnetic system in the adsorption/degradation of methylene blue and esterification. The thermal decomposition method allowed the preparation of Fe3O4 nanoparticles. The crystallites of the Fe3O4 structural phase present an acicular form confirmed by X-ray diffraction. Transmission electron microscopy results identified the acicular shape and agglomeration of the nanoparticles. Mössbauer spectroscopy showed that the spectrum is composed of five components at room temperature, a hyperfine magnetic field distribution (HMFD), two sextets, a doublet, and a singlet. The presence of the HMFD means that a particle size distribution is present. Fluorescence spectroscopy studied the CA of the nanoparticles with methylene blue and found adsorption/degradation properties of the dye. The catalytic activity of the nanoparticles was evaluated in the esterification reaction by comparing the results in the presence and absence of catalyst for the reaction with isobutanol and octanol, where it is observed that the selectivity for the products MIBP and MNOP is favored in the first three hours of reaction.

Production and Characterization of Nanostructured Powders of Nd2Fe14B and Fe90Al10 by Mechanical Alloying.

The objective of this work is to evaluate the applicability of exchange coupling between nanoparticles of Nd2Fe14B (hard magnetic material) and Fe90Al10 (soft magnetic material), as permanent magnets produced by surfactant-assisted mechanical alloying. The obtained powders were then mixed with 85% of the Nd2Fe14B system and 15% of the Fe90Al10 system and subsequently sintered at 300 °C, 400 °C and 500 °C for one hour. The results obtained by Mössbauer spectrometry (MS) show a ferromagnetic behavior with six magnetic sites represented by sextets (16k1, 16k2, 8j1, 8j2, 4c and 4e), characteristic of the Nd2Fe14B system. X-ray diffraction (XRD) results show a tetragonal and BCC structure for the Nd2Fe14B and FeAl systems, respectively. The results obtained by vibrating sample magnetometry (VSM), for mixtures of the Nd2Fe14B and Fe90Al10 sy stems sintered at 300 °C, 400 °C and 500 °C, allow for the conclusion that the coercive field (Hc) decreases drastically with temperature and the percentage of soft phase at values of Hc = 132 Oe compared to the coercive field values reported for Nd2Fe14B Hc = 6883 Oe, respectively. Images obtained by transmission electron microscopy (TEM), for the Fe90Al10 system, show a tendency for the nanoparticles to agglomerate.

A Personalized Ontology-Based Decision Support System for Complex Chronic Patients: Retrospective Observational Study.

BACKGROUND: Due to an increase in life expectancy, the prevalence of chronic diseases is also on the rise. Clinical practice guidelines (CPGs) provide recommendations for suitable interventions regarding different chronic diseases, but a deficiency in the implementation of these CPGs has been identified. The PITeS-TiiSS (Telemedicine and eHealth Innovation Platform: Information Communications Technology for Research and Information Challenges in Health Services) tool, a personalized ontology-based clinical decision support system (CDSS), aims to reduce variability, prevent errors, and consider interactions between different CPG recommendations, among other benefits. OBJECTIVE: The aim of this study is to design, develop, and validate an ontology-based CDSS that provides personalized recommendations related to drug prescription. The target population is older adult patients with chronic diseases and polypharmacy, and the goal is to reduce complications related to these types of conditions while offering integrated care. METHODS: A study scenario about atrial fibrillation and treatment with anticoagulants was selected to validate the tool. After this, a series of knowledge sources were identified, including CPGs, PROFUND index, LESS/CHRON criteria, and STOPP/START criteria, to extract the information. Modeling was carried out using an ontology, and mapping was done with Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT; International Health Terminology Standards Development Organisation). Once the CDSS was developed, validation was carried out by using a retrospective case study. RESULTS: This project was funded in January 2015 and approved by the Virgen del Rocio University Hospital ethics committee on November 24, 2015. Two different tasks were carried out to test the functioning of the tool. First, retrospective data from a real patient who met the inclusion criteria were used. Second, the analysis of an adoption model was performed through the study of the requirements and characteristics that a CDSS must meet in order to be well accepted and used by health professionals. The results are favorable and allow the proposed research to continue to the next phase. CONCLUSIONS: An ontology-based CDSS was successfully designed, developed, and validated. However, in future work, validation in a real environment should be performed to ensure the tool is usable and reliable.

Mechanochemical Synthesis and Nitrogenation of the Nd1.1Fe10CoTi Alloy for Permanent Magnet.

In this work, the mechanochemical synthesis method was used for the first time to produce powders of the nanocrystalline Nd1.1Fe10CoTi compound from Nd2O3, Fe2O3, Co and TiO2. High-energy-milled powders were heat treated at 1000 °C for 10 min to obtain the ThMn12-type structure. Volume fraction of the 1:12 phase was found to be as high as 95.7% with 4.3% of a bcc phase also present. The nitrogenation process of the sample was carried out at 350 °C during 3, 6, 9 and 12 h using a static pressure of 80 kPa of N2. The magnetic properties Mr, µ0Hc, and (BH)max were enhanced after nitrogenation, despite finding some residual nitrogen-free 1:12 phase. The magnetic values of a nitrogenated sample after 3 h were Mr = 75 Am2 kg-1, µ0Hc = 0.500 T and (BH)max = 58 kJ·m-3. Samples were aligned under an applied field of 2 T after washing and were measured in a direction parallel to the applied field. The best value of (BH)max ~ 114 kJ·m-3 was obtained for 3 h and the highest µ0Hc = 0.518 T for 6 h nitrogenation. SEM characterization revealed that the particles have a mean particle size around 360 nm and a rounded shape.

Phthalates exposure during pregnancy a study in a Mexican cohort.

A prospective cohort study was conducted to measure the concentration levels of three primary phthalate metabolites (MBP, MEHP, MEP) during pregnancy in a group of women from the State of Mexico. The urinary concentration levels of the three phthalate primary metabolites were measured by gas chromatography mass spectrometry during the first, second and third trimesters of pregnancy. The geometric mean and 95 % CI for MBP was 20.38 µg/mL (15.35-27.09); for MEHP 13.43 µg/mL (8.93-20.20), and MEP 52.47 µg/mL (39.88-69.04) adjusted to one g of creatinine. No significant trends were observed among the studied metabolites during the pregnancy period. MBP was higher in less educated women, while women who resided in industrialized zones showed higher levels of MEHP and MEP than women from non-industrialized zones. Consumption of plastic bottled beverages was associated with MBP and MEHP phthalate exposure. Women who used non-registered brands of plastic food containers for storage or for microwave oven use showed the highest levels of MBP and MEP phthalates. The pregnant women in our study were exposed to the three studied primary phthalate metabolites, and this could present a risk to their newborns. To better integrate public health policies, major exploration of potential exposure sources and effects at the regional level is required.

First record of the interaction between the arthropod-pathogenic fungus Gibellula and a new species of harvestman Auranus (Stygnidae) narrowly endemic to the Brazilian rain forest.

Harvestmen are one of the largest groups of arachnids with more than 6,500 species distributed in 1,500 genera and 50 families. However, the interactions between harvestmen and arthropod-pathogenic fungi have rarely been studied. Certain previous studies report that fungal attack represents one of the most important factors for the mortality of harvestmen, but the fungus has rarely been identified, and most of the important information about the fungus-host interactions remains unrecorded. In the present study, we have described the new species Auranus quilombola sp. nov. and reported its interactions with the arthropod-pathogenic fungus Gibellula sp. Auranus quilombola sp. nov. belongs to the family Stygnidae, and it is endemic to the humid mountain forests of Cear state, Brazil in an area of endemism known as Brejos Cearenses. The species is related to five other species of Auranus, all of which have been recorded from the Amazon rainforest. A taxonomic description of this new species and its biogeographic implications have also been discussed in this paper.

A data mining based clinical decision support system for survival in lung cancer.

BACKGROUND: A clinical decision support system (CDSS ) has been designed to predict the outcome (overall survival) by extracting and analyzing information from routine clinical activity as a complement to clinical guidelines in lung cancer patients. MATERIALS AND METHODS: Prospective multicenter data from 543 consecutive (2013-2017) lung cancer patients with 1167 variables were used for development of the CDSS. Data Mining analyses were based on the XGBoost and Generalized Linear Models algorithms. The predictions from guidelines and the CDSS proposed were compared. RESULTS: Overall, the highest (> 0.90) areas under the receiver-operating characteristics curve AUCs for predicting survival were obtained for small cell lung cancer patients. The AUCs for predicting survival using basic items included in the guidelines were mostly below 0.70 while those obtained using the CDSS were mostly above 0.70. The vast majority of comparisons between the guideline and CDSS AUCs were statistically significant (p < 0.05). For instance, using the guidelines, the AUC for predicting survival was 0.60 while the predictive power of the CDSS enhanced the AUC up to 0.84 (p = 0.0009). In terms of histology, there was only a statistically significant difference when comparing the AUCs of small cell lung cancer patients (0.96) and all lung cancer patients with longer (≥ 18 months) follow up (0.80; p < 0.001). CONCLUSIONS: The CDSS successfully showed potential for enhancing prediction of survival. The CDSS could assist physicians in formulating evidence-based management advice in patients with lung cancer, guiding an individualized discussion according to prognosis.

Trabéculo-trabeculectomía como tratamiento quirúrgico inicial del glaucoma congénito primario / Trabeculotomy-trabeculectomy as initial surgical treatment for primary congenital glaucoma

El glaucoma congénito primario constituye la forma más común de glaucoma infantil, el cual exige un diagnóstico precoz y un tratamiento quirúrgico relativamente urgente, ya que puede ocasionar graves secuelas morfológicas y funcionales. Se presenta la realización, por primera ocasión, de la trabéculo-trabeculectomía combinada en la República Democrática y Popular de Argelia. Se ejecutó en un paciente árabe, de un año de edad, a quien se le diagnosticó el glaucoma congénito primario II. Se evaluó el seguimiento posoperatorio con resultados satisfactorios, por lo que se consideró la trabéculo-trabeculectomía como el proceder quirúrgico efectivo y suficientemente seguro, el cual debe ser realizado por un personal calificado para poder admitirse como primera opción en el tratamiento quirúrgico del glaucoma congénito primario(AU)

Primary congenital glaucoma is the most common form of childhood glaucoma. This condition requires early diagnosis and relatively urgent surgical treatment, since it may leave serious morphological and functional sequelae. A description is provided of the first combined trabeculotomy-trabeculectomy performed in the People's Democratic Republic of Algeria. The operation was performed on a male one-year-old Arab patient diagnosed with primary congenital glaucoma II. Post-operative follow-up found satisfactory results, and trabeculotomy-trabeculectomy was thus considered to be an effective, sufficiently safe surgical procedure, which should be performed by qualified personnel to be accepted as the first surgical treatment option for primary congenital glaucoma(AU)

Characteristics and Prognosis of Patients Who Receive Noninvasive Ventilation and Present Limitation of Life Support Treatment: The LLST-NIVCat Multicenter Cohort Study.

BACKGROUND: Patients who receive noninvasive ventilation (NIV) in the emergency department (ED) sometimes have a limitation of life support treatment (LLST). The characteristics and prognosis in these patients may be worse, however, few studies have been carried out in this respect. OBJECTIVE: Analyze the differences between patients receiving NIV in the ED with LLST (NIV-LLST) or without LLST (NIV-noLLST) and their impact on in-hospital mortality, as well as investigate in-hospital mortality in the NIV-LLST group. METHOD: We performed a secondary analysis of data from the NIVCat registry. This was a prospective, multicenter, analytical cohort study with consecutive inclusion of patients receiving NIV from February to March 2015 in 11 hospital EDs in Spain. Data on the baseline characteristics, the acute episode, and final patient destination were collected. The dependent variable was all-cause in-hospital mortality. RESULTS: We analyzed 152 cases receiving NIV, 66 (43.4%) of whom had NIV-LLTS. Age ≥ 75 years was associated with NIV-LLST. In-hospital mortality was higher in the NIV-LLST group, with an adjusted hazard ratio of 2.50 (95% confidence interval [CI] 1.03-6.06). Patients with NIV-LLST presenting an exacerbation of chronic obstructive pulmonary disease (COPD) presented the lowest mortality, with an odds ratio of 0.27 (95% confidence interval 0.08-0.93), compared with the remaining patients. CONCLUSION: In our cohort of patients receiving NIV in the ED, the presence of LLST is frequent and is associated with high hospital mortality. The NIV-LLST patients with a COPD exacerbation have a better prognosis than NIV-LLST patients with other diseases.