Access to legacy-oriented interventions at end of life for pediatric oncology patients: A decedent cohort review.

BACKGROUND: Legacy-oriented interventions have the potential to offer pediatric oncology patients and families comfort at end of life and during bereavement. Certified child life specialists often provide these services, and presently little is known about whether disparities exist in the provision of legacy-oriented interventions. METHODS: In this retrospective decedent cohort study, we examined demographic and clinical characteristics from a sample of 678 pediatric oncology patients who died between 2015 and 2019. Bivariate analysis assessed differences between patients who received any versus no legacy-oriented intervention. Uni- and multivariable logistic regression models assessed associations of baseline characteristics and likelihood of receiving legacy-oriented intervention. Further multivariable analysis explored joint effects of significant variables identified in the univariable analysis. RESULTS: Fifty-two percent of patients received a legacy-oriented intervention. Older adolescents (≥13 years) were less likely (odds ratio [OR]: 1.73, p = .007) to receive legacy-oriented interventions than younger ones. Patients with home/hospice deaths were also less likely (OR: 19.98, p < .001) to receive interventions compared to patients who passed away at SJCRH locations. Hispanic patients (OR: 1.53, p = .038) and those in palliative care (OR: 10.51, p < .001) were more likely to receive interventions. No significant race association was noted. CONCLUSION: All children and adolescents with cancer deserve quality care at end of life, including access to legacy-oriented interventions, yet nearly half of patients in this cohort did not receive these services. By identifying demographic and clinical characteristics associated with decreased odds of receiving legacy-oriented interventions, healthcare professionals can modify end-of-life care processes to improve access. Introducing legacy-oriented interventions early and increasing exposure in community spaces may enhance access to legacy-oriented interventions for pediatric oncology patients.

Dextrocardia with Situs Solitus in a Neonate - an Overview.

Dextrocardia, a rare congenital heart condition, can occur in about 1 out of every 12,000 pregnancies. Dextrocardia with situs solitus refers to when the heart is on the right side of the thorax while other viscera are found in their normal positions. The condition can go unnoticed in cases of limited prenatal care and newborn evaluation, leading to patients never receiving pertinent cardiac evaluations and condition progression monitoring throughout their lives. This is the first case reported of isolated dextrocardia with situs solitus in a neonate without any additional cardiovascular abnormalities. This case report highlights the importance of prenatal and postnatal evaluation to ensure the identification of neonates with dextrocardia and improve their quality of life and outcomes.

Mesenchymal Cells Support the Oncogenicity and Therapeutic Response of the Hedgehog Pathway in Triple-Negative Breast Cancer.

The paracrine interaction between tumor cells and adjacent stroma has been associated with the oncogenic activity of the Hedgehog (Hh) pathway in triple-negative breast tumors. The present study developed a model of paracrine Hh signaling and examined the impact of mesenchymal cell sources and culture modalities in the oncogenicity of the Hh pathway in breast tumor cells. Studies consisted of tumor cell monocultures and co-cultures with cancer-associated and normal fibroblasts, tumor cells that undergo epithelial-mesenchymal transition (EMT), or adipose-derived mesenchymal stem cells (ADMSCs). Hh ligand and pathway inhibitors, GANT61 and NVP-LDE225 (NVP), were evaluated in both cell cultures and a mouse xenograft model. Results in monocultures show that tumor cell viability and Hh transcriptional activity were not affected by Hh inhibitors. In co-cultures, down-regulation of GLI1, SMO, and PTCH1 in the stroma correlated with reduced tumor growth rates in xenografted tumors and cell cultures, confirming a paracrine interaction. Fibroblasts and EMT cells supported Hh transcriptional activity and enhanced tumor cell growth. Mixed and adjacent culture modalities indicate that tumor growth is supported via fibroblast-secreted soluble factors, whereas enriched tumor stemness requires close proximity between tumor and fibroblasts. Overall this study provides a tumor-mesenchymal model of Hh signaling and highlights the therapeutic value of mesenchymal cells in the oncogenic activity of the Hh pathway.

Mejora en el diagnóstico y tratamiento oportuno de malaria con el uso de pruebas rápidas por promotores de salud en la Amazonía Peruana / Improvements in timely malaria diagnosis and appropriate therapy with the use of rapid tests by health promoters in Peruvian Amazon jungle

Objetivos. Comparar la oportunidad en el diagnóstico y tratamiento apropiado de la malaria antes y después de la incorporación del uso de pruebas rápidas por promotores de salud en comunidades periféricas de Iquitos. Material y métodos. Estudio longitudinal con evaluación pre y postintervención. En ambas evaluaciones se recolectó un número mínimo de 200 pacientes febriles (casos sospechosos de malaria) que habían sido atendidos por el promotor en las seis semanas previas, datos relacionados a la oportunidad en el diagnóstico y tratamiento, y los diagnósticos confirmatorios por gota gruesa. Resultados. Con la intervención hubo una disminución significativadel tiempo transcurrido entre el inicio de síntomas y el inicio del tratamiento de 110 horas (4,6 días) a 46,3 horas (1,9 días) (p menor que0,001). Dicha variación fue debida mayormente a la reducción del tiempo transcurrido desde la consulta al promotor hasta la obtención del diagnóstico del paciente, de 69 horas (2,9 días) a sólo 20 minutos (p menor que 0,001). Además, hubo un incremento significativo de la proporción de pacientes con malaria que recibieron tratamiento antimalárico oportuno de 15,5 a 54,9 por ciento (p menor que 0,001), la proporción de pacientes con malaria que recibieron tratamiento apropiado a la especie del parásito de 26,7 por ciento a 83,5 por ciento (p menor que 0,001) y la proporción de pacientes conmalaria falciparum que recibieron tratamiento apropiado de 5,3 a 73,1 por ciento (p mneor que 0,001). Conclusiones. A través de la incorporación del uso de pruebas rápidas por promotores de salud en las comunidades seleccionadas, se ha mejorado la oportunidad en el diagnóstico y tratamiento apropiado de la malaria.

Objectives. To compare the achievement of a timely diagnosis and appropriate therapy for malaria before and after the incorporation of rapid tests for diagnosing this disease used by health promoters in peripheral communities in Iquitos. Material and methods. Alongitudinal study with pre- and post- intervention assessments was performed. Two hundred febrile patients (suspected malaria cases) seen by health promoters during the last 6 weeks were selected, and data related to a timely malaria diagnosis and therapy, as well as confirmatory diagnoses using thick smears was collected. Results. There was a significant decrease in the time elapsed from symptom onset to therapy initiation with the intervention, from 110 hours (4.6 days) to 46,3 hours (1.9 days) (p minor that 0.001). This variation was mainly due to a reduction of the time since the patient was first seen by a health promoter until the time when a diagnosis was achieved, from 69 hours (2.9 days) to only 20 minutes (p minor that 0.001). There was also a significant increase in the frequency of malaria patients who received timely antimalarial therapy, from 1,5 per cent to 54,9 per cent (p minor that0.001); the proportion of malaria patients receiving appropriate therapy according to the parasite species increased from 26.7 per cent to 83.5 per cent (p minor that 0.001), and the proportion of P. falciparum malaria patients who received appropriate therapy rose from 5.3 per cent to 73.1 per cent (p minor that 0.001). Conclusions. Now it is possible to achieve a timely diagnosis and appropriate therapy formalaria with the use of rapid tests by health promoters in these selected communities.

Connecting evolutionary morphology to genomics using ontologies: a case study from Cypriniformes including zebrafish.

One focus of developmental biology is to understand how genes regulate development, and therefore examining the phenotypic effects of gene mutation is a major emphasis in studies of zebrafish and other model organisms. Genetic change underlies alterations in evolutionary characters, or phenotype, and morphological phylogenies inferred by comparison of these characters. We will utilize both existing and new ontologies to connect the evolutionary anatomy and image database that is being developed in the Cypriniformes Tree of Life project to the Zebrafish Information Network (HYPERLINK "file://localhost/Library/Local%20Settings/Temp/zfin.org" zfin.org) database. Ontologies are controlled vocabularies that formally represent hierarchical relationships among defined biological concepts. If used to recode the free-form text descriptors of anatomical characters, evolutionary character data can become more easily computed, explored, and mined. A shared ontology for homologous modules of the phenotype must be referenced to connect the growing databases in each area in a way that evolutionary questions can be addressed. We present examples that demonstrate the broad utility of this approach.

Minor myocardial damage detected by troponin T is a powerful predictor of long-term prognosis in patients with acute decompensated heart failure.

BACKGROUND: The progression of chronic heart failure (CHF) is characterized by frequent exacerbation requiring hospitalization and high mortality. Clinical deterioration is triggered by many factors that could promote ongoing myocytes injury. We sought to determine whether a specific marker of cardiac injury, troponin T (cTnT), is associated with prognosis in acute decompensated heart failure (ADHF). METHODS: One hundred and eighty-four consecutive patients with ADHF were enrolled in the absence of an acute coronary syndrome. A cTnT value> or =0.1 ng/ml in samples drawn at 6, 12 or 24 h after hospital admission was considered abnormal. RESULTS: Increased levels of cTnT were found in 58 patients (31.5%, group 1). There were no significant differences between group 1 and patients with cTnT<0.1 ng/ml (group 2) in terms of demographic and clinical characteristics, although ischemic etiology was more prevalent in group 1 (51.7% vs. 31.7%, p=0.009). During follow-up, the mortality in groups 1 and 2 was 31% and 17.5% (p=0.038, OR=2.13, 95% CI: 1.03-4.69), respectively. The 3-year free-CHF readmission survival in group 1 and 2 was 25% and 53% (log rank test p=0.015). In a Cox proportional hazard model, poor tissue perfusion (HR=2.46, 95% CI=1.31-4.6), previous infarction (HR=1.99, 95% CI=1.02-3.9) and cTnT> or =0.1 ng/ml (HR=1.74, 95% CI=1.05-2.9) emerged as the independent predictors of long-term outcome. CONCLUSIONS: One third of patients with decompensated CHF had elevated levels of cTnT. Troponin T was an independent long-term prognostic marker of morbidity and mortality and it suggests a role of biochemical risk stratification in this setting.

High levels of troponin T are associated with ventricular remodeling and adverse in-hospital outcome in heart failure.

BACKGROUND: Heart failure progression is associated with ventricular remodeling and ongoing myofibrillar degradation. We hypothesized that myocardial damage, detected by high levels of troponin T, would correlate with echocardiographic measurements of left ventricular remodeling and worse in-hospital course in decompensated heart failure. MATERIAL/METHODS: 159 patients with decompensated heart failure without acute coronary event were included. A troponin T value >0.2 ng/ml in samples taken 6, 12 or 24 hours after admission was considered abnormal. RESULTS: High troponin T levels were identified in 24 patients (15%) (Group 1). Mean age for group 1 was 65.9 vs. 63.7 years in patients with troponin T<0.2 (Group 2) (p=ns). Ischemic etiology in groups 1 and 2 was found in 58.3 and 38.5% (p=0.07). Two-dimensional echocardiograms in groups 1 and 2 revealed higher left ventricular diameters, diastolic (61.7+/-10 vs. 56.9+/-10.3 mm, p=0.041) as well as systolic (49.4+/-13.5 vs. 42.0+/-12.0 mm, p=0.012), and lower ejection fraction (30.1+/-14 vs. 39.0+/-17.7%, p=0.03). Incidence of combined end point of death or refractory heart failure was 20.8 and 3.7% in groups 1 and 2 (p=0.007; OR=6.8; CI95%=1.5-31.2). In a multiple regression model, a history of infarction and chronic obstructive pulmonary disease, tissue hypoperfusion, radiographic pulmonary edema, and high troponin T levels emerged as the independent predictors. CONCLUSIONS: High troponin T levels were found in 15% of patients with acute exacerbation of heart failure; this finding was independently associated with worse prognosis. Echocardiograms suggested that more severe ventricular remodeling is one subjacent mechanism related with biochemically detected myocardial injury in this setting.

[Differences in clinical profile and outcome in patients with decompensated heart failure and systolic dysfunction or preserved systolic function]. / Características clinicoevolutivas en la insuficiencia cardíaca descompensada con disfunción sistólica y función sistólica preservada.

OBJECTIVES: To compare the clinical characteristics and short- and long-term prognosis for chronic heart failure with left ventricular systolic dysfunction or preserved systolic function. PATIENTS AND METHOD: Three-hundred twenty-eight consecutive patients with decompensated chronic heart failure were studied prospectively. Depending on ejection fraction, participants were classified as having systolic dysfunction (group 1, ejection fraction < or = 40%,) or preserved systolic function (group 2, ejection fraction >40%). RESULTS: Systolic dysfunction was detected in 192 patients (58.5%) and preserved systolic function in 41.5%. Mean age was 62.7 (12.5 years) in group 1 and 65.2 (16.2 years) in group 2 (P=.03), with a male prevalence of 73.3% and 49.3%, respectively (P<.001). Ischemic cardiomyopathy was more frequent in group 1 (44.8% vs 25%; P<.001). Physical examination and electrocardiogram findings were similar in both groups, except for a higher proportion of patients in group 1 with a heart third sound (43.2% vs 25%; P=.001) and left bundle branch block (40.6% vs 15.4%; P<.001) and abnomal Q waves (31.3% vs 20.6%; P=.04). In-hospital mortality was similar in patients with systolic dysfunction and preserved systolic function (2.9% vs 1%; P=NS). Twenty-four-month cumulative survival was 61% for patients with systolic dysfunction and 76% for patients with preserved systolic function (log rank test P=NS). In the Cox proportional hazards model, which included age, sex, functional class, hepatomegaly, peripheral hypoperfusion, BUN, sodium level, ejection fraction > 40%, and biventricular heart failure, preserved systolic function was not associated with late mortality. The variables that were independent predictors of late mortality were peripheral hypoperfusion (OR = 3.7; P<.0001), low sodium level (OR=0.9; P=.009) and male sex (OR=1.9; P=.041). CONCLUSIONS: Decompensated chronic heart failure with preserved systolic function was more frequent in women and older patients. Patients with preserved systolic function had a lower prevalence of coronary heart disease. However, these differences had no impact on the short- and long-term prognosis.

Características clinicoevolutivas en la insuficiencia cardíaca descompensada con disfunción sistólica y función sistólica preservada / Differences in clinical profile and outcome in patients with decompensated heart failure and systolic dysfunction or preserved systolic function

Objetivos. Comparar las características clínicas y el pronóstico hospitalario y tardío en la insuficiencia cardíaca crónica con disfunción sistólica o función sistólica preservada. Pacientes y método. Se incluyó a 328 pacientes consecutivos ingresados en el Instituto de Cardiología de Corrientes con insuficiencia cardíaca descompensada. Según la fracción de eyección evaluada por ecocardiograma bidimensional, la población fue clasificada como con disfunción sistólica (grupo 1, con una fracción de eyección 40 por ciento) o con función sistólica preservada (grupo 2, con una fracción de eyección > 40 por ciento). Resultados. Se detectó una disfunción sistólica en 192 pacientes (58,5 por ciento) y una función sistólica preservada en el 41,5 por ciento restante. En los grupos 1 y 2, la edad media fue de 62,7 ñ 12,5 frente a 65,2 ñ 16,2 años (p = 0,03) y la proporción de varones fue del 73,3 frente al 49,3 por ciento, respectivamente (p 40 por ciento e insuficiencia global, el tipo de disfunción no se asoció con una mortalidad tardía, y fueron predictores independientes la hipoperfusión periférica (OR = 3,7; p < 0,0001), la concentración baja de sodio (OR = 0,9; p = 0,009) y el sexo masculino (OR = 1,9; p = 0,041). Conclusiones. La insuficiencia cardíaca descompensada con una función sistólica preservada se presentó con mayor frecuencia en las mujeres y los pacientes más ancianos, con una baja prevalencia de enfermedad coronaria. A pesar de estas diferencias, el tipo de disfunción no tuvo implicaciones en el pronóstico hospitalario y tardío (AU)