A Humanized Yeast Model for Studying TRAPP Complex Mutations; Proof-of-Concept Using Variants from an Individual with a TRAPPC1-Associated Neurodevelopmental Syndrome.

Variants in membrane trafficking proteins are known to cause rare disorders with severe symptoms. The highly conserved transport protein particle (TRAPP) complexes are key membrane trafficking regulators that are also involved in autophagy. Pathogenic genetic variants in specific TRAPP subunits are linked to neurological disorders, muscular dystrophies, and skeletal dysplasias. Characterizing these variants and their phenotypes is important for understanding the general and specialized roles of TRAPP subunits as well as for patient diagnosis. Patient-derived cells are not always available, which poses a limitation for the study of these diseases. Therefore, other systems, like the yeast Saccharomyces cerevisiae, can be used to dissect the mechanisms at the intracellular level underlying these disorders. The development of CRISPR/Cas9 technology in yeast has enabled a scar-less editing method that creates an efficient humanized yeast model. In this study, core yeast subunits were humanized by replacing them with their human orthologs, and TRAPPC1, TRAPPC2, TRAPPC2L, TRAPPC6A, and TRAPPC6B were found to successfully replace their yeast counterparts. This system was used for studying the first reported individual with an autosomal recessive disorder caused by biallelic TRAPPC1 variants, a girl with a severe neurodevelopmental disorder and myopathy. We show that the maternal variant (TRAPPC1 p.(Val121Alafs*3)) is non-functional while the paternal variant (TRAPPC1 p.(His22_Lys24del)) is conditional-lethal and affects secretion and non-selective autophagy in yeast. This parallels defects seen in fibroblasts derived from this individual which also showed membrane trafficking defects and altered Golgi morphology, all of which were rescued in the human system by wild-type TRAPPC1. This study suggests that humanized yeast can be an efficient means to study TRAPP subunit variants in the absence of human cells and can assign significance to variants of unknown significance (VUS). This study lays the foundation for characterizing further TRAPP variants through this system, rapidly contributing to disease diagnosis.

Safety and efficacy of electric cardioversion in the emergency department: analysis of associated factors according to gender. / Eficacia y seguridad de la cardioversión eléctrica en urgencias: factores asociados y perspectiva de sexo.

OBJECTIVE: To explore the safety and effectiveness of electric cardioversion to treat atrial fibrillation in a hospital emergency department (ED). METHODS: Retrospective observational study in a hospital ED. We reviewed episodes of atrial fibrillation in patients aged 18 years orolder treated with cardioversion in our ED or referred for scheduling of cardioversion. Clinical outcome measures were conversion to sinus rhythm, immediate adverse effects (hypotension, arrythmia, or bronchial aspiration), revisiting within 90 days for atrial fibrillation, and complications (stroke, major bleeding, heart failure, or death). We studied factors associated with recurrence and adverse effects according to sex. RESULTS: Cardioversion was used in 365 episodes (median patient age, 67 years); 38.6% were women. Cardioversion was applied in the ED in 75.1% of the episodes, and 24.9% were referred for scheduled cardioversion. Sinus rhythm was restored in 90.7% of the episodes. Emergency cardioversion was more effective than a scheduled procedure (odds ratio [OR], 4.258; 95% CI, 2.046-8.859; P < .001). No serious immediate adverse effects were reported, but 16.7% of the patients revisited for atrial fibrillation within 90 days. Factors associated with revisits were heart failure (hazard ratio [HR], 2.603; 95% CI, 1.298-5.222; P = .007), sleep apnea (HR, 2.598; 95% CI, 1.163-5.803; P = .020), and, in women, hypertension (HR, 3.706; 95% CI, 1.051-13.068; P = .042). Eleven patients developed late adverse events, including stroke (n = 2), major bleeding (n = 1), heart failure (n = 5), and death (n = 3). CONCLUSIONS: Cardioversion is a useful, effective, and safe treatment for atrial fibrillation in the ED, although there are frequent recurrences. Factors associated with recurrence differ according to sex.

OBJETIVO: Conocer la seguridad y eficacia de la cardioversión eléctrica (CVE) en la fibrilación auricular (FA) en un servicio de urgencias hospitalario (SUH). METODO: Estudio observacional y retrospectivo realizado en un SUH. Se revisaron los episodios de FA en pacientes con edad igual o mayor a 18 años a los que se les realizó CVE en el SUH o se les programó de forma diferida. Las variables resultado fueron: reversión a ritmo sinusal (RS), efectos adversos inmediatos (hipotensión, arritmia y broncoaspiración), reconsulta a 90 días por FA y desarrollo de complicaciones (ictus, hemorragia mayor, insuficiencia cardiaca y mortalidad). Se estudiaron los factores asociados a recurrencia y efectos adversos, y se analizaron las diferencias por sexo. RESULTADOS: Se incluyeron 365 episodios de CVE (67 años; 38,6% mujeres); el 75,1% se realizó en el SUH y el 24,9% se derivaron para CVE diferida. El 90,7% revirtieron a RS. La CVE urgente fue más efectiva que la diferida (OR 4,258; IC 95% 2,046-8,859; p < 0,001). No hubo efectos adversos inmediatos graves. El 16,7% de pacientes reconsultaron por FA en los 90 días posteriores. Los factores asociados a reconsulta fueron insuficiencia cardiaca (HR 2,603; IC 95% 1,298-5,222; p = 0,007), apnea del sueño (HR 2,598; IC 95% 1,163-5,803; p = 0,020) y, en mujeres, hipertensión arterial (HR 3,706;IC 95% 1,051-13,068; p = 0,042). Tras la CVE, 11 pacientes presentaron eventos adversos tardíos que incluyeron ictus (n = 2), hemorragia mayor (n = 1), insuficiencia cardiaca (n = 5) y muerte (n = 3). CONCLUSIONES: La CVE es útil, eficaz y segura para la FA en los SUH, aunque las recurrencias son frecuentes. Los factores asociados a recurrencia difieren entre sexos.

Acetonitrile real gas phase behavior from quasi-ideal gas to nanodroplets: A microscopical view.

We have applied a recently developed general purpose acetonitrile force field based on first-principles calculations to simulate acetonitrile in the gas phase at different temperatures and densities. These conditions range from nearly ideal to real gas phase behavior and condensation. The molecular dynamics simulation results agree fairly well with the experimental studies available in the literature on the gas samples. The structural analysis of aggregates and their associated interaction energies is examined and related to the early model proposed on molecular association and equilibrium determining the non-ideal behavior. The formation of dimers is mainly responsible for the non-ideal behavior of the gas at very low density, confirming suggested models based on previous experimental studies. However, when the density of the sample rises, the level of aggregation increases and the simple concept of dimerization does not hold anymore. The real behavior adopted by the gas is related to the distribution of molecular structures observed. The macroscopical view of a real gas as a generic interparticle interaction system without a defined form may then be rationalized on the basis of a defined molecular association originated by a distribution of aggregates at the low density regime. The sample with the highest density (∼1.4 × 103 mol m-3) at the lowest temperature exhibits a massive aggregation where most of the acetonitrile (ACN) molecules in the simulation box form a big cluster. Its radial distribution function is similar to that of the liquid ACN. This strongly inhomogeneous distribution in the box can be considered a condensation in the gas phase under specific density-T conditions. This formation opens the door to the potential tuning of its solvent properties as a function of its size in these nanodroplets that in turn are controlled by the density-T conditions.

Comparison of Three Preharvest Sampling Strategies to Monitor Pathogens in Cattle Lairage Areas.

The objective of this study was to compare preharvest monitoring strategies by evaluating three different sampling methods in the lairage area to determine pathogen recovery for each sampling method and incoming pathogen prevalence from the cattle to inform in-plant decision making. Samples were gathered over a 5-month period, from February to June 2022, at a harvesting and processing facility located in Eastern Nebraska. Sampling methods included (i) fecal pats, (ii) boot swabs, and (iii) MicroTally swab. A total of 329 samples were collected over the study period (fecal pats: n = 105, boot swabs: n = 104, and MicroTally swabs: n = 120). Specific media combinations, an incubation temperature of 42°C, and incubation timepoints (18-24 h) were utilized for each matrix and the prevalence of Salmonella, Escherichia coli O157:H7, and six non-O157 Shiga-toxin producing E. coli (STEC) was evaluated using the BAX system Real-Time PCR assay. Overall, results from the study concluded that boot swabs were an effective sampling method for pathogen detection in the cattle lairage area. Boot swabs (97.1%) were statistically more likely to detect for Salmonella (p < 0.05) when compared to fecal pats (67.6%) and MicroTally swab (77.5%) methods. For E. coli O157:H7 and STEC - O26, O121, O45, and O103 prevalence, boot swabs were significantly better at detecting for these pathogens (p < 0.05) than MicroTally swabs (OR = 3.16 - 11.95) and a comparable sampling method to fecal pats (OR = 0.93 - 2.01, p > 0.05). Lastly, all three sampling methods detected a very low prevalence for E. coli O111 and O145; therefore, no further analysis was conducted. The boot swab sampling method was strongly favored because they require little training to implement, are inexpensive, and they do not require much sampling labor; therefore, would be a simple and effective sampling method to implement within the industry to evaluate pathogen prevalence preharvest.

Predicting Conversion to Insulin Sensitivity With Metformin: A Promising Tool for Clinicians in Addressing Insulin Resistance and Improving Outcomes in Patients With Treatment Resistant Bipolar Depression.

BACKGROUND: Insulin resistance (IR) changes the trajectory of responsive bipolar disorder to a treatment-resistant course. A clinical trial conducted by our group demonstrated that IR reversal by metformin improved clinical and functional outcomes in treatment-resistant bipolar depression (TRBD). To aid clinicians identify which metformin-treated TRBD patients might reverse IR, and given strong external evidence for their association with IR, we developed a predictive tool using body mass index (BMI) and homeostatic model assessment-insulin resistance (HOMA-IR). METHODS: The predictive performance of baseline BMI and HOMA-IR was tested with a logistic regression model using known metrics: area under the receiver operating curve, sensitivity, and specificity. In view of the high benefit to low risk of metformin in reversing IR, high sensitivity was favored over specificity. RESULTS: In this BMI and HOMA-IR model for IR reversal, the area under the receiver operating curve is 0.79. At a cutoff probability of conversion of 0.17, the model's sensitivity is 91% (95% confidence interval [CI], 57%-99%), and the specificity is 56% (95% CI, 36%-73%). For each unit increase in BMI or HOMA-IR, there is a 15% (OR, 0.85; 95% CI, 0.71-0.99) or 43% (OR, 0.57; CI, 0.18-1.36) decrease in the odds of conversion, respectively. CONCLUSIONS: In individuals with TRBD, this tool using BMI and HOMA-IR predicts IR reversal with metformin with high sensitivity. Furthermore, these data suggest early intervention with metformin at lower BMI, and HOMA-IR would likely reverse IR in TRBD.

RoBétArmé Project: Human-robot collaborative construction system for shotcrete digitization and automation through advanced perception, cognition, mobility and additive manufacturing skills.

The importance of construction automation has grown worldwide, aiming to deliver new machineries for the automation of roads, tunnels, bridges, buildings and earth-work construction. This need is mainly driven by (i) the shortage and rising costs of skilled workers, (ii) the tremendous increased needs for new infrastructures to serve the daily activities and (iii) the immense demand for maintenance of ageing infrastructure. Shotcrete (sprayed concrete) is increasingly becoming popular technology among contractors and builders, as its application is extremely economical and flexible as the growth in construction repairs in developed countries demand excessive automation of concrete placement. Even if shotcrete technology is heavily mechanized, the actual application is still performed manually at a large extend. RoBétArméEuropean project targets the Construction 4.0 transformation of the construction with shotcrete with the adoption of breakthrough technologies such as sensors, augmented reality systems, high-performance computing, additive manufacturing, advanced materials, autonomous robots and simulation systems, technologies that have already been studied and applied so far in Industry 4.0. The paper at hand showcases the development of a novel robotic system with advanced perception, cognition and digitization capabilities for the automation of all phases of shotcrete application. In particular, the challenges and barriers in shotcrete automation are presented and the RoBétArmésuggested solutions are outlined. We introduce a basic conceptual architecture of the system to be developed and we demonstrate the four application scenarios on which the system is designated to operate.

The RoBétArmé European project targets the Construction 4.0 transformation of the construction with shotcrete with the adoption of breakthrough technologies such as sensors, augmented reality systems, high-performance computing, additive manufacturing, advanced materials, autonomous robots and simulation systems, technologies that have already been studied and applied so far in Industry 4.0. This paper showcases a case study on which novel robotic systems will be developed for the automation of shotecrete application. The outcomes of this research can be widely used in other application technologies related to the construction domain.

Hospital at Home Program for the Treatment of Pediatric Osteoarticular Infections.

OBJECTIVES: Hospital at home (HAH) replaces acute inpatient hospital care for selected patients by providing care in their homes. We sought to describe the characteristics, management, and complications of patients with osteoarticular infections (OAIs) treated in an HAH program and its economic impact. METHODS: We conducted a retrospective observational study evaluating an HAH program in a pediatric hospital in Spain, describing the characteristics of patients with confirmed OAIs requiring intravenous antibiotic therapy admitted to this program between January 2019 and December 2022. The program operates as a virtual ward with possible daily visits by physicians and nurses and 24/7 telephone contact. RESULTS: A total of 88 patients (median age, 4.1 years; interquartile range [IQR], 1.7-10.6) with OIAs were admitted to the HAH program. Osteomyelitis (57%) and septic arthritis (29%) were the most frequent infections. Cefuroxime (42%) and cefazolin (39%) were the most frequently prescribed antibiotics. Caregiver self-administration was performed in 99%, allowing multiple daily doses of antimicrobial therapy, 80% by peripheral line. Thirteen patients (15%) had drug-related adverse events, only 3 requiring drug modification. Two patients (2%) were readmitted during HAH, and 1 was readmitted within 30 days of HAH discharge. The median HAH stay was 7 days (IQR, 4-8.75). For osteomyelitis, hospital days lowered from 8.5 days (IQR, 4.5-12) to 4 days (IQR, 3-7) after HAH implementation (P = .005) with 68% per-patient estimated cost savings. CONCLUSIONS: HAH treatment of OAIs is effective and cost-efficient. Patient support by medical and nursing staff, adequate family training, and regular communication are essential to ensure safe home admission.

Smoking cessation intervention in the community pharmacy: Cost-effectiveness of a non-randomized cluster-controlled trial at 12-months' follow-up.

BACKGROUND: This study evaluated the cost-effectiveness of an intervention based on a training course for community pharmacists and a smoking cessation service (CESAR©), using limited societal and the health provider perspectives. METHODS: Non-randomized controlled trial of 12-months' follow-up. Spanish community pharmacists who were previously trained with CESAR© formed the intervention group (n = 102), and control group delivered usual care (n = 80). CESAR Patients were smokers identified by the community pharmacists when they attended the pharmacy. Data were self-reported. Outcomes were smoking cessation and quality-of-life (EQ-5D-3L) and were collected at baseline, 6, and 12 months. Costs data included direct health costs, work loss, and intervention costs. Smoking cessation was analyzed through logistic regression models. Generalized linear models were carried out for quality-adjusted life year (QALY) and costs. Incremental cost-effectiveness ratio (ICER) and cost-utility ratio (ICUR) were calculated. RESULTS: In total, 800 smoking patients were included in the intervention group and 278 in the control group. Of these, 487 and 151 patients completed the study, respectively. Costs were lower in the intervention group compared to the control group in both perspectives. At 12 months, 54.3% and 37.1% patients from the intervention and the control groups reported smoking cessation, respectively. The difference in probability of cessation in the intervention compared to the control group was 17.6% (CI:0.05; 0.25). The mean QALY was higher in the intervention group [0.03(CI: 0.01; 0.07)]. The ICER and the ICUR were dominant for the intervention group. CONCLUSION: This intervention for smoking cessation showed that the CESAR© intervention, that combined a training for community pharmacists with a smoking cessation service was efficient for smoking cessation and QALY at 12 months' follow-up. TRIAL REGISTRATION: NCT05461066, retrospectively registered (July 15, 2022).

Flaxseed Oil (Linum usitatissimum) Prevents Cognitive and Motor Damage in Rats with Hyperammonemia.

Hyperammonemia is characterized by the excessive accumulation of ammonia in the body as a result of the loss of liver detoxification, leading to the development of hepatic encephalopathy (HE). These metabolic alterations carry cognitive and motor deficits and cause neuronal damage, with no effective treatment at present. In this study, we aimed to evaluate the effect of two subacute oral administrations of flaxseed oil (0.26 and 0.52 mL/kg) on short- and long-term memory, visuospatial memory, locomotor activity, motor coordination, and the neuronal morphology of the prefrontal cortex (PFC) via tests on Wistar rats with hyperammonemia. The goal was to identify its role in the regulation of cerebral edema, without liver damage causing cerebral failure. In contrast with an ammonium-rich diet, flaxseed oil and normal foods did not cause cognitive impairment or motor alterations, as evidenced in the short-term and visuospatial memory tests. Furthermore, the flaxseed oil treatment maintained a regular neuronal morphology of the prefrontal cortex, which represents a neuroprotective effect. We conclude that the oral administration of flaxseed oil prevents cognitive and motor impairments as well as neuronal alterations in rats with hyperammonemia, which supports the potential use of this oil to ameliorate the changes that occur in hepatic encephalopathy.

Effect of high-intensity interval training compared to moderate-intensity continuous training on body composition and insulin sensitivity in overweight and obese adults: A systematic review and meta-analysis.

Objective: To compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on adults with overweight and obesity. Outcomes, including changes in insulin sensitivity, weight, body mass index (BMI), waist circumference, and body fat, were analyzed. Methods: A systematic literature review was conducted. This review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42021281899. Clinical trials involving individuals who are overweight and obese and comparing HIIT with MICT effects on insulin sensitivity, weight, BMI, body fat percentage, and waist circumference were included. PubMed, Web of Science, Embase, and Scopus databases were searched using controlled vocabulary and free-text terms related to HIIT, obesity, and overweight. The search included studies published until September 2022. The Rob2 tool was used to assess the risk of bias. The results were presented through meta-analyses that provided summary estimators and confidence intervals. Subgroup analyses were conducted to assess the effect of the risk of bias on the outcomes. This research did not receive any specific funding. Results: Of the 2534 articles, 30 met the eligibility criteria. The intervention duration ranged from 4 to 16 weeks. The observed effects for each outcome were as follows: insulin sensitivity (p = 0.02), weight (p = 0.58), BMI (p = 0.53), waist circumference (p = 0.87), body fat percentage (p = 0.07), body fat mass in kilograms (p = 0.39). The level of evidence obtained was moderate except for waist circumference, which was rated as low. Limitations included heterogeneity in training protocols, measurements, and study duration. Additionally, a risk of bias was identified in these studies. Conclusion: HIIT and MICT did not significantly differ in their effects on weight, BMI, waist circumference, or body fat mass in adults with overweight and obesity. However, a moderate beneficial effect of HIIT was observed on insulin sensitivity. Therefore, further evidence is required to confirm these findings.

Prediction of neonatal death in pregnant women in an intensive care unit: Application of machine learning models.

Introduction: Neonatal mortality remains a critical concern, particularly in developing countries. The advent of machine learning offers a promising avenue for predicting the survival of at-risk neonates. Further research is required to effectively deploy this approach within distinct clinical contexts. Objective: This study aimed to assess the applicability of machine learning models in predicting neonatal mortality, drawing from maternal and clinical characteristics of pregnant women within an intensive care unit (ICU). Methods: Conducted as an observational cross-sectional study, the research enrolled pregnant women receiving care in a level III national hospital's ICU in Peru. Detailed data encompassing maternal diagnosis, maternal characteristics, obstetric characteristics, and newborn outcomes (survival or demise) were meticulously collected. Employing machine learning, predictive models were developed for neonatal mortality. Estimations of beta coefficients in the training dataset informed the model application to the validation dataset. Results: A cohort of 280 pregnant women in the ICU were included in this study. The Gradient Boosting approach was selected following rigorous experimentation with diverse model types due to its superior F1-score, ROC curve performance, computational efficiency, and learning rate. The final model incorporated variables deemed pertinent to its efficacy, including gestational age, eclampsia, kidney infection, maternal age, previous placenta complications accompanied by hemorrhage, severe preeclampsia, number of prenatal checkups, and history of miscarriages. By incorporating optimized hyperparameter values, the model exhibited an impressive area under the curve (AUC) of 0.98 (95 % CI: 0.95-1), along with a sensitivity of 0.98 (95 % CI: 0.94-1) and specificity of 0.98 (95 % CI: 0.93-1). Conclusion: The findings underscore the utility of machine learning models, specifically Gradient Boosting, in foreseeing neonatal mortality among pregnant women admitted to the ICU, even when confronted with maternal morbidities. This insight can enhance clinical decision-making and ultimately reduce neonatal mortality rates.

The protometabolic nature of prebiotic chemistry.

The field of prebiotic chemistry has been dedicated over decades to finding abiotic routes towards the molecular components of life. There is nowadays a handful of prebiotically plausible scenarios that enable the laboratory synthesis of most amino acids, fatty acids, simple sugars, nucleotides and core metabolites of extant living organisms. The major bottleneck then seems to be the self-organization of those building blocks into systems that can self-sustain. The purpose of this tutorial review is having a close look, guided by experimental research, into the main synthetic pathways of prebiotic chemistry, suggesting how they could be wired through common intermediates and catalytic cycles, as well as how recursively changing conditions could help them engage in self-organized and dissipative networks/assemblies (i.e., systems that consume chemical or physical energy from their environment to maintain their internal organization in a dynamic steady state out of equilibrium). In the article we also pay attention to the implications of this view for the emergence of homochirality. The revealed connectivity between those prebiotic routes should constitute the basis for a robust research program towards the bottom-up implementation of protometabolic systems, taken as a central part of the origins-of-life problem. In addition, this approach should foster further exploration of control mechanisms to tame the combinatorial explosion that typically occurs in mixtures of various reactive precursors, thus regulating the functional integration of their respective chemistries into self-sustaining protocellular assemblies.

Predicting Critical Loads in Fused Deposition Modeling Graphene-Reinforced PLA Plates Containing Notches Using the Point Method.

The use of 3D-printed composites in structural applications beyond current prototyping applications requires the definition of safe and robust methodologies for the determination of critical loads. Taking into account that notches (corners, holes, grooves, etc.) are unavoidable in structural components, the presence of these types of stress risers affects the corresponding load-carrying capacity. This work applies the point method (PM) to the estimation of the critical (fracture) loads of graphene-reinforced polylactic acid (PLA-Gr) plates obtained via fused deposition modeling (FDM) with a fixed raster orientation at 45/-45. Additionally, the plates contain three different notch types (U-notches, V-notches, and circular holes) and comprise various thicknesses (from 5 mm up to 20 mm) and ratios of notch length to plate width (a/W= 0.25 and a/W = 0.50). The comparison between the obtained experimental critical loads and the corresponding estimations derived from the application of the PM reveals that this approach generates reasonable accuracy in this particular material that is comparable to the accuracy obtained in other structural materials obtained via traditional manufacturing processes.

Relación entre la luna llena y la incidencia en partos prematuros vaginales en un hospital nivel III de Lima, Perú / Relationship between the full moon and the incidence of premature vaginal births in a level III hospital in Lima, Peru

Objetivo. Determinar la asociación entre la luna llena y la incidencia de partos prematuros vaginales entre mujeres con parto vaginal de un hospital de tercer nivel de Lima, Perú. Material y método. Se realizó un estudio transversal analítico de base secundaria del Certificado de Nacido Vivo (CNV) de Perú. Se estudiaron a todos los recién nacidos del Instituto Nacional Materno Perinatal entre los años 2013 a 2021. La duración de la fase de luna llena se determinó a través de lenguaje de programación con Python 3.6 y el análisis de la incidencia de prematuridad con el paquete estadístico STATA v15. Resultados. Se seleccionaron 90 653 recién nacidos del CNV de los cuales 11563 (12.75%) participantes nacieron durante los días de luna llena y 79089 (87.25%) durante las otras fases. Se observó una mayor incidencia de partos prematuros vaginales durante la fase de luna llena en comparación con otras fases (p<0.01). El análisis multivariado encontró que la luna llena tenía un 1.17% más de valor promedio de incidencia de partos prematuros vaginales ajustado por año en comparación con las demás fases (IC 95% 1.050 - 1.292, p<0.01). Conclusiones. Se encontró una mayor incidencia de partos prematuros vaginales durante la fase de luna llena en la población estudiada. Se deben tomar con cuidado estos resultados debido a que en el análisis se incluyeron los partos inducidos.

Análisis de seguridad y eficiencia de la hospitalización a domicilio directamente desde urgencias en pacientes con insuficiencia cardiaca aguda / Safety and efficiency of discharge to home hospitalization directly after emergency department care of patients with acute heart failure

Objetivos: Analizar si la hospitalización domiciliaria (HDom) directamente desde los servicios de urgencias (SU) de pacientes con insuficiencia cardiaca aguda (ICA) resulta eficiente y si se asocia con diferencias en evolución a corto y largo plazo comparada con hospitalización convencional (HCon). Método: Análisis secundario del registro Epidemiology Acute Heart Failure in Emergency departments (EAHFE), que es un registro multicéntrico, multiporpósito, analítico no intervencionista, con seguimiento prospectivo que incluye de forma consecutiva a los pacientes que acuden por episodio de ICA al SU. Se incluyeron, retrospectivamente, todos los pacientes diagnosticados de ICA en dos SU ingresados directamente en HDom entre marzo de 2016 y febrero de 2019 (3 años) y se compararon sus resultados con los pacientes diagnosticados de ICA incluidos en el registro EAHFE por esos 2 SU e ingresados en HCon durante los periodos marzo-abril 2016 (EAHFE-5), enero-febrero 2018 (EAHFE-6), y enero-febrero 2019 (EAHFE-7) (6 meses). Los resultados se ajustaron por las características basales y clínicas del episodio de descompensación. Resultados: Se incluyeron 370 pacientes en HDom y 646 en HCon. El grupo HDom tenía mayor edad, mayor comorbilidad y peor situación funcional basal, pero menor gravedad del episodio de descompensación, más frecuentemente desencadenado por anemia y menos por crisis hipertensiva y síndrome coronario agudo. La duración del ingreso fue mayor [mediana (RIC) 9 (7-14) días frente a 7 (5-11) días, p < 0,001], pero no hubo diferencias en mortalidad intrahospitalaria (7,0% frente a 8,0%, p = 0,56), eventos adversos a 30 días posalta (30,9% frente a 32,9%, p = 0,31) ni mortalidad al año (41,6% frente a 41,4%, p = 0,84). (AU)

Objectives: To analyze whether discharge to home hospitalization (HHosp) directly from emergency departments (EDs) after care for acute heart failure (AHF) is efficient and if there are short-term differences in outcomes between patients in HHosp vs those admitted to a conventional hospital ward (CHosp). Methods: Secondary analysis of cases from the EAHFE registry (Epidemiology of Acute Heart Failure in Emergency Departments). The EAHFE is a multicenter, multipurpose, analytical, noninterventionist registry of consecutive AHF patients after treatment in EDs. Cases were included retrospectively and registered to facilitate prospective follow-up. Included were all patients diagnosed with AHF and discharged to HHosp from 2 EDs between March 2016 and February 2019 (3 years). Cases from 6 months were analyzed in 3 periods: March-April 2016 (corresponding to EAHFE-5), January-February 2018 (EAHFE-6), and January-February 2019 (EAHFE-7). The findings were adjusted for characteristics at baseline and during the AHF decompensation episode. Results: A total of 370 patients were discharged to HHosp and 646 to CHosp. Patients in the HHosp group were older and had more comorbidities and worse baseline functional status. However, the decompensation episode was less severe, triggered more often by anemia and less often by a hypertensive crisis or acute coronary syndrome. The HHosp patients were in care longer (median [interquartile range], 9 [7-14] days vs 7 [5-11] days for CHosp patients, P < .001), but there were no differences in mortality during hospital care (7.0% vs. 8.0%, P = .56), 30-day adverse events after discharge from the ED (30.9% vs. 32.9%, P = .31), or 1-year mortality (41.6% vs. 41.4%, P = .84). (AU)

Safety and efficiency of discharge to home hospitalization directly after emergency department care of patients with acute heart failure. / Análisis de seguridad y eficiencia de la hospitalización a domicilio directamente desde urgencias en pacientes con insuficiencia cardiaca aguda.

OBJECTIVES: To analyze whether discharge to home hospitalization (HHosp) directly from emergency departments (EDs) after care for acute heart failure (AHF) is efficient and if there are short-term differences in outcomes between patients in HHosp vs those admitted to a conventional hospital ward (CHosp). MATERIAL AND METHODS: Secondary analysis of cases from the EAHFE registry (Epidemiology of Acute Heart Failure in Emergency Departments). The EAHFE is a multicenter, multipurpose, analytical, noninterventionist registry of consecutive AHF patients after treatment in EDs. Cases were included retrospectively and registered to facilitate prospective follow-up. Included were all patients diagnosed with AHF and discharged to HHosp from 2 EDs between March 2016 and February 2019 (3 years). Cases from 6 months were analyzed in 3 periods: March-April 2016 (corresponding to EAHFE-5), January-February 2018 (EAHFE-6), and January-February 2019 (EAHFE-7). The findings were adjusted for characteristics at baseline and during the AHF decompensation episode. RESULTS: A total of 370 patients were discharged to HHosp and 646 to CHosp. Patients in the HHosp group were older and had more comorbidities and worse baseline functional status. However, the decompensation episode was less severe, triggered more often by anemia and less often by a hypertensive crisis or acute coronary syndrome. The HHosp patients were in care longer (median [interquartile range], 9 [7-14] days vs 7 [5-11] days for CHosp patients, P .001), but there were no differences in mortality during hospital care (7.0% vs. 8.0%, P = .56), 30-day adverse events after discharge from the ED (30.9% vs. 32.9%, P = .31), or 1-year mortality (41.6% vs. 41.4%, P = .84). Risks associated with HHosp care did not differ from those of CHosp. The odds ratios (ORs) for HHosp care were as follows for mortality while in care, OR 0.90 (95% CI, 0.41-1.97); adverse events within 30 days of ED discharge, OR 0.88 (95% CI, 0.62-1.26); and 1-year mortality, OR 1.03 (95% CI, 0.76-1.39). Direct costs of HHosp and CHosp averaged €1309 and €5433, respectively. CONCLUSION: After ED treatment of AHF, discharge to HHosp requires longer care than CHosp, but short- and longterm outcomes are the same and at a lower cost.

OBJETIVO: Analizar si la hospitalización domiciliaria (HDom) directamente desde los servicios de urgencias (SU) de pacientes con insuficiencia cardiaca aguda (ICA) resulta eficiente y si se asocia con diferencias en evolución a corto y largo plazo comparada con hospitalización convencional (HCon). METODO: Análisis secundario del registro Epidemiology Acute Heart Failure in Emergency departments (EAHFE), que es un registro multicéntrico, multiporpósito, analítico no intervencionista, con seguimiento prospectivo que incluye de forma consecutiva a los pacientes que acuden por episodio de ICA al SU. Se incluyeron, retrospectivamente, todos los pacientes diagnosticados de ICA en dos SU ingresados directamente en HDom entre marzo de 2016 y febrero de 2019 (3 años) y se compararon sus resultados con los pacientes diagnosticados de ICA incluidos en el registro EAHFE por esos 2 SU e ingresados en HCon durante los periodos marzo-abril 2016 (EAHFE-5), enero-febrero 2018 (EAHFE-6), y enero-febrero 2019 (EAHFE-7) (6 meses). Los resultados se ajustaron por las características basales y clínicas del episodio de descompensación. RESULTADOS: Se incluyeron 370 pacientes en HDom y 646 en HCon. El grupo HDom tenía mayor edad, mayor comorbilidad y peor situación funcional basal, pero menor gravedad del episodio de descompensación, más frecuentemente desencadenado por anemia y menos por crisis hipertensiva y síndrome coronario agudo. La duración del ingreso fue mayor [mediana (RIC) 9 (7-14) días frente a 7 (5-11) días, p 0,001], pero no hubo diferencias en mortalidad intrahospitalaria (7,0% frente a 8,0%, p = 0,56), eventos adversos a 30 días posalta (30,9% frente a 32,9%, p = 0,31) ni mortalidad al año (41,6% frente a 41,4%, p = 0,84). En el modelo ajustado, el riesgo asociado a HDom tampoco difirió significativamente en mortalidad intrahospitalaria (OR = 0,90, IC 95% = 0,41-1,97), eventos adversos posalta a 30m días (HR = 0,88, IC95% = 0,62-1,26) ni mortalidad al año (HR = 1,03, IC 95% = 0,76-1,39). El coste directo promedio del episodio en HDom y HCon fue 1.309 y 5.433 euros, respectivamente. CONCLUSIONES: En la ICA, la HDom directamente desde el SU es más prolongada que la HCon, pero consigue los mismos resultados a corto y largo plazo, y su coste es inferior.

Usefulness of Community Pharmacy for Early Detection of Cognitive Impairment in Older People Using the IQ-CODE Questionnaire.

BACKGROUND: People with cognitive impairment (CI) need to be identified early because of the risk of progression to dementia. OBJECTIVES: The primary objective of the study was to analyze the usefulness of the community pharmacy for early detection of CI in older people through their caregivers. As secondary objective the risk factors related to IQ-CODE classification of risk of CI were identified. DESIGN: A cross-sectional observational study was designed. SETTING: Caregivers were selected by pharmacists from Spanish community pharmacies. PARTICIPANTS: Subjects with a close relationship to persons over 70 years of age who were not previously diagnosed with CI and who did not live in a nursing home or were hospitalized participated in the study. MEASUREMENTS: The proportion of older people who were classified as "at risk of CI" was assessed using the Informant Questionnaire on Cognitive Decline in the Elderly (IQ-CODE), which was completed by the caregiver. RESULTS: A total of 197 pharmacists selected 910 caregivers with an average age of 53 years, 75.5% of whom were women. In 324 people over the age of 70 (38.5%), "risk of CI" was observed, increasing with age. The risk of CI was 4.3 times higher in older people who complained of memory loss (p<0.001), 2.5 times higher if they had had a stroke in the last two years (p=0.007), 1.9 times higher if they were smokers (p=0.045) and 1.6 times higher if they were diabetic (p=0.028). CONCLUSION: Detection of risk of CI from the community pharmacy showed prevalence figures consistent with the CI figures observed in the Spanish primary care setting, demonstrating the capacity of the community pharmacy to contribute to early detection of CI.

Adherencia a la guía de práctica clínica de sepsis neonatal según tipo de sepsis en un Instituto Materno Perinatal de Lima, Perú / Adherence to neonatal sepsis clinical practice guideline according to type of sepsis in a Maternal Perinatal Institute of Lima, Peru

RESUMEN Objetivo: El objetivo de la presente investigación es describir adherencia a la guía de práctica clínica de sepsis neonatal según tipo de sepsis en un instituto materno perinatal de Lima, Perú. Método: Se elaboró un estudio descriptivo entre los meses de junio a diciembre del 2021 en el Instituto Nacional Materno Perinatal (INMP). Se evaluó la adherencia de las atenciones a la GPC de prevención, diagnóstico y tratamiento de sepsis neonatal basada en la evidencia del INMP. Las atenciones médicas fueron evaluadas por dos médicos quienes revisaron el cumplimiento o no de las 16 recomendaciones de la GPC enmarcadas en 6 dimensiones. Se consideró adherencia adecuada a un cumplimiento de 80% a más de las recomendaciones establecidos por la guía en una atención. Se calculó en porcentajes la adherencia global, por dimensiones, por ítem y según características maternas y perinatales de las atenciones. Resultados: Se evaluaron un total de 968 atenciones médicas de las cuales 553 fueron de casos de sepsis neonatal temprana y 435 de tardía. Para sepsis temprana se encontró una adherencia del 84.4% mientras que para sepsis tardía se encontró un 66.8%. El menor porcentaje de adherencia se encontró en las recomendaciones 2.7 y 3.2 de las atenciones de sepsis tardía. Conclusiones: Se encontró una adherencia adecuada en las atenciones de sepsis neonatal temprana, mientras que, en relación con la sepsis neonatal tardía, no se alcanzó un nivel de adherencia adecuado.

ABSTRACT Objective: The objective of this research is to describe adherence to the neonatal sepsis clinical practice guideline according to the type of sepsis in a perinatal maternal institute in Lima, Peru. Method: A descriptive study was carried out between the months of June to December 2021 at the Instituto Nacional Maternal Perinatal (INMP). The adherence of care to the CPG for the prevention, diagnosis and treatment of neonatal sepsis based on the INMP evidence was evaluated. Medical care was evaluated by two physicians who reviewed compliance or not with the 16 CPG recommendations. Adequate adherence was considered to be in compliance with 80% or more of the recommendations established by the guideline in one care. Global adherence was calculated in percentages, by dimensions, by item and according to maternal and perinatal characteristics of care. Results: A total of 968 medical attentions were evaluated, of which 553 were early neonatal sepsis cases and 435 late. For early sepsis, an adherence of 84.4% was found, while for late sepsis, 66.8% was found. The lowest percentage of adherence was found in recommendations 2.7 and 3.2 of late sepsis care. Conclusions: An adequate adherence was found in early neonatal sepsis care, while, in relation to late neonatal sepsis, an adequate level of adherence was not reached.

Emergency department direct discharge compared to short-stay unit admission for selected patients with acute heart failure: analysis of short-term outcomes.

Short stay unit (SSU) is an alternative to conventional hospitalization in patients with acute heart failure (AHF), but the prognosis is not known compared to direct discharge from the emergency department (ED). To determine whether direct discharge from the ED of patients diagnosed with AHF is associated with early adverse outcomes versus hospitalization in SSU. Endpoints, defined as 30-day all-cause mortality or post-discharge adverse events, were evaluated in patients diagnosed with AHF in 17 Spanish EDs with an SSU, and compared by ED discharge vs. SSU hospitalization. Endpoint risk was adjusted for baseline and AHF episode characteristics and in patients matched by propensity score (PS) for SSU hospitalization. Overall, 2358 patients were discharged home and 2003 were hospitalized in SSUs. Discharged patients were younger, more frequently men, with fewer comorbidities, had better baseline status, less infection, rapid atrial fibrillation and hypertensive emergency as the AHF trigger, and had a lower severity of AHF episode. While their 30-day mortality rate was lower than in patients hospitalized in SSU (4.4% vs. 8.1%, p < 0.001), 30-day post-discharge adverse events were similar (27.2% vs. 28.4%, p = 0.599). After adjustment, there were no differences in the 30-day risk of mortality of discharged patients (adjusted HR 0.846, 95% CI 0.637-1.107) or adverse events (1.035, 0.914-1.173). In 337 pairs of PS-matched patients, there were no differences in mortality or risk of adverse event between patients directly discharged or admitted to an SSU (0.753, 0.409-1.397; and 0.858, 0.645-1.142; respectively). Direct ED discharge of patients diagnosed with AHF provides similar outcomes compared to patients with similar characteristics and hospitalized in a SSU.