33 research outputs found
A core outcome set for preâeclampsia research: an international consensus development study
Objective
To develop a core outcome set for preâeclampsia.
Design
Consensus development study.
Setting
International.
Population
Two hundred and eightâone healthcare professionals, 41 researchers and 110 patients, representing 56 countries, participated.
Methods
Modified Delphi method and Modified Nominal Group Technique.
Results
A longâlist of 116 potential core outcomes was developed by combining the outcomes reported in 79 preâeclampsia trials with those derived from thematic analysis of 30 inâdepth interviews of women with lived experience of preâeclampsia. Fortyâseven consensus outcomes were identified from the Delphi process following which 14 maternal and eight offspring core outcomes were agreed at the consensus development meeting. Maternal core outcomes: death, eclampsia, stroke, cortical blindness, retinal detachment, pulmonary oedema, acute kidney injury, liver haematoma or rupture, abruption, postpartum haemorrhage, raised liver enzymes, low platelets, admission to intensive care required, and intubation and ventilation. Offspring core outcomes: stillbirth, gestational age at delivery, birthweight, smallâforâgestationalâage, neonatal mortality, seizures, admission to neonatal unit required and respiratory support.
Conclusions
The core outcome set for preâeclampsia should underpin future randomised trials and systematic reviews. Such implementation should ensure that future research holds the necessary reach and relevance to inform clinical practice, enhance women's care and improve the outcomes of pregnant women and their babies
Estimated blood pressure trajectories and hypertension patterns among pregnant women living with HIV, Haiti, 2007â2017
Abstract Hypertension in pregnancy is a key driver of mortality and morbidity among Haitian women. HIV infection and treatment may worsen hypertension and increase cardiovascular disease risk. The authors examined blood pressure and hypertension patterns among 1965 women (2306 pregnancies ending in live births) in a prevention of maternalâtoâchild transmission (PMTCT) program in PortâauâPrince, Haiti, between 2007 and 2017. Hypertension was defined as blood pressure â„140/90 mm Hg on two consecutive visits. Latent class analysis assessed trajectories of mean arterial pressure (MAP) and multinomial ordinal logistic regression examined factors associated with higher trajectories. Between 2007â2009 and 2013â2016, hypertension at PMTCT entry increased from 1.3% to 3.8% (p = .005), while incidence at any time during PMTCT followâup increased from 5.0 to 16.1 per 100 personâyears (p  20 weeks of gestation (possible gestational hypertension) increased from 1.1% to 3.5% (p = .003) and from 2.3% to 6.9% (p < .001), respectively. Five MAP trajectories ranged from lowâstable to highâincreasing. In multivariable analysis controlling for history of antiretroviral therapy, age, parity, and weight, program entry in more recent years was associated with greater odds of higher MAP trajectory (adjusted odds ratio for 2013â2016 vs. 2007â2009 = 3.1, 95% confidence interval: 1.7â5.6). The increasing prevalence and incidence of hypertension highlight a need for screening and management prior to PMTCT entry and during followâup. In a population with limited access to chronic disease care, and where many deliveries occur outside of a clinical setting, the period of PMTCT followâup represents an opportunity to diagnose and initiate management of preexisting and pregnancyârelated hypertension
Mid-regional pro-atrial natriuretic peptide to predict clinical course in heart failure patients undergoing cardiac resynchronization therapy
Aims: Cardiac resynchronization therapy (CRT) induces reverse cardiac remodelling in heart failure (HF), but many patients receiving CRT remain non-responders. This study assessed the role of amino-terminal-pro-B-type natriuretic peptide (NT-proBNP), mid-regional-pro-atrial natriuretic peptide (MR-proANP), and mid-regional-pro-adrenomedullin (MR-proADM) at the time of device implantation to predict favourable clinical course (CRT response and/or risk of MACE) in HF patients receiving CRT.
Methods and results: A total of 137 HF patients were prospectively included. Blood was drawn from the coronary sinus (CS) at CRT implantation, and from a peripheral vein (PV) simultaneously and after 6 months. Clinical CRT response at 6 months and major adverse cardiovascular events (MACE) at 2 years were assessed. Baseline PV-levels of MR-proANP (202 vs. 318 pmol/L, P = 0.009) and MR-proADM (843 vs. 1112 pmol/L, P = 0.02) were lower in CRT responders compared with non-responders. At 6 months, CRT responders showed a decrease in MR-proANP levels, compared with an increase in non-responders (-32 vs. +7 pmol/L, P = 0.02). During the same period, NT-proBNP decreased by a similar way in responders and non-responders, while MR-proADM was unchanged in both groups. High baseline MR-proANP, either in PV (OR 0.41, 95% CI 0.24-0.71, P = 0.002) or CS (OR 0.32, 95% CI 0.15-0.70, P = 0.005) was associated with reduced likelihood of CRT response. Furthermore, PV and CS levels of NT-proBNP, MR-proANP, and MR-proADM were all associated with increased risk of 2-year MACE (all P < 0.01).
Conclusion: Mid-regional-pro-atrial natriuretic peptide may assist prediction of clinical course in HF patients undergoing CRT implantation. Low circulating MR-proANP at the time of device implantation is associated with CRT response and more favourable outcome
The role of angiotensin-converting enzyme 2 in the pathogenesis of COVID-19: the villain or the hero?
Natriuretic peptides in addition to Zwolle score to enhance safe and early discharge after acute myocardial infarction: A prospective observational cohort study
A core outcome set for pre-eclampsia research: an international consensus development study
Objective: To develop a core outcome set for pre-eclampsia. Design: Consensus development study. Setting: International. Population: Two hundred and eight-one healthcare professionals, 41 researchers and 110 patients, representing 56 countries, participated. Methods: Modified Delphi method and Modified Nominal Group Technique. Results: A long-list of 116 potential core outcomes was developed by combining the outcomes reported in 79 pre-eclampsia trials with those derived from thematic analysis of 30 in-depth interviews of women with lived experience of pre-eclampsia. Forty-seven consensus outcomes were identified from the Delphi process following which 14 maternal and eight offspring core outcomes were agreed at the consensus development meeting. Maternal core outcomes: death, eclampsia, stroke, cortical blindness, retinal detachment, pulmonary oedema, acute kidney injury, liver haematoma or rupture, abruption, postpartum haemorrhage, raised liver enzymes, low platelets, admission to intensive care required, and intubation and ventilation. Offspring core outcomes: stillbirth, gestational age at delivery, birthweight, small-for-gestational-age, neonatal mortality, seizures, admission to neonatal unit required and respiratory support. Conclusions: The core outcome set for pre-eclampsia should underpin future randomised trials and systematic reviews. Such implementation should ensure that future research holds the necessary reach and relevance to inform clinical practice, enhance women's care and improve the outcomes of pregnant women and their babies. Tweetable abstract: 281 healthcare professionals, 41 researchers and 110 women have developed #preeclampsia core outcomes @HOPEoutcomes @jamesmnduffy. [Correction added on 29 June 2020, after first online publication: the order has been corrected.]
Energy savings potential by integrating Phase Change Material into hollow bricks: The case of Moroccan buildings
The building sector in Morocco represents 25% of the country's total energy consumption. The poor thermal performance of the building envelopes is one of the principal reasons for this consumption rate. In this study, the efficiency of integrating Phase Change Materials (PCM) into hollow bricks used in three typical housing types in the six climate zones in Morocco is investigated. The numerical model is based on the heat transfer equation and the apparent heat capacity formulation to model the phase change. A heat flux analysis is performed at the internal surface of the wall, giving a good understanding of the thermal behavior of hollow bricks with PCMs compared with hollow bricks with air. The results show that the heat flux density at the internal face of the wall is constant when the PCM is partially solid/liquid, and follows the outdoor conditions when the PCM is fully solid or fully liquid. Irrespective of the climate zone, the PCM with a 32 °C median melting temperature reduces the heat flux peak value in the hotel housing while the PCM with a 37 °C median melting temperature is better for the individual and collective housing. On the other hand, the PCM with a 27 °C median melting temperature is able to save up to 25% and 40% of energy consumption in the Saharan climate and oceanic climate, respectively. Keywords phase change materials, energy savings in buildings, cooling needs reduction, hollow bricks with PCM with a 27 °C median melting temperature is able to save up to 25% and 40% of energy consumption in the Saharan climate and oceanic climate, respectively