Lipoprotein particles in patients with pediatric Cushing disease and possible cardiovascular risks.

BackgroundCardiovascular (CV) complications are the most significant cause of mortality in adults with Cushing disease (CD); little is known about CV risk factors in children with CD. Measurement of lipoprotein particles by nuclear magnetic resonance (NMR) spectroscopy is a novel technology to assess CV risk. The objective of the current study is to analyze the NMR lipid profile in pediatric CD patients before and 1 year after remission.MethodsNMR lipid profile was obtained via the Vantera NMR analyzer, using frozen serum samples from 33 CD patients (mean age 13.8 ± 4.0 years) evaluated between 1997 and 2017 at the National Institutes of Health (NIH) Clinical Center (CC).ResultsGlycA (glycosylated acute-phase proteins), triglyceride-rich particles (TRLP medium and very small sizes), low-density lipoprotein (LDL) particles (LDLP total and large size), high-density lipoprotein (HDL) particles (HDLP total, medium and small sizes), total cholesterol, LDL-cholesterol, HDL-cholesterol, GlycA inflammatory biomarker, and apolipoprotein B and apolipoprotein A1 (ApoA1) concentrations showed statistically significant changes after remission of CD (p < 0.05).ConclusionIn our study population, most of the lipid variables improved post-CD remission, with the exception of HDL and ApoA1, indicating that NMR lipoprotein profile may be a helpful tool in assessing the CV risk in pediatric patients with CD

Satisfaction with life and its relations with religion and health in Colombian university students

El presente estudio tuvo como objetivo estimar las correlaciones entre la satisfacción con la vida, la religión y la salud en una muestra de 446 participantes (42,60% varones y el 57,40% mujeres), con edades comprendidas entre los 18 a 69 años. Adicionalmente se llevó a cabo un análisis de regresión múltiple por pasos con el fin de conocer las variables predictoras de la satisfacción con la vida. Todos los participantes completaron los siguientes instrumentos: Cuestionario sociodemográfico, Escala de Satisfacción con la Vida, Cuestionario de Salud SF-36 y Escala de Religiosidad. A partir de los resultados se comprobó que la satisfacción con la vida no se asocia con la religión profesada. Mayor satisfacción con la vida fue predicha por mayor práctica religiosa organizacional, mejor salud general, mejor salud mental y mejor rol emocional. En definitiva, el nivel de satisfacción con la vida no parece estar relacionado con la religión profesada, aunque sí con la práctica de actividades que propone la institución religiosa de cada uno.The objective of the present study was to estimate the correlations between the satisfaction with life, religion and health in a sample of 446 participants (42,60% men and 57,40% women) between the ages of 18 to 69 years. In addition, an analysis of multiple regression by steps was made in order to determine the predictors of life satisfaction. All participants completed the following instruments: Sociodemographic Questionnaire, Satisfaction with Life Scales, SF-36 Questionnaire of Health and Scale of Religiosity. From the results it was found that the satisfaction with life was not associated with the religion professed. Greater satisfaction with life was predicted by greater organizational religious practice, better general health, better mental health and better emotional role. In conclusion the level of satisfaction with life does not seem to be related to the religion professed, but with the practice of activities proposed by the religious institution of each one

Depression and anxiety in decision-making, existential isolation, death and lack of vital sense in religious and non-religious people

El presente estudio tiene como objetivo describir la ansiedad ante las situaciones existenciales en religiosos y no religiosos en una muestra 100 universitarios colombianos, con una edad promedio de 22 años. Los participantes completaron el ANSIV que mide ansiedad existencial (ANSIV) y la Escala de Depresión de Zung. Los hallazgos comprueban que los no religiosos presentaron mayor ansiedad que los religiosos frente a la toma de decisiones; que no se observaron diferencias en relación al sentido de vida en ambos grupos; que los no religiosos presentaron ansiedad más exacerbada frente a la muerte que los religiosos y que los religiosos se encontraron menos ligeramente deprimidos que los no religiosos.The present study aims to describe the anxiety in existential situations in religious and non-religious people in a sample of 100 students from Colombia with an average age of 22 years. The participants completed the ANSIV that measures Existential Anxiety and SelfRating Depression Scale. The findings show that the non-religious presented higher anxiety than the religious people in decision-making process; no differences were observed in relation to the meaning of life in both groups; non-religious presented anxiety more exacerbated in the face of death than religious people and the religious were found slightly less depressed than non-religious

Depression and anxiety in decision-making, existential isolation, death and lack of vital sense in religious and non-religious people

El presente estudio tiene como objetivo describir la ansiedad ante las situaciones existenciales en religiosos y no religiosos en una muestra 100 universitarios colombianos, con una edad promedio de 22 años. Los participantes completaron el ANSIV que mide ansiedad existencial (ANSIV) y la Escala de Depresión de Zung. Los hallazgos comprueban que los no religiosos presentaron mayor ansiedad que los religiosos frente a la toma de decisiones; que no se observaron diferencias en relación al sentido de vida en ambos grupos; que los no religiosos presentaron ansiedad más exacerbada frente a la muerte que los religiosos y que los religiosos se encontraron menos ligeramente deprimidos que los no religiosos.The present study aims to describe the anxiety in existential situations in religious and non-religious people in a sample of 100 students from Colombia with an average age of 22 years. The participants completed the ANSIV that measures Existential Anxiety and SelfRating Depression Scale. The findings show that the non-religious presented higher anxiety than the religious people in decision-making process; no differences were observed in relation to the meaning of life in both groups; non-religious presented anxiety more exacerbated in the face of death than religious people and the religious were found slightly less depressed than non-religious

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Partial purification and characterization of two proteolytic enzymes from the venom of Crotalus basiliscus

Abstract not availabl