Second trimester placental thickness: its’ correlation with gestational age, femur length and biparietal diameter

Background: Placental thickness (PT) is the easiest placental dimension to measure, yet little is known about the normal PT. The aim of this study was to determine the normal, sonographically measured PT in millimetre (mm) in the second trimester and to determine if this measurement can be adjusted for gestational age for that time and evaluate its relationship with femur length and biparietal diameter of the fetus.Methods: The study was a cross sectional observational study, recruiting 100 consecutive, singleton pregnancies, reporting for ultrasonography (USG) between 14 weeks and 24 weeks of gestation, having undergone at least one ultrasonogram in the first trimester, with known last menstrual period (LMP). The placental thickness was measured perpendicular to the uterine wall, through the placenta at the site of cord insertion.Results: The average age of study population was 24.96 with a standard deviation (SD) of 2.70 years with the minimum age being 18 years and maximum age being 32 years. Regression analysis yielded the following mathematical relationships between PT, Gestational age (GA), Biparietal diameter (BPD) and Femur length (FL) in the second trimester. Y(PT)= 0.9366x (Gestation age)+1.655, R2 = 0.7332; Y(PT)= 0.2872x(BPD)+6.9578, R2= 0.7314; Y(PT)=0.2995x(FL)+ 10.03, R2 = 0.6186Conclusions: PT in present study showed a positive linear correlation with gestational age, FL and BPD in second trimester. Also, it can be concluded that PT may be used as a predictor of GA in women with unknown LMP

Creation of an Interactive Dashboard to Facilitate Early Detection of Cardiac Amyloidosis in African American Veterans

Background Cardiac amyloidosis (CA) is an underdiagnosed cause of heart failure (HF) that disproportionately impacts men of African descent. Without a standardized method of screening and scattered patient health information, clinicians must integrate data that spans multiple disease systems and is stored across the electronic health record.Objectives The aim of this project was to create a dashboard to facilitate identification of high-risk African American (AA) veterans who would benefit from CA screening tests. This paper described the development of the dashboard and identified barriers and opportunities in dashboard development.Methods Three Veterans Affairs (VA) health systems participated in this project. Microsoft Structured Query Language (SQL) Report Builder was utilized to create an interactive dashboard that refreshes daily through stored procedures using SQL Server Integration Services and the SQL Server Job Agent. Inclusion criteria included AA patients less than 90 years old with a history of HF. The 2023 American College of Cardiology/American Heart Association consensus statement on diagnosis and treatment of transthyretin CA was the source of evidence in creating the inclusion criteria and parameters of interest.Results The final dashboard contained 1,732 HF patients who met inclusion criteria, of which 949 (55%) were identified as high risk. We faced several challenges in this project, including time required for dashboard development, limited team experience in specifying dashboard requirements, identifying informatics counterparts at all sites, and standardizing data across three VA hospitals.Conclusion In this clinical improvement project, we created a dashboard that identifies AA veterans with HF at risk for CA and that can help to mitigate the impact of CA on this population

Comparing Unmet Needs between Community-Based Palliative Care Patients with Heart Failure and Patients with Cancer

Background: As the role of palliative care (PC) has yet to be clearly defined in patients with heart failure (HF), such patients may face barriers regarding PC referral. In order to maximally meet the needs of HF patients, it is necessary to understand how they compare to the classic PC population: patients with cancer

Co-Circulation of Dengue Virus Serotypes 1, 2, and 3 during the 2022 Dengue Outbreak in Nepal: A Cross-Sectional Study

The largest dengue outbreak in the history of Nepal occurred in 2022, with a significant number of casualties. It affected all 77 districts, with the nation’s capital, Kathmandu (altitude 1300 m), being the hardest hit. However, the molecular epidemiology of this outbreak, including the dengue virus (DENV) serotype(s) responsible for this epidemic, remain unknown. Here, we report the epidemic trends, clinico-laboratory features, and virus serotypes and their viral load profiles that are associated with this outbreak in Nepal. Dengue-suspected febrile patients were investigated by routine laboratory, serological, and molecular tools, including a real-time quantitative polymerase chain reaction (qRT-PCR). Of the 538 dengue-suspected patients enrolled, 401 (74.5%) were diagnosed with dengue. Among these dengue cases, 129 (32.2%) patients who required hospital admission had significant associations with myalgia, rash, diarrhea, retro-orbital pain, bleeding, and abdominal pain. DENV-1, -2, and -3 were identified during the 2022 epidemic, with a predominance of DENV-1 (57.1%) and DENV-3 (32.1%), exhibiting a new serotype addition. We found that multiple serotypes circulated in 2022, with a higher frequency of hospitalizations, more severe dengue, and more deaths than in the past. Therefore, precise mapping of dengue and other related infections through integrated disease surveillance, evaluation of the dynamics of population-level immunity and virus evolution should be the urgent plans of action for evidence-based policy-making for dengue control and prevention in the country

Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness: A Randomized Clinical Trial

For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy for patients with limited life expectancy