Development and validation of an instrument to monitor the healing of incontinence-associated dermatitis

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Troponin T in COVID-19 hospitalized patients: Kinetics matter

Background: Coronavirus disease 2019 (COVID-19) emerged as a worldwide health crisis, overwhelming healthcare systems. Elevated cardiac troponin T (cTn T) at admission was associated with increased in-hospital mortality. However, data addressing the role of cTn T in major adverse cardiovascular events (MACE) in COVID-19 are scarce. Therefore, we assessed the role of baseline cTn T and cTn T kinetics for MACE and in-hospital mortality prediction in COVID-19.Methods: Three hundred and ten patients were included prospectively. One hundred and eight patients were excluded due to incomplete records. Patients were divided into three groups according to cTn T kinetics: ascending, descending, and constant. The cTn T slope was defined as the ratio of the cTn T change over time. The primary and secondary endpoints were MACE and in-hospital mortality.Results: Two hundred and two patients were included in the analysis (mean age 64.4 ± 16.7 years, 119 [58.9%] males). Mean duration of hospitalization was 14.0 ± 12.3 days. Sixty (29.7%) patients had MACE, and 40 (19.8%) patients died. Baseline cTn T predicted both endpoints (p = 0.047, hazard ratio [HR] 1.805, 95% confidence interval [CI] 1.009–3.231; p = 0.009, HR 2.322, 95% CI 1.234–4.369). Increased cTn T slope predicted mortality (p = 0.041, HR 1.006, 95% CI 1.000–1.011). Constant cTn T was associated with lower MACE and mortality (p = 0.000, HR 3.080, 95% CI 1.914–4.954, p = 0.000, HR 2.851, 95% CI 1.828–4.447).Conclusions: The present study emphasizes the additional role of cTn T testing in COVID-19 patients for risk stratification and improved diagnostic pathway and management

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

The development, validation and implementation of an international tool for incontinence-associated dermatitis [IAD) classification : the Ghent Global IAD Categorisation tool (GLOBIAD)

Aims: The aim of the study was to develop the Ghent Global IAD Categorisation tool (GLOBIAD) and to examine the inter- and intra-rater reliability of categorizing incontinence-associated dermatitis according to GLOBIAD. Methods: 25 experts in the field of IAD from 14 countries and 5 continents were invited to evaluate the purpose and structure of the existing IAD Severity Categorisation tool, published in 2015, for content validity using a multiple-round Delphi procedure. Next, the reliability assessment will consist of two phases: the inter­ rater and intra-rater reliability assessment. In the first phase, an international convenience sample of nurses and nursing students (>15 countries) will be asked to complete an online survey (using Limesurvey®) including some demographic questions and the categorisation of 34 photographs (based on an anticipated kappa O of 0.8, a desired expected kappa L of 0.7) supplemented by a random selection of 6 photographs (15%) of the same set. Phase 2 will consist of a test-retest procedure with a 1-week interval to evaluate the intra-rater reliability of GLOBIAD using the same 34 photographs, in a different random order to redu(e potential bias. No feedba(k: will be provided between the test and retest procedure. The nurses and nursing students will be invited via mail. Results: Based on the comments of 22 experts (Ameri(a, Australia, Europe and South Afri(a] who participated in the 3 round Delphi procedure, changes to the purpose, structure and (ategories were made. The twofold purpose of GLOBIAD is (1) to create an internationally agreed description of IAD, and (2) to standardize the documentation within clini(al practi(e and for research purposes. The structure of the tool comprises two categories and two subcategories related to infection, each category consists of critical and additional criteria. The critical (riteria are (1) persistent redness without signs of skin loss and (2) skin loss. The presen(e of maceration, vesicles and bullae and pain are some additional criteria. Ea(h category is subdivided into IAD lesions with and without signs of infection (e.g. white scaling of the skin) and is visualised with clear images. Conclusions: The validation of GLOBIAD by an international expert panel is a first major step towards a better systematic assessment of IAD in clinical practice. In the future, the GLOBIAD will be disseminated via wound organisations and embedded in electronic health records. The reliability assessment is currently ongoing, results will be presented at the symposium