Search results for: dietary diversity practice and associated facrors among hypertension patients at tirunesh beijing hospital

Authors: James Patrick A. Diaz, Raul E. Ramboyong

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Background: Hypertensive response during maximal exercise test provides important information on the level of blood pressure control and evaluation of treatment. Method: A single center retrospective descriptive study was conducted among 117 young (aged 20 to 40) and middle age (aged 40 to 65) hypertensive patients, who underwent treadmill stress test. Currently on maintenance frontline medication either monotherapy (Angiotensin-converting enzyme inhibitor/Angiotensin receptor blocker [ACEi/ARB], Calcium channel blocker [CCB], Diuretic - Hydrochlorthiazide [HCTZ]) or combination therapy (ARB+CCB, ARB+HCTZ), who attained a maximal exercise on treadmill stress test (TMST) with hypertensive response (systolic blood pressure: male >210 mm Hg, female >190 mm Hg, diastolic blood pressure >100 mmHg, or increase of >10 mm Hg at any time during the test), on Bruce and Modified Bruce protocol. Exaggerated blood pressure response during exercise (systolic [SBP] and diastolic [DBP]), peak exercise blood pressure (SBP and DBP), recovery period (SBP and DBP) and test for ischemia and their antihypertensive medication/s were investigated. Analysis of variance and chi-square test were used for statistical analysis. Results: Hypertensive responses on maximal exercise test were seen mostly among female population (P < 0.000) and middle age (P < 0.000) patients. Exaggerated diastolic blood pressure responses were significantly lower in patients who were taking CCB (P < 0.004). A longer recovery period that showed a delayed decline in SBP was observed in patients taking ARB+HCTZ (P < 0.036). There were no significant differences in the level of exaggerated systolic blood pressure response and during peak exercise (both systolic and diastolic) in patients using either monotherapy or combination antihypertensives. Conclusion: Calcium channel blockers provided lower exaggerated diastolic BP response during maximal exercise test in hypertensive middle age patients. Patients on combination therapy using ARB+HCTZ exhibited a longer recovery period of systolic blood pressure.

Keywords: antihypertensive, exercise test, hypertension, hyperytensive response

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Authors: Maryam Haghi, Ivan Contreras, Nadia Bhuiyan

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Chemotherapy is one of the most popular and effective cancer treatments offered to patients in outpatient oncology centers. In such clinics, patients first consult with an oncologist and the oncologist may prescribe a chemotherapy treatment plan for the patient based on the blood test results and the examination of the health status. Then, when the plan is determined, a set of chemotherapy and consultation appointments should be scheduled for the patient. In this work, a comprehensive mathematical formulation for planning and scheduling different types of chemotherapy patients over a planning horizon considering blood test, consultation, pharmacy and treatment stages has been proposed. To be more realistic and to provide an applicable model, this study is focused on a case study related to a major outpatient cancer treatment clinic in Montreal, Canada. Comparing the results of the proposed model with the current practice of the clinic under study shows significant improvements regarding different performance measures. These major improvements in the patients’ schedules reveal that using optimization techniques in planning and scheduling of patients in such highly demanded cancer treatment clinics is an essential step to provide a good coordination between different involved stages which ultimately increases the efficiency of the entire system and promotes the staff and patients' satisfaction.

Keywords: chemotherapy patients scheduling, integer programming, integrated scheduling, staff balancing

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Authors: Marija Knez, James C.R. Stangoulis, Manja Zec, Zoran Pavlovic, Jasmina D. Martacic, Mirjana Gurinovic, Maria Glibetic

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Background: Zinc is an essential micronutrient for humans with important physiological functions. A sensitive and specific biomarker for assessing Zn status is still needed. Objective: The major aim of this study was to examine if the changes in the content of plasma phospholipid LA, DGLA and LA: DGLA ratio can be used to efficiently predict the dietary Zn intake and plasma Zn status of humans. Methods: The study was performed on apparently healthy human volunteers. The dietary Zn intake was assessed using 24h recall questionnaires. Plasma phospholipid fatty acid analysis was done by gas chromatography and plasma analysis of minerals by atomic absorption spectrometry. Biochemical, anthropometrical and hematological parameters were assessed. Results: No significant relationship was found between the dietary and plasma zinc status (r=0.07; p=0.6). There is a statistically significant correlation between DGLA and plasma Zn (r=0.39, p=0.00). No relationship was observed between the linoleic acid and plasma Zn, while there was a significant negative correlation between LA: DGLA ratio and plasma Zn status (r=-0.35, p=0.01). Similarly, there were statistically significant difference in DGLA status (p=0.004) and LA: DGLA ratio (p=0.042) between the Zn formed groups. Conclusions: This study is an initial step in evaluating LA: DGLA ratio as a biomarker of Zn status in humans. The results are encouraging as they show that concentration of DGLA is decreased and LA: DGLA ratio increased in people with lower dietary Zn intake. However, additional studies are needed to fully examine the sensitivity of this biomarker.

Keywords: dietary Zn intake Zinc, fatty acid composition, LA: DGLA, healthy population, plasma Zn status, Zn biomarker

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Authors: Gaby Fahmy

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The last decades have seen a rise in metabolic disorders like diabetes, obesity, and fatty liver disease around the world. Environmental factors, especially nutrition, have contributed to this increase. Additionally, pre-conceptional parental nutritional choices have been shown to result in epigenetic modifications affecting gene expression during the developmental process in-utero. These epigenetic modifications have also been seen to extend to the following offspring in a trans-generational effect. This further highlights the significance and relevance of epigenetics and epigenetic tags, which were previously thought to be stripped in newly formed embryos. Suitable prenatal nutrition may partially counteract adverse outcomes caused by exposures to environmental contaminants, ultimately resulting in improved metabolic profiles like body weight and glucose homeostasis. This was seen in patients who were given dietary interventions like restrictive caloric intake, intermittent fasting, and time-restricted feeding. Changes in nutrition are pivotal in the regulation of epigenetic modifications that are transgenerational. For example, dietary choices such as fatty foods vs. vegetables and nuts in fathers were shown to significantly affect sperm motility and volume. This was pivotal in understanding the importance of paternal inheritance. Further research in the field is needed as it remains unclear how many generations are affected by these changes.

Keywords: epigenetics, transgenerational, diet, fasting

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Authors: Katie-Beth Webster

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Mucormycosis is a rare opportunistic fungal infection that, if left untreated, can cause large scale tissue necrosis and death. There are a number of cases of this in the literature, most commonly in the head and neck region arising from sinuses. It is also usually found in immunocompromised patient subgroups. This study reviewed a number of cases of mucormycosis in previously fit and healthy young trauma patients to assess predisposing factors for infection and adequacy of current treatment paradigms. These trauma patients likely contracted the fungal infection from the soil at the site of the incident. Despite early washout and debridement of the wounds at the scene of the injury and on arrival in hospital, both these patients contracted mucormycosis. It was suspected that inadequate early debridement of soil contaminated limbs was one of the major factors that can lead to catastrophic tissue necrosis. In both cases, this resulted in the patients having a higher level of amputation than would have initially been required based on the level of their injury. This was secondary to cutaneous and soft tissue necrosis secondary to the fungal infiltration leading to osteomyelitis and systemic sepsis. In the literature, it appears diagnosis is often protracted in this condition secondary to inadequate early treatment and long processing times for fungal cultures. If fungal cultures were sent at the time of first assessment and adequate debridements are performed aggressively early, it could lead to these critically unwell trauma patients receiving appropriate antifungal and surgical treatment earlier in their episode of care. This is likely to improve long term outcomes for these patients.

Keywords: mucormycosis, plastic surgery, osteomyelitis, trauma

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Authors: Saima Ali, Liaqat Ali, Nasir Orakzai

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Background: Hydronephrosis is the most common abnormal finding in the urinary tract on prenatal screening with Ultrasonography. The prenatal hydronephrosis is a diagnostic dilemma in differentiating between obstructive variant versus physiologic hydronephrosis. The assessment and prompt diagnosis of prenatal hydronephrosis is important because of the fact that untreated obstructive hydronephrosis usually leads to recurrent UTI, Urosepsis, deterioration of renal functions, non-functioning kidneys, and even end-stage renal disease. Objectives: To determine the etiology and outcome of postnatal treatment of children with prenatal hydronephrosis in two teaching hospitals of Khyber Pakhtunkhwa (KPK) Methods: It is a multicentric descriptive study that was conducted in department of Paediatrics in Kuwait teaching hospital Peshawar and Department of Urology in Institute of Kidney Diseases Hayatabad Medical Complex Peshawar from January 2008 till December 2010. Total numbers of 64 neonates were included in the study with the mean follow-up of 14.5 months. All the diagnostic data in prenatal, postnatal data, and operative and non-operative data were collected on structured Proforma and was analyzed on SPSS version 17. Results: Out of 64 patients, 39 (60.9 %) were male while 25 were female. 52 patients had unilateral while 12 patients had bilateral hydronephrosis. Based upon prenatal USG in term of AP diameter, 37 (57 %) patients had mild hydronephrosis (5-10 mm AP diameter), 14 patients had moderate hydronephrosis (10-15 mm AP diameter) while 13 patients had gross hydronephrosis (More than 15mm). Regarding etiology, 44(76 %) patients were labeled as physiologic hydronephrosis, 11 patients (9.3%) with PUJ obstruction, 5 patients with Vesicoureteric reflux (VUR) and 4 patients with posterior urethral valves. Surgery was performed in total of 15 (23.4%) patients that included open Pyeloplasty in 11 patients, Vesicostomy followed by posterior valve fulguration in 4 patients. All the patients of VUR treated medically. The severity in the grade of prenatal hydronephrosis is significantly associated with the need for definitive urological surgery p < 0.005. Ancillary procedures like percutaneous nephrostomy (PCN) were inserted 7 patients. Conclusions: Prenatal hydronephrosis is a common ailment associated with significant morbidity. Physiological Hydronephrosis and VUR can be successfully treated with medical treatment. However obstructive PUJ obstructions and posterior urethral valves require surgical correction with a good success rate.

Keywords: prenatal hydronephrosis, Pelviureteric Junction (PUJ) Obstruction, vesicoureteric reflux, posterior urethral valve, renography

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Authors: Balasooriya B. M. C. M., Sujeeva N., Thowfeek Z., Siddiqa Omo, Liyanagunawardana J. E., Jayawardana Saiu, Manathunga S. S., Katulanda G. W.

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Introduction and objectives: Adrenal venous sampling (AVS) is the gold standard to discriminate unilateral primary aldosteronism (UPA) from bilateral disease (BPA). AVS is technically demanding and only performed in a limited number of centers worldwide. To the best of our knowledge, Except for one study conducted in India, no other research studies on this area have been conducted in South Asia. This study aimed to evaluate the effectiveness of AVS in the management of primary aldosteronism. Methods: A total of 32 patients who underwent AVS at the National Hospital of Sri Lanka from April 2021 to April 2023 were enrolled. Demographic, clinical and laboratory data were obtained retrospectively. A procedure was considered successful when adequate cannulation of both adrenal veins was demonstrated. Cortisol gradient across the adrenal vein (AV) and the peripheral vein was used to establish the success of venous cannulation. Lateralization was determined by the aldosterone gradient between the two sides. Continuous and categorical variables were summarized with mean, SD, and proportions, respectively. The mean and standard deviation of the contralateral suppression index (CSI) were estimated with an intercept-only Bayesian inference model. Results: Of the 32 patients, the average age was 52.47 +26.14 and 19 (59.4%) were males. Both AVs were successfully cannulated in 12 (37.5%). Among them, lateralization was demonstrated in 11(91.7%), and one was diagnosed as a bilateral disease. There were no total failures. Right AV cannulation was unsuccessful in 18 (56.25%), of which lateralization was demonstrated in 9 (50%), and others were inconclusive. Left AV cannulation was unsuccessful only in 2 (6.25%); one was lateralized, and the other remained inconclusive. The estimated mean of the CSI was 0.33 (89% credible interval 0.11-0.86). Seven patients underwent unilateral adrenalectomy and demonstrated significant improvement in blood pressure during follow-up. Two patients await surgery. Others were treated medically. Conclusions: Despite failure due to procedural difficulties, AVS remained useful in the management of patients with PA. Moreover, the success of the procedure needs experienced hands and advanced equipment to achieve optimal outcomes in PA.

Keywords: adrenal venous sampling, lateralization, contralateral suppression index, primary aldosteronism

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Authors: Ahmadreza Bagheri, Seyyed S. Eftekhari, Shervin Rashidinia

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Background: Various stress tests have been proposed yet to assess patients with suspected coronary artery disease. However, their diagnostic properties in terms of sensitivity, specificity, and accuracy are variable and their applicability remained somewhat vague. The aim of this study is to validate per-vessel diagnostic properties of 3 types of stress myocardial perfusion scintigraphy in gated SPECT (Single-Photon Emission Computed Tomography) using either exercise or pharmacological stress testing with dipyridamole or dobutamine. Materials and Methods: Hospital records of 314 patients who referred to Imam Khomeini hospital of Tehran between September 2015 and January 2017 were completely reviewed in this study. All patients underwent coronary angiography within 3 months after stress myocardial perfusion scan. Eventually, the results were analyzed in per-vessel basis to find the proper modality for each involved vessel or scanned site. Results: The mean age of patients was 62.15 ± 4.94 years (30-85) and 35.03% were women. The overall sensitivity, specificity, and accuracy were calculated as 56.59%, 54.24%, and 55.09%, respectively. These values were 56.43% and 53.25%, 54.46% and 47.36%, 56.75% and 54.83% for dipyridamole and exercise, respectively. Ischemia of the anterior wall through exercise stress testing has the highest diagnostic accuracy in detecting LAD (Left Anterior Descending artery) involvement. Inferior wall hypokinesia and anterolateral wall ischemia during exercise stress testing have the highest diagnostic accuracy in detecting RCA (Right Coronary Artery) and LCX artery (Left Circumflex Artery) stenosis, respectively. Conclusion: Stress myocardial perfusion scan should be carried out on the basis of the findings of the preliminary investigations on suspicion of a specific coronary artery or involved myocardial wall.

Keywords: dipyridamole, dobutamine, single-photon emission computed tomography, stress myocardial perfusion scintigraphy

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Authors: Emily Hickmann, Peggy Richter, Maren Kaehlig, Hannes Schlieter

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Patient engagement is a cornerstone of high-quality care and essential for patients with chronic diseases to achieve improved health outcomes. Through digital transformation, possibilities to engage patients in their personal healthcare have multiplied. However, the exploitation of this potential is still lagging. To support the transmission of patient engagement theory into practice, this paper’s objective is to give a state-of-the-art overview of patient engagement tools and methods. A systematic literature review was conducted. Overall, 56 tools and methods were extracted and synthesized according to the four attributes of patient engagement, i.e., personalization, access, commitment, and therapeutic alliance. The results are discussed in terms of their potential to be implemented in digital health solutions under consideration of the “computers are social actors” (CASA) paradigm. It is concluded that digital health can catalyze patient engagement in practice, and a broad future research agenda is formulated.

Keywords: chronic diseases, digitalization, patient-centeredness, patient empowerment, patient engagement

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Authors: Al-Nouri Doha Mostfa, Al-Khalifa Abdulrahman Salih

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The effects of long-term supplementation with different dietary omega-6/omega-3 (ω-6/ω-3) polyunsaturated fatty acid (PUFAs) ratios on the bone marrow fatty acids level, plasma biomarkers of bone metabolism, and minerals content in bone were evaluated in rabbits. Weanling male and female New Zealand white rabbits were randomly assigned to five groups and fed ad libitum for 100 days on diets containing 70 g/kg different dietary oils which providing the following ω-6/ω-3 ratios: soy bean oil (SBO control, 8.68), sesame oil (SO, 21.75), fish oil (FO, 0.39), DHA algae oil (DHA, 0.63), and DHA and ARA algae oils (DHA/ARA, 0.68). The bone marrow arachidonic (ARA), eicosapentaenoic (EPA), and docosahexaenoic (DHA) fatty acid levels were significantly influenced by and reflected the dietary ω-6/ω-3 ratios fed to rabbits. Rabbits fed on the FO diet maintained a lower ω-6/ω-3 ratio and a higher EPA and DHA levels, those fed on the DHA/ARA diet maintained a lower ω-6/ω-3 ratio and a higher ARA level, while those fed on the SO diet maintained a higher ω-6/ω-3 ratio and a lower ARA level. Plasma alkaline phosphatase (ALP) activity was significantly higher in male and female rabbits fed the DHA/ARA diet compared with those fed the control, SO, FO, or DHA diets. There was a significant main effect of dietary treatment on femur calcium (Ca), phosphorous (P), magnesium (Mg), and zinc (Zn) contents in both genders. This study confirmed that different dietary oil sources with varying ω-6/ω-3 ratios significantly altered the fatty acids level of bone marrow. In addition, the significant elevation in minerals content and the maintenance of optimal Ca/P ratio in bone of DHA/ARA and DHA fed groups beside the significant elevation in ALP activity in the DHA/ARA fed group proved that marine algae oils may be promising dietary sources for promoting bone mineralization and formation, thus improving bone mass during the growth stage.

Keywords: arachidonic (ARA), docosahexaenoic (DHA), eicosapentaenoic (EPA), growing rabbits

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Authors: Michael Adebayo, Saheed Lawal

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The Comprehensive Geriatric Assessment (CGA) is the multidimensional tool used to assess elderly, frail patients either on admission to hospital care or at a community level in primary care. It is a tool designed with the aim of using a holistic approach to managing patients. A Cochrane review of CGA use in 2011 found that the likelihood of being alive and living in their own home rises by 30% post-discharge. RCTs have also discovered 10–15% reductions in readmission rates and reductions in institutionalization, and resource use and costs. Past audit cycles at King’s College Hospital, Denmark Hill had shown inconsistent evidence of CGA completion inpatient discharge summaries (less than 50%). Junior Doctors in the Health and Ageing (HAU) wards have struggled to sustain the efforts of past audit cycles due to the quick turnover in staff (four-month placements for trainees). This 7th cycle created a multi-faceted approach to solving this problem amongst staff and creating lasting change. Methods: 1. We adopted multidisciplinary team involvement to support Doctors. MDT staff e.g. Nurses, Physiotherapists, Occupational Therapists and Dieticians, were actively encouraged to fill in the CGA document. 2. We added a CGA Document Pro-forma to “Sunrise EPR” (Trust computer system). These CGAs were to automatically be included the discharge summary. 3. Prior to assessing uptake, we used a spot audit questionnaire to assess staff awareness/knowledge of what a CGA was. 4. We designed and placed posters highlighting domains of CGA and MDT roles suited to each domain on geriatric “Health and Ageing Wards” (HAU) in the hospital. 5. We performed an audit of % discharge summaries which include CGA and MDT role input. 6. We nominated ward champions on each ward from each multidisciplinary specialty to monitor and encourage colleagues to actively complete CGAs. 7. We initiated further education of ward staff on CGA's importance by discussion at board rounds and weekly multidisciplinary meetings. Outcomes: 1. The majority of respondents to our spot audit were aware of what a CGA was, but fewer had used the EPR document to complete one. 2. We found that CGAs were not being commenced for nearly 50% of patients discharged on HAU wards and the Frailty Assessment Unit.

Keywords: comprehensive geriatric assessment, CGA, multidisciplinary team, quality of life, mortality

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Authors: Sintayehu W. Dejene, Ignas M. A. Heitkönig, Herbert H. T. Prins, Zewdu K. Tessema, Willem F. de Boer

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Current theories on diversity-disease relationships describe host species diversity and species identity as important factors influencing disease risk, either diluting or amplifying disease prevalence in a community. Whereas the simple term ‘diversity’ embodies a set of animal community characteristics, it is not clear how different measures of species diversity are correlated with disease risk. We, therefore, tested the effects of species richness, Pielou’s evenness and Shannon’s diversity on bTB risk in cattle in the Afar Region and Awash National Park between November 2013 and April 2015. We also analysed the identity effect of a particular species and the effect of host habitat use overlap on bTB risk. We used the comparative intradermal tuberculin test to assess the number of bTB infected cattle. Our results suggested a dilution effect through species evenness. We found that the identity effect of greater kudu - a maintenance host – confounded the dilution effect of species diversity on bTB risk. bTB infection was positively correlated with habitat use overlap between greater kudu and cattle. Different diversity indices have to be considered together for assessing diversity-disease relationships, for understanding the underlying causal mechanisms. We posit that unpacking diversity metrics is also relevant for formulating control strategies to manage cattle in ecosystems characterized by seasonally limited resources and intense wildlife-livestock interactions.

Keywords: evenness, diversity, greater kudu, identity effect, maintenance hosts, multi-host disease ecology, habitat use overlap

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Authors: Meryem Saban Guler, Saniye Bilici

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Malnutrition is a problem that significantly affects patients with cancer throughout the course of their illness, and it may be present from the moment of diagnosis until the end of treatment. We searched electronic databases using key terms such as ‘malnutrition in cancer patients’ or ‘nutritional status in cancer’ or ‘nutritional screening tools’ etc. Decline in nutritional status and continuing weight loss are associated with an increase in number and severity of complications, impaired quality of life and decreased survival rate. Nutrition is an important factor in the treatment and progression of cancer. Cancer patients are particularly susceptible to nutritional depletion due to the combined effects of the malignant disease and its treatment. With increasing incidence of cancer, identification and management of nutritional deficiencies are needed. Early identification of malnutrition, is substantial to minimize or prevent undesirable outcomes throughout clinical course. In determining the nutritional status; food consumption status, anthropometric methods, laboratory tests, clinical symptoms, psychosocial data are used. First-line strategies must include routine screening and identification of inpatients or outpatients at nutritional risk with the use of a simple and standardized screening tool. There is agreement among international nutrition organizations and accredited health care organizations that routine nutritional screening should be a standard procedure for every patient admitted to a hospital. There are f management of all cancer patients therefore routine nutritional screening with validated tools can identify cancer patients at risk.

Keywords: cancer, malnutrition, nutrition, nutritional screening

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Authors: Bo-Jian Wu, Si-Heng Wu

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Objectives: Frailty is a condition of a person who has chronic health problems complicated by a loss of physiological reserve and deteriorating functional abilities. The frailty syndrome was defined by Fried and colleagues, i.e., weight loss, fatigue, decreased grip strength, slow gait speed, and low physical activity. However, to our best knowledge, there have been rare studies exploring the prevalence of frailty and its association with falls in patients with schizophrenia. Methods: A total of 559 hospitalized patients were recruited from a public psychiatric hospital in 2013. The majority of the subjects were males (361, 64.6%). The average age was 53.5 years. All patients received the assessment of frailty status defined by Fried and colleagues. The status of a fall within one year after the assessment of frailty, clinical and demographic data was collected from medical records. Logistic regression was used to calculate the odds ratio of associated factors. Results : A total of 9.2% of the participants met the criteria of frailty. The percentage of patients having a fall was 7.2%. Age were significantly associated with frailty (odds ratio = 1.057, 95% confidence interval = 1.025-1.091); however, sex was not associated with frailty (p = 0.17). After adjustment for age and sex, frailty status was associated with a fall (odds ratio = 3.62, 95% confidence interval = 1.58-8.28). Concerning the components of frailty, decreased grip strength (odds ratio = 2.44, 95% confidence interval = 1.16-5.14), slow gait speed (odds ratio = 2.82, 95% confidence interval = 1.21-6.53), and low physical activity (odds ratio = 2.64, 95% confidence interval = 1.21-5.78) were found to be associated with a fall. Conclusions: Our findings suggest the prevalence of frailty was about 10% in hospitalized patients with chronic patients with schizophrenia, and frailty status was significant with a fall in this group. By using the status of frailty, it may be beneficial to potential target candidates having fallen in the future as early as possible. The effective intervention of prevention of further falls may be given in advance. Our results bridge this gap and open a potential avenue for the prevention of falls in patients with schizophrenia. Frailty is certainly an important factor for maintaining wellbeing among these patients.

Keywords: fall, frailty, schizophrenia, Taiwan

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Authors: Hasneet K. Kalsi, Julie K. Kilgariff

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Introduction: Within dentistry, the process for gaining informed consent has become more complex. To consent for treatment, patients must understand all reasonable treatment options and associated risks and benefits. Consenting is therefore deeply embedded in health literacy. Patients attending for dental consultation are often presented with an array of information and choices, yet studies show patients recall less than half of the information provided immediately after. Appropriate and comprehensible patient information leaflets (PILs) may be useful aid memories. In 2016 the World Health Organisation set improving health literacy as a global priority. Soon after, Scotland’s 2017-2025 Making it Easier: A Health Literacy Action Plan followed. This project involved the review of Restorative PILs used within Dundee Dental Hospital to assess the Content and Readability. Method: The current PIL on Root Canal Treatment (RCT) was created in 2011. This predates the Montgomery vs. NHS Lanarkshire case, a ruling which significantly impacted dental consenting processes, as well as General Dental Council’s (GDC’s) Standards for the Dental Team and Faculty of General Dental Practice’s Good Practice Guidance on Clinical Examination and Record-Keeping. Current evidence-based guidance, including that stipulated by the GDC, was reviewed. A 20-point Essential Content Checklist was designed to conform to best practice guidance for valid consenting processes. The RCT leaflet was scored against this to ascertain if the content was satisfactory. Having ensured the content satisfied medicolegal requirements, health literacy considerations were reviewed regarding readability. This was assessed using McLaughlin’s Simple Measure of Gobbledygook (SMOG) formula, which identifies school stages that would have to be achieved to comprehend the PIL. The sensitivity of the results to alternative readability methods were assessed. Results: The PIL was not sufficient for modern consenting processes and reflected a suboptimal level of health literacy. Evaluation of the leaflet revealed key content was missing, including information pertaining to risks and benefits. Only five points out of the 20-point checklist were present. The readability score was 16, equivalent to a level 2 in National Adult Literacy Standards/Scottish Credit and Qualification Framework Level 5; 62% of Scottish adults are able to read to this standard. Discussion: Assessment of the leaflet showed it was no longer fit for purpose. Reasons include a lack of pertinent information, a text-heavy leaflet lacking flow, and content errors. The SMOG score indicates a high level of comprehension is required to understand this PIL, which many patients may not possess. A new PIL, compliant with medicolegal and health literacy guidance, was designed with patient-driven checklists, notes spaces for annotations/ questions and areas for clinicians to highlight important case-specific information. It has been tested using the SMOG formula. Conclusion: PILs can be extremely useful. Studies show that interactive use can enhance their effectiveness. PILs should reflect best practice guidance and be understood by patients. The 2020 leaflet designed and implemented aims to fulfill the needs of a modern healthcare system and its service users. It embraces and embeds Scotland’s Health Literacy Action Plan within the consenting process. A review of further leaflets using this model is ongoing.

Keywords: consent, health literacy, patient information leaflet, restorative dentistry

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Authors: Alice Huffman, Joseph Hartland, Sam Gibbs

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Dermatology is often a neglected specialty in low-resource settings, despite the high morbidity associated with skin disease. This becomes even more significant when associated with HIV infection, as dermatological conditions are more common and aggressive in HIV positive patients. African countries have the highest HIV infection rates and skin conditions are frequently misdiagnosed and mismanaged, because of a lack of dermatological training and educational material. The frequent lack of diagnostic tests in the African setting renders basic clinical skills all the more vital. This project aimed to improve diagnosis and treatment of skin disease in the HIV population in a district hospital in Malawi. A basic dermatological clinical tool was developed and produced in collaboration with local staff and based on available literature and data collected from clinics. The aim was to improve diagnostic accuracy and provide guidance for the treatment of skin disease in HIV positive patients. A literature search within Embase, Medline and Google scholar was performed and supplemented through data obtained from attending 5 Antiretroviral clinics. From the literature, conditions were selected for inclusion in the resource if they were described as specific, more prevalent, or extensive in the HIV population or have more adverse outcomes if they develop in HIV patients. Resource-appropriate treatment options were decided using Malawian Ministry of Health guidelines and textbooks specific to African dermatology. After the collection of data and discussion with local clinical and pharmacy staff a list of 15 skin conditions was included and a booklet created using the simple layout of a picture, a diagnostic description of the disease and treatment options. Clinical photographs were collected from local clinics (with full consent of the patient) or from the book ‘Common Skin Diseases in Africa’ (permission granted if fully acknowledged and used in a not-for-profit capacity). This tool was evaluated by the local staff, alongside an educational teaching session on skin disease. This project aimed to reduce uncertainty in diagnosis and provide guidance for appropriate treatment in HIV patients by gathering information into one practical and manageable resource. To further this project, we hope to review the effectiveness of the tool in practice.

Keywords: dermatology, HIV, Malawi, skin disease

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Authors: Alicia Curtin, Kathy Hall

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This paper explores research and practice shared on a masters University module entitled Children's Literature as Pedagogy. Issues explored include the meaning of childhood and literature; the definition of what counts as text, textual and literacy practice for children and adolescents. A sociocultural framework is used to define literacy practice from this perspective and student voice and experience remains central. Lessons from classroom experience and the use of innovative, multi modal and non traditional texts and pedagogical approaches are offered as examples of innovative and inclusive pedagogy in the field of literacy practice.

Keywords: non traditional, pedagogy, practice, sociocultural

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Authors: Maha Salah, Hanaa Hashem, Mahmoud M. Alsagheir, Mohammed Salah

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Acute respiratory distress syndrome (ARDS) represents a complex clinical syndrome and carries a high risk for mortality. The severity of the clinical course, the uncertainty of the outcome, and the reliance on the full spectrum of critical care resources for treatment mean that the entire health care team is challenged. Researchers and clinicians have investigated the nature of the pathological process and explored treatment options with the goal of improving outcome. Through this application of research to practice, we know that some previous strategies have been ineffective, and innovations in mechanical ventilation, sedation, nutrition, and pharmacological intervention remain important research initiatives. Developed Clinical pathway is multidisciplinary plans of best clinical practice for this specified groups of patients that aid in the coordination and delivery of high quality care. They are a documented sequence of clinical interventions that help a patient to move, progressively through a clinical experience to a desired outcome. Although there is a lot of heterogeneity in patients with ARDS, this suggested developed clinical pathway with alternatives was built depended on a lot of researches and evidence based medicine and nursing practices which may be helping these patients to improve outcomes, quality of life and decrease mortality.

Keywords: acute respiratory distress syndrome (ARDS), clinical pathway, clinical syndrome

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Authors: M. Kuzhko, M. Gumeniuk, D. Butov, T. Tlustova, O. Denysov, T. Sprynsian

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Abstract: The objective of this work was to study the efficacy and safety of inhaled nebulized chemotherapy in the treatment of patients with newly diagnosed pulmonary tuberculosis in comparison with standard antimycobacterial therapy. Materials and methods: The study involved 68 patients aged between 20 and 70 years with newly diagnosed pulmonary tuberculosis. Patients were allocated to two groups. The first (main, n=21) group of patients received standard chemotherapy and further 0.15 g of isoniazid and rifampicin 0.15 g inhaled through a nebulizer, also they received salmeterol 50 mcg + fluticasone propionate 250 mcg at 2 breaths twice a day for 2 months. The second (control, n=47) group of patients received standard chemotherapy, consisting of orally administered isoniazid (0.3 g), rifampicin (0.6 g), pyrazinamide (2 g), ethambutol (1.2 g) with a dose reduction after the intensive phase of the therapy. The anti-TB drugs were procured through the Ukraine’s centralized national supply system. Results: Intoxication symptoms in the first group reduced following 1.39±0.18 months, whereas in the second group, intoxication symptoms reduced following 2.7±0.1 months, p<.001. Moreover, respiratory symptoms regression in the first group was observed following 1.6±0.2 months, whereas in the second group – following 2.5±0.2 months, p<0.05. Bacillary excretion period evaluated within 1 month was reduced, as it was shown by 66.6±10.5% in the main group compared to 27.6±6.5%, p<0.05, in the control group. In addition, period of cavities healing was reduced to 2.9±0.2 months in the main group compared to 3.7±0.1 months, p<0.05, in the control group. Residual radiological lung damage findings (large residual changes) were observed in 22 (23.8±9.5 %) patients of the main group versus 24 (51.0±7.2 %) patients in the control group, p<0.05. After completion of treatment scar stenosis of the bronchi II-III art. diagnosed in 3 (14.2±7.8%) patients in main group and 17 (68.0±6.8%) - control group, p<0.05. The duration of hospital treatment was 2.4±0.4 months in main group and 4.1±0.4 months in control group, p<0.05. Conclusion: Administration of of inhaled nebulized chemotherapy in patients with newly diagnosed pulmonary tuberculosis resulted in a comparatively quick reduction of disease manifestation.

Keywords: inhaled nebulized chemotherapy, pulmonary tuberculosis, tuberculosis, treatment of tuberculosis

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Authors: Hussien Ali, Mesfin Menza, Fitsum Hagos, Amare Haileslassie

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Climate change has perverse effects on agricultural productivity and natural resource base, negatively affecting the well-being of the households and communities. The government and NGOs promote climate smart agricultural (CSA) practices to help farmers adapt to and mitigate the negative effects of climate change. This study aims to identify widely available CSA practices and examine their impacts on food security and multi-dimensional poverty of rural farm households in the Central Rift Valley, Ethiopia. Using three-stage proportional to size sampling procedure, the study randomly selected 278 households from two kebeles from four districts each. A cross-sectional data of 2020/21 cropping season was collected using structured and pretested survey questionnaire. Food consumption score, dietary diversity score, food insecurity experience scale, and multidimensional poverty index were calculated to measure households’ welfare indicators. Multinomial endogenous switching regression model was used to assess average treatment effects of CSA on these outcome indicators on adopter and non-adopter households. The results indicate that the widely adopted CSA practices in the area are conservation agriculture, soil fertility management, crop diversification, and small-scale irrigation. Adopter households have, on average, statistically higher food consumption score, dietary diversity score and lower food insecurity access scale than non-adopters. Moreover, adopter households, on average, have lower deprivation score in multidimensional poverty compared to non-adopter households. Up scaling the adoption of CSA practices through the improvement of households’ implementation capacity and better information, technical advice, and innovative financing mechanisms is advised. Up scaling CSA practices can further promote achieving global goals such as SDG 1, SDG 2, and SDG 13 targets, aimed to end poverty and hunger and mitigate the adverse impacts of climate change, respectively.

Keywords: climate-smart agriculture, food security, multidimensional poverty, upscaling CSA, Ethiopia

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Authors: C. Scurr, J. Jeans, S. Srivastava

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Introduction: Acute type two respiratory failure (T2RF) has become a common presentation over the last two decades primarily due to an increase in the prevalence of chronic lung disease. Acute exacerbations can be managed either medically or in combination with non-invasive ventilation (NIV) which should be monitored with regular arterial blood gas samples (ABG). Arterial lines allow more frequent arterial blood sampling with less patient discomfort. We present the experience from a teaching hospital emergency department (ED) and level 2 medical high-dependency unit (HDU) that together form the pathway for management of acute type 2 respiratory failure. Methods: Patients acutely presenting to Charing Cross Hospital, London, with T2RF requiring non-invasive ventilation (NIV) over 14 months (2011 to 2012) were identified from clinical coding. Retrospective data collection included: demographics, co-morbidities, blood gas numbers and timing, if arterial lines were used and who performed this. Analysis was undertaken using Microsoft Excel. Results: Coding identified 107 possible patients. 69 notes were available, of which 41 required NIV for type 2 respiratory failure. 53.6% of patients had an arterial line inserted. Patients with arterial lines had 22.4 ABG in total on average compared to 8.2 for those without. These patients had a similar average time to normalizing pH of (23.7 with arterial line vs 25.6 hours without), and no statistically significant difference in mortality. Arterial lines were inserted by Foundation year doctors, Core trainees, Medical registrars as well as the ICU registrar. 63% of these were performed by the medical registrar rather than ICU, ED or a junior doctor. This is reflected in that the average time until an arterial line was inserted was 462 minutes. The average number of ABGs taken before an arterial line was 2 with a range of 0 – 6. The average number of gases taken if no arterial line was ever used was 7.79 (range of 2-34) – on average 4 times as many arterial punctures for each patient. Discussion: Arterial line use was associated with more frequent arterial blood sampling during each inpatient admission. Additionally, patients with an arterial line have less individual arterial punctures in total and this is likely more comfortable for the patient. Arterial lines are normally sited by medical registrars, however this is normally after some delay. ED clinicians could improve patient comfort and monitoring thus allowing faster titration of NIV if arteral lines were regularly inserted in the ED. We recommend that ED doctors insert arterial lines when indicated in order improve the patient experience and facilitate medical management.

Keywords: non invasive ventilation, arterial blood gas, acute type, arterial line

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Authors: Rui Xing, Xiaowen Zhao, Hao Huang, Chang Liu

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Creativity is regarded as vital for new ventures' development since the whole process of entrepreneurship is rooted in the creation and exploration of new ideas. The entrepreneurial leader is central to the entrepreneurial team, who plays an especially important role in this process. However, few scholars have studied the impact entrepreneurs' leadership styles on the creativity of entrepreneurial teams. In this study, we integrate the historically disjointed literatures of leadership style and team creativity under entrepreneurship circumstance to understand why and when entrepreneurs' different leadership style relates to team creativity. Focus on answering the following questions: Is humility leadership necessarily better than narcissism leadership at increasing the creativity of entrepreneurial teams? Moreover, in which situations humility leadership or narcissism leadership is more conducive to the entrepreneurial team's creativity? Based on the componential theory of creativity and entrepreneurial cognition theory, we explore the relationship between entrepreneurs' leadership style and team creativity, treating team cognitive diversity and environmental uncertainty as moderators and psychological empowerment as mediators. We tested our hypotheses using data gathered from 64 teams and 256 individual members from 53 new firms in China's first-tier cities such as Beijing and Shanghai. We found that there was a significant positive relation between entrepreneurs' humble leadership and psychological empowerment, and the more significant the positive correlation was when the environmental uncertainty was high. In addition, there was a significant negative relation between entrepreneurs' narcissistic leadership and psychological empowerment, and the negative relation was weaker in teams with a high team cognitive diversity value. Furthermore, both entrepreneurs' humble leadership and team psychological empowerment were significantly positively related to team creativity. While entrepreneurs' narcissistic leadership was negatively related to team creativity, and the negative relationship was weaker in teams with a high team cognitive diversity or a high environmental uncertainty value. This study has some implications for both scholars and entrepreneurs. Firstly, our study enriches the understanding of the role of leadership in entrepreneurial team creativity. Different from previous team creativity literatures, focusing on TMT and R&D team, this study is a significant attempt to demonstrate that entrepreneurial leadership style is particularly relevant to the core requirements of team creativity. Secondly, this study introduces two moderating variables, cognitive diversity and environmental uncertainty, to explore the different boundary conditions under which the two leadership styles play their roles, which is helpful for entrepreneurs to understand how to leverage leadership to improve entrepreneurial team creativity, how to recruit cognitively diverse employees to moderate the effects of inappropriate leadership to the team. Finally, our findings showed that entrepreneurs' humble leadership makes a unique contribution to explaining team creativity through team psychological empowerment.

Keywords: entrepreneurs’ leadership style, entrepreneurial team creativity, team psychological empowerment, team cognitive diversity, environmental uncertainty

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Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Abeer Kharshid, Nor Azizah Aziz, Tarek M. Elsayed

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Medication safety is always an issue. In 2015, the National Pharmaceutical Control Bureau released a statement requesting all statins manufacturers in Malaysia to include the risk of diabetes information in the drug information leaflet in response to United States Food and Drug Administration (U.S. FDA) report. However, the data regarding this warning label in Malaysia is limited, so there is still some uncertainty whether such risk can also be observed in the Malaysian population or not. The study aims to determine the effect of statins on HbA1c% in type 2 diabetic outpatients in endocrine clinics at Hospital Pulau Pinang between June 2015 and May 2016 in Malaysia. In a prospective cohort study, records of 400 type 2 diabetic patients (control group 104 patients not using statin and treatment group 296 patients using statin) were reviewed to identify demographic criteria and lab tests. The prevalence of glycemic control (Glycated hemoglobin, HbA1C ≤ 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, according to American Diabetes Association guidelines 2015. The results were presented as descriptive statistics. From 296 patients with Type 2 diabetes using statins cohort with a mean age of 57.52 ± 12.2 years, only 81 (27.4%) cases had controlled glycemia, and 215 (72.6%) had uncontrolled glycemia, CI: 95% (6.3–11.1). While the control group 104 diabetic patients had a mean age 46.1 ± 18 years and distributed among 59 (56.7%) patients with controlled diabetes and 45 (43.3%) cases, had uncontrolled glycemia, CI: 95% (5.2–10.3). The relative risk (RR) of uncontrolled glycemia in diabetic patients used statins was 1.68, and the excessive relative risk (ERR) was 68%. The absolute risk (AR) was 29.3%, and the number needed to harm (NNH) was 4. Diabetic patients using statins have more risk of uncontrolled glycemia than the patients with Type 2 diabetes non-using statins.

Keywords: diabetes mellitus, HbA1c, Malaysia, outpatients, statin, type 2, uncontrolled glycemia

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Authors: Tara Gurung, Suprina Prajapati

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Health and well being of people is a crucial for accomplishing sustainable development goals of any country. The present study focuses on quality of life of patients undergoing hemodialysis. Hemodialysis is a life sustaining treatment for patients with end stage renal disease (ESRD). Hemodialysis can bring about significant impairment in health related quality of life (HRQOL). The purpose of this study was to assess the quality of life of hemodialysis patients undergoing hemodialysis. A descriptive cross-sectional research design was utilized in total 100 samples using random sampling technique. The findings revealed that the total quality of life of the patients was 30.41±3.99 out of 100. The total physical component score was statistically significant with education status of the patients where p value for t test was 0.03 (p=0.03) and occupation of the patients where p value for the ANOVA test was 0.007 (p=0.007). The study recommended that it would be better if awareness programs regarding chronic kidney disease and life style modification in hemodialysis patients is given to the patients so that it would help patients to maintain the HRQOL.

Keywords: health and well bing, hemodialysis, patients quality of life

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Authors: Cedric Herring, Loren Henderson, Hayward Derrick Horton, Melvin Thomas

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This paper asks whether business startups benefit from having racially diverse founding ownership teams. Using nationally representative data from the Kauffman Firm Survey, the analysis examines the relationship between the racial diversity of the founding ownership teams of business startups and their net worth, revenue, debt, and profits. The analysis shows that, net of firm characteristics and human capital characteristics, startups with racially diverse founding teams have higher net worth, lower debt, and greater profits than their non-diverse counterparts. The racial diversity of ownership teams is not, however, related to startup firms’ revenues, net of other factors. The implications of these findings are explored.

Keywords: racial diversity, business startups, founding ownership teams, diversity and business performance

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Authors: Nicholas Marinus Batt, Angus Radford, Khaled Saraya

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Pulmonary Embolus Severity Index (PESI) score is a well-validated decision-making score grading mortality rates (MR) in patients with a suspected or confirmed diagnosis of pulmonary embolism (PE) into 5 classes. Thirty and 90 days MR in class I and II are lower allowing the treatment of these patients as outpatients. In a London District General Hospital (DGH) with mixed ethnicity and high disease burden, we looked at MR at 1, 3, and 7 days of all PESI score classes. Our pilot study of 112 patients showed MR of 0% in class I, II, and III. The current study includes positive Computed Tomographic Scans (CT scans) for PE over the following three years (total of 555). MR was calculated for all PESI score classes at 1, 3 & 7 days. Thirty days MR was additionally calculated to validate the study. Our initial results so far are in line with our pilot studies. Further subgroup analysis accounting for the local co-morbidities and disease burden and its impact on the MR will be undertaken.

Keywords: Pulmonary Embolism (PE), Pulmonary Embolism Severity Index (PESI) score, mortality rate (MR), CT pulmonary artery

Procedia PDF Downloads 246

Authors: Akterono Budiyati, Gita Kusumo, Teguh Putra, Fritzie Rexana, Antonius Kurniawan, Aru Sudoyo, Ahmad Utomo, Andi Utama

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The presence of the programmed death ligand-1 (PD-L1) has been used in multiple clinical trials and approved as biomarker for selecting patients more likely to respond to immune checkpoint inhibitors. However, the expression of PD-L1 is regulated in different ways, which leads to a different significance of its presence. Positive PD-L1 within tumors may result from two mechanisms, induced PD-L1 expression by T-cell presence or genetic mechanism that lead to constitutive PD-L1 expression. Amplification of PD-L1 genes was found as one of genetic mechanism which causes an increase in PD-L1 expression. In case of colorectal cancer (CRC), targeting immune checkpoint inhibitor has been recommended for patients with microsatellite instable (MSI). Although the correlation between PD-L1 expression and MSI status has been widely studied, so far the precise mechanism of PD-L1 gene activation in CRC patients, particularly in MSI population have yet to be clarified. In this present study we have profiled 61 archived formalin fixed paraffin embedded CRC specimens of patients from Medistra Hospital, Jakarta admitted in 2010 - 2016. Immunohistochemistry was performed to measure expression of PD-L1 in tumor cells as well as MSI status using antibodies against PD-L1 and MMR (MLH1, MSH2, PMS2 and MSH6), respectively. PD-L1 expression was measured on tumor cells with cut off of 1% whereas loss of nuclear MMR protein expressions in tumor cells but not in normal or stromal cells indicated presence of MSI. Subset of PD-L1 positive patients was then assessed for copy number variations (CNVs) using single Tube TaqMan Copy Number Assays Gene CD247PD-L1. We also observed KRAS mutation to profile possible genetic mechanism leading to the presence or absence of PD-L1 expression. Analysis of 61 CRC patients revealed 15 patients (24%) expressed PD-L1 on their tumor cell membranes. The prevalence of surface membrane PD-L1 was significantly higher in patients with MSI (87%; 7/8) compared to patients with microsatellite stable (MSS) (15%; 8/53) (P=0.001). Although amplification of PD-L1 gene was not found among PD-L1 positive patients, low-level amplification of PD-L1 gene was commonly observed in MSS patients (75%; 6/8) than in MSI patients (43%; 3/7). Additionally, we found 26% of CRC patients harbored KRAS mutations (16/61), so far the distribution of KRAS status did not correlate with PD-L1 expression. Our data suggest genetic mechanism through amplification of PD-L1 seems not to be the mechanism underlying upregulation of PD-L1 expression in CRC patients. However, further studies are warranted to confirm the results.

Keywords: colorectal cancer, gene amplification, microsatellite instable, programmed death ligand-1

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Authors: N. A. D. P. Niwunhella, W. G. R. C. K. Sirisena

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Appendicitis is one of the most encountered abdominal emergencies worldwide. Proper clinical diagnosis and appendicectomy with minimal post operative complications are therefore priorities. Aim of this study was to ascertain the overall management of acute appendicitis in Sri Lanka in special preference to delayed primary suturing of the surgical site, comparing other local and international treatment outcomes. Data were collected prospectively from 155 patients who underwent appendicectomy following clinical and radiological diagnosis with ultrasonography. Histological assessment was done for all the specimens. All perforated appendices were managed with delayed primary closure. Patients were followed up for 28 days to assess complications. Mean age of patient presentation was 27 years; mean pre-operative waiting time following admission was 24 hours; average hospital stay was 72 hours; accuracy of clinical diagnosis of appendicitis as confirmed by histology was 87.1%; post operative wound infection rate was 8.3%, and among them 5% had perforated appendices; 4 patients had post operative complications managed without re-opening. There was no fistula formation or mortality reported. Current study was compared with previously published data: a comparison on management of acute appendicitis in Sri Lanka vs. United Kingdom (UK). The diagnosis of current study was equally accurate, but post operative complications were significantly reduced - (current study-9.6%, compared Sri Lankan study-16.4%; compared UK study-14.1%). During the recent years, there has been an exponential rise in the use of Computerised Tomography (CT) imaging in the assessment of patients with acute appendicitis. Even though, the diagnostic accuracy without using CT, and treatment outcome of acute appendicitis in this study match other local studies as well as with data compared to UK. Therefore CT usage has not increased the diagnostic accuracy of acute appendicitis significantly. Especially, delayed primary closure may have reduced post operative wound infection rate for ruptured appendices, therefore suggest this approach for further evaluation as a safer and an effective practice in other hospitals worldwide as well.

Keywords: acute appendicitis, computerised tomography, diagnostic accuracy, delayed primary closure

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Authors: Yousif Mohamed Y. Abdallah, Eltayeb Wagi Allah Eltayeb, Mohamed E. Gar-elnabi, Mohamed Ahmed Ali

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To characterize coronary artery obstruction and related findings in ischemic heart patients using cardiac scintigraphy for the identification of myocardial ischemia, 146 patients were studied at basal conditions and also asked for fasting after night till the intravenous injection of the radiopharmaceutical. After the injection time about 15 to 20 minutes, the patient should eat a fatty meal and chocolate for the good excretion of the gall bladder, to evaluate the performance and regional wall motion of the left ventricle (LV). The results showed that the body mass index percentage in this sample was in range of 43.05 to 61.05. The number of patients who were catheter candidates were 56 with 43% and the patients that were not candidate to cathode were 74 patients with 57% of all patients. For the group of patients where type of ischemia was assessed, 29.5% of patients had reversible posterior and inferior wall, 15.1% of patients had fixed large from apex to base, 9.6% of patients had mild basal inferior wall, 4.8 % of patients had mild anterior wall, 6.2% of patients had antro-septal and 34.9% of patients had moderate ischemia.

Keywords: myocardial ischemia, myocardial scintigraphy, contrast ventriculography, coronary artery obstruction

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Authors: Lucia Salvioni, Pietro Giorgio Lovaglio, Valerio Leoni, Miriam Colombo, Luisa Fiandra

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The involvement of plasmatic surfactant protein-D (SP-D) in pulmonary diseases has been long investigated, and over the last two years, more interest has been directed to determine its role as a marker of COVID-19. In this direction, several studies aimed to correlate pulmonary surfactant proteins with the clinical manifestations of the virus indicated SP-D as a prognostic biomarker of COVID-19 pneumonia severity. The present work has performed a retrospective study on a relatively large cohort of patients of Hospital Pio XI of Desio (Lombardia, Italy) with the aim to assess differences in the hematic SP-D concentrations among COVID-19 patients and healthy donors and the role of SP-D as a prognostic marker of severity and/or of mortality risk. The obtained results showed a significant difference in the mean of log SP-D levels between COVID-19 patients and healthy donors, so as between dead and survived patients. SP-D values were significantly higher for both hospitalized COVID-19 and dead patients, with threshold values of 150 and 250 ng/mL, respectively. SP-D levels at admission and increasing differences among follow-up and admission values resulted in the strongest significant risk factors of mortality. Therefore, this study demonstrated the role of SP-D as a predictive marker of SARS-CoV-2 infection and its outcome. A significant correlation of SP-D with patient mortality indicated that it is also a prognostic factor in terms of mortality, and its early detection should be considered to design adequate preventive treatments for COVID-19 patients.

Keywords: SARS-CoV-2 infection, COVID-19, surfactant protein-D (SP-D), mortality, biomarker

Procedia PDF Downloads 61