Risultati per: Come si esegue la raccolta delle urine delle 24 ore

Circulation, Volume 146, Issue Suppl_1, Page A127-A127, November 8, 2022. Background:Urine output (UO) measurement utility after out-of-hospital cardiac arrest (OHCA) survivors who undergo targeted temperature management (TTM) is not well understood.Methods:We included 247 comatose adult patients who underwent TTM after OHCA between 2007 and 2017 and excluded those on maintenance dialysis. Groups were defined based on mean hourly UO during the first 24 hours: Group 1 (1 ml/kg/hr, n=93). Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria were used to define and stage acute kidney injury (AKI). Multivariable analysis was used to evaluate in-hospital mortality.Results:In-hospital mortality decreased as 24-hour mean UO increased (56.2% [41/73] vs 29.6% [24/81] vs 18.3% [17/93] in Groups 1, 2 and 3, respectively; adjusted OR 0.93 per 0.1 ml/kg/h higher, 95% CI 0.87-0.99, p = 0.03), and UO < 0.5 ml/kg/hr was strongly associated with in-hospital mortality (adjusted OR 4.2 [1.6-10.8], p=0.003). In-hospital mortality varied by the KDIGO stage and UO group (Figure), lowest in KDIGO stage 0 and highest in KDIGO stage 3. Both UO (adjusted OR 0.92 per 0.1 ml/kg/h higher, p = 0.002) and KDIGO stage (adjusted OR 1.62 per each stage, p = 0.002) were associated with in-hospital mortality when included in the same model. Among patients with KDIGO stage 0, lower UO portended higher mortality (Figure). Likewise, among patients with low UO (group 1), a higher KDIGO stage predicted higher mortality.Conclusion:Amongst OHCA survivors undergoing TTM, higher UO is incrementally associated with lower in-hospital mortality. The lowest mortality was observed at UO >=1 ml/kg/h, suggesting this as a target for resuscitation in OHCA patients undergoing TTM. Low UO remains associated with in-hospital mortality even when accounting for AKI by creatinine criteria, suggesting that oliguria is a more sensitive prognostic marker in the early post-OHCA phase.

Circulation, Volume 146, Issue Suppl_1, Page A14997-A14997, November 8, 2022. Introduction:Long-term efficacy has not been widely evaluated for computerized cognitive training (CCT) to improve cognition and reduce mortality. The purpose of this study was to evaluate long-term efficacy of CCT to reduce risk of death and test additional predictors of long-term mortality among patients with heart failure (HF).Methods:In this prospective study, a subset of 142 patients with HF were included from the parent 3-arm RCT testing CCT using BrainHQ to improve memory. Mortality data were collected from electronic health records, family caregivers, physicians or nurses during 24 months after the randomization between Mar 2017 and Dec 2020. Multiple logistic regressions were performed with 2 predictor variables (group and an additional predictor) given the small number of death cases. Predictors tested were age, baseline global cognition, memory, working memory, depressive symptoms, and health-related quality of life (HRQL).Results:The sample was 52% women/48% men; mean age 65 (SD=13) years; and race 13% Black, 1% more than one race, 1% Native Hawaiian/Pacific Islander, and 85% White. Mean left ventricular ejection fraction was 46% (SD=14). Of 142 patients, 16 (11.3%) died; 4 (8.3% of 48) in CCT group and 12 (12.8% of 94) in control groups (p=.429). The patients who died were older by 9 years (p=.002), had more depressive symptoms (p=.022), and poorer global cognition (p=.009), memory (p=.069), and HRQL (p=.080) at baseline. In logistic regression models, CCT group was not a statistically significant predictor of 24-month mortality (OR=0.65, 95% CI=0.28-1.15). Patients with better global cognition and memory were less likely to die over 24 months by 27% (OR=0.73, 95% CI=0.58-0.90) and 19% (OR=0.81, 95% CI=0.67-0.99), respectively. Patients with more depressive symptoms (OR=1.10, 95% CI=1.00-1.21) and older age (OR=1.08, 95% CI=1.01-1.14) were more likely to die over 24 months. Working memory and HRQL did not predict mortality.Conclusions:CCT using BrainHQ did not show long-term efficacy on reducing 24-month mortality in HF. Efficacious interventions are needed that are targeted at underlying etiologies of cognitive dysfunction and depressive symptoms in older patients with HF.

Circulation, Volume 146, Issue Suppl_1, Page A14965-A14965, November 8, 2022. Introduction:After myocardial infarction (MI), many women experience depressive symptoms and reduced quality of life (QoL), both of which may be influenced by sedentary behavior (SB), physical activity (PA), and sleep. We examined associations of objectively-measured 24-hour activity with depressive symptoms and QoL, and simulated effects of reallocating 30 mins of SB with other activities on the outcomes.Methods:We used baseline data (≥ 2 months post-MI) of a multicenter trial of stress management in women with MI. Depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), global QoL (PROMIS-mental/physical health), and disease-specific QoL (Seattle Angina Questionnaire-7 [SAQ-7]) were assessed. Participants wore wrist-actigraphs for 7 days. We used a GGIR R-package to classify 24-hour activity into SB, light PA, moderate-to-vigorous PA (MVPA), and sleep. Isotemporal substitution models were used to simulate time reallocation effects of SB on the outcomes adjusting for age, race/ethnicity, and income.Results:Figure 1 shows the 24-hour activity pattern in the sample (n = 87, age = 59.8 ± 12.8y, 67% non-Hispanic white). Greater total SB time (r = -0.34, p < .01) and prolonged (≥ 30mins/bout) SB bouts (r = -0.33, p < .01) were associated with worse SAQ-7 physical limitation but were not associated with other outcomes. The reallocation effects of SB to MVPA or sleep were associated with improved QoL and depressive symptoms (Figure 2).Conclusion:Women with MI had long total SB time with prolonged patterns, both of which are known to increase mortality risk. Breaking up SB bouts, and replacing SB with MVPA or sleep may improve QoL and depressive symptoms in women with MI.

Circulation, Volume 146, Issue Suppl_1, Page A10574-A10574, November 8, 2022. Introduction.A growing body of research shows an association between caregiving and increased cardiovascular disease (CVD) risk. Blood pressure variability (BPV) is known as a surrogate marker of CVD development. However, BPV in caregivers has rarely been used to assess for CVD risk, especially in relation to psychological and behavioral factors. The purpose of this study was to examine the associations of psychological symptoms (i.e., caregiving burden and depressive symptoms) and sleep quality with 24-hour BPV among caregivers of individuals with chronic illness.Methods.Thirty caregivers (25 female; 27 non-Hispanic white; mean age 62 years) who provided in-home care were recruited from the community in this cross-sectional study. Caregiver demographic data, caregiving stress (Zarit Burden Interview), and depressive symptoms (Patient Health Questionnaire-9) were obtained. Sleep quality (i.e., sleep efficiency, wake after sleep onset, the number of awakenings) was assessed using an actigraph for 7 consecutive days. Systolic and diastolic BPV over 24 hours, while awake (daytime), and while sleeping (night time) were obtained by ambulatory BP monitoring. Pearson’s correlations and multiple linear regression were conducted to examine associations of psychological symptoms and sleep quality with BPV.Results.Sleep efficiency was negatively correlated with diastolic BPV while awake (r= -0.368,p= 0.045). The number of awakenings during sleep was positively correlated with systolic BPV while awake (r= 0.426,p= 0.019) and diastolic BPV while awake (r= 0.422,p= 0.020). Caregiving stress and depression were not correlated with BPV. After controlling for age and mean arterial pressure, the number of awakenings was associated with increased systolic BPV over 24 hours (B= 0.194,p= 0.018) and systolic BPV while awake (B= 0.280,p= 0.002), respectively.Conclusion.Caregivers’ disrupted sleep represented by frequent awakenings may play a role in increased CVD risk as evidenced by increased BPV. While future large clinical studies should be conducted to confirm these findings, improving sleep quality would need to be considered for CVD prevention strategies for caregivers.

Objective
This study aims to assess the prevalence of early initiation of breast feeding (EIBF) and associated factors among mothers having children less than 2 years of age in Ethiopia.

Design
Community-based cross-sectional study.

Setting
In this analysis, data from 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) was used. The survey included all the nine regional states and two city administrations of Ethiopia.

Participants
We extracted data of 2054 mothers who had last-born children and those mothers who ever breast fed or still breast feeding their children during the survey from the 2019 EMDHS datasets.

Main outcome measures
We performed a two-stage multilevel mixed-effects logistic regression to identify individual and community-level determinants of EIBF. In the final model, variables with a p-value less than 5% and an adjusted OR with a 95% CI were reported as statistically significant variables with EIBF.

Result
The prevalence of EIBF among mothers having children aged 0–23 months was 73.56% (95% CI: 71.65% to 75.47%). Women who delivered at a health facility (adjusted OR (AOR)=1.98; 95% CI: 1.39 to 2.79) and have children with birth order second–fourth (AOR=1.76; 95% CI: 1.24 to 2.49) were more likely to initiate early breast feeding than their counterparts. On the other hand, women who gave birth by caesarean section (AOR=0.21; 95% CI: 0.13 to 0.33), had multiple births (AOR=0.35; 95% CI: 0.13 to 0.92) and had postnatal check-up (AOR=0.62; 95% CI: 0.44 to 0.91) were less likely to practise EIBF as compared with their counterparts. Region of residence of women was also significantly associated with EIBF.

Conclusion
In this study, the overall prevalence of EIBF was good. Place of delivery, mode of delivery, postnatal check-up, type of birth, birth order and region were factors significantly associated with EIBF. Therefore, government and stakeholders need to show commitment to improve access and utilisation of basic maternal health services to increase the practice of EIBF.

Objective
With advances in mobile technology, smartphone-based point-of-care testing (POCT) urinalysis hold great potential for disease screening and health management for clinicians and individual users. The purpose of this study is to evaluate the analytical performance of Hipee S2 POCT urine dipstick analyser.

Design
A multicentre, hospital-based, cross-sectional study.

Setting
Analytical performance of the POCT analyser was conducted at a clinical laboratory, and method comparison was performed at three clinical laboratories in China.

Participants
Urine samples were collected from 1603 outpatients and inpatients at three hospitals, and 5 health check-up population at one of the hospitals.

Outcome measures
All tests were performed by clinical laboratory technicians. Precision, drift, carry-over, interference and method comparison of Hipee S2 were evaluated. Diagnostic accuracy of semiquantitative albumin-to-creatinine ratio (ACR) for albuminuria was carried out using quantitative ACR as the standard.

Results
The precision for each parameter, assessed by control materials, was acceptable. No sample carry-over or drift was observed. Ascorbate solution with 1 g/L had an inhibitory effect for the haemoglobin test. Agreement for specific gravity (SG) varied between moderate to substantial ( values 0.496–0.687), for pH was moderate ( values 0.423–0.569) and for other parameters varied between substantial to excellent ( values 0.669–0.991), on comparing the Hipee S2 with laboratory analysers. The semiquantitative microalbumin and creatinine were highly correlated with the quantitative results. The sensitivity of semiquantitative ACR to detect albuminuria was 87.2%–90.7%, specificity was 70.7%–78.4%, negative predictive value was 85.3%–87.9% and positive predictive value was 73.9%–83%.

Conclusions
Hipee S2 POCT urine analyser showed acceptable analytical performance as a semiquantitative method. It serves as a convenient alternate device for clinicians and individual users for urinalysis and health management. In addition, the POCT semiquantitative ACR would be useful in screening for albuminuria.

Introduction
Perfusion imaging according to the DEFUSE 3 or DAWN criteria has been applied to select patients with large vascular occlusive stroke undergo endovascular therapy (EVT) in the extended time window. Emerging studies have shown that collateral blood flow-based criteria may be as effective as DEFUSE 3 and DAWN criteria for the evaluation of EVT eligibility beyond 6 hours. We will conduct a meta-analysis to compare collateral status-based criteria with DEFUSE 3 or DAWN criteria.

Methods and analysis
We will conduct a search for the studies comparing collateral blood flow-based imaging with CT perfusion using the DEFUSE 3 or DAWN criteria in selecting patients with acute ischaemic stroke undergo EVT in the Web of Science, PubMed, EMBASE and the Cochrane Library databases between November 2017 and November 2021. We will also search the sources of grey literature, the reference lists of included studies and the newly published studies during the review period. Two investigators will independently screen the eligible studies and extract data. The study quality will be assessed by using the Newcastle-Ottawa Scale or the Cochrane risk bias tool. Stata V.17 will be used to conduct data analysis.

Ethics and dissemination
Patient informed consent and ethics approval are not necessary as this study uses only published studies. The finding of this meta-analysis will be propagated through committee conferences or peer-reviewed journals.

PROSPERO registration number
CRD42021281928.

Objective
The objective of this study was to evaluate how urine drug screening (UDS) frequency is associated with retention in opioid agonist treatment (OAT).

Methods
Data for this retrospective cohort study of 55 921 adults in OAT in Ontario, Canada, were derived from administrative sources between 1 January 2011 and 31 December 2015. All patient information was linked anonymously across databases using encrypted health card numbers. Descriptive statistics were calculated for comparing UDS frequency groups using standardised differences (d) where d less than 10% indicated a statistically significant difference. A logistic regression model was then used to calculate ORs adjusting for baseline covariates, including sex, age, location of residence, income quintile, mental disorders, HIV status and deep tissue infections.

Results
Over 70% of the cohort had four or more UDS tests per month (weekly or more UDS). Significant associations were observed between UDS frequency and 1-year treatment retention in OAT biweekly (adjusted OR (aOR)=3.20, 95% CI 2.75 to 3.75); weekly UDS (aOR=6.86, 95% CI 5.88 to 8.00) and more than weekly (aOR=8.03, 95% CI 6.87 to 9.38) using the monthly or less groups as the reference.

Conclusion
This study identified an association between weekly UDS and 1-year treatment retention in OAT. There is an active discussion within Canada about the utility of UDS. The lack of evidence for the impact of UDS on retention has left it open to some to argue they simply provide a barrier to patient engagement. Therefore, it is timely of this study to demonstrate that more frequent urine testing is not associated with a reduction in treatment retention.

New England Journal of Medicine, Volume 387, Issue 15, Page 1373-1384, October 2022.

This cross-sectional study investigates the prevalence of 24-hour activity pattern phenotypes in older adults and tests which phenotypes are associated with depression symptoms and cognitive performance.

Objective
This study examined profile and treatment outcomes of young patients with tuberculosis (TB) registered at a district TB centre under the National TB Elimination Programme in Faridabad district of Haryana state in India.

Methods
In this secondary data analysis, we studied the records of young TB patients aged 15–24 years registered under a TB programme during October 2013–December 2017 in Faridabad district of Haryana state.

Results
We analysed records of 5257 young patients with TB. Majority (58.7%) were patients with pulmonary TB and most of them (83.6%) were registered as new patients. Majority of the young patients with TB (93.2%) had a successful treatment outcome, and patients having sputum result 2+ or less and patients who did not have a previous history of TB were found to be significantly associated with a successful treatment outcome on multivariable analysis.

Conclusion
There was a high treatment success rate noted in young patients with TB. More focus is needed to patients having a history of TB and sputum result >2+. Targeted interventions can be designed for these groups in future programmatic strategies to reduce disease burden in this section of young population.

Annals of Internal Medicine, Volume 175, Issue 10, Page 1374-1382, October 2022.

Objective
This study aimed to assess the validity of three commonly used (Tanaka, Kawasaki, INTERSALT) methods based on spot urinary sodium excretion against the 24-hour urinary sodium excretion to estimate the dietary salt intake in Bangladesh.

Design
A population-based cross-sectional survey.

Setting
A cross-sectional survey was done in an urban and a rural area of Bangladesh in 2012–2013.

Participants
418 community living residents aged 40–59 years participated in the survey and data of 227 subjects who had complete information were analysed for this validation study.

Outcome measures
The Bland-Altman method was used to evaluate the agreement between the estimated and measured 24-hour urinary sodium. The estimated average salt intake from Tanaka, Kawasaki and INTERSALT methods were plotted against 24-hour urinary sodium excretion.

Results
The mean 24-hour estimated salt intake was 10.0 g/day (95% CI 9.3 to 10.6). The mean estimated urinary salt by Tanaka, Kawasaki and INTERSALT methods were 8.5 g/day (95% CI 8.2 to 8.8), 11.4 g/day (95% CI 10.8 to 12.0) and 8.8 g/day (95% CI 8.6 to 9.0), respectively. Compared with the estimated mean salt intake from 24-hour urine collection, the Bland-Altman plot indicated the mean salt intake was overestimated by the Kawasaki method and underestimated by Tanaka and INTERSALT methods. The linear regression line showed the Kawasaki method was the least biased and had the highest intraclass correlation coefficient (0.57, 95% CI 0.45 to 0.67).

Conclusion
Tanaka, Kawasaki and INTERSALT methods were not appropriate for the estimation of 24-hour urinary sodium excretion from spot urine samples to assess dietary salt intake in Bangladesh. Among the three methods, the Kawasaki method has the highest agreement with the 24-hour urinary sodium excretion concentration in this population.

Objectives
To retrospectively evaluate ophthalmological and neurological outcomes in a Swedish cohort of infants born before 24 weeks gestational age (GA) and explore risk factors for visual impairment.

Setting
Eye and paediatric clinics in Sweden.

Participants
Infants screened for retinopathy of prematurity (ROP) (n=399), born before 24 weeks GA, 2007–2018. Cases were excluded if ophthalmological follow-up records could not be traced.

Primary and secondary outcome measures
Primary outcomes were ophthalmological, including visual acuity (VA), refractive error, strabismus, nystagmus and cerebral visual impairment (CVI). Secondary outcomes comprised neonatal and neurological morbidities. Data were retrospectively retrieved from medical records.

Results
The 355 assessed children had a median GA of 23 weeks and 2 days and a median birth weight of 565 g. At the last available ophthalmological examination, the median age was 4.8 years (range 0.5–13.2 years). Nystagmus was recorded in 21.1%, strabismus in 34.8%, and 51.0% wore spectacles. Seventy-three of 333 (21.9%) were visually impaired, defined as being referred to a low vision clinic and/or having a VA less than 20/60 at 3.5 years of age or older. ROP treatment was a significant risk factor for visual impairment (OR 2.244, p=0.003). Visually impaired children, compared with children without visual impairment, more often had neurological deficits such as intellectual disability 63.8% versus 33.3% (p

Objective
To analyse the prevalence and heart rate variability (HRV) characteristics of premature ventricular contraction (PVC) detected by 24-hour Holter among Chinese outpatients with palpitations.

Design
A cross-sectional study.

Setting
This study was conducted in a tertiary hospital.

Participants
A total of 4754 outpatients who received 24-hour Holter for palpitations.

Main outcome measures
Prevalence, HRV time-domain and frequency-domain analyses of 24-hour Holter, and echocardiographic parameters were assessed. Propensity score matching (PSM) was applied to balance baseline variables (age, gender) to decrease the bias between comparison groups.

Results
The prevalence of PVC was 67.7% (3220/4754), and was higher in men than women (69.9% vs 66.0%, p=0.004); the prevalence of frequent PVCs (PVC burden≥5%) was 7.7% (368/4754). Older patients had the highest frequency of PVC among all patients. However, among 3220 patients with PVC, younger patients’ PVC burden was much higher. Matched 1:1 by age and gender, the HRV time-domain parameters in patients with PVC were all lower than those in patients without PVC (all p

Question: A 24-year-old woman with a history of immune thrombocytopenic purpura presents to clinic with a 3-month history of hematochezia. She had associated left lower quadrant abdominal pain and tenesmus. She had been diagnosed with immune thrombocytopenic purpura 5 months before presentation at which time she was started on prednisone 10 mg daily. Laboratory analysis was notable for a platelet count of 27,000/μL, hemoglobin of 13.2 g/dL, and protein gap of 4.8 g/dL. Physical examination was unremarkable.