Citations

ABSTRACT Background and Aims Out‐of‐hospital cardiac arrest stands as the primary cause of worldwide mortality. Therefore, all healthcare workers must comprehensively understand and practically apply cardiopulmonary resuscitation (CPR). To address the paucity of literature on this subject, we conducted a nationwide survey among healthcare professionals in Pakistan. Methods This nationwide cross‐sectional study was based on an online questionnaire. The sample pool comprised healthcare professionals and medical students from all over Pakistan. The survey comprised 18 questions aimed to assess the comprehension of CPR, determine the source of their basic life support (BLS) training, and evaluate their competence in performing CPR in real‐life situations. Results The sample size consisted of 951 participants from Pakistan. A total of 712 responders (75%) reported having received CPR or CPR with an Automated External Defibrillator (AED) course, and the same percentage reported that their respective universities had organized the course. The responders reported that the BLS course was made mandatory in only 60% of cases. Most of the respondents were first‐year medical students (21%) and postgraduates (21%). Most of the respondents (78%) professed that the courses had been theoretical as well as practical, and 66% felt confident enacting CPR in out‐of‐hospital settings. Overall, no province was able to achieve a score of greater than 50% when assessed about their knowledge regarding cardiac arrest and CPR. Conclusion This study provides a detailed insight into Pakistan healthcare workers' CPR knowledge and perceptions belonging to different provinces, institutes, designations, and specialties. The participants reported being confident in performing CPR but demonstrated gaps when assessed regarding the revised guidelines and their performance in different scenarios. There is room for further research in overcoming the language barriers and other discrepancies faced by this study.

AimsPolymyalgia rheumatica (PMR) is a chronic autoimmune disorder that mainly affects older adults. Pulmonary disease in PMR is rare but may be under‐recognized and pathological descriptions thereof are few. We aimed to characterize diffuse parenchymal lung disease (DPLD) in PMR.Methods and resultsInstitutional archives were searched for patients having PMR and DPLD with lung tissue sampling. After excluding cases with infection, concomitant rheumatoid arthritis, or smoking‐related DPLD only, 11 patients (9 women, median age 75 years) were enrolled. Clinical history and pathology slides were reviewed. One of the 11 patients (9%) had concomitant giant cell arteritis; the remaining patients had no other rheumatological diseases. All had been treated for PMR with immunosuppression, and most presented years later (median 6 years) with non‐specific respiratory symptoms. Radiographically, bilateral ground‐glass opacities and reticulation were typical and were usually lower lobe predominant. Histologically, fibrosis was seen in 8 of 11 (73%) patients and was unclassifiable in four; non‐specific interstitial pneumonia was encountered in three patients, and usual interstitial pneumonia was seen in only one case. Evidence of acute lung injury occurred in 9 (82%) patients, including three with acute lung injury only, usually manifesting as organizing pneumonia. Diffuse alveolar haemorrhage was seen in four cases (29%), including two patients with haemoptysis and capillaritis.ConclusionsOur data corroborate prior reports of clinically significant DPLD in some patients with PMR. Histopathological findings mirror other rheumatological disorders and include diffuse alveolar haemorrhage with capillaritis. Additional studies are warranted to clarify the association between PMR and DPLD.

ABSTRACT Cardiogenic shock (CS) remains a high morbidity and mortality condition worldwide frequently complicating acute myocardial infarction (AMI) and decompensated heart failure (HF). Within the management of CS, mechanical circulatory support (MCS) devices play a critical role in maintaining hemodynamic stability, preserving end‐organ perfusion and bridging patients through to recovery, implantation of durable support or transplantation. Despite their use, optimal timing of initiation, as well as patient and device selection remain unclear. This review explores the current landscape of MCS devices, surrounding evidence and key distinctions between devices. With increasing acknowledgment for the heterogeneity of CS, understanding the strengths and limitations of each device remains crucial to improving outcomes in this high‐risk population.

ABSTRACT Background In healthy controls, higher gastric accommodation (GA) was associated with slower gastric emptying (GE) of solids. Aims In patients with gastroparesis: (1) To investigate the association between GA and GE of solids. (2) To assess the prevalence of abnormally high GA. Methods An electronic medical records (EMR) review (2010–2024) was conducted on 745 adult patients with measured GA following 300 kcal Ensure using SPECT, and scintigraphy‐based GE of solids (320 kcal, 30% fat, egg meal). Among these patients, 284 had gastroparesis (GE < 25% emptied at 2 h or < 75% emptied at 4 h). Spearman correlation analysis examined associations between GA volume or ratio and GE at 1, 2, and 4 h, and GE T 1/2 . Results Weak positive correlations were observed between GA volume and GE of solids % at 1 and 2 h (respectively R s = 0.148, p = 0.0234, and R s = 0.121, p = 0.042). In addition, there was a correlation between GA ratio and GE of solids % at 2 h ( R s = 0.143, p = 0.0160). However, there were no significant correlations of GA with GE % at 4 h or GE T 1/2 . Among the 284 patients with gastroparesis, we had documented increased GA, assessed by postprandial minus preprandial gastric volume (> 640 mL), in 7.75%, and increased GA by GA ratio > 3.85 in 22.9%. Conclusions Among patients with gastroparesis, higher GA is associated with accelerated GE of solids in the first 2 h, though the effect size is small. There is no significant effect on delayed GE at 4 h or GE T 1/2 .

AbstractPurposeThe Collaborative care model (CoCM) is the leading model for integrating behavioral health into primary care for patients with major depressive disorder (MDD). However, CoCM requires engagement and ongoing participation. We aimed to assess whether two area‐based measures, the area‐deprivation index (ADI) and rurality, were associated with enrollment, participation, and outcomes with CoCM.MethodsThis was an observational analysis of Mayo Clinic patients eligible for CoCM: adults aged ≥18 years, empaneled in primary care, and with a PHQ‐9 of ≥10. We operationalized ADI as quintiles with Q1 being least deprived and Q5 being most deprived and rurality using RUCA codes with two categories: urban and rural. We evaluated enrollment in CoCM, drop out defined by leaving the program early, the count and type of contacts with the care coordinator, and clinical improvement measured using the PHQ‐9.FindingsWe identified 54,030 individuals with 16,532 (30.6%) residing in rural areas and 11,122 (20.6%) residing in the most deprived ADI quintile (Q5). Living in a rural area was associated with lower enrollment in CoCM (–2.3 percentage points [95% confidence interval (CI): –2.5, 2.2]), longer length in CoCM (18.6 days [95% CI: 5.7, 31.5]), more contacts with the care coordinator (1.1 contacts [95% CI: 0.2, 2.0]), and worse response and remission. In contrast, ADI Q5 was only associated with worse response and remission.ConclusionsRurality was associated with lower enrollment, greater engagement, and worse clinical outcomes. More work may be needed to address enrollment barriers for individuals living in rural areas to improve clinical outcomes.

Introduction Differentiated thyroid cancer (DTC) is the most common endocrine malignancy, with a high 5-year survival rate of approximately 98%. Despite advances in diagnosis and treatment, up to 20% of patients experience recurrence, adversely affecting their quality of life. Predictive models have been developed to assess recurrence risk and guide clinical decision-making, but these models often face limitations such as retrospective design, lack of diversity in study populations and absence of external validation. The primary aim is to externally validate existing predictive models for DTC recurrence using prospective data from a diverse Latin American cohort. The secondary aim is to explore opportunities for model recalibration to improve their performance in our population. Methods and analysis The CaTaLiNA study is a multicentre prospective observational study conducted across 10 hospitals in five Latin American countries, including Ecuador, Peru, Uruguay and Mexico. Patients aged 18 years or older receiving treatment for DTC, such as the first thyroid surgery, active surveillance or radiofrequency ablation will be included. Recruitment will occur from November 2023 to June 2025, with follow-up extending until June 2028. Data collection will include baseline clinical, surgical and histological characteristics, treatment details and follow-up outcomes. Statistical analysis will follow the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis guidelines, using imputation strategies for missing data and evaluating calibration and discrimination of the prediction models. Calibration measures include the ratio of expected and observed events, calibration slope and calibration plot, while discrimination will be assessed using the C-index and area under the receiver operating characteristic curve. Ethics and dissemination This study protocol was approved by Comité de Ética de Investigación en Seres Humanos de la Universidad San Francisco de Quito USFQ ‘CEISH-USFQ’ APO-010–2023-CEIHS-USFQ Oficio No. 161-2023-CA-23030M-CEISH-USFQ. Results will be disseminated via peer-reviewed publications.

Objective To assess the association between educational level and cardiovascular age acceleration metric derived from ECG, and to determine whether this association is mediated by established cardiovascular disease (CVD) risk factors. Design Prospective population-based cohort study (the Tromsø Study). Setting General population of the Tromsø municipality, Norway. Participants The study sample consisted of 4367 participants of the Tromsø Study, who took part in both Tromsø6 (2007–2008) and Tromsø7 (2015–2016), had a 12-lead ECG obtained at Tromsø7 and did not report a history of heart attack, stroke or atrial fibrillation. Primary outcome measures δ-age, a biomarker of cardiovascular ageing, is defined as the difference (in years) between an individual’s ECG-predicted heart age and their chronological age. ECG-predicted heart age was estimated using a previously validated deep neural network. Results Our findings indicate an inverse association between education and δ-age, with a regression coefficient per increment increase in education of −0.24 (95% CI −0.41 to –0.07) in the overall sample, −0.38 (95% CI −0.59 to –0.16) for women and −0.04 (95% CI −0.31 to 0.23) for men. Participants with the highest level of education (university/college for 4 or more years) had the lowest estimated δ-age with a regression coefficient of −0.69 years (95% CI −1.23 to –0.16) compared with the group with primary education for the overall sample, −1.05 years (95% CI −1.73 to –0.37) for women and −0.15 years (95% CI −1.03 to 0.73) for men. CVD risk factors mediated up to 75% of the association between overall education and δ-age, and 80% of the association among those with the highest education level (university/college for 4 or more years). Among women, 50% of the effect of overall education on δ-age was mediated by CVD risk factors, rising to 53% in the category with the highest level of education. However, in the subsample of men, there was no significant association between education and δ-age, and the mediation analysis produced natural direct and indirect effects pointing in opposite directions. Conclusions Cardiovascular ageing is inversely associated with educational level, an effect that appears to be largely mediated through established risk factors.

Background The optimal timing and type of venous thromboembolism chemoprophylaxis (VTEp) for adults with acute traumatic brain injury (TBI) remains unknown. This systematic review synthesized evidence on the timing and type of VTEp in adults with TBI and highlights evidence gaps. Methods We searched Ovid MEDLINE, Embase, and the Cochrane Library through November 4, 2024 for English language, randomized or non-randomized studies with a comparator that reported VTEp timing or agent in adults with acute TBI, and reported intracranial hemorrhage progression (ICHP), VTE, pulmonary embolism (PE), deep vein thrombosis (DVT), neurosurgical intervention (NSI), adverse events (AEs), length of stay (LOS), function, or mortality. Risk of bias (ROB) was assessed with ROBINS-I as low, moderate, serious, or critical risk in studies that used advanced analytic methods (AAMs) to control selection bias; all other studies were deemed critical risk. We qualitatively synthesized evidence and focused text reporting on studies with AAM. Results From 738 citations, 21 non-randomized studies met criteria (1 moderate, 20 critical ROB): 16 on VTEp timing, 7 on agents. Seven studies used AAM. For VTEp timing (five AAM studies), one study of adults with mostly mild TBI found no significant difference between Early and Late VTEp on ICHP (moderate ROB); no timing studies with AAM reported ICHP for adults with moderate or severe TBI. Findings were mixed for VTE timing on NSI and PE. Early VTEp was associated with fewer DVTs. There was no difference in mortality or serious AEs by VTEp timing. For VTEp agents, three studies with AAM found no significant difference between low molecular weight heparin (LMWH) and unfractionated heparin (UH) on ICHP, PE, DVT, and serious or overall AEs. Results were mixed for LMWH versus UH effects on NSI after VTEp, VTE, LOS and mortality. TBI severity labeling varied across studies and within measures, reducing comparability. Conclusions Clinical evidence on the timing and type of VTEp for adults with acute TBI is of insufficient quality for clinical decision-making. Prospective research designs, standardization of TBI severity labeling, and improved reporting of interventions and outcomes would advance the field. PROSPERO registration number CRD42023421534 Level of evidence Systematic Review, Level IV

INTRODUCTION A retrospective cohort study on patients aged &lt; 18 years included in the Society of Critical Care Medicine: Viral Infection and Respiratory Illness Universal Study registry from March 2020 to April 2024 with an objective of calculating the prevalence of sepsis as defined by the Phoenix Sepsis Score (PSS) and to validate the PSS with respect to outcomes in children with COVID-19. METHODS Linear mixed-effects regression was used to examine the relationship between the PSS and hospital length of stay after controlling for confounding factors. The performance of the PSS was assessed using the receiver operating characteristic (ROC) and the precision-recall curve (PRC). Cross-validation was performed using leave-one-out cross-validation. RESULTS Out of 1731 patients (58 hospitals), 326 (18.8%) met criteria for sepsis and 167 (9.7%) for septic shock. The overall mortality was 1.4% (25/1731), with significant differences between nonseptic (10/1405, 0.7%) and both sepsis (15/326, 4.6%) and septic shock (9/167, 5.4%) groups. After adjusting for confounders, the septic group was associated with a longer hospital length of stay than the nonseptic group. One unit increase in the numeric PSS led to a 70% increase in risk of mortality (odds ratio 1.70; P &lt; .001). The area under the ROC curve was 0.80 and the area under the PRC curve was 0.13. The threshold of ≥ 2 for detection of mortality had a sensitivity of 0.63, specificity of 0.82, and positive predictive value of 0.05. CONCLUSION Phoenix Sepsis Criteria retain its validity in identifying sepsis in children with COVID-19 and can be used in further epidemiological studies in this population

Abstract Background We retrospectively assessed volumetric response of myxoid liposarcoma (MLPS) with preoperative radiotherapy (RT) and sought to identify disease and treatment characteristics associated with response. Patients and methods We identified all patients with a histologic diagnosis of MLPS who received preoperative RT from 2013 to 2021 at our institution. We used cone beam computed tomography (CBCT) to assess changes in tumor volume and greatest dimension during treatment. Tumors were contoured on CBCT images prior to treatment and at the end of each week of RT. Percentage change in tumor volume and greatest dimension were calculated based on pre-treatment and final week contours. Patients with tumors incompletely visualized on CBCT were excluded from volume analysis but included on greatest dimension analysis. Magnetic resonance imaging (MRI) was used to evaluate pre- and post-RT radiographic features. Surgical pathology was reviewed to record pathologic characteristics. Results Twenty patients met inclusion criteria. Most tumors (18/20) were low grade. The most frequent dose/fractionation scheme was 50 Gy in 25 fractions (16/20), with 3 patients receiving 36 Gy in 18 fractions. Median pre-RT volume and greatest dimension were 120 cc (interquartile range [IQR]: 56–399) and 11.2 cm (IQR: 8.4–14.1), respectively. Median percentage change in volume and greatest dimension were -37% (IQR: -57 to -29) and -10% (IQR: -20 to -7). All evaluable tumors decreased in volume during RT. Between pre- and post-RT MRI, most patients had a decrease in intratumoral (16/20) and peritumoral edema (11/20). Sixteen patients exhibited extensive pathologic response. There were no significant associations between radiographic and pathologic features and volumetric change. Local failure at 3 years was 9% (95% confidence interval: 1–59). Conclusions We report significant decreases in MLPS tumor size during preoperative RT. There may be a role for adaptive RT planning to reduce target volumes and minimize RT-associated morbidity.