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The safety of exercise practice by individuals with cardiovascular disease is due to a good clinical evaluation to identify patients with a higher risk of adverse events, thus the study of simple variables capable of predicting the rate of events during exercise is relevant and may provide better screening tools to be applied in the clinical practice. The study aimed to evaluate if clinical and physical parameters can predict the rate of adverse events during exercise-based cardiac rehabilitation. This was a cohort study that followed 73 patients during 24 sessions of exercise. Were registered 217 simple adverse events, at a rate of 2.5 events per hour of exercise. We found that higher adiposity, worse pulmonary function, lower functional capacity, and reduced heart rate variability were significant and acceptable predictors of adverse events during exercise, according to the ROC curve analysis. We state that these simple physical parameters may be useful for cardiac risk stratification in cardiac rehabilitation programs with low resources, contributing to its safety.

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Protein-energy wasting and inflammation are major risk factors for complications in hemodialysis patients. As these risk factors are triggered by a pro-inflammatory state, oxidative stress and hemodynamic dysfunction, which overlap in hemodialyzed subjects, we aimed to assess the efficacy of a cost-effective and straightforward screening tool, the Prognostic Inflammatory and Nutritional Index (PINI), in regularly screening maintenance hemodialysis (MHD) patients, to detect early signs of inflammation and malnutrition. A 12-month follow-up was carried out on a cohort of 102 adult patients undergoing maintenance dialysis, during which the Prognostic Inflammatory and Nutritional Index (PINI) was calculated using the formula alpha1-Acid Glycoprotein (AGP) × C-reactive protein (CRP)/albumin (ALB) × transthyretin (TTR). A PINI score < 1 was considered normal. The patients were stratified based on their PINI score: 66 patients (64.70%) had a normal score, below 1, while 36 patients (35.30%) had a PINI score ≥ 1. Despite the absence of clinical evidence of inflammation at enrollment, the latter group exhibited higher levels of CRP. During the follow-up period, all patients with a PINI score ≥ 1 experienced at least one acute event, compared to only 6% of patients with a normal PINI score, which presented COVID-19 infection as an acute event. The evaluation of the PINI can effectively identify the silent malnutrition-inflammation syndrome and predict the risk of acute events. This straightforward test appears to be a rapid tool that is independent of the examiner's experience and subjectivity, thereby potentially reducing hospitalization costs.

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Background: COPDPredict™ is a novel digital application dedicated to providing early warning of imminent COPD (chronic obstructive pulmonary disease) exacerbations for prompt intervention. Exacerbation prediction algorithms are based on a decision tree model constructed from percentage thresholds for disease state changes in patient-reported wellbeing, forced expiratory volume in one second (FEV1) and C-reactive protein (CRP) levels. Our study determined the validity of COPDPredict™ to identify exacerbations and provide timely notifications to patients and clinicians compared to clinician-defined episodes. Methods: In a 6-month prospective observational study, 90 patients with COPD and frequent exacerbations registered wellbeing self-assessments daily using COPDPredict™ App and measured FEV1 using connected spirometers. CRP was measured using finger-prick testing. Results: Wellbeing self-assessment submissions showed 98% compliance. Ten patients did not experience exacerbations and treatment was unchanged. A total of 112 clinician-defined exacerbations were identified in the remaining 80 patients: 52 experienced 1 exacerbation; 28 had 2.2±0.4 episodes. Sixty-two patients self-managed using prescribed rescue medication. In 14 patients, exacerbations were more severe but responded to timely escalated treatment at home. Four patients attended the emergency room; with 2 hospitalised for <72 hours. Compared to the 6 months pre-COPDPredict™, hospitalisations were reduced by 98% (90 vs 2, p<0.001). COPDPredict™ identified COPD-related exacerbations at 7, 3 days (median, IQR) prior to clinician-defined episodes, sending appropriate alerts to patients and clinicians. Cross-tabulation demonstrated sensitivity of 97.9% (95% CI 95.7-99.2), specificity of 84.0% (95% CI 82.6-85.3), positive and negative predictive value of 38.4% (95% CI 36.4-40.4) and 99.8% (95% CI 99.5-99.9), respectively. Conclusion: High sensitivity indicates that if there is an exacerbation, COPDPredict™ informs patients and clinicians accurately. The high negative predictive value implies that when an exacerbation is not indicated by COPDPredict™, risk of an exacerbation is low. Thus, COPDPredict™ provides safe, personalised, preventative care for patients with COPD.

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Background: Studies that identify children after acute trauma and prospectively track risk/protective factors and trauma responses over time are resource-intensive; small sample sizes often limit power and generalizability. The Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive was created to facilitate more robust integrative cross-study data analyses. Objectives: To (a) describe creation of this research resource, including harmonization of key variables; (b) describe key study- and participant-level variables; and (c) examine retention to follow-up across studies. Methods: For the first 30 studies in the Archive, we described study-level (design factors, retention rates) and participant-level (demographic, event, traumatic stress) variables. We used Chi square or ANOVA to examine study- and participant-level variables potentially associated with retention. Results: These 30 prospective studies (N per study = 50 to 568; overall N = 5499) conducted by 15 research teams in 5 countries enrolled children exposed to injury (46%), disaster (24%), violence (13%), traffic accidents (10%), or other acute events. Participants were school-age or adolescent (97%), 60% were male, and approximately half were of minority ethnicity. Using harmonized data from 22 measures, 24% reported significant traumatic stress ≥1 month post-event. Other commonly assessed outcomes included depression (19 studies), internalizing/externalizing symptoms (19), and parent mental health (19). Studies involved 2 to 5 research assessments; 80% of participants were retained for ≥2 assessments. At the study level, greater retention was associated with more planned assessments. At the participant level, adolescents, minority youth, and those of lower socioeconomic status had lower retention rates. Conclusion: This project demonstrates the feasibility and value of bringing together traumatic stress research data and making it available for re-use. As an ongoing research resource, the Archive can promote 'FAIR' data practices and facilitate integrated analyses to advance understanding of child traumatic stress.

Antecedentes: Los estudios que identifican niños luego de la exposición a trauma agudo y realizan un seguimiento prospectivo para identificar factores protectores o de riesgo, y respuestas al trauma en el tiempo requieren una gran cantidad de recursos; el tamaño pequeño de las muestras frecuentemente limita su poder y generalización. El Banco de Información de los Estudios Prospectivos sobre Trauma Agudo y Recuperación en el Niño (PACT/R por sus siglas en inglés) se creó para facilitar un análisis de datos más robusto e integrativo entre los estudios.Objetivos: a) Describir la creación de este recurso de investigación, incluyendo la armonización de variables clave; b) describir las variables clave a nivel de estudios y de participantes; y c) evaluar la permanencia del seguimiento en los estudios.Métodos: Describimos las variables 'nivel de estudio' (diseño, factores, tasas de permanencia) y 'nivel de participantes' (demografía, evento, estrés traumático) en los 30 primeros estudios del Banco. Empleamos Chi cuadrado o ANOVA para evaluar los niveles de estudio y de participante potencialmente asociados con la permanencia.Resultados: Estos 30 estudios prospectivos (N por estudio = 50 a 568; total N = 5499) realizados por 15 grupos de investigación en 5 países reclutaron niños expuestos a lesión (46%), desastre (24), violencia (13%), accidentes de tránsito (10%) u otros eventos agudos. Los participantes estaban en edad escolar o en la adolescencia (97%), 60% eran varones y, aproximadamente la mitad pertenecían a una minoría étnica. Empleando la armonización de datos para 22 mediciones, el 24% reportó estrés traumático significativo mayor o igual a un mes luego del evento. Otros desenlaces comúnmente evaluados incluyeron a la depresión (19 estudios), síntomas internalizantes y externalizantes (19), y salud mental de los padres (19). Los estudios incluyeron entre 2 y 5 evaluaciones de investigación; 80% de los participantes fueron mantenidos para dos o más evaluaciones. En el nivel de estudio, una mayor permanencia se asoció a un mayor número de evaluaciones planificadas. En el nivel de participantes, los adolescentes, los jóvenes pertenecientes a minorías, y aquellos en niveles socioeconómicos más bajos presentaron menores tasas de permanencia.Conclusión: Este proyecto demuestra la viabilidad y el valour de integrar la información sobre la investigación en estrés traumático y hacerla disponible para ser reutilizada. Como recurso de investigación en curso, el Banco puede promover el uso de prácticas de información 'FAIR' y facilitar el análisis integrado para generar progreso en la comprensión del estrés traumático infantil.

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OBJECTIVE: The study objective was to identify determinants of adverse outcomes in patients undergoing univentricular palliation after the shunt procedure. METHODS: We performed a retrospective study of patients with univentricular lesions undergoing modified Blalock-Taussig shunt and central shunt placement, with or without concomitant Norwood/Damus-Kaye-Stansel procedures, between 2004 and 2014. RESULTS: Overall, 246 patients were included, with 150 patients undergoing concomitant Norwood/Damus-Kaye-Stansel procedure. The 30-day and in-hospital mortality were 7.3% and 14.6%, respectively. Progression to bidirectional cavopulmonary connection was achieved in 76% of patients. Acute events occurred in 66 patients (27%), with 42 having an acute event in the first 72 hours postoperatively. Of all in-hospital deaths, 75% had preceding acute events. On multivariable analysis, the risk factor for 30-day or in-hospital mortality was the incidence of an acute event (odds ratio [OR], 13.5; 95% confidence interval [CI], 5.51-36.4; P < .001). Postoperative pH was associated with fewer acute events (OR, 0.61 per 0.1 unit increase; 95% CI, 0.45-0.82; P = .002). Risk factors for shunt thrombosis associated with an acute event were increased postoperative hematocrit (OR, 2.12 per 0.1 unit increase; 95% CI, 1.01-4.58; P = .049) and 3.0-mm shunt size (OR, 3.78; 95% CI, 1.47-10.6; P = .007). Damus-Kaye-Stansel/Norwood procedure, shunt type, morphology, and extracardiac or genetic anomaly were not risk factors for mortality or acute events. CONCLUSIONS: More than one-fifth of patients shunted during univentricular palliation die before the second stage. The majority of these deaths are associated with acute events occurring early after surgery. Strategies to improve survival should focus on prevention and management of acute events.

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Streptococcus pneumoniae (the pneumococcus) is the leading cause of community-acquired pneumonia and is now recognized to be a direct contributor to adverse acute cardiac events. During invasive pneumococcal disease, S. pneumoniae can gain access to the myocardium, kill cardiomyocytes, and form bacterium-filled "microlesions" causing considerable acute and long-lasting cardiac damage. While the molecular mechanisms responsible for bacterial translocation into the heart have been elucidated, the initial interactions of heart-invaded S. pneumoniae with cardiomyocytes remain unclear. In this study, we used a model of low multiplicity of S. pneumoniae infection with HL-1 mouse cardiomyocytes to investigate these early events. Using adhesion/invasion assays and immunofluorescent and transmission electron microscopy, we showed that S. pneumoniae rapidly adhered to and invaded cardiomyocytes. What is more, pneumococci existed as intravacuolar bacteria or escaped into the cytoplasm. Pulse-chase assays with BrdU confirmed intracellular replication of pneumococci within HL-1 cells. Using endocytosis inhibitors, bacterial isogenic mutants, and neutralizing antibodies against host proteins recognized by S. pneumoniae adhesins, we showed that S. pneumoniae uptake by cardiomyocytes is not through the well-studied canonical interactions identified for vascular endothelial cells. Indeed, S. pneumoniae invasion of HL-1 cells occurred through clathrin-mediated endocytosis (CME) and independently of choline binding protein A (CbpA)/laminin receptor, CbpA/polymeric immunoglobulin receptor, or cell wall phosphorylcholine/platelet-activating factor receptor. Subsequently, we determined that pneumolysin and streptococcal pyruvate oxidase-derived H2O2 production were required for cardiomyocyte killing. Finally, we showed that this cytotoxicity could be abrogated using CME inhibitors or antioxidants, attesting to intracellular replication of S. pneumoniae as a key first step in pneumococcal pathogenesis within the heart.

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In the Democratic Republic of Congo, the incidence of sickle cell anemia (SCA) is estimated to affect 30,000 to 40,000 neonates per year. However, there is paucity of data on acute clinical manifestations in sickle cell children. In these circumstances, it is difficult to develop a health care policy for an adequate management of sickle cell patients. This was a seven years' retrospective study of children admitted with acute sickle cell crisis in the Department of Pediatrics in University Hospital of Kinshasa, Kinshasa, the Democratic Republic of Congo. A total of 108 patients were identified as having SCA. There were 56 (51%) girls and 52 (49%) boys. Median age was 10.5 years (range 1-24 years). No child was diagnosed by neonatal screening. The median age of diagnosis of sickle cell anemia was 90 months (range: 8-250 months). The median age at the first transfusion was 36 months (range 4-168). In this series, 61 (56.5%) patients were eligible for hydroxyurea. However, this treatment was only performed in 4 (6.6%) of them. Pain episodes, acute anemic crisis and severe infection represent respectively 38.2%, 34.3% and 21.9% of events. Altered sensorium and focal deficit were encountered occasionally and represented 3.4% of acute events. Acute renal manifestations, cholelithiasis and priapism were rarely reported, in this cohort. In Kinshasa, the care of patients suffering from sickle cell anemia is characterized by the delayed diagnosis and low detection of organ complications compared to reports of Western countries. This situation is due to resources deficiencies.