Diagnostic Re-Evaluation and Potential Predictor Factors of Transient and Permanent Congenital Hypothyroidism in Eutopic Thyroid Gland

Background: The incidence of congenital hypothyroidism (CH) has increased over the years, and many predictors for detecting newborns with transient forms (TCH) as early as possible have been considered. Methods: All newborns diagnosed with primary CH and eutopic gland in the Piedmont region of Italy in the period of January 2014–June 2019 were enrolled and re-evaluated at the age of 2 years. Results: 105 newborns were diagnosed with CH during the study period. Dyshormonogenesis was observed in 55/105. At re-evaluation, we found that 52.7% had permanent CH (PCH), while 47.3% had TCH. Male/female rate, TSH levels at diagnosis, levothyroxine requirement at withdrawal and extra-thyroid congenital malformations rate were higher in the PCH group (p = 0.02, p = 0.009, p = 0.02 and p = 0.01), while fT4 levels at diagnosis were lower (p = 0.03). Sensitivity of 72.4% and specificity of 80.7% for serum TSH above 60 mcUI/mL, sensitivity of 73% and specificity of 72.4% for serum fT4 level below 7.2 pg/mL and sensitivity of 66% and specificity of 68% for drug requirement above 2.25 mcg/kg/day were observed in PCH. Conclusions: Demographic, clinical and hormonal data at diagnosis and levothyroxine requirement during the first two years should be adequately monitored to identify infants who are most likely to discontinue therapy after the age of 24 months.

Optimal timing of intervention in NSTE-ACS without pre-treatment

Introduction In patients (P) with non-ST segment elevation acute coronary syndromes (NSTE-ACS), an invasive strategy is recommended to reduce adverse outcomes. The optimal timing to perform coronary angiography (CA) remains undetermined, particularly in our era attending to the new European guidelines restricting pre-treatment (PT). Objective To evaluate the prognostic value of an early strategy (ES; <24h) versus a delayed strategy (DS; >24h) when no loading dose of a P2Y12 antagonist was given as PT in NSTE-ACS. Material and methods Retrospective analysis of P data admitted with NSTE-ACS at multicentric national registry between 2015–19. Compared demographic and clinical characteristics of P with an ES versus DS. A multivariate logistic regression was performed to evaluate predictor factors of in-hospital and 1-year endpoints. Survival was evaluated through Kaplan-Meier curve and Cox multivariate regression. Results 691P were included, mean age 64±11 years, 77.4% male. 59.2% performed CA as an ES. P proposed to a DS presented higher KK class, higher levels of creatinine and lower of hemoglobin. They also needed more frequently invasive (1.1 vs 0.7%, p=0.692) or non-invasive ventilation (1.8 vs 0.7%, p=282). A higher proportion of DS patients used the transfemoral access (5.5 vs 9.3%, p=0.058). On CA, 6.2% had normal coronary arteries, 49.2% 1-vessel disease and 45.1% multivessel disease. Revascularization was performed in 88.2%: PCI in 86.2%, CABG in 1.7% and both in 0.3%, with no significant differences. Pending CA, 98.4% were medicated with aspirin, 64.8% ticagrelor and 44% clopidogrel, with no differences. P proposed to an ES were more medicated with glycoprotein inhibitor (36.3 vs 26.4%, p=0.015) and non-fractioned heparin (6.4 vs 2.1%, p=0.01) and less with fondaparinux (56.2 vs 65.2%, p=0.017). A higher percentage of calcium-channel blockers (25.2 vs 11.7%, p<0.001) and nitrates (74.1 vs 53.3%, p<0.001) was observed in the DS. No difference was observed in beta-blockers (p=0.581). Discharge medication followed these tendencies. There was a trend to worse in-hospital outcomes in the DS regarding heart failure, shock, ventricular arrhythmias, cardiac arrest and death, although not significatively different, except for major bleeding (1.8 vs 0.2%, p=0.044). 1-year composite endpoint of mortality and cardiovascular rehospitalization occurred in 9.9%, with no difference between groups (p=0.181). Predictor factors, evaluated through Cox multivariate regression, were ejection fraction <50% (p=0.001), KK class >I (p=0.002) and nitrate prescription at discharge (p=0.001). A DS was not a predictor factor (p=0.812). Conclusion Our results are in accordance with available data. In P with higher-risk NSTE-ACS in the absence of P2Y12 antagonist PT, an ES was not associated with a reduction in the composite of global mortality and rehospitalization for cardiovascular causes. FUNDunding Acknowledgement Type of funding sources: None.

Non-Invasive Ventilation in COVID-19 Related Respiratory Failure

Non-invasive ventilation (NIV) refers to the technique of providing mechanical ventilation that does not require definitive airway clearance using an endotracheal tube or tracheostomy. Since its early development in the 1980s, the use of NIV has become increasingly popular in the last three decades. However, its usage on COVID-19 related respiratory failure still lacked guidelines, although several recent studies have shown its benefits. Many aspects, ranging from indications or patient selection, timing to start, understanding the predictor factors of failure, and choosing suitable interfaces, are keys of success for NIV. In principle, each patient has a different condition and should be treated case by case. NIV is not an absolute solution, and intubation can still be the first choice if NIV is deemed less beneficial for the patient.

Confirmatory Factor Analysis of Determinants of Entrepreneurship Career Inclination among Entrepreneurship Club Members in Secondary School/ Analisis Faktor Pengesahan Bagi Peramal Kecenderungan Kerjaya Keusahawanan dalam Kalangan Ahli Kelab Keusahawanan Sekolah Menengah

Entrepreneurship is a tool that the Malaysian Governmentsed to uplift income from the middle-income trap. Therefore, this study aims to identify the predictor factors that influence the inclination of entrepreneurship club members towards the entrepreneurship career by using factor analysis to achieve the Government goal through the Ministry of Education Malaysia. In other words, this study uses several tests related to validation factor analysis to determine the predictor factors that influence the propensity of entrepreneurship club members towards entrepreneurship careers. This study involved 161 respondents who were members of secondary school entrepreneurship clubs in the State of Terengganu who were randomly selected. Data gathered were analyzed using Statistical Package for the Social Sciences (SPSS) involving factor analysis and descriptive test. The factor analysis has identified nine predictor factors. The first predictor factor is role model, followed by a barrier, social identity, personality, entrepreneurship skill, social norm, financial, entrepreneurship knowledge, and prosperity. Prosperity was the new predictor factor that was identified using factor analysis in this research. The descriptive test found that the most influenced predictor factor of the entrepreneurship career inclination was finance, followed by personality, social identification, role model, social norm, prosperity, and barrier. Meanwhile, entrepreneurship knowledge was found as a predictor factor which uncertain in influencing the entrepreneurship career inclination among secondary school entrepreneurship club members in the State of Terengganu. The results of this study imply that the Government should give financial factors the priority through the Ministry of Education in formulating policies towards producing more young generation of entrepreneurs in Malaysia because that predictor has a positive impact on secondary school students who were the members of entrepreneurship clubs.

Total Tumor Diameter and Unilateral Multifocality as Independent Predictor Factors for Metastatic Papillary Thyroid Microcarcinoma

The purpose of this study was to assess whether total tumor diameter (TTD) and multifocality are predictors for metastatic disease in papillary thyroid microcarcinomas (PTMC). Eighty-two patients with histologically proven PTMC were retrospectively included. Patients were divided according to the presence of metastatic disease in the metastatic (n = 41) and non-metastatic (n = 41) demographic-matched group. The morphological features of PTMCs (primary tumor diameter, multifocality, TTD, number of foci, and tumor site) were compared between groups using univariate, multivariate, and receiver operating characteristic analyses. TTD (p = 0.026), TTD > 10 mm (p = 0.036), and Unilateral Multifocality (UM) (p = 0.019) statistically differed between the groups. The combination of the two independent predictors (TTD and UM) was able to assess metastatic risk with 60.98% sensitivity and 75.61% specificity. TTD and UM can be used to predict metastatic disease in PTMC, which may help to better adapt the RAI therapy decision. We believe that TTD and multifocality are tumor features that should be considered in future guidelines.

Companions and Casual Acquaintances: The Nature of Associations Among Bull Sharks at a Shark Feeding Site in Fiji

Provisioning activities in wildlife tourism often lead to short-term animal aggregations during the feeding events. However, the presence of groups does not necessarily mean that individuals interact among each other and form social networks. At the Shark Reef Marine Reserve in Fiji, several dozen bull sharks (Carcharhinus leucas) regularly visit a site, where direct feeding is conducted during tourism driven shark dives. On 3,063 shark feeding dives between 2003 and 2016, we visually confirmed the presence of 91 individual bull sharks based on external and long-lasting identification markings. We measured the intensity of associations between pairs of individuals by calculating the Simple Ratio Index (SRI) and calculated Generalized Affiliation Indices (GAIs) to distinguish true associations between dyads from structural predictor factors. Although the resulting mean SRIs were low, ranging from 0.01 to 0.12 (SRImean = 0.06; mean SRImax = 0.21), preferred long-term companionships were observed between individuals. Avoidances were also observed within pairs of individuals during the second half of the study. The best fitting model describing the temporal association patterns of bull sharks revealed a social structure which is characterized by preferred companionships and casual acquaintances. Our results suggest that the aggregation resulting from direct feeding has served to facilitate the development of social associations.