A Combination of Chest Radiography and Estimated Plasma Volume May Predict In-Hospital Mortality in Acute Heart Failure

Background: Patients with heart failure (HF) often display dyspnea associated with pulmonary congestion, along with intravascular congestion, both may result in urgent hospitalization and subsequent death. A combination of radiographic pulmonary congestion and plasma volume might screen patients with a high risk of in-hospital mortality in the emergency department (ED).Methods: In the pathway of dyspneic patients in emergency (PARADISE) cohort, patients admitted for acute HF were stratified into 4 groups based on high or low congestion score index (CSI, ranging from 0 to 3, high value indicating severe congestion) and estimated plasma volume status (ePVS) calculated from hemoglobin/hematocrit.Results: In a total of 252 patients (mean age, 81.9 years; male, 46.8%), CSI and ePVS were not correlated (Spearman rho <0 .10, p > 0.10). High CSI/high ePVS was associated with poorer renal function, but clinical congestion markers (i.e., natriuretic peptide) were comparable across CSI/ePVS categories. High CSI/high ePVS was associated with a four-fold higher risk of in-hospital mortality (adjusted-OR, 95%CI = 4.20, 1.10-19.67) compared with low CSI/low ePVS, whereas neither high CSI nor ePVS alone was associated with poor prognosis (all-p-value > 0.10; Pinteraction = 0.03). High CSI/high ePVS improved a routine risk model (i.e., natriuretic peptide and lactate)(NRI = 46.9%, p = 0.02), resulting in high prediction of risk of in-hospital mortality (AUC = 0.85, 0.82-0.89).Conclusion: In patients hospitalized for acute HF with relatively old age and comorbidity burdens, a combination of CSI and ePVS was associated with a risk of in-hospital death, and improved prognostic performance on top of a conventional risk model.

Impact of Crop Diversification on Household Food and Nutrition Security in Southern and Central Mali

Many African countries, including Mali, depend on the production of a single or a limited range of crops for national food security. In Mali, this heavy reliance on a range of basic commodities or staple crops, or even just one, exacerbates multiple risks to agricultural production, rural livelihoods, and nutrition. With this in mind, the smart food campaign was initiated to strengthen the resilience and nutritional situation of households and peasant communities where the diet is mainly cereal-based and remains very undiversified and poor in essential micronutrients. As part of the campaign, our study aims to analyze the impact of agricultural diversification on food consumption and household nutritional security. The analysis uses survey data from 332 individuals randomly selected. Multinomial logistic regression and the Simpson diversity index were used to determine the index and estimate the determinants of crop diversification. The consumption score index weighted by consumption frequency and anthropometric indices (for children) were used to assess the nutritional status of households. The results show four types of strategies of diversification: 7.55% are cereals only, 5.66% combine millet–sorghum–groundnut, 41.51% combine millet–sorghum–groundnut–cowpea, and 45.28% combine millet–sorghum–groundnut–cowpea–maize. The estimation of the regression model shows that socioeconomic factors have a positive influence. With a consumption score index of 34 in the villages and 40.5 in Bamako, based on eight food groups, we find that the quality of food is insufficient in rural areas, but it is acceptable in the urban center of Bamako. Analysis of the nutritional status of children aged 6–48 months reveals that 30% of the surveyed population is in a situation of nutritional insecurity (all forms combined). To help improve crop diversification and the nutritional quality of foods, we suggest, among other things, subsidies and public spending to facilitate access to inputs that allow the acquisition of a wider range of inputs and services, intensification of nutrition awareness, and education programs to maximize the incentive to consume nutritious foods from self-production and market purchases. Finally, we propose to facilitate access to technologies promoting food diversification and improving food and nutritional security, particularly in rural areas.

Impact of Vitamin D Supplementation in a Heart Failure Population

Introduction: Vitamin D (VD) deficiency is a major comorbidity, frequently associated to heart failure (HF). VD supplementation effects in these patients remain unknown. Therefore, this study aims to evaluate the impact of VD deficiency treatment or therapy correction in HF patients´ cohort. Material and Methods: Observational retrospective single-center study enrolling patients admitted to a HF clinic with VD deficiency. VD was prescribed to these patients with reassessment of its levels 12 months later. Study population was divided in: [VD (+) group: corrected VD deficiency] and [VD (-): maintained VD deficiency]. Variables were analysed in both groups. Results and Conclusion: Eighty-seven patients were included with no difference of baseline characteristics between the groups. Poor compliance was reported in 40% of VD (-) patients. After treatment, there were no statistically difference in variables analysed between the two groups: NYHA class I, NT-proBNP, HF hospitalizations in the previous year, Duke Activity Score Index score and 6-minute Walking Distance. VD (+) group had a statistically significant decrease of NT-proBNP level over time (1740 ± 2761 pg/mL to 851 ± 1436 pg/mL, p = 0.001). Statistically, both groups had a significant reduction of the number of HF hospitalizations, between baseline and 12 months later (1.02 ± 0.67 to 0.29 ± 0.82, p< 0.001 and 1.03 ± 1.04 to 0.40 ± 0.81, p = 0.001, for VD (+) and VD (-), respectively). Therefore, the correction of VD deficiency did not have impact in the variables analysed. The improvements reported within both groups may reflect the impact of the HF clinic optimized care.

401 Myocardial viability and ischaemia assessment in chronic coronary total occlusions according to collaterals distribution: a retrospective analysis

Aims Whether CTO-PCI (chronic total occlusions—percutaneous coronary intervention) offers clinical benefit over optimal medical therapy is still a matter of debate. Viability and ischaemia assessment could improve selection of candidates to PCI. Traditionally, well-developed collaterals are considered a marker of myocardial viability in CTO territory. Current literature offers few data concerning the relationship between viability/ischaemia and collaterals distribution. Methods and results We retrospectively analysed the Cardiovascular Magnetic Resonance (CMR) studies and coronary angiographies of patients with at least one CTO referred at Humanitas Research Hospital between June 2009 and September 2020. We included 131 patients who underwent CMR with LGE assessment; of them, 111 (85%) underwent stress-CMR with adenosine. AHA segments (16 segment/patient for a total of 2096 segment assessed) were assessed on three short axis projection and scored for WMSI on cine images, for the presence of ischaemia on first pass perfusion, and for viability on LGE images. Viability was defined as LGE transmurality ≤50% and WMSI (wall motion score index) &gt;1. Patients were divided in three groups according to collaterals distribution at coronary angiography: Patients with TD collaterals were more likely to have viable segments in the CTO-territory (90% of the segments in TD, 76% in WD, and 71% in PD, coeff. 0.107, P &lt; 0.001). No statistically significant differences were found between groups as regard the amount of ischaemic segments (61% of the segments in TD, 65% in WD, and 60% in PD, P = 0.189). Conclusions The presence of myocardial viability is slightly associated with the degree of coronary collateralization at coronary angiography while the amount of ischaemia is not. Stress CMR should be considered in CTO patients before a reopening attempt.

Anthropometric measures and biomarkers for cardiovascular disease risk factors: evidence from a study of Polish adults participating in the cardiovascular disease prevention program (CHUK)

The Polish national program for the prevention of cardiovascular disease (CHUK) uses the Systematic Coronary Risk Evaluation (SCORE) index which evaluates the upcoming risk of death from cardiovascular causes for a 10 year period, based on information such as age, systolic blood pressure, cholesterol levels, smoking and gender. The aim of this study was to determine health indicators in the population enrolled in the program and identify the relationships between the cardiovascular risk factors. The data was collected from 303 participating individuals; 172 women (aged 35 to 58 years) and 131 men (aged 31 to 60 years). The SCORE index showed a statistically significant positive relationship between CVD and the male gender. The higher frequency of 3–4% and 5–9% for SCORE index in men indicates that they were at a higher risk of cardiovascular incidents. The increased risk of a cardiovascular incidence in men was associated with a higher mean arm circumference, waist circumference, BMI, systolic blood pressure, diastolic blood pressure, total cholesterol, LDL cholesterol, triglyceride and fasting glucose. HDL cholesterol and heart rate were statistically significantly higher in women. Among the study subjects, the most common parameters above the normal range were elevated LDL cholesterol and total cholesterol. The highest correlation with the SCORE index was observed for the age of the subjects, total cholesterol and LDL cholesterol, regardless of gender. The results showed that biochemical parameters and blood pressure were above normal values in almost all subjects. Men had significantly less favorable parameters compared to women of similar age range. According to the SCORE index, total cholesterol and LDL cholesterol significantly increased the risk of cardiovascular incident regardless of gender. Women were characterized by a lower risk of cardiovascular incident according to the SCORE index.

Suplementasi Zinc Sebagai Upaya Peningkatan Pertumbuhan Berdasarkan Indeks Z-Score Pada Anak Stunting Usia 2 – 5 Tahun

In stunted children, there was a deficiency of macro and micro nutrients. One of the micronutrients, namely zinc, can help protein synthesis, cell growth and differentiation so that food intake that enters the body can be easily absorbed and function optimally in helping the growth process. The purpose of this community service activity was to provide zinc supplementation as an effort to increase growth based on Z-score index in stunted children aged 2-5 years. The methods used include: 1) Conducting surveys and data collection on the number of stunting children, 2) Conducting cross-program and cross-sector collaboration, 3) Providing counseling to the targets regarding zinc supplementation, 4) Conducting zinc supplementation activities (February – May 2021), 5) Evaluating the growth of stunting children through Z-score index. The instrument used questionnaire, weight scale, stature meter, maternal and child health book, and zinc syrup. Zinc syrup was given to 16 stunting children at a dose of 1 tablespoon (10 mg) per day. After 16 weeks of zinc supplementation in stunted children 2-5 years, the results showed that 16 children (100%) experienced an increase in weight/age, height/age and weight/height. The average weight gain was 2.7 kg and the average height increase was 2.9 cm. Zinc supplementation is effective given to stunting children, especially during the golden age because the growth and development process can be optimized rapidly.Keywords: Zinc Supplementation; Growth; Stunting; Z-Score Index. AbstrakPada anak yang mengalami stunting terjadi defisiensi zat gizi makro maupun mikro. Salah satu zat gizi mikro yaitu zinc dapat membantu sintesis protein, pertumbuhan dan diferensiasi sel sehingga asupan makanan yang masuk ke dalam tubuh dapat mudah diserap dan berfungsi optimal dalam membantu proses pertumbuhan. Tujuan kegiatan pengabdian kepada masyarakat ini adalah untuk memberikan suplementasi zinc sebagai upaya peningkatan pertumbuhan berdasarkan indeks Z-score pada anak stunting usia 2-5 tahun. Metode yang dilakukan meliputi : 1) Melakukan survei dan pendataan jumlah balita stunting, 2) Mengadakan kerjasama lintas program dan lintas sektor, 3) Memberikan penyuluhan kepada sasaran mengenai suplementasi zinc, 4) Melakukan kegiatan suplementasi zinc (Februari – Mei 2021), 5) Mengevaluasi pertumbuhan anak stunting melalui indeks Z-score. Instrumen kegiatan menggunakan kuesioner, timbangan berat badan, staturemeter, buku KIA, dan sirup zinc. Sirup zinc diberikan kepada 16 anak stunting dengan dosis 1 sendok takar (10 mg) per hari. Setelah 16 minggu dilakukan suplementasi zinc pada anak stunting 2-5 tahun didapatkan hasil bahwa 16 anak (100%) mengalami peningkatan BB/U, TB/U dan BB/TB. Rata-rata peningkatan berat badan adalah 2,7 kg dan rata-rata peningkatan tinggi badan adalah 2,9 cm. Suplementasi zinc efektif diberikan kepada anak stunting terutama pada masa golden age karena proses pertumbuhan dan perkembangan dapat dioptimalkan secara pesat.Kata kunci: Suplementasi Zinc; Pertumbuhan; Stunting; Indeks Z-Score.

Comparison of Four Precipitation Based Meteorological Drought Indices in Yesilirmak Basin, Turkey

Drought, which is often defined as not enough precipitation, does not a mean simple lack of precipitation. This condition, which occurs when humidity is less than the average value for many years, is caused by a disrupted balance between precipitation and evaporation in a region. It is very difficult to predict the start and the end time of drought. In the present study, the drought conditions of the stations selected from Yesilirmak Basin between 1970 and 2014 were determined by using Z-Score Index (ZSI), China-Z Index (CZI), Modified China-Z Index (MCZI), and Standard Precipitation Index (SPI), and the compliance of these indices to the SPI was investigated. It was determined that these indices gave parallel results to each other, and SPI detected drought earlier than other indices.

Assessment and monitoring of drought in Chitradurga district of Karnataka using different drought indices

Drought is a natural disaster due to less precipitation than the normal that can occur irrespective of climate regimes. Impact assessment of drought and monitoring are the most important mitigation stratregies to combat the drought effects. As the single index cannot assess all the drought conditions, in the present study multi-variate indices approach has been used to assess and monitor drought. Five indices were assessed using precipitation data such as deciles index (DI), percent normal (PN), China-Z index (CZI), Z-Score index (ZSI) and standardized precipitation index (SPI). Monthly total precipitation data was used to calculate drought events occurred during the period 1967–2017 in different talukas of Chitradurga district of Karnataka, India. The assessment revealed that SPI, CZI and ZSI performance was similar in identifying drought. PN was very much responsive for the rainfall events that occurred during the particular year however, it exhibited variations in dry conditions. DI was not that much satisfactory in identifying drought conditions. Among the five indices assessed, SPI seems to be the best indicator to predict the drought onset than the other four drought indices. Therefore SPI can be recommended for assessing and monitoring the drought in Chitradurga district of Karnataka, India.

A study of Madrid sonographicenthesis score Index (MASEI) versus spondyloarthritis research consortium of Canada (SPARCC) in the assessment of early enthesopathy among psoriatic skin patient

Objective To compare between Sonographic Madrid score index (MASEI) versus Spondyloarthritis research consortium of canada (SPARCC) for early assessment of enthesopathy among psoriatic skin patients. Patients and Methods This study included fifty psoriatic skin patients. All underwent history, laboratory investigation, clinical examination using SPARCC score, Psoriasis Area and Severity Index (PASI) and musculoskeletal ultrasound using MASEI score with power Doppler (PD) bilaterally for assessment of enthesitis. Results The mean age of fifty patients was 42.00 ± 10.923 years, disease duration of 11.110 ±7.402 and BMI of 29.356 ± 3.753. The mean PASI was 12.950±8.044. SPARCC score was positive in 10 out of 50 patients (20%).MASEI score was positive in 20 out of 50 patients (40%) with 10 out of 50 patients had power Doppler signals. Highly statistically significant difference between MASEI and SPARCC score( pvalue &lt;0.001). Highly statistically significant positive correlation was observed between PASI score and MASEI(r = 0.498, p-value &lt;0.001). Conclusion musculoskeletal ultrasound is useful for early detection of enthesitis and to be a sensitive tool in detecting of enthesitis and subclinical enthesitis that can be missed during routine clinical examination.