Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Slow Frequency Anuloma Viloma Pranayama Modulates Cardiac and Neural Oscillations in Yoga Practitioners

Anuloma viloma pranayama (AVP) also known as Alternate nostril breathing (ANB) is the most commonly used form of pranayama, the ancient breath control practice. It is known to modulate cardiovascular control and brain activity. This study analysed the simultaneous recording of Heart rate variability (HRV) and brain activity during and after AVP at a very slow frequency. We carried out an observational cohort study from October 2021 to December 2021 with purposive sample of 30 (Thirty) healthy volunteers involved in regular kriya yoga practice for the last 15 years were inducted into this study AVP involves slow and deep inhalation through one nostril at a time. The ECG for HRV analysis and spectrum of EEG waves were recorded throughout the pre-AVP, during-AVP and post-AVP (each of five-minute duration). The parameters were compared and analysed by repeated measures of analysis of variance with post-hoc analysis using Bonferroni and Holm's multiple comparisons. In time Domain parameters, SDNN and RMSSD were significantly higher during AVP as compared to the pre-AVP and post AVP. In frequency domain parameters total power, LF power, HF power, showed a significant increase during AVP, LF/HF ratio increased during AVP and remained higher post-AVP also. Similarly, Alpha, Beta and Gamma wave power increased significantly during AVP as compared to pre-AVP and post-AVP. The lungs-heart-brain act as coupled oscillators, the analysed data show an increased arousal, attentive and focused state with a negligible change in the heart rate. An overall increased variability in HRV was recorded.

P-688 Combination of letrozole and clomiphene citrate versus letrozole alone for ovulation induction in women with polycystic ovary syndrome - a randomized controlled trial

Study question

Does clinical pregnancy rate improve using combination of letrozole and clomiphene versus letrozole alone for ovulation induction in infertile women with PCOS

Summary answer

The present study showed that combination drugs had no added advantage over Letrozole alone in terms of ovulation induction.

What is known already

Letrozole can offer a benefit over CC for ovulation induction because it doesn’t block estrogen receptors in both central and peripheral target tissues, therefore normal central feedback mechanisms remain intact. As letrozole and CC have different mechanisms of action, the combination of these medications can achieve an improved ovulatory rate over letrozole alone.

We aimed to test the hypothesis of whether combined therapy of letrozole and CC is effective and superior to the use of letrozole alone to achieve pregnancy in women with PCOS.

Study design, size, duration

Prospective Randomized Controlled Trial conducted from July 2019 to December 2020 at tertiary care centre in Uttarakhand

According to studies done earlier (49), it was observed that proportion of positive outcome in letrozole and clomiphene citrate combined therapy was assumed to be 0.7700 and for letrozole therapy alone was 0.4400. With significance level of 0.05 and power 90% a sample size of 42 in each group to detect assumed 0.33 difference between the two groups.

Participants/materials, setting, methods

68 patients randomised in two group. Group I received combination of Letrozole (2.5mg) and clomiphene citrate (50 mg) once daily for 5 days (day 3-7 of cycle). Group II received Letrozole 2.5mg once daily for 5 days (day 3-7 of cycle) for 4 cycles. After induction follicular monitoring done and HCG given when dominant follicle size > =18mm with ET > =8mm followed by timed intercourse.

Main results and the role of chance

No statistically significant difference seen between the two groups in baseline characterstics. Comparing the pregnancy rate, 9.3% in Group 1 (n = 3) & 6.3% in Group 2 (n = 2) became pregnant after first cycle of ovulation induction (OVI), after 2nd cycle, 7.1% in Group 1 (n = 2) & 13.8% in Group 2 (n = 4) became pregnant. 11.5 % in Group 1 (n = 3) & 8.0 % in Group 2 (n = 2) became pregnant after cycle 3 and 21.7% in Group 1 (n = 5) & 8.7% in Group 2 (n = 2) became pregnant after 4th cycle of OVI. Though the pregnancy rate was statistically not significant in all the cycle (p <  0.615,0.413,0.671,0.218 respectively). The median number of cycles required for conception in Group 1 was 3 and that of group 2 was 2.

Limitations, reasons for caution

Small sample size

Larger multicentric randomised controlled trials required

Wider implications of the findings

Pregnancy rate was higher when ovulation induction was done using combination of clomiphene and letrozole but difference was not statistically significant.

Mean number of cycles required for conception similar in both groups.

Trial registration number

CTRI no: CTRI/2020/06/025688

Hypertriton Production in p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The study of nuclei and antinuclei production has proven to be a powerful tool to investigate the formation mechanism of loosely bound states in high-energy hadronic collisions. The first measurement of the production of _{Λ}^{3}H in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV is presented in this Letter. Its production yield measured in the rapidity interval -1<y<0 for the 40% highest-multiplicity p-Pb collisions is dN/dy=[6.3±1.8(stat)±1.2(syst)]×10^{-7}. The measurement is compared with the expectations of statistical hadronization and coalescence models, which describe the nucleosynthesis in hadronic collisions. These two models predict very different yields of the hypertriton in charged particle multiplicity environments relevant to small collision systems such as p-Pb, and therefore the measurement of dN/dy is crucial to distinguish between them. The precision of this measurement leads to the exclusion with a significance larger than 6.9σ of some configurations of the statistical hadronization model, thus constraining the theory behind the production of loosely bound states at hadron colliders.

1049 IMPROVING TELEPHONE COMMUNICATION WITH FAMILIES ON A BUSY MEDICAL WARD DURING THE PANDEMIC

During the pandemic it became critical to reduce visiting to only very specific situations. This resulted in an increase of complaints where a lack of communication from the ward had been recognised as a theme, in spite of the fact that many doctors spent a great deal of time providing updates over the phone to patient’s families. It was noted there were a number of inefficiencies with respect to communicating with families; some families were being contacted repeatedly whereas others were struggling to get in touch. Chronic staffing shortages were also a barrier to effective and timely communication. Qualitative data collected via an online survey demonstrated that junior doctors valued the importance of communicating with families, particularly to provide clinical updates or obtain collateral histories, but found that the extra burden created by the pandemic resulted in far less time to do this efficiently and often resulted in time management difficulties.

We introduced a strategy, by way of a magnetic communication board, that provided a flexible, at-a-glance method of ensuring all families had received regular updates from the medical team and collateral histories had been obtained for all relevant patients. We collected weekly data regarding the number of interactions between the medical team and patient relatives’ as a percentage of the total number of bed spaces. An overall improvement was noted: 67% pre-intervention to 76% post, with a maximum of 88% during one particularly successful week. We also were able to demonstrate an increase in ReSPECT form completion (from 40% to 65%).

The introduction of an organisational tool such as our communication board resulted in improved patient and relatives’ satisfaction; and an improvement in team performance and overall time management. We are now aiming to build on this and roll it out during the next wave of the pandemic.

A Simple and General Debiased Machine Learning Theorem with Finite Sample Guarantees

Debiased machine learning is a meta algorithm based on bias correction and sample splitting to calculate confidence intervals for functionals, i.e., scalar summaries, of machine learning algorithms. For example, an analyst may desire the confidence interval for a treatment effect estimated with a neural network. We provide a non-asymptotic debiased machine learning theorem that encompasses any global or local functional of any machine learning algorithm that satisfies a few simple, interpretable conditions. Formally, we prove consistency, Gaussian approximation, and semiparametric efficiency by finite sample arguments. The rate of convergence is n−1/2 for global functionals, and it degrades gracefully for local functionals. Our results culminate in a simple set of conditions that an analyst can use to translate modern learning theory rates into traditional statistical inference. The conditions reveal a general double robustness property for ill-posed inverse problems.

Relationship between spiritual intelligence (SI) & job satisfaction (JS) in millennials

In this fast-paced lifestyle with escalating cases of anxiety and depression, millennial are trying to find meaning in life and at work. The presence of high-octane electronic media both in millennial’ personal & professional life is making them more anxious about their career and personal beliefs. There is a belief that a person who exhibits spiritual intelligence is most likely to achieve a sense of job satisfaction in life. Various MNCs are organizing many programs to develop and enhance the employee’s spiritual intelligence. This paper focuses on millennial working in the Defense and IT field with empirical study to analyze the influence of spiritual intelligence on their job satisfaction. Dhamodharan and Ravikumar mention that millennial, born in the period between 1981-1995, witnessed consumerism and technological advancement worldwide. People born in this era were less exposed to traditional religious teaching due to changing social-cultural values; hence they indulge in spirituality to balance their lifestyle to optimize the basic value of life. Emmons mentions that “SI is a blend of internal & external structure: spirituality being an internal structure and intelligence as an external structure to create a new structure which evolves the person with remarkable capacities to practically use their spirituality on their everyday basis.”

Epithelial-to-mesenchymal transition based diagnostic and prognostic signature markers in non-muscle invasive and muscle invasive bladder cancer patients

BACKGROUND

Diagnostic and prognostic significance of epithelial-to-mesenchymal transition (EMT) associated biomarkers are evaluated in a cohort of NMIBC (non-muscle invasive bladder cancer) and MIBC (muscle invasive bladder cancer) patients.

METHODS AND RESULTS

Real-time quantitative polymerase chain reaction (RT-qPCR) and immunohistochemical (IHC) staining were carried out in 100 tumor specimens (59 NMIBC and 41 MIBC). The expressions of the epithelial marker, mesenchymal markers and EMT-activating transcription factors (EMT-ATFs) were determined at transcriptome and protein level followed by their statistical associations with clinicohistopathological variables of the patients. Transcriptomic expression analysis showed statistical relevance of tumor stage with increased Twist and Zeb-1; tumor type with reduced E-cadherin and increased Snail; and smoking/tobacco chewing status (S/TC) of patients with increased N-cadherin and Snail in NMIBC patients. Tumor grade with reduced message E-cadherin, gain of N-cadherin, Snail, Twist and Zeb-1; patients' age with reduced E-cadherin and Twist gain; and tumor type with increased message N-cadherin exhibited associations in MIBC patients. Protein expression analysis identified statistical relevance of tumor grade with nuclear gain of Snail and Twist; and nuclear gain of Slug with S/TC status of NMIBC patients. Novel gain of membranous Vimentin deduced association with patients' age in MIBC patients. Survival analysis identified novel Vimentin as the positive predictor of short progression free survival (PFS) and short overall survival (OS) in MIBC patients. Study established altered EMT profile as the independent negative predictor of short recurrence free survival (RFS) in NMIBC patients and positive predictor of short PFS and OS in MIBC patients.

CONCLUSIONS

EMT associated biomarkers could provide diagnostic and prognostic risk stratification and hence could be of importance in the clinical management of bladder cancer patients.

Polarization of Λ and Λ[over ¯] Hyperons along the Beam Direction in Pb-Pb Collisions at sqrt[s]_{NN}=5.02 TeV

The polarization of the Λ and Λ[over ¯] hyperons along the beam (z) direction, P_{z}, has been measured in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV recorded with ALICE at the Large Hadron Collider (LHC). The main contribution to P_{z} comes from elliptic flow-induced vorticity and can be characterized by the second Fourier sine coefficient P_{z,s2}=⟨P_{z}sin(2φ-2Ψ_{2})⟩, where φ is the hyperon azimuthal emission angle and Ψ_{2} is the elliptic flow plane angle. We report the measurement of P_{z,s2} for different collision centralities and in the 30%-50% centrality interval as a function of the hyperon transverse momentum and rapidity. The P_{z,s2} is positive similarly as measured by the STAR Collaboration in Au-Au collisions at sqrt[s_{NN}]=200  GeV, with somewhat smaller amplitude in the semicentral collisions. This is the first experimental evidence of a nonzero hyperon P_{z} in Pb-Pb collisions at the LHC. The comparison of the measured P_{z,s2} with the hydrodynamic model calculations shows sensitivity to the competing contributions from thermal and the recently found shear-induced vorticity, as well as to whether the polarization is acquired at the quark-gluon plasma or the hadronic phase.

Safety, Reactogenicity and Patient Perceptions of COVID-19 Vaccination in Solid Organ Transplant Recipients at a Quaternary Referral Center

Purpose

Solid organ transplant recipients (SOTR) are at high-risk for poor health outcomes following COVID-19. Several studies have evaluated the antibody response to the vaccine amongst SOTR, yet there is a need to better understand peri-vaccination reactogenicity and patient behavior in SOTR. Our study reports the side effects, safety and the patient perceptions of the Pfizer vaccine amongst our center's SOTR.

Methods

In this single-center study, SOTR (heart, kidney, liver, lung, combined) who received the Pfizer (BNT162b2) vaccine in February-March 2021 completed an online survey about their side effects (SE) after the first and second dose of the vaccine, co-morbidities, masking behaviors, breakthrough infection, and perceptions regarding sense of protection and safety after vaccination. Descriptive and logistical regression analyses were performed.

Results

The survey was sent to 550 SOTR, of which 210 SOTR completed it thus far. Median age is 62 years, 154 (72%) are males and 61 (28 %) are females. 81 (39%) experienced SE after both doses. After dose one, 53% patients experienced a SE, the most common being injection site pain (79%). After dose two, 53% patients experienced a SE, including injection site pain (61%) followed by systemic SE (39%). No patient hospitalization after either dose was reported. Within a 6-month period post vaccination, only 1 patient tested positive for COVID-19 after the first dose. Increased age reduced the risk for SE for both first and second doses (0.95 (0.92-0.97, p<0.001 and 0.96 (0.94-0.99), p<0.002). SOTR without diabetes had a significant increase in injection site pain (1.92 (1.05-3.49),p=0.033). For masking behaviors, 83% plan to continue masking in healthcare settings while 10% will no longer mask in any setting. Regarding sense of worry of receiving the vaccine, 66% did not feel worried while 10% felt very worried. After vaccination, 53% felt very protected while 15% did not feel protected at all.

Conclusion

In SOTR who received the Pfizer vaccine, 39% of patients reported side effects after both doses. Injection site pain was most common after first dose and systemic side effects were more after the second dose. The study reinforces the safety profile of the vaccine and SOTR with reactogenicity similar to other studies. Even after vaccination, majority of SOTR plan to wear masks in various settings.

A cross sectional survey on the effect of COVID-19 related restrictions on undergraduate and postgraduate medical education in Qatar

BACKGROUND

COVID-19 pandemic has affected all dimensions of day to day life across the world and medical education was no exception. With this study, we aimed to understand the effect of nationwide restrictions on medical education in Qatar, the models of education adopted during this period and perceptions of participants to the same.

METHODS

We conducted a cross-sectional study utilizing an online questionnaire distributed via convenience sampling between April-October 2020. Study participants were faculty and trainees in governmental undergraduate and postgraduate medical education institutes. Two sets of questionnaires were designed for each group. They were asked a series of questions to assess pre- and post-COVID pandemic educational practices, their preferred teaching methods, and their familiarity with electronic teaching platforms. Faculty respondents were asked about their perceived barriers to delivery of medical education during the pandemic and their agreement on a 5-point Likert scale on specific elements. Trainees were asked a series of multiple-choice questions to characterize their pre- and post-COVID pandemic educational experiences. Both groups were asked open-ended questions to provide qualitative insights into their answers. Data were analysed using STATA software version 12.0.

RESULTS

Majority of trainees (58.5%) responded that the pandemic has adversely affected medical education at both the undergraduate and postgraduate levels. Trainees (58.5%) and faculty (35.7%) reported an increased reliance on e-learning. Trainees preferred face-to-face education, while faculty preferred a combination of models of education delivery (33.5% versus 37.1%, p = 0.38). Although 52.5% of the faculty had no previous experience of delivering education through e-learning modalities, 58.9% however felt confident in using e-learning software.

CONCLUSIONS

Faculty and trainees agree that the COVID-19 pandemic has had a significant impact on the provision of medical education and training in Qatar, with an increased dependence on e-learning. As trainee's prefer face-to-face models of education, we may have to consider restructuring of medical curricula in order to ensure that optimum learning is achieved via e-learning, while at the same time enhancing our use, knowledge and understanding of the e -learning methods. Further research is warranted to assess if these changes have influenced objective educational outcomes like graduation rates or board scores.

Evolution of Vibrational Spectra in the Manganese-Silicon Clusters Mn2Sin, n = 10, 12, and 13, and Cationic [Mn2Si13]. J Phys Chem A 2022;126:1617-1626. [PMID: 35238570 PMCID: PMC9084549 DOI: 10.1021/acs.jpca.1c10027]

A comparison of DFT-computed and measured infrared spectra reveals the ground state structures of a series of gas-phase silicon clusters containing a common Mn₂ unit. Mn₂Si₁₂ and [Mn₂Si₁₃]⁺ are both axially symmetric, allowing for a clean separation of the vibrational modes into parallel (a₁) and perpendicular (e₁) components. Information about the Mn–Mn and Mn–Si bonding can be extracted by tracing the evolution of these modes as the cluster increases in size. In [Mn₂Si₁₃]⁺, where the antiprismatic core is capped on both hexagonal faces, a relatively simple spectrum emerges that reflects a pseudo-D_6d geometry. In cases where the cluster is more polar, either because there is no capping atom in the lower face (Mn₂Si₁₂) or the capping atom is present but displaced off the principal axis (Mn₂Si₁₃), the spectra include additional features derived from vibrational modes that are forbidden in the parent antiprism.

Clinical correlation and assessment of olfactory dysfunction with n-butanol in COVID-19 patients: our experience

Background: Studies showed olfactory disturbances in COVID patients. This has attracted focus of clinicians as an easy clinical screening tool in suspected population. Material and methods: 70 mild and moderate category COVID-19 RT-PCR positive patients, more than 10 years of age were tested on day of admission for olfaction with serial dilution of n-butanol and asked to grade severity of their olfactory dysfunction according to visual analogue score from 1-10. Results: Fatigue 42 (93.33%), sore throat 37 (82.22%), fever 36 (80%) and dyspnea 23 (51.11%) were the most common symptoms in moderate patients. Diabetes, hypertension and allergy were the three prominent risk factors. At time of admission, n-butanol diagnosed 20 patients having olfactory dysfunction compared to 11 by VAS. Patients tend to grade their dysfunction higher on VAS whereas the n-butanol test classified their olfactory dysfunction lower. Viral load and high CRP were not found to be significantly related with olfactory dysfunction. d-Dimer and LDH levels were found statistically associated with higher grading of olfactory dysfunction detected by n-butanol. Conclusion: The majority of cases developed hyposmia before they were admitted to hospital even before they realized that they were having hyposmia as revealed by n-butanol testing. We should go for objective tests of olfaction.

Measurement of the Groomed Jet Radius and Momentum Splitting Fraction in pp and Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

This article presents groomed jet substructure measurements in pp and Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV with the ALICE detector. The soft drop grooming algorithm provides access to the hard parton splittings inside a jet by removing soft wide-angle radiation. We report the groomed jet momentum splitting fraction, z_{g}, and the (scaled) groomed jet radius, θ_{g}. Charged-particle jets are reconstructed at midrapidity using the anti-k_{T} algorithm with resolution parameters R=0.2 and R=0.4. In heavy-ion collisions, the large underlying event poses a challenge for the reconstruction of groomed jet observables, since fluctuations in the background can cause groomed parton splittings to be misidentified. By using strong grooming conditions to reduce this background, we report these observables fully corrected for detector effects and background fluctuations for the first time. A narrowing of the θ_{g} distribution in Pb-Pb collisions compared to pp collisions is seen, which provides direct evidence of the modification of the angular structure of jets in the quark-gluon plasma. No significant modification of the z_{g} distribution in Pb-Pb collisions compared to pp collisions is observed. These results are compared with a variety of theoretical models of jet quenching, and provide constraints on jet energy-loss mechanisms and coherence effects in the quark-gluon plasma.