Assessment and Monitoring of Patients with Immune-Mediated Thrombotic Thrombocytopenic Purpura (iTTP): Strategies to Improve Outcomes

Background

Acquired or immune-mediated TTP (iTTP) is a life-threatening thrombotic microangiopathy, characterized by the presence of microangiopathic hemolytic anemia and severe thrombocytopenia, and a variable degree of ischemic organ damage, related to a severe deficiency of ADAMTS13, which is a serine metalloprotease necessary for cleavage of large vWF multimers. There has been a dramatic decrease in mortality rates with the recognition of the pathophysiology of iTTP over the years. Although therapeutic plasma exchange (TPE) together with corticosteroids are the backbone of the upfront treatment of patients with iTTP with successful outcomes, patients may remain refractory and/or relapse following an initial response to this treatment.

Methods

We performed a review regarding the pathogenesis, diagnosis, treatment strategies, monitoring, and prognosis of iTTP.

Results

There are several new treatment strategies, which can be used among these patients, helping in improving outcomes of iTTP. Rituximab has been shown to be a safe and effective adjunct to TPE, especially in patients with refractory and/or relapse as well as it is increasingly used preemptively to prevent exacerbation or recurrence. Recently, caplacizumab, a nanobody targeting vWF, was approved as an addition to the current regimen of TPE and immunomodulation for patients of iTTP.

Conclusion

Specific predictors of relapse in patients in remission can be relevant for an optimal patient management. Different models including ADAMTS13 biomarkers can provide a new screening strategy to identify patients who may predict outcomes and the risk of relapse, benefit from preemptive therapy prior to relapse.

Electroencephalographic Patterns Recorded by Continuous EEG Monitoring in Patients with Change of Consciousness in the Neurological Intensive Care Unit

INTRODUCTION

Our aim was to examine the frequency of various electrographic patterns including periodic discharges (PD), repetitive spike waves (RSW), rhythmic delta activities (RDA), nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) in continuous EEG monitoring (cEEG) of the critically ill patients with change of consciousness and the presence of specific clinical and laboratory findings associated with these important patterns in this study.

METHODS

Patients with changes of consciousness in the neurological intensive care unit (NICU) were consecutively monitored with cEEG during 2 years. Their clinical, electrophysiological, radiological and laboratory findings were evaluated retrospectively.

RESULTS

This sample consisted of 57 (25 men) patients with a mean age of 68.2 years. Mean duration of cEEG monitoring was 2532.6 minutes. The most common electrographic patterns were PD (33%) and NCS-NCSE (26.3%). The presence of NCS-NCSE was significantly associated with PD (57.9%, p<0.001). PD and NCS-NCSE were the mostly seen in patients with acute stroke and hypoxic encephalopathy. Duration of monitoring was significantly longer in the group with PD and NCS-NCSE (p:0.004, p:0.014). Detection of any electrographic pattern in EEG before monitoring was associated with the presence of any pattern in cEEG (59.3%, p<0.0001). Convulsive or nonconvulsive seizure during monitoring was common in patients with electrographic patterns (p<0.0001). 66.7% of NCS-NCSE was seen within the first 12 hours and 26.7% was seen within the 12-24 hours of the monitoring.

CONCLUSION

Detection of any electrographic pattern in EEG before monitoring was associated with the presence of any important pattern in cEEG monitoring. This association suggest that at least 24 hours-monitoring of these patients could be useful for the diagnosis of clinical and/or electrographic seizures.

Relationship between Objective and Subjective Fatigue Monitoring Tests in Professional Soccer

Studying fatigue is challenging because it is influenced by physiological, psychological, and sociological states. Fatigue can be assessed objectively or subjectively, but the literature has difficulty understanding how an analytical test relates to a response via a questionnaire. Thus, the purpose of this study was to evaluate the relationships between objective fatigue variables (Squat Jump (SJ) and Countermovement Jump (CMJ)) measured on day-2 to the game and subjective fatigue (Rating Perceived Exertion (RPE) measured on day-3 to the game and Hooper Index (HI) measured on day-2). The sample comprised 32 professional football players from the First Portuguese League aged 25.86 ± 3.15 years. The Spearman correlations and regression analyses were used to study the relationships between the variables. The results showed statistically significant (p < 0.05) but small correlations (0.113−0.172) between several objective metrics and the subjective metrics evaluated. In addition, we found two weak models with statistical significance (p < 0.05) between the dependent objective variables (contact time, height, and elasticity index) and the HI (R2 = 3.7%) and RPE (R2 = 1.6%). Also, nine statistically significant (p < 0.05) but weak models were observed between the subjective dependent variables (HI and RPE) and contact time (R2 = 1.8−2.7%), flight time (R2 = 1.1−1.9%), height (R2 = 1.2−2.3%), power (R2 = 1.4%), pace (R2 = 1.2−2.1%), and elasticity index (R2 = 1.6%). In conclusion, objective and subjective fatigue-monitoring tests in professional soccer do not measure identical but rather complementary aspects of fatigue, and therefore, both need to be considered to gain a holistic perspective.

Vertical Farming Monitoring: How Does It Work and How Much Does It Cost?

Climate change, resource scarcity, and a growing world population are some of the problems facing traditional agriculture. For this reason, new cultivation systems are emerging, such as vertical farming. This is based on indoor cultivation, which is not affected by climatic conditions. However, vertical farming requires higher consumption of water and light, since in traditional agriculture those resources are free. Vertical cultivation requires the use of new technologies and sensors to reduce water and energy consumption and increase its efficiency. The sensorization of these systems makes it possible to monitor and evaluate their performance in real time. In addition, vertical farming faces economic uncertainty since its profitability has not been studied in depth. This article studies the most important variables when monitoring a vertical farming system and proposes the sensors to be used in the data acquisition system. In addition, this study presents a cost model for the installation of this type of system. This cost model is applied to a case study to evaluate the profitability of installing this type of infrastructure. The results obtained suggest that the investment made in VF installations could be profitable in a period of three to five years.

Efficacy of ultrasonographic caudal vena cava to aorta ratios for quantifying canine parvoviral enteritis rehydration

Quantifying changes in intravascular fluid volume is important for treatment planning and follow-up assessment in dogs with dehydration. Recently, it has been reported that current standard methods used to estimate intravascular fluid volume in dogs are inadequate, invasive, or have complications such as thrombosis. The ultrasonographic ratio of dimensions for the caudal vena cava relative to the aorta (CVC/Ao) has been previously described as a promising, noninvasive method for quantifying changes in blood volume in dogs. This prospective observational study aimed to describe ultrasonographic CVC/Ao values before and after fluid replacement in a sample of dogs with varying degrees of dehydration due to naturally-occurring canine parvoviral enteritis (CPE), test correlations between this measure and clinical dehydration scores and determine the clinical efficacy of this measure for fluid therapy follow-up. The clinical dehydration score of 30 dogs naturally infected with canine parvovirus was determined at the first admission using standard clinical scoring methods, and then CVC/Ao was measured ultrasonographically. Following initial fluid therapy, the clinical dehydration scores and ultrasonographic CVC/Ao values were remeasured. On the basis of receiver operating characteristic analyses, ultrasonographic CVC/Ao was found to be a more sensitive and specific indicator than physical examination-based methods for estimating intravascular fluid alterations in dogs with dehydration due to parvovirus and rehydration following fluid therapy. Findings supported the use of this measure for treatment planning and follow-up in future dogs presenting with dehydration.

Is intensive care necessary after major thoracic surgery? A propensity score-matched study

Background

This study aims to compare the surgical results, complications, mortality rates, and inpatient costs in two patient groups followed, whether in the intensive care unit or general ward after a major thoracic procedure and to examine clinical and surgical factors related to the development of complications.

Methods

Between January 2018 and June 2021, a total of 485 patients (150 males, 335 females; mean age: 58.3±13.2 years; range, 22 to 86 years) who underwent a major thoracic surgery in our clinic were retrospectively analyzed. The patients were divided into two groups as the intensive care unit patients (n=254) and general ward patients (n=231). In the former group, the patients were followed in the intensive care unit for a day, while in the general ward group, the patients were taken directly to the ward. The groups were compared after propensity score matching. All patients were analyzed for risk factors of morbidity development.

Results

After propensity score matching, 246 patients were enrolled including 123 patients in each group. There was no statistically significant difference between the groups in any features except for late morbidity, and inpatient costs were higher in the intensive care unit group (p<0.05). In the multivariate analysis, age, American Society of Anesthesiologists Class 3, and secondary malignancy were found to be associated with morbidity (p<0.05).

Conclusion

In experienced centers, it is both safe and costeffective to follow almost all of the major thoracic surgery patients postoperatively in the general ward.

Trends of rheumatoid arthritis monitorization in Romania

BACKGROUND

rheumatoid arthritis (RA) is associated with the loss of overall functionality, which leads to substantial economic losses. Second line agents used in RA treatment require careful monitorization in terms of efficiency and tolerability.

OBJECTIVE

trends, predictive factors and characteristics of clinical, biological and radiological RA monitorization in a cross sectional observational cohort study, conducted on over 206 patients in Romania, with a 12 months follow up (December 2007 - December 2008).

METHOD

Cases were recruited from the south-west region of the country, covering a geographical area of 23 counties. Patients were invited to complete three sets of interviews (collected by post) in a consent letter, containing self reported questionnaires, at 6 months intervals: an original questionnaire (which included quantitative self reported of pain, disease activity and fatigue on visual analogue scale-VAS), Health Assessment Questionnaire-HAQ-Disability and Discomfort Scales and EUROQOL EQ-5D, validated in Romanian (obtaining a user agreement by authors of the original version).

RESULTS

analysis was carried out in SPSS 10. The cohort enrolled 206 patients, with the average age of 54.90 +/- 12.67 years, 66% urban, 86.4% women, 29.1% professionally active, 48.5% graduates of primary education. The average disease duration after diagnosis of RA was of 9.40 +/- 8.87 years. The duration of the treatment reported at baseline was of 2.70 +/- 2.64 years. Most patients followed a program of monthly monitoring at a general practitioner (GP) (41.7% at baseline and 37.1% to 12 months). Visits to the rheumatologist followed a monthly regimen (32.3% at baseline and 31.7% to 12 months) or a 2 months interval (19.4% at baseline and 29.6% to 12 months, p = 0.000). Biological monitoring was quarterly (39.6% and 53.2% at 12 months; p = 0.000) or at 2 months interval (26.2% at baseline and 16.7% to 12 months, p = 0.000). X-ray monitoring lacked in over half the cases in a year of disease progression (63.3% at 6 months and 62.2% at 12 months), although it sums between 1 and 3 radiographs to one third of the cases (36.8%),

CONCLUSION

generally, in our country, there is a lack of aggregation in the dispensarization algorithm of patients with RA; consequently, the decision is awarded to the human factor. Under these circumstances, some patients are over evaluated. Promoting a dispensarization guide for RA patients could induce benefits both clinically and economically. Therefore, we submit a proposal of recommendations as a guideline for clinical, biological and radiological monitoring, according to the phase and stage of RA.

A Narrative Review of the Impact of Sleep on Athletes: Sleep Restriction Causes and Consequences, Monitoring, and Interventions

This narrative review synthesizes evidence on the impact of sleep on athletic performance, the prevalence and causes of sleep disturbances, and effective monitoring and intervention strategies to enhance sleep quality and duration. A comprehensive review of case studies, observational studies, randomized controlled trials, systematic reviews, and meta-analyses was conducted using PubMed, Cochrane Library, and Google Scholar up to July 2024. Sleep plays a crucial role in the overall well-being and performance of athletes, yet sleep issues are highly prevalent due to factors such as competition schedules, psychological stress, and travel across time zones. Inadequate sleep negatively affects physical strength, endurance, cognitive function, and injury risk. Sleep tracking is highlighted as both a diagnostic and therapeutic tool, with interventions such as extending sleep duration, adopting sleep hygiene practices, and, when necessary, pharmacological approaches proving effective. The review concludes that tailored sleep strategies are essential to optimize athletic performance, recovery, and overall well-being.