A Cross-Sectional Study of the Physical and Mental Well-Being of Long COVID Patients in Aruba.

Objective: To investigate the pattern and prevalence of persistent symptoms of Post-COVID-19 Syndrome (PCS) at 3, 6, 9, and 18 months after discharge. Associated risk factors were further examined to potentially explain the persistence of these symptoms.Design and Setting: A cross-sectional cohort study was conducted at the primary health care facility of Aruba, Dr. Horacio E. Oduber Hospital (HOH).Participants: Inclusion criteria were adults hospitalized at HOH for at least one night between March and July 2021 and laboratory-confirmed COVID-19 diagnosis. Exclusion criteria were deceased before the follow-up, not able to mobilize before or after discharge, living outside of Aruba or in nursing homes, and patients with psychosis, dementia, or hospitalized due to unrelated diseases.Methods: Eligible and willing participants completed a 20-question survey: a self-reported symptoms questionnaire about symptoms during and after COVID-19 infection, level of dyspnea measurement (mMRC-scale), quality of life measurement (EQ-5D-5E with EuroQoL VAS), and mental well-being (WHO-5). Hospitalization related data were gathered via retrospective analysis of patient records. Chi-square test, logistic regression, and ANOVA analyses were conducted; P<0.05 was chosen as level of statistical significance for all analyses.Results: In total, 222 (34.5%) patients were eligible, consenting, and completed the survey. Most participants were interviewed a year or more after their initial COVID-19 infection. Fatigue (37.8%), new-onset dyspnea (38.7%), hair loss (20.3%), and muscle pain (18.0%) were the most frequently reported symptoms at any time post COVID-19 infection. Female participants were found more likely to experience fatigue (P<0.05, OR 2.135, 95% CI 1.154-3.949) and new-onset dyspnea (P<0.05, OR 2.026 95% CI 1.093-3.756) after initial infection. Participants with one or more respiratory comorbidity were more likely to experience new-onset dyspnea (P<0.05, OR 2.681, 95% CI 1.223-5.873). None of the predictor variables was associated with cognitive impairment.Conclusion: This study identified female sex and respiratory comorbidity as crucial risk factors for PCS. Females were also found to have significantly lower health scores. Female participants were more likely to experience fatigue and dyspnea after COVID-19 infection.

Thyroid disease-specific quality of life questionnaires - A systematic review.

INTRODUCTION: Thyroid diseases are very common and rarely life-threatening. One of the main therapeutic goals is an improvement in quality of life, making it important to measure in clinical and research settings. The aim of this systematic review is to provide an overview of the currently available thyroid-specific quality of life questionnaires with regard to their validation quality in order to make recommendations for clinical use with a special focus on German questionnaires. METHODS: A systematic literature search was performed in Pubmed, Google Scholar and the Cochrane Library. A total of 904 studies were identified. After excluding duplicates, non-English- or German-language texts, full texts that were not freely available and studies with irrelevant content, 64 studies reporting on 16 different questionnaires were included in the analysis. RESULTS: Four questionnaires concerned benign thyroid diseases (ThyPRO, ThyPRO-39, Thy-R-HRQoL and Thy-D-QOL), six malignant thyroid diseases (THYCA-QoL, ThyCa-HRLQOL, EORTC-Thy34, MADSI-Thy, QOL-Thyroid and ThyCAT), and six endocrine orbitopathy (GO-QOL, GO-QLS, TED-QOL, STED-QOL, TAO-QoL and Ox-TED). Only five questionnaires were at least developed, if not validated, in German, and five were developed in more than two languages. CONCLUSIONS: ThyPRO and the ThyPRO-39 are the best-evaluated questionnaires for benign thyroid diseases. Alternatively, in hypothyroid patients, the adequately validated Thy-D-QoL can be used. For malignant thyroid diseases, the choice should be made individually, as all six questionnaires (THYCA-QoL, ThyCA-HRQOL, EORTC-Thy34, MDASI-Thy, QOL-Thyroid and ThyCAT) have different strengths and weaknesses. The GO-QOL is the best-validated questionnaire in endocrine orbitopathy. However, the TED-QOL is also suitable as a short-screening questionnaire for these patients.

Better Understanding the Workers' Retirement Decision Attitudes: Development and Validation of a New Measure.

The aim of the present research was to develop a measure that could be used in future research for in-depth study of the psychological management of retirement. We report the results of six studies involving 1,898 French workers designed to develop and assess the psychometric properties of a new instrument named the Workers' Retirement Motivations Inventory (WRMI) using the push pull anti-push anti-pull model. The items were constructed based on a review of the relevant psychological literature and face-to-face interviews with senior workers. A combined method of exploratory structural equations modeling and confirmatory factor analysis (CFA) was employed and provided evidence for validating this structure of the inventory. The WRMI showed consistency of the four-factor structure across different samples, internal consistency, test-retest reliability, and predictive validity of workers' plans for retirement. Implications of these findings and avenues for counseling activities and future research are discussed.

A novel, hydroxyapatite-based screw-like device for anterior cruciate ligament (ACL) reconstructions.

BACKGROUND: Rupture of the anterior cruciate ligament (ACL) is one of the most common injuries of the knee. Common techniques for ACL reconstruction require a graft fixation using interference screws. Nowadays, these interference screws are normally made of titanium or polymer/ceramic composites. The main challenge of application of a fixation device made entirely of bioactive ceramic is in relation to the low strength of such materials. The purpose of this study was to evaluate a novel geometry for a fixation device made of pure hydroxyapatite for ACL reconstructions that can overcome some problems of the titanium and the polymer/ceramic screws. METHODS: Finite Element Analysis was used for optimization of the stress distribution in conventional interference screw geometry. For experimental evaluation of the new fixation device, ex vivo tests were performed. RESULTS: The innovative screw-like fixation device is characterized by multiple threads with a large thread pitch. The novel design enabled the insertion of the screw into the bone without the application of an external torque or a screwdriver. In turn, it also allowed for the use of low-strength and high-bioactivity materials, like hydroxyapatite. Ex vivo tests showed that the novel screw can sustain pull-out forces up to 476 N, which is comparable to that of the commercially available BioComposite™ interference screws (Arthrex Inc., Germany), as a reference. CONCLUSIONS: In summary, the novel screw design is a promising strategy to develop all-ceramic fixation devices for ACL reconstructions, which may eliminate some drawbacks of the current interference screws.

Induced Pluripotent Stem Cell Differentiation Enables Functional Validation of GWAS Variants in Metabolic Disease.

Genome-wide association studies (GWAS) have highlighted a large number of genetic variants with potential disease association, but functional analysis remains a challenge. Here we describe an approach to functionally validate identified variants through differentiation of induced pluripotent stem cells (iPSCs) to study cellular pathophysiology. We collected peripheral blood cells from Framingham Heart Study participants and reprogrammed them to iPSCs. We then differentiated 68 iPSC lines into hepatocytes and adipocytes to investigate the effect of the 1p13 rs12740374 variant on cardiometabolic disease phenotypes via transcriptomics and metabolomic signatures. We observed a clear association between rs12740374 and lipid accumulation and gene expression in differentiated hepatocytes, in particular, expression of SORT1, CELSR2, and PSRC1, consistent with previous analyses of this variant using other approaches. Initial investigation of additional SNPs also highlighted correlations with gene expression. These findings suggest that iPSC-based population studies hold promise as tools for the functional validation of GWAS variants.

Examining the effect of affective commitment to the supervisor on nurses' psychological health as a function of internal locus of control.

AIM: This research aimed to examine how affective commitment to the supervisor related to nurses' well- and ill-being, and to explore the moderating function of internal locus of control in these relationships. BACKGROUND: Little is known about the effects of affective commitment to the supervisor on well- and ill-being, even less so in the nursing profession. Moreover, previous studies suggested that nurses' psychological reactions to their work environment might vary as a function of their individual characteristics. METHODS: This cross-sectional research used a questionnaire survey to explore the hypothesised relationships in a sample of 100 female certified nursing assistants. RESULTS: The results revealed that affective commitment to the supervisor was most strongly related to job satisfaction and well-being, and associated with lower levels of emotional exhaustion, when the internal locus of control was high. CONCLUSIONS: The present study emphasises the importance of a high quality relationship between nurses and their supervisors in order to promote their psychological health, and underscores the importance of individual characteristics. IMPLICATIONS FOR NURSING MANAGEMENT: This research indicates how nurses' psychological health could be promoted by fostering their affective commitment to the supervisor. It also emphasises that managers' relationships with their subordinates should be adjusted as a function of nurses' individual characteristics.

Asialoglycoprotein receptor 1 is a specific cell-surface marker for isolating hepatocytes derived from human pluripotent stem cells.

Hepatocyte-like cells (HLCs) are derived from human pluripotent stem cells (hPSCs) in vitro, but differentiation protocols commonly give rise to a heterogeneous mixture of cells. This variability confounds the evaluation of in vitro functional assays performed using HLCs. Increased differentiation efficiency and more accurate approximation of the in vivo hepatocyte gene expression profile would improve the utility of hPSCs. Towards this goal, we demonstrate the purification of a subpopulation of functional HLCs using the hepatocyte surface marker asialoglycoprotein receptor 1 (ASGR1). We analyzed the expression profile of ASGR1-positive cells by microarray, and tested their ability to perform mature hepatocyte functions (albumin and urea secretion, cytochrome activity). By these measures, ASGR1-positive HLCs are enriched for the gene expression profile and functional characteristics of primary hepatocytes compared with unsorted HLCs. We have demonstrated that ASGR1-positive sorting isolates a functional subpopulation of HLCs from among the heterogeneous cellular population produced by directed differentiation.

Maternal plasma levels of complement Factor H in miscarriage and in normal pregnancy: A cohort study.

The incidence of clinically recognizable miscarriage in general population is up to 15%. It has been shown that complement Factor H (CFH) mRNA levels were increased in endometrium of women during early pregnancy, compared to non-pregnant women. We hypothesized that patients with miscarriage could have lower protein levels of CFH. The objectives of this prospective cohort is to measure plasma levels of Factor H in pregnancies up to 20 weeks, and to investigated whether there is an association between CFH and miscarriage. Plasma levels of CFH were measured in a cohort of pregnant women, ranging from 3 to 19.6 weeks who attended a gynecologic emergency unit in Brazil. Subjects had a blood sample obtained at the first consultation and were followed up to 24 weeks. After reaching outcome, subjects were divided into 4 groups: (1) miscarriage at entry the study, (2) normal pregnancy, (3) those that evolved to miscarriage, and (4) a control group of 6 non-pregnant, fertile proven women. Kruskal-Wallis test was used for statistical analysis. From 193 eligible women, 4 were excluded due technical problems and 33 were lost to follow-up. Median levels (range) of CFH were 989.2 µg/mL (372-1644) n=64; 1042 µg/mL (600.7-1915) n=74; 1089 µg/mL (813.7-1250) n=12; 1004 µg/mL (901.7-1335) n=6 in groups 1-3 and control, respectively; p=0.46-Kruskal-Wallis; post-hoc power (1-ß)=31.6%. Therefore, median plasma levels of CFH are not different between women with miscarriage or normal pregnancy up to 19.6 weeks.

Tuberculine reaction measured by infrared thermography.

SETTING: The infection with Mycobacterium tuberculosis gives a delayed immune response, measured by the tuberculine skin test. We present a new technique for evaluation based on automatic detection and measurement of skin temperature due to infrared emission. DESIGN: 34 subjects (46.8±16.9 years) (12/22, M/F) with suspected tuberculosis disease were examined with an IR thermal camera, 48 h after tuberculin skin injection. RESULTS: In 20 subjects, IR analysis was positive for tuberculine test. Mean temperature of injection area was higher, around 1°C, for the positive group (36.2±1.1°C positive group; 35.1±1.6°C negative group, p<0.02 T test for unpaired groups). CONCLUSION: IR image analysis achieves similar estimation of tuberculin reaction as the visual evaluation, based on higher temperature due to increased heat radiation from the skin lesion.

Pleuroparenchymal Fibroelastosis: A New Entity within the Spectrum of Rare Idiopathic Interstitial Pneumonias.

Pleuroparenchymal fibroelastosis (PPFE) is a rare entity that has been recently included in the official American Thoracic Society/European Respiratory Society (ATS/ERS) statement in 2013 as a group of rare idiopathic interstitial pneumonias (IIPs). PPFE is characterized by pleural and subpleural parenchymal thickening due to elastic fiber proliferation, mainly in the upper lobes. The etiology of the disease is unclear, although some cases have been associated as a complication after bone marrow transplantation, lung transplantation (LT), chemotherapy, and recurrent respiratory infections. The patients usually report progressive dyspnea and dry cough and are predisposed to develop spontaneous or iatrogenic pneumothoraces after surgical lung biopsy (SLB) for its diagnosis. That is why better awareness with the clinical and radiologic features can help optimal management by the multidisciplinary team. Novel invasive techniques such as cryobiopsy may become useful tools in these patients as it could spare SLB. We present the first reported cases in Spain.

Dynamical characterization of two differentially disease associated MHC class I proteins in complex with viral and self-peptides.

Major histocompatibility complex (MHC) class I proteins are expressed on the cell surface where they present foreign and self-peptides to effector cells of the immune system. While an understanding of the structural prerequisites for antigen presentation has already been achieved, insight into subtype- or peptide-dependent dynamical characteristics of a peptide-MHC antigen is so far largely obscure. We approached this problem by employing 400-ns molecular dynamics simulations with two human MHC class I subtypes as model systems: the ankylosing spondylitis-associated HLA-B∗27:05 and the non-ankylosing spondylitis-associated HLA-B∗27:09. Both proteins differ only by a micropolymorphism at the floor of the peptide binding groove (Asp116His). A viral (pLMP2) and three self-peptides (pVIPR, pGR, and TIS) were evaluated. The stability of the binding grooves was found to be both subtype dependent and peptide dependent. A detachment from the C- and/or N-terminal pockets was observed for all peptides except TIS, resulting in a stabilization of the α1-helix in both TIS-displaying subtypes. Estimates of the entropy associated with the bound peptides showed an increased entropy for pLMP2 presented by B∗27:05 as compared to B∗27:09, in contrast to the self-peptides. Additionally, the flexibility of the α1-helix that is probably important for receptor binding to the B27:peptide epitope is significantly enhanced for B∗27:05. These in silico results show that the dynamic properties of peptide-MHC complexes are affected both by the bound peptide and by micropolymorphisms of the heavy chain. Our findings suggest a role for the conformational flexibility of MHC class I molecules in the context of recognition by receptors on effector cells.

A integração da informação entre hospital e laboratório privado de análises clínicas no Vale do Rio dos Sinos

A informação tem importância fundamental nas organizações. Atualmente os gestores vêm se deparando com grandes desafios para o gerenciamento da grande quantidade de informações geradas dentro das organizações. Antigamente cada setor desempenhava suas funções de forma individualizada, hoje em dia para garantir sua colocação no mercado cada vez mais competitivo é necessário que essas funções sejam integradas através de sistemas de informação (SI). O SI é o conjunto de componentes que são inter-relacionados e que coletam, processam, armazenam e distribuem informações, facilitando o controle e análises de processos e tomada de decisões. Esta realidade também está inserida na área da saúde, com a ampliação dos sistemas, a maior complexidade nos atendimentos faz com que os hospitais e laboratórios de análises clínicas utilizem os SI para gerenciar e integrar todas as informações produzidas, visando o melhor atendimento dos pacientes e a melhor qualidade dos processos. Assim o presente estudo tem por finalidade verificar a percepção dos colaboradores das unidades de um hospital e um laboratório de análises clínicas quanto ao acesso às informações.

Síndrome hemofagocítico asociado a tuberculosis diseminada / Hemophagocytic syndrome associated with disseminated tuberculosis

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Growth differentiation factor-15 as a prognostic biomarker in ovarian cancer.

OBJECTIVES: There is a need for identification of new biomarkers improving our understanding, diagnosis, and follow-up of ovarian cancer. Growth differentiation factor-15 (GDF-15) is a member of the transforming growth factor-beta superfamily, and GDF-15 overexpression has been found in several cancer forms but has not been explored in ovarian cancer. The aim of the study was to explore preoperative plasma concentration and tissue expression of growth differentiation factor (GDF)-15 in ovarian tumors. METHODS: GDF-15 concentration was measured by immunoradiometric assay in plasma samples from patients with invasive ovarian cancer (n=125), borderline ovarian tumor (BOT, n=43), and benign ovarian tumor (n=144), from healthy women (n=40), as well as in effusion samples (n=44) from women with advanced ovarian cancer. Sections of ovarian carcinoma (n=20), BOT (n=9), and cystadenoma (n=7) were immunostained for GDF-15. RESULTS: Median plasma GDF-15 concentration was elevated in ovarian cancer as compared to healthy controls and women with benign ovarian tumors or BOT (p<0.001). GDF-15 plasma concentration correlated inversely with survival time and was an independent predictor of survival, after correction for FIGO stage and age (p=0.01). GDF-15 protein was cytoplasmatically expressed in serous tumor cells and detectable in high concentrations in effusion samples. CONCLUSION: GDF-15 emerges as a new potential biomarker in ovarian cancer.

Human and software error in ductus venosus Doppler waveform analysis.

Ductus venosus waveform analysis has become increasingly affected by technical errors; however, these errors could be avoided if more attention was paid during sampling and analysis. The most common misevaluations include incorrect tracing, under- or overestimation of the peak systolic velocity, overestimation of the end-diastolic velocity, and, as a consequence, incorrect calculation of the pulsatility index facilitated either by human or software error. This article proposes practical suggestions to avoid technical errors in ductus venosus waveform analysis.