Door-to-balloon: Where do we lose time? Single centre experience in India

Background/AimsTo assess the factors causing delay in attaining DTB time of <90 min.MethodsEighty-five patients who underwent primary PCI from August 2008 to July 2009 were studied. From door-to-balloon, time was divided into 6 stages; any reason for delay was studied.ResultsThe mean DTB time was 80.5 min (SD = 34.4, median time 75 min, range 30–195). DTB time was <90 min in 76.5%, and DTB time >90 min occurred in 23.5%. Mean door to ECG – 6.5 min (SD = 2.7), mean time for the decision of PCI – 7.5 min (SD = 10.5), mean time taken for the patient's consent – 19.6 min (SD = 17.6), for STEMI team activation – 6.7 min (SD = 7.6), average time for financial process – 39.2 min (SD = 22.9). Average time for sheath to balloon – 5.2 min (SD = 1.7). Hospital related delay occurred in 5%, patient related delay in 80%, both together in 15%. 89.5% of patient related delay was due to delay in giving consent and financial reasons. There was no statistically significant delay for patients presented at morning or night and during the weekdays or weekend. Total mortality was 4.7%. Mortality among <90 min was 3.1%, mortality among >90 min was 10% (‘p’ = 0.2).ConclusionsWith effective hospital strategies, the DTB time of 90 min can be achieved in majority of patients. The chief delay in DTB time in this study was due to a delay in obtaining consent and financial reasons.     

Accuracy of the door-to-balloon time for assessing the result of the interventional reperfusion strategy in acute ST-segment elevation myocardial infarction

Background

In patients with acute ST-segment elevation myocardial infarction (STEMI), recent clinical guidelines recommend that primary percutaneous coronary intervention (PCI) should be performed within 90 min of first medical contact or 45 min after admission in cathlab. The Door-to-Balloon time (D2B) is widely used to measure the performance of interventional centres.

Aim of the study

To analyze the time to reperfusion in a consecutive series of STEMI patients referred for primary PCI, and to evaluate the clinical accuracy of D2B in primary PCI.

Methods

From January 2007 to March 2008, 177 patients were admitted within 12 hours of a STEMI in our institution, and 87 were referred for a direct coronary angiography for primary PCI (47 by mobile medical emergency unit, 40 by the emergency department of the institution).

Results

The median time from first medical contact to balloon inflation (M2B) was 135 min [IQR 112–183]. Recommended times were fulfilled in a minority of patients (M2B < 90 min: 9%, <120 min: 34%). Median cathlab D2B was 51 min [IQR 44–65], and was less than 45 min in 34% of patients. No differences for times to reperfusion within cathlab were found between in- and off-time hours. M2B and D2B were unavailable in 23 patients (26%), because of a spontaneous TIMI 3 flow reperfusion without indication for immediate PCI in 20 patients, contra-indication for PCI in two (distal occlusion, culprit vessel diameter less than 2 mm), and failure in occlusion crossing by the guide-wire in one patient. In contrast, first medical contact- or door-to-reperfusion times, assessed by a TIMI 3 flow without no-reflow in culprit artery, were available in 95% of patients, and were shorter than M2B or D2B, respectively.

Conclusion

Although it is a feasible and reproducible process performance measure, D2B time is weakly associated with the outcome of the interventional reperfusion strategy in acute STEMI. This measure should be associated with an outcome performance measure, such as the rate of TIMI 3 flow achieved by primary PCI, or replaced by the Door-to-TIMI 3 flow reperfusion time.     

Sedentary time and markers of inflammation in people with newly diagnosed type 2 diabetes

Background and aimsWe investigated whether objectively measured sedentary time was associated with markers of inflammation in adults with newly diagnosed type 2 diabetes.Methods and resultsWe studied 285 adults (184 men, 101 women, mean age 59.0 ± 9.7) who had been recruited to the Early ACTivity in Diabetes (Early ACTID) randomised controlled trial. C-reactive protein (CRP), adiponectin, soluble intracellular adhesion molecule-1 (sICAM-1), interleukin-6 (IL-6), and accelerometer-determined sedentary time and moderate-vigorous physical activity (MVPA) were measured at baseline and after six-months. Linear regression analysis was used to investigate the independent cross-sectional and longitudinal associations of sedentary time with markers of inflammation.At baseline, associations between sedentary time and IL-6 were observed in men and women, an association that was attenuated following adjustment for waist circumference. After 6 months of follow-up, sedentary time was reduced by 0.4 ± 1.2 h per day in women, with the change in sedentary time predicting CRP at follow-up. Every hour decrease in sedentary time between baseline and six-months was associated with 24% (1, 48) lower CRP. No changes in sedentary time between baseline and 6 months were seen in men.ConclusionsHigher sedentary time is associated with IL-6 in men and women with type 2 diabetes, and reducing sedentary time is associated with improved levels of CRP in women. Interventions to reduce sedentary time may help to reduce inflammation in women with type 2 diabetes.     

Implementation of multiple strategies for improved door-to-balloon time in patients with ST-segment elevation myocardial infarction

Several strategies have been found to be associated with a significant reduction in door-to-balloon (D2B) time in the management of ST-segment elevation myocardial infarction (STEMI). The objective of this retrospective cohort study was to assess D2B time before and after specific hospital strategies, including a computerized provider order entry (CPOE), were implemented to reduce D2B time. Patients who presented to the emergency department within 12 h of STEMI were enrolled. Strategies adopted included: (1) electrocardiography during triage for patients with chest pain; (2) implementing a CPOE; (3) activating the catheterization laboratory by sending a cell phone notification via the computer system; (4) using an open real-time on-line STEMI registry; and (5) conducting a monthly meeting to review registration. A total of 134 patients were included in the study (preintervention, n = 69; postintervention, n = 65). Median D2B time improved from 83 to 63 min after the new strategies were implemented (P = 0.001). Median door-to-electrocardiogram (5–2 min) and door-to-laboratory time (60–41 min) also significantly improved (P < 0.001). The proportion of patients with a D2B time within 90 min increased from 59.4 % to 98.5 % (P < 0.001). In conclusion, our findings suggest that implementing specific strategies can substantially improve D2B time for patients with STEMI and increase the proportion of patients with D2B time less than 90 min.     

Évolution de la prise en charge interventionnelle et des délais de reperfusion à la phase aiguë de l’infarctus du myocarde avec sus-décalage du segment ST

BackgroundIn patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), the recommended times (first medical contact-to-balloon (M2B) < 120 or < 90 min, and door-to-balloon (D2B) < 45 min) are reached in less than 50% of patients.PurposeTo compare the interventional reperfusion strategy and reperfusion times between two series of consecutive STEMI patients referred for pPCI within 12 hours of symptom onset, in 2007 and 2012.MethodsRetrospective study of 182 patients, 87 admitted from January 2007 to March 2008 (period 1), and 95 admitted from January to December 2012 (period 2). The procedural characteristics and the different times between onset of pain and mechanical reperfusion were gathered and compared by non-parametric tests.ResultsRadial access, thromboaspiration, and drug eluting stents were more frequent, and cardiogenic shock was less common during period 2, compared with the period 1. The median time from first medical contact to balloon (M2B) decreased by 26% (135 min, [quartiles: 113–183] in 2007 versus 100 [76–137] in 2012, P < 0.001), in relation to the reduction in both prehospital times and time in the catheterization laboratory (D2B: 51 [44–65] and 44 min [37–55], respectively, P < 0.01).ConclusionsThe D2B and M2B times significantly decreased in our centre between 2007 and 2012, and reached the recommended values in > 60% of the cases. This may be explained by better coordination between emergency medical units and interventional cardiologists, and by the presence of two paramedics in the catheterization laboratory for 24/24 7/7 pPCI since 2010 in France, in accordance with recent national regulation.     

The impact of donor pancreas extraction time on graft survival and postoperative complications in pancreas transplant recipients

BackgroundSimultaneous pancreas kidney transplantation (SPK) is the best therapeutic option for patients with diabetes mellitus type 1 and end-stage renal disease. Recently, donor organ extraction time has been shown to affect kidney and liver graft survival. This study aimed to assess the effect of pancreas donor extraction time on graft survival and postoperative complications.MethodsWe retrospectively analyzed all pancreas transplants performed in two Eurotransplant centers. The association of pancreas extraction time with pancreas graft survival was analyzed by a Cox proportional hazards regression analysis after 3 months, 1 and 5 year. Besides, the effect of pancreas extraction time on the incidence of severe postoperative complications was analyzed.ResultsA total of 317 pancreas transplants were included in this study. Death-censored pancreas graft survival was 85.7% after one year and 76.7% after five years. Median pancreas donor extraction time was 64 min [IQR: 52–79 min]. After adjustment for potential confounders, death censored graft survival after 30 days (HR 1.01, 95% CI 0.9–1.03 (p = 0.23), 1 year (HR 1.01, 95% CI 0.99–1.03 (p = 0.22) and 5 years (HR 1.00, 95% CI 0.99–1.02 (p = 0.57) was not associated with pancreas donor extraction time. However, extraction time was significantly associated with a higher incidence of Clavien-Dindo ≥3 complications compared to Clavien-Dindo 1 + 2 complications: OR 1.012, 95% CI 1.00–1.02 (p = 0.039).ConclusionsOur findings suggest that although no effect on graft survival was found, limiting pancreas extraction time can have a significant impact on lowering postoperative complications.     

Acute promyelocytic leukaemia is characterized by stable incidence and improved survival that is restricted to patients managed in leukaemia referral centres: a pan‐Canadian epidemiological study

Timely diagnosis and care are major determinants of the outcome in acute promyelocytic leukaemia (APL), a malignancy whose incidence may be increasing. The Canadian Cancer Registry (CCR) and health system represent valuable settings to study APL epidemiology. We analysed the CCR, which contains data on all Canadians with APL. To provide clinical information lacking in the CCR, we obtained data from five leukaemia referral centres during a similar time period. Between 1993 and 2007, there were 399 APL in Canada. Age‐standardized incidence was 0·083/100 000 and was stable over time. The early death (ED) rate was 21·8% (10·6% in patients <50 years old and 35·5% for those aged >50 years), with no improvement over time. Five‐year overall survival (OS) was 54·6% (73·3% in patients <50 years; 29·1% older patients). In the referral cohort, 131 patients were diagnosed between 1999 and 2010. ED was 14·6% and 2‐year OS was 76·5%. Within this cohort, ED and OS improved over time, although advanced patient age remained an adverse determinant of OS. In Canada, APL incidence is unexpectedly low and temporally stable. ED was higher than reported in clinical trials, but similar to reports from other registries. In contrast, ED was lower in referral centres and improved with time.     

Viral pathogens in acute exacerbations of chronic obstructive pulmonary disease

The objective of this study is to determine the prevalence of respiratory syncytial virus (RSV) and other viral respiratory pathogens in emergency department (ED) patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). COPD patients presenting to the ED with <10 days of AECOPD symptoms were eligible. We used PCR to test nasal swabs for common viral respiratory pathogens. We completed viral studies on 76 patients from two EDs. Patients had a mean age of 72 years, and were 68% male, 99% white, and 29% current smokers. Influenza vaccination was reported by 87%. Viruses were detected in 19 of 76 patients (25%). These included RSV A (2) and B (4); parainfluenza 1 (1), 2 (0), and 3 (2); influenza A (3) and B (0); rhinovirus (4); and human metapneumovirus (3). A putative viral etiology was identified in 25% of AECOPD presenting for emergency care, of which approximately one-third were RSV-related.     

What is the best biological parameter to predict erectile dysfunction in men aged >55 years with type 2 diabetes?

To date, there is no evidence regarding the best biological marker to predict erectile dysfunction (ED) in men aged >55 years with type 2 diabetes. This prospective study included data from men aged >55 years with type 2 diabetes. ED was assessed by the International Index of Erectile Function 15‐item survey. Total testosterone (TT) levels and bioavailable testosterone were measured; the free testosterone index was calculated. Data from 155 men (aged 64 ± 7 years) were explored. The prevalence of ED and testosterone deficiency was 78.7% and 34.8%, respectively. After univariate analysis, TT and bioavailable testosterone were associated with ED (P = 0.01). After multivariate analysis, and adjustment for age, body mass index, tobacco, alcohol, duration of diabetes, TT, bioavailable testosterone, vitamin D and high‐sensitivity C‐reactive protein, we found that only high‐sensitivity C‐reactive protein was significantly predictive of ED. TT could predict ED, but it lacks specificity. We found a potential role of high‐sensitivity C‐reactive protein as a predictive marker of ED in this targeted population.     

Erectile dysfunction,microangiopathy and UKPDS risk in type 2 diabetes

BackgroundErectile dysfunction (ED) is a frequent comorbidity in patients with type 2 diabetes mellitus (T2DM), and is now increasingly considered a surrogate marker of endothelial dysfunction as well as a sentinel predictor of new-onset macroangiopathic events. Less attention, however, has been directed at the potential association of ED and microangiopathy in hyperglycaemic states.MethodsWe analyzed 221 consecutive male T2DM outpatients in whom ED was assessed by the International Index of Erectile Function (IIEF-5) questionnaire. ED(+) patients (IIEF-5 1–20; n = 83) were compared with an age-matched ED(−) cohort (IIEF-5 21–25; n = 51), with similar diabetes duration, in terms of cardiovascular (CV) risk factors, micro-/macroangiopathy and the United Kingdom Prospective Diabetes Study (UKPDS) risk score.ResultsMean age and diabetes duration were 58 and 10 years, respectively. IIEF-5 score (1 S.D) was 23 (1) in ED(−) vs 11 (6) in ED(+). Anamnestic impotence and erectogenic drug use were reported by 52% and 36%, respectively, of ED(+) vs 12% and 8%, respectively, of ED(−) (P < 0.0002 and P < 0.0001, respectively). The metabolic syndrome prevalence (88% vs 64%; P = 0.002) and central adiposity markers (waist, waist/height and visceral fat) were all significantly higher in ED(+). HbA_1c was similar in both groups: 7.5% (1.3%), and there were also no significant differences in smoking, blood pressure, HOMA insulin sensitivity, cholesterol and glomerular filtration rate. However, prevalences of retinopathy, polyneuropathy and elevated albuminuria, and the composite endpoint of peripheral artery disease, transient ischaemic attacks and/or stroke, were markedly increased in ED(+) (all P < 0.05). No differences were observed in coronary artery disease prevalence or in the UKPDS 10-year CV risk between the two ED groups.ConclusionIIEF-5-defined ED in men with T2DM is associated with a marked increase in the metabolic syndrome, central adiposity and microangiopathy. These data suggest that diagnosing ED in T2DM warrants detailed screening and monitoring for microangiopathy in target organs.     

Plasma homocysteine is associated with nonproliferative retinopathy in patients with type 2 diabetes without renal disease

Background and aimsThis study aimed to assess the role of plasma homocysteine (Hcy) in the development of nonproliferative diabetic retinopathy (NPDR) in patients with type 2 diabetes (T2DM) without chronic kidney disease.MethodsThis was a cross-sectional study that included 94 T2DM. Hcy, serum 25-hydroxy (25-OH) vitamin D, vitamin B12, and folate were determined by the CMIA method. NPDR was determined according to the EURODIAB retinal photography methodology and optical coherence tomography (OCT) of the macula.ResultsCompared to patients without NPDR, patients with NPDR had longer diabetes duration (p < 0.001), higher Hcy (p < 0.001), lower vitamin B12 (p = 0.028) and lower estimated glomerular filtration rate (eGFR) (p = 0.004). NPDR was positively associated with diabetes duration (p < 0.001), HbA₁c (p = 0.049) and Hcy (p < 0.001), and negatively with vitamin B12 (p = 0.027) and eGFR (p = 0.005). Logistic regression analyses showed that diabetes duration (OR = 1.13, p < 0.001), Hcy (OR = 1.06, p = 0.047), and eGFR (OR = 0.96, p = 0.004) were the main predictors of NPDR in T2DM. Stepwise regression analyses showed that the best model for predicting Hcy (R2 = 0.104) included vitamins B12 and D.ConclusionsHigher Hcy is associated with NPDR and may play a role as a risk factor for its development in T2DM. Vitamins B12 and D seem to modify this association.     

Factors affecting STEMI performance in six hospitals within one healthcare system

BackgroundHow quickly percutaneous coronary intervention is performed in patients with ST-elevation myocardial infarction (STEMI) is a quality measure, reported as door-to-balloon (D2B) time.ObjectivesTo explore factors affecting STEMI performance in six hospitals in one healthcare system.MethodsThis was a retrospective chart review of clinical features and D2B times. Predictors for D2B times were identified using multivariate linear regression.ResultsThe median D2B time for all six hospitals was 63 minutes and all hospitals surpassed the minimal recommended percentage of patients achieving D2B time ≤90 minutes (87.8%vs75%,p<0.001). Patient confounders adversely affect D2B times (+21.5 minutes, p<0.001). Field ECG/activation with emergency department (ED) transport (-22.0 minutes) or direct cardiac catheterization laboratory (CCL) transport (-27.3 minutes) was superior to ED ECG/activation (p<0.001).ConclusionField ECG/STEMI activation significantly shortened D2B time. To improve D2B time, hospital and Emergency Medical Service collaboration should be advocated to increase field activation and direct patient transportation to CCL.     

急性ST段抬高心肌梗死患者急诊介入治疗门-囊时间及其影响因素

目的探讨急性ST段抬高心肌梗死(STEMI)患者直接介入治疗(PCI)门-囊(D2B)时间及其影响因素。方法回顾性分析潞河医院2005年1月至2008年8月连续收治的行直接PCI的STEMI患者的D2B时间及其组成成分,记录如下时间(中位数):院前时间、门-CCU时间、CCU-获得知情同意时间、知情同意-导管室时间,导管室-首次球囊扩张时间。将D2B时间分为两组:短D2B组(≤120min)和长D2B组(120min),应用Logistic回归分析影响D2B时间的因素。结果477例STEMI患者中,院前延迟时间125min,总的D2B时间120min,其中门-CCU时间19min,CCU-获得知情同意时间30min,知情同意-导管室时间30min,导管室-首次球囊扩张30min。D2B时间低于90min的患者占19.5%(93/477)。Logistic回归分析表明:与长D2B时间(120min)有关的因素是节假日住院(OR=1.85,95%CI1.19～2.85),门诊就医(OR=2.28,95%CI1.21～4.33),入CCU时无症状(OR=2.17,95%CI1.47～3.20)。而通过急救医疗服务系统(EMS)转运(OR=0.36,95%CI0.23～0.55),入CCU时间在6am～10pm(OR=0.48,95%CI0.30～0.74)预测短D2B时间(≤120min)。结论多数STEMI患者的D2B时间超过指南要求,临床因素和院内机制与长D2B时间相关,应当建立起有效的院内机制来降低院内延迟。     

Door-to-balloon time in radial versus femoral approach for primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

Primary percutaneous coronary intervention (pPCI) is considered the preferred reperfusion strategy for patients presenting with ST-segment elevation myocardial infarction (STEMI). This study compares the door-to-balloon (D2B) time between transradial vs. the transfemoral approach in patients presenting with STEMI.MethodsA retrospectively collected catheterization laboratory database was reviewed for the consecutive patients presenting with a STEMI. Specific time parameters were recorded, and our composite end points were time to revascularization, angiographic success, short term clinical success, and procedural vascular complications.ResultsRadial PCI (r-PCI) was performed in 33 patients (67.3%) and in 16 patients (32.7%) PCI was done through femoral artery (f-PCI). No significant difference was observed in the pre-catheter and catheter laboratory times. Mean times from emergency room door-to-catheter laboratory time for r-PCI vs. f-PCI were 82.48 ± 37.42 and 76.29 ± 34.32 min, respectively (P = 0.636). The mean time from patient arrival to the cardiac catheter laboratory-to-balloon inflation was 34.56 ± 14.2 in the r-PCI group vs. 33.12 ± 12.56 min with the f-PCI group (P = 0.215). The total D2B time was not significantly different between r-PCI vs. f-PCI groups (100.32 ± 36.3 vs. 97.31 ± 30.37 min, respectively, P = 0.522). Angiographic success rates were observed in 92.1% of the patients for r-PCI, and in 87.5% for f-PCI (P = 0.712). There were no vascular complications in both groups.ConclusionsPatients presenting with STEMI can undergo successful pPCI via radial artery without compromising patient care.     

Association of erectile dysfunction and type II diabetes mellitus at a tertiary care centre of south India

Background and aimsErectile Dysfunction (ED) is more common in diabetic men and, unfortunately, occurs at an earlier age in diabetic patients when compared with the general population. The study aims to evaluate the independent predictors of ED in adult men with type 2 diabetes mellitus (DM) at a tertiary care center of South India.MethodsA total of 720 men aged 30–70 years who had been diagnosed with type 2 DM were enrolled for the study from January 2017 to January 2020 from the outpatient diabetes clinic of the Hospital. All patients completed the abridged version of the International Index of Erectile Function (IIEF-5) questionnaire.ResultsThe mean age of the patients was (58.4 ± 7.8 years). 68.6% of subjects had varying degrees of erectile dysfunction, of which 54.6% had moderate to severe ED. 55.8% had poor glycemic control (HbA1c ≥ 7%). Subjects with ED had a longer duration of DM than those without ED (mean DM duration was 8.1 ± 4.9 years versus 4.4 ± 3.5 years; p < 0.001). Longer duration of DM, poor glycemic control, hypertension, peripheral arterial disease, testosterone deficiency were all independent predictors ED (p < 0.05).ConclusionsA high incidence of erectile dysfunction was observed in type 2 DM patients attending the diabetic clinic, and over half of the people affected were of moderate-to-severe in intensity. Poor glycemic control, testosterone deficiency, peripheral arterial disease were the modifiable risk factors for ED in diabetic subjects. At the same time, a longer duration of type 2 DM was noticed as a glaring non-modifiable risk factor, according to our study.     

Comparison of sexual function in men with spondyloarthritis and rheumatoid arthritis

Aim of the workTo evaluate sexual function in Tunisian men with spondyloarthritis (SpA) and rheumatoid arthritis (RA) compared to healthy controls. The association between erectile dysfunction (ED) and specific parameters of SpA and RA was also studied.Patients and methodsThe study included 37 SpA, 13 RA patients and 50 healthy age matched controls. Sexual function of patients and controls was evaluated by the International Index of Erectile Function-5. ED was considered if the score was <21. Pain during intercourse and sexual desire were also assessed.ResultsThe mean age of the SpA and RA patients and control were comparable (42.5 ± 11.4 years, 49.6 ± 12.8 years and 48.8 ± 13.9 years). The prevalence of ED in rheumatic disease patients (SpA and RA) was 80% versus 70% in controls. A significant difference was found in the severity of the ED between patients and control (p = 0.04) and between SpA and RA patients (p = 0.012). There was also a higher prevalence of pain during intercourse (p < 0.0001), lower intensity of sexual desire (p = 0.005) and more dissatisfaction in relation with the partner (p < 0.0001) in the RD patients. ED in SpA and RA patients was significantly associated with higher age (p = 0.001), marital status (p = 0.007), higher age of disease’s onset (p = 0.027), pain during intercourse (p = 0.05) and lower sexual desire (p < 0.0001). On regression analysis, only sexual desire was significantly associated with ED (p = 0.03).ConclusionThis work suggests that patients with SpA or RA have a more severe ED in comparison with healthy control. However, specific disease parameters were not linked to ED.     

Diabetes and erectile dysfunction: The relationships with health literacy,treatment adherence,unrealistic optimism,and glycaemic control

Purpose

The aim of this study was to evaluate the relationships between health literacy, unrealistic optimism, and adherence to glycometabolic disease management related to erectile dysfunction (ED) in male patients with type 2 diabetes (T2D) or preDM.

Materials and Methods

This prospective observational study enroled 167 consecutive patients with T2D and ED. All patients underwent the following examinations: (a) medical history collection; (b) Body Mass Index (BMI) determination; (c) hormonal and biochemical assessment; (d) duration of T2D, complications and treatment; (e) International Index of Erectile Function-5 questionnaire to assess ED; and (f) validated questionnaire to evaluate health literacy, unrealistic optimism, and treatment adherence.

Results

Overall, mean age was 62.5 ± 9.4 years (range: 20–75) and mean BMI was 28.4 ± 4.8 kg/m² (range: 18.4–46.6). The mean IIEF-5 score was 15.4 ± 5.2 (range: 5–25). The majority of patients showed high health literacy. However, low health literacy was found in patients with higher IIEF-5 scores and high BMI. Unrealistic optimism was low in most patients. Higher adherence to treatment was found in patients who reported regular physical activity, who followed a diet, and in patients with a family history of T2D. Regarding anti-diabetic treatment, patients treated with insulin showed higher health literacy than patients not treated with other medications, whereas higher adherence was found in patients using SGLT2-i.

Conclusions

This study highlighted the close relationship between metabolic compensation, BMI, ED, and psychological attitudes, including health literacy and unrealistic optimism.

     

Diagnostic accuracy of hepatic vein arrival time performed with contrast-enhanced ultrasonography for HCV liver cirrhosis

Background and study aims: Contrast-enhanced ultrasonography (CEUS) has increased considerably the use of ultrasound for hemodynamical analyses and quantification. Bolus injection of microbubble agents is used to evaluate transit times. This study aimed to determine the diagnostic accuracy of arrival time (seconds) to the hepatic artery (HAAT), hepatic vein (HVAT), and portal vein (PVAT), based on CEUS used for the diagnosis of cirrhosis, and to correlate these arrival times with the liver stiffness and disease severity. Patients and methods: This study evaluated 29 HCV cirrhotic and 19 chronic hepatitis C patients. History, clinical examination, laboratory investigations, abdominal ultrasonography, point shear-wave elastography (pSWE), and CEUS were conducted. Results: The mean liver stiffness increased significantly in cirrhotic versus chronic HCV (22.7 versus 5.1; p-value < 0.001). The mean HAAT (p-value = 0.001), PVAT (p-value = 0.002), and HVAT values (p-value: 0.001) were significantly prolonged in cirrhotic compared with chronic HCV. The HVAT cut-off point of cirrhotic patients was 18 s with a sensitivity, specificity, and accuracy of 96.6%, 63.2%, and 83.3%, respectively (area under curve: 0.801). Significant positive correlation was found between liver stiffness (kPa) and HVAT (s) (r = 0.585; p-value = 0.005). No significant correlation was detected between HVAT (s) and the severity of liver disease, as assessed by the Child or MELD scores in cirrhotic patients. Conclusion: Measuring HVAT by CEUS yielded high-accuracy and correlation outcomes for cirrhosis detection. It could be a valuable noninvasive method for the diagnosis of cirrhosis.     

Infant feeding behaviours and attitudes to feeding amongst mothers with eating disorders: A longitudinal study

This study aims to investigate breastfeeding, infant feeding behaviours, and attitudes to feeding amongst women with eating disorders (ED) and healthy controls (HC). Women with active ED (C‐ED; N = 25), past ED (P‐ED; N = 28), and HC (N = 46) were recruited in pregnancy and followed up longitudinally. Post‐natally infant feeding behaviour was investigated at 8 weeks, 6 months, and 1 year and parental modelling at 1 and 2 years. Women with P‐ED and C‐ED reported higher concerns about their infant being/becoming overweight compared with HC, respectively, at 8 weeks and 6 months and 6 months only post‐partum. Women with P‐ED showed less awareness of infant hunger and satiety cues compared with HC at 8 weeks. Despite few differences between ED and HC, both P‐ED and C‐ED predicted maternal attitudes and worries about child's eating. These are likely to impact on child's growth and later eating behaviours and might impact on the intergenerational transmission of ED.     

Effect of maternal eating disorders on mother-infant quality of interaction,bonding and child temperament: A longitudinal study

Aims

This study aims to investigate the effect of maternal eating disorders (ED) on mother-infant quality of interaction at 8 weeks and bonding and child temperament at 1 and 2 years postnatally. We also aimed to explore the relationship between maternal ED psychopathology, comorbid psychiatric difficulties, and both mother-infant quality of interaction and bonding in women with ED. Women were recruited to a prospective longitudinal study. By the time of giving birth, the sample consisted of 101 women of the initial 137 (73.7%). Overall, 62 women (ED = 36; HC = 26) participated in the 8-week assessment, 42 (ED = 20; HC = 22) at 1 year, and 78 (ED = 34; HC = 44) at 2 years. Mann-Whitney U Test was used to explore association between maternal ED and mother-infant quality of interaction and between maternal ED and bonding. Spearman correlations were used to explore associations between maternal ED psychopathology, comorbid psychiatric difficulties, and both mother-infant quality of interaction and bonding.

Results

We found no differences between early mother-infant interaction and bonding in mothers with ED in comparison to HC. High levels of maternal ED psychopathology were correlated with high anxiety levels, higher negative affectivity, and lower extraversion in children of ED mothers both at 1 and 2 years. Furthermore, high levels of ED psychopathology were also associated with lower effortful control at 1 year.

Conclusions

Findings imply that maternal ED have an impact on child temperament. Future research should focus on resilience and on which protective factors might lead to positive outcomes. These factors can be then used as therapeutic and preventative targets.