Challenges with non-descriptive compliance labeling of end-stage renal disease patients in accessibility for renal transplantation

Non-descriptive and convenient labels are uninformative and unfairly project blame onto patients.The language clinicians use in the Electronic Medical Record,research,and clinical settings shapes biases and subsequent behaviors of all providers involved in the enterprise of transplantation.Terminology such as noncompliant and nonadherent serve as a reason for waitlist inactivation and limit access to life-saving transplantation.These labels fail to capture all the circum-stances surrounding a patient’s inability to follow their care regimen,trivialize social determinants of health variables,and bring unsubstantiated subjectivity into decisions regarding organ allocation.Furthermore,insufficient Medicare coverage has forced patients to ration or stop taking medication,leading to allograft failure and their subsequent diagnosis of noncompliant.We argue that perpetuating non-descriptive language adds little substantive information,in-creases subjectivity to the organ allocation process,and plays a major role in reduced access to transplantation.For patients with existing barriers to care,such as racial/ethnic minorities,these effects may be even more drastic.Transplant committees must ensure thorough documentation to correctly encapsulate the entirety of a patient’s position and give voice to an already vulnerable population.

Palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease

BACKGROUND Long-term abdominal drains(LTAD)are a cost-effective palliative measure to manage malignant ascites in the community,but their use in patients with end-stage chronic liver disease and refractory ascites is not routine practice.The safety and cost-effectiveness of LTAD are currently being studied in this setting,with preliminary positive results.We hypothesised that palliative LTAD are as effective and safe as repeat palliative large volume paracentesis(LVP)in patients with cirrhosis and refractory ascites and may offer advantages in patients’quality of life.AIM To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver disease.METHODS A retrospective,observational cohort study comparing the effectiveness and safety outcomes of palliative LTAD and regular palliative LVP as a treatment for refractory ascites in consecutive patients with end-stage chronic liver disease followed-up at our United Kingdom tertiary centre between 2018 and 2022 was conducted.Fisher’s exact tests and the Mann-Whitney U test were used to compare qualitative and quantitative variables,respectively.Kaplan-Meier survival estimates were generated to stratify time-related outcomes according to the type of drain.RESULTS Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular LVP.The baseline characteristics were similar between the groups.Prophylactic antibiotics were more frequently prescribed in patients with LTAD(P=0.012),while the incidence of peritonitis did not differ between the two groups(P=0.46).The incidence of acute kidney injury(P=0.014)and ascites/drain-related hospital admissions(P=0.004)were significantly higher in the LVP group.The overall survival was similar in the two groups(log-rank P=0.26),but the endpoint-free survival was significantly shorter in the LVP group(P=0.003,P<0.001,P=0.018 for first ascites/drain-related admission,acute kidney injury and drain-related complications,respectively).CONCLUSION The use of LTAD in the management of refractory ascites in palliated end-stage liver disease is effective,safe,and may reduce hospital admissions and utilisation of healthcare resources compared to LVP.

Frailty in end-stage liver disease:Understanding pathophysiology,tools for assessment,and strategies for management

Frailty and sarcopenia are frequently observed in patients with end-stage liver disease.Frailty is a complex condition that arises from deteriorations across various physiological systems,including the musculoskeletal,cardiovascular,and immune systems,resulting in a reduced ability of the body to withstand stressors.This condition is associated with declined resilience and increased vulnerability to negative outcomes,including disability,hospitalization,and mortality.In cirrhotic patients,frailty is influenced by multiple factors,such as hyperammonemia,hormonal imbalance,malnutrition,ascites,hepatic encephalopathy,and alcohol intake.Assessing frailty is crucial in predicting morbidity and mortality in cirrhotic patients.It can aid in making critical decisions regarding patients’eligibility for critical care and transplantation.This,in turn,can guide the development of an individualized treatment plan for each patient with cirrhosis,with a focus on prioritizing exercise,proper nutrition,and appropriate treatment of hepatic complications as the primary lines of treatment.In this review,we aim to explore the topic of frailty in liver diseases,with a particular emphasis on pathophysiology,clinical assessment,and discuss strategies for preventing frailty through effective treatment of hepatic complications.Furthermore,we explore novel assessment and management strategies that have emerged in recent years,including the use of wearable technology and telemedicine.

Outcomes of ABO-incompatible liver transplantation in end-stage liver disease patients co-infected with hepatitis B and human immunodeficiency virus

BACKGROUND Human immunodeficiency virus(HIV)-positive patients coinfected with hepatitis B virus(HBV)are eligible for liver transplantation(LT)in Africa and Southeast Asia,particularly China.However,the outcome of HIV-HBV coinfected patients referred for ABO-incompatible LT(ABOi-LT)is unknown.AIM To clarify the outcome of ABOi-LT for HIV-HBV coinfected patients with endstage liver disease(ESLD).METHODS We report on two Chinese HIV-HBV coinfected patients with ESLD who underwent A to O brain-dead donor LT and reviewed the literature on HIV-HBV coinfected patients treated with ABO-compatible LT.The pretransplantation HIV viral load was undetectable,with no active opportunistic infections.Induction therapy consisted of two sessions of plasmapheresis and a single dose of rituximab in two split doses,followed by an intraoperative regimen of intravenous immunoglobulin,methylprednisolone,and basiliximab.Post-transplant maintenance immunosuppressive agents consisted of tacrolimus and mycophenolate mofetil,and prednisone.RESULTS At the intermediate-term follow-up,patients showed undetectable HIV viral load,CD4(+)T cell counts greater than 150 cells/μL,no HBV recurrence,and stable liver function.A liver allograft biopsy showed no evidence of acute cellular rejection.Both patients survived at 36-42 mo of follow-up.CONCLUSION This is the first report of ABOi-LT in HIV-HBV recipients with good intermediate-term outcomes,suggesting that ABOi-LT may be feasible and safe for HIV-HBV coinfected patients with ESLD.

palliative care and end-stage colorectal cancer management:The surgeon meets the oncologist

Colorectal cancer(CRC)is a common neoplasia in the Western countries,with considerable morbidity and mortality.Every fifth patient with CRC presents with metastatic disease,which is not curable with radical intent in roughly 80%of cases.Traditionally approached surgically,by resection of the primitive tumor or stoma,the management to incurable stageⅣCRC patients has significantly changed over the last three decades and is nowadays multidisciplinary,with a pivotal role played by chemotherapy(CHT).This latter have allowed for a dramatic increase in survival,whereas the role of colonic and liver surgery is nowadays matter of debate.Although any generalization is difficult,two main situations are considered,asymptomatic(or minimally symptomatic)and severely symptomatic patients needing aggressive management,including emergency cases.In asymptomatic patients,new CHT regimens allow today long survival in selected patients,also exceeding two years.The role of colonic resection in this group has been challenged in recent years,as it is not clear whether the resection of primary CRC may imply a further increase in survival,thus justifying surgeryrelated morbidity/mortality in such a class of shortliving patients.Secondary surgery of liver metastasis is gaining acceptance since,under new generation CHT regimens,an increasing amount of patients with distant metastasis initially considered non resectable become resectable,with a significant increase in long term survival.The management of CRC emergency patients still represents a major issue in Western countries,and is associated to high morbidity/mortality.Obstruction is traditionally approached surgically by colonic resection,stoma or internal by-pass,although nowadays CRC stenting is a feasible option.Nevertheless,CRC stent has peculiar contraindications and complications,and its long-term cost-effectiveness is questionable,especially in the light of recently increased survival.Perforation is associated with the highest mortality and remains mostly matter for surgeons,by abdominal lavage/drainage,colonic resection and/or stoma.Bleeding and other CRC-related symptoms(pain,tenesmus,etc.)may be managed by several mini-invasive approaches,including radiotherapy,laser therapy and other transanal procedures.

Long-term outcomes of pediatric liver transplantation in acute liver failure vs end-stage chronic liver disease:A retrospective observational study

BACKGROUND Children with acute liver failure(ALF)who meet the criteria are eligible for super-urgent transplantation,whereas children with end-stage chronic liver disease(ESCLD)are usually transplanted electively.Pediatric liver transplantation(PLT)in ALF and ESCLD settings has been well described in the literature,but there are no studies comparing the outcomes in these two groups.AIM To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.METHODS This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019.ALF and ESCLD groups were compared for pretransplant recipient,donor and operative parameters,and post-operative outcomes including graft and patient survival.RESULTS Over a 20-year study period,232 primary PLTs were performed at our center;195 were transplanted for ESCLD and 37 were transplanted for ALF.The ALF recipients were significantly older(median 8 years vs 5.4 years;P=0.031)and heavier(31 kg vs 21 kg;P=0.011).Living donor grafts were used more in the ESCLD group(34 vs 0;P=0.006).There was no difference between the two groups concerning vascular complications and rejection,but there were more bile leaks in the ESCLD group.Post-transplant patient survival was significantly higher in the ESCLD group:1-,5-,and 10-year survival rates were 97.9%,93.9%,and 89.4%,respectively,compared to 78.3%,78.3%,and 78.3%in the ALF group(P=0.007).However,there was no difference in 1-,5-,and 10-year graft survival between the ESCLD and ALF groups(90.7%,82.9%,77.3%vs 75.6%,72.4%,and 66.9%;P=0.119).CONCLUSION Patient survival is inferior in ALF compared to ESCLD recipients;the main reason is death in the 1st year post-PLT in ALF group.Once the ALF children overcome the 1st year after transplant,their survival stabilizes,and they have good long-term outcomes.

Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning

BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.

Brain Functional Networks with Dynamic Hypergraph Manifold Regularization for Classification of End-Stage Renal Disease Associated with Mild Cognitive Impairment

The structure and function of brain networks have been altered in patients with end-stage renal disease(ESRD).Manifold regularization(MR)only considers the pairing relationship between two brain regions and cannot represent functional interactions or higher-order relationships between multiple brain regions.To solve this issue,we developed a method to construct a dynamic brain functional network(DBFN)based on dynamic hypergraph MR(DHMR)and applied it to the classification of ESRD associated with mild cognitive impairment(ESRDaMCI).The construction of DBFN with Pearson’s correlation(PC)was transformed into an optimization model.Node convolution and hyperedge convolution superposition were adopted to dynamically modify the hypergraph structure,and then got the dynamic hypergraph to form the manifold regular terms of the dynamic hypergraph.The DHMR and L_(1) norm regularization were introduced into the PC-based optimization model to obtain the final DHMR-based DBFN(DDBFN).Experiment results demonstrated the validity of the DDBFN method by comparing the classification results with several related brain functional network construction methods.Our work not only improves better classification performance but also reveals the discriminative regions of ESRDaMCI,providing a reference for clinical research and auxiliary diagnosis of concomitant cognitive impairments.

Guided Care护理模式对老年骨质疏松症患者自我管理能力和生活质量的影响

目的探讨分析Guided Care护理模式对老年骨质疏松症患者自我管理能力和生活质量的影响。方法简单随机选取2022年1月—2023年9月山东省泰安荣军医院收治的60例老年骨质疏松症患者为研究对象,按随机数表法将其分为常规组(实施常规护理干预),模式组(在常规组的基础上给予Guided Care护理模式干预),每组30例,两组均持续干预2个月,比较两组患者干预前后的健康认知水平、跌倒风险、自我管理能力、生活质量、护理满意度。结果干预2个月后,模式组的健康认知水平评分高于常规组,差异有统计学意义(P<0.05)。干预2个月后,模式组的跌倒风险评分低于常规组,差异有统计学意义(P<0.05)。干预2个月后,模式组的自我管理能力评分高于常规组,生活质量评分低于常规组,差异有统计学意义(P均<0.05)。干预2个月后,模式组的护理满意度为93.33%,高于常规组的护理满意度73.33%,差异有统计学意义(χ^(2)=4.320,P<0.05)。结论在老年骨质疏松症患者中,应用Guided Care护理模式,可以有效地提升患者的健康认知水平及自我管理能力,提高患者的生活质量,降低患者跌倒的风险。

Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives

Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.

Discharging patients home from the intensive care unit:A new trend

Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.

Mitigating the Prevalence of Diabetic Retinopathy in the United States: Utilization of the Chronic Care Model as a Public Health Framework

As the prevalence of diabetic retinopathy continues to be on the rise, the Chronic Care Model (CCM) offers a transformative, patient-focused approach for efficient diabetic retinopathy care, emphasizing the need for urgent and innovative strategies in the United States. The model integrates community resources, healthcare organizations, self-management support, delivery system design, decision support, and clinical information systems. Addressing challenges and solutions, the model emphasizes proactive and preventive measures, collaborative multidisciplinary care, technological integration, and overcoming resistance to change. This paper proposes the utilization of the Chronic Care Model (CCM) as a possible public health framework for comprehensive management of diabetic retinopathy in the United States. Implementing the CCM offers a comprehensive approach to diabetic retinopathy care, addressing both individual and systemic factors, essential for improving public health outcomes.

Evaluation of the effectiveness of preventive nursing measures for pressure injuries in patients in the neurology intensive care unit

BACKGROUND Patients in neurology intensive care units(ICU)are prone to pressure injuries(PU)due to factors such as severe illness,long-term bed rest,and physiological dysfunction.PU not only causes pain and complications to patients,but also increases medical burden,prolongs hospitalization time,and affects the recovery process.AIM To evaluate and optimize the effectiveness of pressure injury prevention nursing measures in neurology ICU patients.METHODS A retrospective study was conducted,and 60 patients who were admitted to the ICU of the Department of Neurology were selected and divided into an observation group and a control group according to the order of admission,with 30 people in each group.The observation group implemented pressure injury prevention and nursing measures,while the control group adopted routine care.RESULTS Comparison between observation and control groups following pressure injury prevention nursing intervention revealed significantly lower incidence rates in the observation group compared to the control group at 48 h(8.3%vs 26.7%),7 d(16.7%vs 43.3%),and 14 d(20.0%vs 50.0%).This suggests a substantial reduction in pressure injury incidence in the observation group,with the gap widening over time.Additionally,patients in the observation group exhibited quicker recovery,with a shorter average time to get out of bed(48 h vs 72 h)and a shorter average length of stay(12 d vs 15 d)compared to the control group.Furthermore,post-intervention,patients in the observation group reported significantly improved quality of life scores,including higher scores in body satisfaction,feeling and function,and comfort(both psychological and physiological),indicating enhanced overall well-being and comfort following the implementation of pressure injury prevention nursing measures.CONCLUSION Implementing pressure injury preventive care measures for neurology ICU patients will have better results.

Predicting intensive care unit-acquired weakness:A multilayer perceptron neural network approach

In this editorial,we comment on the article by Wang and Long,published in a recent issue of the World Journal of Clinical Cases.The article addresses the challenge of predicting intensive care unit-acquired weakness(ICUAW),a neuromuscular disorder affecting critically ill patients,by employing a novel processing strategy based on repeated machine learning.The editorial presents a dataset comprising clinical,demographic,and laboratory variables from intensive care unit(ICU)patients and employs a multilayer perceptron neural network model to predict ICUAW.The authors also performed a feature importance analysis to identify the most relevant risk factors for ICUAW.This editorial contributes to the growing body of literature on predictive modeling in critical care,offering insights into the potential of machine learning approaches to improve patient outcomes and guide clinical decision-making in the ICU setting.

Personalized and continuous care intervention affects rehabilitation,living quality,and negative emotions of patients with breast cancer

BACKGROUND Breast cancer is among the most common malignancies worldwide.With progress in treatment methods and levels,the overall survival period has been prolonged,and the demand for quality care has increased.AIM To investigate the effect of individualized and continuous care intervention in patients with breast cancer.METHODS Two hundred patients with breast cancer who received systemic therapy at The First Affiliated Hospital of Hebei North University(January 2021 to July 2023)were retrospectively selected as research participants.Among them,134 received routine care intervention(routing group)and 66 received personalized and continuous care(intervention group).Self-rating anxiety scale(SAS),self-rating depression scale(SDS),and Functional Assessment of Cancer Therapy-Breast(FACT-B)scores,including limb shoulder joint activity,complication rate,and care satisfaction,were compared between both groups after care.RESULTS SAS and SDS scores were lower in the intervention group than in the routing group at one and three months after care.The total FACT-B scores and five dimensions in the intervention group were higher than those in the routing group at three months of care.The range of motion of shoulder anteflexion,posterior extension,abduction,internal rotation,and external rotation in the intervention group was higher than that in the routing group one month after care.The incidence of postoperative complications was 18.18%lower in the intervention group than in the routing group(34.33%;P<0.05).Satisfaction with care was 90.91% higher in the intervention group than in the routing group(78.36%;P<0.05).CONCLUSION Personalized and continuous care can alleviate negative emotions in patients with breast cancer,quicken rehabilitation of limb function,decrease the incidence of complications,and improve living quality and care satisfaction.

Assessment of Breast Cancer Prevention Practices among Women Attending Primary Health Care in Abha City, Aseer Region, Saudi Arabia

Cancer is a leading cause of death worldwide, with breast cancer being the most common (2.26 million new cases and 685,000 deaths). In Saudi Arabia, breast cancer ranked the first among females in 2014, accounting for 15.9% of all cancers reported among Saudi nationals and 28.7% of all cancers reported among females of all ages. Early detection of breast cancer could decrease the risks, have a better prognosis, and have better outcomes/more successful treatments. Prevalence of breast cancer reached more than 25% of all diagnosed cancer in the kingdom among women. Aim: This study aims to assess the knowledge and performance of women attending primary care centers about breast self-examination and mammogram screening for prevention and early detection of breast cancer in Abha city primary healthcare centers, Kingdom of Saudi Arabia. Research Method: cross sectional design was conducted by using questionnaire, which was distributed to primary care center nurses. The collected data was statistically analyzed using the Statistical Package for Social Sciences, version 25. Results: The study found that participants had poor awareness and knowledge about breast self-examination, risk factors for breast cancer, and trends and practices in early diagnosis of breast cancer. Conclusion and Recommendations: It recommends increasing awareness campaigns and providing educational programs to improve knowledge and practices.

Provision of Preconception Care by Midwives, Nurses and Doctors at Ndola Teaching Hospital in Ndola District, Zambia

Background: The goal of preconception care is to improve the outcome of a mother’s pregnancy and childbirth. Nevertheless, in most developing nations;Zambia included, there are still issues with implementation of preconception care. Therefore, the aim of this study was to establish the provision of preconception care by midwives, nurses and doctors at Ndola Teaching Hospital in Zambia. Methods: A concurrent embedded mixed methodology utilising a descriptive explorative study design, where 107 respondents were randomly selected using the lottery technique for quantitative part and two focused group discussions for qualitative part of the study was used. A self-administered questionnaire was used to collect quantitative data and a focus group discussion guide was used for the focus group discussions. Statistical Package of Social Sciences version 26 with significance set at 0.05 and at 95% confidence level and thematic analysis were used for data analysis. Results: 75% of the respondents in this study were not providing preconception care and only 25% of respondents were providing preconception care;however, this was provided randomly because there were no guidelines to follow. Among the respondents, 81.3% had medium knowledge, 70.1% had good practices and 92.5% had positive attitudes towards preconception care. Further analysis showed that the association between preconception care and knowledge, practices and attitudes was not statistically significant (p = values 0.336;0.344;1.000 respectively). Multivariate logistic regression revealed that participants with high knowledge were five times more likely to provide preconception care (OR = 5.00, CI = 0.42 - 59.7, P = 0.203). Generally, all the participants acknowledged that preconception care was an important package that could prevent maternal and child morbidities and mortalities. Conclusions: The study revealed that most of the respondents were not providing preconception care. Provision of preconception was done by a small fraction of the respondents and it was done in an unorderly manner due to lack of set standards and guidelines. Despite medium levels of knowledge and generally good practices and positive attitudes towards preconception care, its random provision indicates a need for established standards to enhance maternal and child health outcomes.

Decision-Making and Management of Self-Care in Persons with Traumatic Spinal Cord Injuries: A Preliminary Study

Patients and physicians understand the importance of self-care following spinal cord injury (SCI), yet many individuals with SCI do not adhere to recommended self-care activities despite logistical supports. Neurobehavioral determinants of SCI self-care behavior, such as impulsivity, are not widely studied, yet understanding them could inform efforts to improve SCI self-care. We explored associations between impulsivity and self-care in an observational study of 35 US adults age 18 - 50 who had traumatic SCI with paraplegia at least six months before assessment. The primary outcome measure was self-reported self-care. In LASSO regression models that included all neurobehavioral measures and demographics as predictors of self-care, dispositional measures of greater impulsivity (negative urgency, lack of premeditation, lack of perseverance), and reduced mindfulness were associated with reduced self-care. Outcome (magnitude) sensitivity, a latent decision-making parameter derived from computationally modeling successive choices in a gambling task, was also associated with self-care behavior. These results are preliminary;more research is needed to demonstrate the utility of these findings in clinical settings. Information about associations between impulsivity and poor self-care in people with SCI could guide the development of interventions to improve SCI self-care and help patients with elevated risks related to self-care and secondary health conditions.

Risk Factors for Mortality in Acute Kidney Injury in Intensive Care Units in Togo

Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.

Prevalence and Factors Associated with Hypertension among People Living with HIV Receiving Care in Three Large HIV Clinics in Nasarawa State, Nigeria

In the last decade, the long-term survival among people living with HIV (PLHIV) has significantly improved. This is accompanied by an increased burden of non-communicable diseases such as hypertension due to the combined effect of the aging population and the metabolic effect of the Human Immuno-deficiency Virus (HIV) virion and antiretroviral therapy. This study aims to assess the prevalence and factors associated with hypertension among people living with HIV in three large health facilities in Nasarawa State, Nigeria. A descriptive cross-sectional study employed a multistage sampling technique to select 309 adults with HIV, 18 years and above, receiving HIV care in three large health facilities in Nasarawa State. The outcome variable was the participants’ self-reported history of hypertension, confirmed through a positive history of hypertension treatment. Exposure variables included the participant’s socio-demographic characteristics, lifestyle factors, and HIV care and treatment history. Data were presented using frequency tables. Factors associated with hypertension were assessed using binary logistic regression at a 0.05 level of statistical significance. A total of 309 adults living with HIV were sampled. A larger percentage of the participants were married 228 (73.8%), female, 191 (61.8%), within the age group 41 - 50 years, 141 (45.6%). Most of the participants had no family history of hypertension, 188 (60.8%). The prevalence of self-reported hypertension was 11.0% (34/309). Factors associated with hypertension at the bivariate level were age group 21 - 30 years, 41 - 50 years, being widow/widower, divorced, retired from employment or with family history of hypertension. Only participants age group 31 - 40 years [Adjusted Odd Ratio (AOR): 0.18, 95%CI: 0.04 - 0.91, p = 0.04] and family history of hypertension [(AOR): 83.44, 95%CI: 15.75 - 442.11, p < 0.01] were found to predict hypertension among the study participants after adjusting for confounders. In conclusion, Hypertension remains a public health issue among PLHIV. Factors associated with hypertension among PLHIV include age and family history of hypertension. Regular screening for hypertension, its appropriate treatment and optimal control are essential in PLHIV.