Diagnosis and clinical management of thrombotic thrombocytopenic purpura (TTP): a consensus statement from the TTP Catalan group

Thrombotic thrombocytopenic purpura (TTP) is a low prevalence disease characterized by severe deficiency of the enzyme ADAMTS13, leading to the development of thrombotic microangiopathy (TMA) and often resulting in severe organ disfunction. TTP is an extremely serious condition and, therefore, timely and appropriate treatment is critical to prevent life-threatening complications.Over the past 25 years, significant advances in the understanding of the pathophysiology of immune TTP have led to the development of readily available techniques for measuring ADAMTS13 levels, as well as new drugs that are particularly effective in the acute phase and in preventing relapses. These developments have improved the course of the disease.Given the complexity of the disease and its various clinical and laboratory manifestations, early diagnosis and treatment can be challenging.To address this challenge, a group of experienced professionals from the Catalan TTP group have developed this consensus statement to standardize terminology, diagnosis, treatment and follow up for immune TTP, based on currently available scientific evidence in the field. This guidance document aims to provide healthcare professionals with a comprehensive tool to make more accurate and timely diagnosis of TTP and improve patient outcomes.

Improving Low-Value Clinical Practices In Murcia: A Healthcare Management Area In Spain

BACKGROUND

The "Do Not Do" movement looks for improving patient safety and reducing health spending by decreasing the prevalence of unnecessary clinical practices through building and launching "do not do" recommendations (DND), although the impact is generally low. The objective of this study is to improve the quality of care and safety of patients assigned to a health management area by reducing the prevalence of DND practices.

METHODS

Quasi-experimental before and after study carried out in a Spanish health management area of 264,579 inhabitants, 14 primary care teams and a 920-bed 3rd level reference hospital. The study included the measurement of a set of 25 valid and reliable indicators on DND prevalence from different clinical areas previously designed, considering acceptable prevalence values of less than 5%. For those indicators that exceeded this value, a bunch of interventions was implemented: (1) inclusion in the annual objectives of the clinical units involved; (2) discussion of results in a general clinical session; (3) educational outreach visits to the clinical units involved; and (4) detailed feedback reports. A second evaluation was subsequently carried out.

RESULTS

In the first evaluation, 12 DNDs (48%) showed prevalence values below 5%. In the second 9 DND of the remaining 13 (75%) improved results, reaching 5 of them (42%) prevalence values below 5%. Thus, a total of 17 of the 25 DNDs initially evaluated (68%) achieved this goal.

CONCLUSION

Reducing the prevalence of low-value clinical practices in a healthcare organization makes it necessary to turn them into easily measurable indicators and carry out multicomponent interventions. Among these, it seems essential that the professionals involved are informed and that training activities are carried out on-site. Improvement cycles are emerging as a useful tool to do this.

Association between cognitive performance and self-reported glaucoma in middle-aged and older adults: a cross-sectional analysis of ELSA-Brasil

Recent evidence suggests that glaucoma and Alzheimer's disease are neurodegenerative diseases sharing common pathophysiological and etiological features, although findings are inconclusive. We sought to investigate whether self-reported glaucoma patients without dementia present poorer cognitive performance, an issue that has been less investigated. We employed cross-sectional data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) and included participants ≥50 years of age without a known diagnosis of dementia and a self-reported glaucoma diagnosis. We excluded those with previous stroke, other eye conditions, and using drugs that could impair cognition. We evaluated cognition using delayed word recall, phonemic verbal fluency, and trail making (version B) tests. We used multinomial linear regression models to investigate associations between self-reported glaucoma with cognition, adjusted by several sociodemographic and clinical variables. Out of 4,331 participants, 139 reported glaucoma. Fully-adjusted models showed that self-reported glaucoma patients presented poorer performance in the verbal fluency test (β=-0.39, 95%CI=-0.64 to -0.14, P=0.002), but not in the other cognitive assessments. Thus, our results support the hypothesis that self-reported glaucoma is associated with poor cognitive performance; however, longitudinal data are necessary to corroborate our findings.

Association between ideal cardiovascular health and depression incidence: a longitudinal analysis of ELSA-Brasil

OBJECTIVE

We investigated whether ideal cardiovascular health (ICH), a metric proposed by the American Heart Association, predicts depression development.

METHODS

Cohort analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Adults with no current depression and other common mental disorders, cardiovascular diseases, and antidepressant drug use at baseline had their ICH (composite score of smoking, dietary habits, body mass index, blood pressure, fasting glucose, cholesterol, and physical activity) assessed and classified into poor, intermediate, and optimal. Depression was assessed using the Clinical Interview Schedule-Revised (CIS-R). Poisson regression models, adjusted for sociodemographic factors and alcohol consumption, were employed. Stratified analyses were performed for age and sex.

RESULTS

We included 9214 participants (mean age 52 ± 9 years, 48.6% women). Overall depression incidence at 3.8-year follow-up was 1.5%. Intermediate and poor ICH significantly increased the risk rate (RR) of developing depression (2.48 [95%CI 1.06-5.78] and 3 [1.28-7.03], respectively) at a 3.8-year follow-up. Higher ICH scores decreased the rate of depression development (RR = 0.84 [0.73-0.96] per metric). Stratified analyses were significant for women and adults < 55 years old.

CONCLUSIONS

Poor cardiovascular health tripled depression risk at follow-up in otherwise healthy adults. Ameliorating cardiovascular health might decrease depression risk development.

Incubation and rearing-effort partitioning of wing-banded hornero Furnarius figulus (Passeriformes: Furnariidae)

We studied incubation and feeding rates in two of five broods in two oven nests of Furnarius figulus at Lagoa Rodrigo de Freitas. During incubation, the number of visits and time spent in the nest did not differ between the adults. The number of feeding visits was significantly different between members of the breeding pair of the first but not of the second nest. Nestlings received arthropods, fishes, and larvae in the first nest and, in the second, arthropods, larvae, and fruits. The nestlings stayed about 23 days in the nests.

Eating behavior in junior high school females

Female junior high school students (N = 175) were surveyed in an effort to ascertain present eating behavior as well as attitudes regarding dieting and concern about body weight. It was found that many subjects appear to have concerns as early as elementary school. Limitations of these findings are discussed as well as implications for further research.