The unnoticed truth: Patients on the heart transplantation waiting list are becoming cachexic

Heart transplantation is a major lifesaving surgery practiced globally on daily basis. The scarcity of donors has led to long waiting lists for the surgery. Both physiology and psychology of patients are affected severely during this period. The nutritional status is known to be correlated with postoperative outcomes. The aim of this study was to investigate the significance of the weight loss of patients by comparing their weights and ideal body weights. The data of 259 patients were used in this study and unpaired t-test was applied to the patient groups. The weight difference of the patient population was found as extremely significant (p<0.0001). The results demonstrated that the weight difference of female patient group was very significant (p=0.0012) and the male patient group was extremely significant (p<0.0001). The weight difference of young patients (18-34 years) was not significant (0.7309), middle aged patients (35-64 years) was extremely significant (p<0.0001) and elderly patients (65 years and above) was not significant (p=0.3540). Therefore, weight change is prominent in most of the patients who are on heart transplantation waiting list. Employment of a dietitian or nutrition specialist to transplant multidisciplinary teams is advised, to minimize patient cachexia.

Can Fetal Weight Discordancy Measured by Ultrasound During Pregnancy Predict Maternal Complications and Neonatal Outcomes in Dichorionic Diamniotic Twins?

Purpose: The aim of this study was to determine the relationships between the estimated fetal weight discordancy, which was measured by ultrasound during pregnancy, and maternal pregnancy complications and neonatal outcomes in dichorionic diamniotic twin pregnancies.Methods: We conducted a retrospective review of the medical records of 320 twin pregnancies delivered at Chilgok Kyungpook National University Hospital between January 2011 and February 2020. This study included dichorionic diamniotic twin mothers who delivered between 32+1 and 38+0 weeks of gestation. Mothers who had one fetal demise, a major anomaly, or twin-specific complications were excluded. At 20–24 weeks and 28–32 weeks of gestation, participants were divided into 2 groups: discordant twins with an estimated fetal weight difference of more than 20% and concordant twins with a weight difference of less than 20%. The maternal complications and neonatal outcomes were compared between the two groups. Results: The incidences of preeclampsia and placenta previa were significantly higher in discordant twins measured between 20 and 24 weeks compared with concordant twins, but no statistical significance was found in the neonatal outcomes between the two groups. Delivery times were earlier and neonatal weights were lower in discordant twins measured between 28 and 32 weeks. Neonatal outcomes such as ventilator use and neurodevelopment were also significantly different. Conclusion: Discordance in estimated fetal weight measured by ultrasound between 20 and 24 weeks is a risk factor for maternal preeclampsia and placenta previa, whereas discordancy at 28–32 weeks can predict poor neonatal outcomes.

Twin Vaginal Deliveries: Impact of Delivery Time Interval on Twin B

Background:A vaginal twin delivery is a natural commonplace occurrence, but which can sometimes present a concern which may require action. Recently, the delivery time interval has been recognized as a variable that can be helpful for its safe conduct.Objectives:To view the delivery time interval in an obstetric population undergoing a twin vaginal trial of labor in consecutive deliveries during a specified time period.Study Design:A retrospective observational cohort of twin vaginal trials of labor was investigated to view the delivery time interval and its association with other factors, such as birth weights and the need for cesarean delivery of the second twin. The twin deliveries were divided into 2 groups, those with a delivery time interval of ≤ 30 minutes (Group A) and those with a delivery time interval of > 30 minutes (Group B), in a single institution.Results:No perinatal outcome difference was found between Group A (248 patients) or Group B (72 patients). However, 13 patients in Group B required a cesarean birth for a safe delivery, and 3 patients in Group A. The birth weight difference between each Baby A and Baby B varied according to the delivery time interval. Conclusion:The delivery time interval for vaginal twin deliveries may be useful to predict the need for a cesarean delivery of the second twin. The birth weight difference between Baby A and Baby B may be responsible for this finding.

How the Wakamola chatbot studied a university community’s lifestyle during the COVID-19 confinement

This work aimed to study the effect of confinement on weight and lifestyle using the Wakamola chatbot to collect data from 739 adults divided into two groups (341 case-control, 398 confinement). Nutrition score (0–100 scale) improved for men (medians 81.77–82.29, p < 0.05), with no difference for women (medians 82.29 in both cases). Both genders reduced the consumption of sweetmeats and sugared drinks ( p < 0.01); men increased their consumption of vegetables, salad, and legumes ( p < 0.01). Both genders reduced their physical activity score (men 100–40.14, p < 0.01, women 80.42–36.12, p < 0.01). Women sat less hours/week, men’s medians 28.81–28.27, women’s medians 35.97–23.33, p = 0.03. Both genders slept longer (hours/day), men 7–7.5, women 7–8 ( p < 0.01) (medians). Their overall health score was significantly reduced (men 85.06–74.05, p < 0.01, women 84.47–72.42, p < 0.01), with no significant weight difference in either gender. Wakamola helped to contact participants and confirm changes in their lifestyle during confinement.

Abstract TP494: Estimated tPA Dosing Weight on a Mobile Stroke Unit: Comparison between Estimated and Hospital-measured Weights

Introduction: The purpose of the Houston Mobile Stroke Unit (MSU) is to expedite stroke care by treating patients in the pre-hospital setting where obtaining a measured body weight, critical for accurate pre-hospital tPA dosing, is challenging and impossible. The paramedic and nurse on the MSU subjectively estimate by assessment (with patient report if possible) the weight for calculating tPA dosing. We aimed to determine the accuracy of the estimated weight method compared to the actual weight of patients treated with tPA on the MSU. Methods: Data were prospectively collected for MSU tPA-treated patients as part of the BEST-MSU study comparing MSU to standard EMS management. We collected the first-documented hospital-measured weight (bed scale) within 24 hours of hospital arrival, and the estimated weight used on the MSU for treatment. Mean absolute and percent difference in weights were calculated; less than 10% difference in weights was considered acceptable. To compare the estimated and measured weights, we conducted a Wilcoxon signed-rank test. Differences between weights were set as 0 if both weights were above 100kg. Fisher’s exact test was used to explore association between weight difference > 10% and patient outcomes. Results: Among 337 patients, mean age was 67.8 (15.6) and average measured weight was 81.2 kg (SD 22.3). Median absolute difference in measured versus estimated weight was 2.70 kg (IQR 0.55-7.60), and both weights were significantly different from each other (p value < 0.0001). The average absolute percent difference in weight was 7.04% (SD 9.11%). The absolute mean difference in tPA dosage was 3.49 mg (SD 6.06). Among patients whose estimated and measured weights were not both ≥100 kg, 56 (16.6%) had weight difference >10%. In patients with overestimation of weight by >10%, there were no symptomatic intracerebral hemorrhages. There was no association between weight difference and discharge modified Rankin score (p value = 0.5921). Conclusion: Weight estimation on a mobile stroke unit can lead to similar tPA dosing for 82% of subjects compared to if dosing were determined based on actual weight. Weight over- or under-estimation had no detected significant impact on tPA outcomes.

Isometric beak morphology in Phoenicopterus ruber roseus, Phoenicopteriformes

It is well documented that size of various body parts tends to correlate within the same individual. In the current study, we explore the relationship between body weight and some area and lineal beak measurements in a sample of 17 corpses of Greater flamingo Phoenicopterus ruber roseus (10 immatures and 7 adults), collected and after obtaining beak radiographic latero-lateral projections. On images, the following traits were obtained: area of rhinotheca -the sheath covering the maxilla- and gnathotheca -the sheath covering the mandibular-, rhamphotheca height, ocular area, ocular height, ocular width, height, width and area of nares. Our results suggest that some beak measurements are positively correlated with body weight, while nostril area is not. Specifically, rhinotheca and gnathotheca areas and rhamphotheca height were strongly coupled and largely correlated to body weight. The observed differences in beak dimensions are merely a consequence of body weight difference. It is suggested, that the cranial skeleton and musculature are closely linked at least developmentally, allowing for efficient functional integration, but genetic and functional tests must have been performed to reveal the exact nature of the flamingo beak change.