Biotronik (Switzerland)

Keterbatasan sarana dan program pembinaan sosial di panti asuhan sering berdampak pada rendahnya perilaku prososial anak, seperti empati dan kerja sama. Kegiatan Pengabdian kepada Masyarakat ini bertujuan mengelola program literasi sosial sebagai upaya meningkatkan perilaku prososial anak panti asuhan. Metode yang digunakan adalah deskriptif kualitatif dengan pendekatan PKM berbasis program. Subjek kegiatan berjumlah 12 anak asuh berusia 3–18 tahun di Panti Asuhan Mustika Abadi Anak Indonesia, yang dikelompokkan ke dalam tiga kelompok usia. Intervensi dilakukan melalui ceramah interaktif, diskusi kelompok, simulasi permainan, dan refleksi berbasis experiential learning. Hasil kegiatan menunjukkan peningkatan perilaku prososial anak, ditandai dengan munculnya sikap empati, saling membantu, kerja sama, dan komunikasi sosial yang lebih positif pada seluruh kelompok usia. Program literasi sosial berbasis tahap perkembangan terbukti efektif sebagai media pembinaan sosial anak panti asuhan.

Background and ObjectiveAnticholinergic medications are known to affect the prognosis of older nursing home residents. Various anticholinergic scales were developed to measure the cumulative anticholinergic burden; among them, the CRIDECO Anticholinergic Load Scale (CALS) has recently emerged as a new tool to identify patients with cognitive impairment due to anticholinergic burden. This study aimed to externally validate the CALS and to evaluate the association of CALS and the anticholinergic cognitive burden (ACB) scales with baseline cognitive and functional impairment, as well as with 3-year mortality rates.MethodsA prospective cohort of 600 nursing home residents (mean age 80.4 ± 8.0 years; 69.8% women) underwent a comprehensive geriatric assessment. Anticholinergic burden was assessed at baseline using both CALS and ACB scales. Cognitive impairment (Mini-Mental State Examination < 24) and physical disability (one or more impaired activities of daily living) were evaluated cross-sectionally using a logistic regression model. Cox proportional hazards models were used to estimate the association between anticholinergic burden and 3-year mortality, adjusting for age, sex, multimorbidity, nutritional status, and cognitive and functional status.ResultsAmong 600 nursing home residents included in the study, 72.0% had cognitive impairment and 56.3% had at least one activity of daily living limitation. The CALS and ACB scores were significantly correlated (rho = 0.76), but CALS identified a higher number of residents with moderate-to-high anticholinergic burden. Multivariate logistic regression showed that CALS ≥ 2 was independently associated with cognitive impairment (odds ratio 1.84, 95% confidence interval 1.02–3.34), whereas ACB ≥ 2 was not. Both scales were associated with activities of daily living disability, with a stronger gradient and better goodness of fit for CALS than ACB. During the 3-year follow-up, 25.3% of residents died. Cox regression analyses showed that residents with CALS or ACB ≥ 2 had significantly lower survival over 3 years. In fully adjusted Cox models, both CALS ≥ 2 (hazard ratio 1.93, 95% confidence interval 1.07–3.46) and ACB ≥ 2 (hazard ratio 1.69, 95% confidence interval 1.02–2.83) remained associated with increased mortality. Prognostic performance was similar (CALS C-index: 0.783; ACB: 0.781), but the model fit favored CALS.ConclusionsIn this cohort of nursing home residents, anticholinergic burden as measured by both CALS and ACB was associated with baseline physical impairment and 3-year mortality, but CALS showed a better goodness of fit. Between the two scales, CALS only was independently associated with baseline cognitive impairment. These findings support the clinical utility of CALS in assessing anticholinergic-related risk among frail older adults in institutional settings.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-025-00509-7.

ABSTRACTSinus bradycardia, sinoatrial block, sinus arrest, and bradycardia-tachycardia syndrome are manifestations of intermittent or persistent sinus node dysfunctions (SNDs). SND is classified as intrinsic, when related to an anatomic disease of sinoatrial cells, or extrinsic, when bradycardia is caused by inappropriate vagal outflow. Chronotropic incompetence is often associated with SND, especially in elderly patients. When symptoms are related to SND, pacemaker implantation is the recommended therapy, and rate-adaptive pacing modes are often preferred in cases of chronotropic incompetence. Closed-Loop Stimulation (CLS) is a rate-adaptive system based on continuous evaluation of contractility and contraction speed through the analysis of right-ventricular unipolar impedance trends during the systole of each cardiac cycle. An increase in contractility or contraction speed modifies the impedance trends, to which the CLS algorithm responds by adapting the pacing rate, and thereby heart rate and cardiac output. Therefore, CLS is integrated into the autonomic mechanisms of cardiac output regulation. This feature has drawn interest in the use of CLS in several forms of SND, from the treatment of intrinsic bradycardias to the prevention of vasovagal syncope and device-detected atrial fibrillation. We will examine the working principle of CLS and review the results of recent clinical investigations.

Fetal growth restriction is implicated in the programming of later-life neurodegeneration. We hypothesized that growth-restricted offspring would show accelerated changes to microglial white matter morphology, relative to controls. Control guinea pig sows were fed ad libitum, while maternal nutrient restriction sows received 70% of control diet switched to 90% from mid-gestation. Offspring were sacrificed at ∼26 days (neonate) or ∼110 days (adult) postpartum. Coronal brain sections from the frontal cortex were subject to IBA1 staining for microglial detection and analyzed by machine learning software. At birth, total body weight of growth-restricted offspring was reduced relative to control (p<0.0001) with postnatal catch-up growth observed. Microglial density was reduced in the corpus callosum of control (p<0.05) and growth-restricted (p=0.13) adults, relative to neonates. Adults from both groups showed greater IBA1-positive area in the cingulum and periventricular white matter (p<0.05) and increased microglial fractal dimension in the corpus callosum (p<0.10) and periventricular white matter (p<0.05), relative to neonates. At the time points studied, we report age-related changes in white matter microglial morphology. However, maternal nutrient restriction leading to fetal growth restriction in guinea pigs does not appear to exacerbate these white matter microglia morphological changes as a marker for later-life neurodegeneration.

Background: Symptomatic bradyarrhythmias in dogs can lead to sever hemodynamical compromise due to impaired oxygen and nutrients delivery and even sudden cardiac death. In cases refractory to medical therapy the heart rate and therefore the cardiac output are maintained in physiological ranges using artificial external, internal and temporary (emergency situations) or internal and permanent cardiac pacing. Methods: This case report documents the implantation of a permanent transvenous Pacemaker using active fixation, for the first time in Romania in a 8 years old canine Dogue de Bordeaux with a suspicion (on surface electrocardiography) of Persistent Atrial Standstill. The diagnostic in this atrial muscular dystrophy requires differentiation from Atrial Fibrillation with Third Degree Atrioventricular Block using Cardiac Mapping, but in emergency situations or progressive Congestive Heart Failure the decision to implant the pacemaker should be based on the hemodynamical effects of the dysrhythmia and the definitive diagnostic should be made during the implantation of the device. Results: We succesfully implanted in this case a transvenous ventricular Solia S60 lead at the level of the 1/2 distance between the mid-septal and right ventricular apex that was connected to the subcutaneousely placed Pulse Generator (Enitra 6 SR). The survival after the procedure was 202 days (6 months and 18 days) and the patient's death was not related to a cardiac cause. The necropsy showed that the active fixation in this case was preserved and there were not identified any local rejections of the lead or at the site of the pulse generator. Conclusions: The outcome of the patient was positive regarding the described cardiac function in this case and the clinical signs went into remission shortly after the pacing.

In the PARTITA trial (Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator?), antitachycardia pacing (ATP) predicted the occurrence of implantable cardioverter defibrillator (ICD) shocks. Catheter ablation of ventricular tachycardia after the first shock reduced the risk of death or worsening heart failure. A threshold of ATPs that might warrant an ablation procedure before ICD shocks is unknown. Our aim was to identify a threshold of ATPs and clinical features that predict the occurrence of shocks and cardiovascular events. We analyzed data from 517 patients in phase A of the PARTITA study. We used classification and regression tree analysis to develop and test a risk stratification model based on arrhythmia patterns and clinical data to predict ICD shocks. Secondary end points were worsening heart failure and cardiovascular hospitalization. Classification and regression tree classified patients into 6 leaves by increasing shock probability. Patients treated with ≥5 ATPs in 6 months (active arrhythmia pattern) had the highest risk of ICD shocks (93% and 86%, training and testing samples, respectively). Patients without ATPs had the lowest (1% and 2%). Other predictors included left ventricle ejection fraction<35%, age of <60 years, and obesity. Survival analysis revealed a higher risk of worsening heart failure (hazard ratio, 5.45 [95% CI, 1.62-18.4]; P=0.006) and cardiovascular hospitalization (hazard ratio, 7.29 [95% CI, 3.66-14.5]; P<0.001) for patients with an active arrhythmia pattern compared with those without ATPs. Patients with an active arrhythmia pattern (≥5 ATPs in 6 months) are associated with an increased risk of ICD shocks, as well as heart failure hospitalization and cardiovascular hospitalization. These data suggest that additional treatments may be helpful to this high-risk group as a preventive strategy to reduce the incidence of major events. Further prospective randomized trials are needed to confirm the benefits of early ventricular tachycardia ablation in this setting.