Hamilton Health Sciences

Shareable abstractThe organisation and implementation of long-term home noninvasive ventilation treatment for COPD patients across Europe is complex and heterogeneous. Further research and experience sharing is required to optimise and align the patient pathway.https://bit.ly/3M3r566

Serum beta-human chorionic gonadotropin (β-hCG) hormone is a well-established biomarker used for pregnancy monitoring and prognosis in in vitro fertilization (IVF) cycles. After embryo transfer, a high serum β-hCG level with a prompt doubling time is typically reassuring, while a low initial β-hCG often leads to counselling around likely impending pregnancy loss and/or ectopic pregnancy. However, the number of patients with low β-hCG who ultimately deliver a live birth is unclear. This is a single-centre retrospective cohort study of IVF pregnancies between January 2019 and December 2022. Serum β-hCG was drawn 14 days post-fertilization. We considered an initial β-hCG ≤ 50 mIU/mL as low. A logistic mixed-effects regression model assessed the odds of live birth for every 10 mIU/mL increase in β-hCG, adjusting for patient and cycle characteristics (age, body mass index, embryo stage, number of embryos transferred, and preimplantation genetic testing for aneuploidy). Receiver operating characteristic curves were plotted to determine optimal cut-points. Among 2443 pregnancies, the prevalence of live birth was 12% for those with an initial β-hCG ≤ 50 mIU/mL. For each 10 mIU/mL difference in initial β-hCG, the odds of live birth increased significantly (aOR = 1.035 [95% CI 1.027, 1.042]). Receiver operating characteristic curve analysis showed that an initial β-hCG greater than 22.5 mIU/mL identified over 99% of patients who ultimately had a live birth (sensitivity 1, specificity 0.21, AUC 0.726). The rate of change from initial β-hCG demonstrated stronger discriminatory performance for live birth among patients with low initial β-hCG (AUC 0.876 [95% CI 0.84, 0.91]) than among those with an initial β-hCG > 50 mIU/mL (AUC 0.584 [95% CI 0.56, 0.61]). While IVF pregnancies with a low initial β-hCG can result in live birth, the likelihood is low. The rate of β-hCG rise emerged as a stronger discriminator of pregnancy outcomes when the initial β-hCG is low. Live birth was extremely rare when the initial β-hCG was below 22.5 mIU/mL. These findings offer prognostic data to guide counselling and refine expectations after IVF.

Antiphospholipid antibodies (aPL) are directed against phospholipids and phospholipid-binding proteins. Laboratory assays used to detect aPL include serological tests for aPL against β2-glycoprotein 1, cardiolipin and other molecules, as well as functional assays for lupus anticoagulant. The presence of aPL can lead to endothelial dysfunction or a hypercoagulable state through prothrombotic and antifibrinolytic mechanisms. These processes, often in conjunction with a 'second hit', such as trauma, surgery, or other causes of hypercoagulability or stasis, can lead to venous or arterial thrombosis. The thrombotic risk associated with aPL is best recognized in thrombotic antiphospholipid syndrome, characterized by a persistently positive test for lupus anticoagulant or seropositivity for aPL associated with venous, arterial or microvascular thrombosis. However, aPL seropositivity and its clinical effect on thrombotic events have been increasingly recognized in a broader group of individuals who do not meet traditional research criteria for thrombotic antiphospholipid syndrome. In this Review, we provide an overview of the evidence related to aPL seropositivity in individuals with or without previous thrombosis and the clinical relevance of aPL seropositivity in predicting the risk of thrombotic cardiovascular events. We discuss potential management strategies and identify key knowledge gaps that warrant further research.

Fetal growth restriction (FGR) is a major contributor to perinatal morbidity and mortality. While guidelines address timing of delivery, the optimal mode-induction of labor (IOL) versus planned cesarean delivery (CD)-remains uncertain. To evaluate the association between planned mode of delivery and neonatal outcomes in pregnancies complicated by late onset FGR (LOFGR). We conducted a retrospective cohort study at a tertiary Canadian center (2017-2022). Singleton pregnancies with LOFGR (> 34 weeks' gestation), defined by Society for Maternal-Fetal Medicine (SMFM) criteria, were eligible if the last ultrasound was within 14 days of delivery. Exclusions included spontaneous labor, delivery < 34 weeks, and contraindications to labor. Planned mode of delivery (IOL vs CD) was the exposure. Outcomes were classified as severe (perinatal death, 5-min Apgar < 4, umbilical arterial pH < 7.05, base deficit ≥ 12 mmol/L, hypoxic-ischemic encephalopathy/therapeutic hypothermia, grade III-IV intraventricular hemorrhage, necrotizing enterocolitis, sepsis, or invasive ventilation > 24 h) or moderate (NICU stay > 72 h, Apgar 4-6, pH 7.05-7.10, non-invasive respiratory support > 6-12 h, transient tachypnea, or brief resuscitation). Multivariable logistic regression adjusted for confounders. A prespecified subgroup applied the ISUOG criteria. Of 12,270 deliveries, 1,143 (9.3%) met SMFM criteria for LOFGR; 869 were eligible (192 planned CD, 677 IOL). Severe outcomes and moderate outcomes were more frequent after CD (23.4% vs 16.7%; p = 0.03 and 42.2% vs 31.2%; p < 0.01, respectively). IOL was associated with lower adjusted risk of severe outcomes (aOR 0.35; 95% CI 0.19-0.67) and moderate outcomes (aOR 0.43; 95% CI 0.24-0.76). Results were consistent using ISUOG criteria (aOR 0.33; 95% CI 0.17-0.62 and aOR 0.44; 95% CI 0.25-0.79, respectively) About 20% of induced patients required intrapartum CD. IOL was associated with reduced severe and moderate neonatal morbidity compared with planned CD. IOL represents a safe alternative when intrapartum surveillance and timely operative delivery are available.

BackgroundZinc deficiency (ZD) is one of the most prevalent nutritional deficiencies reported in celiac disease (CeD). Oral supplementation and dietary modifications are the primary strategies for addressing it. However, it is unclear whether individuals with CeD would prefer to make additional dietary modifications or opt for supplementation to treat ZD.AimThis study aimed to explore patient preferences for the treatment of ZD.MethodsAdult patients (≥18 years) with a confirmed diagnosis of CeD who were already adopting a gluten-free diet (GFD) and had untreated ZD were recruited from the Adult Celiac Disease Clinic at McMaster University. After providing informed consent, participants completed study questionnaires at baseline and three months after initiating zinc supplementation. Data were collected using REDCap. Statistical analyses were performed using IBM SPSS software (V22, Chicago, USA).ResultsFrom March 2022 to January 2024, 44 participants were enrolled in the study. All completed baseline questionnaires, of them 25 (57%) completed questionnaires at follow-up. At baseline, 34% of participants preferred to treat nutrient deficiencies through dietary changes, compared with 28% at follow-up. Plasma zinc level normalized in all participants after 3 months of supplementation. At follow-up, the proportion of participants with significant gastrointestinal symptoms increased from 72% at baseline to 80% (p = 0.01).ConclusionsOne-third of patients with CeD preferred to manage nutrient deficiencies through dietary modifications. A zinc-optimized GFD may represent a promising approach to address zinc deficiency in this population. These findings provide preliminary evidence to inform the design of future randomized clinical trials.

Chronic cough affects many adults, with ∼4% having refractory or untreated disease. Most cases resolve over time, especially with smoking cessation or stopping ACE inhibitors, highlighting the importance of addressing treatable traits. Chronic cough (CC), defined as a persistent cough lasting &gt;8 weeks, affects 16% of Canadian adults in the community. Chronic cough can be classified as refractory chronic cough (RCC) when cough persists despite treatment of any identifiable underlying condition. The prevalence of RCC is unclear, but also those who despite having a persistent cough, remain untreated. This prospective cohort study included 26 606 adults aged 45–85 from the Canadian Longitudinal Study of Aging (CLSA) with available chronic cough data at baseline and first follow-up at 3 years. Chronic cough was defined by self-reported daily cough for ≥12 months. In this cohort, 4,059 participants had a cough at baseline. Among them, 26.2% had RCC on medications, 27.4% had RCC without medication who we considered untreated CC, 19.3% had resolution with medication, and 27.1% resolved without medication. Overall, the prevalence of RCC on medication was 4.0% (1063/26 606) in this population and was 4.2% for the untreated CC group. RCC was more common in males, persistent smokers, and those with asthma, COPD, migraine, and inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS). Smoking cessation and discontinuing ACE inhibitors were associated with resolution of cough. Despite guideline-recommended therapies, neuromodulators were infrequently prescribed by physicians. This population-based study was able to explore the outcomes of chronic cough over 3 years and identify risk factors with its development. Nearly one-third of cases resolved without new medication, but with likely targeting treatable traits such as smoking and stopping ACE-Inhibitor use.