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Many proven heart failure (HF) therapies decrease N-terminal pro B-type natriuretic peptide (NT-proBNP) values over time, yet some patients have an NT-proBNP >1000 pg/ mL following treatment, which is associated with poor outcomes. A total of 151 patients with left ventricular systolic dysfunction were treated with aggressive HF therapy in the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) study. Clinical characteristics and NT-proBNP were measured at each visit during 10 months. In this post hoc analysis, biomarker nonresponse was defined as an NT-proBNP >1000 pg/ mL and its relationship with echocardiographic and clinical characteristics and outcomes were explored. A risk model predictive of nonresponse was derived and externally validated. A rising NT-proBNP over time was associated with increased cardiovascular event rates while a decreasing NT-proBNP was associated with better clinical outcomes (58.2% vs 27.6%, P=.001). A higher percentage of time in biomarker response was associated with lower event rates ( P<.001). Importantly, responders showed improved left ventricular remodeling parameters (all P<.001), while nonresponders did not. A risk model for predicting nonresponse had a C statistic of 0.82 ( P<.001) and predicted outcomes well. Using data from the NT-proBNP-Assisted Treatment to Lessen Serial Cardiac Readmissions and Death (BATTLESCARRED) cohort, the risk score was validated for its ability to predict nonresponse (C statistic 0.73, P<.001). Serial changes in NT-proBNP inform risk for adverse outcome and are associated with prognostically meaningful metrics. Prediction of future NT-proBNP nonresponse to HF therapy is possible. [ABSTRACT FROM AUTHOR]

Software testing is a domain of software engineering that deals with the validation and verification of software work products. This domain has gained a lot of importance after the advancement and realization of the concept of globalization. Software testing was done manually till last decade, however this paradigm has seen a shift from manual techniques to automatic process because of the increasing concern about software reliability and usability, cost incurred on software testing, scaling, performance and compatibility issues. We present an approach for automatic test case generation based on Model Based Testing (MBT) methodology. In this approach a UML model is created using a standard tool from the set of user scenarios and then based on this model automatic test case are generated by applying certain algorithms. [ABSTRACT FROM AUTHOR]

Objective: Included evaluation of the possibility of using the systemic inflammatory indices for preoperative screening for the presence and severity of endometriosis (EM) in comparison to the findings of the exploratory laparoscopy., Methods: 88 women with clinical manifestations suggestive of EM were evaluated clinically and by US and gave blood samples for estimation of serum cancer antigen-125 (CA125), platelet and total and differential leucocytic counts for calculation of inflammatory indices; the Systemic Immune-Inflammation index, the Systemic Inflammation Response Index (SIRI), the Neutrophil-Lymphocyte ratio (NLR), the Neutrophil-Monocyte ratio, the Neutrophil-Platelet ratio and the Platelet-Lymphocyte ratio. Then, patients were prepared to undergo laparoscopy for diagnosis and staging., Results: Laparoscopy detected EM lesions in 63 patients; 27 of stage I-II and 36 of stage III-IV. Positive laparoscopy showed significant relation with US grading, high serum CA125 levels, platelet and inflammatory cell counts and indices. Statistical analyses defined high SIRI and NLR as the significant predictors for positive laparoscopy and high serum CA125 and NLR as the most significant predictors for severe EM (stage III-IV) on laparoscopy., Conclusion: The intimate relation between EM and inflammation was reflected systematically as high levels of blood cellular components, but indices related to neutrophil especially NLR and SIRI showed highly significant relation to the presence and severity of EM and might be used as routine, cheap and non-invasive screening test before exploratory laparoscopy to guide the decision-making., Competing Interests: Conflicts to interest: none to declare., (© 2024. Federação Brasileira de Ginecologia e Obstetrícia. All rights reserved.)

A 64-year-old man being evaluated for pulmonary thromboendarterectomy (PTE) preoperatively experienced pulseless electrical activity secondary to right ventricular failure while undergoing bronchoscopy. After return of spontaneous circulation, a percutaneous right ventricular assist device (RVAD) was placed through the right internal jugular vein. He continued on right ventricular support with demonstration of right ventricular recovery over the following 8 days, and subsequently underwent PTE for treatment of his primary condition. He recovered and was weaned from his RVAD support uneventfully. The need for RVAD support has traditionally been a contraindication for PTE; however, circulatory assist devices have been used as a salvage procedure for right-heart failure after PTE. This case highlights the potential for percutaneous mechanical circulatory support in treating severe perioperative right ventricular dysfunction, and to facilitate successful recovery in patients undergoing PTE.

Background: Obese patients with chronic HF have a lower mortality than do non-obese patients with heart failure (HF) i.e. "obesity paradox". We sought to determine the relationship between obesity (defined by body-mass index; BMI) and survival in inotrope-dependent patients with Stage D HF., Methods and Results: We screened the medical records of adults with ACC/AHA stage D HF who were admitted to our institution between January, 2010 and July, 2018 who were both initiated and discharged on continuous intravenous milrinone. Patients were divided into three groups: non-obese patients (Nob-BMI < 30 kg/m 2 ), Class 1 obese patients (Ob1-BMI 30 to 34.9 kg/m 2 ), and class 2/3 obese patients (Ob2/3-BMI ≥ 35 kg/m 2 ). The primary endpoint was all-cause mortality. Of the 233 patients included in the study, 154 were NOb, 39 were Ob1, and 40 were OB2/3. Age and baseline comorbidities did not differ significantly among the groups. Mean follow up was 21.8 months (Median: 12.4, IQ range: 3.6-31.3). Compared to the NOb, relative mortality (HR) was 0.68 for Ob1 patients and 1.21 for Ob2/3 patients ( P = 0.30). Adjusting for age, sex, race, and medical comorbidities, relative mortality was 0.85 in the Ob1 and 1.77 in the Ob2/3 ( P = 0.08)., Conclusion: In this retrospective study of stage D inotrope-dependent HF patients, there was trend of an "obesity paradox" with higher survival in the Ob1 group patients compared to NOb and Ob2/3 patients. Ob2/3 patients had the worst survival., Competing Interests: None.

Background: Heart failure (HF) treatment guided by amino-terminal pro-B type natriuretic peptide (NT-proBNP) may reduce cardiovascular event rates compared to standard-of-care (SOC) management. Comprehensive understanding regarding effect of NT-proBNP guided care on patient-reported quality of life (QOL) remains unknown., Methods: One hundred fifty-one subjects with HF due to left ventricular systolic dysfunction were randomized to either SOC HF management or care with a goal to reduce NT-proBNP values ≤1000 pg/mL. Effects of HF on QOL were assessed using the Minnesota Living with HF Questionnaire (MLHFQ) quarterly, with change (Δ) in score assessed across study procedures and as a function of outcome., Results: Overall, baseline MLHFQ score was 30. Across study visits, QOL improved in both arms, but was more improved and sustained in the NT-proBNP arm (repeated measures P = .01); NT-proBNP patients showing greater reduction in MLHFQ score (-10.0 vs -5.0; P = .05), particularly in the physical scale of the questionnaire. Baseline MLHFQ scores did not correlate with NT-proBNP; in contrast, ∆MLHFQ scores modestly correlated with ∆NT-proBNP values (ρ = .234; P = .006) as did relative ∆ in MLHFQ score and NT-proBNP (ρ = .253; P = .003). Considered in tertiles, less improvement in MLHFQ scores was associated with a higher rate of HF hospitalization, worsening HF, and cardiovascular death (P = .001)., Conclusions: We describe novel associations between NT-proBNP concentrations and QOL scores among patients treated with biomarker guided care. Compared to SOC HF management, NT-proBNP guided care was associated with greater and more sustained improvement in QOL (Clinical Trial Registration: www.clinicaltrials.govNCT00351390)., (Copyright © 2012 Mosby, Inc. All rights reserved.)

Background: Elderly patients with heart failure (HF) have a worse prognosis than younger patients. We wished to study whether elders benefit from natriuretic peptide-guided HF care in this single-center study., Methods and Results: A total of 151 patients with HF resulting from left ventricular systolic dysfunction (LVSD) were treated with HF treatment by standard-of-care (SOC) management or guided by N-terminal pro-B type natriuretic peptide (NT-proBNP) values (with a goal to lower NT-proBNP ≤1000 pg/mL) over 10 months. The primary end point for this post-hoc analysis was total cardiovascular events in 2 age categories (<75 and ≥75 years). In those ≥75 years of age (n = 38), NT-proBNP values increased in the SOC arm (2570 to 3523 pg/mL, P = .01), but decreased in the NT-proBNP-guided arm (2664 to 1418 pg/mL, P = .001). Elderly patients treated with SOC management had the highest rate of cardiovascular events, whereas the elderly with NT-proBNP management had the lowest rate of cardiovascular events (1.76 events per patient versus 0.71 events per patient, P = .03); the adjusted logistic odds for cardiovascular events related to NT-proBNP-guided care for elders was 0.24 (P = .008), whereas in those <75 years (n = 113), the adjusted logistic odds for events following NT-proBNP-guided care was 0.61 (P = .10)., Conclusions: Natriuretic peptide-guided HF care was well tolerated and resulted in substantial improvement in cardiovascular event rates in elders (ClinicalTrials.Gov #00351390)., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To compare the clinical outcomes of a loading dose regimen of quinine with a uniform dose regimen in patients with severe falciparum malaria., Methods: A retrospective chart review of 315 patients admitted with severe falciparum malaria and treated with quinine at a tertiary care teaching hospital of Karachi, Pakistan during 1999-2006 was conducted. Group A with 103 patients (32.7%) was given an initial loading dose of quinine while group B with 212 patients (67.3%) did not receive the loading dose. The two groups were compared in terms of reduction of parasite load, resolution of fever, recovery of consciousness and incidence of adverse effects. Outcome parameters were measured on the third day of therapy., Results: More individuals in group A (62.1%) were afebrile as compared to group B (54.7%) at day 3 of therapy. Patients in group B showed greater reduction in parasitaemia (47.2% at baseline to 4.7% on day 3) as compared to group A (56.3 % at baseline to 9.7% on day 3). Following therapy, fewer patients in group B had altered consciousness (7.1% at baseline to 4.7% on day 3) as compared to patients in group A (7.8% at baseline to 5.8% on day 3). However, these associations were not statistically significant. The incidence of thrombocytopenia was higher in Group A (5.8%) as compared to Group B (0.9%)., Conclusion: Although quinine loading dose may be more effective than uniform dose in rapid fever clearance; it also appears to be associated with higher toxicity. Uniform dose of quinine may be prescribed in severe falciparum malaria in view of its better safety profile.

The emergence of BNP or NT-proBNP testing has improved the management of acutely decompensated heart failure patients significantly by aiding in early recognition, prognostication, and treatment. Furthermore, their logical application may not only reduce healthcare costs but also potentially reduce adverse clinical outcomes. This article reviews the understanding of utilizing natriuretic peptide testing to correctly diagnose and manage acute heart failure.

Cardiac troponin is the biomarker of choice for the serological diagnosis of acute myocardial infarction. With the development of "highly sensitive" troponin assays, it is now possible to measure levels of this marker at and below the current 99th percentile of a healthy population; high sensitive troponin assays show great potential in earlier detection of acute myocardial infarction and better risk prediction in patients with acute coronary syndrome.