2nd Visit Research Articles

Comprehensive risk factor management through a dedicated secondary prevention clinic: experience from hamilton, Ontario

Abstract Introduction and Background Atherosclerotic cardiovascular diseases (ASCVD) remain a major source of morbidity and mortality. Modifiable ASCVD risk factors can be effectively treated, however, there is a lack of systematic implementation of secondary prevention therapies in ASCVD patients. We established a comprehensive secondary prevention program for patients with ASCVD to provide care for all modifiable risk factors in an integrated manner. Methods Patients with established coronary artery disease (CAD), cerebrovascular disease (CVD) and peripheral vascular disease (PVD) who had one or more uncontrolled risk factors, were referred to the center(s). Patients were assessed between November 2022 and October 2023. Uncontrolled risk factors were defined as dyslipidemia (LDL > 70 mg/dL [1.8 mmol/L]), hypertension (defined as BP >130/80 mmHg), diabetes (HbA1c >6.5%), chronic kidney disease (eGFR <60 ml/min/1.73m2) obesity (BMI >30 kg/m2) and current tobacco use. Data was collected at the initial visit and subsequent follow-up visits. Results A total of 274 patients were seen, with 85% were referred for CAD. Median age was 62 years,72% were men. The most common uncontrolled modifiable risk factor was hypertension (62% of patients), followed by dyslipidemia (60%) and obesity (50%). 39% of patients had diabetes, with 57% on a SGLT2i, 16% on a GLP-1 agonist and with 23% with HbA1c >8%. Blood pressure was above 140/90 mm Hg in 41% of patients, 20% were current smokers and 75% of patients had two or more uncontrolled risk factors. At the first visit, 56% of patients had a pharmacological intervention. The most common was for management of dyslipidemia, followed by diabetes and then hypertension. 17.8%(n=49) patients had a change in statin,13.8% (n= 38) patients were started on Ezetmibe, 9.1%(n=25) on Icosapent Ethyl, and 16.4% (n= 45) on a PCSK9i inhibitor (monoclonal antibody or Inclisiran). Among patients with diabetes, 5.1%(n=14) patients were started on a GLP-1 agonist and 2.5%(n=7) were started on a SGLT2i. 2.9%(n=8) patients were started on Varenicline and 2.9%(n=8) were started on NRT. Mean LDL (with LDL >1.8 at baseline) at visit 1 was at 3.03 ± 1.1 (n=157) mmol/dl, which reduced to 2.05 ± 0.9 (n=77) mmol/dl by 2nd visit and to 1.90 ± 1.3 (n=32) mmol/dl by visit 3. Average SBP (SBP >130 at baseline) at visit 1 was 143.3 ± 13.4 (n=114) mm Hg, this was subsequently reduced to 126.4 ± 14.0 (n=58) mm Hg at visit 2 and further reduced to 123.2 ± 14.7 (n=31) mm Hg by visit 3. Discussion and Impact: In our tertiary Cardiac Care center there are a significant number of patients with established ASCVD that remain on inadequate treatment for secondary prevention. Addressing these risk factors in a timely and integrated fashion in one clinic improves the implementation of guideline directed therapies for management of secondary risk factors in ASCVD and is expected to result in improved outcomes.

An optimized strategy triggered at the 2nd immunization visit to prevent HIV acquisition by breastfeeding: a phase 2 trial in Burkina Faso (PREVENIR-PEV)

BackgroundMother-to-child transmission of HIV during breastfeeding remains a challenge in low- and middle-income countries (LMIC). A prevention package was initiated during the highly attended 2nd visit of the Expanded Program of Immunisation (EPI-2) to identify the undiagnosed infants living with HIV and reduce the postnatal transmission of infant exposed to HIV.MethodsPREVENIR-PEV is a non-randomized phase II clinical trial conducted at two health centres in Bobo Dioulasso (Burkina Faso). The study recruited mothers living with HIV aged 15 years and older with their singleton breastfed infants. During EPI-2 (at 8 weeks) and upon signature of the informed consent, a point-of-care early infant diagnosis (EID) was performed. HIV exposed uninfected (HEU) infants were followed-up until 12 months of age. High risk HEU infants (i.e., whose maternal viral load ≥ 1000 cp/mL at EPI-2 or M6) received an extended postnatal prophylaxis (PNP) with lamivudine until end of follow-up or the end of breastfeeding.ResultsBetween 4 December 2019 and 4 December 2020, 118 mothers living with HIV-1 were identified, and 102 eligible mother/infant pairs had their infants tested for HIV EID. Six infants were newly diagnosed with HIV, and 96 HEU infants were followed-up for 10 months. Among the participants followed-up, all mothers were prescribed antiretrovirals. All 18 infants eligible for PNP at either EPI-2 or 6 months (M6) were initiated on lamivudine. No HIV transmission occurred, and no serious adverse events were reported in infants receiving lamivudine.ConclusionsThe PREVENIR-PEV prevention package integrated into existing care is safe and its implementation is feasible in a LMIC with a low HIV prevalence. More research is needed to target mother/infant pairs not adhering to the intervention proposed in this trial.Trial registrationNCT03869944; first registered on 11/03/2019.

Exercise capacity in COVID-19 surviving patients: impact of physical rehabilitation

Background: At least 65 million individuals worldwide have Long COVID and despite efforts to explain the effects of exercise prescription on the recovery of these individuals, there is a need to explore its effects on exercise tolerance and cardiorespiratory fitness. Therefore, our main objective was to evaluate the effect of the Physical Rehabilitation Program (PRP) on muscle strength and physical exercise capacity of COVID-19 survivors. Methods: The cohort included 28 patients post COVID-19, each participant performed a comprehensive and multisystem evaluation in two visits, in the pre- and post-PRP: 1st visit = clinical evaluation periods (maximal inspiratory pressure (MIP); maximal expiratory pressure (MEP) and Duke Activity Status Index (VO2peak). 2nd visit= physical evaluation [6-minute Step Test (6MST) and Handgrip Strength (HGS)]. The PRP consisted of breathing exercises, muscle strength exercises for upper and lower limbs and aerobic exercise, 2 or 3 times/week for 03 months. Results: The post-PRP we found: improvement in peripheral [95%CI 2.7 (2.0-3.4), p=0.001, Huge] and respiratory [MIP 95%CI 1.6 (0.9-2.3), p<0.001, Very large) and MEP 95%CI 2.7 (2.0-3.4), p=0.001, Huge)] muscle strength; increase in cardiorespiratory fitness according to estimated-VO2peak [95%CI 2.3 (1.5-3.1), p<0.001, Huge] and the number of steps climbed in the 6MST [95%CI 1.6 (0.9-2.3), p<0.001, Very large]; adaptations resulting lower resting heart rate (HR), higher peak HR, good modulation of HR resulting from stress caused by 6MST; linear and positive association between peripheral and respiratory muscle strength and the number of steps climbed 6MST and greater HR recovery especially post-PRP; recovery-first minute HR remained unchanged post-PRP. Conclusion: In patients post COVID19, we emphasize the great effect of individualized and supervised PRP on the increase in peripheral and respiratory muscle strength/ quality and cardiorespiratory fitness. Despite the gains obtained in PRP, the risk of death based on HR recovery did not change.

The evolution of cardiac function in patients with non-Hodgkin’s lymphoma under chemotherapy

In clinical practice, the treatment of non-Hodgkin’s lymphoma (NHL) often involves the combination of several chemotherapy agents, radiotherapy and immunotherapy. While these multimodal approaches improve the efficacy of pathology-specific treatment, they also increase the risk of cardiovascular complications, the most common of which is ventricular dysfunction induced by anti-tumor therapy. Aim of the study: Evaluation of the impact of anti-tumor treatment of NHL on the trajectory of left and right ventricular echocardiographic function. Materials and methods: 127 randomly selected patients from the hematology departments of the PSMI Institute of Oncology were included in the study. Patients were investigated during 3 visits by comprehensive echocardiography, the first visit was up to the onset of anti-tumoral treatment, the 2nd visit was 1 month after initiation and the 3rd visit at 6 months after the debut of chemotherapy. Results: During the anti-tumor treatment, a statistically significant decrease in left ventricular systolic indicators was attested by following parameters: left ventricular ejection fraction (LV EF), mean left ventricular S’, the ratio between the maximum velocity of the E wave and the flow propagation velocity (E/Vp), with an ANOVA p-value <0.001. Regarding the right ventricular systolic function, the indices reflected by TAPSE and S’ right ventricular free wall were reduced statistically significantly also (p ANOVA <0.001). The given analysis confirmed the impairment of ventricular relaxation throughout the treatment, the increase in left ventricular filling pressures, the ratio E/A and E/e’ showed a statisticallysignificant increase, parameters such as the deceleration time of the E wave, the relaxation isovolumetric time, the ratio e’/a’ did not register a statistically significant dynamic (p ANOVA = 0,897; 0,705 and 0,145 respectively). 6 months after the start of treatment, cardiac dysfunction associated with cancer therapy (CTRCD) was found in 18 patients (14,2%), 8 (6,3%) presented a moderate asymptomatic form, 7 (5,7%) had a mild asymptomatic form and 3 (2,4%) a symptomatic one.Conclusion: The left ventricular systolic function was statistically significantly reduced under the impact of the applied treatment, which was confirmed by the LV EF, the mean S’ value at the LV and the E/Vp ratio, the diastolic function having an impact through the E/A and E/e’ ratio. Regarding the function of the right ventricle, we attested statistically significant changes only in the longitudinal contraction parameters. CTRCD was confirmed in 18 patients.

#2848 Persistent albuminuria is a marker of persistent congestion in patients with chronic heart failure

Abstract Background and Aims Albuminuria is prevalent in patients with heart failure (HF) and associated with poor prognosis. Initial reports indicate albuminuria as a congestion marker in HF. Frequency and associations of persistent albuminuria with kidney function, NT-proBNP and venous congestion in this population are not clearly understood. We aimed to evaluate the dynamics of albuminuria and its relationship with congestion and renal function in patients with chronic HF (CHF). Method The study included patients ≥18 years, observed in an outpatient HF center, who signed an informed consent. Patients receiving renal replacement therapy, with cancer or primary kidney diseases were excluded. The visits were carried out with an interval of 3 months. During each visit we performed routine physical examination, laboratory tests (NT-proBNP, urine albumin/creatinine ration (uACR), and serum creatinine) and pulse-wave Dopplerography to assess renal venous blood flow. Persistent albuminuria was defined as maintaining an uACR > 30 mg/g on two visits. Albuminuria level was assessed according to KDIGO guidelines 2012 (A1, A2, A3). The absence of venous congestion was defined as continuous renal blood flow, while venous congestion - as intermittent (biphasic or monophasic) blood flow. A P value <0.05 was considered statistically significant. We prospectively included 103 patients with CHF (46% male, mean age - 70 (61;75) Me (IQR) years, 53% with reduced ejection fraction (EF), mean EF 45(34;53)%, 92% hypertensive, 60% with atrial fibrillation, 34% with diabetes mellitus type 2, 51% with chronic kidney disease (CKD), 43% with coronary heart disease). Results Mean uACR values at the 1st visit was 18(8;56) mg/g, at the 2nd visit - 11(0;35) mg/g. The frequency of albuminuria levels at the 1st visit were A1-66%, A2-26%, A3-8%; at the 2nd visit – A1-73%, A2-23%, A3-4%. Persistent albuminuria was detected in 37 patients (36%). The mean values of albuminuria were higher in the persistent albuminuria group on the 1st visit (76(39;222) vs 10.5(0;19.5) for patients with and without persistent albuminuria, p<0.001) and on the 2nd visit (94(44;176) vs 7(0;13), p < 0.001). The patient groups were comparable in gender, age, frequency of comorbidities, EF. The administration of disease-modifying therapy was the same in the groups, however, the dose of loop diuretic was higher in the group of persistent albuminuria (20 (10;75) vs 10(5;20) mg respectively, p = 0.024 (doses in terms of furosemide)). Serum creatinine level was 95(79;121) mmol/l; GFR (CKD-EPI 2021)- 69(52;88) mL/min/ 1.73 m2 at the 1st visit. Kidney function did not statistically differ in the groups with and without persistent albuminuria (at the 1st visit eGFE - 63(52;87) vs 70 (50;90) mL/min/1.73 m2, p = 0.52 and the 2nd visit eGFR- 68(48;85) vs 66 (48;89) mL/min/1.73, p = 0.65 respectively). The level of NT-proBNP was higher in patients with persistent albuminuria during the 1st (926 (472;1820) vs 550(260;919), pg/ml p = 0.04) and the 2nd visit (1244(987;2000) vs 593(264;1405), pg/ml, p = 0.0008). Intermittent renal veins blood flow on the 2nd visit was observed in 26 patients (25%). In patients with persistent albuminuria persistence of intermittent venous renal blood flow was more frequently than in patients without it (43% vs 7%, p = 0.017, respectively). Figs. 1 and 2 demonstrate that renal venous congestion was more severe in group of persistent albuminuria on visit 1st and 2nd respectively. Conclusion Persistent albuminuria over 3 mounts in patients with stable chronic heart failure is associated with persisting congestion (higher NT-proBNP levels and higher incidence and severity of renal venous congestion). There was no association between changes in albuminuria and changes in renal function.

Evaluation of the effect of the antioxidant complex “BESTFertil-DHA” on spermogram parameters and the index of sperm DNA fragmentation in men from infertile couples with metabolic syndrome

Introduction.Antioxidant therapy is the optimal type of treatment for idiopathic male infertility due to the good ratio of efficacy and safety. Considering that oxidative stress is one of the pathogenetic links in sperm DNA damage, antioxidant drugs can also reduce the DNA fragmentation index. Men who are overweight or severely obese have a high risk of sexual dysfunction and reproductive disorders. Antioxidant therapy plays a leading role in infertility associated with metabolic syndrome. The main active ingredients in «BESTFertil-DHA» are L-carnitine, eicosapentaenoic and docosahexaenoic acids, the action of which is complemented by other components, which makes the use of the complex attractive in combination with male infertility and metabolic syndrome. However, it is unknown how well they work with a combination of these pathological conditions.Aim.Is to evaluate the effectiveness of administration of Russian complex «BESTFertil-DHA» on spermogram parameters and the index of sperm DNA fragmentation in men from infertile couples with metabolic syndrome.Materials and methods.The study included 60 patients divided into cohort A- 26 patients with metabolic syndrome, cohort B- 34 patients without metabolic syndrome. All patients received «BESTFertil-DHA». All patients underwent a spermogram, an analysis for the fermentation of sperm DNA, blood for sex hormones, markers of metabolic syndrome on the first visit, and on the 2nd visit after therapy.Results.In cohort A, significant results were observed in terms of weight, BMI, C-reactive protein level, and HOMA-IR index. There is a significant improvement in the parameters of the spermogram, a decrease in the index of fragmentation of sperm DNA, a decrease in estradiol, normalization of the T/E2 index. In cohort B, changes in weight, BMI and a number of spermological parameters were observed, there were no changes in metabolic and endocrine parameters.Conclusion.Combined antioxidant therapy in the form of a complex of nutrients «BESTFertil-DHA» effectively reduces the index of fragmentation of sperm DNA and leads to normalization of spermogram parameters, both in the general cohort of patients and among men with metabolic syndrome. Moreover, in the latter, the «BESTFertilDHA» complex in combination with measures to reduce body weight gives additional therapeutic effects, affecting carbohydrate metabolism, aromatization of testosterone and the severity of systemic inflammation.

Dynamics of clinical and echocardiographic parameters of patients with cardiovascular diseases 3, 12 and 26 months after COVID-19 pneumonia

Aim: to study the dynamics of clinical and echocardiographic parameters in patients with cardiovascular diseases (CVD) at 3, 12, and 26 months after COVID-19 pneumonia. Material and methods. The dynamics of clinical and echocardiographic parameters were studied in 130 patients with CVD at 3, 12, and 26 months after COVID-19 pneumonia (57 ± 8 years old, 46.9 % males). Results. Between the 1st and 2nd visits, body mass index (BMI) increased (30.6 ± 5.1 kg/m2 vs. 31.4 ± 5.4 kg/m2, p < 0.001), the number of patients with obesity of grades 2 –3 increased (14.6 % vs. 23.1 %, p < 0.001). Early diastolic septal mitral annular velocity decreased from the 2nd to the 3rd visit (7.0 [6.0; 8.0] cm/s vs. 6.0 [5.0; 8.0] cm/s, p = 0.023), as did the maximum diastolic lateral tricuspid annular velocity (12.0 [11.0; 14.0] cm/s vs. 8.0 [6.0; 9.0] cm/s, p < 0.001). Between the 2nd and 3rd visits, the average global longitudinal strain of the left ventricle increased ( –19.3 ± 2.6 % vs. –19.8 ± 2.2 %, p = 0.034), the frequency of detecting its reduced values decreased (34.9 % vs. 17.4 %, p = 0.003). Conclusion. In the long term after COVID-19 pneumonia, patients with CVD show an increase in BMI accompanied by worsening of diastolic ventricular function parameters without signifi cant progression in the frequency and severity of CVD.

Pseudomyopia treated with auricular point sticking combined with periocular needle-embedding therapy and prevention of true myopia: a multicenter randomized controlled trial.

To observe the clinical effect and safety of auricular point sticking combined with periocular needle-embedding therapy for pseudomyopia and prevention of true myopia. A total of 269 children with pseudomyopia were randomized into an observation group (134 cases, 2 cases dropped out) and a control group (135 cases, 5 cases dropped out). In the control group, the healthy education was provided. In the observation group, besides the intervention as the control group, the auricular point sticking was delivered at gan (CO12), pi (CO13), xin (CO15) and yan (LO5) on one ear in each treatment, combined with periocular needle-embedding technique at bilateral Cuanzhu (BL 2), Yuyao (EX-HN 4) and Sibai (ST 2). There were 2 weeks of interval after 4 weeks of treatment. One course of treatment was composed of 6 weeks and 2 courses were required. Separately, before treatment, after 6 and 12 weeks of treatment, and after 12 weeks (the 1st follow-up visit) and 24 weeks (the 2nd follow-up visit) of treatment completion, the spherical equivalent (SE), SE progression, axial length (AL) progression, accommodative amplitude (AMP), the score of the TCM symptom and the general symptom were observed in the two groups. The safety and compliance were evaluated in the two groups. After 6 and 12 weeks of treatment, and in the 1st and 2nd follow-up visits, SE increased when compared with that before treatment in the two groups (P<0.05), and AMP was larger than that before treatment in the observation group (P<0.05). After 12 weeks of treatment, and in the 1st and 2nd follow-up visits, the progression of SE was slower in the observation group compared with that in the control group (P<0.01, P<0.001). After 6 and 12 weeks of treatment, and in the 1st and 2nd follow-up visits, the progression of AL in the observation group was lower than that of the control group (P<0.05, P<0.01, P<0.001); and in the 1st and 2nd follow-up visits, AMP of the observation group was larger when compared with that in the control group (P<0.05, P<0.001). After 6 and 12 weeks of treatment, and in the 1st and 2nd follow-up visits, the total scores of TCM symptom and general symptom were reduced in comparison with those before treatment in the observation group (P<0.05); after 6 and 12 weeks of treatment, the total scores of TCM symptom and general symptom were lower than those before treatment in the control group (P<0.05). In the 1st and 2nd follow-up visits, the difference of the total score of TCM symptom and general symptom in the observation group was larger than that of the control group (P<0.05). In the observation group, compared with the control group, the scores for pale/dark complexion in the 1st and 2nd follow-up visits and that for lassitude in the 2nd follow-up visit were lower (P<0.05), the score for poor concentration after 12 weeks of treatment and that for poor sleep and memory in the 2nd follow-up visit were lower (P<0.05). There were no adverse reactions in the two groups. The compliance was 98.5% in the observation group and was 96.3% in the control group, without statistical difference (P>0.05). On the basis of health education, auricular point sticking combined with periocular needle-embedding therapy can effectively prevent from true myopia, control the increase of SE, delay the growth of AL and improve AMP in children with pseudomyopia. This compound therapeutic regimen can relieve the general symptom and comprehensively prevent from myopia through multiple approaches, with high safety and satisfactory compliance.

Changes in the cardiovascular profile in patients 3 and 12 months after COVID-19 pneumonia: parameters of arterial stiffness, global longitudinal strain, and diastolic function of the left ventricle

Aim. To study changes in the brachial – ankle pulse wave velocity (baPWV), ankle – brachial index (ABI), diastolic function, and global longitudinal strain of the left ventricle (LV) 3 and 12 months after COVID-19 pneumonia.Materials and methods. The dynamics of vascular age and LV global longitudinal strain was studied in 154 patients 3 and 12 months after COVID-19 pneumonia (51 ± 12 years, 48% were women). The control group consisted of 55 sexand age-matched individuals.Results. During the follow-up, the average baPWV decreased (13.2 [11.8; 15.1] cm / sec vs. 13.0 [11.8; 14.1] cm/ s; p &lt; 0.001), and the frequency of its elevated values declined (45.4 vs. 35.1%; p = 0.008). The average ABI increased (1.09 [1.04; 1.14] vs. 1.11 [1.06; 1.17]; p = 0.012), but remained within the normal range. LV global longitudinal strain (LV GLS) (–19.6 ± 2.2 and –19.7 ± 2.5%; p = 0.854) and the frequency of reduced LV GLS (21.4 and 26.6%; p = 0.268) did not change significantly and did not differ from values in the control group. Global longitudinal strain in the LV basal inferoseptal segment improved (–19.2 ± 3.6% vs. –20.1 ± 4.0%; p = 0.032). The early diastolic mitral annular velocity decreased (8.4 ± 3.0 cm / s vs. 8.0 ± 2.5 cm / s; p = 0.023). The LV isovolumic relaxation time was greater than in the control group (101.8 ± 22.3 ms at the 1st visit vs. 92.9 ± 21.5 ms; p = 0.012; 105.9 ± 21.9 ms vs. 92.9 ± 21.5 ms at the 2nd visit; p &lt; 0.001). A positive correlation was found between baPWV (r = 0.209; p = 0.009) and ABI (r = 0.190; p = 0.021) and strain parameters of the LV basal segments 12 months after discharge.Conclusion. Patients with optimal visualization on echocardiography at 12 months after COVID-19 pneumonia, compared to the results of the examination 3 months after the disease, had deteriorated parameters of LV diastolic function. LV GLS was within the grey zone and did not change significantly. An improvement in arterial stiffness was noted, associated with an improvement in the strain of basal LV segments.

Assessment of Hearing in Patients with Head Injury: A Prospective Study.

Hearing impairment is a well-known outcome of head trauma. The most prevalent site of injury is the peripheral structures. Hearing loss dissipates in most cases but can continue in some cases and may improve in some. To evaluate the incidence of hearing loss and ascertain its type and degree in patients with head injury. To estimate the progression or regression of hearing loss in head injury patients during follow-up. 60 patients with head injuries with any ear symptoms were included in the study. The severity of head injury is graded according to the Glasgow Coma Scale (GCS). Patients were subjected to High Resolution Computed Tomogram (HRCT) temporal bone, and Pure Tone Audiometry (PTA) was performed within 24h of presenting. PTA repeated after 3months. The degree of hearing loss and its progression or regression were assessed. Of the 60 patients, 56 (93.3%) had hearing loss on PTA. 50 Cases (83.3%) showed conductive hearing loss (CHL). 6 (10%) had mixed hearing loss (MHL). 4 cases with MHL had a transverse temporal bone fracture on radiological evaluation. 41 (68.3%) had mild CHL, 4 (6.7%) had moderate MHL, and 2 (3.3%) had moderately severe MHL. PTA values reduced significantly from 1st to 2nd visit in both ears. In our study, there was significant improvement in hearing during follow-up, after 3months of head injury indicating improvement in hearing. The improvement in hearing was noticed in all cases except for one case with transverse temporal bone fracture and moderately severe hearing loss. Routine otological examination should be considered in all patients with head injuries. Meticulous and timely management of these cases can significantly reduce morbidity in the patient.

1975 Does attendance at a geriatrician led, oncogeriatric clinic, improve the symptoms for older adults with cancer?

Abstract Introduction In the cancer setting, Comprehensive Geriatric Assessment (CGA) reduces chemotherapy toxicity, improves QOL and increases advance directive completion (ASCO 2020: The Geriatric Assessment Comes of Age; Soto-Perez-de-Celis et al; The Oncologist). We wanted to look at whether CGA improved symptomatology, as patients attending our oncogeriatric clinic complained of a range of symptoms, related to their cancer, as well as other co-morbidities and frailty. Methods We retrospectively analysed follow up clinic letters of patients who had attended the oncogeriatric clinic, between June 2022 and June 2023. We used a Lirkert scale, to see whether symptoms they had complained of had 1 – got worse, 2 – stayed the same, 3 – improved or 4 – resolved. Results 32 patients with a wide range of malignancies were included. 59 patients were excluded because they: died before the 2nd appointment, did not require a second appointment, had their second appointment outside the analysis window, DNA or in 1 case the follow up letter could not be found. On average each patient complained of 3 symptoms. 30 different symptoms were noted (2 excluded as there was no mention of them in the 2nd visit.) The top presentations were pain, constipation, low mood, breathlessness, reduced mobility, falls and dizziness. 68% of the symptoms complained of showed improvement – including all the top presentations. The average score on the Lirkert scale was 2.76. 78% of patients had shown improvement or resolution in at least some of their symptoms. Conclusions Our retrospective review shows that older, cancer patients, have a high burden of varied symptomatology, because of their cancer, co-morbidities and frailty. Attendance at an oncogeriatric clinic results in improvement in the symptom burden for the majority of older adults, and an improvement in some symptoms, whether they are related to cancer, or other frailty syndromes.

Alterations in muscle strength among patients with GI cancers receiving oral nutritional support as soon as malnutrition was detected: ONMUS study.

741 Background: The main goal of our multicenter study, focusing on patients with gastrointestinal (GI) cancers receiving nutritional support, was to monitor the alterations in muscle strength among individuals who began oral nutritional support (ONS) as soon as malnutrition was detected. Additionally, our study had secondary objectives, which included assessing the adherence to ONS, examining the impact of ONS on anthropometric measurements, analyzing chemotherapy compliance, and evaluating the overall quality of life. Methods: The ONMUS study was conducted at 8 centers in Turkey. The study aimed to involve patients with GI cancer who had used ONS for a minimum of 1 week and had an ECOG performance score of 0-1. Patients underwent evaluations by both a dietitian and an oncologist during the baseline visit, as well as at the 2nd and 3rd month visits. Various parameters, including age, gender, performance status, disease stage, treatment adherence, food consumption records, anthropometric measurements, muscle function measured with a handgrip device, and quality of life scales, were assessed. Results: The study comprised 426 patients. The median age was 62 years, with a range spanning from 19 to 90 years. Colorectal cancer was the primary diagnosis in 51% of the patients, while hepatobiliary, gastric, esophageal, and small bowel cancers accounted for 20.9%, 20.7%, 6.5%, and 1% of cases, respectively. A significant majority, 78.2% (n=319), of the patients were diagnosed at stage 4, and nearly all, 99.3% (n=411), were undergoing chemotherapy. Patients who adhered to ONS at or above 75% of the recommended usage were categorized as compliant. Among this group, there was a significant increase in body mass index ( P=0.005). Handgrip measurements for assessing muscle strength demonstrated a statistically significant increase, with handgrip weight rising from 24.9 ± 8.9 kg at the first visit to 26.1 ± 8.9 kg at the third visit ( P=0.009). ONS-compliant patients also showed statistically significant improvements in weight, total body water, basal metabolic rate, and calf circumference measurements. The proportion of ONS-compliant patients decreased from 80.5% (n=343) at the first visit to 62.4% (n=93) at the third visit. Additionally, a statistically significant improvement was observed in food consumption records ( P=0.004). In assessments using the EORTC QLQ-C30, there were significant improvements noted in general health status, fatigue, pain, and insomnia scales, as well as in physical, emotional, and social functioning. Furthermore, a significant difference was identified between visits 1 and 2 in PG-SGA scoring ( P&lt;0.001). Conclusions: ONS compliance is evident in the significant improvement observed in muscle strength, anthropometric measurements, and quality of life data. The importance of addressing malnutrition in patients with GI cancer cannot be overstated. Therefore, it is imperative to maintain regular monitoring of their nutritional status and adherence to ONS.

The long-term effects of topical latanoprost 0.005% treatment on pupillary functions: A 2-year longitudinal study.

To investigate the long-term effects of topical latanoprost 0.005% treatment on pupillary functions in early-stage primary open-angle glaucoma (POAG) eyes using automated pupillometry. This prospective study involved 20 eyes of 20 treatment-naive subjects with early-stage POAG. After comprehensive ophthalmic examination, static and dynamic pupillometry measurements were performedbefore treatment, at the 1st follow-up visit (1.10 ± 0.30 months) and the 2nd follow-up visit (25.85 ± 10.26 months) after treatment initiation. Dynamic parameters included resting diameter (mm), amplitude (mm), latency (ms), duration (ms), and velocity (mm/s) of pupil contraction and dilation. Static pupillometry parameters were pupil diameter (PD, mm) in high-photopic, low-photopic, mesopic and scotopic conditions. The velocity of pupil dilation significantly decreased during the 1st visit (p = 0.008) and the 2nd visit (p = 0.0003) of treatment compared to the pre-treatment visit. The resting PD was also significantly higher after the 1st visit (p = 0.003) and the 2nd visit (p = 0.001) compared to the pre-treatment visit. However, the difference in resting PD measured between the 1st and 2nd visits did not reach statistical significance (p = 0.065). There were no significant changes in other dynamic parameters (p > 0.05 for all). Additionally, a mild, but not significant, mydriatic effect was observed in PD measurements under scotopic, mesopic and low photopic lighting conditions after follow-up. None of the static and dynamic parameters correlate with age, changes in intraocular pressure (IOP) or mean deviation (MD) values of visual field tests. The long-term topical latanoprost 0.005% treatment in early-stage POAG has a slight mydriatic effect on the pupil. Further longitudinal clinical studies with larger patient cohorts are necessary to better understand the effects of latanoprost on pupillary functions.

To study the role of tofacitinib and betamethasone pulse in the treatment of vitiligo at a tertiary care centre: an observational comparative study

Background: According to recent updates, both genetic and non-genetic factors play a role in the pathogenesis of vitiligo, and CD8T lymphocytes and interferon γ are also known to result in vitiligo. The new oral biologic tofacitinib, which is a Janus kinase inhibitor, is a new addition to the armamentarium of immunosuppressive therapy to halt disease progression in vitiligo. Tofacitinib is also known to inhibit IFN-γ mediated inflammation, which is an important step in the development of vitiligo lesions. Aims and objectives: The aim of this study was to compare tofacitinib with betamethasone pulse in reducing the disease activity with respect to reduction in VASI (vitiligo area severity index) and BSA (body surface area) in patients with vitiligo. The primary objective was to see the efficacy of tofacitinib over betamethasone in the treatment of vitiligo, and the secondary objective was to assess its safety in treating vitiligo patients. Methodology: All the patients with vitiligo of age &gt;12 years attending the dermatology clinic of our institute and willing to give written informed consent were included in the study. Group A patients were prescribed betamethasone 4 mg twice weekly, and group B patients were given tofacitinib 5 mg twice daily, followed by sun exposure in both groups, and photography was done at each monthly visit. Results: The mean change in VASI and BSA in the tofacitinib group was better at each visit than in the betamethasone group. The mean VASI scores at baseline, 1st, 2nd, and 3rd visits were 13.64, 12.79, 11.57, and 10.57, respectively, and the mean BSA at baseline, 1st, 2nd, and 3rd visits were 10.80, 9.75, 8.30, and 7.75 respectively, in the betamethasone group. Similarly, in the tofacitinib group, mean BSA values from baseline to the 3rd visit were consecutively 11.47, 9.50, 7.50, and 5.25, and mean VASIs were 14.92, 12.46, 9.46, and 7.08, respectively. Further, mean changes in BSA and VASI from baseline at each visit. as depicted in graphs 1 and 2, were more in tofacitinib group. There was no side effect in either group at any of the visits. Conclusion: Tofacitinib, along with sun exposure, can cause faster repigmentation and faster control of disease activity, as evident from mean changes at each visit, than oral betamethasone pulse in vitiligo patients.

Динамика клинических и иммунологических показателей при патогенетической терапии острого или обострения хронического фарингита

Objective. To study the anti-inflammatory properties of Tonsilgon N preparation and its effect on the indices of local immunity of oropharyngeal mucosa in patients with acute or exacerbation of chronic pharyngitis without a pronounced systemic inflammatory syndrome. Patients and methods. 60 people diagnosed with acute catarrhal pharyngitis with intoxication syndrome were examined. Group 1 – 30 people took the drug Tonsilgon N in the form of alcohol solution, group 2 – 30 people – sage in the form of tablets for resorption in the oral cavity according to the scheme of 25 drops or 1 tablet every 2 hours for the first 3 days of treatment, then 3 times a day until day 7 inclusive. Pharyngoscopy was performed by an otorhinolaryngologist at each visit on day 1, day 3–4 and day 7–8 of the disease. Using a 10-point visual analogue scale (VAS) with scores from 0 (no sign) to 10, we evaluated the severity of symptoms (pain when swallowing, a feeling of parching in the oropharynx, a feeling of a foreign body in the oropharynx, dry cough, weakness, headache) and the condition of the oropharyngeal mucosa. Additionally, at 3 visits, scrapings from the oropharyngeal mucosa were made with a cytobrush probe and the content of IL-6 and sIgA proteins was determined by enzyme immunoassay. For the control group, 30 conventionally healthy people were taken, not differing in sex and age from the main group of patients and having no inclusion criteria. Results. All patients by day 7 of observation had no expressed complaints, none of them had progression of inflammatory process or development of any complications, patients did not need further continuation of treatment. Pain at swallowing, feelings of foreign body in the oropharynx, feelings of feathering and intensity of hyperemia of the mucous membrane of the posterior pharyngeal wall when treated with Tonsilgon N on the 3–4 day of observation compared to the group of patients taking Sage. On the 7th day of observation at Tonsilgon N treatment all analyzed clinical manifestations of pharyngitis were absent, and in Sage group in some cases weakly expressed symptoms of pain at swallowing, feeling of foreign body in the oropharynx, feeling of fever, intensity of hyperemia of the mucous membrane of the back wall of the pharynx (Me = 0 [0;1] points) and dry cough (Me = 0 [0;0.5] points) remained. On day 1 of observation, an increase in IL-6 protein content compared with normal was noted in pharyngitis, and sIgA levels were low. Further, both groups showed a decrease in IL-6 level, in group 1 in the group receiving Tonsilgon N, its level on the 2nd and 3rd visit was lower compared to group 2. The amount of sIgA on the first day with pharyngitis was minimal, then in group 1 its values increased on day 3 but remained below control, and in group 2 further decreased, on day 7 of observation in group 1 sIgA slightly increased but was below control. In group 2 the sIgA level was determined in minimal values. Conclusion. Tonsilgon N or sage therapy showed a clear relief of clinical symptoms of tonsillopharyngitis during the treatment period without taking non-steroidal anti-inflammatory drugs, and their reduction was significantly faster with Tonsilgon N. Decrease of proinflammatory cytokine IL-6 on the background of treatment was faster on the background of treatment with Tonsilgon N. Increased synthesis of sIgA against the background of Tonsilgon N treatment allows to explain the rapid onset of clinical recovery in patients and to identify an additional mechanism of action of this drug on the local immune response of the oropharyngeal mucosa. It can be assumed that Tonsilgon N is not only pathogenetic, but also immunoregulatory, creating the most effective response of the body to inflammation. Key words: pharyngitis, oropharyngeal mucosa, interleukin-6 (IL-6), secretory immunoglobulin A (sIgA), enzyme-linked immunosorbent assay (ELISA), treatment, Tonsilgon N, sage

Systemic Melatonin Supplementation as an Adjunct to Non-Surgical Periodontal Treatment in Obese Patients with Periodontitis

Background: Obesity is considered an important risk factor for periodontal disease. It has been reported that reactive oxygen species linking both diseases, systemic melatonin supplementation as antioxidant therapy, was addressed as an adjuvant to scaling and root surface debridement (SRP) to enhance the treatment of periodontitis. Objective: To investigate the efficacy of systemic melatonin administration in periodontitis-obese patients as an adjuvant to scaling and root surface debridement (SRP). Methods: A randomized clinical trial was conducted at a dental-specialized center. Eighty subjects were included and allocated into group-I: twenty periodontium-healthy, normal-weight people; group-II: 30 obese patients with stage-III treated only with SRP; and group-III: 30 obese patients with stage-III periodontitis treated with SRP and 5mg melatonin. periodontitis and subjected to estimation, serum levels of Receptor Activator of Nuclear Factor-Kappa B Ligand (RANKL) were estimated in all groups. Probing pocket depth (PPD), bleeding on probing (BOP), and relative attachment level (RAL) were estimated in Groups II and III at baseline and after a one-month visit. Results: RANKL baseline visits were significantly different between the control and studied groups, with no significant difference in clinical parameters except for PPD. The 2nd visit showed a significant difference in BOP score-1 compared to RAL and BOP score 0. In the second visit, only weak negative and positive significant correlations were found between RANKL and BOP. Conclusion: Daily use of 5 mg of melatonin improves periodontal parameters and decreases serum RANKL levels.

4% Articaine Buccal Infiltration Versus 2% Lignocaine Inferior Alveolar Nerve Block for Pulpal Anaesthesia in Mandibular First Molars

The aim of the quasi-experimental study was to assess and compare anaesthetic efficiency of 4% articaine buccal infiltration (BI) and 2% lignocaine inferior alveolar block (IANB) for pulpal anaesthesia in mandibular first molars. Thirty-nine participants with healthy 1st molar teeth on both sides of the mandible who came for root canal treatment of adjacent teeth were recruited for the trial. All participants received 2% lignocaine IANB on 1st visit and 4% articaine BI on 2nd visit and the appointment was given at least 1 week apart. Pulpal anaesthesia onset and duration were checked by an electric pulp tester. The result showed that 4% of articaine BI secured 53.8% successful pulpal anaesthesia in mandibular first molar teeth while 2% of lignocaine IANB did 61.5%, and this difference was not statistically significant. The onset time of pulpal anaesthesia showed no significant difference between these two methods. But, the duration of pulpal anaesthesia was significantly shorter in articaine BI than in lignocaine IANB. It can be concluded that 4% articaine BI is a safe and effective method for pulpal anaesthesia in mandibular first molar teeth. But it should be used considering its shorter duration.

Abstract 12012: Adverse Social Determinants of Health Are Associated With Increased Risk of Uncontrolled Hypertension Among Cancer Patients in Rural Georgia: A Prospective Cohort Study

Introduction: The role of social determinants of health (SDOH) in the short-term control of hypertension (HTN) in cancer patients is unknown. Understanding the role of SDOH is important for equitable care of cancer patients, especially in the rural US. Hypothesis: High SDOH scores are associated with uncontrolled HTN in hypertensive cancer patients. Methods: We performed a prospective observational study at a tertiary care cancer center cardio-oncology clinic. Patients with cancer and HTN were asked to complete the Protocol for Responding to &amp; Assessing Patients' Assets, Risks &amp; Experiences (PRAPARE) questionnaire on their first visit. Blood pressure (BP) readings were taken at 2 follow-up visits. Uncontrolled HTN was defined as SBP≥130 mmHg and/or DBP≥80 mmHg with corroborated home blood pressure readings. Patients who did not perform home readings but had elevated BP at 2 nd visit were considered uncontrolled. The goals were the same regardless of cancer treatment. The SDOH score was calculated using PRAPARE SDH Risk Tally Score. We performed Cox proportional hazards regression adjusting for age, gender, and metastasis to identify the role of SDOH on short-term HTN control. The adversity cutoff for the SDOH score was informed by spline regressions. Results: In the cohort of 175 patients, median age was 66 (IQR 58-75) years, 55% were females, 42.2% were Non-Hispanic Black patients and 20.5% had breast cancer. Mean SDOH score was 6±3. The median duration of follow-up was 91 days (55-139). Uncontrolled HTN was noted in 59.4% of patients at their 2nd visit. For each 1-point increase in the SDOH score, uncontrolled hypertension increased by 9% (HR=1.09, 95% CI=1.03-1.15, p=0.002). Conclusions: Rural cardio-oncology patients with HTN have a high burden of SDOH. These study findings help identify contributors of SDOH that limit optimal HTN control in this population, allowing for better risk stratification and preventive intervention in clinical practice.

Adherence to the Dietary Approaches to Stop Hypertension (DASH) and Serum Urate Concentrations: A Longitudinal Analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BackgroundIncreased serum urate (SU) and hyperuricemia (HU) are associated with chronic noncommunicable diseases and mortality. SU concentrations are affected by several factors, including diet, and are expected to rise with age. We investigated whether the Dietary Approaches to Stop Hypertension (DASH) diet alter this trend. ObjectiveThe objective was to assess whether adherence to the DASH diet predicts a longitudinal change in SU concentrations and risk of HU in 8 y of follow-up. MethodsLongitudinal analyses using baseline (2008–2010, aged 35–74 y), second (2012–2014), and third (2016–2018) visits data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The inclusion criteria were having complete food frequency questionnaire (FFQ) and urinary sodium measurement, in addition to having SU measurement at the 1st visit and at least 1 of the 2 follow-up visits. For the HU incidence analyses, participants had also to be free from HU at baseline. The final samples included 12575 individuals for the SU change analyses and 10549 for the HU incidence analyses. Adherence to DASH diet was assessed as continuous value. HU was defined as SU>6.8 mg/dL and/or urate-lowering therapy use. Mixed-effect linear and Poisson regressions (incidence rate ratio [IRR] and 95% confidence interval [CI]) were used in the analyses, adjusted for confounders. ResultsThe mean age was 51.4 (8.7) y, and 55.4% were females. SU means (standard deviation) were 5.4 (1.4) at 1st visit, 5.2 (1.4) at 2nd visit, and 5.1(1.3) mg/dL at 3rd visit. The HU incidence rate was 8.87 per 1000 person-y. Each additional point in adherence to the DASH diet accelerated SU decline (P< 0.01) and lowered the incidence of HU by 4.3% (IRR: 0.957; 95% CI: 0.938,0.977) in adjusted model. ConclusionThe present study findings reinforce the importance of encouraging the DASH diet as a healthy dietary pattern to control and reduce the SU concentrations and risk of HU.

A personalized approach to the management of breastfed infants with functional gastrointestinal disorders and cow’s milk allergy. The role of nutritional recommendations for a nursing mother

Introduction. Functional gastrointestinal disorders (FGID) in infants are a complex of symptoms from the gastrointestinal tract that cannot be explained by structural or biochemical disorders. To alleviate the symptoms of functional disorders, a set of measures is required, first of all, psychological support for the mother and, of course, rational feeding, which includes maintaining breastfeeding, optimizing the nutrition of the nursing mother. Despite the abundance of professional information on this issue, previous studies demonstrate a low level of women’s awareness of nutrition during breastfeeding. The aim of the work is to determine the effectiveness of recommendations on nursing mother’s nutrition in the complex treatment of breastfed children with FGID and allergy to cow’s milk proteins.&#x0D; Materials and methods. Seventy five mother–child pairs were included in the study. 1–4 months infants exclusively breastfed during the study were divided into two groups: 1 — FGID infants (n = 51) and 2 — infants with suspected cow’s milk allergy (CMA) n = 24. In addition to the comprehensive treatment of the child, mothers of both groups were given recommendations on the nursing woman’s nutrition. Mothers of children from group 2 were assigned a diagnostic dairy-free diet for a period of 1 month. &#x0D; Results. On the 2nd visit, when analyzing the symptoms of the FGID in group 1, the number of children with symptoms of regurgitation of more than 2 episodes per day decreased by 28% (p &lt; 0.001), crying for more than 3 hours per day — by 52% (p &lt; 0.001). Children of group 2 with a clear positive effect from the diagnostic dairy-free diet therapy of the mother (n = 20) were diagnosed with Allergic and alimentary gastroenteritis and colitis (K52.2 — 10th revision of ICD-10), the continuation of the dairy-free diet for the mother and the supervision of an allergist were prescribed. The survey of women showed that all nursing women were interested in nutrition issues during lactation, 92% of the surveyed mothers searched for this information on the Internet. At the same time, only 12% of women considered this information to be sufficient. Evaluating the presented materials on nutrition, the overwhelming majority of respondents replied that they helped them to adjust their diet and expand nutrition, as well as to maintain breastfeeding.&#x0D; Conclusion. Thus, an integrated approach in the management of FGID infants and gastrointestinal manifestations of food allergies, including the use of nutrition recommendations developed in the National Medical Research Center of Children’s Health for nursing women, allows achieving a positive effect on the side of symptoms both in FGID and CMA patients, and also contributes to the improvement of the psycho-emotional state of a woman and prolonged breastfeeding.