Additional Comorbid Conditions Research Articles

Akut Üst Gastrointestinal Kanama İle Başvuran Hastaların Endoskopi Yapılma Zamanının Hastaların Mortalitesine Etkileri

Background: Endoscopy is recommended in acute upper gastrointestinal bleeding (AUGIB) to detect the bleeding source and stop the bleeding. The optimal timing of endoscopy in AUGIB is controversial. We aimed to investigate the time of endoscopy and the factors affecting it.
 Materials and methods: Retrospective, single-center study. The patients were divided into four groups: endoscopy after discharge, 0-12 hours endoscopy, 12-24 hours endoscopy and 24 hours later. Age, sex, vital signs, laboratory findings were recorded. Glasgow-Blatchford Score (GBS) and Charlson comorbidity index (CCI) were calculated. The obtained data were compared between these four groups. All-cause mortality for 30 days was recorded.
 Results: A total of 318 patients were included. In the comparison of endoscopy times, the parameters found to be statistically significant between the four groups are Hb, BUN, and INR levels, GBS and CCI. As a result of CHAID analysis, the most crucial variable affecting the timing of endoscopy was found to be the Hb value of the patients (χ2=66.528; adjusted p=0.000). Mortality occurred in 10.69% of the patients. The timing of endoscopy did not affect mortality. In binary logistic regression analysis, low systolic BP (0.967 times increase), high CCI (86,402 times increase) were found to affect mortality.
 Conclusion: The factors affecting the timing of endoscopy are the signs of bleeding. A thorough follow-up of vital signs in patients presenting to the emergency department with acute gastrointestinal bleeding, particularly an evaluation of systolic blood pressure and detailed questioning of additional comorbid conditions, is critical to reduce mortality.

Dental interventions in oral antithrombotic therapy.

Dentists commonly encounter patients taking oral antithrombotic agents who require invasive dental procedures. Although antithrombotics can cause an increase in bleeding, there is consensus that treatment regimens with antiplatelet agents, older anticoagulants (warfarin) and direct oral anticoagulants should not be altered before routine dental procedures when the risk of bleeding is low. Thromboembolic risk of their discontinuing likely outweighs potential bleeding complications associated with surgery. Therefore, the risks of stopping or reducing these medications must be weighed against the potential consequences of prolonged bleeding, which can be controlled with local measures such as mechanical pressure, suturing, haemostatic agents or antifibrinolytics. Some patients who are taking antithrombotic medications may have additional comorbid conditions or receive other therapy that can increase the risk of prolonged bleeding after dental treatment. Where a patient is believed to be at high bleeding risk, the dentist should consider a consultation with the patient's physician to discuss temporarily discontinuing the antithrombotic therapy.

An Analysis of the Prevalence and Risk Factors of Contrast-Associated Acute Kidney Injury in Patients With Diabetic Foot Ulcer.

The occurrence of contrast-associated acute kidney injury (CA-AKI) is influenced by both patient-related and contrast-related factors. More specifically, CA-AKI has been linked to renal dysfunction, diabetes mellitus (DM), and atherosclerotic cardiovascular diseases (ASCVD). We hypothesized that the prevalence of CA-AKI was high in patients with diabetic foot ulcers (DFU) because they frequently have several ASCVD risk factors and additional comorbid conditions (including ASCVD). We retrospectively examined the medical records of 208 type 2 diabetic patients who were hospitalized for DFU. These patients were divided into two groups: group 1 included 107 patients who underwent contrast-enhanced computed tomographic angiography (CTA); group 2 (control group) included 101 patients who did not receive contrast media. Following CTA, 13 (12.1%) patients developed CA-AKI in group 1, while 3 (3.0%) patients in group 2 had serum creatinine elevations consistent with AKI (P = 0.013). The following risk factors for CA-AKI were identified: longer history of DM, higher baseline serum creatinine, congestive heart failure, Wagner stage 4 and 5 DFUs, peripheral artery disease, older age, and lower hemoglobin values. CA-AKI is a common complication after CTA in patients with DFU. To reduce the risk of CA-AKI in these patients, associated risk factors and preventive measures should be considered.

Incident edentulism and number of comorbidities among middle-aged and older Americans.

Certain chronic non-communicable diseases have been associated with the loss of all natural permanent teeth, referred to as edentulism. It has been suggested that edentulism, a chronic dental state, involving the loss of all teeth and poorer masticatory efficiency, could be associated with multiple chronic conditions as people age. In this study, we describe the association between the number of comorbidities and incident edentulism in a representative sample of older Americans. We took data from the Health and Retirement Study (HRS). Dentate participants aged 50 or older at the baseline of 2006 (N=13 221) and 2012 (N=13 938) were linked to their dentate and survival status at the follow-up interviews in 2012 and 2018, respectively. The association between the number of comorbidities and incident edentulism was investigated by using multinomial logistic regression models. Over the two observation periods, the number of selected chronic conditions was predictive of edentulism 6 years later. A 10% higher chance of becoming edentulous by 2012 (OR=1.10, 95% CI=1.01, 1.20) was found for every additional comorbid condition to those who remained dentate in 2012. A similar association was identified for the 2012-2018 period. Among older adults, the number of comorbidities was predictive of incident edentulism, and the same association pattern was found across two longitudinal study periods. Older adults with an increase in the number of comorbidities may experience a higher chance of tooth loss later in time.

Strongyloides stercoralis Presenting as diffuse alveolar hemorrhage in a lupus nephritis patient

Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis (SS), a nematode predominately endemic to the tropical and subtropical regions. Autoinfection enables the organism to infect the host for extended periods. Symptoms, when present, are nonspecific and may initially lead to misdiagnosis, particularly if the patient has additional comorbid conditions. Immunosuppressive states place patients at risk for strongyloides hyperinfection syndrome, whereby the organism rapidly proliferates. Unfortunately, the nonspecific presentation of strongyloidiasis often leads to delays in diagnosis and treatment. We describe an unusual case of SS hyperinfection in a 34-year-old female with a long-standing history of lupus nephritis Class V on treatment, who presented to us with diffuse alveolar hemorrhage. The diagnosis was rendered on the identification of numerous organisms during histologic examination of the bronchoalveolar lavage specimen. Despite specific anti-infective treatment, the patient succumbed to her illness.

Early age at diagnosis of endometrial intraepithelial neoplasia and association with body mass index and other clinical factors (389)

Early age at diagnosis of endometrial intraepithelial neoplasia and association with body mass index and other clinical factors (389)

Differential impact of glycemic control and comorbid conditions on the neurophysiology underlying task switching in older adults with type 2 diabetes.

Type 2 diabetes is known to negatively affect higher order cognition and the brain, but the underlying mechanisms are not fully understood. In particular, glycemic control and common comorbidities are both thought to contribute to alterations in cortical neurophysiology in type 2 diabetes, but their specific impact remains unknown. The current study probed the dynamics underlying cognitive control in older participants with type 2 diabetes, with and without additional comorbid conditions (i.e., cardiovascular disease, nephropathy, peripheral neuropathy, retinopathy), using a task switching paradigm and a dynamic functional brain mapping method based on magnetoencephalography (MEG). We hypothesized that neural dynamics would be differentially impacted by the level of glycemic control (i.e., diabetes itself) and the burden of additional comorbid conditions. Supporting this hypothesis, our findings indicated separable, but widespread alterations across frontal, parietal, temporal and cerebellum regions in neural task-switch costs in type 2 diabetes that were differentially attributable to glycemic control and the presence of comorbid conditions. These effects were spatially non-overlapping and the effects were not statistically related to one another. Further, several of the effects that were related to the presence of comorbidities were associated with behavioral performance, indicating progressive deficits in brain function with extended disease. These findings provide insight on the underlying neuropathology and may inform future treatment plans to curtail the neural impact of type 2 diabetes.

Clinical evaluation of Major Depressive Disorder (MDD) and Borderline Personality Disorder(BPD) in youth adolescents

IntroductionAccording to international studies, at least 70% of BPD in adolescence are comorbid with MDD.ObjectivesTo determine the clinical and psychopathological markers of MDD in BPD in adolescence.MethodsClinical psychopathological interview, SCID-II, Hamilton Depression Rating Scale (HDRS). Sample: N=73 male and female, age: 18-25 with MDD and BPD.ResultsMDD comorbid with BPD in adolescence is characterized by polymorphism of its’ psychopathological manifestations due to the structure of BPD and the input of the age factor. In the studied sample 31 (42,5%) with both MDD and BPD also revealed addictions; 24 patients (32,9%) - anxiety and obsessive-compulsive (OCD) disorders, 18 patients (24,7%) had overvalued ideas. The high contingency of MDD with autoaggressive actions confirmed their high suicidal risk (53 patients). Among them - 31 patients (58,5%) - had non-suicidal self-harm (NSSI), 7 patients – (13,2%) had suicidal attempt (SA), and 15 patients (28,3%) had NSSI and suicidal attempts (NSSI+SA). The highest incidence of NSSI and NSSI+SA was noted in MDD with addictive disorders: NSSI – N=20 (80,00%), NSSI+SA - N=5 (20,00%), SA – N=0. MDD with BPD and anxiety disorders: NSSI – N=9 (56,25%), NSSI+SA – N= 6 (37,50%), SA–N=1 (6,25%). MDD with BPD and overvalued ideas: NSSI – N=2 (16,67%), NSSI +SA – N= 4 (33,33%), SA N=6 (50,0%), (results p<0.01).ConclusionsPsychopathological relations between BPD and MDD in youth are different due to additional comorbid conditions, like addictions, anxiety and OCD, overvalued ideas and have clinical implications in terms of suicidal and NSSI risks, individualized interventions and prognosis.DisclosureNo significant relationships.

Prevalence and predictors of peripheral neuropathy after chemotherapy: Outcomes from the Detroit Research on Cancer Survivorship (ROCS) cohort.

12069 Background: Increased life expectancy for cancer survivors following advances in treatment has led to a greater likelihood of developing long-term complications. Among them is chemotherapy-induced peripheral neuropathy (CIPN), which adversely impacts the functional capacity of survivors. We assessed prevalence and predictors of CIPN in a cohort of African-American (AA) cancer survivors. Methods: The study population included 633 breast, colorectal, prostate and lung cancer survivors who received chemotherapy and participated in the Detroit Research on Cancer Survivorship (ROCS) study. Presence of CIPN was based on self-reported pain, numbness or tingling in the hands or feet, occurring either for the first time or worsening after chemotherapy. If participants reported continued CIPN at the time of survey, their symptoms were reported as persistent. CIPN severity was self-reported as mild, moderate or severe. Logistic regression analysis was used to evaluate socio-demographic and clinical factors (including 12 common comorbid conditions) associated with CIPN prevalence, persistence and severity. Results: Overall, 67% of the cohort reported CIPN at a mean time of 25.3 months (range 2-74 months) after cancer diagnosis, and 51% reported persistent CIPN. The distribution of CIPN severity consisted of 32.2% with mild, 30.8% with moderate, and 36.9% with moderate to severe symptoms. Diagnosis of primary breast (OR 3.99, 95% CI 1.52-10.46) or colorectal cancers (OR 5.24, 95% CI 2.17-12.69) conferred greater CIPN prevalence relative to a diagnosis of prostate cancer. The presence of each additional comorbid condition among those outlined in the survey also conferred a 20% greater prevalence of CIPN (OR 1.2, 95% CI 1.03-1.39). Similar trends were seen among those who reported persistent CIPN. Using age > 65 at diagnosis as the reference group, age < 50 (OR 2.64, 95% CI 1.43-4.88) and age 51-64 (OR 1.96, 95% CI 1.14-3.35) resulted in an increased risk of moderate or severe compared to mild CIPN. Conclusions: In the Detroit ROCS cohort, CIPN was reported in two-thirds of cancer survivors receiving chemotherapy. Out of them, more than one-third reported moderate to severe symptoms, more commonly seen among those age < 65. Consideration of CIPN as a prominent long-term complication of cancer treatment should play a role in treatment decisions and development of new chemotherapy regimens.

Comorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve Replacement.

BackgroundTranscatheter aortic valve replacement (TAVR) has become the preferred treatment for symptomatic patients with aortic stenosis and elevated procedural risk. Many deaths following TAVR are because of noncardiac causes and comorbid disease burden may be a major determinant of postprocedure outcomes. The prevalence of comorbid conditions and associations with outcomes after TAVR has not been studied.Methods and ResultsThis was a retrospective single‐center study of patients treated with TAVR from January 2015 to October 2018. The association between 21 chronic conditions and short‐ and medium‐term outcomes was assessed. A total of 341 patients underwent TAVR and had 1‐year follow‐up. The mean age was 81.4 (SD 8.0) years with a mean Society of Thoracic Surgeons predicted risk of mortality score of 6.7% (SD 4.8). Two hundred twenty (65%) patients had ≥4 chronic conditions present at the time of TAVR. There was modest correlation between Society of Thoracic Surgeons predicted risk of mortality and comorbid disease burden (r=0.32, P<0.001). After adjusting for Society of Thoracic Surgeons predicted risk of mortality, age, and vascular access, each additional comorbid condition was associated with increased rates of 30‐day rehospitalizations (odds ratio, 1.21; 95% CI, 1.02–1.44), a composite of 30‐day rehospitalization and 30‐day mortality (odds ratio, 1.20; 95% CI, 1.02–1.42), and 1‐year mortality (odds ratio, 1.29; 95% CI, 1.05–1.59).ConclusionsComorbid disease burden is associated with worse clinical outcomes in high‐risk patients treated with TAVR. The risks associated with comorbid disease burden are not adequately captured by standard risk assessment. A systematic assessment of comorbid conditions may improve risk stratification efforts.

Hospital Survival After Surgical Repair of Truncus Arteriosus with Interrupted Aortic Arch: Results from a Multi-institutional Database.

Truncus arteriosus (TA) is a major congenital cardiac malformation that requires surgical repair in the first few weeks of life. Interrupted aortic arch (IAA) is an associated malformation that significantly impacts the complexity of the TA operation. The aim of this study was to (1) define the comorbid conditions associated with TA and (2) determine the hospital survival and morbidity of patients with TA with and without an IAA. Data was collected from the Vizient Clinical Database/Resource Manager, formerly University HealthSystem Consortium, which encompasses more than 160 academic medical centers in the United States. The database was queried for patients admitted from 2002 to 2016 who were ≤ 4months of age at initial admission, diagnosed with TA, and underwent complete surgical repair during that hospitalization. Of the 645 patients with TA who underwent surgery, 98 (15%) had TA with an interrupted aortic arch (TA-IAA). Both TA and TA-IAA were associated with a high prevalence of comorbidities, including DiGeorge syndrome, prematurity, and other congenital malformations. There was no difference in mortality between TA and TA-IAA (13.7-18.4%, p value = 0.227). No comorbid conditions were associated with an increased mortality in either group. However, patients with TA-IAA had a longer post-operative length of stay (LOS) compared to those without IAA (30 versus 40.3days, p value = 0.001) and this effect was additive with each additional comorbid condition. In conclusion, the addition of IAA to TA is associated with an increased post-operative LOS, but does not increase in-hospital mortality.

Outcomes after Descemet membrane endothelial keratoplasty over a period of 7 years at a tertiary referral center: endothelial cell density, central corneal thickness, and visual acuity

PurposeTo better assess clinical trajectories of patients with or without ocular comorbidity after Descemet membrane endothelial keratoplasty. Background: To report on the outcomes of eyes with differing starting conditions following surgery. Design: Retrospective study at a University Eye Hospital. Participants: 361 eyes separated into group 1 (n=229; eyes with endothelial disease only) and group 2 (n=132; eyes with additional ocular comorbid conditions, such as herpetic eye disease 18/132 (13.6%), glaucoma 16/132 (12.1%), dry age-related macular degeneration 14/132 (10.6%), epiretinal membranes 10/132 (7.6%), and wet age-related macular degeneration 9/132 (6.8%)).MethodsConsecutive eyes that underwent Descemet membrane endothelial keratoplasty over a follow-up period of up to 7 years at a tertiary referral center were reviewed. Main outcome measures were best-corrected visual acuity, postoperative complications, graft survival, central corneal thickness, and endothelial cell density.ResultsPostoperative best-corrected visual acuity at year 1 improved in both groups significantly (Wilcoxon signed rank test: group 1, p =.002; .63 to .23 logMAR; group 2, p <.001; 1.15 to .87 logMAR) with a group difference in favor of group 1 (p =.009, Mann-Whitney-Wilcoxon). A decrease of the endothelial cell density and central corneal thickness was noted at postoperative year 1 for both groups (paired t-tests (group 1, p <.001; group 2, p =.045) and paired t-tests (group 1, p <.001; group 2, p =.003). Complications were less common, and graft longevity was superior in group 1.ConclusionEyes with different starting conditions might experience a visual improvement and benefit from surgery. Descemet membrane endothelial keratoplasty is a valid treatment for endothelial disorders in manifold of eyes. Further long-term studies are required.

Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain

Background: Risk factors for in-hospital mortality from severe coronavirus disease 2019 (COVID-19) infection have been identified in studies mainly carried out in urban-based teaching hospitals. However, there is little data for rural populations attending community hospitals during the first wave of the pandemic. Methods: A retrospective, single-center cohort study was undertaken among inpatients at a rural community hospital in Spain. Electronic medical records of the 444 patients (56.5% males) admitted due to severe SARS-CoV-2 infection during 26 February 2020–31 May 2020 were reviewed. Results: Mean age was 71.2 ± 14.6 years (rank 22–98), with 69.8% over 65. At least one comorbidity was present in 410 patients (92.3%), with chronic obstructive pulmonary disease (COPD) present in 21.7%. Overall in-hospital mortality was 32%. Multivariate analysis of factors associated with death identified patients’ age (with a cumulative effect per decade), COPD as a comorbidity, and respiratory insufficiency at the point of admission. No additional comorbid conditions proved significant. Among analytical values, increased serum creatinine, LDH > 500 mg/dL, thrombocytopenia (<150 × 109/per L), and lymphopenia (<1000 cells/µL) were all independently associated with mortality during admission. Conclusions: Age remained the major determinant for COVID-19-caused mortality; COPD was the only comorbidity independently associated with in-hospital death, together with respiratory insufficiency and analytical markers at admission.

COVID-19 ve Romatizmal Hastalıklar

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an infectious agent affecting respiratory system the most and spreads rapidly due to large number of ACE2 receptors in the lung. Arthralgia and myalgia are the most common rheumatologic findings, but arthritis is rare. Hyperinflammatory condition called cytokine storm causes acute respiratory distress syndrome (ARDS) leading to death. Although coronavirus disease 2019 (COVID-19) is mild or asymptomatic in most cases, it may progress to pneumonia and ARDS, especially in elderly patients who have comorbidities. Drugs such as tocilizumab which suppress inflammatory response and reduce cytokine storm may be effective on treating COVID-19 pneumonia. Cytokine storm, the cause of which is not fully understood and in which many structures of immune system interact with each other, is quite complex and has different mechanisms contributing to it. Although antimalarial drugs such as hydroxychloroquine are used in the treatment, there is no definite evidence that they are effective. It has been shown that the prevalence and course of COVID-19 in rheumatic diseases is similar to the general population, and that increasing age and additional comorbid conditions increase the risk of mortality. It is recommended that anti-rheumatic drugs used in the treatment of rheumatic diseases should not be stopped unless the patient is infected with COVID-19.

Cardiovascular and Metabolic Risk in Patients with Chronic Myeloid Leukemia in Chronic Phase Receiving First-Line BCR-ABL1 Tyrosine Kinase Inhibitors in the United States: Baseline and Six-Month Follow-up Results from a Prospective Real-World Observational Study

Introduction: Tyrosine kinase inhibitors (TKIs) are the standard-of-care for patients with chronic myeloid leukemia in chronic phase (CML-CP) and are associated with improved outcomes. The risk of cardiovascular (CV) events has emerged as an important consideration during TKI therapy, mostly due to associated complications and the need to understand causality and proper mitigation. While nilotinib has been associated with an increased risk of CV events, few prospective studies have assessed the CV and metabolic risk profile of TKIs administered during routine clinical practice in a real-world setting. Importantly, data regarding the role of baseline CV risk factors at initiation of specific TKIs and subsequent CV events are limited. Here we assess CV and metabolic risk in patients with CML-CP undergoing first-line treatment with TKIs in a real-world setting. Methods: CA180-653 (NCT03045120) is an ongoing, non-interventional, prospective clinical trial characterizing the impact of approved TKIs (bosutinib, dasatinib, imatinib, and nilotinib) on CV and metabolic risk factors following initial TKI therapy in newly diagnosed patients with CML-CP in the USA. Baseline clinical and demographic characteristics, including medical history, vital signs, and evidence of additional comorbid conditions were assessed. CV and metabolic risk factors, as well as CV disease surrogates, were also measured, including ankle brachial index (ABI), echocardiogram (ECHO), electrocardiogram (EKG), and Framingham coronary heart disease score. Metabolic risk variables included fasting blood glucose, HbA1c, and fasting lipid panel. Enrolled patients were analyzed at both baseline and at six months after study enrollment. Results: Between March 2017 and December 2019, 109 patients were enrolled at 16 study sites across the USA. The analysis included patients treated with dasatinib (n = 48), imatinib (n = 47), and nilotinib (n = 14); key characteristics and CV findings are summarized in the Table. In all, 48.9% of patients prescribed imatinib were ≥ 65 years of age, compared with 22.9% of dasatinib and 28.6% of nilotinib patients. Patients treated with dasatinib had a marginally lower proportion of reported baseline CV/metabolic conditions (50.0%) compared to imatinib (53.2%) and nilotinib (57.1%). Interestingly, among patients with baseline Ca2+ scoring, 57.1% of nilotinib patients had coronary artery calcification present at baseline compared to 35.7% of imatinib patients and 28.9% of dasatinib patients. Most patients receiving an ECHO (96%) or EKG (99%) were assessed as normal or presenting clinically not significant abnormalities both at baseline and at the 6-month follow-up. Baseline corrected QT (QTC) scores were similar for dasatinib, imatinib, and nilotinib patients. Among patients with a change in QTC at six months, patients on imatinib had a larger change in median score (13.5 msec) than patients on nilotinib (8.0 msec) or dasatinib (2.0 msec). At six months, changes in ABI scores were small and unlikely to be statistically significant: left ABI scores changed by -0.030, -0.020, and 0.015 for patients on dasatinib, nilotinib, and imatinib respectively; right ABI scores changed by -0.030, 0.055, and 0.060 for patients on dasatinib, imatinib, and nilotinib, respectively. Additional longitudinal data will be presented. Conclusions: These preliminary findings confirm that just over half of patients with CML-CP in the USA have CV/metabolic comorbidities present at baseline, as measured by reproducible and sequentially evaluable studies known to be predictive of systemic vascular disease risk. Measurement of baseline clinical data is vital for assessing CV and metabolic risk in the US oncology settings. CA180-653 was powered to capture the impact of first- and second-generation TKIs on CV and metabolic risk factor outcomes within treatment arms, rather than between treatment arms. Further analysis is ongoing to determine the differential effects of TKIs used in CML-CP, the effect of long-term TKI therapy, and the value of specific CV evaluations to assess optimally and manage risk in patients with CML-CP. Study support:BMS. Table Disclosures Mauro: Sun Pharma/SPARC:Research Funding;Pfizer:Consultancy, Honoraria, Other: Travel, Accommodation, Expenses, Research Funding;Takeda:Consultancy, Honoraria, Other: Travel, Accommodation, Expenses, Research Funding;Novartis:Consultancy, Honoraria, Other: Travel, Accommodation, Expenses, Research Funding;Bristol-Myers Squibb:Consultancy, Honoraria, Other: Travel, Accommodation, Expenses, Research Funding.Oehler:Pfizer:Research Funding;Bristol-Myers Squibb, Takeda:Consultancy.McCloskey:Jazz:Consultancy, Honoraria;AbbVie:Consultancy, Honoraria;Takeda:Consultancy, Honoraria;BMS:Consultancy, Honoraria;Amgen:Consultancy, Honoraria.Heinrich:Novartis:Consultancy, Patents &amp; Royalties: Patent on treatment of GIST licensed to Novartis;Blueprint Medicines:Consultancy;Deciphera:Consultancy, Speakers Bureau.DeGutis:Bristol-Myers Squibb:Current Employment, Current equity holder in publicly-traded company.Tabano:Bristol-Myers Squibb:Current Employment.Khan:Bristol-Myers Squibb:Current Employment, Current equity holder in publicly-traded company.Moslehi:AstraZeneca, Janssen, BMS, Boston Biomedical, Immunocure, Myovant, Boston Biomedical, Deciphera:Consultancy.

Treatment receipt patterns among individuals with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders.

To determine latent classes of treatment receipt among people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) and describe each class by demographics, disease characteristics, and psychiatric diagnoses. Participants were National Epidemiologic Survey on Alcohol and Related Conditions-III respondents with lifetime PTSD and SUD (n = 1,349; mean age 40.3; 62.5% female; 30.9% non-White or Hispanic-White). Cross-sectional data were collected using the DSM-5 Alcohol Use Disorder and Associated Disabilities Interview Schedule. Latent class analysis was used to identify subgroups of participants with different patterns of treatment receipt. Of the patients, 36% received at least 1 SUD treatment while 84% received at least 1 mental health (MH) treatment. Six latent classes were identified: no treatment (17.3%), outpatient MH (34.0%), outpatient + inpatient MH (17.9%), SUD (7.3%), SUD + outpatient MH (15.7%), and SUD + outpatient MH + inpatient MH (7.7%). The SUD treatment classes evidenced greater social instability, had higher alcohol use disorder symptom severity, and used more drug types than the non-SUD classes. Classes receiving inpatient MH treatment had a greater incidence of additional comorbid conditions and suicidal behaviors. Across all 6 classes, most respondents met diagnostic criteria for chronic PTSD (overall: 68.9%) while fewer met diagnostic criteria for chronic SUD (overall: 38.7%). Most people with lifetime PTSD and SUD have sought either SUD or MH treatment or both, with substantially greater receipt of MH treatment. This comorbid group has complex clinical presentations that differ depending upon treatment subgroup, and for most, their PTSD persisted despite high rates of treatment engagement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Abstract S12-02: Risk of morbidity and mortality in COVID-19 patients with cancer

Abstract Introduction: Morbidity and mortality of cancer patients with COVID-19 have not been examined. The goal of this analysis was to compare the demographics and clinical characteristics of COVID-19 cancer patients to the rest of COVID-19 patients and assess whether cancer is associated with morbidity or mortality. Methods: COVID-19-positive patients with an inpatient or emergency encounter at the Mount Sinai Health System between 03/01/20-05/27/20 were included in the analysis. Patients were compared across cancer status (noncancer, non-solid cancers, and solid cancers) on demographics and clinical characteristics. Multivariable logistic regressions were used to model the associations of cancer status with sepsis, acute venous thromboembolism, and mortality. Results: There were 5,516 COVID-19 positive patients included, 96 (1.7%) with non-solid cancers and 325 (5.8%) with solid cancers. Those with solid cancers were significantly older (mean: 70.9 vs. 63.8 and 63.2 years) and more likely to be non-Hispanic Black (26.5% vs. 23.9% and 22.9%) than noncancer and non-solid cancers patients. Those with cancer had significantly more additional comorbid conditions (42.7% and 49.8% ≥2 comorbidities for non-solid and solid cancers, vs. 30.4% for noncancer). Platelets (mean [noncancer]: 223.8, mean [non-solid cancer]: 182.6, mean [solid cancer]: 218.3 × 103/μL), white blood cell count (mean [noncancer]: 8.4, mean [non-solid cancer]: 6.7, mean [solid cancer]: 8.0 × 103/μL), hemoglobin (mean [noncancer]: 13.1, mean [non-solid cancer]: 11.2, mean [solid cancer]: 12.0 g/dL), and red blood cell count (mean [non-cancer]: 4.5, mean [non-solid cancer]: 3.7, mean [solid cancer]: 4.1 × 106/μL) were significantly lower in cancer patients, and lowest in those with non-solid cancers. After adjustment and compared to noncancer patients, those with cancer had significantly higher risk of acute venous thromboembolism (ORadj: 1.77, 95% CI: 1.01-3.09) and sepsis (ORadj: 1.34, 95% CI: 1.09-1.64). There was no significant difference in mortality (ORadj: 1.02, 95% CI: 0.81-1.29). There was no significant difference in all outcomes for solid and non-solid cancer types. Conclusion: COVID-19 patients with cancer, particularly solid tumors, are significantly older, with more comorbidities than those without cancer. There was no statistically significant difference in mortality for COVID-19 patients with cancer, but a significantly higher risk of thromboembolism and sepsis. Further research into the effect that cancer treatments may have in inflammatory and immune responses to COVID is warranted. Citation Format: Naomi Alpert, Bridget Marcellino, Joseph Rapp, Wil Lieberman-Cribbin, Emanuela Taioli. Risk of morbidity and mortality in COVID-19 patients with cancer [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S12-02.

Does single gene expression omnibus data mining analysis apply for only tumors and not mental illness? A preliminary study on bipolar disorder based on bioinformatics methodology.

Background:Bipolar disorder (BD), a common kind of mood disorder with frequent recurrence, high rates of additional comorbid conditions and poor compliance, has an unclear pathogenesis. The Gene Expression Omnibus (GEO) database is a gene expression database created and maintained by the National Center for Biotechnology Information. Researchers can download expression data online for bioinformatics analysis, especially for cancer research. However, there is little research on the use of such bioinformatics analysis methodologies for mental illness by downloading differential expression data from the GEO database.Methods:Publicly available data were downloaded from the GEO database (GSE12649, GSE5388 and GSE5389), and differentially expressed genes (DEGs) were extracted by using the online tool GEO2R. A Venn diagram was used to screen out common DEGs between postmortem brain tissues and normal tissues. Functional annotation and pathway enrichment analysis of DEGs were performed by using Gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses, respectively. Furthermore, a protein-protein interaction network was constructed to identify hub genes.Results:A total of 289 DEGs were found, among which 5 of 10 hub genes [HSP90AA1, HSP90AB 1, UBE2N, UBE3A, and CUL1] were identified as susceptibility genes whose expression was downregulated. Gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses showed that variations in these 5 hub genes were obviously enriched in protein folding, protein polyubiquitination, apoptotic process, protein binding, the ubiquitin-mediated proteolysis pathway, and protein processing in the endoplasmic reticulum pathway. These findings strongly suggested that HSP90AA1, UBE3A, and CUL 1, which had large areas under the curve in receiver operator curves (P < .05), were potential diagnostic markers for BD.Conclusion:Although there are 3 hub genes [HSP90AA1, UBE3A, and CUL 1] that are tightly correlated with the occurrence of BD, mainly based on routine bioinformatics methods for cancer-related disease, the feasibility of applying this single GEO bioinformatics approach for mental illness is questionable, given the significant differences between mental illness and cancer-related diseases.

613-P: The Needs of Caregivers for Recently Hospitalized Older Adults with Type 2 Diabetes Mellitus

Background: Caregivers play a crucial role in the management of older adults with type 2 diabetes mellitus (T2DM). Caregivers often lack support and experience caregiver burden. Purpose: The purpose of the study was to investigate the needs and experience of caregivers of recently hospitalized older adults with T2DM. Methods: Qualitative interviews were conducted using a semi-structured interview guide with open-ended questions that highlighted the caregivers’ experience caring for a recently hospitalized older adult with T2DM. All interviews were digitally recorded and professionally transcribed. Once transcribed, transcripts were uploaded to ATLAS.ti to organize and retrieve data. Transcripts were analyzed using qualitative content analysis. Results: A total of 20 caregivers were interviewed. Most of the subjects were caregivers for a family member, with a majority of subjects caring for their parents. Participants were mostly female (75%), above age 50, and non-Hispanic Black (80%). The main themes that emerged from the qualitative data were: (1) the role itself, (2) challenges, (3) role preparation, and (4) additional comorbid diagnoses. Conclusion: Our findings provide an understanding of experience, tasks, and needs of caregivers for older adults with T2DM. This study revealed that many caregivers feel that care taking is an obligation and a full-time role. A majority of caregivers indicated they did not receive education regarding caring for someone with DM, despite being solely responsible for providing care. Although many of the caregivers did not identify T2DM as the main concern due to additional comorbid conditions, the most pertinent patient and caregiver challenges identified include diet, multiple responsibilities, and time-management. This study identifies the importance of inclusion of family caregivers when providing education. Disclosure A. Danner: None. M. OConnor: None. C. Whitehouse: None.

Evaluating quality of overall care among older adults with diabetes with comorbidities in Ontario, Canada: a retrospective cohort study

ObjectivesThis study aimed to: (1) explore whether the quality of overall care for older people with diabetes is differentially affected by types and number of comorbid conditions and (2) examine...