Borderline Level Research Articles

P139 THE GUT MICROBIOME AS A PREDICTOR OF INCIDENT HYPERTENSION: DATA FROM A POPULATION SAMPLE OF 3055 INDIVIDUALS WITH A FOLLOW-UP OF 20 YEARS

Background and Objective: Our goal was to examine the previously unknown long-term association between gut microbiome composition and incident hypertension in a representative population cohort. Methods: We collected fecal samples from a population sample of 3,055 non-hypertensive Finns (mean age 43.1 years; 60.8% women) in 2002. These individuals were followed up for incident hypertension until 31 December 2021 using nationwide register data. The samples were sequenced using shotgun metagenomics. We examined associations between gut microbiome composition and incident hypertension using Cox regression (alpha diversity and microbial taxa), permutational multivariate ANOVA (beta diversity) and Analysis of Compositions of Microbiomes with Bias Correction (ANCOM-BC; microbial taxa) models adjusted for conventional hypertension risk factors. Results: Altogether, 587 cases of incident diabetes occurred over the median follow-up of 19.8 years. Gut microbiome alpha diversity (Shannon index; p=0.98) and beta diversity (R2=0.49%; p=0.99) were not associated with incident hypertension. Furthermore, the associations between microbial taxa and incident hypertension were non-significant. In Cox regression models (Figure), two species reached an FDR-corrected P-value <0.1: Eubacterium G Ventriosum (hazard ratio per 1-SD increase 0.89; 95% CI 0.83-0.96; P=0.07) and Hespellia Stercorisuis (hazard ratio 1.16; 95% CI 1.05-1.27; P=0.098). In ANCOM-BC models, three species reached an FDR corrected P-value of <0.1: Merdousia sp000438015 (log2 fold change 0.32±0.09; P=0.06), Mitsuokella multacida (log2 fold change -0.32±0.09; P=0.06), and Scybalousia sp900543675 (log2 fold change -0.28±0.09; P=0.07). Conclusions: In this first-ever analysis on the association between the gut microbiome and long-term hypertension incidence, we observed that the associations between overall gut taxonomic composition and incident hypertension are weak. In addition, only a few microbial taxa reached a borderline level of significance with inconsistent results between two statistical methods. These findings suggest that the gut microbiome is not a strong predictor of future hypertension.

Microbiological aspects of dental health in children with osteogenesis imperfecta

Background. Oral microbiome actively affects the child’s health and is an available tool for diagnosing and predic­ting dental and systemic diseases. Studying the colonization of the oral cavity by cariogenic and periodontopathogenic bacteria, given the congenital, genetically determined decrease in the quality of collagen in children with osteogenesis imperfecta, is an urgent problem. The purpose of the study was to determine the level of cariogenic and periodontopathogenic microorganisms in the oral cavity of children with osteogenesis imperfecta. Materials and methods. Clinical studies were conducted with the participation of children aged 2 to 17 years diagnosed with osteogenesis imperfecta, in whom the level of contamination of the oral cavity with cariogenic bacteria Streptococcus mutans and Lactobacter spp. and periodontal pathogens Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Treponema denticola, Bacteroides forsythus, Prevotella intermedia was determined. Results. All children with osteogenesis imperfecta were found to have a borderline high level of Streptococcus mutans contamination and the presence of periodontal pathogens of the first order, mainly in the form of monocultures in preclinical concentration, which, against the background of low collagen quality, indicates a sufficiently high risk of developing ­caries and periodontal diseases.

Diagnostic utility of the average peak LH levels measured during GnRH stimulation test.

Gonadotropin-releasing hormone (GnRH) test is the gold standard test to evaluate the hypothalamus-pituitary-gonadal (HPG) axis for the diagnosis of central precocious puberty (CPP). However, the diagnosis of cases with clinical features of CPP whilst have borderline peak luteinizing hormone (LH) remain challenges. We aimed to evaluate diagnostic performance of the average of LH levels measured during GnRH stimulation test. Cases with diagnosis of CPP and premature thelarche (PT) who had a GnRH stimulation test results were retrospectively reviewed. Anthropometric measurements (weight, height, and body mass index), age and sex-specific standard deviation scores, growth velocity, puberty stages, bone ages, serum FSH, LH, and estradiol levels were measured by electrochemiluminescence immunological method (ECLIA), and the GnRH stimulation test results, which performed by obtaining venous blood samples at basal, 20th, and 40th minutes for FSH and LH measurement, were recorded. A total of 76 girls (38 CPP, 38 PT) were included. We detected an average peak LH cut-off value of 4.25 IU/L with 94.7 % sensitivity and 97.4 % specificity, a 97.3 % positive predictive value, and a 94.9 % negative predictive value in GnRH test to differentiate cases with CPP from PT. This is the first study evaluating the diagnostic utility of the average of LH levels measured during GnRH stimulation test. We showed that the average of two LH measurements has a high diagnostic performance. Therefore, it can be used as a valid and reliable diagnostic tool for assessment of HPG axis activation, particularly for cases with a borderline peak LH level.

Twelve tips for final year medical students undertaking clinical assessment

Background Clinical assessors in pre-registration examinations have been shown to make decisions about student performance by drawing on two overlapping, yet slightly different perspectives: achieving academic learning outcomes, and contributing to clinical workplace function. The implication for senior medical students is that they should be aware that in ‘final’ clinical assessments they may be judged from both academic and workplace perspectives, where the emphasis may be on how well the candidate would fit into a clinical team, demonstrating reliability, trustworthiness, teachability and ‘safety’. Methods This article presents 12 tips for how senior medical students may demonstrate progress towards achieving ‘work readiness’, and so improve performance in assessments close to graduation. Results Clinical assessors may include judgment of how well the candidate might work as a junior member of a clinical team, particularly when candidates perform at the borderline level and where assessors are more experienced. This judgment is based on an impression of the student’s demonstration of reliability, trustworthiness, patient safety and teachability. While the underpinning theory was explored in final OSCEs, the suggestions may also be relevant to workplace-based clinical learning and assessment. Conclusions Senior medical students should prepare for clinical assessments that will consider more than essential knowledge and skills.

Humoral immunity trends in a hemodialysis cohort following SARS-CoV-2 mRNA booster: A cohort study.

Patients with end stage kidney disease on hemodialysis are vulnerable to SARS-CoV-2 infection. Current guidelines recommend boosters of SARS-CoV-2 mRNA-based vaccines. The long-term humoral response of hemodialysis patients infected with SARS-CoV-2 after receiving a booster of SARS-CoV-2 mRNA-based vaccines has been incompletely characterized. Here, we determined the long-term humoral response of hemodialysis patients to two and three doses of the Pfizer BioNTech (BNT162b2) mRNA SARS-CoV-2 vaccine and investigated the effect of postbooster SARS-CoV-2 infection on antibody levels over time. Samples were collected on a monthly basis and tested for anti-SARS-CoV-2 antibodies against anti-spike S1 domain. Thirty-five hemodialysis patients were enrolled in the original study and 27 of these received a booster. Patients were followed up to 6 months after the first two doses and an additional 7 months after the third BNT162b2 dose. Results are presented as the internationally harmonized binding antibody units (BAU/mL). Antibody level significantly increased from prebooster to 2 weeks postbooster, with a median [25th, 75th percentile] rise from 52.72 [28.55, 184.7] to 6216 [3806, 11,730] BAU/mL in the total population. Of patients with a negative or borderline detectable antibody level 6 months after vaccination who received a third dose, 89% developed positive antibody levels 2 weeks postbooster. Postbooster antibody levels declined an average rate of 29% per month in infection-naïve patients. Antibody levels spiked in patients infected with SARS-CoV-2 after receiving a booster but declined rapidly. No patients infected postbooster required hospitalization. A third dose of BNT162b2 restores antibody levels to high levels in dialysis patients but levels decline over time. A third dose did not necessarily prevent infection, but no patients suffered severe infection or required hospitalization. SARS-CoV-2 recovered patients appear to have a blunted rise in antibody levels after a third dose. Although patients infected with SARS-CoV-2 postbooster had an immediate spike in antibody levels, these declined over time.

Characteristics of the mental health of employees of healthcare facilities in the conditions of war.

Aim: To study the state of mental health of staff of healthcare facilities (HCFs) of different categories (managers, doctors, nurses) 2 years after the beginning of the Russian invasion of Ukraine. Materials and Methods: The study, using valid psycho-diagnostic methods, was conducted in 3 stages: studying the frequency of mental states, Mental Health Continuum, and occupational self-efficacy. Using descriptive and analytical statistics, we analyzed the results obtained from 114 respondents. Results: It was found that in the majority of the study group, regardless of the position held (manager, doctor, nurse), the levels of anxiety, frustration, aggressiveness, and rigidity were low (64.0%-50.9% of respondents); flourishing and high development of occupational self-efficacy were recorded in 59.6% and 61.0%, staff of HCFs respectively. A small proportion of specialists (10.5%-4.4%) revealed a high level of manifestation of mental states; languishing and a low level of professional self-efficacy were practically absent. In other study participants, all indicators were at the borderline level. Conclusions: Almost 2 years of functioning in the context of the war has led to the development of a certain adaptation and resilience in all categories of healthcare employees, which allows them to fulfill their professional duties. At the same time, there is a significant number of healthcare professionals who have moderate and high levels of mental stress, and problems with mental health stability, which requires systemic decisions to be made at the sectoral level to ensure the mental health of staff of healthcare facilities.

Availability of dietary secoisolariciresinol diglucoside on borderline blood cholesterol level in men: a randomized, parallel, controlled, double-blinded clinical trial.

Borderline low-density lipoprotein cholesterol levels (120-139 mg/dl) increase the risk of cardiovascular disease. Therefore, the use of functional dietary nutrients is expected to control blood low-density lipoprotein cholesterol levels. This study aimed to evaluate the effect of dietary secoisolariciresinol diglucoside on blood cholesterol in healthy adults with borderline low-density lipoprotein cholesterol levels. A randomized, parallel, controlled, double-blinded clinical trial was performed for participants with borderline low-density lipoprotein cholesterol levels, for 12 weeks with secoisolariciresinol diglucoside (60 mg/day) or placebo. Lipid profile [low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio, total cholesterol, and triglycerides] and liver disease risk markers were measured at weeks 0, 4, 8, and 12. Analyzing 36 participants in each group revealed a significant interaction between treatment and time, indicating reduced low-density lipoprotein cholesterol (p = 0.049) and total cholesterol (p = 0.020) levels in secoisolariciresinol diglucoside-receiving men but not women. However, no significant differences were observed in other markers regardless of gender. The results suggest that a daily intake of 60 mg of secoisolariciresinol diglucoside lowers low-density lipoprotein cholesterol and total cholesterol levels in men with borderline low-density lipoprotein cholesterol, proposing secoisolariciresinol diglucoside potential as a functional dietary nutrient for cardiovascular disease prevention. This study was registered in the UMIN-CTR database (UMIN000046202).

Factors Affecting the Implementation of Nursing Care Plans in Patient Care

Abstract: Background: Nursing Care Plan (NCP) is used in practice as a systematic and scientific problem-solving method to determining the care needs of individuals. There is lack of research on factors affecting regarding utilization of nursing care plan in patient care. Objective: The objective of this study were to evaluate the implementation of the nursing process and to determine the factors that may influence the implementation of the nursing process. Materials and Methods: A cross-sectional survey was conducted at a private hospital during February to June, 2023. The study protocol was reviewed and approved. Permission from institutional heads was sought. Informed consent was obtained before data collection. Simple random sampling method was employed. The data were collected with structured questionnaires whose responses were rated on Likert scale. Data were coded and analyzed using SPSS v25.0. Result: A total 108 nurses participated in the study. Study findings revealed 89% of the nurses were female nurses and 82% possessed diploma in nursing. The knowledge 50.5%, confidence 50.9% and willingness 54.2%, were at borderline good level. Whereas, assessment and diagnosis, planning, implementation, evaluation, and nurses’ views about nursing care planning implementation were at < 50% as poor. There was a moderate positive correlation between knowledge and implementation R-Value 0.312 and confidence and evaluation R-Value 0.246. Barrier to implement nursing process included uncooperative patients, lack of awareness about nursing process, lack of preparedness, low satisfaction level, lack of in-service training, lack of time, and high patient flow. Conclusion: Study’s findings revealed knowledge, confidence and willingness of the nurses determine the use of nursing process in their nursing practice.

TLR4 GENE POLYMORPHISM rs2149356 IN TYPE 2 DIABETES - POSSIBLE RELATIONSHIP WITH DIABETIC MACULAR EDEMA

Background. Polymorphisms in the non-coding regions of the TLR4 gene are known to be associated with the risk of ocular complications of type 2 diabetes (T2DM), with some polymorphisms having no association, others increasing the risk, and some reducing the risk of complications.
 Aim: to establish the association of the TLR4 gene polymorphism rs2149356 with diabetic retinopathy (DR) and diabetic macular edema (DME) in T2DM.
 Materials and methods. The study included 81 patients (81 eyes) with T2DM, in whom, according to the guidelines of the American Academy of Ophthalmology (2002), DR and DME were detected, the control group consisted of 50 patients (50 eyes) with T2DM, normalized carbohydrate metabolism, DR 0 (no retinopathy) and absent DME. Genotypes of rs2149356 were determined by real-time polymerase chain reaction using the Gene Amp® PCR System 7500 amplifier (Applied Biosystems, USA) and TaqMan Mutation Detection Assays Life-Technology (USA). MedStat and MedCalc v.15.1 software packages (MedCalc Software bvba) were used for statistical research.
 Results. In this study, no association of the genetic polymorphism rs2149356 of the TLR4 gene with the development of DR and DME in T2DM was found (p=0.326). Stratification by stages of DR showed no dependence of the distribution of genotypes, while according to the degree of DME, the distribution of genotypes was definitely different in DME 3. Thus, among the carriers of the ancestral genotype G/G, none of DME 3 was found, the borderline level of the total retinal volume (TRV) was 6.7 mm3, above which DME 1 or DME 2 was determined. All carriers of the heterozygote G/T had DME 3, and for carriers of the minor homozygote T/T, two threshold values of TRV were determined: above 6.7 mm3, DME 1 or DME 2 was determined, and higher than 8.7 mm3 – DME 3. Analysis of the relationship between the rs2149356 TLR4 and the phenotype of patients showed greater central retinal thickness and TRV in heterozygous and minor homozygous T/T carriers, which corresponded to greater retinal damage compared to ancestral homozygous G/G carriers (p<0.001).
 Conclusion. Data were obtained on the association of diabetic retinal damage with the rs2149356 TLR4 – retinal edema was more pronounced in carriers of the T allele.

Evaluation of oral health literacy among medical interns in Saudi Arabia: A cross-sectional study

Abstract Introduction: Physicians can play an essential role in promoting their patients’ oral health by integrating oral health screening and education into their practices. Thus, physicians’ oral health literacy (OHL) level can determine their role in oral health promotion. Aim: The assessment of OHL and its related factors among medical interns in Saudi Arabia. Materials and Methods: A cross-sectional study was conducted on medical interns using the OHL- adult questionnaire (OHL-AQ) for data collection. This validated questionnaire has 17 close-ended questions listed in four sections: 1 – perception and knowledge of oral health, 2 – numeracy skills for prescriptions of antibiotic and mouthwash, 3 – communication skills, and 4 – decision-making skills regarding common oral health problems. Results and Discussion: A total of 266 medical interns participated in the study (113 male and 153 female). The mean score of OHL was 10.7 ± 4.24 (out of 17), which falls in the borderline range. About 34% of medical interns had an inadequate level of OHL. OHL was not significantly correlated with age, gender, grade point average, or parent’s level of education (P > 0.05). Conclusion: The present study shows that medical interns demonstrated a borderline level of OHL. Enhancement of oral health knowledge of those future physicians is recommended by the inclusion of oral health courses in their educational curriculum.

Relationship of the occurrence of self-reported anxiety and depression symptoms and achievement of cardiovascular risk factors control

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Nicolaus Copernicus University in Torun. Introduction Anxiety and depression influence lifestyle and therefore interfere with preventive measures aimed at eliminating or reducing the severity of modifiable risk factors for cardiovascular diseases (CVD). Aim The study aimed to evaluate the influence of self-reported anxiety and depression symptoms on achieving the control of cardiovascular (CV) risk factors in patients without a history of atherosclerotic coronary heart disease (CHD). Methods A total of 200 patients from the Polish arm of the EUROASPIRE V were included. The median age was 52.0 years (IQR 43.0-60.5). Patients were assessed regarding the control of major CV risk factors: blood pressure, BMI, waist circumference, physical activity, smoking, and the concentration of LDL cholesterol, triglycerides, and blood glucose. Risk factors were considered adequately controlled when the therapeutic target was achieved. The number of controlled CV risk factors was assessed for each individual, as well as the rate of patients who achieved the therapeutic target for particular risk factor was analyzed. Total CVD risk was analyzed with the SCORE scale. The level of anxiety and depression was evaluated based on the results of the Hospital Anxiety and Depression Scale (HADS), which consists of two subscales (HADS Anxiety and HADS Depression). For each subscale obtained score indicated normal, borderline, or abnormal level. Results The median score of anxiety (HADS Anxiety) and depression (HADS Depression) levels were 3.0 (IQR 2.0-6.0) and 3.0 (IQR 1.0-5.0), respectively. In the studied group the median of adequately controlled CV risk factors was 4.0 (IQR 3.0-5.0) and the median SCORE result was 2.0% (IQR 1.0-3.0%). No relationship between the level of anxiety or depression and the CVD risk measured by the SCORE sale was observed (Table 1.). Patients with self-reported anxiety or depression symptoms (borderline and abnormal level) had a significantly lower median number of adequately controlled CV risk factors (HADS Anxiety p = 0.0014; HADS Depression p = 0.0304) (Table 1.). A significantly lower rate of patients with adequate waist circumference (HADS Anxiety p = 0.0464; HADS Depression p = 0.0200) and with regular physical activity (HADS Anxiety p = 0.0431; HADS Depression p = 0.0055) was observed in groups with anxiety or depression symptoms (Table 2.). In patients with anxiety symptoms, a significantly lower rate of normal BMI (p = 0.0218) and adequate triglycerides concentration (p = 0.0278) was found (Table 2.). Conclusion The occurrence of anxiety and depression might influence the achievement of therapeutic targets regarding the control of CV risk factors in patients without a history of CHD.

Incidence, predictors and outcomes of redo pancreatectomy in infants with congenital hyperinsulinism: a 16-year tertiary center experience

Recurrent severe hypoglycemic attacks often persist even after performing pancreatectomy for medically unresponsive congenital hyperinsulinism (CHI). In this study, we present our experience with redo pancreatectomy for CHI. We reviewed all children who underwent pancreatectomy for CHI between January 2005 and April 2021 in our center. A comparison was made between patients whose hypoglycemia was controlled after primary pancreatectomy and patients who required reoperation. A total of 58 patients underwent pancreatectomy for CHI. Refractory hypoglycemia after pancreatectomy occurred in 10 patients (17%), who subsequently underwent redo pancreatectomy. All patients who required redo pancreatectomy had positive family history of CHI (p = 0.0031). Median extent of initial pancreatectomy was lesser in the redo group with borderline level of statistical significance (95% vs. 98%, p = 0.0561). Aggressive pancreatectomy at the initial surgery significantly (p = 0.0279) decreased the risk for the need to redo pancreatectomy; OR 0.793 (95% CI 0.645-0.975). Incidence of diabetes was significantly higher in the redo group (40% vs. 9%, p = 0.033). Pancreatectomy with 98% extent of resection for diffuse CHI, especially with positive family history of CHI, is warranted to decrease the chance of reoperation for persistent severe hypoglycemia.

Level of identity diffusion in patients with borderline, narcissistic, avoidant and other specified personality disorder

Traditional conceptions of personality disorder (PD) view severe identity disturbance as a defining characteristic of borderline personality disorder (BPD). In the alternative DSM-5 model for PDs (AMPD) and in the outlined substantial changes to PD diagnostics in ICD-11, disturbances in self and identity are elevated from a specific diagnostic criterion for BPD to a defining criterion for PD in general. In line with Kernberg’s theory of personality organization (PO), it is expected that although identity disturbance may be characteristic of most or all PDs, severe identity diffusion is a more pronounced and defining characteristic of BPD and possibly other PDs organized on a borderline level (BPO). Here, we examined the level of identity disturbance in SCID-diagnosed patients with BPD, narcissistic PD (NPD), avoidant PD (AVPD), comorbid BPD with NPD and AVDP, as well as other specified PD (PD-OT). We found that measures of identity diffusion were higher in BPD and NPD patients compared with patients diagnosed with AVPD. Hierarchical multiple regression analyses showed that number of SCID criteria met for BPD and NPD predicted level of identity diffusion when gender, age and general symptomatology were controlled for, whereas number of SCID criteria met for AVPD did not. The presented data support severe identity diffusion as a prominent characteristic of BPD with possible implications for how we should differentiate BPD from other PDs. The findings are discussed in relation to Kernberg’s model and the AMPD.

Determinants of health during the COVID-19 pandemic

Introduction. The relevance of the study is due to the expediency of implementing intersectoral interaction on public health protection in the conditions of the COVID-19 pandemic with an impact on health determinants that haven’t been sufficiently studied. The aim of the work is to study the list and significance of health determinants in the conditions of a pandemic of a new coronavirus infection (COVID-19). Material and methods. An expert survey of forty nine healthcare managers was conducted. The criteria for the selection of experts included management experience in the field of health protection, the level of self-assessment of competence, and congruence of opinions. The list and significance of determinants of health in the conditions of the COVID-19 pandemic were compared with the data obtained before its occurrence. Results. The list of health determinants that are sufficiently significant for the COVID-19 pandemic was established to include the same 37 factors as without it. However, important differences were identified. The significance of most determinants of health (64.9%) in a pandemic exceeds the borderline level of 7.0 points on a 10-point scale, that is, significant (without a pandemic - 16.2%). At the same time, priority factors determining the health of the population are widely represented in all groups of determinants and among non-group ones (without a pandemic - only in the “Lifestyle” group and “heredity” determinant). The consequence was that during a pandemic, the significance of 70.3% of the determinants of health statistically significantly exceeds that of the same factors without it, the opposite picture was recorded only in relation to 5.4% of the factors (the rest don’t differ). Limitations. In the study of the determinants of health in the conditions of the COVID-19 pandemic, the opinion of healthcare managers whose quantitative and qualitative parameters meet the requirements for experts was evaluated. Conclusion. The data obtained expand the understanding of the scientific apparatus for implementing health-saving activities in the conditions of the COVID-19 pandemic.

The Levels of Anti-SARS-CoV-2 Spike Protein IgG Antibodies Before and After the Third Dose of Vaccination Against COVID-19.

The COVID-19 pandemic has been going on for almost three years, and so far, many preventive and therapeutic strategies have been developed. The issue of subsequent booster vaccinations is currently being discussed. We aimed to analyze how the third dose of vaccination against COVID-19 correlates with the dynamics of IgG anti-SARS-CoV-2 spike protein antibody levels in a group of healthy people. The prospective study included 93 participants before and after a second booster of COVID-19 vaccination, from whom 4 blood samples were collected at intervals. The levels of IgG anti-SARS-CoV-2 in serum were identified using the chemiluminescent immunoassay specific for the receptor-binding domain (RBD) of the S1 protein. The analysis of the results was performed using appropriate statistical methods, considering p <0.05 as a statistically significant value. The IgG levels were significantly higher and less diverse after the same follow-up time from the second booster vaccination compared to the first booster. The antibody levels were positively correlated with female, healthcare workers, the elderly and participants with a negative COVID-19 history. Furthermore, the increase in IgG antibodies after the second booster vaccination correlated inversely with the baseline level of antibodies before the vaccination. The latest results showed that antibody levels dropped 1.5-fold after approx. 10 months from the second booster vaccination but still remained at a protective level. Booster vaccinations seem to better stimulate immune memory, and in the case of borderline IgG level induces the greatest increase in antibodies. It is worth considering the individual parameters of patients and measuring antibodies before vaccination.

Impact of Insomnia on Anxiety and Depression among Post Stroke Patients

Introduction: Insomnia is prevalent but unappreciated condition follows a stroke that can hamper recovery. The impact of insomnia on post stroke patient’s anxiety and depression remains unclear. Aim/Objectives: The study aimed to evaluate the association between the Insomnia with Anxiety and Depression among post stroke patients. Methodology: A cross sectional, observational, study was conducted among post stroke patients, aged above 30years. Of 200 responses, 191 responses who were willing to participate in the study were included. The survey instrument used were Hospital Anxiety Depression Scale (HADS) and Insomnia Severity Index (ISI) to access the anxiety, depression and quality of sleep among post stoke patients. Results: Majority of the study participants were males (59.2 %). In the present study, 34% of the participants were under the age group of 50 – 60. Based on Insomnia Severity Index majority of the responders had moderate insomnia (57%). Majority of study population had abnormal (71.20%) level of Anxiety and borderline (41.36%) depression level. There was significant association of severity of ISI with severity of Anxiety (p-0.030) and depression (p-0.049) among post stroke patients. Conclusion: Stroke leads to significant reduction in quality of life. Reduction in daily activity results in worsening of function and disturbance in sleep, leads to depression that affects the physical and mental health. Post stroke patients with the symptoms of insomnia are at the risk of developing anxiety and depression.

Study of the Relationship of Lipid Profile, BMI and Blood Pressure among Non-diabetic Hypertensive Patients - A Hospital Based Study

Introduction: Several research have demonstrated the connection between lipid levels, diabetes mellitus (DM), and hypertension, but none have focused specifically on the association between lipid levels and essential hypertension in Nepal's non-diabetic population.&#x0D; Aims: To study the relationship between lipid profile, body mass index (BMI), and blood pressure (BP) in the nondiabetic hypertensive population.&#x0D; Methods: A hospital-based cross-sectional study was conducted among 150 participants. Anthropometric measurements including height, weight and BP were taken. Blood was collected in serum vial for lipid profile [total cholesterol (TC), triglyceride (TG) and low and high density lipoprotein cholesterol (LDLC and HDLC)] after an overnight fasting.&#x0D; Results: 44.7% were female, and 55.3% were male with the age ranging between 28-80 years. Among 48.67% of the overweight participants, 56.8% were male. 25.33% were obese, among which 52.6% were male. 56% of participants had systolic blood pressure (SBP) ≥140 mmHg and 58% had diastolic blood pressure (DBP) ≥90 mmHg and showed no significance among the gender. Borderline TG level was observed in 76.2% of participants with SBP ≥140 mmHg and in 74.7% with DBP ≥90 mmHg. HDLC vs gender showed significance. SBP and DBP had a significant relationship with LDLC and TC. The association of BMI with BP and lipid profile was not significant.&#x0D; Conclusion: Dyslipidemia is prevalent among non-diabetic hypertensive individuals. The majority of participants were overweight, however blood pressure and lipid profile did not correlate with BMI presumably because other anthropometric characteristics have better predictive values than BMI.

Are anti-PD-1-associated immune related adverse events a harbinger of favorable clinical prognosis in patients with gastric cancer?

BackgroundImmune checkpoint inhibitors (ICIs) has shown remarkable benefit in the treatment of a range of cancer types, although it may initiate immune related adverse events (irAEs) in patients. Some studies have shown that there is a close relationship between the occurrence of irAEs and prognosis. In present study, we have attempted to establish whether the occurrence of irAEs after the use of anti PD-1 antibodies is associated with treatment efficacy in people with advanced gastric cancer (AGC).MethodsThis study included patients treated with the anti-PD-1 antibodies for AGC patients at The Fourth Hospital of Hebei Medical University. IrAEs were identified clinically and graded as per the National Cancer Institute Common Terminology Criteria for Adverse Events ver. 4.03. Efficacy was evaluated with objective response rate (ORR), disease control rate (DCR), progression free survival (PFS) and overall survival (OS). The analysis was performed to determine the association between irAEs and clinical outcomes.ResultOf the 74 AGC patients in our study, 24 developed irAEs. The DCR of the irAE displayed a trend better than that of non-irAE group but without statistical difference (41.70% VS 6.0%, p = 0.118). Median PFS in the irAE group was superior to that in the non-irAE group (176 days VS 94 days, p = 0.001). Median OS also showed this trend of difference at borderline statistical level (292 days VS 239 days, p = 0.057). Multivariate analysis also demonstrated irAE (HR = 0.269, 95%CI: 0.088 to 0.822, p = 0.021) were associated independently with the better prognosis for AGC patients.ConclusionIn advanced gastric cancer treated with anti PD-1 antibodies, the occourence of irAEs might contribute to the improved prognosis.

Quality of Life, Anxiety and Depression among Clients with Ostomy Attending Selected Stoma Clinics.

Ostomy is a part of treatment among patients which has detrimental effects in patient's life. The main aim is to identify the quality of life, anxiety and Depression in clients with an ostomy. Descriptive exploratory study design was used. Total of 116 clients with ostomy, aged 18 years and above were selected from stoma clinics. The modified version of City of Hope and Beckman Research Institute, Quality of Life Questionnaire for Patient with Ostomy and Hospital Anxiety and Depression Scale was adopted for data collection using an interview technique. The overall mean ± S.D quality of life score was 5.89 ± 1.34. Majority (59.5%) of respondents possessed low Quality of life. Among the quality of life domains, the least and most affected domains were physical (5.96±1.52) and social (4.71±1.44) respectively. Duration of having an ostomy (p<0.001), problem in clothing (p<0.002) and change in clothing style (p= 0.002) were significantly associated with the level of quality of life. Almost two-thirds of the respondents were in the borderline and abnormal level of anxiety and depression. The level of anxiety has significant association with suicidal consideration/attempt (p=.04). Presence of ostomy affects patient's quality of life by increasing financial burden, adjustment difficulties, sexual and psychological problems (anxiety, depression, suicidal consideration). Sexual and psychological counselling, ostomy support groups and free health services to ostomates may improve their quality of life.

A CURIOUS CASE OF ACQUIRED ANGIOEDEMA: DIAGNOSIS AND MANAGEMENT OF C1-INH-AAE WITHOUT AN UNDERLYING CONDITION

<h3>Introduction</h3> Angioedema results from localized fluid extravasation into interstitial tissues mediated by mast cells, bradykinin, and other undescribed mechanisms. Recurrent bradykinin-mediated angioedema is most often hereditary, though can rarely be acquired due to autoantibody production. We present a case of acquired C1 esterase inhibitor deficiency (C1-INH-AAE) requiring tracheotomy, and review additional evaluation and maintenance therapy following diagnosis. <h3>Case Description</h3> An 80-year-old woman with multiple comorbidities was referred after two episodes of facial angioedema without clear triggers, including severe recurrence involving her oropharynx that required tracheotomy. Family history was negative, and both losartan and NSAIDs were previously discontinued. Initial evaluation following episode demonstrated indeterminate C1 inhibitor functional assay, low quantitative C1 inhibitor, and borderline C4 level; C1-INH-AAE was subsequently confirmed with C1 esterase autoantibody evaluation. She was prescribed icatibant rescue therapy and started on cetirizine and prednisone 5mg every other day without further recurrence of oropharyngeal symptoms. No evidence of underlying oncologic or rheumatologic process was found on extensive evaluation. During ongoing management over 5 years, tracheotomy was taken down, daily antihistamine was discontinued, and prednisone has been successfully titrated for symptoms associated with local tissue damage and iron deficiency anemia. <h3>Discussion</h3> C1-INH-AAE is a rare cause of recurrent angioedema which presents in older age and is often associated with underlying lymphoproliferative, malignant, or autoimmune disease. Our case reminds that acquired angioedema should be considered in older adults with negative family history, however had no evidence of commonly associated conditions on extensive evaluation. Her subsequent course also offers insight into management of triggers and maintenance therapy.