Chronic Heart Research Articles

Vessels and pressures: Update on the management of pulmonary arterial hypertension

Pulmonary hypertension (PH) refers to an abnormal elevation in pulmonary arterial pressure (PAP) under resting conditions. PH is often encountered in patients with chronic heart and lung disease. Rarely, it occurs in the absence of any identifiable heart or lung abnormalities. Under these conditions, the increase in PAP may be caused by diffuse remodeling of the distal pulmonary circulation characterized by an obliterative vasculopathy that leads to a marked increase in pulmonary vascular resistance, progressive right heart failure, and usually death. This disease is referred to as pulmonary arterial hypertension (PAH) and has become the focus of intense basic science and clinical research over the past quarter century. Since 1995, five classes of drugs that encompass more than a dozen specific agents have been developed and approved for the treatment of PAH. The large number of drugs and the myriad forms of pulmonary vascular disease has made the evaluation and treatment of PH an intriguing challenge. This review discusses the most recent definitions of PH and current classification of the pulmonary hypertensive diseases. An overview of the importance and proper approach to diagnosis is provided as well as the impact of patient selection on the approach to management. An evidence-based approach is used to determine how initial therapy is chosen and how additional medications can be used in patients who do not achieve treatment goals. Finally, the results of recently completed clinical trials that evaluated the safety and efficacy of a new class of medications that have been developed to target the underlying pathophysiology of PAH are presented and the potential impact on the management of PAH is discussed. The purpose of this review is to present the reader with an update on the current approach to evaluation and management of PH with an emphasis on PAH.

2D MoS2 plasmonic nanocavity based SERS platform for bilirubin detection

Although various methods can be used to detect bilirubin at the micromolar level, achieving reliable detection in the sub-nanomolar range remains challenging. Sensitivity at these ultralow levels is vital, as new evidence strongly associates bilirubin with chronic heart, lung, and neurological disorders. This accuracy is also essential for creating diagnostic protocols that can efficiently track bilirubin levels, assisting in managing related conditions. Such advancements will lead to enhanced diagnostic tools and methods, enabling more precise bilirubin monitoring in clinical environments. Here, the aforesaid blind-spot is addressed by utilizing surface enhanced Raman spectroscopy (SERS) as fingerprint technique to detect bilirubin concentrations as low as 0.1 nM. A plasmonically active 2D MoS2 based SERS substrate is formulated and optimized for single step SERS sensing of bilirubin. Plasmonic cavity based approach is utilized to circumvent the problem related to fluorescent background overwhelming the SERS signal. The 2D MoS2 based SERS platform shows threefold enhancement of scattering in comparison to the traditional gold nanoparticle on Si/SiO2 approach. The Raman signature of bilirubin is calibrated by taking citrate as a stable reference analyte and is shown to vary linearly with logarithmic concentration across the picomolar to micromolar range.

Costing a Nurse and Social Worker Palliative Telecare Intervention for People with Chronic Heart and Lung Diseases (RP304)

Costing a Nurse and Social Worker Palliative Telecare Intervention for People with Chronic Heart and Lung Diseases (RP304)

Do all Emergency Room Patients With Influenza-like Symptoms Need Blood Cultures? A Retrospective Cohort Study of 2 Annual Influenza Seasons.

In this retrospective cohort study, we evaluated risk factors for bacteremia in emergency department patients presenting with influenza-like symptoms during influenza epidemic seasons. In patients without fever, chronic heart or chronic liver disease, blood culture collection might be omitted.

Utilization of broad- versus narrow-spectrum antibiotics for the treatment of outpatient community-acquired pneumonia among adults in the United States.

To characterize antibiotic utilization for outpatient community-acquired pneumonia (CAP) in the United States. We conducted a cohort study among adults 18-64 years diagnosed with outpatient CAP and a same-day guideline-recommended oral antibiotic fill in the MarketScan® Commercial Database (2008-2019). We excluded patients coded for chronic lung disease or immunosuppressive disease; recent hospitalization or frequent healthcare exposure (e.g., home wound care, patients with cancer); recent antibiotics; or recent infection. We characterized utilization of broad-spectrum antibiotics (respiratory fluoroquinolone, β-lactam + macrolide, β-lactam + doxycycline) versus narrow-spectrum antibiotics (macrolide, doxycycline) overall and by patient- and provider-level characteristics. Per 2007 IDSA/ATS guidelines, we stratified analyses by otherwise healthy patients and patients with comorbidities (coded for diabetes; chronic heart, liver, or renal disease; etc.). Among 263 914 otherwise healthy CAP patients, 35% received broad-spectrum antibiotics (not recommended); among 37 161 CAP patients with comorbidities, 44% received broad-spectrum antibiotics (recommended). Ten-day antibiotic treatment durations were the most common for all antibiotic classes except macrolides. From 2008 to 2019, broad-spectrum antibiotic use substantially decreased from 45% to 19% in otherwise healthy patients (average annual percentage change [AAPC], -7.5% [95% CI -9.2%, -5.9%]), and from 55% to 29% in patients with comorbidities (AAPC, -5.8% [95% CI -8.8%, -2.6%]). In subgroup analyses, broad-spectrum antibiotic use varied by age, geographic region, provider specialty, and provider location. Real-world use of broad-spectrum antibiotics for outpatient CAP declined over time but remained common, irrespective of comorbidity status. Prolonged duration of therapy was common. Antimicrobial stewardship is needed to aid selection according to comorbidity status and to promote shorter courses.

The two therapeutic strategies of surgical intervention and medical management in a patient with enhanced-fibrinolytic type of disseminated intravascular coagulation after aortic replacement for Stanford type A aortic dissection with chronic heart and renal failure

BackgroundManagement of the enhanced-fibrinolytic type of disseminated intravascular coagulation (DIC) caused by aortic disorders is the two strategies of surgical intervention and medical treatment based on the patient’s age and comorbidities.Case presentationAn 81-year-old woman with a history of two previous aortic surgeries and chronic heart and renal failure was admitted for uncontrollable subcutaneous hemorrhage. The hemorrhage was caused by the enhanced-fibrinolytic type of disseminated intravascular coagulation (DIC) caused by periprosthetic graft hematoma after aortic replacement for Stanford type A aortic dissection. Open thoracic hemostasis temporarily controlled the subcutaneous hemorrhage, but she was readmitted for the recurrence seven months after discharge. On the second admission, the combination of anticoagulant and antifibrinolytic agents was successful.ConclusionManagement of the enhanced-fibrinolytic type of DIC caused by aortic disorders is important of a successful combination of surgical and medical therapy tailored the patient’s condition.

Serum ferritin/C-reactive protein ratio is a simple and effective biomarker for diagnosing iron deficiency in the context of systemic inflammation.

Diagnosing iron deficiency is challenging in the presence of systemic inflammation. To investigate the relationship between plasma C-reactive protein (CRP), serum ferritin (SF) and transferrin saturation (TS), with the objective of establishing a straightforward ratio applicable in the presence of inflammatory syndrome. Test prospective cohort and validation retrospective cohort. A prospective cohort of inpatients (n = 140) assessed the correlation between CRP and SF/TS levels. The diagnostic performance of a determined ratio was evaluated for identifying iron deficiency (ID) using different definitions and in the presence of inflammation and/or chronic heart and/or kidney failure. A large validation cohort (n = 795) further assessed the predictive power of this ratio. In a training cohort (median age 76 years [57-84]), a linear relation was observed between SF (µg/l) and CRP (mg/l), unlike with TS. The SF/CRP ratio accurately predicted ID, with receiver operating characteristic-area under the curve (ROC-AUC) values ranging from 0.85 to 0.92 for different ID definitions. A threshold of ≤6 demonstrated the highest Youden index (0.61). In the validation cohort (age 72 years [57-84]), the SF/CRP ratio exhibited an ROC-AUC of 0.88 [95% CI: 0.85-0.90], with an odds ratio of 37.9 [95% CI: 20.3-68.9] for the threshold of ≤6. In this study, we demonstrated that the SF/CRP ratio, with a threshold of ≤6, is a simple and effective biomarker for ID, even in the presence of systemic inflammation or comorbidities. This ratio could potentially replace the complex set of criteria currently recommended by learned societies.

Clinical characteristics associated with recurrent viral RNA positivity in patients within two weeks after recovering from the first SARS-CoV-2 infection.

Many studies have shown that recovered coronavirus disease 2019 (COVID-19) patients frequently exhibit recurrent viral RNA positivity (RP) for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our study aimed to summarize the clinical characteristics of these patients and explore potential reasons for RP occurrence. We divided 439 participants into four groups based on the severity of illness prior to the COVID-19 recovery and age: mild-child group, moderate-child group, mild-adult group, and moderate-adult group. Laboratory data were collected and statistical analyzed using the SPSS software, version 24.0. Significant differences were observed in age, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), interleukin 6 (IL-6), and neutrophil to lymphocyte ratio (NLR) levels between the mild-adult group and the moderate-adult group (P < 0.05). Additionally, AST levels differed significantly between the mild-child group and the moderate-child group (P < 0.05). The proportion of RP patients within the four groups varied from 7.95% to 26.13% within a 2-week period. Logistic regression analysis revealed that younger age and moderate symptoms were risk factors for RP in children, while the presence of comorbidities (such as chronic heart, lung, liver, and kidney diseases), elevated IL-6 levels, and NLR were risk factors for RP in adults. We constructed two predictive models containing these relevant parameters, and the results of the receiver operating characteristic (ROC) curves indicated strong predictive utility. Our findings suggest that younger children with more severe symptoms, as well as adult patients with elevated levels of IL-6 and NLR and underlying diseases, are at higher risk of RP occurrence.

A scale for measuring home-based cardiac rehabilitation exercise adherence: a development and validation study

BackgroundThe benefits of home-based cardiac rehabilitation exercise are well-established and depend on long-term adherence. However, there is no uniform and recognized cardiac rehabilitation criterion to assess home-based cardiac rehabilitation exercise adherence for patients with cardiovascular disease. This study aimed to develop a home-based cardiac rehabilitation exercise adherence scale and to validate its psychometric properties among patients with chronic heart failure.MethodsThe dimensions and items of the scale were created based on grounded theory research, literature content analysis, and defined by a Delphi survey. Item analysis was completed to assess the discrimination and homogeneity of the scale. Factor analysis was adopted to explore and validate the underlying factor structure of the scale. Content validity and calibration validity were evaluated using the Delphi survey and correlation analysis, respectively. Reliability was evaluated by Cronbach’s α coefficients, split-half reliability coefficients, and test-retest reliability coefficients.ResultsA scale covering four dimensions and 20 items was developed for evaluating home-based cardiac rehabilitation exercise adherence. The content validity index of the scale was 0.986. In exploratory factor analysis, a four-factor structure model was confirmed, explaining 75.1% of the total variation. In confirmatory factor analysis, the four-factor structure was supported by the appropriate fitting indexes. Calibration validity of the scale was 0.726. In terms of reliability, the Cronbach’s α coefficient of the scale was 0.894, and the Cronbach’s α coefficients of dimensions ranged from 0.848 to 0.914. The split-half reliability coefficient of the scale was 0.695. The test-retest reliability coefficient of the scale was 0.745.ConclusionIn this study, a home-based cardiac rehabilitation exercise adherence scale was developed and its appropriate psychometric properties were confirmed.

Association Between the Combined Effects of Physical Activity Intensity and Particulate Matter and All-Cause Mortality in Older Adults

ObjectiveTo investigate the association between the combined effects of physical activity (PA) intensity and particulate matter ≤10 μm in diameter (PM10) and mortality in older adults. MethodsThis nationwide cohort study included older adults without chronic heart or lung disease who engaged in regular PA. Physical activity was assessed by a standardized, self-reported questionnaire that asked the usual frequency of PA sessions with low (LPA), moderate (MPA), or vigorous intensity (VPA). Each participant’s annual average cumulative PM10 was categorized as low to moderate and high PM10 on the basis of a cutoff value of 90th percentile. ResultsA total of 81,326 participants (median follow-up, 45 months) were included. For participants engaged in MPA or VPA sessions, every 10% increase in the proportion of VPA to total PA sessions resulted in a 4.9% (95% CI, 1.0% to 9.0%; P=.014) increased and 2.8% (95% CI, −5.0% to −0.5%; P=.018) decreased risk of mortality for those exposed to high and low to moderate PM10, respectively (Pinteraction, <.001). For participants engaged only in LPA or MPA sessions, every 10% increase in the proportion of MPA to total PA sessions resulted in a 4.8% (95% CI, −8.9% to −0.4%; P=.031) and 2.3% (95% CI, −4.2% to −0.3%; P=.023) decreased risk of mortality for those exposed to high and low to moderate PM10, respectively (Pinteraction, .096). ConclusionWe found that for the same level of total PA, MPA was associated with delayed mortality whereas VPA was associated with hastened mortality of older adults in high levels of PM10.

Pneumococcal vaccination coverage among US adults enrolled in Medicaid and newly diagnosed with underlying medical conditions

ABSTRACTBackgroundAdults with chronic or immunocompromising conditions have an elevated risk of invasive pneumococcal disease, yet their pneumococcal vaccination rates remain low.MethodsThis retrospective cohort study used the IBM MarketScan® Multi-State Medicaid database to examine pneumococcal vaccination uptake among adults 19–64 years of age with underlying conditions. Gompertz accelerated failure time model was used to examine factors associated with vaccination.ResultsIn the study population of 108,159 adults, the vaccination rate was 4.1% after 1 year of follow-up and 19.4% after 10 years. The mean time from initial diagnosis to vaccination was 3.9 years. Adults aged 35–49 and 50–64 years (relative to 19–34) or those receiving an influenza vaccination were more likely to receive a pneumococcal vaccination. Adults with HIV/AIDS were more likely, while adults with chronic heart or lung disease, alcohol or tobacco dependence, or cancer were less likely to be vaccinated than adults with diabetes mellitus. Adults diagnosed by specialists were less likely to be vaccinated than those diagnosed by primary care providers.ConclusionsThe rates of pneumococcal vaccination among adults with Medicaid plans and underlying conditions were well under Healthy People Initiative targets. Insights into factors associated with vaccination can inform efforts to improve vaccination rates among this population.

Advancing heart failure research using machine learning

Advancing heart failure research using machine learning

Prognosis of hospitalised adult patients with respiratory syncytial virus infection: a multicentre retrospective cohort study

ObjectivesRespiratory syncytial virus (RSV) is a common agent of viral respiratory infections with significant morbidity and mortality in adults. The objective of this study was to determine risk factors for mortality and invasive mechanical ventilation and to describe the characteristics of patients who received ribavirin. MethodsA retrospective multicentre observational cohort study was conducted in Great Paris area hospitals, including patients hospitalised between 1 January 2015 and 31 December 2019 for documented RSV infection. Data were extracted from the Assistance Publique-Hôpitaux de Paris Health Data Warehouse. The primary endpoint was in-hospital mortality. ResultsOne thousand one hundred sixty-eight patients were hospitalised for RSV infection, including 288 (24.6%) patients who required intensive care unit (ICU) admission. The median (interquartile range) age of patients was 75 (63–85) years, and 54% (n = 631/1168) of them were women. In-hospital mortality was 6.6% (n = 77/1168) in the whole cohort and 12.8% (n = 37/288) in ICU patients. Factors associated with hospital mortality were age >85 years (adjusted odds ratio [aOR] = 6.29, 95% confidence interval [2.47–15.98]), acute respiratory failure (aOR = 2.83 [1.19–6.72]), non-invasive (aOR = 12.60 [1.41–112.36]), and invasive mechanical ventilation support (aOR = 30.13 [3.17–286.27]) and neutropenia (aOR = 13.19 [3.27–53.27]). Factors associated with invasive mechanical ventilation were chronic heart (aOR = 1.98 [1.20–3.26]) or respiratory failure (aOR = 2.83 [1.67–4.80]), and co-infection (aOR = 2.62 [1.60–4.30]). Patients who were treated with ribavirin were significantly younger than others (62 [55–69] vs. 75 [63–86] years; p < 0.001), more frequently males (n = 34/48 [70.8%] vs. n = 503/1120 [44.9%]; p 0.001), and almost exclusively immunocompromised (n = 46/48 [95.8%] vs. n = 299/1120 [26.7%]; p < 0.001). DiscussionThe mortality rate of patients hospitalised with RSV infections was 6.6%. Twenty-five per cent of the patients required ICU admission.

Outcome of patients admitted with oxygen mismatch and myocardial injury or infarction in emergency departments.

To describe the outcomes and associated factors in a population of patients admitted to emergency departments with at least one condition of oxygen supply/demand imbalance, regardless of the troponin result or restrictive criteria for type 2 myocardial infarction. We constituted a retrospective cohort of 824 patients. Medical records of patients having undergone a troponin assay were reviewed for selection and classification, and data including in-hospital stay and readmissions were collected. The reported outcomes are in-hospital mortality, 3-year mortality, and major adverse cardiovascular events. Patients with myocardial infarction or injury, either chronic or acute, were older, with more history of hypertension and chronic heart or renal failure but not for other cardiovascular risk factors and medical history. Acute myocardial injury and type 2 myocardial infarction were significantly associated with in-hospital mortality [odds ratio (OR) 3.71 95% confidence interval (CI) 1.90-7.33 and OR 3.15 95% CI 1.59-6.28, respectively]. However, the long-term mortality does not differ in comparison with patients presenting chronic myocardial injury or nonelevated troponin, ranging from 26.9 to 34.3%. Patients with chronic myocardial injury and type 2 myocardial infarction had more long-term major cardiovascular events (39.3 and 38.8%), but only for acute heart failure, and none was associated with this outcome after adjustment. Among patients admitted to emergency departments with an oxygen supply/demand imbalance, acute myocardial injury and type 2 myocardial infarction are strongly associated with in-hospital mortality. However, they are not associated with higher long-term mortality or major cardiovascular events after discharge, which tend to occur in elderly people with comorbidities.

Evaluation of Water Quality, Urinary Mercury &amp; Arsenic Investigation and Survey of Diseases Associated with Drinking Water Sources

Background: Contamination of freshwater sources can be caused by both anthropogenic and natural processes. WHO reported that 1.1 billion people worldwide consume contaminated water, and the majority of diarrheal diseases (88%) are caused by it. According to Central Pollution Control Board (CPCB), Maharashtra along with two other states contribute 80% of hazardous waste, including heavy metal pollution in India. Certain dissolved heavy metals are easily absorbed by aquatic organisms and can enter the body through drinking water, skin absorption, and biological chains, posing a health risk. Hence, the main objectives of the study were, (1) surface and groundwater quality assessment, (2) to determine the association of diseases/symptoms with different sources of drinking water used, and (3) urinary Mercury (Hg) and Arsenic (As) levels investigation in the study population. Methods: The cross-sectional study was conducted in the industrialized city of Solapur, Maharashtra, India. The study area was limited to 25 km around the industrial hub. A total of 557 people were randomly selected for the survey, with consumers from all four types of water sources i.e., surface, handpump, wells, and municipal water. Spot urine samples were collected for estimating Hg and As levels after considering inclusion and exclusion criteria. People under treatment for tuberculosis, cancer, and chronic heart, lung, or kidney ailments were excluded. Also, pregnant and lactating women were not included. One surface water, one municipal water, and five handpump water samples were collected for evaluating water quality. Samples were analyzed for pH, Total Dissolved Solids (TDS), Dissolved Oxygen (DO), Biological Oxygen Demand (BOD), Chemical Oxygen Demand (COD), Fluoride, Ammonia, Mercury, Arsenic, Cadmium, Lead, Nickel, Copper, Zinc, Chromium, and Manganese. Results: The water samples were observed to be neutral to slightly basic. TDS was between 410 to 1898 mg/L for groundwater whereas for surface water was 378 &amp; 450 mg/L. F concentration ranged between 0.4 to 0.9 mg/L, Zn from 0.32 to 0.57 mg/L, and NH3 was found to be &lt;0.1 mg/L. Out of 557 people, 43 (7.7%) used surface water, 194 (34.8%) used handpump, 64 (11.5%) used well, and 256 (46%) used municipal water. Among surface water users, 14 (32.5%) people reported frequent loose stools (p-value &lt;0.05), and 11 (25.5%) people reported frequent abdominal pain. Handpump and well water users majorly reported frequent abdominal pain and gastric discomfort (p-value &lt;0.05) respectively. 47 people were selected for estimating urinary Hg and As levels after considering exclusion and inclusion criteria. The mean value of urinary Hg &amp; As are 4.91 ± 0.280 &amp; 42.04 ± 2.635 µg/L respectively. Conclusion: In our study frequent loose stools, abdominal pain, and gastric discomfort were associated with the various sources of drinking water. Urine Hg levels were above the permissible reference value set by NHANES (USA) Survey. Additionally, it is advised that frequent drinking water monitoring be implemented in the vicinity of the industrial hub since metal accumulation may be dangerous to consumers when it is present in excess, and if found higher, necessary action should be taken to reduce exposure.

Changes in Clinical Manifestations Due to AFLD Retyping Based on the New MAFLD Criteria: An Observational Study Based on the National Inpatient Sample Database.

(1) Background: As the introduction of "positive" diagnostic criteria for metabolic dysfunction-associated fatty liver disease (MAFLD) does not exclude alcohol consumption, some patients originally diagnosed with alcoholic fatty liver disease (AFLD) may be diagnosed with dual- etiology fatty liver disease (AFLD&MAFLD), which requires us to urgently explore the impact of the changes in this classification of AFLD on clinical manifestations. (2) Methods: Utilizing data from the Nationwide Inpatient Sample database 2016-2018, a total of 9269 participants with AFLD were selected. With the definition of MAFLD, these patients were further categorized into two groups: single AFLD and AFLD&MAFLD. The primary outcome was the risk of comorbidities and organ failures. The secondary outcomes were the length of stay, total charges, and in-hospital all-cause mortality. (3) Results: The patients with AFLD&MAFLD were older, were predominantly male, and had more comorbidities and organ failures compared to the patients with AFLD. These comorbidities included coronary atherosclerosis, myocardial infarction, cerebrovascular disease, arrhythmia, asthma, chronic obstructive pulmonary disease, and chronic kidney disease (all p values < 0.05). The patients with AFLD&MAFLD were more likely to develop acute and chronic heart and/or kidney failures than those with single AFLD (all p < 0.05). The length of stay and total charges of the patients in the AFLD&MAFLD group were greater than the single AFLD group (p = 0.029 and p < 0.001, respectively). No significant difference in all-cause mortality was observed. (4) Conclusions: The patients with AFLD&MAFLD have more comorbidities and organ failures, longer hospital stays, and higher hospitalization costs than the patients with single AFLD. Hence, patients with dual-etiology fatty liver disease deserve more attention from clinical staff during treatment.

The essence of nursing a patient with chronic heart failure – case study

The essence of nursing a patient with chronic heart failure – case study

Iron deficiency anemia

Iron deficiency anemia is a pathology caused by hemo­glo­bi­­no­­synthesis disorder, with a significant decrease in iron de­­po­­sits in the body. Iron deficiency has several important cau­­ses, among which we mention: inadequate intake of iron, early childhood growth and development, pregnancy – by in­­creased need, small but repeated bleeding, abun­dant men­s­­tru­a­­tion, metrorrhages, fibroids, gastric or duodenal ulcer, hemorrhoidal disease, oncological path­o­logy, mal­­­ab­­sorp­­tion syndromes, inflammatory bo­wel diseases, pa­­­­ra­­­­si­­­to­sis etc. Iron deficiency anemia can be isolated or may be in the context of chronic di­seases (chronic heart fai­­lure, chronic kidney disease, in­flam­ma­tory bowel syn­dromes, cancer) etc. Anemia can be asymptomatic for a long time. The symptoms that may ap­pear are not spe­ci­fic: pallor, fatigue, lethargy, diz­ziness, ir­ri­ta­bi­li­ty, dif­fi­culty con­­cen­­tra­­ting, sweating, pal­pi­ta­tions, in­som­nia. Cli­ni­cal signs can highlight angular chei­litis, atro­­­phic glos­­sitis, dry skin, diffuse alopecia and soft nails. De­­creased in­­tel­­ligence, de­­pres­­sion and decreased immunity can also be due to iron de­fi­cien­cy. In the human body there are about 3-4 grams of iron. Ferritin is the main storehouse of iron in the body. To diag­nose iron deficiency anemia, there are necessary la­­bo­­ra­­tory tests for the value of hemoglobin, per­­­form serum fer­ritin – the most important test, along with transferrin sa­­tu­­ra­­tion and serum iron, since iron deficiency can exist in­­de­­pen­­den­t­ly of the presence of anemia. Serum ferritin loses its strength in the diagnosis of iron deficiency anemia in case there is con­co­mi­tant inflammation, being an acute phase protein. Iron deficiency anemia always has a cause, being very important to diagnose the underlying di­sease and treat it. The treatment of iron deficiency anemia is carried out depending on the seve­ri­ty of the anemia and depending on the patient’s con­di­tion, with oral, pa­ren­te­ral preparations or even blood trans­fu­sions. The treat­ment follows a serum ferritin value above 50 ng/mL.

An Epidemiological Study of Addictive Behavior Pattern Among Adolescent Tobacco Users.

The risk of developing tobacco-related cancer and chronic heart and lung disease is greater if addiction starts in adolescence. Even experimental use of tobacco in adolescents significantly increases the risk of addiction in adulthood. This study intends to collect valuable data regarding sociodemographic characteristic of tobacco use, pattern of dependence among adolescent tobacco users, which will be essential for formulating recommendations, and their possible intervention aimed at reducing the problem of tobacco use. A community-based cross-sectional study was done where 400 subjects were enrolled. Nonprobability Snowball sampling technique was used to locate adolescents aged 12-18 years, who were practicing tobacco use. Face-to-face interviews were taken for data collection. Fragerstorm dependency test for tobacco was used to classify dependency of tobacco product into high and low dependency. Data was analyzed using Chi-square test and proportions using SPSS software version 21. Majority of the subjects were in the age group of 16-18 years; mean age for initiation of tobacco was 15.6 years. Gutkha was the predominant form of tobacco product being used. Peer pressure 192 (48.0%) was the major reason for initiation of tobacco use. A significant association was found between dependency on tobacco and age, literacy, and socioeconomic status. Tobacco use starting from early age has many health implications. There is a need for stringent laws against the selling of tobacco to adolescents and targeted health awareness program against tobacco.

2321. Long-term immunogenicity of Ad26.RSV.preF/RSV preF protein vaccine against RSV in a phase 2b study by age and risk level

Abstract Background Respiratory syncytial virus (RSV) can cause serious lower respiratory tract disease (LRTD) among older adults. There is no licensed RSV vaccine. In CYPRESS (a randomized, double-blind, placebo-controlled, phase 2b proof-of concept trial; NCT03982199), an Ad26.RSV.preF/RSV preF protein vaccine demonstrated 80.0% efficacy for prevention of RSV LRTD and 69.8% efficacy for prevention of any RSV acute respiratory infection in adults aged ≥65 years through the first RSV season. This study evaluated the durability of immune responses elicited by Ad26.RSV.preF/RSV preF protein after two RSV seasons (up to 1.5 years post-vaccination) in the overall study population and in groups of participants stratified by age and risk level for severe RSV LRTD. Methods Participants (N=5782) were randomized 1:1 to receive vaccine or placebo before the RSV season. The primary endpoint was first occurrence of RSV LRTD. RSV A2 virus neutralizing antibodies (VNAs; through Day 365), RSV preF binding antibodies (through Day 533), and RSV-F–specific IFN-γ enzyme-linked immune absorbent spot (ELISpot; through Day 533), were evaluated in an immunogenicity subset (n=195; ages 65–74 years: n=141; 75–84 years: n=47; ≥85 years: n=6; increased risk [chronic heart or lung disease]: n=48; non-increased risk: n=147). Results In the vaccine group of the immunogenicity subset, RSV A2 VNAs peaked at Day 15 and were maintained at 2.8-fold over baseline at 1 year. Similarly, RSV preF-specific binding antibodies peaked at Day 15 and were maintained at 2.1-fold above baseline at 1.5 years. Median RSV-F–specific IFN-γ T-cell frequency increased from 34 spot-forming cells (SFC)/106 peripheral blood mononuclear cells (PBMCs) at baseline to 143 SFC/106 PBMCs at 1.5 years. Comparable immune responses were observed in age/risk subgroups. No relevant changes were observed in the placebo group at any time point. Pre-existing Ad26 VNAs did not appear to impact RSV-specific immune response durability. Conclusion Ad26.RSV.preF/RSV preF protein vaccine was efficacious and elicited robust, durable (to at least 1.5 years) humoral and cellular immune responses in adults aged ≥65 years, older participants (≥75 years), and in participants with increased risk for severe RSV LRTD. Disclosures Christy A. Comeaux, MD, PhD, Janssen Vaccines &amp; Prevention B.V.: Employee Ann R. Falsey, MD, BioFire Diagnostics: Grant/Research Support|Janssen: Grant/Research Support|Merck Sharp &amp; Dohme: Grant/Research Support|Novavax: Advisor/Consultant|Pfizer: Grant/Research Support Kristi Williams, PhD, Janssen Research and Development: Employee John E. Ervin, MD, The Alliance for Multispecialty Research – KCM: Contractual agreement for conduct of study protocol Arangassery R. Bastian, PhD, Janssen Vaccines &amp; Prevention BV: Employee Joris Menten, PhD, Janssen Infectious Diseases: Employee Els De Paepe, MSc, Janssen Infectious Diseases: employee Sjouke Vandenberghe, PhD, Janssen Infectious Diseases: Employee Eric K. H. Chan, PhD, Janssen Global Services, LLC: Employee Jerald Sadoff, MD, Janssen Vaccines &amp; Prevention BV: Employee Macaya Douoguih, MD, MPH, Janssen Vaccines &amp; Prevention B.V.: Employee Benoit Callendret, PhD, Janssen Vaccines &amp; Prevention B.V.: Employee Esther Heijnen, MD, PhD, Janssen Vaccines &amp; Prevention B.V.: Employee.