Clinic In January Research Articles

Effect of Electroacupuncture on the Treatment of Chronic Achilles Tendinopathy: A Case Report

Background and Objective: Chronic Achilles tendinopathy is among the most prevalent musculoskeletal disorders, especially among athletes. Despite numerous non-surgical procedures performed for this disorder, the treatment of these patients is still challenging. Given that electroacupuncture is a novel technique for the treatment of tendinopathy, a few studies have addressed it. This case report aimed to present the electroacupuncture technique for the treatment of chronic Achilles tendinopathy. Case Presentation: A 53-year-old male patient with a 6-month history of left Achilles tendon pain and limited daily activities was referred to Mobasher Physiotherapy Clinic in January 2024. For this purpose, 3-mm needles were inserted into the distal part of Achilles tendon at points BL 60, BL 61, KI 3, and KI 4. The patient received ten 20-min sessions of electroacupuncture treatment (three times per week at the frequency of 5 Hz and current intensity of 5 mA). Pain intensity and ankle range of motion were evaluated at first and last sessions. Conclusion: As evidenced by the results of this study, applying electroacupuncture for Achilles tendinopathy, especially chronic tendinitis that has not been treated with other conservative procedures, could improve the patient’s symptoms and ankle function, enhancing the patient’s functional activities and life quality.

Evaluation of diseases complicating long COVID: A retrospective chart review

AbstractBackgroundEvidence for the pathogenesis and treatment of postacute coronavirus disease 2019 (COVID‐19) (long COVID) is lacking. As long COVID symptoms are predicted to have an impact on the global economy, clarification of the pathogenesis is urgently needed. Our experiences indicated that some symptoms were complicated by diseases established before the COVID‐19 pandemic.MethodsUsing a retrospective, cross‐sectional study, we aimed to evaluate the diseases complicating long COVID. Using the medical records of patients with confirmed COVID‐19 exhibiting residual symptoms lasting ≥60 days postinfection who visited our clinic in January 2021–February 2023, we investigated the symptoms and diseases observed. We identified diseases that occurred after COVID‐19 and excluded those that were exacerbations of existing diseases.ResultsDuring the first visit, the most common symptoms reported in a total of 798 patients were fatigue (523 patients), anxiety (349 patients), and lack of motivation (344 patients). Complicating diseases were observed in 452 patients (57%). There were 115, 65, and 60 patients with postural tachycardia syndrome, postural syndrome without tachycardia, and mood disorders, respectively. Some diseases requiring immediate treatment included pulmonary thromboembolism, purulent shoulder arthritis, cerebellopontine angle tumors, myasthenia gravis, and cervical myelopathy.ConclusionNot all symptoms that occur after COVID‐19 should be treated as long COVID. Similar to normal medical treatment, a list of differential diagnoses should be maintained based on symptoms to obtain definitive diagnoses.

Validation of phenomenon and cross-sectional investigation of predictors for a post-COVID-19 surge of osteoporosis outpatients in China

An unexpected surge of osteoporosis outpatients occurred after COVID-19 lockdown was lifted in China. To confirm the observation and identify possible reasons driving patients care seeking behaviors post-pandemic, we compared the outpatient volumes at the osteoporosis clinic in January through May, 2019–2022 and surveyed seven osteoporosis specialists across China to validate the phenomenon before devising an online questionnaire to collect patients’ characters and physical activity levels. Univariate and binary logistic regression analyses were calculated to identify predictors of post-lockdown care-seeking. We received 480 valid responses, including 397 (82.7%) patients having visited the clinic after lockdown and 83 (17.3%) having not. Four significant predictors were identified, including being female, experiencing pain, aggravating symptoms, and heightened anxiety during lockdown (P < 0.05). Both groups experienced lower physical activity levels during lockdown, which however was not a significant predictor (P = 0.317). The surge in osteoporosis outpatient visits after COVID-19 lockdown suggests vast latent demand for osteoporosis care accumulated during the pandemic. Four significant factors predict post-lockdown outpatient care-seeking, including being female, experiencing pain and aggravating symptoms, and heightened anxiety levels. Though physical activity levels decreased during lockdown, it failed to predict care-seeking. This demonstrates resilience of osteoporosis patients to resume regular care despite disruption and stress the substantial backlog of unmet healthcare needs.

Investigation of Calcified Atherosclerotic Plaques on Panoramic Radiographs

Aim: This study aims to determine the prevalence of calcified atherosclerotic plaques (CAPs) incidentally encountered in the carotid artery within panoramic radiography (PR) images. Materials and Methods: A total of 1200 patients (646 females, 554 males) referred to our clinic in January 2022 and January 2023 were included. CAPs within PRs were assessed, with data stratified by gender, age, and systemic conditions. Statistical analysis employed descriptive statistics and chi-square tests (p&lt;0.05). Results: Among the 1200 patients, 251 CAPs (20.92%) were detected, with 128 (50.1%) occurring in females and 123 (49.9%) in males. The gender-based analysis demonstrated no statistically significant disparity in CAPs occurrence. Conversely, a notable correlation was established between the incidence of CAPs and age groups as well as systemic conditions (p&lt;0.05). Conclusion: Panoramic radiography, routinely used in dental practice, offers a cost-effective, low-radiation means for preliminary CAPs assessment. Dental practitioners should consider referring patients with identified CAPs in PRs to cardiology departments, potentially reducing stroke risks.

Porokarcinom noge - dijagnostički i terapijski izazovi i potencijalni uticaj pandemije Kovida 19 na dijagnozu i lečenje

Introduction: Cutaneous porocarcinoma is a rare malignant tumor, arising from the eccrine sweat gland. High rates of extracutaneous spread, local recurrence and high mortality are observed. Definitive diagnosis could be complex due to its histopathological similarity to squamous cell skin carcinoma and Paget's disease. Primary treatment still relies on surgical excision. Patient review: A 76-year-old male presented at our clinic in January 2020, with a bleeding skin tumor of the right thigh. Multiple wide surgical excisions were performed between January 2020 and November 2022, due to repetitive local recurrence. For a period of time, our patient was lost to follow up caused by COVID-19 pneumonia and a long recovery period. Initially, a poorly differentiated squamous cell skin carcinoma was reported. In the first post-COVID-19 follow-up, in January 2022, there was a new tumor locally, and porocarcinoma was diagnosed. In follow-ups, apart from skin tumor recurrence, inguinal nodal involvement was confirmed. CT showed no signs of disseminated disease in the lungs or in the abdomen, in any of the succeeding follow-ups. Finally, MRI of the pelvis revealed a suspicious mass in the bladder, radiologically consistent with metastatic disease and the patient was referred to an oncologist and a urologist. Conclusion: Porocarcinoma remains insufficiently explored. There are no official treatment protocols. Due to its similarity to squamous cell carcinoma, a dermatopathology expert should be consulted, while a multidisciplinary approach is necessary for managing the disease. Since early diagnosis and treatment are of paramount importance, any factors that delay them, such as COVID-19 pandemic in our case, could be detrimental to the patient and poorly affects the prognosis and final outcome.

Efek Pemberian Campuran Madu Terhadap Peningkatan Kadar Hemoglobin Pada Ibu Hamil Dengan Anemia

Background: Anemia in pregnant women can increase the risk of premature birth, maternal and child mortality, and infectious diseases. According to WHO, the prevalence of anemia in pregnant women is around 35-75%, and it increases with the growth of gestational age. Objective: This study aims to increase insight and knowledge and to find out the incidence of pregnant women with anemia before and after the intervention. In addition, to analyze the effect of giving a mixture of honey to increase hemoglobin levels in anemic pregnant women. Methods: The design in this study used the Quasi-experimental design method. Quasi-experimental design (quasi-experimental) with a quantitative approach to one group design pre-test and post-test. The population in this study were all pregnant women who came to check their pregnancy at the Pratama Hidayah Clinic in January 2022. The sampling technique in this study was purposive sampling, namely taking samples based on considerations with the desired elements by inclusion criteria with the number of a sample of 15 respondents. Results: Test using the Shapiro Wilk method. The significance value of the pre-test variable is 0.994 and the significance value of the post-test variable is 0.153 or &gt; 0.050, meaning that the data in this study are normally distributed. So the statistical test used is the T-test with a p-value of pre-test - post test of 0.000 &lt; 0.050. Thus, it can be concluded that there is a significant difference between the average pre-test and post-test variables. This means that there is an effect of giving a mixture of honey increases hemoglobin levels in pregnant women with anemia. Conclusion: From the research conducted that there is a significant difference between the value of the pre-test and post-test, besides that there is a very strong relationship between the effect of giving a mixture of honey to the increase in hemoglobin levels in the mother. pregnant with anemia.

Perceived Service Quality and User Satisfaction with Orthotic-Prosthetic Devices and Services Among Individual with Physical Disabilities

This research contributes to ongoing efforts to enhance healthcare service quality and improve the well-being of individuals with disabilities, particularly those with physical disabilities relying on orthotic-prosthetic care in their communities. Currently, there is limited evidence available to guide policy, funding decisions, and practitioners in Indonesia. Study participants included adult orthosis/prosthesis users and parents/guardians of children using these devices, all of whom sought services at the Jakarta I Ministry of Health Polytechnic educational clinic in January to June 2023. Subsequently, the socket fabrication, fitting, and evaluation process took place, utilizing purposive sampling for surveys encompassing demographics and the Modified Orthotic Prosthetic User Survey (OPUS) – Client Satisfaction with Devices and Services. 73% of patients reported satisfaction with high-quality Orthotic-Prosthetic devices, while 86% expressed satisfaction with excellent service. This highlights the effectiveness of the Modified Orthotic Prosthetic User Survey (OPUS) in assessing user satisfaction with prosthetic-orthotic devices and services, underscoring the need for ongoing tool refinement.

Subtotal and Total Colectomy as a One-Stage Surgical Treatment for Malignant Left-Sided Colonic Obstruction

Abstract Aim: We conducted this retrospective study in order to evaluate the short- and long-term results of Subtotal/Total Colectomy (STC/TC) and primary anastomosis for the treatment of occlusive left colon cancer. Methods: Data were retrospectively collected from the medical records from general surgery clinic in January 2016 to June 2022 period. The study included patients diagnosed with acute colonic occlusion produced by tumor located from the splenic flexure to the rectosigmoid junction. Results: During the study period, 40 patients who underwent STC/TC and primary anastomosis were included in the study. According to the Clavien-Dindo grades, major complication rate was 17.5%. Seven patients (17.5%) had synchronous adenocarcinoma. Adenoma was detected in 11 of 40 patients, and 18.1% of them were reported as high-grade dysplasia. Besides, incidental low grade appendiceal mucinous neoplasm was reported in one patient. Ischemia and perforation of proximal colon was found in 28 cases (70%). No patient had anastomotic leak. After one year of surgery, the average defecation was two stools per day. Three-year OS was 92.3% in stage II and 68.7% in stage III. There was no survival more than three years in stage IV patients. The three-year overall disease- free survival was 90.6%. Conclusion: Treatment of obstructive left colon cancer using STC/TC and primary anastomosis is a confident method resulting in a good bowel function. The method allows the resection of synchronous tumors. Besides, it removes the proximal colon with ischemic lesions, serosal tears and filled with stool.

An initiative to promote value-based stress test selection in primary care and cardiology clinics: A mixed methods evaluation.

Exercise stress echocardiograms (stress echos) are overused, whereas exercise stress electrocardiograms (stress ECGs) can be an appropriate, lower-cost substitute. In this post hoc, mixed methods evaluation, we assessed an initiative promoting value-based, guideline-concordant ordering practices in primary care (PC) and cardiology clinics. Change in percent of stress ECGs ordered of all exercise stress tests (stress ECGs and echos) was calculated between three periods: baseline (January 2019-February 2020); Period 1 with reduced stress ECG report turnaround time + PC-targeted education (began June 2020); and Period 2 with the addition of electronic health record-based alternative alert (AA) providing point-of-care clinical decision support. The AA was deployed in two of five PC clinics in July 2020, two additional PC clinics in January 2021, and one of four cardiology clinics in February 2021. Nineteen primary care providers (PCPs) and five cardiologists were interviewed in Period 2. Clinicians reported reducing ECG report turnaround time was crucial for adoption. PCPs specifically reported that value-based education helped change their practice. In PC, the percent of stress ECGs ordered increased by 38% ± 6% (SE) (p < 0.0001) from baseline to Period 1. Most PCPs identified the AA as the most impactful initiative, yet stress ECG ordering did not change (6% ± 6%; p = 0.34) between Periods 1 and 2. In contrast, cardiologists reportedly relied on their expertise rather than AAs, yet their stress ECGs orders increased from Period 1 to 2 to a larger degree in the cardiology clinic with the AA (12% ± 5%; p = 0.01) than clinics without the AA (6% ± 2%; p = 0.01). The percent of stress ECGs ordered was higher in Period 2 than baseline for both specialties (both p < 0.0001). This initiative influenced ordering behaviour in PC and cardiology clinics. However, clinicians' perceptions of the initiative varied between specialties and did not always align with the observed behaviour change.

Pressure force on tissues in various osteopathic techniques (pilot study)

Introduction. The main tool of the osteopathic physician, which carries out most of the diagnostic and therapeutic actions, is the hands. To conduct scientifi c research in osteopathy, it is necessary to understand the nature of the impact and its quantitative characteristics, in particular, the pressure force of the physician′s hands on the patient′s body. In the available literature, it was possible to fi nd single instrumental studies of the pressure force of the osteopath′s hands during performing cranial techniques. Similar studies about the performance of other techniques could not be found in the available literature.Aims: to measure by an instrumental method the pressure force of the osteopath hands during various osteopathic techniques (cranial, visceral, structural).Materials and methods. The study was conducted on the basis of the Mokhov Institute of Osteopathy Clinic in January 2023. The study involved 6 lecturers of the Institute of Osteopathy (St. Petersburg), their experience as an osteopath is at least 5 years; the age is from 33 to 53 years. As patients, the residents of the Osteopathy Department of Mechnikov North-West Medical State University were involved. There were 2 men and 4 women, aged from 24 to 26 years, with a normosthenic constitution and a body mass index from 19,5 to 24. The following devices were used to measure the pressure strength of the osteopathic physician′s hands: Fsr402 resistive pressure sensors (Arduino Italy) and A402 (Tekscan USA), FlexiForce Prototyping Kit with FlexiForce MicroView software (Tekscan USA), and a device for determining skin elasticity and human skin scars (strain gauge attached to a caliper, Patent RU 2763 843 C1). Each physician demonstrated several osteopathic techniques on one patient. During the execution of each technique, three measurements were made, and the arithmetic mean was calculated. Structural, visceral and cranial techniques of osteopathic correction were performed.Results. The Friedman test showed a statistically signifi cant difference in pressure strength for different techniques (p&lt;0,01). The greatest pressure force was measured during the mobilization of the descending colon (3,6±0,3 Newton); the minimum force was measured during the mobilization of the thoracic spine in the extension (1,5±0,3 Newton). When performing each technique, there was a range (the difference between the minimum and maximum values) between physicians from 0,95 Newton for performing a frontal bone lift to 1,8 Newton for mobilizing the sigmoid colon. Conclusion. The pilot study showed that during performing different techniques, the pressure strength of the osteopathic physician′s hands differed signifi cantly. It is advisable to continue the study on a more representative sample.&gt; &lt;0,01). The greatest pressure force was measured during the mobilization of the descending colon (3,6±0,3 Newton); the minimum force was measured during the mobilization of the thoracic spine in the extension (1,5±0,3 Newton). When performing each technique, there was a range (the difference between the minimum and maximum values) between physicians from 0,95 Newton for performing a frontal bone lift to 1,8 Newton for mobilizing the sigmoid colon.Conclusion. The pilot study showed that during performing different techniques, the pressure strength of the osteopathic physician′s hands differed signifi cantly. It is advisable to continue the study on a more representative sample.

Does the SARS-CoV-2 mRNA vaccine damage the ovarian reserve?

To search whether or not the severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) messenger ribonucleic acid (mRNA) vaccine affects the fertility of women at the 6th months by using AMH, which is an ovarian reserve test. Our study, designed as a prospective case-control study, included 104 women who presented to the GOP EAH obstetrics and gynecology outpatient clinic in January and February 2022. The study group included 74 women who presented to the outpatient clinic and planned to be vaccinated and 30 women who refused to be vaccinated as the control group. Anti-COVID-19 antibody levels in all participants were checked before participation in the study, and participants who were positive were excluded from the study. Blood was taken from the participants in both control and study groups to evaluate their AMH levels before the 2 doses of vaccination. After 2 doses of the vaccine, they were called for follow-up, and serological tests were performed to check whether they were positive for anti-COVID-19 antibodies. Participants in both groups were referred for follow-up after 6 months, samples were taken again for AMH, and the data were recorded. The mean age of the study group was 27.6 ± 5.3 years, and the mean age of the control group was 28.65 ± 5.25 years (P = .298). There was no statistically significant difference between the vaccinated and nonvaccinated groups in terms of AMH levels measured at the 6th month (P = .970). When the vaccinated group was compared in terms of AMH values at the first visit before vaccination and at the 6th month after vaccination, no statistically significant difference was found between them (p:0.127) mRNA vaccination to protect against SARS-CoV-2 does not adversely affect ovarian reserve, which is an indirect indicator of fertility. mRNA vaccines continue to be the most important method of protection against epidemics. Carefully and accurately informing women who are hesitant to get vaccinated is of great importance for the success of the fight against the epidemic.

P181 Assessing and improving mental health in axial spondyloarthritis through digital solutions

Abstract Background/Aims Mental health issues in axial spondyloarthritis (AxSpA) such as anxiety and depression can affect up to two thirds of patients. We aimed to detect the prevalence of anxiety and depression in our AxSpA patients in order to provide interventions to improve the condition. This is part of our work in the National Axial Spondyloarthritis Society’s (NASS) Aspiring to Excellence programme to improve patient outcomes. We have provided an online mental health assessment and self-management video that signpost patients to psychological help and resources. Methods We used the Hospital Anxiety and Depression Score (HADS) for AxSpA patients attending the clinic in January to March 2020. We also collected the BASDAI, Spinal Pain, BASFI and BASG. The HADS scores are divided into three groups, 0-7 (normal), 8-10 (borderline abnormal) and 11-21 (abnormal). Patients were invited to watch a self-help video on managing anxiety and depression, which we produced in house with our clinical psychologist. Patients were directed to online mental health resources and self-management programmes. Follow up HADS were collected post watching the video. Results All patients met the ASAS criteria for AxSpA. 100 patients were assessed and invited to watch the video. 90/100 (90%) of patients completed the baseline and follow up score. The mean (SD) age was 44.7 (13.2) years. The male:female ratio was 3:1. The mean disease duration was 9 years. The number of patients on biologics was 36 (40%). At baseline, the mean (SD) HADS was 10 (6), BASDAI 4.4 (2.3), Spinal pain 4.2 (3), BASFI 3.7 (2.7) and BASG 4.3 (2.7). The number of patients with a HADS score 0-7 was 28 (31%), 8-10 was 18 (20%) and &amp;gt;11 was 44 (49%). All patients participated in the viewing of the video and used the self-management programme. 34 (38%) patients reported engaging with psychological services such as talking therapies. At follow up, the mean (SD) HADS score was 9 (6), BASDAI 3.7 (2.1), Spinal pain 3.8 (2.2), BASFI 3.4 (2) and BASG 3.9 (2.4). The number of patients with a HADS score 0-7 was 38 (42%), 8-10 was 28 (31%) and &amp;gt;11 reduced to 24 (27%). There was a reduction in the number of patients with HADS &amp;gt;11 (from 49% to 31%) and a trend towards lower HADS (HADS 0-7 increased from 31% to 42%) and AxSpA outcome scores (reduction in all four AS scores from baseline). Conclusion Mental health issues in AxSpA can be improved through the use of digital mental health assessment and self-management programmes. This study shows that this is a useful method of delivering care. There was a trend towards the improvement of the mental health and AS disease activity scores using the digital video. Disclosure A. Chan: None. K. Rigler: None. A. McDougall: None.

Patient-reported quality of life during PARP-inhibitor treatment for high-grade serous ovarian cancer (468)

<b>Objectives:</b> To determine the impact of PARP inhibitor maintenance treatment on the health-care quality of life (QOL) of women with high-grade serous ovarian cancer after cytoreductive surgery. <b>Methods:</b> Patient-reported outcome (PRO) collection was implemented at our gynecologic oncology clinic in January 2018. At serial visits, patients were administered general oncology and diseasespecific PRO measures (PROMs) based on the patient disease site. All patients with ovarian cancer (OC) were then identified, and data on PARP inhibitor use was collected from the electronic health records. The date of cytoreductive surgery, as well as initiation of PARP inhibitor therapy, were noted. Specific PROM questions reflecting the quality of life were selected a priori from questionnaires for analysis, and health-related quality of life was compared pre- and post- PARP inhibitor therapy and between patients who were and were not treated with PARP inhibitors. <b>Results:</b> Between January 2018 and July 2020, 285 patients with ovarian cancer were identified who had both undergone cytoreductive surgery and completed PROMs. From these 285 patients, 1275 individual PROMs responses were available for analysis. Seventy- three patients from the cohort had been started on PARP inhibitor maintenance therapy postoperatively. Utilizing the quality-of-life items within the EORTC-QLQ C-30, patients reported an initial drop in quality of life after initiation of PARP inhibitor therapy (Figure 1 A). However, with increasing duration of PARP inhibitor use, patients reported an improvement in their quality of life which surpassed pre-treatment levels at 180 days post-initiation (Figure 1A). When patients who received PARPs were compared to those who did not, the quality of life in the PARP-inhibitor group was worse during the first six postoperative months (Figure 1B). However, at one year post- operatively, the quality of life in the two groups was equal (Figure 1B). <b>Conclusions:</b> PARP inhibitor use is associated with an initial reduction in healthcare quality of life in patients with high-grade serous ovarian cancer. However, with increasing duration of use, quality of life surpasses pre-treatment levels and is equal to that of patients who are not receiving PARP inhibitor therapy by one year postopera- tively. This study confirms the tolerability of PARP inhibitor maintenance therapy in women with high-risk ovarian cancer.

VORICONAZOLE-ASSOCIATED MUCOSAL ULCERATION AFTER LUNG TRANSPLANT

TYPE: Case Report TOPIC: Transplantation INTRODUCTION: Colonization and isolation of Aspergillus from bronchial specimens predisposes lung transplant (LTx) recipients to airway anastomotic complications and allograft rejection. Post-LTx antifungal prophylaxis with voriconazole has been associated with cutaneous malignancies. We report a case of voriconazole-associated mucosal ulceration in an LTx recipient that improved upon drug discontinuation. CASE PRESENTATION: A 56-year-old LTx recipient (November 2020) presented to the clinic in January 2021 for painful oral and anal ulcers. He was managed with reduced maintenance immunosuppression, filgrastim, lidocaine-diphenhydramine-corticosteroid oral rinse, and topical nitroglycerin-nystatin ointments without relief. He returned to the emergency department in February for worsening pain, facial swelling, inability to open mouth, and difficult defecation. Inpatient evaluation demonstrated neutropenia (0.8/μL), lymphopenia (0.5/μL), and elevated inflammatory markers [ESR: 119 mm/h; CRP: 123.2 mg/L; procalcitonin: 0.14 ng/mL]. However, blood culture, serology for Epstein-Barr virus, herpes simplex virus, cytomegalovirus, head-neck and chest imaging, esophagogastroduodenoscopy, perianal punch biopsy, and anal canal incisional biopsy were unremarkable. Importantly, serum voriconazole level was elevated (7.2 μg/mL). Discontinuation of voriconazole led to relief in symptoms and discharge. On clinic follow-up, he endorsed complete resolution of ulcers. Of note, his antifungal prophylaxis was temporarily switched from isavuconazole to voriconazole in January. DISCUSSION: Voriconazole-induced photosensitivity and elevated plasma retinol levels may progress to cutaneous malignancies. In our patient, temporality of onset (one week) and resolution (within days) of mucosal ulceration with voriconazole discontinuation suggest an association. No residual scarring or recurrence was observed. CONCLUSIONS: Physicians must be mindful of dermatologic adverse events of voriconazole in LTx recipients. DISCLOSURE: Nothing to declare. KEYWORD: Lung transplantation

Virtual clinics versus face-to-face review: Is the benefit the same for new orthopaedic patients?

BackgroundCOVID-19 shocked global healthcare systems, particularly the surgical services, resulting in a significant backlog of patients with waiting times not expected to return to pre-pandemic levels until 2025. The Royal College of Surgeons has recommended a wider use of virtual clinics to meet the increased demand. The efficacy of virtual follow up is well documented in the literature; however, there is very little evidence of the role of virtual clinics in the assessment of new elective patients. MethodsObservational study comparing clinical outcomes of new patients electively referred to orthopaedic virtual clinics between January and February 2021 with face-to-face clinics in January and February 2020. ResultsOver the equivalent time frame, more patients were reviewed in virtual clinics compared to traditional face-to-face (821 vs 499). However, virtual clinics lead to significantly more patients being brought back for follow up (78.3% vs 37.3%) and fewer patients received outcomes that progressed their journey towards a definitive intervention or discharge. ConclusionThe overall benefit of virtual clinic appointments in the context of reviewing new patients remains to be proven. Despite increasing use of virtual clinics in the National Health Service, we have shown a potential delay to patients’ clinical progression, ultimately delaying healthcare delivery. Potential methods to improve the benefit of virtual clinics are proposed.

Legal Relief for Children in Immigrant Families: A Mixed-Methods Study.

Objective: Immigration status is a known social driver of health. Little research exists on addressing concerns about immigration status in primary care. The objective of this study is to understand the experiences of immigrant families that received a clinical-community intervention to address immigration-related concerns. Methods: We conducted a mixed-methods study: an embedded experimental design study. We implemented an immigration-focused legal needs screening tool and referral intervention at one academic primary care clinic in January 2018. Caregivers who screened positive for immigration-related concerns and were referred to a local immigration law firm were invited to participate in a semi-structured interview. Interviews were recorded, de-identified, transcribed, and systematically coded using an inductive content analysis approach. A modified constant comparative method was used to iteratively review codes, identify emerging themes, and resolve differences through consensus. Results: Nineteen caregivers reported immigration-related legal concerns, seven of whom were interviewed. Most (84.2%) were mothers, identified as Hispanic (94.7%), were from Mexico (52.6%), and reported persecution and fear of returning to their country of origin (57.9%). In interviews, we identified three major themes: (1) families were motivated to immigrate due to mental health trauma and persecution; (2) families sought legal services for several immigration-related concerns; and (3) families experienced challenges in navigating the legal system, with which clinics may assist. Conclusion: This study demonstrates the need for immigration-related services in primary care settings and the feasibility and potential benefits of implementing a legal screening and referral intervention.

Energy Alterations in Patients with Pulmonary Artery Thrombosis After COVID-19 Treatment

Introduction: There are some studies in the literature reporting cases of pulmonary thrombosis after treatment of acute phase of SARS-CoV-2 infection. Purpose: The purpose of this study is to show that patients that have pulmonary thrombosis has in the back ground prior to COVID-19, energy deficiency in the five internal massive organs, responsible for the production of energy necessary to keep the Blood flowing normally inside the Blood vessels. The treatment used nowadays to treat patient with SARS-CoV-2 infection can reduce even more this energy and can cause Blood stagnation inside the blood vessels in any part of the body, in this case, in the pulmonary vessels. Methods: Through one case report of 36 years-old female patient with history of SARS-CoV-2 infection on February 2nd 2021. In the beginning of her symptoms, she presented only runny nose and flu-like symptoms. She evolves to body pain and headache and in the third day, she tested positive to SARSCoV-2. It was prescribed Ivermectin and Azithromycin and she stayed 14 days isolated at home. On 16th day since the first manifestation, she returned to work and began to feel left chest pain. She did many exams to see if the Heart was compromised but nothing was found. There was only alteration in the pulmonary artery pressure and after it was diagnosed pulmonary thrombosis after performing Angio tomography. She started to use Rivaroxaban (Xarelto) and after this treatment, she improved and the symptoms disappeared but she is still using the medication until today. She went to my clinic in January 2022 to treat anxiety and she told me about all history of SARS-CoV-2 infection and complications. I performed to measurement of her internal massive organs through a crystal-pendulum using radiesthesia procedure. Results: what I found was a complete lack of energy inside the five internal massive organs (Liver, Heart, Spleen, Lungs, Kidney) responsible for the production of Yin, Yang, Qi and Blood to keep the blood flowing inside the blood vessels. Conclusion: The conclusion of this study is that patients with pulmonary artery thrombosis post COVID-19 symptoms can have energy deficiency inside the five internal massive organs and the use of highly concentrated medications to treat this condition and many other clinical conditions can worse more this reduction in energy and cause stagnation of Blood inside the blood vessels and cause in this case, pulmonary thrombosis.

Evaluating immunity to SARS-CoV-2 in nursing home residents using saliva IgG.

SARS-CoV-2 circulating variants coupled with waning immunity pose a significant threat to the long-term care (LTC) population. Our objective was to measure salivary IgG antibodies in residents and staff of an LTC facility to (1) evaluate IgG response in saliva post-natural infection and vaccination and (2) assess its feasibility to describe the seroprevalence over time. We performed salivary IgG sampling of all residents and staff who agreed to test in a 150-bed skilled nursing facility during three seroprevalence surveys between October 2020 and February 2021. The facility had SARS-CoV-2 outbreaks in May 2020 and November 2020, when 45 of 138 and 37 of 125 residents were infected, respectively; they offered two Federal vaccine clinics in January 2021. We evaluated quantitative IgG in saliva to the Nucleocapsid (N), Spike (S), and Receptor-binding domain (RBD) Antigens of SARS-CoV-2 over time post-infection and post-vaccination. One hundred twenty-four residents and 28 staff underwent saliva serologic testing on one or more survey visits. Over three surveys, the SARS-CoV-2 seroprevalence at the facility was 49%, 64%, and 81%, respectively. IgG to S, RBD, and N Antigens all increased post infection. Post vaccination, the infection naïve group did not have a detectable N IgG level, and N IgG levels for the previously infected did not increase post vaccination (p < 0.001). Fully vaccinated subjects with prior COVID-19 infection had significantly higher RBD and S IgG responses compared with those who were infection-naïve prior to vaccination (p < 0.001 for both). Positive SARS-COV-2 IgG in saliva was concordant with prior infection (Anti N, S, RBD) and vaccination (Anti S, RBD) and remained above positivity threshold for up to 9 months from infection. Salivary sampling is a non-invasive method of tracking immunity and differentiating between prior infection and vaccination to inform the need for boosters in LTC residents and staff.

Abstract 12872: Adherence to Guidelines for Heart Rate in Stable Ischemic Heart Disease in the Primary Care Setting

Per 2012 ACC/AHA Guidelines, patients with stable ischemic heart disease (IHD) should be treated with beta-blockers (BB) to target a resting heart rate (HR) of 55-60 bpm due to associations of higher HR with all-cause mortality. We sought to determine adherence to this in the resident primary care (PC) clinic at our institution. Two hundred twenty-nine patients with a medication list in the electronic medical record (EMR) that includes metoprolol succinate or tartrate or carvedilol who were seen in PC clinic in January 2020 were identified. Of these, 100 had a diagnosis of IHD, and their EMR were reviewed for vital signs; medication changes; and contraindications (CI) to BB titration such as hypotension, bradycardia, and max dosing; during their PC and cardiology visits. We found that 10% (10 of 100) had HR within goal during their PC visit, whereas 6 and 84 had HR below and above goal, respectively. Of the 90 whose HR was not at goal, 24 had some perceivable CI to BB titration. Of those without CI to titration, 9% (6 of 66) had their BB increased, 4.5% (3 of 66) had their BB switched to a different medication, and 85% (56 of 66) did not have their BB changed. Of those whose BB was unchanged, 79% (44 of 56) had no other antihypertensive changed. Moreover, 88% (74 of 84) of those with HR above goal had a HR also above goal at their last two PC visits. Sixty-eight of the 100 patients with IHD were also managed by cardiology, and in contrast, 18% (8 of 45) of those with HR not at goal and without CI to titration had their BB dose adjusted at their last cardiology visit. A chi-square test was performed to examine the relation between BB titration and clinic setting with no statistical significance, X 2 (1, N = 106) = 1.18, p = 0.28. In sum, adherence to guidelines for HR in stable IHD were poor and not significantly different in the PC and cardiology settings. Lack of provider initiative, perhaps due to trainee unfamiliarity with guidelines, may be one of many factors and warrants more investigation to improve quality of care.

A-24 An Evaluation of Anxiety, Depression, and Neuropsychological Performance before and during the COVID-19 Pandemic

Abstract Objective High levels of depression and anxiety have been consistently linked to performance on neuropsychological evaluations. In this regard, recent evidence of increased emotional distress due to COVID-19 may exacerbate impairment typically demonstrated on evaluations. The current study examined differences in the severity of depression and anxiety ratings reported before and during COVID-19, and the relationship between mood and cognitive functioning before and during COVID-19. Method 75 adults seeking neuropsychological assessment services from a private outpatient clinic in January 2020 and 2021 were included in the study. Depression, anxiety, and cognitive functioning were measured using the BDI-II, BAI, RDS, FAS, and Trailmaking test. T-tests were conducted to examine mood and cognitive differences between groups. Correlations were used to assess the relationship between mood and cognitive functioning. Results T-tests revealed no significant differences between groups for anxiety, depression, performance validity, verbal fluency, and Trailmaking tests. No significant relationship was observed between reported mood level and cognitive functioning before and during COVID-19. A significant correlation was observed between age and anxiety, which showed that older adults reported less anxiety. All statistical findings will be reported fully in the poster. Conclusions No significant change in emotional distress was found between pre- and during COVID-19 groups. The absence of measurable change may also suggest measures commonly employed should be reviewed and possibly modified to better capture the distress experienced by patients during the pandemic.