Comorbid Type Research Articles

Peculiarities of formation and clinical course of symptomatic epilepsy as a result of cranial injury

Post-traumatic epilepsy (PTE) is a formidable and frequent consequence of traumatic brain injury (TBI) in the long term. 41 patients with PTE were examined, mostly men of working age. The time of formation of PTE after was 14.3 ± 1.4 months, which decreased depending on the severity of brain injury, the average frequency of seizures was 2.93 ± 0.8 per month.Focal seizures were mainly registered (63.4%, p <0.05), and taking into account the focal onset in bilateral tonic-clonic seizures, this figure reached 90.2% (p <0.05). Among the selected syndromes, except for direct PTE, autonomic dysfunctions (87.8%) with paroxysmal course (58.5%) prevailed, especially in persons with moderate trauma (r = 0.51, p <0.05).Typical comorbid symptoms in people with PTE were cognitive deficits, which correlated with the severity of TBI, as well as depressive and anxiety symptoms. Depressive layers were more often observed in the presence of the focal component of seizures (94.7%, p <0.05), temporal localization of the pathological process and predominant vagotonia. Anxiety manifestations affected all types of attacks on the background of sympathicotonia (83.3%, p <0.05), which in our opinion improved the implementation of crisis conditions, which were observed in 66.7% of cases.

EVALUATION OF PARAMETERS OF ACTUAL TYPICAL PATHOGENETIC SYNDROMES IN COMORBIDITY OF TYPE 2 DIABETES MELLITUS AND CHRONIC PANCREATITIS

The aim: To assess the state of typical pathogenetic syndromes (inflammation, endotoxicosis, liperoxidation, enzymatic and non-enzymatic antioxidant deficiency) in the comorbidity of type 2 diabetes mellitus (DM2) and chronic pancreatitis (CP). Materials and methods: We examined 137 patients (112 patients with comorbidity of CP and DM2 and 25 patients with isolated CP. Typical pathogenetic syndromes (inflammation, endotoxicosis, liperoxidation, enzymatic and non-enzymatic antioxidant deficiency) were determined. Results: It was proved that patients with CP even in the remission phase of the active course of EI and LPO, which was significantly more significant in comorbidity with DM2. Statistically significant more significant changes in the parameters of antioxidant protection in the comorbidity of CP and DM2 in relation to those in isolated CP. Conclusions: Treatment of CP and DM2 is a difficult task and should take into account the impact on the studied common typical pathogenetic syndromes – inflammation, endotoxicosis, lipid peroxidation, and enzyme and non-enzymatic antioxidant protection – to address short-term and prevent long-term complications.

Diabetic patients with COVID-19 need more attention and better glycemic control.

BACKGROUNDCoronavirus disease 2019 (COVID-19) is a pandemic disease spreading all over the world and has aroused global concerns. The increasing mortality has revealed its severity. It is important to distinguish severe patients and provide appropriate treatment and care to prevent damages. Diabetes is reported to be a common comorbidity in COVID-19 patients and associated with higher mortality. We attempted to clarify the relationship between diabetes and COVID-19 patients’ severity.AIMTo determine the role of type 2 diabetes in COVID-19 patients.METHODSTo study the relationship between diabetes and COVID-19, we retrospectively collected 61 patients’ data from a tertiary medical center in Wuhan. All the patients were diagnosed with laboratory-confirmed COVID-19 and admitted to the center from February 13 to March 1, 2020. Patients’ age, sex, laboratory tests, chest computed tomography findings, capillary blood glucose (BG), and treatments were collected and analyzed. Fisher exact test was used for categorical data. Univariate and multivariate logistic regressions were used to explore the relationship between clinical characteristics and patients’ severity.RESULTSIn the 61 patients, the comorbidity of type 2 diabetes, hypertension, and heart diseases were 24.6% (15 out of 61), 37.7% (23 out of 61), and 11.5% (7 out of 61), respectively. The diabetic group was related to more invasive treatments (P = 0.02) and severe status (P = 0.003). In univariate logistic regression, histories of diabetes (OR = 7.13, P = 0.003), hypertension (OR = 3.41, P = 0.039), and hepatic dysfunction (OR = 7.69, P = 0.002) were predictors of patients’ severity while heart disease (OR = 4.21, P = 0.083) and large lung involvement (OR = 2.70, P = 0.093) also slightly exacerbated patients’ conditions. In the multivariate analysis, diabetes (OR = 6.29, P = 0.016) and hepatic dysfunction (OR = 5.88, P = 0.018) were risk factors for severe patients. Diabetic patients showed elevated BG in 61.7% of preprandial tests and 33.3% of postprandial tests, revealing the limited control of glycemia in COVID-19 patients.CONCLUSIONA history of type 2 diabetes is correlated with invasive treatments and severe status. Suboptimal glycemic control and hepatic dysfunction have negative effects on severity status and may lead to the exacerbation of COVID-19 patients.

A system biological approach to investigate the genetic profiling and comorbidities of type 2 diabetes

BackgroundType 2 diabetes (T2D) is an interminable illness that makes many types of genetic dysfunction in the human body, particularly to the nerves, veins, kidneys, liver and uterus. T2D existence in a longer period of time may create the risk of building some comorbidities, however the indication of this risk is inadequately comprehended. To address this issue, we studied the transcriptomic data to recognize the link between T2D and its major comorbidities. MethodsWe developed a quantitative model to investigate the genetic links between T2D and its significant comorbidities. We analyzed gene expression omnibus (GEO) microarray data from T2D, liver cancer (LC), endometrial cancer (EC), xanthoma (Xa), myocardial infarction (MI), embolic stroke (ES), kidney failure (KF), xerostomia (Xe) and control datasets. We constructed gene-disease association networks (GDN), identified signaling and ontological pathways, formed protein-protein interaction (PPI) network employing neighborhood-based benchmarking and multilayer network topology. ResultsWe observed, T2D shared 22, 15, 18, 21, 12, 14 and 13 differentially expressed genes (DEGs) with LC, EC, Xa, MI, ES, KF, and Xe respectively. DEG investigation, signaling and ontological pathways, and PPI network suggest significant links between T2D and the advancement of LC, EC, Xa, MI, ES, KF, and Xe. ConclusionsOur systematic approach to identify the genetic links of T2D with the progression of LC, EC, Xa, MI, ES, KF, and Xe by understanding the causal influences of T2D may be helpful to develop therapeutic strategies for T2D and those comorbidities. This study will also be useful to predict comorbidities occurrence and build human awareness against the dangerous effects of T2D.

Long-acting GLP-1 receptor agonists: Findings and implications of cardiovascular outcomes trials.

Cardiovascular disease (CVD) is a common and serious comorbidity of type 2 diabetes mellitus (T2DM), and cardiovascular (CV) risk assessment has become an important aspect of evaluating new therapies for T2DM before approval by the FDA. Since 2008, in order to establish safety, new therapies for T2DM have been required to demonstrate that they will not result in an unacceptable increase in CV risk. Studies performed for this purpose are termed CV outcome trials, or CVOTs. This article reviews CVOTs completed to date for the class of long-acting glucagon-like peptide-1 receptor agonists (GLP-1RAs; liraglutide, exenatide extended-release, albiglutide, dulaglutide, semaglutide injectable, semaglutide oral) and implications for clinical management of T2DM. All CVOTs have confirmed long-acting GLP-1RAs to be noninferior to (not worse than) placebo with regard to first occurrence of a primary outcome of three-point major adverse cardiovascular events (MACE; composite outcome of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke). Further, a number of the studies demonstrated a statistically significant reduction in primary outcomes of three-point MACE with GLP-1RA treatment compared with placebo. As a result, the product labeling for liraglutide, semaglutide injectable, and dulaglutide has been updated with an indication for reducing the risk of MACE in adults with T2DM and established CVD (all) or multiple CV risk factors (dulaglutide only). These findings have brought about an exciting paradigm shift from concern about not inflicting CV harm to the exciting prospect of reducing risks of CV outcomes. Major diabetes care guidelines now encourage early consideration of GLP-1RA use in patients with atherosclerotic CVD.

A national analysis of risk for potential chronic kidney disease of unknown etiology in Ecuador

An increase of chronic kidney disease (CKD) has affected many tropical countries but with an atypical presentation. This illness, known as Chronic Kidney Disease of Unknown Etiology (CKDu), presents in younger adults without the typical comorbidities for CKD, often among those working in agricultural production. The cause of disease is unknown but temperature, heat stress, or dehydration are thought to contribute to the development of this condition. There is no information on whether anyone in Ecuador is affected by this illness. We describe CKD rates in Ecuador and hypothesize that CKD is impacted by temperature and the agricultural industry in Ecuador. Using publicly available data from the Instituto Nacional de Estadísticas y Censos from the years 2010—2015, we describe the rate of CKD among adults aged 20—45 in each province, as well as the agricultural industry across Ecuador. We combined this information with land surface temperature and used a Poisson mixed effects model to assess the relationship between mean temperature, maximum temperature and agricultural industry with CKD rates among adults aged 20—49 in each province. We found that the CKD rate is increasing in this age group over 2010—2015 (p=0.017), and in 2015, CKD rates were highest in Pastaza. Our spatial analysis found that both mean temperature and proportion of population in agriculture were positively associated with CKD rate by province in 2014 and 2015. This preliminary analysis shows that temperature and agricultural industry are associated with CKD rates among adults aged 20—49. While this association does not definitively show the presence of CKDu, it provides evidence to support further investigation of this illness in Ecuador.

Integrated Datasets of Proteomic and Metabolomic Biomarkers to Predict Its Impacts on Comorbidities of Type 2 Diabetes Mellitus.

ObjectiveThe objective of the current study is to accomplish a relative exploration of the biological roles of differentially dysregulated genes (DRGs) in type 2 diabetes mellitus (T2DM). The study aimed to determine the impact of these DRGs on the biological pathways and networks that are related to the associated disorders and complications in T2DM and to predict its role as prospective biomarkers.MethodsDatasets obtained from metabolomic and proteomic profiling were used for investigation of the differential expression of the genes. A subset of DRGs was integrated into IPA software to explore its biological pathways, related diseases, and their regulation in T2DM. Upon entry into the IPA, only 94 of the DRGs were recognizable, mapped, and matched within the database.ResultsThe study identified networks that explore the dysregulation of several functions; cell components such as degranulation of cells; molecular transport process and metabolism of cellular proteins; and inflammatory responses. Top disorders associated with DRGs in T2DM are related to organ injuries such as renal damage, connective tissue disorders, and acute inflammatory disorders. Upstream regulator analysis predicted the role of several transcription factors of interest, such as STAT3 and HIF alpha, as well as many kinases such as JAK kinases, which affects the gene expression of the dataset in T2DM. Interleukin 6 (IL6) is the top regulator of the DRGs, followed by leptin (LEP). Monitoring the dysregulation of the coupled expression of the following biomarkers (TNF, IL6, LEP, AGT, APOE, F2, SPP1, and INS) highlights that they could be used as potential prognostic biomarkers.ConclusionThe integration of data obtained by advanced metabolomic and proteomic technologies has made it probable to advantage in understanding the role of these biomarkers in the identification of significant biological processes, pathways, and regulators that are associated with T2DM and its comorbidities.

611-P: Splenic Stimulation with Focused Ultrasound Aids in Wound Healing

Wound care in at risk populations is a growing problem. The cost of care of these non-healing wounds is projected to be in the billions with the number of people affected being above 6.5 million and increasing as the population ages. There is significant mortality related with non-healing wounds with 5-year rates being higher than many cancers such as prostate or breast. Chronic inflammation, a comorbidity of type 2 diabetes, when left unchecked may result in non-healing wounds. This study explores the use of non-invasive focused ultrasound (FUS) targeted to the spleen to aid in healing of full thickness excision skin wounds in Obese Zucker Diabetic (ZDF) or Zucker Diabetic Sprague Dawley (ZDSD) rats. Splenic stimulation with FUS has been shown to decrease TNF-α 60 minutes post stimulation in both whole blood and the spleen of animals injected with LPS. By decreasing systemic proinflammatory cytokines, wounds may progress to better outcomes. In the current study, FUS was targeted to the spleen daily while wounds were healing (16 days). Hyperglycemic (fed glucose >250 mg/dL) ZDF stimulated with FUS were predicted (by linear regression) to heal 5 days faster than shams (17.1 ±0.8 days vs. 22.3±1.6 days respectively). Glucose levels remained similar throughout the study. The same FUS conditions were applied to prediabetic ZDSD (fed glucose < 195 mg/dL). FUS stimulated rats were predicted to heal 2 days faster than shams (20 ±1.2 vs. 22.3±1.1 respectively). Disclosure C.A. Morton: None. V.E. Cotero-Lefevre: None. C. Puleo: Employee; Self; General Electric. J. Ashe: Employee; Self; General Electric.

Care of Critically Ill Patients with Human Immunodeficiency Virus.

Care of patients with human immunodeficiency virus (HIV) infection in the intensive care unit (ICU) has changed dramatically since the infection was first recognized in the United States in 1981. The purpose of this review is to describe the current important aspects of care of patients with HIV infection in the ICU, with a primary focus on the United States and developed countries. The epidemiology and initial approach to diagnosis and treatment of HIV (including the newest antiretroviral guidelines), common syndromes and their management in the ICU, and typical comorbidities and opportunistic infections of patients with HIV infection are discussed.

NUTRITIONAL STATUS, QUALITY OF LIFE AND LIFE HABITS OF WOMEN WITH IRRITABLE BOWEL SYNDROME: A CASE-CONTROL STUDY.

Irritable bowel syndrome is a functional and chronic gastrointestinal disorder that may cause abdominal pain and altered bowel habits, affecting the nutritional status and quality of life of its carriers. Its prevalence is high, affecting about 10% to 15% of the general population in developed countries, being more prevalent in women than in men in the proportion 2:1. The aim of our study was to compare the profile of body adiposity, life habits, and the quality of life of women with irritable bowel syndrome with a healthy control group. Case-control study on 70 women, 34 with irritable bowel syndrome and 36 healthy. We applied the "Irritable Bowel Syndrome Quality of Life Questionnaire"to assess quality of life. Body adiposity was assessed from body mass index, waist circumference, and waist-to-hip ratio. We investigated the self-reporting of gastrointestinal symptoms with food deemed as problematic for carriers of irritable bowel syndrome and the presence of typical comorbidities. Assessment of life habits included: practice of physical activities, alcoholism, smoking, daytime sleepiness, and exclusion of foods from the feeding routine. For statistical analysis we used the IBM SPSS program, with a significance level at 5%. There was higher volume of central and general adiposity in the case group compared with the control group (P<0.05). Cases presented a higher chance of developing IBS-related comorbidities (P<0.05). About of 80% of patients with irritable bowel syndrome have excluded some food from the diet (P<0.01) and the total amount of troublesome foods varied from 7 to 21 (P<0.01). The case group featured worse quality of life compared with the control (P<0.05). Compared to the control group, women with irritable bowel syndrome showed greater body adiposity, higher frequency of comorbidities, greater restriction on the consumption of problematic foods and worse quality of life.

Diabetes Knowledge and its relationship with metabolic control and comorbidities in type 2 diabetes patients

Background: Education in diabetes patients is key in the intervention to avoid complications and develop new and better habits. It is necessary to know the relationship between the current diabetes knowledge of these patients with their metabolic control and the presence of comorbidities. Objective: To evaluate the diabetes knowledge and its probable association with their metabolic control and comorbidities in type 2 diabetes patients. Methods: A validated questionnaire (Diabetes Knowledge Questionnaire, DKQ) was applied to 134 patients who attended a nutrition consultation at the UMF7-IMSS. Their sociodemographic data, metabolic parameters and presence of comorbidities were determined. Results: 89 patients were women (66.4%). The mean age was 53 years; body weight 75.5 kg (95% CI: 72.8-78.3); glucose 201.2 mg/dL (95% CI: 187-215); cholesterol 205 mg/dL (95% CI: 190.8-219.1); triglycerides 260.7 mg/dL (95% CI: 240.3-281.1). The level of diabetes knowledge is low, a negative relationship was found between age and the number of right answers in the DKQ. High level of general metabolic alterations was found in most of the subjects studied; an increase in the number of comorbidities was observed as glucose levels increased. In the present study, no correlation was found between the level of knowledge in diabetes and the degree of metabolic control. Conclusion: Although patients know the consequences of their disease status, they have difficulty identifying key aspects to prevent complications and promote adequate metabolic control. This work identifies the need to develop studies on effective educational strategies to minimize knowledge gaps about this condition.

Coagulation disorders in Duchenne muscular dystrophy? Results of a registry-based online survey.

Different complications of hemostasis have been reported in patients with Duchenne Muscular Dystrophy (DMD). These comprise an increased rate of bleeding-symptoms during scoliosis surgery but also thromboembolic complications such as pulmonary embolism, cerebral infarction, deep vein thrombosis or cardiac thrombus.For this cross-sectional study, personalized online survey-links were forwarded to 682 registered patients with a genetically confirmed diagnosis of DMD via the German-Austrian DMD patient registry (www.dmd-register.de). The questionnaire enquired data regarding the degree of mobility, disposition to hematoma, epistaxis and gum bleeding, occurrence of peri- and postsurgical hemorrhage, stroke, deep vein thrombosis, and cardiac thromboembolism. Further data on regular medication and age were recorded.Three-hundred-fifty-one DMD-patients completed the questionnaire (response rate of 51.5%). Of those, 164 (46.7%) were ambulatory and 187 (53.3%) were non-ambulatory. Age distribution was homogeneous. Two participants had a history of thromboembolic events (0.6%). Correlations analysis revealed no coherence with the degree of mobility, age or regular medication. A bleeding tendency was reported by 76 participants (21.7%). No significant correlations with age or degree of mobility were found. We found no association with underlying genetic variants.Results of this patient registry-based survey do not indicate a distinct DMD-specific risk for thromboembolic events that exceeds the risk by typical comorbidities of chronic immobility and cardiac insufficiency in advanced stages of the disease. The results of this survey suggest a mild bleeding tendency in this DMD cohort, whereas a selection bias cannot be excluded.

Interrelation of fibroblast growth factor 19 with the bile acids’ levels and lipid profile parameters in patients with chronic non-calculous cholecystitis with and without type 2 diabetes mellitus

Objective — to study changes in the levels of fibroblast growth factor 19 (FGF‑19), bile acids (BAs) and lipid profile parameters in patients with a combined course of type 2 diabetes mellitus (DM2) and chronic non‑calculous cholecystitis (CNC) and with isolated CNC, as well as to investigate the nature of these relationships between the indicators.Materials and methods. Examinations involved 93 patients with CNC, from them CNC was combined with DM2 in 62 cases (the main group). The comparison group consisted of 31 patients with isolated CNC. The age of patients ranged between 44 and 75 years. The DM2 duration varied 1 to 19 years. The control group consisted of 20 practically healthy age‑ and gender‑matching subjects. The assessments included the lipid metabolism status (total cholesterol, high, low and very low density lipoprotein cholesterol («Dac spectrum med reagent» kits, Moldova), triglycerides («Dac spectrum med reagent» kits, Moldova). «Dialab» reagent kit (Austria) was used to determine the blood serum BAs levels. The FRF‑19 level was studied by the enzyme immune method («BioVendor» reagent kit, Czech Republic).Results. It has been established that RFF‑19 levels in the groups of combined CNC‑DM2 pathology and isolated CNC were significantly lower than in patients from the control group, with more pronounced decrease was masked in patients with comorbid pathology. In patients with CNC‑DM2 comorbidity, the serum BAs level was in 4.8 times higher, and in patients with isolated CNC in 2.6 times higher than in subjects from control group (p &lt; 0.05). The comparison of the studied parameters in patients with comorbidity of type 2 diabetes and CNC and patients with isolated CNC showed differences. In patients with CNC‑DM2 comorbidity vs isolated CNC, the BAs levels were higher by 82 % and FGF‑19 levels were lower by 39.6 % (p &lt; 0.05). The changes in lipid profile vs norm were determined in all investigated patients, the most pronounced they were in case of the CNC and DM2 comorbidity. The levels of total cholesterol, triglycerides and low density lipoproteins levels were higher at CNC and DM2 comorbidity by 46.1 %, in 1.4 times and by 29.8 %, respectively (p &lt; 0.05). The levels of high density lipoproteins were significantly lower at the combined course of CNC and DM2 when compared with patients who had isolated CNC (p &lt; 0.05).Conclusions. In patients with comorbidity of type 2 diabetes mellitus and CNC and with isolated cholecystitis, an increase in the serum BAs levels have been established against the background of the low serum levels of their regulator FRF‑19 along with the changes in lipid profile of atherogenic nature when compared with the control group. Dysregulation of BAs homeostasis and proatherogenic activity of lipid profile markers are more profound in cases with the simultaneous course of DM2 and CNC compared to the cases with isolated CNC.

The Psycho-Social Impact of Urinary Incontinence on the Quality of Life among Kuwaiti Women with Type 2 Diabetes Mellitus

This study was conducted to determine the psycho-social impact of urinary incontinence (UI) on the quality of life of 250 Kuwaiti women with type 2 diabetic mellitus (DM). A survey method, using a 33-item 5-point Likert scale Arabic questionnaire adapted from the King’s Health Questionnaire (KHQ), was employed for data collection from February to May, 2014 while all the participants were receiving treatment for UI at a specialized urology center in Kuwait. Participants with UI and a co-morbidity of type 2 DM and obesity were 20 to 65 years old. Results showed the following variables were statistically significant for frequency of urine leak: Age was (χ2 = 36.877, df = 3, P ≤ 0.000). Parity showed nulliparous women reported less urine leak compared to parous women: Chi-square was (χ2 = 24.83, df = 12, P ≤ 0.016). Type 2 DM for more than 3 years duration had the highest incidence of several leaks per day. BMI of above 25 kg/m2 caused daily urine leak: Chi-square (χ2 = 17.912, df = 9, P ≤ 0.036). Participants’ self reports of good general health were those who leaked urine either 2 - 3 times weekly or occasionally. Finally, the impact of incontinence on their lifestyle was reported as extreme by 128 (51.2%), and 6 (2.4%) reported little or no impact on their quality of life: Chi-square was (χ2 = 52.392, df = 18, P ≤ 0.000). In conclusion, this study showed a clear correlation between UI and reduced quality of life. Midwives are well positioned to correct the myth that UI is an inevitable byproduct of childbearing. Midwives should explain to all pregnant women how childbirth can be a risk factor and provide anticipatory guidance by teaching preventive measures like pelvic floor exercises before and after delivery. Family members should assist sufferers in coping with their challenges by dispelling any form of stigmatization, joining them in practicing pelvic floor exercises, and encouraging, empathizing and supporting them emotionally.

The cognitive and psychological effects of living with type 1 diabetes: a narrative review.

Across the lifespan, type 1 diabetes mellitus has a profound (neuro)psychological impact. In young people, type 1 diabetes can interfere with psychosocial development and hamper school performance. In adulthood, it can interfere with work life, relationships and parenting. A substantial minority of adults with type 1 diabetes experience coping difficulties and high diabetes‐related distress. In youth and adulthood, type 1 diabetes is related to mild cognitive decrements as well as affective disorders, such as depression and anxiety. There is limited literature available that explores the interaction between cognitive and psychological comorbidity and underlying mechanisms. The aims of the present narrative review were to summarize the current state of the literature regarding both cognitive and psychological comorbidities in type 1 diabetes across the lifespan, and to explore potential links between the two domains of interest to make suggestions for future research and clinical practice.

PRO61 EPIDEMIOLOGY OF HEMOPHILIA IN GERMANY: RESULTS FROM A GERMAN STATUTORY HEALTH INSURANCE CLAIMS DATABASE-ANALYSIS

Hemophilia is a rare, non-curable disease which manifests in a lack of blood clotting factor and mostly affects men. Little is known about the epidemiology of hemophilia in Germany and recent data describing hemophilia patients are scarce. Our aim was to extend the knowledge on hemophilia by consulting real-world data from a large German health claims database. The study was conducted with an age- and sex-representative sample of the InGef research database. We assessed the prevalence, cumulative incidence, demographic and clinical characteristics of hemophilia patients for the year 2017. Patients were identified by the ICD-10-GM code D66 for hemophilia A and D67 for hemophilia B and a prescription of the respective clotting factors in 2017 or 2016. Approx. 3.5 million insurants were included into the study, from which 127 persons had hemophilia A and 22 persons had hemophilia B. Prevalence of treated hemophilia A was 3.58 cases per 100,000 persons (95%-CI 2.99-4.26) and cumulative incidence (patients of all ages not meeting the case definition in 2016) was 0.34/100,000 (95%-CI 0.17-0.59). Prevalence of hemophilia B was 0.62/100,000 (95%-CI 0.39-0.94). Due to low patient numbers (<5 patients) cumulative incidence of hemophilia B could not be calculated. Mean age of hemophilia A patients was 29±20 years and for hemophilia B 32±20 years. 13.4% of hemophilia A patients were 0-6 years old, 25.2% 7-18 years, 42.5% 19-50 years and 18.9% were ≥50 years old. The most common comorbidities were joint-, pain-, and infection-related diseases, e.g. osteoarthritis, viral hepatitis, or back pain. Our results show novel real-world data on hemophilia patients in Germany. Compared to the German Hemophilia Registry, the prevalence was higher. We found that at the time of the study typical comorbidities like pain-, infection-related, and especially joint-disease were still a major concern for hemophilia patients with need for further research and intervention.

Echocardiography improves prediction of major adverse cardiovascular events in a population with type 1 diabetes and without known heart disease: the Thousand & 1 Study.

Cardiovascular disease is the most common comorbidity in type 1 diabetes. However, current guidelines do not include routine assessment of myocardial function. We investigated whether echocardiography provides incremental prognostic information in individuals with type 1 diabetes without known heart disease. A prospective cohort of individuals with type 1 diabetes without known heart disease was recruited from the outpatient clinic. Follow-up was performed through Danish national registers. The association of echocardiography with major adverse cardiovascular events (MACE) and the incremental prognostic value when added to the clinical Steno T1D Risk Engine were examined. A total of 1093 individuals were included: median (interquartile range) age 50.2 (39.2-60.3) years and HbA1c 65 (56-74) mmol/mol; 53% men; and mean (SD) BMI 25.5 (3.9) kg/m2 and diabetes duration 25.8 (14.6) years. During 7.5years of follow-up, 145 (13.3%) experienced MACE. Echocardiography significantly and independently predicted MACE: left ventricular ejection fraction (LVEF) <45% (n = 18) vs ≥45% (n = 1075), HR (95% CI) 3.93 (1.91, 8.08), p < 0.001; impaired global longitudinal strain (GLS), 1.65 (1.17, 2.34) (n = 263), p = 0.005; diastolic mitral early velocity (E)/early diastolic tissue Doppler velocity (e') <8 (n = 723) vs E/e' 8-12 (n = 285), 1.59 (1.04, 2.42), p = 0.031; and E/e' <8 vs E/e' ≥12 (n = 85), 2.30 (1.33, 3.97), p = 0.003. In individuals with preserved LVEF (n = 1075), estimates for impaired GLS were 1.49 (1.04, 2.15), p = 0.032; E/e' <8 vs E/e' 8-12, 1.61 (1.04, 2.49), p = 0.033; and E/e' <8 vs E/e' ≥12, 2.49 (1.41, 4.37), p = 0.001. Adding echocardiographic variables to the Steno T1D Risk Engine significantly improved risk prediction: Harrell's C statistic, 0.791 (0.757, 0.824) vs 0.780 (0.746, 0.815), p = 0.027; and net reclassification index, 52%, p < 0.001. In individuals with type 1 diabetes without known heart disease, echocardiography significantly improves risk prediction over and above guideline-recommended clinical risk factors alone and could have a role in clinical care.

P2487Echocardiography and NT-ProBNP both provide independent and improved prediction of prognosis in a type 1 diabetes population without heart disease and with preserved ejection fraction

Abstract Background Cardiovascular disease is the most common comorbidity in type 1 diabetes (T1D). Current guidelines, however, do not include routine echocardiography or cardiac biomarkers in T1D. Objectives To investigate if echocardiography and NT-proBNP provide incremental prognostic information in individuals with T1D without heart disease and with preserved left ventricular ejection fraction (LVEF). Methods A prospective cohort of individuals with T1D without heart disease and with preserved LVEF (≥45%) from the outpatient clinic were included. Follow-up was performed through Danish national registers. The association between E/e', a marker of diastolic function, from echocardiography and NT-proBNP with major adverse cardiovascular events (MACE) was tested. MACE was defined as death from all-causes, acute coronary syndromes, cardiac revascularization, incident heart failure, or stroke. Additionally, the incremental prognostic value when adding E/e' and NT-proBNP to the clinical Steno T1D Risk Engine score (including age, sex, duration of diabetes, systolic blood pressure, LDL, HbA1c, presence of albuminuria (micro-or macroalbuminuria), eGFR, smoking status, and physical activity [low, medium, high]), was examined. Follow-up was 100% complete. Results Of 964 individuals (mean (SD)) age 49.7 (14.5) years, 51% men, HbA1c 66 (14) mmol/mol, BMI 25.6 (4.0) kg/m2, and diabetes duration 26.1 (14.5) years), 121 (12.6%) experienced MACE during 7.5 years of follow-up. In the full multivariable model, E/e' significantly and independently predicted MACE: (HR (95%)) E/'e &lt;8 (n=639) vs. 8–12 (n=248): 2.00 (1.23; 3.25), p=0.005, E/'e &lt;8 vs E/e'≥12 (n=77): 3.36 (1.8; 6.1), p&lt;0.001. Also, NT-proBNP significantly predicted outcome: NT-proBNP &lt;150 pg/ml (n=435) vs. 150–450 pg/ml (n=386): 1.52 (0.9; 2.5), p=0.11, NT-proBNP &lt;150 pg/ml vs NT-proBNP &gt;450 pg/ml (n=143): 2.78 (1.6; 4.9), p&lt;0.001. Adding both (log)E/e' and (log)NT-proBNP to the Steno T1D Risk Engine score significantly and incrementally improved risk prediction: Harrell's C-index: Steno T1D Risk Engine (AUC 0.783 (0.747; 0.818)) vs. Steno T1D Risk Engine + (log)E/e' (AUC 0.805 (0.773; 0.837)): p&lt;0.001 and Steno T1D Risk Engine + (log)E/e' + (log) NT-proBNP (AUC 0.816 (0.783; 0.848)): p=0.002. The risk of MACE by groups of E/e' and NT-proBNP is shown in the figure. Figure 1 Conclusion In individuals with T1D without heart disease and with preserved LVEF, E/e' and NT-proBNP significantly improved risk prediction of cardiovascular events beyond clinical risk factors alone. Echocardiography and NT-proBNP could have a role in clinical care.

1726 A Tough Pill to Swallow: A Rare and Unusual Case of Recurrent Esophageal Candidiasis

INTRODUCTION: Esophageal candidiasis (EC) is one of the most common infections in immunocompromised individuals. Fungal infections, particularly in the esophagus, have been found in individuals with predisposing factors, such as uncontrolled diabetes mellitus, gastric acid suppression, malignant neoplasms, corticosteroids, antibiotics, or immunosuppressant use. Factors that suppress cellular immunity often cause opportunistic fungal infections; however, little is known regarding significant risk factors in individuals who are immunocompetent. For our study, we report a rare and unusual case of a 58 year old immunocompetent male who presented with recurrent esophageal candidiasis. CASE DESCRIPTION/METHODS: EC is not a rare complication for individuals who are immune compromised or who are uncontrolled diabetics; however, our case is unique and rare because our patient did not have the typical comorbidities associated with esophageal candidiasis. The patient had a PMHx of well-controlled DM type 2, HIV (-), diet controlled GERD who is not taking PPI therapy who presented with a 20 pound weight loss and dysphagia to solids. An EGD revealed a benign gastric mass and esophageal candida, then treated with Fluconazole. After completion of therapy, he returned with dysphagia, abdominal pain, weakness, and weight loss, requiring hospitalization. A repeat EGD revealed a second EC infection, this one an ulcerated EC infection, which was treated with IV Fluconazole. On outpatient follow up after discharge, the patient underwent CT scan of abdomen/pelvis. It showed moderately thickened and dilated esophageal walls, bullae, and migration of the stent into the stomach which had been placed previously. Additional findings on imaging include, bilateral renal masses, left para-aortic adenopathy, and loculated fluid collection in the abdomen. Consequently, the patient underwent another EGD to remove the stent and was sent to Oncology for further care. DISCUSSION: Our patient’s clinical manifestations, initial findings, and developmental course of the presenting illness in this patient makes this case particularly rare and unusual in terms of assessment and diagnosis. EC in an immunocompetent patient is rare; however, recurrent EC is even rarer. At this time there is limited data reported on attributable causes of EC, especially in individuals without predisposing factors. Thus, this case highlights the need for further investigation regarding the mechanisms of colonization and its development in such individuals are needed.

Clinical Characteristics Of Patients with Type 2 Diabetes Mellitus Receiving a Primary Total Knee Arthroplasty

To characterize the clinical severity and comorbidities of type 2 diabetes mellitus (T2DM) and osteoarthritis (OA) clinical management progression.