Concomitant Medical Conditions Research Articles

Comprehensive insight into common urinary problems in older adults

In geriatric medicine, overactive bladder, incontinence and nocturia are recurrently observed in the elderly demographic. The etiology of these disorders is often multifactorial, with prescribed pharmacotherapies, concomitant medical conditions, and physiological aging processes playing significant roles. For optimal therapeutic outcomes, it is essential for healthcare professionals to undertake a rigorous evaluation to elucidate the underlying etiological contributors and subsequently employ an integrative clinical approach. This review describes the prevalent urinary pathologies in the geriatric population and provides an in-depth analysis of the diverse factors that may compromise normal micturition in older age group.

Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities.

The population of older adults (≥65 years) with type 2 diabetes mellitus (T2DM) is diverse, encompassing individuals with varying functional capabilities, living arrangements, concomitant medical conditions, and life expectancies. Hence, their categorization into different patient profiles (ie, good health, intermediate health, poor health) may aid in clinical decision-making when establishing glycemic goals and pharmacological treatment strategies. Further granularity in assessing each patient profile through interdisciplinary collaboration may also add precision to therapeutic and monitoring decisions. In this review, we discuss with a multidisciplinary approach how to deliver the best benefit from advanced diabetes therapies and technologies to older adults with T2DM according to each patient profile. There remain however several areas that deserve further research in older adults with T2DM, including the efficacy and safety of continuous glucose monitoring and automated insulin delivery systems, the switch to once-weekly insulin, the effectiveness of multidisciplinary care models, and the use of supported telemedicine and remote blood glucose monitoring in the oldest-old (≥85 years) who particularly require the assistance of others.

The efficacy of a single-dose anakinra injection during disease attack in pediatric familial Mediterranean fever.

The aim of this retrospective study is to evaluate the efficacy of a single-dose anakinra during familial Mediterranean fever (FMF) attacks and its effect on the duration, severity, and frequency of attacks. The patients with FMF who had disease episode and received a single-dose anakinra during disease episode between December 2020 and May 2022 were included. Demographic characteristics, MEFV gene variants detected, concomitant medical conditions, demographics of recent and previous episodes, laboratory findings and length of hospital stay were recorded. A retrospective analysis of medical records revealed 79 attacks from 68 patients who met inclusion criteria. The patients had a median age of 13 (2.5-25) years. All patients reported that the average duration of their previous episodes lasted longer than 24h. When the recovery time of attacks after subcutaneous anakinra application at the disease attack was examined, it was observed that 4 attacks (5.1%) ended in 10min; 10 attacks (12.7%) in 10-30min; 29 attacks (36.7%) in 30-60min; 28 attacks (35.4%) in 1-4h; 4 attacks (5.1%) in 24h; and 4 attacks (5.1%) ended in more than 24h. There was no patient who did not recover from their attack after a single dose of anakinra. Although the efficacy of a single-dose anakinra administration during FMF attacks in children needs to be confirmed by prospective studies, our results suggest that use of a single-dose anakinra during FMF attacks is effective in reduction of severity and duration of disease attacks.

An in vivo analysis of implanted programmable device interference during magnetically controlled growing rod lengthenings: a story of 129 lengthenings.

Early-onset scoliosis (EOS) is often treated with magnetically controlled growing rods (MCGR) which can be lengthened with a magnetic external remote control (ERC). Many individuals with EOS have concomitant medical conditions which are managed with other implanted programmable devices (IPD). Some providers are concerned that the magnetic field generated during MCGR lengthening may interfere with other IPD, such as ventriculoperitoneal shunts (VPS), intrathecal baclofen pumps (ITBP), vagal nerve stimulators (VNS), and cochlear implants (CI). The aim of this study was to evaluate the safety of MCGR lengthenings in patients with EOS and other IPD. This single-center, single-surgeon case series followed 12 patients with 13 IPD as they underwent treatment with MCGR. Post MCGR lengthening, monitoring of patient symptoms, and interrogation of IPD were conducted to evaluate for magnetic interference. After 129 MCGR lengthenings, post-lengthening VPS interrogation found 2 instances of potential interference in settings (both in Medtronic Strata shunts); however, no pre-lengthening interrogation was completed to confirm if these changes occurred prior to or during the lengthening procedure. ITBP interrogation found no changes, and there were no patient-reported adverse effects related to VNS or CI function. It is safe and effective to utilize MCGR in patients with IPD. However, the possibility of magnetic interference must be considered, particularly in individuals with VPS. We recommend approaching with the ERC from a caudal direction to minimize potential interference and all patients be monitored during treatment. If possible, IPD settings should be assessed pre-lengthening, confirmed afterwards and readjusted if necessary. Level IV.

Association of Acute Myocardial Infarction with Ossification of the Posterior Longitudinal Ligament in Korea: A Nationwide Longitudinal Cohort Study

Objective: This nationally matched longitudinal study aimed to investigate the relationship between acute myocardial infarction (AMI) and ossification of the posterior longitudinal ligament (OPLL) in Korea.Methods: We collected patient data from January 1, 2004 to December 31, 2015 from the National Health Insurance Service Health Screening Cohort. Patients with OPLL were defined as patients with the International Classification of Diseases, Tenth Revision code M48.8 (other specified spondylopathies) and were newly diagnosed through computed tomography imaging. The OPLL group had a total of 1,289 patients. The control group included 6,445 people. Utilizing the Kaplan-Meier technique, The incidence of AMI in both groups was estimated. A Cox proportional-hazards regression analysis was used to compute the AMI hazard ratio.Results: After controlling for age and sex, the hazard ratio of AMI in the OPLL group was 2.065 (95% confidence interval [CI], 1.228-3.474). The adjusted hazard ratio in the OPLL group was 2.209 after restricting the sample for demographics and concomitant medical conditions (95% CI, 1.311-3.721). In a subgroup analysis, the incidence of AMI was substantially greater in the OPLL group, which included women younger than 65 years and without hypertension, diabetes, or dyslipidemia.Conclusion: This nationwide longitudinal study found that patients with OPLL were at higher risk of AMI.

Genotype-phenotype correlation in Jordanian children with genetically-proven familial Mediterranean fever: The effect of R202Q mutation

<h3>Background</h3> Familial Mediterranean fever (FMF) is a hereditary periodic fever syndrome inherited as an autosomal recessive pattern; nonetheless, patients with symptomatic heterozygous variants exist. This study aimed to review children with genetically-proven FMF, to describe their mutation maps and clinical characteristics, and to explore the genotype–phenotype correlation. <h3>Methods</h3> Medical charts of pediatric FMF patients who were diagnosed by both genetic mutation and clinical criteria and followed up at our hospital were reviewed. Demographic and clinical data, results of <i>MEFV</i> genetic testing, procedures, concomitant medical conditions, disease severity, and treatment response were recorded and analyzed. <h3>Results</h3> A total of 132 patients (71 females [54%]) were included in the final analysis. The average ages at presentation and diagnosis were 6.2 ± 3.1 and 7.6 ± 4.4 years, respectively. The most common clinical features were abdominal pain (n = 120, 91%), fever (n = 97, 73.5%), and arthritis (n = 75, 56.2%). Gastrointestinal endoscopy was the most frequently reported procedure (n = 27, 20.45%). The most common mutation was R202Q (n = 71, 53.8%), followed by E148Q (n = 36, 27.3%), M694V (n = 30, 22.7%), and V726A (n = 22, 16.7%). Two rare variants with potential pathogenicity were identified—namely, c.-15 and c.-330. A novel <i>MEFV</i> mutation (p. Lys629 Met) was noted. Abdominal pain, arthritis, arthralgia, and skin rashes were more common with the R202Q mutation. Patients with compound heterozygous mutations showed a higher rate of abdominal pain (94.1%) and exhibited the best response to colchicine (67.6%). Patients with complex alleles had the highest rate of fever (80%) and arthritis/arthralgia (70%). <h3>Conclusion</h3> FMF is endemic in Jordan. Genetic testing is important in FMF evaluation; however, the genotype–phenotype correlation needs further study. The R202Q mutation is possibly pathogenic and is associated with the manifestation of the full spectrum of FMF features; hence, it needs to be considered in the diagnosis of FMF patients in Jordan.

Selective Serotonin Reuptake Inhibitor (SSRI) Bleeding Risk: Considerations for the Consult-Liaison Psychiatrist.

To present a clinically oriented review of selective serotonin reuptake inhibitor (SSRI)-related bleeding issues commonly addressed by consult-liaison psychiatrists. Concomitant medical, surgical, or hospital-based conditions exacerbate the risk of SSRI-related bleeding even though a review of the literature suggests it is only marginally elevated. Psychiatrists and other clinicians need to consider these conditions along with antidepressant benefits when answering the question: to start, hold, continue, or change the antidepressant? Where an evidence base is limited, mechanistic understanding may help consult-liaison psychiatrists navigate this terrain and collaborate with other medical specialties on responsible antidepressant management. Most often, the risk is cumulative; data are not directly applicable to complex clinical situations. This review incorporates a hematologic perspective and approach to bleeding risk assessment along with extant data on SSRI-induced bleeding risk ad specific medical conditions.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

The Association of Acute Myocardial Infarction with Pyogenic Spondylitis in Korea: A Nationwide Longitudinal Cohort Study

Objective: The goal of this nationally matched longitudinal study was to investigate the relationship between acute myocardial infarction (AMI) and pyogenic spondylitis (PS) in Korea.Methods: We collected patient data from the National Health Insurance Service Health Screening cohort from January 1, 2004 to December 31, 2015. PS was classified using the International Classification of Diseases codes M46.2 (osteomyelitis), M46.8 (inflammatory spondylopathy), M49.2 (enterobacterial spondylitis), and M49.3 (enterobacterial spondylitis) (spondylopathy in other infectious and parasitic diseases). The PS group had a total of 628 patients. The control group included 3,140 people. Utilizing the Kaplan-Meier technique, the groups’ AMI rates were estimated. A Cox proportional-hazards regression analysis was used to compute the hazard ratio for AMI.Results: After controlling for age and sex, the hazard ratio for AMI in the PS group was 2.241 (95% confidence interval [CI], 1.112-4.516). The adjusted hazard ratio in the PS group was 2.138 after controlling for demographics and concomitant medical conditions (95% CI, 1.056-4.318). In a subgroup analysis, the AMI percentages were substantially greater in the PS group in women over 65, those with diabetes, and in non-hypertension and non-dyslipidemia subgroups. Conclusion: This nationwide longitudinal study found that PS patients had an elevated risk of AMI.

Characteristics and outcomes of vaccinated and nonvaccinated patients hospitalized in a single Italian hub for COVID-19 during the Delta and Omicron waves in Northern Italy

ObjectiveWe compared the characteristics and outcomes of vaccinated and nonvaccinated patients hospitalized with COVID-19. DesignWe analyzed patients hospitalized in a COVID hub during three one-month periods: (i) October 15, 2020-November 15, 2020 (prevaccination peak); (ii) October 15, 2021-November 15, 2021 (Delta wave); (iii) December 15, 2021-January 15, 2022 (Omicron wave). To define the epidemiologic context, SARS-CoV-2 infection in healthcare workers was analyzed. ResultsSARS-CoV-2 infection incidence in healthcare workers was 146 cases per 1000 persons in 2020 (prevaccination) and 67 in 2021 (postvaccination, when the Omicron variant caused most infections). There were 420 hospitalized patients in the prevaccination period, 51 during the Delta wave (52.1% vaccinated) and 165 during the Omicron wave (52.9% vaccinated). During the Delta wave, a significantly higher number of nonvaccinated (29.2%) than vaccinated patients (3.7%) were admitted to the intensive care unit (ICU) (p = 0.019). Nonvaccinated patients were younger and had a lower rate of concomitant medical conditions (53.2% vs 83.7%; p < 0.001) during the Omicron wave when 80% of patients admitted to ICU and all those who died were still infected by the Delta variant. ConclusionsVaccine effectiveness in fragile individuals appears to be lower because of a faster immunity decline. However, the Omicron variant seems to cause less severe COVID-19.

Sodium-glucose cotransporter 2 inhibitor associated diabetic ketoacidosis in chronic heart failure: a case series

Abstract Funding Acknowledgements Type of funding sources: None. Background The sodium-glucose cotransporter 2 inhibitor (SGLT2i) medications have proven mortality and morbidity benefit for patients with type 2 diabetes mellitus (T2DM) and chronic heart failure (HF) over the previous decade leading to a rapid expansion of societal guideline recommendations and US FDA indications. With this rapid expansion of SGLT2i indications and prescribing, it is essential that we understand the safety and adverse effects of this drug class. Diabetic ketoacidosis (DKA) is a life-threatening adverse effect of the SGLT2i that has been described in post-marketing reports, prompting an FDA warning. The clinical characteristics of patients with T2DM and HF who develop SGLT2i associated DKA are lacking. Purpose To describe the clinical characteristics of patients with T2DM and chronic HF prescribed SGLT2i who develop DKA. Methods Data was collected retrospectively with Penn State Health TriNetX Local, a web-based tool for healthcare system research population queries, between January 1, 2013-December 31, 2020. Patients with T2DM and chronic HF who were prescribed empagliflozin, canagliflozin or dapagliflozin and subsequently developed DKA were eligible for inclusion. Patients with type 1 diabetes mellitus were excluded. Patient health records were reviewed to confirm SGLT2i use at the time of DKA hospitalization. Baseline characteristics, clinical features and outcome data of hospitalized patients were collected. Results Four unique patient records were identified. Mean age was 59.8 years, BMI 30.5 kg/m2, HbA1c 10.6%. Two patients had baseline heart failure mid-range ejection fraction and two patients had heart failure preserved ejection fraction. All patients were baseline NYHA class II, ACC/AHA stage C. Three patients were on a baseline diuretic, two were on ACE/ARB, two were on beta blocker, three were on metformin, two were on pioglitazone and none were on insulin. Two patients were on baseline empagliflozin 10 mg daily and two were on canagliflozin 100 mg daily. Two patients were on SGLT2i for less than 1 month prior to presentation. Three patients presented with SGLT2i associated DKA and one with euglycemic DKA. None of the patients presented with decompensated congestive HF. Three patients presented with concomitant acute medical conditions; Fournier’s gangrene, asthma exacerbation and alcoholic hepatitis. One patient developed acute stress induced cardiomyopathy while hospitalized. Another patient suffered cardiac arrest secondary to acidosis. Average duration of insulin infusion was 60 hours before resolution of DKA. All of the patients recovered. Conclusions In this single center study, we presented four unique cases of SGLT2i associated DKA in patients with T2DM and chronic HF. Diagnosis can be challenging as concomitant acute medical conditions and/or euglycemia can mask underlying DKA. Early diagnosis and management of SGLT2i associated DKA is important as this condition is life-threatening.

Hypothyroidism and Levothyroxine, Review Article

Hypothyroidism is a communal thyroid hormone deficit disorder. It affects ten percent of the general population and it is estimated that 5% go undiagnosed. If not treated properly, it can cause serious health problems and even death1-2. There is no great variability in the clinical picture or specificity of symptoms, therefore it is most often diagnosed mainly biochemically3. Levothyroxine (L-thyroxine, LT4) is the gold standard in the treatment of hypothyroidism. It was introduced in 1949 and has since improved the lives of millions of hypothyroid patients. As it is usually given for the patient's life, the dose can be affected by physiological changes. In addition, the dosage should be adjusted in the event of concomitant medical conditions, pregnancy and the elderly. Clinically significant interactions between levothyroxine and other drugs, food and dietary supplements may occur. This can change the safety and effectiveness of the treatment4-5. The physician should be aware of the use of thyroxine and its interactions with other medications and diet6. Hypothyroidism, levothyroxine uses and dose adjustments and their interactions will be discussed in this review. Keywords: hypothyroidism, levothyroxine, dose adjustment, interaction

Factors Associated with Colorectal Cancer Prevalence Among Long-Haul Truck Drivers in the United States.

To determine the age-adjusted association between colorectal cancer (CRC) risk factors and CRC prevalence among long-haul truck drivers (aged 21-85), after adjustment for age. Pooled cross-sectional analysis using Commercial Driver Medical Exam (CDME) data. Setting. National survey data from January 1, 2005, to October 31, 2012. 47,786 commercial motor vehicle drivers in 48 states. CRC prevalence was the primary outcome; independent variables included demographics, body mass index (BMI), and concomitant medical conditions. Kruskal-Wallis tests to analyze continuous variables; Fischer's exact tests to analyze categorical variables; univariate and multivariable logistic regression for rare events (Firth method) to quantify the association between the independent variables of interest and CRC prevalence. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for age, gender, years with current employer, year of exam, and BMI in a multivariate logistic regression. Many factors were statistically significant. Obesity (OR = 3.14; 95% CI = 1.03-9.61) and increasing age (OR = 1.10 per year; 95% CI = 1.07-1.13) were significantly associated with CRC prevalence. Truckers with 4 or more concomitant medical conditions were significantly more likely to have CRC (OR = 7.03; 95% CI = 1.83-27.03). Our findings highlight mutable risk factors and represent an opportunity for intervention that may decrease CRC morbidity and mortality among truck drivers, a unique population in the United States estimated to live up to 16years less than the general population.

Need for resuming sports and physical activity for children and adolescents following COVID-19 infection.

IntroductionA decline in sports activities among children and adolescents was noted during the stay-at-home restrictions imposed by COVID-19. With the easing of restrictions, physical activities are being resumed.Evidence acquisitionA data search was conducted to identify the role of parents in resuming sporting activities, the risks and benefits of doing so, the physical examination to be conducted prior to physical activity, the existence of guidelines/protocols for return to sports and physical activity, the role of comorbidities in influencing the restart of the same.Evidence synthesisParents should consult the child’s physician prior to allowing he/she to resume physical exercise. In preparation for this, a careful physical examination should be performed. Children with COVID-19, even if asymptomatic, should not resume any physical activity until at least 10 days after testing positive. Those with moderate or severe COVID-19 should be referred for cardiological evaluation. The level of activity should be resumed gradually, as per the GRTP protocol. Athletes with a positive COVID-19 test in the presence of concomitant medical conditions (diabetes, cardiovascular or respiratory or renal disease) should undergo medical evaluation prior to adhering to a GRTP. Those with complicated COVID19 infection or long Covid may need additional investigations.ConclusionsWhile there is no doubt that it will bring multiple benefits in terms of general health, returning to play sport should be gradual and preceded by an accurate physical examination in those young subjects previously affected by the coronavirus disease, especially when their heart and/or lungs and/or kidneys were affected.

Frailty Syndrome-Fall Risk and Rehabilitation Management Aided by Virtual Reality (VR) Technology Solutions: A Narrative Review of the Current Literature.

Frailty, a physiological syndrome (FS) affecting primarily the older adults, manifests itself through significantly depleted bodily reserves, and appreciably higher (up to over threefold) individual exposure to fall risk. Concomitant medical conditions such as balance impairment, reduced visual acuity, limited mobility, and significantly diminished daily functional performance further exacerbate the patients’ condition. Their resultant susceptibility to frequent hospitalisations makes their prognosis even worse. This narrative review aimed to provide an overview of published studies focused on rehabilitation management approaches aided by virtual reality (VR) technology in frail older adults. The authors had it also augmented with their own, evidence-based body of experience in rehabilitation. Making use of technologically advanced exercise machinery, specially adapted for rehabilitating frail older adults, combined with a structured exercise regimen, further aided by the application of select virtual reality (VR) technology solutions, clearly proved effective. Consequently, the patients were helped to move back from the frail to the pre-frail stage, as well as had their motor and cognitive functions appreciably enhanced. The application of modern technology in rehabilitating older adults over 65, affected by FS, when specifically aided by the select VR technology solutions, was also proven to complement successfully the conventional rehabilitation management. The overall versatility of the VR technology solutions, e.g., adaptation for home use allowing remote supervision, also makes this novel approach to rehabilitation far more appealing to the patients. They find it both very attractive and far more mentally engaging. Its considerable potential lies mostly in being appreciably more effective in bringing in desirable therapeutic outcomes.

Small steps, strong shield: directly measured, moderate physical activity in 65 361 adults is associated with significant protective effects from severe COVID-19 outcomes

ObjectiveTo determine the association between directly measured physical activity and hospitalisation, intensive care unit (ICU) admission, ventilation and mortality rates in patients with a confirmed diagnosis of COVID-19.MethodsDirectly measured physical...

Chemotherapy delivery in early-onset colorectal cancer is impacted by urban versus rural settings in Colorado.

19 Background: While colorectal cancer (CRC) incidence has been decreasing overall, incidence in adults under age 50 has been rising both nationally and across Colorado. National guidelines have adapted to recognize this trend, but knowledge gaps regarding early-onset CRC remain. This group has previously established rising early-onset CRC incidence in Colorado, as well as later stage at diagnosis and worse prognosis. This study examines demographics, treatment, survival, and concomitant disease among patients &lt; 50 and diagnosed with CRC across a multicenter healthcare system in Colorado in order to better understand early-onset CRC. Methods: We analyzed 1,192 CRC cases in patients &lt; 50 from the Colorado Health Data Compass database and cross-referenced these cases with the Colorado Central Cancer Registry to examine for association of gender, race/ethnicity, BMI, zip code, insurance type, stage, and concomitant medical conditions with overall survival and oncologic treatment modality. Logistic regressions were used to evaluate the relationships between chemotherapy and the important variables while adjusting for covariates, with 95% confidence intervals reported. Cox proportional hazard regressions were used to evaluate the relationships between overall survival and the important variables while adjusting for covariates, with 95% confidence intervals reported. Results: Overall, early-onset CRC in our population was 2.8% stage I, 6.3% stage II, 12.7% stage III, 18.5% stage IV, and 59.8% were unstageable or no stage recorded. Surgical treatment was associated with a 52% improvement in overall survival. Chemotherapy treatment was not associated with any survival changes in stage II disease. Radiation treatment, insurance type, number of concomitant conditions, geographic location, and race/ethnicity were not associated with overall survival. Upon exploring chemotherapy relationships, patients from urban areas were significantly more likely to receive chemotherapy than patients from rural areas, while adjusting for ethnicity, inpatient encounters, and stage (OR 5.55, p = 0.001). Conclusions: While less is known about CRC in patients &lt; 50, trends are emerging that are not as well described in a traditional CRC population. The difference between urban and rural patients and their rates of chemotherapy points to a potential disparity in access to care, particularly when considering advanced stage CRC. This persisted through insurance type, indicating that distance from an infusion center, rather than ability to pay, is more likely to be driving this relationship. Further research is needed to determine if these findings are generalizable to the larger early-onset CRC population, and how access may be affecting care for this population.

Abstract PO-184: Investigating factors associated with colorectal cancer incidence among long-haul truck drivers in the United States

Abstract A retrospective cross-sectional analysis using Commercial Driver Medical Exam (CDME) data was performed to determine the association between colorectal cancer (CRC) risk factors and CRC incidence among long-haul truck drivers (ages 21-85), after adjustment for age. Our hypothesis was that long-haul truck drivers with poor health have a higher prevalence of CRC due to the confluence of CRC risk factors experienced by this population after adjusting for age. CRC is a common and deadly malignancy with several known risk factors, including heavy alcohol use, obesity, high consumption of processed and red meat, sedentary lifestyle, and tobacco use. Long-haul truck drivers have a high prevalence of the abovementioned risk factors, yet CRC risk has not been studied in this group. Given the reported risk factors associated with the truck driving occupation married to the lack of health literature and, a need remains to extensively examine the health of long-haul truck drivers. National survey data from January 1, 2005, to October 31, 2012, among commercial motor vehicle drivers in 48 states were examined. The CDME does not have a specific question about CRC diagnosis, text recognition was used to identify specific terms in the CDME notes and comments. Next, the entire CDME was reviewed by two researchers to determine definite versus probable CRC diagnosis, blinded to all other data. Our team also identified 311 records by searching for the following terms: colon, rectum, cancer, colorectal, CRC, and polyp. To achieve the study purpose, Kruskal-Wallis tests were employed to analyze continuous variables and Fischer's exact tests to analyze categorical variables. CRC incidence was the primary outcome, while our independent variables included demographics, body mass index, along with concomitant medication conditions verified by a medical examiner. Univariate and multivariable logistic regression was utilized to quantify the magnitude and direction of the association between our independent variables of interest and CRC incidence. Odds ratio (OR) and 95% confidence intervals (95% CI) were adjusted for age, gender, years of employment with the company, and Body Mass Index in a multivariate logistic regression. Obesity (OR=4.28; 95% CI=1.28-14.29) and increasing age (OR=1.09; 95% CI=1.06-1.12) were significantly associated with CRC incidence. Additionally, truckers with 4+ concomitant medical conditions were more likely to have CRC (OR=5.58; 95% CI=1.26 – 24.75). Despite a growing body of literature ascertaining the health of truck drivers and risk factors associated with truck driving as an occupation, knowledge gaps remain, and inadequate data is available on this population for CRC. Our findings highlight mutable risk factors and represent an opportunity for intervention that may decrease CRC morbidity and mortality among truck drivers—a unique population estimated to live up to 16 years less than the general male population. Citation Format: Jasmine A. Lopez, Ethan M. Petersen, Folasade P. May, Ellen Brooks, Matthew S. Thiese, Carson D. Kennedy, Charles R. Rogers. Investigating factors associated with colorectal cancer incidence among long-haul truck drivers in the United States [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-184.

Invasive aspergillosis in patients with COVID-19 in intensive care units: results of a multicenter study

Objective. To study risk factors, clinical and radiological features and effectiveness of the treatment of invasive aspergillosis (IA) in adult patients with COVID-19 (COVID-IA) in intensive care units (ICU). Materials and Methods. A total of 60 patients with COVID-IA treated in ICU (median age 62 years, male – 58%) were included in this multicenter prospective study. The comparison group included 34 patients with COVID-IA outside the ICU (median age 62 years, male – 68%). ECMM/ISHAM 2020 criteria were used for diagnosis of CAPA, and EORTC/MSGERC 2020 criteria were used for evaluation of the treatment efficacy. A case-control study (one patient of the main group per two patients of the control group) was conducted to study risk factors for the development and features of CAPA. The control group included 120 adult COVID-19 patients without IA in the ICU, similar in demographic characteristics and background conditions. The median age of patients in the control group was 63 years, male – 67%. Results. 64% of patients with COVID-IA stayed in the ICU. Risk factors for the COVID-IA development in the ICU: chronic obstructive pulmonary disease (OR = 3.538 [1.104–11.337], p = 0.02), and prolonged (&gt; 10 days) lymphopenia (OR = 8.770 [4.177–18.415], p = 0.00001). The main location of COVID-IA in the ICU was lungs (98%). Typical clinical signs were fever (97%), cough (92%), severe respiratory failure (72%), ARDS (64%) and haemoptysis (23%). Typical CT features were areas of consolidation (97%), hydrothorax (63%), and foci of destruction (53%). The effective methods of laboratory diagnosis of COVID-IA were test for galactomannan in BAL (62%), culture (33%) and microscopy (22%) of BAL. The main causative agents of COVID-IA are A. fumigatus (61%), A. niger (26%) and A. flavus (4%). The overall 12-week survival rate of patients with COVID-IA in the ICU was 42%, negative predictive factors were severe respiratory failure (27.5% vs 81%, p = 0.003), ARDS (14% vs 69%, p = 0.001), mechanical ventilation (25% vs 60%, p = 0.01), and foci of destruction in the lung tissue on CT scan (23% vs 59%, p = 0.01). Conclusions. IA affects predominantly ICU patients with COVID-19 who have concomitant medical conditions, such as diabetes mellitus, hematological malignancies, cancer, and COPD. Risk factors for COVID-IA in ICU patients are prolonged lymphopenia and COPD. The majority of patients with COVID-IA have their lungs affected, but clinical signs of IA are non-specific (fever, cough, progressive respiratory failure). The overall 12-week survival in ICU patients with COVID-IA is low. Prognostic factors of poor outcome in adult ICU patients are severe respiratory failure, ARDS, mechanical ventilation as well as CT signs of lung tissue destruction.

Characterization of a transgender population in Portugal

IntroductionGender dysphoria (GD) is a condition in which the individual's gender identity does not correspond to their biological sex, causing significant distress. Biological males who identify as females are referred to as transgender females or as showing male-to-female GD (MtF GD) and biological females who identify as males are referred to as transgender males or as showing female-to-male GD (FtM GD). In our center, there is a multidisciplinary consultation to approach and follow patients with GD. AimWe aimed to analyze the characteristics of the individuals who attend this consultation. MethodsRetrospective study of individuals attending the Sexual Medicine Group Consultation. Age, comorbidities, symptom onset, and hormonal and surgical treatment were analyzed. ResultsIn total, 114 patients were diagnosed with GD: 68.4% FtM GD and 31.6% MtF GD. Median age was 30.2±12years. Among the patients, 63.2% reported symptom onset in childhood: 14.9% between 10 and 18years, and 4.4% later than 18years. Median age at treatment initiation was 23.1±7.1years. Several individuals had concomitant medical conditions, notably smoking (n=37; 32.5%) and depression (n=26; 22.3%). The majority of (92.3% FtM GD and 88.9% MtF GD) were under hormone treatment, and about one-third had undergone some sex reassignment surgery. DiscussionWe found higher prevalence of FtM than MtF, in contrast with most other studies. The reasons for this are not clear. A high percentage of our patients were self-medicated. Other characteristics were similar to those previously reported. ConclusionMedical requests by individuals with GD are increasing worldwide. To our knowledge, this is the first study to portray a case series in a consultation center dedicated to the diagnosis, treatment and follow-up of individuals with GD in Portugal.