Department Of General Hospital Research Articles

P110 Characteristics of Difficult to treat Rheumatoid Arthritis patients in a large District Hospital in the UK

Abstract Background/Aims Difficult-to-treat rheumatoid arthritis (D2T RA) has a notably higher impact on a patient’s quality of life and is a significant cost and service pressure to the health care provision in comparison to non-D2T RA. The primary aim of this study is to delineate the major contributing factors and characteristics of patients leading to a diagnosis of D2T RA, using the criteria established by the European League Against Rheumatism (EULAR). Methods A retrospective study was conducted within the Rheumatology department in a large district general hospital, with a catchment population of over 700,000 people. A cohort of 722 patients, all of which were on biologic Disease Modifying Anti-Rheumatic Medications (DMARDs) was selected. In this study, we present our findings for the first 95 consecutive patients. Results Of the selected 95 patients, 13% met the EULAR criteria for D2T RA. The key characteristics within this subset include 75% being sero-positive (both Rheumatoid factor and anti-cyclic citrullinated peptide), 66% being categorized as obese, and 42% having concurrent fibromyalgia and osteoarthritis. Among these 13% D2T RA patients, 25% demonstrated a high disease activity index and 75% showed moderate severity. All these patients had been started on at least two conventional DMARDs including methotrexate before escalating to more advanced treatments in line with NICE guidelines. From the subgroup of high disease activity D2T RA patients, 67% had tried at least three types of biologic or targeted synthetic DMARDs (b/ts DMARDs), and 33% had been trialled on four different types of b/ts DMARDs. Similarly, out of the medium severity D2T RA subgroup, 45% had tried three and four DMARDs respectively and 10% had been given five biologic or synthetic DMARDs. Conclusion The major contributing factors leading to D2T RA within this study population appear to be seropositivity for both RF and anti-CCP, obesity, and the presence of comorbidities like fibromyalgia and osteoarthritis. The intertwined relationship between these factors emphasizes the need for a comprehensive and individualized approach to managing patients with D2T RA. Although this cohort is larger than the previous studies, the sample size is relatively small. We aim to look at the remaining 627 patients to identify trends and modifiable risk factors that could help prevent the future development of D2T RA. Disclosure K. Oo: None. M. Memon: None. P. Sharma: None. S. Dahiya: None.

Assessment of Left Ventricular Hypertrophy Incidence and Antihypertensive Therapy Efficacy in Hypertensive Patients

Objectives: This study aimed to assess the incidence of left ventricular hypertrophy (LVH) in hypertensive individuals in Karachi, Pakistan, and to evaluate the effectiveness of antihypertensive therapy in preventing LVH. Methodology: A total of 200 hypertensive patients were referred from the Cardiac OPD to the Radiology department of Medicare Cardiac and General Hospital, Karachi, for echocardiography. Echocardiographic measurements of cardiac chambers were performed by expert echocardiographers, and left ventricular mass (LVM) was calculated using the formula recommended by the American Society of Echocardiography. Results: Among the hypertensive patients, 100 had uncontrolled blood pressure (≥140/90 mmHg) while 100 had controlled blood pressure (≤130/80 mmHg). The female-to-male ratio was 3:1, with ages ranging from 21 to 80 years. Patients with uncontrolled hypertension exhibited a higher mean body mass index (29 ± 5 kg/m2) and significantly elevated LVM (mean 154 ± 4 g/m2). Angiotensin receptor inhibitors were the most commonly prescribed and effective antihypertensive agents, either as monotherapy or in combination therapy (60%), demonstrating utility in preventing LVH. Conclusion: This study highlights a high incidence of LVH in uncontrolled hypertensive individuals compared to those with controlled hypertension. Transthoracic echocardiography emerged as a highly valuable, non-invasive tool for measuring LVM and assessing the effectiveness of antihypertensive therapy.

Navigating personal recovery: multinomial logistic regression analysis of schizophrenia outcomes in community-dwelling individuals

BackgroundSchizophrenia is a chronic mental disorder affecting individuals globally, emphasising the significance of personal recovery in mental healthcare. Understanding the recovery stages and the associated factors can provide essential insights...

Cost-effectiveness of sodium zirconium cyclosilicate for advanced chronic kidney patients in Singapore.

Hyperkalaemia (HK) is prevalent among patients with chronic kidney disease (CKD) and chronic heart failure, especially if they are treated with renin-angiotensin-aldosterone system inhibitors (RAASi). This study evaluated the cost-effectiveness of a newly developed anti-HK therapy, sodium zirconium cyclosilicate (SZC), to the current standard of care for treating HK in advanced CKD patients from the Singapore health system perspective. We adapted a global microsimulation model to simulate individual patients' potassium level trajectories with baseline potassium ≥5.5 mmol/L, CKD progression, changes in treatment, and other fatal and non-fatal events. Effectiveness data was derived from ZS-004 and ZS-005 trials. Model parameters were localised using CKD patients' administrative and medical records at the Singapore General Hospital Department of Renal Medicine. We estimated the lifetime cost and quality-adjusted life years (QALYs) of each HK treatment, and the incremental cost-effectiveness ratio of SZC. SZC demonstrated cost-effectiveness with an incremental cost-effectiveness ratsio of SGD 45 068 per QALY over a lifetime horizon, below the willingness-to-pay threshold of SGD 90 000 per QALY. Notably, SZC proved most cost-effective for patients with less severe CKD who were concurrently using RAASi. Sensitivity analyses confirmed the robustness of the findings, accounting for alternative parameter values and statistical uncertainty. This study establishes the cost-effectiveness of SZC as a treatment for HK, highlighting its potential to mitigate the risk of hyperkalaemia and optimise RAASi therapy. These findings emphasise the value of integrating SZC into the Singapore health system for improved patient outcomes and resource allocation.

Risk factor analysis and prediction model construction for surgical patients with venous thromboembolism: A prospective study

Abstract Objective: Patients undergoing surgery are at high risk of developing venous thromboembolism (VTE). This study aimed to determine the predictive value of risk factors for VTE in surgical patients and to develop a prediction model by integrating independent predictors. Methods: A total of 1111 patients who underwent surgery at clinical departments in a tertiary general hospital were recruited between May and July 2021. Clinical data, including patient-related, surgery-related, and laboratory parameters, were extracted from the hospital information system and electronic medical records. A VTE prediction model incorporating ten risk variables was constructed using artificial neural networks (ANNs). Results: Ten independent factors (X1: age, X2: alcohol consumption, X3: hypertension, X4: bleeding, X5: blood transfusions, X6: general anesthesia, X7: intrathecal anesthesia, X8: D-dimer, X9: C-reactive protein, and X10: lymphocyte percentage) were identified as associated with an increased risk of VTE. Ten-fold cross-validation results showed that the ANN model was capable of predicting VTE in surgical patients, with an area under the curve (AUC) of 0.89, a Brier score of 0.01, an accuracy of 0.96, and a F1 score of 0.92. The ANN model slightly outperformed the logistic regression model and the Caprini model, but a DeLong test showed that the statistical difference in the AUCs of the ANN and logistic regression models was insignificant (P>0.05). Conclusion: Ten statistical indicators relevant to VTE risk prediction for surgical patients were identified, and ANN and logistic regression both showed promising results as decision-supporting tools for VTE prediction.

Utilization of repeat services in the outpatient department of Dewi Sartika general hospital, Kendari City, 2023

The reutilization of services in outpatient clinics of hospitals plays a crucial role in enhancing the quality and effectiveness of healthcare services. This study aims to analyze the factors associated with service reutilization in hospital outpatient clinics using a cross-sectional design and quantitative approach. Data were collected through questionnaires from 100 respondents at Dewi Sartika General Hospital in Kendari, Southeast Sulawesi, during October-November 2023, using accidental sampling techniques. The analysis results indicate that factors such as service quality, family encouragement, facilities, location, and patient attitudes are significantly associated with service reutilization in outpatient clinics. Univariate analysis was used to describe sample and variable characteristics, while bivariate analysis involved correlation testing to evaluate the relationships among variables. The conclusion of this study highlights the importance of enhancing communication, education, and family support in influencing patient decisions to reuse the same services at the hospital. The development of family support programs, patient empowerment, family-friendly policies, and periodic program evaluations are crucial steps in improving patient experiences and healthcare outcomes. Recommendations include critical steps such as enhancing communication, education, and family support, as well as developing structured family support programs, empowering patients, implementing family-friendly policies, and conducting regular program evaluations. It is expected that the implementation of these recommendations will improve patient experience, enhance adherence to treatment, and overall improve healthcare outcomes.

Open-Access Oesophagogastroduodenoscopy as an Effective and Safe Strategy for Patients With Non-alarming Symptoms.

Open-access oesophagogastroduodenoscopy (OAO) is defined as the performance of oesophagogastroduodenoscopy (OGD) requested by referring physicians without a prior specialist consultation. With the increasing demand for specialist appointments, the use of OAO has helped to reduce healthcare utilization by decreasing prior clinic visits. This also allows endoscopies to be scheduled and performed earlier. This study aims to evaluate our experience in providing OAO services to patients with non-alarming dyspepsia symptoms under the age of 60. The records of patients scheduled for OAO from January 2019 to December 2022 at Singapore General Hospital (SGH) Department of Gastroenterology were analyzed. Five hundred sixty-nine patients were scheduled for OAO, and 436 patients underwent the procedure. The mean age of patients was 45.7 (SD=10.9) years old. Thirty-six percent were males, and there were 80.8% Chinese, 5.3% Malay, 8.6% Indian, and 5.3% others. The median waiting time for endoscopy was 23 days (IQR 16-36), and no major adverse events were reported. Over half of the endoscopies were unremarkable (n=231, 53%). There were 25 (5.7%) patients with major findings; three had upper gastrointestinal adenocarcinoma (one oesophageal and two gastric), one had oesophageal varices, and 21 had peptic ulcer disease (10 gastric and 11 duodenal ulcers). A rapid urease test was conducted on 409 patients, and 55 (13.4%) were positive. OAO is a safe and effective strategy for providing timely diagnostic OGD to normal-risk patients at our center. Primary care physicians are encouraged to refer non-alarming dyspepsia symptoms patients under 60 years for OAO over the conventional route.

Prevalence of Dyslipidemia, Drug Therapy Problems, and Medication Adherence in Type 2 Diabetes Mellitus Patients in North Central Nigeria

Background Patients with diabetes mellitus have an increased risk of developing dyslipidemia, predisposing them to macro- and microvascular consequences such as coronary heart disease. Aim The aim of this study was to assess the prevalence of dyslipidemia, drug therapy problems (DTPs), and medication adherence in type 2 diabetes mellitus (T2DM) patients in a tertiary hospital in North Central Nigeria. Method This study was a cross-sectional convenient sampling of eligible patients conducted in the General Outpatient Department of General Hospital, Ilorin, from March to May 2022. A validated questionnaire was administered to obtain all relevant information on sociodemographic information, and blood samples were collected in a medium plain heparinized tube and sent to the laboratory where fasting blood sugar, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) values were calculated as appropriate. Morisky's Medication Adherence Scale 8 (MMAS-8) was used to capture patient's adherence level, and DTP was assessed using the Pharmaceutical Care Network Europe (PCNE) Criteria version 7. Ethical approval was obtained from the Ministry of Health, Ilorin. Statistical Package for Social Sciences was used to analyze the data collected for descriptive and inferential statistics. Results The mean age of the respondents was 60 ± 0.7 years. Of the 60 respondents, 25 (41.67%) were males and 35 (58.33%) were females. All the respondents had dyslipidemia, 30% respondents were identified with a DTP of nonadherence, 16.7% needed additional drug/monitoring, dosage was too low in 11.7%, and 11.6% could not afford their medication due to high cost. In all, 45 (75%) respondents had poor sugar control and 33 (55%) had poor blood pressure control. Using MMAS-8, the majority (41, [68.30%]) of the respondents were found to have poor adherence to their diabetic medications. Conclusion High prevalence of dyslipidemia, poor medication adherence, and DTPs were found in the T2DM patients in this study.

A Cross-Sectional Study about Demographic and Medical Characteristics of Hypertensive Pregnant Women in Two Secondary Healthcare Facilities, in Ilorin, Nigeria

Background Hypertension is one of the major causes of related maternal deaths worldwide and it is one of the most common medical disorders encountered during pregnancy. Aim This study aimed at assessing the demographic and medical characteristics of hypertensive pregnant women in two secondary healthcare facilities, in Ilorin, Nigeria Method This was a cross-sectional study among 104 pregnant women with hypertension attending the outpatient department of General Hospital and Civil Service Clinic, Ilorin between March and May 2021. A validated self-administered questionnaire was used to obtain information on sociodemographics. Data on the medical characteristics of the respondents and their medications were extracted from the respondent's medical files. Ethical approval was obtained from the Ministry of Health and General Hospital, Ilorin. For statistical analysis for categorical measurements, the frequencies and percentages were computed. Results Seventy-five percent of the correspondents were below 36 years old, 97% were married, 79% had tertiary education, and 74% were above 24 weeks of gestation. About 68% of the correspondents had blood pressure more than or equal to 140/90 and 10% had blood pressure more than 160 mm Hg systolic or more than 100 mm Hg diastolic. About 78.8% of the correspondents had a family history of hypertension, 13.5% had a family history of diabetes mellitus, and 22.1% had a family history of obesity. About 27.9% had pre-existing hypertension, 61.5% developed hypertension before the end of 20 weeks of gestation, and 10.6% developed hypertension after 20 weeks of gestation. About 24% had their antihypertensive medication changed during pregnancy, 38.5% were treated with methyldopa, 31.7% with nifedipine, and 27% with nifedipine and methyldopa. Majority (83.6%) of the respondents were not adherent to their medications. Conclusion Two-third of the patients had poor blood pressure control irrespective of the fact that all were under drug therapy. Family history and large body mass index are the main risk factors for the development of hypertension during pregnancy. Noncompliance may play a significant role in no drug response.

1721 Enhancing the recognition of sensory impairment on the Care of the Elderly wards

Abstract Introduction Although hearing loss is the foremost cause of years lived with disability in people over 70, it remains commonly under-recognised. Health of the UK signing deaf community is reportedly worse than the general population, often due to resulting undertreatment of associated co-morbidities including visual impairment, falls and dementia. Local Problem There is an estimated 21% prevalence of ≥25dBHL hearing loss within the Wolverhampton adult population, this increasing with age. A large number of inpatients admitted to the Older Adult Medicine (OAM) wards at New Cross Hospital have clinically evident sensory impairment, impacting upon interactions with healthcare staff. This project identified the current methods through which hearing and/or visual impairment is formally screened for and documented within the OAM Department of a large district general hospital, targeting interventions towards mitigating barriers faced in sensory assessment. Methods and Intervention Baseline and post-intervention documentation of sensory impairment was collected from admission and bedside notes of 23 inpatients during each cycle. A multidisciplinary focus group of medical, nursing and practice education facilitators identified a marked underutilisation of bedside alert signs (4%), prompting creation of a redesigned bedside poster with a greater focus on sensory aid functionality. Results 60% of posters were utilised 10 days after introduction, with an increase from 4% to 36% in recording of known sensory impairment being observed. 100% and 25% of inpatients with correctly functioning hearing aids and spectacles were documented respectively. 100% of patients admitted through frailty intervention streams were assessed for sensory loss, compared to 0% admitted via the unselected medical take. Conclusions Improved bedside alert posters provided initial evidence as a sustainable improvement in supporting inpatients with sensory impairment. Incorporating positive lessons from frailty team practice will assist in developing future education sessions, highlighting intended sign usage and transferrable sensory assessment methods for involved healthcare teams.

Pediatric COVID-19: clinical and epidemiological data of 1303 cases in a general hospital in Brazil.

This study aimed to describe the clinical characteristics of the pediatric population with COVID-19 in an Emergency Department (ED) of a Brazilian general hospital. Epidemiological and clinical data of patients younger than 20 years old were collected from patients' medical records from February 2020 to July 2021. Most of the epidemiological data described pertains to hospitalized patients. We also reviewed coinfections, treatment, and outcomes and compared the first and second waves of COVID-19. We identified a total of 1303 episodes of SARS-CoV-2 infection. The median time from symptom onset to diagnosis was three days. Symptoms were present in 92.3% of the patients. The most common symptoms were fever (45.2%), nasal congestion/discharge (44.2%), and cough (39.4%). Chest radiography and tomography were performed in 7.7 and 3.3% of cases, with abnormal findings in 29.7 and 53.4%, respectively. Hospital admissions occurred in 3.5% of patients, mainly in the presence of comorbidities, in children under five years old and in those who presented to the ED during the first wave of COVID-19. Coinfection with a viral agent was identified in 20% of the 71 cases tested in this study, and a positive rapid test for Streptococcus pyogenes was found in 8% of the 174 cases tested, with no impact of these coinfections on hospitalization. We found that COVID-19 was a mild disease in most children in our study population, with most hospitalizations and readmissions occurring during the first wave of COVID-19.

Tzanaki’s Score Vs Modified Alvarado’s Score In Diagnosing Acute Appendicitis: A Comparative Study In A Tertiary Care Hospital

Introduction: Acute appendicitis is commonly diagnosed when a patient presents with pain in right iliac fossa. Various Scoring systems are used to diagnose acute appendicitis and mainly include the presenting signs and symptoms, but are not acceptable for patients. The purpose of this study was to assess effectiveness of modified Alvarado score and Tzanaki’s Score in the diagnosis of acute appendicitis. Methods: A prospective observational study was done in department of General Surgery JLN Medical College Hospital, Ajmer which incorporated 200 patients presenting with the signs and symptoms of acute appendicitis. Patients were evaluated by Modified Alvarado score and Tzanaki’s Score during admission and based on the treating surgeon’s decision, were operated. Finally, the score was compared with the diagnosis done by histopathological examination of the operated specimen. Results: The sensitivity & specificity of Modified Alvarado Score was 84.26% & 72.7% respectively with a positive predictive value of 96.15% & negative predictive value of 36.3%. The sensitivity and specificity of Tzanaki’s score was 88.2% and 72.7% respectively with a positive predictive value of 96.31% and negative predictive value of 43.24%. The diagnostic accuracy of Alvarado score was 83% and that of Tzanaki’s score was 86.5%. Conclusion: Tzanaki’s scoring system can be used as an effective modality in the diagnosis of acute appendicitis. There is increased sensitivity and diagnostic accuracy in Tzanaki’s scoring when compared to modified Alvarado score.

The Mothers Attitude for Infantile Colic Attending Salah-Alden General Hospital

Background: Infantile colic is a benign condition and a common cause that made parents to seek medical advice in the early three months of life. It is defined as paroxysms of crying and fussiness more than three hours per day, more than three days in a week for three weeks in a healthy infant from fourteen days to four months of life .The real cause still unknown but underlying organic causes less than 5%. Aim of the study: To evaluate the mother's attitude about infantile colic. Patient and Method: A cross sectional hospital-based study done on 200 mothers whose baby had infantile colic to evaluate mother’s knowledge about treatment of their problem, the study was done at the Pediatric consulting department of Salah-Alden General Hospital during the period from 2nd January to 30th August 2021 selected not randomly. The Mother’s knowledge were taken by the wards of the mother without interference and without guidance, the source of the knowledge depend whether it is taken from her previous experience, her relatives and friends, health care provider, from social media. Regarding educational level of the mothers were divided into illiterate, read and write, primary school, secondary school and college. Regarding the type of formula, the formulas divided into the types as AC formula, AD formula regardless the name of the company. Results: The study showed that the high rate of males and females children enrolled in this study was in 2 months of age (29.73 and 30.34% respectively). The majority of children were belonged to families lived in urban area. 52% of the mothers consulted physician, 50.5% consulted medical staff. Most of mothers haven’t knowledge about infantile colic 63.5%, and 17% acquired their knowledge from previous experience or relatives and friends. 30% of mothers were completed primary school, 27% were illiterate, 19% read and write and 13% for each of secondary school and college. The high rates of most mothers with variety education levels haven’t previous experience. Conclusions: The study showed that the high rate of children was in 2 months of age and belonged to families lived in urban area. Most of the mothers consulted doctor and health care providers and most of them haven’t experience about infantile colic and manage it by anti-colic drugs and changing of formula.

Surgical Management of Goiter with Intrathoracic Extension at the Philippine General Hospital Department of Otolaryngology Head and Neck Surgery

Objective: To describe the demographic and clinical characteristics of patients diagnosed with intrathoracic thyroid masses managed surgically in our institution, determine associated factors affecting eventual operative approaches for these patients, and assess postoperative outcomes and complications associated with surgical intervention. Methods: Design: Retrospective descriptive case series Setting:Tertiary National University Hospital Participants: 24 patients Results: The mean age of patients diagnosed with intrathoracic goiters was 55.71 years old, with a 1:1.4 male to female ratio; with most having an intrathoracic extent of Huins Grade 1 (67%) compared to others having Huins Grade 2-3. Majority of patients pre-operatively had a Fine Needle Aspiration (FNA) Bethesda Thyroid Nodule Classification of Category II (benign); 79% of total patients underwent excision of thyroid mass utilizing a transcervical approach alone. As Intrathoracic Extension (ITE) grade increased, additional transthoracic approaches were performed; duration of operation, average estimated blood loss, length of hospital stay was also noted to increase. Majority of post operative surgical histopathology results revealed malignant thyroid masses, in contrast to pre-operative FNA. Post-operative transient hypocalcemia was the most reported immediate complication. Conclusions: Management of intrathoracic goiter is often multidisciplinary. Referral to the thoracic vascular service is warranted for access to the thoracic inlet. Classification by grade of intrathoracic goiters is helpful to determine the most appropriate operative approach and maybe predictive of intraoperative and postoperative outcomes. Postoperative histopathology across all ITE grades mostly yield malignant results; hence, preoperative FNA results should be used with caution.

HPB P48 Liver Abscess Secondary to Cocktail Stick Migration Following Accidental Ingestion

Abstract Background Liver abscess formation following foreign body ingestion is rare. This may occur if the foreign body is lodged in the upper gastrointestinal tract and persists. Initial management consists of antibiotics with or without percutaneous abscess drainage. However, referral to the regional HPB unit may need to be considered to discuss foreign body retrieval, especially if it is located within the liver parenchyma itself, in order to treat persistent sepsis or prevent abscess recurrence in the future. Methods A 38-year-old gentleman, previously healthy, presented to the emergency department of a district general hospital with nausea, upper abdominal pain, and fever. He stated that he had accidentally ingested a piece of a wooden cocktail stick while eating some weeks back. Leucocytosis and raised inflammatory markers were present on bloodwork. Computed tomography revealed a 6 cm hypoattenuating lesion in the left lobe of the liver, which demonstrated features of a hepatic abscess on magnetic resonance imaging. Abdominal ultrasound visualised a 4 cm linear hyperechoic structure within the hypoechoic lesion, raising the suspicion of foreign body retention with abscess formation. Results The fever subsided, and symptoms resolved with antibiotics. Follow-up imaging revealed abscess resolution with foreign body persistence in the liver. He was referred to the regional HPB unit and underwent laparoscopy for foreign body removal. A fistulous communication between liver segment II and lesser curvature of the stomach was seen and disconnected using diathermy. Minimal pus was drained and the foreign body retrieved. The gastric perforation was sealed using a linear stapling device. A nasogastric tube was left in the stomach until the patient tolerated a liquid diet and discharged on the first post-operative day. He remains well on follow-up. Conclusions This case highlights that scrupulous history taking and imaging review are required for a timely diagnosis of foreign body retention.

CLINICAL AND HEMATOLOGICAL PROFILE OF PATIENTS WITH DENGUE FEVER AT A TERTIARY CARE HOSPITAL: AN OBSERVATIONAL STUDY

Objectives: The objective of this study was to analyze the clinical and hematological profile and studying outcome of patients having dengue fever (DF). Methods: This was an observational study conducted in the Department of General Medicine, Basveshwar Teaching and General Hospital, Kalaburagi, India. One hundred patients with DF were included in this study. Demographic details were obtained, detailed history was taken, and clinical examination was done. The cases were classified into dengue without warning signs, dengue with warning signs, and severe dengue as per world health organization classification of dengue. Clinical features, hematological profile, and outcome were assessed in studied cases. SSPE 21 software was used for statistical analysis. P value less than 0.05 was taken as statistically significant. Results: Out of these 100 cases, there were 62 (62.00 %) males and 38 (38 %) females with a M: F ratio of 1: 0.61. The mean age of male and female patients was found to be comparable with no statistically significant difference in the age group (p=0.391). Out of 100 studied cases, non-severe dengue was seen in 56 (56%) patients whereas 31 (31.00%) patients had non-severe dengue with warning signs and remaining 13 (13.00%) patients had severe dengue. The most common presenting complaint was fever which was present in all patients (100%). The other complaints included headache (82%) nausea and vomiting (74%). Positive torniquet test was seen in 7 (7%) patients and hypotension, decreased pulse pressure, and altered sensorium were seen in 5 (5%) patients each. In cases of dengue with warning signs or severe dengue out of 44 patients, 21 (21%) patients required blood component therapy and 5 (5%) patients landed up in shock despite fluid therapy. Two (2%) succumbed to complications of severe dengue. Conclusion: Comprehensive understanding of clinical features, hematological profile, and warning signs in DF is essential for timely diagnosis and effective management. With early diagnosis and proper management, the outcome of patients is usually good.

Clinical value of arterial stiffness assessment on risk prediction of vascular stiffness in the octogenarian elderly

Objective: This study aimed to analyze clinical factors related to arterial stiffening and establish a risk prediction nomogram of arterial stiffening in the octogenarian(≥80 years). Methods: This study was a retrospective cross-sectional study, which enrolled the octogenarian elderly who underwent physical examination and secondary prevention intervention in the outpatient department of Chinese People's Liberation Army General Hospital from April 2022 to August 2022. Clinical data including demographics, biochemical indicators and medical history were collected. Brachial-ankle pulse wave velocity (baPWV) was detected during the clinical visit. Participants were divided into the control group (baPWV≤1 800 cm/s) and vascular sclerosis group (baPWV>1 800 cm/s). The risk factors of arterial stiffness were analyzed by univariate and logistic regression analysis, and the nomogram model was constructed by R programming language. The predictive effect of the nomogram model was evaluated by the receiver operating characteristic curve (ROC). Results: The median age of the 525 participants was 87.0 (82.0, 92.0) years, 504 (96.0%) were male, 82 in the control group, 443 in the vascular sclerosis group. The baPWV, age, systolic blood pressure, mean arterial pressure and diastolic blood pressure were significantly lower in the control group than those in the vascular sclerosis group (all P<0.05). Logistic regression analysis showed that high-density lipoprotein cholesterol, alanine aminotransferase and amylase were protective factors, and alkaline phosphatase and creatinine were risk factors of arterial stiffening (all P<0.05). The combined nomogram model scores including age, mean arterial pressure and the above five laboratory indicators indicated that mean arterial pressure and serum creatinine levels were strongly correlated with vascular sclerosis. The ROC curve suggested that the nomogram model had good prediction ability. Conclusions: Age, mean arterial pressure, high-density lipoprotein cholesterol, alanine aminotransferase, alkaline phosphatase, amylase and creatinine are independently determinants for increased vascular stiffness. The combined prediction model in this study can provide reference for individualized clinical risk prediction of vascular sclerosis in the octogenarian elderly.

Clinical value of hemoglobin, albumin, lymphocyte, and platelet indexes in predicting lymph node metastasis and recurrence of endometrial cancer: a retrospective study.

To study the clinical importance of hemoglobin, albumin, lymphocyte, and platelet (HALP) indexes in predicting lymph node metastasis and recurrence of endometrial cancer. From July 2016 to July 2020, 158 patients suffering from endometrial cancer who visited the gynecology department of General Hospital of Ningxia Medical University from were collected. Employing the X-Tiles program, the ideal HALP cut-off value was established, and the patients were separated into low and high HALP groups. Univariate and multivariate analysis were used to determine the relationship between HALP score and lymph node metastasis and recurrence of endometrial cancer. The optimal cut-off value of HALP score was established to be 22.2 using X-Tiles software, and the patients were separated into high HALP group (HALP score > 22.2, with 43 cases) and low HALP group (HALP score ≤ 22.2, 115 cases). Endometrial cancer patients' HALP scores were strongly connected with differentiation, the degree of myometrial invasion, and lymph node metastasis (P < 0.05), although not with age, menopausal status, or stage (P > 0.05). Multivariate logistic regression analysis revealed that the HALP score (OR = 2.087) was the influencing factor for lymph node metastasis (P < 0.05). The ROC curve suggested that the AUC of HALP score in predicting lymph node metastasis was 0.871, which had high diagnostic value. When compared to patients without recurrence, HALP scores of patients with recurrence were considerably lower (P < 0.05). Multivariate logistic regression analysis showed that HALP score (OR = 2.216) was the influencing factor for the occurrence of lymph node metastasis (P < 0.05). The ROC curve suggested that the AUC of HALP score in predicting relapse was 0.855, with high diagnostic value. The HALP score shows good predictive performance in predicting lymph node metastasis and recurrence of endometrial cancer, and has high clinical value, which helps in improving the accuracy and effectiveness of clinical diagnosis and prognosis research.

Trends in Racial Inequalities in the Administration of Opioid and Non-opioid Pain Medication in US Emergency Departments Across 1999-2020.

Despite initiatives to eradicate racial inequalities in pain treatment, there is no clear picture on whether this has translated to changes in clinical practice. To determine whether racial disparities in the receipt of pain medication in the emergency department have diminished over a 22-year period from 1999 to 2020. We used data from the National Hospital Ambulatory Medical Care Survey, an annual, cross-sectional probability sample of visits to emergency departments of non-federal general and short-stay hospitals in the USA. Pain-related visits to the ED by Black or White patients. Prescriptions for opioid and non-opioid analgesics. A total of 203,854 of all sampled 625,433 ED visits (35%) by Black or White patients were pain-related, translating to a population-weighted estimate of over 42 million actual visits to US emergency departments for pain annually across 1999-2020. Relative risk regression found visits by White patients were 1.26 (95% CI, 1.22-1.30; p<0.001) times more likely to result in an opioid prescription for pain compared to Black patients (40% vs. 32%). Visits by Black patients were also 1.25 (95% CI, 1.21-1.30; p<0.001) times more likely to result in non-opioid analgesics only being prescribed. Results were not substantively altered after adjusting for insurance status, type and severity of pain, geographical region, and other potential confounders. Spline regression found no evidence of meaningful change in the magnitude of racial disparities in prescribed pain medication over 22 years. Initiatives to create equitable healthcare do not appear to have resulted in meaningful alleviation of racial disparities in pain treatment in the emergency department.

1149 Bringing Recycling to the Operating Department - a Sustainability Project in a DGH in London

Abstract Aim The Lancet Commissions report of 2015 suggested that tackling climate change could be the greatest global health opportunity of the 21st century. Both the Royal College of Surgeons of England and the Royal College of Anaesthetists have committed to sustainability task forces and have published guidance on improving care through small, sustainable practices including recycling waste. Method We conducted a theatre staff survey on SurveyMonkey in an operating department in an acute district general hospital without any recycling facilities on the attitudes towards recycling, and how this could be implemented. Results We received 103 responses, including a broad spectrum of the multi-disciplinary team including surgeons, anaesthetists, scrub nurses, operating department practitioners and healthcare assistants. Results showed that little to no recycling occurred (59%), 48% of respondents were not familiar with which material can be recycled, and 96% were agreeable to improving access to recycling in theatres. Two main areas identified as barriers to recycling were inadequate access to recycling bins and inadequate information on what can and what cannot be recycled. In terms of implementation, 75% of respondents indicated that posters around the department would be most useful in raising awareness and providing information on recyclable materials. Conclusions Currently, we are in conversation with the Trust and the waste management company to identify a list of recyclable materials and to incorporate recycling bins as part of the waste management pathway.