Disease Rating Research Articles

Risk of Pulmonary Diseases in Osteogenesis Imperfecta in Denmark: A Register-Based Cohort Study

Osteogenesis imperfecta (OI) is a rare hereditary disease mainly resulting in reduced or altered collagen type I. Collagen type I is a major constituent of the respiratory system, and normal collagen type I is vital for pulmonary tissue function. Do patients with OI have increased admission rates resulting from pulmonary diseases compared with the general population? This was a register-based, nationwide cohort study, including all patients with OI in Denmark and a reference population. From January 1, 1995, through December 31, 2018, we evaluated the rates of admissions resulting from asthma, COPD, and pneumonia as well as the use of bronchodilator drugs and antibiotics comparing individuals with OI with the reference population. We included 862 individuals with OI and 4,283 people from the reference population covering 15,952 and 79,471 person-years of observation, respectively, in the two cohorts. The admissions rate (incidence rate [IR]) was highest in women with OI 65 years of age or older, with 56.3 admissions per 1,000 person-years and 29.4 admissions per 1,000 person-years in the reference population (amounting to an admissions incident rate ratio [IRR] of 1.91 [95%CI, 1.38-2.70]). The highest admission rate in men with OI was found among participants 0 to 18 years of age, with an IR of 30.4 per 1,000 person-years compared with an IR of 7.7 per 1,000 person-years in the reference population (IRR, 4.92 [95%CI, 3.79-6.38]). We found a higher proportion of long-acting and short-acting bronchodilator drug users in the OI cohort, but no increased use of antibiotics. Overall, the admission rates for respiratory diseases were low in the OI cohort, but a higher relative risk of hospitalizations resulting from respiratory disease compared with the general population. Timely diagnosis and treatment of respiratory complications in individuals with OI is warranted.

Abstract 42: Fecal Microbiota Transplantation Decreases Autoantibody Production and Lowers Blood Pressure in an Experimental Model of Autoimmune Disease

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder that disproportionately affects women. It is characterized by a breach of immunological self-tolerance and the expansion of autoreactive T and B lymphocytes, leading to the production of autoantibodies. Autoantibody production leads to downstream chronic inflammation resulting in high rates of hypertension, renal injury, and cardiovascular disease. Gut dysbiosis is associated with many autoimmune diseases, including SLE. In the present study, we hypothesized that gut dysbiosis in SLE may play a role in the development of immune system dysfunction and hypertension in an experimental model of SLE, and that fecal microbiota transplantation (FMT) with microbes from control mice may improve these parameters. To test this hypothesis, we treated 26-week-old female control (NZW, n=10) and SLE (NZBWF1, n=9) mice with broad spectrum antibiotics in drinking water for one week to deplete the existing microbiota. Subsequently, mice were given 0.1 mL of fecal microbes from either control or SLE mice via oral gavage two times per week for four weeks in the following groups (n=9-10 mice/group): Control-vehicle, Control-SLE microbes, SLE-vehicle, SLE-Control microbes. Changes in the gut microbiome after FMT were assessed by metagenomic sequencing of fecal pellets from all four groups. Mean arterial pressure (MAP, mmHg) was higher in SLE mice compared to control mice (Control: 112±3 vs. SLE: 140±2 mmHg, p<0.0001). SLE mice that received FMT with control microbes had lower blood pressure (SLE-FMT: 126±4 mmHg, p=0.03). While there were no changes in circulating and splenic B cell percentages, SLE mice had significantly higher percentages of CD11b + CD11c + autoimmune-associated B cells compared to control mice (Control: 0.41±0.04% vs. SLE: 1.2±0.1%, p=0.0006), which were significantly decreased in SLE-FMT mice (SLE-FMT: 0.76±0.1%, p=0.02). Circulating autoantibodies were also measured at the conclusion of the study. Anti-dsDNA IgG was elevated in SLE mice compared to control (Control: 149±38 vs. SLE: 527±114 kU/mL, p=0.02), and were significantly lower in SLE mice treated with control microbes (SLE-Control microbes: 126±4 mmHg, p=0.03). These data suggest that gut microbiota present in NZBWF1 mice contribute to the accumulation of activated B cells and increased autoantibody production, which are known pathogenic factors in the development of hypertension in SLE.

Clinical characteristics of apical segment lung abscess: a 10-year retrospective study.

Lung abscess in the apical segment of the lung is not rare and is often underestimated in clinical practice. However, the clinical features of apical segment lung abscess (AL) have scarcely been reported. Hence, this study aimed to determine the clinical characteristics of AL and explore moderate therapeutic strategies. This was a retrospective, single-center cohort study. We reviewed the medical records of consecutive patients who were admitted to Shanghai Pulmonary Hospital in Shanghai, China, from January 2009 to December 2018. This study collected information on patients with lung abscess, including demographics, symptoms, clinical findings, and treatment. The statistical methods used were descriptive statistics, Chi-squared test, Fisher's exact test, t-tests, and logistic regression analysis. Of 824 patients, 431 with lung abscess were finally eligible after a review of medical records. The patients were divided into two groups: the AL group (n=68) and the non-apical segment lung abscess (NAL) group (n=363). Compared with patients in the NAL group, those in the AL group had lower rates of chronic obstructive pulmonary disease (COPD) (5.9% vs. 17.4%, P=0.02), diabetes (14.7% vs. 32.2%, P=0.004) and hypoprealbuminemia (10.3% vs. 25.3%, P=0.007). Regarding clinical symptoms, patients in the AL group exhibited lower fever (38.2% vs. 58.4%, P=0.002) and less purulent sputum (32.4% vs. 45.5%, P=0.045). Moreover, regarding radiological features, the AL group had a lower proportion of air-fluid level on chest computed tomography (CT) (7.4% vs. 16.8%, P=0.047). In addition, the study demonstrated that the AL group had a shorter duration of intravenous antibiotic treatment [8 (7-8) vs. 10 (8-12) days, P <0.001]. Surprisingly, the AL group had a high rate of surgical treatment (36.8% vs. 15.4%, P<0.001). In multivariate analysis, surgical treatment occurred more frequently in patients with AL [odds ratio (OR): 2.58, 95% confidence interval (CI): 1.40-4.77, P=0.002], lower in patients who had fever (OR: 0.55, 95% CI: 0.31-0.98, P=0.04), and imaging features of liquefaction necrosis (OR: 0.32, 95% CI: 0.15-0.69, P=0.004). Patients with AL presented with atypical and relatively mild clinical symptoms. However, the rate of surgical treatment was significantly higher. These data should be considered when managing the AL.

Abstract 20: Orthostatic Hypotension in Patients with Heart Failure taking Carvedilol or Metoprolol

Background: Metoprolol succinate and carvedilol are widely prescribed beta-blockers for the treatment of heart failure (HF). Both can reduce mortality, but unlike the β-1 selective metoprolol, carvedilol has α-1 blocking effects. Since orthostatic hypotension (OH) is a common comorbidity in HF patients, we conducted a case-control study to assess if the vasodilatory effect of carvedilol, compared to metoprolol, is associated with a higher risk for newly diagnosed OH. Methods: A deidentified retrospective database of all HF patients seen at the Vanderbilt University Medical Center who were taking metoprolol or carvedilol (n=272,019) was used. Cases of newly diagnosed OH were defined as those who had a new diagnosis of OH after the first mention of either drug (n=3,006) and controls as those who did not have a diagnosis of OH (n=269,013). Demographic information, presence of other comorbidities, and concomitant use of other drugs known to cause hypotension were obtained. One-way analysis of variance (ANOVA) and Pearson’s chi-square tests were used to compare continuous and categorical variables between both groups, respectively. Results: OH was diagnosed in 1% of all patients and metoprolol was more commonly prescribed than carvedilol (81% vs. 19%). Compared to controls, OH patients were older (58 vs. 66 yr) and had a higher rate of hypertension (22% vs. 96%), Parkinson disease (1% vs. 3%) and concomitant use of diuretics, calcium channel blockers, other α-1 blockers and other drugs associated with OH (Table). The prevalence of OH cases was higher in the carvedilol group compared to the metoprolol group (1.96% vs. 0.91%), but only age differed between the OH cases in both groups (metoprolol: 64 vs. carvedilol: 71 yr). We found that patients were more likely to be diagnosed with OH after taking carvedilol vs. metoprolol (unadjusted odds ratio 2.2078, 95% CI 2.0448 – 2.3838, p &lt; 0.001). Conclusions: The prevalence of OH among patients with heart failure was higher in patients taking carvedilol compared to metoprolol. Given that both drugs have similar beneficial effects on mortality, metoprolol appears to be preferable in the treatment of heart failure in patients at risk of developing OH. Studies to further assess the relationship between heart failure classification and orthostatic hypotension are needed.

Appendicitis links to the afterward subsequent psoriatic disease occurrence in Taiwan national health insurance research database: A population-based cohort study: Appendicitis links to psoriatic diseases.

To investigate the psoriatic disease risk among patients with previous appendicitis. This study was a nationwide population-based case-control study about the association between the psoriatic disease risk among patients with a history of appendicitis in Taiwan. The study population consisted of newly diagnosed psoriatic disease with at least two outpatient visits, and the control group included those patients without psoriatic disease at the same index date. Patients with a previous diagnosis of appendicitis or who underwent appendectomy surgery prior to their psoriatic disease diagnosis were recorded. The odds ratio of psoriatic disease diagnosis in the two groups with and without a history of appendicitis were analyzed and compared. A total of 48 894 individuals diagnosed with psoriatic disease were matched with 292 656 controls by age and gender. Notably, the proportion of patients with a history of appendicitis or primary appendectomy was significantly elevated among those with psoriatic disease compared with the control cohort (both p < .05). On average, the occurrence of appendicitis preceded the index date by 3.3 ± 2.3 years. Multivariate analysis revealed a heightened incidence rate of psoriatic disease in patients previously diagnosed with appendicitis, periodontal disease, Charlson comorbidity index score (CCIS) ≧1, and ill-defined intestinal infections. This association persisted after adjusting for confounding factors, such as periodontal disease, CCIS, Salmonella, and ill-defined intestinal infections. The odds ratios for psoriatic disease in individuals with a history of appendicitis, periodontal disease, CCIS ≧1, and ill-defined intestinal infections were 1.16, 1.008, 1.69, and 1.23, respectively, with corresponding 95% confidence intervals of 1.03-1.31, 1.05-1.11, 1.65-1.74, and 1.20-1.26. These findings underscore the independent association between appendicitis and subsequent development of psoriatic disease, even after adjusting for relevant comorbidities and potential confounders. Our research illustrates that appendicitis is associated with an increased likelihood of developing a psoriatic disease, despite several limitations. These limitations encompass variables such as dietary and smoking habits, alongside other potential confounding factors that were not fully considered. Moreover, inherent biases in utilizing national health insurance data, such as the absence of laboratory information, as well as the constraints inherent in a retrospective study design, should be acknowledged.

A traffic light approach for treatment and supportive care stratification in lung cancer.

Comprehensive supportive care interventions for patients with lung cancer are being investigated in a range of ways, including: early palliative care, prehabilitation and rehabilitation. We review recent literature on supportive care and propose a traffic light system to individualise comprehensive supportive care. Green for those very likely to receive anti-cancer treatment, red for those very unlikely to receive anti-cancer treatment and orange where the chance of accessing treatment is uncertain. Comprehensive supportive care can be individualised based on the group a particular patient is in. Lung cancer outcomes are improving with the availability of increasingly efficacious treatments; however, treatment rates for advanced disease remain low. In this review, we discuss how person-centred outcomes could be improved, how outcomes can be prognosticated and how the 'host' can be staged as well as the cancer. Recent data suggests that early comprehensive supportive care improves quality of life, reduces time spent in hospital and may affect survival. Comprehensive supportive care is likely to improve quality of life in patients with advanced lung cancer. Further work is needed to see if it can improve treatment rates and survival.

Rationale and Design of the COPERNIC Trial: A Study of On-treatment ctDNA Changes in Chemo-refractory Colorectal Cancer Patients

BackgroundEvidence suggests that ctDNA may be a reliable biomarker to monitor metastatic colorectal cancer (CRC) evolution. Nevertheless, evidence on the potential of liquid biopsy in this setting is still low quality, mostly consisting of retrospective studies. MethodsCOPERNIC is an international, multicenter clinical trial. The pilot study aims to confirm the predictive potential of early on-treatment ctDNA dynamics, and inform the design of a larger ctDNA-driven trial. Advanced CRC patients who are candidates for ≥3rd lines of systemic therapy undergo longitudinal blood sample collection during treatment (day 1, 15 and 29 for 2- or 4-weekly treatment regimens; day 1, 22 and 43 for 3-weekly treatment regimens) and at each imaging assessment. ctDNA analyses are carried out with the FoundationOne Liquid CDx and FoundationOneMonitor assays, and ctDNA changes during treatment are correlated with radiologic response (as assessed every 8-12 weeks by RECIST v1.1). The primary objective is to select the optimal timepoint and cut-off value for early ctDNA changes (at day 15/22) to predict progressive disease as best radiological response with a high positive predictive value. The cut-off value for ctDNA will be defined based on nonparametric ROC-curves with bootstrapping. Based on the expected rate of progressive disease and statistical assumptions, 109 patients are needed to be screened to have 87 assessable patients. COPERNIC is sponsored by the Institut Jules Bordet, and supported by Roche and Foundation Medicine. Recruitment is open in 13 centres across Belgium and France. The study is registered with clinicaltrials.gov (NCT05487248).

Intrahepatic cholestasis of pregnancy: Introduction and overview 2024.

Considerable progress has been made to explain the aetiology of intrahepatic cholestasis of pregnancy (ICP) and of the adverse pregnancy outcomes associated with high maternal total serum bile acids (TSBAs). The reported thresholds for non-fasting TSBA associated with the risk of stillbirth and spontaneous preterm birth can be used to identify pregnancies at risk of these adverse outcomes to decide on appropriate interventions and to give reassurance to women with lower concentrations of TSBA. Data also support the use of ursodeoxycholic acid to protect against the risk of spontaneous preterm birth. A previous history of ICP may be associated with higher rates of subsequent hepatobiliary disease: if there is a suspicion of underlying susceptibility, clinicians caring for women with ICP should screen for associated disorders or for genetic susceptibility and, where appropriate, refer for ongoing hepatology review.

471. MANAGEMENT OF EARLY ESOPHAGEAL CANCER - A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

Abstract Background and Objectives Optimal surgical management for early oesophageal cancer remains controversial. We aimed to perform a network meta-analysis (NMA) of studies comparing outcomes after open esophagectomy (OE), minimally invasive esophagectomy (MIE), endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early oesophageal cancer. Methods A systematic search of electronic databases was undertaken. A network meta-analysis was performed as per PRISMA-NMA guidelines. Statistical analysis was performed using R and Shiny. Results 21 studies including 10,002 patients with stage Tis, T1a or T1b oesophageal carcinoma were included. Overall, 3,103 patients underwent ESD (31%, 3103/10,002), 6,191 underwent OE (61.9%, 6,191/10,002), 502 underwent EMR (5.2%, 502/10,002) and 206 underwent MIE (2.1%, 206/10,002). At NMA, at approximately 3.5 years follow up, there was a significant difference in recurrence rates of Tis, T1a or T1b disease following OE (odds ratio (OR): 0.32, 95% CI 0.12 – 0.83) as compared to EMR. Compared to ESD, estimated 5 year overall survival for Tis, T1a and T1b disease were equivocal following OE and EMR respectively (OR: 0.98, 95% CI 0.66 – 1.44), (OR: 0.88, 95% CI 0.38-2.04). When compared with ESD, superior resection rate was observed in OE (OR: 4.04 95% CI 2.56, 6.37) and MIE (OR: 16.49, 95% CI 2.19, 123.86). OE had the highest rate of pulmonary complications. Compared with ESD, pulmonary complications were significantly different to those who underwent OE (OR: 4.06, 95% CI 2.28 – 7.22). OE had the highest rate of recurrent laryngeal nerve injury, post operative ileus and procedure specific mortality as compared to ESD, EMR and MIE which was not found to be significantly different at NMA. ESD and EMR exhibited advantages over OE and MIE in certain procedural aspects including procedure duration, length of hospital stay and cost. Conclusions OE was associated with superior surgical outcomes compared to ESD. Disease recurrence was also higher in EMR compared to OE with improved cost-effectiveness for ESD and EMR. ESD demonstrated reduce morbidity as compared to OE. Considering these results, OE, MIE, ESR and EMR are all feasible options for primary early oesophageal cancer, contingent on surgeon and institutional expertise.

Association between serum hormone levels in early pregnancy and risk of hypertensive diseases of pregnancy in women undergoing assisted reproduction.

We examined the association between progesterone (P4), estradiol (E2), and human chorionic gonadotropin (hCG) levels in early pregnancy and the development of hypertensive diseases of pregnancy among women undergoing assisted reproduction. Retrospective study including patients who underwent frozen embryo transfer (FET), ovarian stimulation (OS), or unassisted conception (UC) and had a live singleton birth. The primary outcome was the development of hypertensive diseases of pregnancy (gestational hypertension, preeclampsia, HELLP, or eclampsia). Secondary outcomes were the development of fetal intrauterine growth restriction (IUGR), gestational diabetes mellitus, birth weight, and pre-term birth. Hormone levels and the development of the outcomes were correlated. A total of 681 patients were included; 189 had FET, 193 had OS, and 299 had UC. Patients undergoing FET or OS were not more likely to develop hypertensive diseases of pregnancy compared with UC patients. While median levels of E2 and P4 were significantly different between P-FET and NC-FET patients (E2: 252 vs 317pg/mL, P4: 64 vs 29ng/mL, respectively; both p < 0.01), rates of hypertensive diseases of pregnancy did not significantly differ between those two groups. In the multivariate analyses, P4, E2, and hCG were not associated with the development of hypertensive diseases of pregnancy, but progesterone levels were significantly higher among those with IUGR. This remained consistent when the analysis was limited to FET patients. P4, E2, and hCG levels did not correlate with the development of hypertensive diseases of pregnancy but elevated progesterone levels did correlate with the development of IUGR.

Antimoniosis: Radiological Insights into a Rare Pneumoconiosis in Miners.

Pneumoconiosis describes diseases caused by the accumulation of inorganic dust particles in the lungs, leading to tissue damage. The diagnosis relies on a history of exposure and compatible radiological findings. We aimed to investigate the radiological findings in individuals exposed to antimony-inert dust relative to their working periods. Fifty-six symptomatic male antimony miners were retrospectively evaluated for demographics and chest computed tomography (CT) scans. The demographic and radiological data of patients with a history of antimony mining, who presented at our pulmonary clinic between June 2017 and June 2023, were analyzed according to the duration of exposure. The study included 56 male patients with a mean age of 58.5±13.02 years and a mean exposure duration of 13.63 ± 6.82 years. CT scans showed that 73.2% (n=41) had upper and middle lung zone involvement, and 55.4% (n=31) had extensive involvement. Micronodules with centriacinar ground-glass opacities were the most common finding (n=37, 66.1%), followed by nodular opacities with irregular margins (n=22, 39.3%) and solid micronodules (n=20, 35.7%). Patients with over 20 years of exposure had significantly higher rates of respiratory and cardiovascular disease (p<0.05). Increased exposure time correlated with more extensive parenchymal involvement and higher rates of calcification in mediastinal lymph nodes, solid micronodules, nodular opacities with irregular margins, honeycombing, and conglomerate mass appearance. Radiological findings in pneumoconiosis generally worsen with longer exposure. Given the scarcity of up-to-date information on antimony pneumoconiosis, further studies focusing on radiological findings and chemical analyses of those exposed to antimony mine dust are essential to identify related pathologies.

Single vs Double Lung Transplantation in Older Adults: A Propensity-Matched Analysis

BackgroundSingle lung transplantation (SLT) is associated with worse long-term outcomes than bilateral lung transplantation (BLT) but is often performed for older adults at risk of not tolerating BLT. Research QuestionHow do the outcomes of SLT and BLT compare among older adult recipients? Study Design and MethodsThe Scientific Registry of Transplant Recipients database (2005-2022) was queried for lung transplant recipients aged ≥65 years. Patients were stratified by whether they underwent BLT or SLT, and propensity matched. Baseline characteristics and morbidity were compared with frequentist statistics. Survival was analyzed via Kaplan-Meier estimation. Risk factors for mortality were identified with Cox regression. ResultsOf 9,904 included patients, 4,829 (48.8%) underwent SLT. SLT patients had lower lung allocation scores (39.6 v. 40.6, p<0.001), more interstitial lung disease (74.4% v. 64.6%, p<0.001) and lower rates of bridging (0.7% v. 2.4%, p<0.001). Groups did not differ significantly by sex, body mass index, or donor characteristics. Propensity matching resulted in 2,539 patients in each group. On matched analysis, SLT patients had shorter lengths of stay (14 v. 18 d), lower reintubation rates (14.7% v. 19.8%), and less postoperative dialysis use (4.2% v. 6.4%) (all p<0.001). SLT patients had comparable survival at 30-days (97.6% v. 97.3%, p=0.414) and 1-year (85.5% v. 86.3%, p=0.496), but lower survival at 5-years (45.4% v. 53.4%, p<0.001) on matched analysis. SLT was a risk factor for 5-year mortality (adjusted hazard ratio: 1.19, p<0.001). InterpretationIn older adults, SLT is associated with less morbidity and comparable early survival relative to BLT, but lower five-year survival. SLT is reasonable to perform in older adults at high risk for BLT.

356. TUMOUR BURDEN CORRELATES WITH THE RISK OF RECURRENCE AFTER PIECEMEAL ENDOSCOPIC RESECTION OF EARLY-STAGE ADENOCARCINOMA IN BARRETT’S OESOPHAGUS

Abstract Background Endoscopic resection (ER) is curative for Barrett’s oesophagus-related early-stage oesophageal adenocarcinoma (EAC) without high-risk features, such as lymphovascular invasion (LVI), positive margins (R1), and deep submucosal invasion (T1bsm2-3). Piecemeal endoscopic mucosal resection (pEMR), often used for lesions larger than 15mm, prevents assessment of lateral margins and therefore complicates precise risk estimation for residual EAC at the first post-ER endoscopy. Thus, we investigated alternative clinical factors that could potentially be used to assess the risk for residual and recurrent EAC post-ER. Methods We performed a longitudinal cohort study of patients who underwent ER between 2006-2023. Inclusion criteria were: T1a or well/moderately differentiated T1bsm1 EAC; LVI-, and R0 resection. ER was categorised as pEMR (n=106) or en-bloc ER (n=22 en-bloc EMR, n=9 endoscopic submucosal dissection). The primary outcome was residual EAC at first post-ER endoscopy. Secondary outcomes were residual HGD at first post-ER endoscopy, EAC and HGD recurrence at any post-ER endoscopy, and remission of EAC, HGD and intestinal metaplasia (IM) at latest endoscopy. Multivariate logistic regression, receiver operating characteristics, chi-squared, and Kaplan Meier analyses were performed to investigate possible associated risk factors. Results Rates of EAC/HGD recurrence were higher post-pEMR versus en-bloc ER (p=0.019), with residual EAC at first post-ER endoscopy accounting for 34% of post-pEMR recurrence. The percentage of pEMR specimens with EAC (p=0.022) and T1bsm1 staging (p=0.013) were independent risk factors for residual EAC at first post-pEMR endoscopy (Table 1). A 53.5% cut-off of involved pEMR specimens was identified as the optimal threshold for residual EAC prediction (specificity=0.68, sensitivity=0.67). Indeed, residual (p=0.012) and recurrent (p=0.00077) EAC rates were higher when EAC involvement was &amp;gt;53.5%. However, rates of EAC (p=0.13), HGD (p=0.19) and IM (p=0.76) remission were unaffected by high EAC burden. Conclusions High burden of EAC on pEMR specimens correlates with increased risk of residual and recurrent EAC at post-pEMR endoscopy. Post-pEMR site check is recommended prior to endoscopic ablation, particularly in patients where more than 50% of pEMR specimens show EAC and in cases of flat subtle lesions. This will ensure eradication of any residual disease and high success rates for treatment of early EAC using endotherapy.

Population dietary-metabolic characteristics and mortality from major cardiovascular disease subtypes: the Seven Contries Study 60-year follow-up

Background and aimDuring the last few years, the Seven Countries Study of Cardiovascular Diseases (SCS) produced some new analyses dealing with the relationships of a dietary score, the pool of dietary fatty acids and serum cholesterol with major types of cardiovascular disease (CVD) mortality in 10 cohorts of 6 countries made of middle-aged men followed-up for 60 years until extinction. This sparse evidence is condensed here to provide a coherent view. Methods and resultsThe Mediterranean Adequacy Index (MAI, a dietary score whose high levels depict the characteristics of the Mediterranean Diet), was highly and significantly associated in an inverse way, at country levels, with the Atherogenicity (ATI) and the Thrombogenicity (THI) indexes that included a series of dietary fatty acids. These indexes were highly and significantly associated in a direct way with country baseline serum cholesterol levels. Countries with high serum cholesterol had largely higher death rates from coronary heart disease (CHD) and lower rates from other heart diseases of uncertain etiology and stroke. The reverse was observed in countries with low serum cholesterol. ConclusionThe chain of diet, dietary fatty acids and serum cholesterol seems to be responsible in various ways for the different distribution of major CVD mortality subtypes in extincted cohorts.

381. MULTICENTER PAN-CANADIAN EXPERIENCE OF PER ORAL ENDOSCOPIC MYOTOMY (POEM) FOR THE TREATMENT OF ACHALASIA: A RETROSPECTIVE STUDY

Abstract Background Per oral endoscopic myotomy (POEM) has emerged as a modality for the surgical treatment of achalasia using a minimally invasive approach with similar clinical efficacy to laparoscopic Heller myotomy. Japanese, European, American and International clinical practice guidelines now cite POEM as a first line treatment for achalasia. In Canada, single-centre experiences with POEM have shown promising results. This study aims to capture the pan-Canadian national experience with POEM for the treatment of achalasia across multiple institutions. Methods This was a retrospective study of patients who underwent POEM for achalasia across four Canadian institutions (St. Joseph's Healthcare Hamilton, Kingston Health Sciences Centre, Surrey Memorial Hospital and Montreal Sacred Heart Hospital) between 2012 to 2022. Pre-operative, procedural and post-operative data was collected. Our primary outcome was the proportion of patients with normal Eckhardt score (≤ 3) at 4 weeks. Secondary outcomes included procedure related adverse events, length of stay in hospital, post-procedure lower esophageal sphincter pressures, post-procedure gastroesophageal reflux disease (GERD) and response rate at further timepoints. Outcomes are reported as either proportions (%) or medians (IQR). Results POEM was attempted in 369 patients with a success rate of 99%. The median duration of surgery was 64 (47 – 89) minutes and length of stay was ≤1 day in 88% of patients. Peri-operative complications occurred in 11% of patients, all of which were Clavien-Dindo Grade ≤III. The post-operative response rate (Eckhardt score ≤3) was 100%, 98% and 95% at 1, 6 and 12 months, respectively. Additional interventions for achalasia following POEM were required in 6% of patients. High DeMeester scores, endoscopic esophagitis and symptomatic GERD were reported in 36%, 43% and 44%, respectively. 93% of GERD was treated with PPI therapy. Conclusions POEM is safe and feasible in Canadian institutions with efficacy in keeping with current international literature.

Chronic Health Conditions Among Adults With Intellectual and Developmental Disabilities in a State Medicaid System.

Despite a growing number of adults with intellectual and developmental disabilities (IDD) and documented risk for adverse outcomes as they age, little is known about the health and healthcare patterns of adults with different IDD throughout adulthood. This study uses Wisconsin Medicaid claims data to characterize health conditions among adults with IDD. Results indicate high prevalence of asthma, diabetes, heart disease, and hypertension. Heart disease rates were particularly high, having been observed among 39% of autistic adults, 64% of autistic adults with intellectual disability (ID), 67% of adults with Down syndrome, and 75% of adults with ID only. Given there are no known biological differences underlying increased morbidities among most people with IDD, developing inclusive prevention measures should be prioritized in future research.

Assessing gait dysfunction severity in Parkinson’s Disease using 2-Stream Spatial-Temporal Neural Network

Parkinson’s Disease (PD), a neurodegenerative disorder, significantly impacts the quality of life for millions of people worldwide. PD primarily impacts dopaminergic neurons in the brain’s substantia nigra, resulting in dopamine deficiency and gait impairments such as bradykinesia and rigidity. Currently, several well-established tools, such as the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and Hoehn and Yahr (H&Y) Scale, are used for evaluating gait dysfunction in PD. While insightful, these methods are subjective, time-consuming, and often ineffective in early-stage diagnosis. Other methods using specialized sensors and equipment to measure movement disorders are cumbersome and expensive, limiting their accessibility. This study introduces a hierarchical approach to evaluating gait dysfunction in PD through videos. The novel 2-Stream Spatial-Temporal Neural Network (2S-STNN) leverages the spatial–temporal features from the skeleton and silhouette streams for PD classification. This approach achieves an accuracy rate of 89% and outperforms other state-of-the-art models. The study also employs saliency values to highlight critical body regions that significantly influence model decisions and are severely affected by the disease. For a more detailed analysis, the study investigates 21 specific gait attributes for a more nuanced quantification of gait disorders. Parameters such as walking pace, step length, and neck forward angle are found to be strongly correlated with PD gait severity categories. This approach offers a comprehensive and convenient solution for PD management in clinical settings, enabling patients to receive a more precise evaluation and monitoring of their gait impairments.

Scale consistance in cognitive status awareness of patients with Parkinson’s disease

Objectives: This study aimed to investigate the relationship between patients’ awareness of their cognitive symptoms and the presence of cognitive involvement according to neuropsychological tests. Patients and methods: In this cross-sectional study, 539 patients (276 males, 263 females; mean age: 64.3±11.0 years; range, 19 to 88 years) were assessed between September 2020 and June 2023. The Mini-Mental Status Examination (MMSE) scores were recorded in addition to age, sex, education level, and chronic diseases. Patients were classified as having cognitive disorders if their MMSE scores were &lt;26, while those with scores ≥26 were classified as cognitively healthy. The relationship between the frequency of cognitive involvement according to a related question from the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and the frequency of cognitive disorders according to the MMSE scores was evaluated. Results: No relationship was detected between the frequency of cognitive disorders according to the MMSE scores and the frequency of cognitive involvement according to the corresponding question in the nonmotor component of the MDS-UPDRS (p&lt;0.001). Conclusion: The findings indicate that the cognitive impairment inquiry in the nonmotor section of the MDS-UPDRS is not an effective method for detecting cognitive involvement in Parkinson’s disease.

Management and associated outcomes of COVID-19 infection among Ghanaian autoimmune rheumatic disease patients.

This study assessed the prevalence of infection, management strategies and associated disease outcomes of COVID-19 among Autoimmune Rheumatic Disease (AIRD) patients in a teaching hospital in Ghana. This was a retrospective cross-sectional study. Rheumatology Unit, Korle Bu Teaching Hospital. Autoimmune Rheumatic Disease patients. Thirty-one (31) out of approximately 1700 AIRD patients in the unit tested positive for COVID-19, registering a COVID-19 prevalence of 1.82%. The majority, 25(80.6%), were females with a mean ± SD age of 41.7 ± 12.8 years. Systemic lupus erythematosus was the most affected autoimmune rheumatic condition, reporting fever as the commonest COVID-19-related symptom. Most participants, 22(71%), were managed by the "self-isolation"/home management" strategy. In comparison, 7(22.5%) were monitored at the hospital, with both strategies having resulted in complete recovery. The remaining 2(6.5%) patients who managed under "intensive care unit" strategy resulted in mortality. These findings highlight the relatively low frequency of COVID-19 infection among AIRD patients, the encouraging recovery, and the low severe disease rates observed within this cohort. Additionally, the outcome of self-isolation and home management strategies underscore the importance of personalised approaches to COVID-19 management in this population. None.

Abstract P102: Reducing Testing Burden in Patients Screened for Primary Aldosteronism

Introduction: Primary aldosteronism (PA) is an increasingly recognized secondary cause of hypertension characterized by higher cardiovascular, renal, and metabolic disease rates than blood pressure-matched essential hypertensives. Current literature suggests expanding screening for PA to include the majority, if not all, hypertensive patients. This expansive screening would place considerable burden on patients and the healthcare system. A simple clinical risk prediction model that identifies patients with low risk for PA could reduce this testing burden. Methods: We evaluated 111 hypertensive patients in the Southern Illinois University Hypertension Clinic who underwent a screening test and, if positive, had subsequent confirmatory testing for PA. We characterized patients based on routine clinical measures including antihypertensive treatment intensity, blood pressure, serum electrolytes, and body size. Classification trees incorporating 96 patients without missing data points for any considered predictor variable were used to identify hypertensive screen-positive patients who have low to absent risk for PA as determined by confirmatory testing. Results: Patients with PA had higher serum aldosterone levels at screening (mean = 22.5 ng/dl ± SD = 11.6 vs. 15.2 ± 4.5, p &lt; 0.001), higher BMI (35.8 kg/m 2 ± 9.9 vs. 29.9 ± 5.8, p &lt; 0.001), lower potassium (3.9 mmol/L ± 0.5 vs. 4.1 ± 0.6, p = 0.03), and more intense antihypertensive drug therapy (defined by the World Health Organization defined daily dose [6.1 ± 3.2 vs. 4.4 ± 3.0, p = 0.01]) than hypertensive patients without PA. The optimal classification tree model performed relatively poorly at differentiating those with PA from those without PA (sensitivity = 0.76, specificity = 0.86, positive predictive value = 0.87, and negative predictive value = 0.73). However, the model did reveal a subset of individuals who consistently tested negative for PA. Out of 14 patients with serum aldosterone concentration &lt; 25.5, serum potassium &gt; 3.55, and BMI &lt; 27, none had PA. Conclusion: We identified a set of readily available clinical variables for identifying hypertensive patients who screened positive for PA but in whom PA was subsequently proven to be absent. Applying these criteria to our screen-positive hypertensive cohort reduces confirmatory testing by approximately 15%. Study in a larger sample size and external validation of this model is needed prior to recommending it for use in clinical decision-making.