Early Prophylaxis Research Articles

Prophylactic Versus Endoscopy-driven Treatment of Crohn's Postoperative Recurrence: A Retrospective, Multicentric, European Study [PORCSE Study

No consensus exists on optimal strategy to prevent postoperative recurrence [POR] after ileocaecal resection [ICR] for Crohn's disease [CD]. We compared early medical prophylaxis versus expectant management with treatment driven by findings at elective endoscopy 6-12 months after ICR. A retrospective, multicentric, observational study was performed. CD patients undergoing first ICR were assigned to Cohort 1 if a biologic or immunomodulator was [re]started prophylactically after ICR, or to Cohort 2 if no postoperative prophylaxis was given and treatment was started as reaction to elective endoscopic findings. Primary endpoint was rate of endoscopic POR [Rutgeerts >i1]. Secondary endpoints were severe endoscopic POR [Rutgeerts i3/i4], clinical POR, surgical POR, and treatment burden during follow-up. Of 346 included patients, 47.4% received prophylactic postoperative treatment [proactive/Cohort 1] and 52.6% did not [reactive/Cohort 2]. Endoscopic POR [Rutgeerts >i1] rate was significantly higher in Cohort 2 [41.5% vs 53.8%, OR 1.81, p = 0.039] at endoscopy 6-12 months after surgery. No significant difference in severe endoscopic POR was found [OR 1.29, p = 0.517]. Cohort 2 had significantly higher clinical POR rates [17.7% vs 35.7%, OR 3.05, p = 0.002] and numerically higher surgical recurrence rates [6.7% vs 13.2%, OR 2.59, p = 0.051]. Cox proportional hazards regression analysis showed no significant difference in time to surgical POR of proactive versus expectant/reactive approach [HR 2.50, p = 0.057]. Quasi-Poisson regression revealed a significantly lower treatment burden for immunomodulator use in Cohort 2 [mean ratio 0.53, p = 0.002], but no difference in burden of biologics or combination treatment. The PORCSE study showed lower rates of endoscopic POR with early postoperative medical treatment compared with expectant management after first ileocaecal resection for Crohn's disease.

Early detection of diabetic foot ulcer using IoT and ML

This study explores the critical realm of Diabetic Foot Ulcers (DFUs) and proposes an innovative approach for early detection using Internet of Things (IoT) and Machine Learning (ML). A chronic metabolic condition with elevated blood glucose levels is called diabetes mellitus. A foot ulcer is an open wound that is typically located beneath the feet. It can be shallow and less severe, occurring just below the skin's surface, or it can be deep and expose the bones, tendons, and joints. However, diabetes patients may be able to avoid complications from diabetic foot ulcers if early prophylaxis is practiced. One of the complications that this condition is frequently linked to is diabetic foot ulcers. Focusing on Diabetes Mellitus, the chronic metabolic condition leading to DFUs, the study introduces a wearable shoe prototype equipped with temperature and pressure sensors. This IoT-enabled device facilitates daily foot evaluation at home, allowing for timely identification of early symptoms and severity monitoring. By integrating ML algorithms, the real-time ulcer detection system aims to prevent complications, reduce amputations, and enhance proactive diabetic care.

Disclosure Concerns and the Correlation Among Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV Receiving Antiretroviral Therapy in Taiwan.

Gay, bisexual, and other men who have sex with men (GBMSM) are associated with the widespread human immunodeficiency virus (HIV) transmission in Taiwan. Additionally, little is known about disclosure patterns and rates, as well as factors influencing disclosure, among GBMSM living with HIV in the country. HIV prevention for GBMSM is effective when HIV status is disclosed. For instance, GBMSM disclosing their HIV status can result in early pre-exposure prophylaxis with a serodiscordant partner. In this cross-sectional study of 200 GBMSM living with HIV conducted from June to November 2020, we assessed internalized homophobia (IHP Scale) and social support (Multidimensional Scale of Perceived Social Support), as well as self-reported disclosure and non-disclosure. Among the participants, 75.5% revealed their HIV status within 3 months of diagnosis. Younger age, occupation type, and number of sexual partners were some factors associated with disclosure. Those receiving more social support and who experienced less IHP were more likely to reveal their HIV status. On the contrary, older GBMSM and GBMSM living with HIV who worked in educational enterprises still experienced severe IHP. Policymakers and healthcare practitioners should be aware of the problems faced by GBMSM living with HIV and offer practical assistance to improve their mental health.

Blood-Induced Arthropathy: A Major Disabling Complication of Haemophilia.

Haemophilic arthropathy (HA) is one of the most serious complications of haemophilia. It starts with joint bleeding, leading to synovitis which, in turn, can cause damage to the cartilage and subchondral bone, eventually inducing degenerative joint disease. Despite significant improvements in haemophilia treatment over the past two decades and recent guidelines from ISTH and WFH recommending FVIII trough levels of at least 3 IU/dL during prophylaxis, patients with haemophilia still develop joint disease. The pathophysiology of HA is complex, involving both inflammatory and degenerative components. Early diagnosis is key for proper management. Imaging can detect joint subclinical changes and influence prophylaxis. Magnetic resonance imagining (MRI) and ultrasound are the most frequently used methods in comprehensive haemophilia care centres. Biomarkers of joint health have been proposed to determine osteochondral joint deterioration, but none of these biomarkers has been validated or used in clinical practice. Early prophylaxis is key in all severe haemophilia patients to prevent arthropathy. Treatment is essentially based on prophylaxis intensification and chronic joint pain management. However, there remain significant gaps in the knowledge of the mechanisms responsible for HA and prognosis-influencing factors. Better understanding in this area could produce more effective interventions likely to ultimately prevent or attenuate the development of HA.

Dentofacial characteristics of children and adolescents with foetal alcohol spectrum disorders: a comparison with matched controls

BackgroundFoetal alcohol spectrum disorders (FASD) include somatic and neurological developmental disturbances after prenatal alcohol exposure, including facial anomalies. However, the knowledge of the orthodontic skeletal and dental cephalometric relations in this group is limited. The aim of the study was to assess the dentofacial characteristics of children and adolescents with FASD and to compare them with a matched control group.MethodsThe study group comprised all available children and adolescents diagnosed with FASD (> 7 years of age) in whom good quality cephalograms were available. The control group comprised non-syndromic, orthodontically untreated children with normal occlusion and skeletal relations matched with age and gender. Cephalometric analysis included eighteen linear and angular measurements. The general linear model for repeated measures regarding age, gender and the type of FASD was applied.ResultsThe group with FASD included 35 individuals (21 girls and 14 boys) aged 7–18 years including 21 with foetal alcohol syndrome. The mean age in the study and the control group was 12.8 years (SD, range 3.2, 7.1–18.1) and 13.0 (SD, range 2.9, 9.1–18.1), respectively. Statistically significant differences between the groups were found in 15 out of 18 of the cephalometric measurements (83%). In children with FASD the mandible was more retrusive, the incisors were more proclined and the mandibular incisors and the lips were more protruded when compared with controls. There was no significant evidence of an influence of age, gender or FASD type.ConclusionsDentofacial characteristics of children and adolescents with FASD significantly differ from controls. Early orthodontic diagnosis and prophylaxis should play a part of the interdisciplinary care of patients in this group.

Racial Distribution and Associated Outcomes for Patients With and Without Severe-Isolated Traumatic Brain Injuries Following Venous Thromboembolism Prophylaxis.

Disparities in venous thromboembolism (VTE) incidence and prophylaxis have been observed across racial groups. This study investigates the relationship between race, injury type, and the timing of VTE prophylaxis in severe trauma patients, both with and without isolated traumatic brain injuries. The primary goal is to analyze how these factors interact and their potential impact on clinical outcomes. A retrospective cohort study of the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) from 2018 to 2021. Patient demographics, injury categories, VTE prophylaxis timing, injury severity, and in-hospital complications were collected. Multivariable regression models explored associations between race, injury type, VTE prophylaxis, and in-hospital mortality. Groups were analyzed by injury profile (isolated TBI vs non-TBI) and then by VTE prophylaxis timing (early ≤24hours, late >24hours). Of 68,504 trauma patients analyzed, the majority were non-Hispanic or Latino (83.3%), White (71.2%), and male (69.6%). Patients receiving late VTE prophylaxis had higher rates of DVT and PE across race groups than patients with early prophylaxis. Logistic regression showed Asian patients with TBI receiving early prophylaxis were significantly more likely to have in-hospital mortality (OR 16.27, CI = 1.11-237.43, P = .04) than other races. Patients who received late prophylaxis had higher VTE rates than early prophylaxis, independent of injury pattern or race. Additionally, assessing the implications of race in early VTE prophylaxis for isolated TBI showed that adult Asian patients had 16 times higher odds of in-hospital mortality compared to other races.

Biologic use is not associated with postoperative complications in patients with Crohn's disease undergoing stoma reversion.

Stoma creation is a common procedure in patients with Crohn's disease (CD), and early prophylaxis with biologics is recommended for high-risk patients. However, the effect of biologic exposure on morbidity after stoma closure remains unknown. Therefore, this study aimed to investigate the impact of biologic use on the occurrence of complications in CD patients following stoma closure. Consecutive patients diagnosed with CD who underwent ileostomy reversal at a tertiary care centre between 1 January 2013 and 1 December 2021, were included in the study. The primary outcome was the occurrence of 90-day postoperative complications. The study included 347 eligible patients who underwent ileostomy reversal. There was no significant difference in terms of infectious complications, overall complications or length of postoperative stay between the biologic and non-biologic groups. Multivariate logistic regression analysis identified several predictors of postoperative morbidity, including preoperative haemoglobin levels below 100 g/L, CRP levels above 10 mg/L, anastomotic site, ileostomy-related infectious complications and albumin levels below 35 g/L. This study demonstrated that the use of biologics is not associated with adverse outcomes. However, such as high CRP levels, ileostomy-related infectious complications, hypoproteinemia, and hemoglobinemia, should be optimized prior to surgery to reduce postoperative morbidities.

Outbreak of ciguatera poisoning in a commercial vessel: lessons learnt and prospects of early diagnosis, management, and prophylaxis.

An outbreak of food poisoning of unknown origin was notified to Central Queensland Public Health Unit on 9 December 2021. The bulk carrier sailing from Higashiharima, Japan to Gladstone, Australia reported an incident of sudden illness, with 19 out of 20 sailors on board reporting a combination of gastrointestinal and neurological symptoms. Central Queensland Public Health Unit started the outbreak investigation as per Queensland Health public health management guidelines. All 20 of the sailors consumed a self-caught barracuda and squid, prepared by the ship's cook, the day before. Unconsumed samples of the fish and squid were sent for testing. The affected sailors were triaged on arrival and were provided with medical care as required. The barracuda sample contained ciguatoxins (CTXs; P-CTX-1, P-CTX-2, P-CTX-3) with a total count of 3.40 ug/kg confirming the diagnosis. We propose the usage of the combination of gastrointestinal symptoms and paraesthesia in the light of a recent intoxication event for early detection of ciguatera poisoning (CP) in the eastern seaboard of Australia.

Severe Recurrent Bleedings in Infant with a Factor VII Deficiency (Case Report)

Factor VII deficiency considered the most common of rare bleeding disorders. The symptoms of this affection can begin at any age, although the most severe cases are apparent in infancy. However, up to one-third of people with factor VII deficiency never have any bleeding problems. Symptoms can range from epistaxis up to cerebral hemorrhage. We here report the case of a child, diagnosed with factor VII deficiency with severe recurrent Bleedings (umbilical haemorrhage, hemarthrosis. lingual hematoma, gastrointestinal and cerebral bleeding). Prophylaxis with rFVIIa in a schedule based on 20-30 μg/kg of rFVIIa one, twice or three times a week has been described as the therapeutic regimen with the best outcomes in terms of reduction of bleeding's severity and frequency. Our patient underwent early prophylaxis with a 30 μg/kg of rFVIIa a week schedule. Unfortunately, prophylaxis hasen't been successful to prevent further bleedings. The evolution was marked by occurrence of several gastrointestinal and cerebral bleeding, then death by a cerebral hemorrhage at the age of 6 months. Congenital Factor VII deficiency is a rare cause of bleeding disorder, which should be suspected in a healthy bleeding child presenting in infancy when platelets and aPTT is normal with a deranged PT.

Atrial fibrillation burden and timing of anticoagulation therapy in patients with screen-detected and clinically-diagnosed AF

Abstract Purpose We evaluated the impact of atrial fibrillation (AF) burden and timing of oral anticoagulation (OAC) therapy initiation on stroke risk in patients with screen-detected and clinically-diagnosed AF. Methods Consecutive patients aged ≥65 years attending medical outpatient clinics with or without known AF were prospectively enrolled for AF-screening using handheld single-lead ECG (AliveCor) from 12/2014 to 12/2017 (NCT02409654). Repeated screening was performed in patients with >1 visit during this period. Patients who participated in repeat screening were included in final analysis. Patients with previously known AF who were in AF in the initial screening and those with repeat screen-positivity were considered probably persistent AF, otherwise paroxysmal AF (single screen-positivity) or no AF (never screen-positive). Time from AF detection to initiation of OAC (Dx-to-Rx) was divided into two exposure levels, Dx-to-Rx ≤ 1 and >1 month. Ischemic stroke risk was estimated using adjusted sub-distribution hazard ratios (aSHR) derived from Fine and Gray regression models, accounting for death as competing risk, adjusting for components of CHA2DS2VASC score and chronic renal disease, with no AF as reference and stratified according to AF burden and Dx-to-Rx. Results Of 11,972 patients enrolled, 3,853(32.2%) received repeated screening (mean age 76.7±7.3, female 47.5%), of which 3.7% (n=144) had screened-detected AF, 25.2% (n=972) previously known AF, 5.9% (n=226) clinically-diagnosed AF during follow-up, and 65.2% (n=2,511) no AF. Persistent AF was identified in 16.7% (n=644/3,853). Of patients with all AF categories, 55.1% (n=739/1,342) initiated OAC within 1 month after AF diagnosis. During a median follow-up period of 7.2(IQR: 6.1-7.5) years, compared to no AF, patients with paroxysmal AF and Dx-to-Rx ≤ 1m (aSHR=1.40, 95%CI:0.80-2.47) had similar low risk of ischemic stroke, while aSHR was highest for persistent AF and Dx-to-Rx >1m (aSHR=2.42, 95%CI:1.38-4.26), followed by persistent AF with Dx-to-Rx≤ 1m (aSHR=2.19,95%:1.47-3.28), and paroxysmal AF with Dx-to-Rx >1m (aSHR=2.00,95%CI:1.32-3.02) (Figure). Subgroup analysis revealed the effect of early initiation of OAC (P for interaction=0.936) and higher AF burden (P for interaction=0. 863) were consistent across screen-detected and clinically-diagnosed AF. Conclusion Among patients with screen-detected AF or clinically-diagnosed AF, lower AF burden and immediate initiation of OAC therapy were associated with reduction in risk of ischemic stroke. Early detection of AF by screening facilitating early OAC prophylaxis might improve clinical outcomes.Cumulative risk of ischemic stroke

Immune Reconstitution and Infection Patterns Following CAR T-Cell Therapy in Patients with Aggressive Lymphoma

Introduction: Chimeric antigen receptor T-cell therapy (CAR T) is an effective therapy in relapsed/refractory (R/R) large B-cell lymphoma (LBCL) but is associated with prolonged cytopenias, persistently low CD4 T-cells, and hypogammaglobulinemia (defined as serum IgG <500 mg/dL) resulting in an immunocompromised state post CAR T [Logue 2021]. Prophylactic antimicrobials and intravenous immunoglobulin (IVIG) have been utilized to mitigate infectious complications, but practices are not standardized. We sought to examine patterns of immune reconstitution and their impact on incidence, timing, and management of infection following CAR T. Methods: We identified patients (pts) with R/R LBCL treated with CAR T between 2015 - 2022 across 13 academic institutions. Data on measures of immune recovery and infections were captured post CAR T. Time-to-event curves were established by Kaplan-Meier method. Results: 582 pts were included with a median age of 62 yrs (range 19-89). Pts were heavily pretreated with 3 median lines (range 1-18), and 26% with prior autologous transplant. Median time to ANC > 500 cells/mm3 was 11 days (D); median CD4 counts were 155 and 223 cells/mm 3 at 6 and 12 mo, respectively. Median absolute neutrophil and lymphocyte counts at 6 mo were 2300 and 690 cells/mm 3, respectively. At D90 post-CAR T, 61.5% (136/221) of pts had hypogammaglobulinemia (HGG) that persisted in 62.1% (90/145) at 1yr and 48.3% (56/116) at 2yrs. Data for D90-2 yrs post CAR T were analyzed to characterize late effects of CAR T as follows: Figure 1 describes time to first infection by organism of interest. 66.8% (193/389) of pts developed bacterial infections; median time to infection was 6.7 mo. Most common organisms were Pseudomonas (n =33), E. Coli (n=24), S. Aureus (n=22), C. Diff (n=26), Klebsiella (n= 18). HGG at D30 and D90 was associated with increased risk of bacterial infection, p = 0.002 (OR 2.5) and p= 0.013 (OR 2.1), respectively. Low CD4 counts and neutropenia at any time point within 2 years, did not correlate with increased rate of bacterial infection. Excluding COVID, 31.2% (138/443) of pts developed viral infections; median time to infection was 5.4 mo. Most common organisms were COVID (n=49), Rhinovirus (n= 20), CMV (n= 21), and Influenza (n= 13). Median time to COVID infection was 15.6 mo (range 0.2- 33.1). Neither neutropenia, nor low CD4 counts within 2 yrs post CAR T correlated with increased rate of viral infection. HGG at any time point within 6 mo post CAR T was associated with increased risk of viral infections, including COVID (p = 0.04, OR 2.2). Fungal and PJP infections were infrequent, occurring in 19 and 6 pts, respectively. Median time to fungal infection was 1.7 mo. For infection risk mitigation: 98.4% (496/504) of pts received prophylactic antivirals for median duration of 9.0 mo (0.2- 80.0) and 74.5% (371/498) received PJP prophylaxis for median duration of 6.3 mo (0.2-62.6). IVIG was administered in 34.3% (192/560) of pts with median time to initiation of 3.9 mo post CAR T. Pts with infection D90- 2 yrs were more likely to receive IVIG than those without infection (43.5% vs 26.9% respectively, p= 0.001). Median follow-up in living pts was 35.3 mo with median OS of 27.8 mo (CI 21.2-34.5). Ninety-six (16.5%) pts received salvage therapy post CAR T. Infection of all types <90 days post- CAR T was associated with inferior OS (16 mo vs 43.3 mo, p=0.001). Infection >90 days-2 yrs post CAR T was not associated with worse OS. Presence of HGG at any time point did not impact OS (p = 0.218). However, median OS was not reached in pts who received IVIG vs 16.9 mo in pts who did not (Figure 2, p= 0.001). Furthermore, in pts with HGG, lack of IVIG utilization at D90 was associated with worse OS (p <0.001). Conclusions: Immune suppression is a long-term toxicity of CAR T. Bacterial infections were common and most occurred within ~ 7 mo of infusion while viral infections were less frequent and occurred earlier. Both were associated with prolonged HGG. These observations should inform use of early antimicrobial prophylaxis. The majority of pts received anti-viral and PJP prophylaxis which may have contributed to lower rates of these infections. Pts with infection were more likely to receive IVIG with administration of IVIG improving survival. Our results support continued use of antiviral and PJP prophylaxis and the consideration of empiric IVIG within 30 days following CAR T to mitigate risk of infection and improve survival following CAR T.

Positive Impacts of the Universal Newborn Screening Program on the Outcome of Children with Sickle Cell Disease in the Province of Quebec: A Retrospective Cohort Study

Background Sickle cell disease (SCD) is the most common monogenic disease worldwide. Benefits of preventive measures such as early penicillin prophylaxis and ease of neonatal diagnosis led to the inclusion of SCD in newborn screening programs (NSP) in the US and later in several Canadian provinces. Universal NSP was implemented in the province of Québec (QcNSP) in November 2013, close in time to the recommendation of early hydroxyurea (HU) therapy. Our study objective was to evaluate how the QcNSP impacted the clinical outcomes of SCD infants and children followed at CHU Ste-Justine between the age of 0-5 years of age. We hypothesized that the introduction of QcNSP has shortened the time to referral to SCD comprehensive centres and the time to HU initiation, while also reducing the number of acute SCD complications. Methodology This is a retrospective cohort study of patients referred to the pediatric comprehensive SCD centre at CHU Sainte-Justine (Montreal), a leading tertiary pediatric center in Canada from Jan 1-2000, to Dec 31-2019. To be included, patients had to be followed for at least two years. Two cohorts were defined: Cohort Pre-QcNSP included patients who had their first visit between January 1 st 2000 and October 31 st2013, whereas cohort post-QcNSP included patients who had their first visit between November 1st 2013 and December 31 st 2019. SCD genotypes were stratified into two groups: HbSS/Sß 0 and SC/Sß +. Reasons for referral were extracted. A Kaplan-Meier curve for hospitalization-free survival (HFS), a poisson regression for the number of VOC emergency (ED) visits and a logistic regression for clinical outcomes, adjusting for age at first visit, gender, place of birth, follow-up period and QcNSP were computed. The software R version 4.2.1 was used for all statistical analyses. The study was approved by the local IRB. Results Of 600 files examined, 410 met the inclusion criteria. 253 were referred pre-QcNSP, 157 post-QcNSP. There were equal gender representations in both groups, and no statistical differences between genotype representation between cohorts. Median age at 1st visit decreased from 1.2 [IQR: 0.2-6.0] pre-QcNSP to 0.2 years [IQR:0.1-4.8] post-QcNSP (p<0.001). The percentage of children born in the province of Qc diagnosed through NS increased from 48.1% (79) pre-QcNSP to 100% (102) post-QcNSP (p<0.004). The percentage of undiagnosed children born in Qc and referred after a first SCD-related complication (DRC) dropped from 42% to 0% (p<0.0001). The median age of HU-introduction for SS patients decreased from 4.5 [IQR:2.6-5.5] pre-QcNSP to 0.75 years [IQR:0.8-1.08] post-QcNSP (p<0.001). Similarly, the percentage of SS patients receiving HU by the age of 2 years old significantly increased from 28.6% preQcNSP to 59.3% post-DN patients (p=0.003). The overall percentage of SS patients eventually receiving HU was nevertheless statistically not different between cohorts (89.7% (61/68) post-QcNSP vs 82.5% (80/97) pre-QcNSP). The number of hospitalizations in HbSS/Sß 0 decreased from 2 hospitalizations/pt-year pre-QcNSP [IQR 1.0-3.0] to 1.0 [IQR: 0.6-1.4] (p<0.001). Hospitalization-free survival (HFS) also improved (257 days post-QcNSP vs. 140 days pre-QcNSP, p<0.001) for HbSS/Sß 0 patients. Similarly, HFS for VOC was significantly longer post-QcNSP (1320 days vs. 573 days, p<0.002). Evaluating ED visits for VOC, HbSS/Sß 0 children referred pre-QcNSP had much greater risk of ED-VOC visits than post-QcNSP (1.44, CI 1.22-1.67); similarly, SS/Sb 0 children referred for DRC vs NS had a higher risk of ED-visit for VOC (0.25, CI 0.02-0.48). There was however no statistical difference in SC/Sß + patients. Conclusion. In Quebec, the universalization of the NSP has enabled early detection and referral of children with SCD to comprehensive care centre. Earlier access to this expertise ensures that children benefit from the essential preventive interventions that are vaccination, prophylactic penicillin, early HU-use as well as caregiver education. These combined interventions may explain in part the improvement in acute events. This cohort study highlights that universal NSP of SCD is an essential public health measure.

Discontinuation of Levetiracetam and Valproic Acid Due to Adverse Effects in Early Post-traumatic Seizure Prophylaxis.

Levetiracetam (LEV) and valproic acid (VPA) are two anti-epileptic drugs (AEDs) routinely used for post-traumatic seizure (PTS) prophylaxis at our institution. In our practice, VPA is used for its beneficial effects on behavioral agitation and headaches, but it is also associated with abnormal liver function tests (LFTs). Both medications may be associated with thrombocytopenia. There is less literature comparing the adverse effect profiles and discontinuation rates of LEV and VPA in the context of PTS prophylaxis. We conducted a quality improvement (QI) analysis to determine the safety of LEV and VPA for traumatic brain injury (TBI) patients at our institution. In particular, our QI analysis involved calculating the rates of discontinuation or change of drug regimen due to the adverse effects. Our QI analysis focused on patients treated for TBI at our institution during a six-year period. We recorded the AED usedand if the AED was discontinued or switched due to thrombocytopenia, behavioral agitation, headaches, or elevated LFTs (including elevated aspartate aminotransferase or alanine aminotransferase values). We also recorded the incidence of early PTS, defined as seizures within seven days of the TBI. Our QI analysis included patients with a mean age of approximately 49 years with nearly 75% males. The mean Glasgow Coma Scale (GCS) score was 12.88, with 73.11% of patients having a mild GCS. The three leading injury mechanisms were fall, assault, and motor vehicle collision. The three leading types of TBI were traumatic subarachnoid hemorrhage, subdural hematoma, and cerebral contusion. Among patients with no prior history of seizures, we found an early PTS incidence of 7.28%. For patients administered LEV and VPA, 0.11% (1/898) and 3.85% (4/104)had the medication discontinued or changed because of thrombocytopenia (p < 0.001), respectively. For patients on LEV, 4.01% (36/898) and 1.78% (16/898) had the medication discontinued or changed because of behavioral agitation and headaches, respectively. For patients on VPA, 2.88% (3/104) had the medication discontinued or changed because of hepatotoxicity. In total, 5.90% versus 6.73% (p > 0.5) of patients on LEV and VPA, respectively, had their medication regimens changed due to the adverse effects. The incidence of early PTS in our patients is within the range of what has been reported in the literature. The rate of discontinuation of LEV and VPA on account of adverse events is low in the context of PTS prophylaxis. Both medications had similar overall rates of discontinuation. VPA was discontinued more frequently than LEV due to thrombocytopenia, but discontinuation was not common in either case. LEV is associated with behavioral agitation and headaches, which makes VPA a desirable alternative for patients suffering from these symptoms.

32 Risk Factors for Iron Deficiency in Formula-fed very Preterm Infants: A Population-based Study from Nova Scotia

Abstract Background Iron prophylaxis is routinely recommended for preterm infants, as they are vulnerable to develop iron deficiency (ID). Recent work from our group has demonstrated that despite early iron prophylaxis, ID is common in very preterm infants (VPI), with an incidence of 32% at 4 to 6 months corrected age (CA). Additionally, ID is more prevalent in exclusively formula-fed (FF) VPI compared to infants who are exclusively or partially breast-fed. Objectives To explore the risk factors associated with ID in the FF infants. Design/Methods A retrospective population-based cohort study was conducted using a provincial database. All VPI born in Nova Scotia from 2005 to 2018 who were exclusively fed with iron-rich formula (&amp;gt;10 mg/L) at 4 to 6 months CA were included. Information about formula type, iron intake from formula, and supplemental iron therapy at 4- to 6-month follow-up was extracted, as were neonatal variables. ID was defined as serum ferritin &amp;lt;20 and &amp;lt;12 mcg/L at 4- and 6-months CA, respectively. Results ID was present in 36.8% (105) of 285 FF infants. Table 1 shows key characteristics of ID and non-ID FF infants. Mean gestational age and birth weight were lower in the ID group. More babies in the ID group received blood transfusion (Odds:1.1-3.0). Other maternal and neonatal variables were comparable between the groups. ID children did not have a lower iron intake than non-ID children. Conclusion Lower gestational age, lower birth weight, and need for blood transfusions increased the risk of ID in FF infants. Optimal iron supplementation in this population should be guided by a risk-adapted strategy.

PREVALENCE OF ANAEMIA (REDUCED PACKED CELL VOLUME) AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINICS IN KATSINA METROPOLIS

Anaemia during pregnancy is still a major health problem in malaria endemic countries with clinical consequences including death of both mother and child. Moderate or severe anaemia during pregnancy may be associated with heavy parasitic infestation. This study investigated prevalence of anaemia among pregnant women attending antenatal clinics in Katsina metropolis, Katsina state. A cross-sectional study was carried out among 250 pregnant women attending four different public health centers in Katsina metropolis. Blood samples were obtained to determine their PCV. The PCV count was determined using hematocrit reader. The overall prevalence of anaemia for the all hospital was 110 (44.0%). The highest prevalence of anaemia 54 (84.38%) was recorded among pregnant women attending Turai Yar’adua Maternal and Children Hospital. The least prevalence of anaemia 14 (28.58%) was recorded among pregnant women attending PHC Kofar Marusa. A high prevalence of anaemia among pregnant women in this study was an indication of possible anaemia within the study area. This study advocates the need for pregnant women to undergo routine haemoglobin estimation and early malaria prophylaxis considering the deleterious effects of anaemia on them and their foetus.

Age-specific incidence of joint disease in paediatric patients with haemophilia: A single-centre real-world outcome based on consecutive US examination.

Joint health is one of the most important factors contributing to a healthy life in patients with haemophilia. Recent study revealed that starting early prophylaxis was not enough to prevent joint disease in most paediatric patients with haemophilia. In this study, we aimed to determine the age-specific incidence of acute joint disease during childhood at single haemophilia treatment centre (HTC). The joint health in 48 patients was evaluated based on consecutive US testing for 5 years at annual multidisciplinary comprehensive care. During the study period, 23 patients (47.9%) had no joint disease since the initial examination, whereas 13 patients (27.0%) showed development from negative to positive findings. The incidence of joint disease increased with age: 0% in preschool, 5.3% in elementary school, 14.3% in junior high school and 35% beyond high school age. Among the 13 patients who developed joint disease, two experienced acquired synovitis that resolved during the follow-up period. Statistical analysis revealed that the patients who routinely underwent follow-up by the HTC exhibited a significantly lower incidence of joint disease than did those followed up at other institutions (p<.001). These results indicated that close check-up, including routine joint examination using US as well as frequent assessment of pharmacokinetic profile at the HTC, might play an important role in avoiding joint disease among paediatric patients with haemophilia.

Perioperative perampanel administration for early seizure prophylaxis in brain tumor patients.

The efficacy of perioperative prophylactic antiepileptic drug therapy in "seizure-naïve" patients with brain tumor, including glioblastoma (GBM), remains controversial. This study investigated whether perampanel (PER) is effective and safe for preventing perioperative onset of epileptic seizures, so-called early seizure, in patients with brain tumors. Forty-five patients underwent tumor resection through craniotomy for a primary supratentorial brain tumor at Ehime University Hospital between April 2021 and July 2022. PER was administered from the 1st to the 6th day after surgery for seizure prophylaxis. Occurrence of early seizure, hematological toxicities, and various side effects were recorded on postoperative days 7 and 14. In addition, the clinical course of these patients was compared with 42 brain tumor patients under the same treatment protocol who received levetiracetam (LEV) for seizure prophylaxis between April 2017 and October 2018. In 45 patients with brain tumor, including GBM, who received PER administration, no early seizures were identified within 7 days postoperatively. No adverse drug reactions such as hematological toxicity, liver or kidney dysfunction, or exanthematous drug eruption were observed in any cases. As side effects, somnolence was reported in 14 patients (31.1%), vertigo in 3 patients (6.7%), and headache in 3 patients (6.7%). Although somnolence and vertigo were difficult to assess in the case of intraparenchymal tumors, particularly GBM, these side effects were not identified in patients with extraparenchymal tumors such as meningiomas, epidermoid cysts, and pituitary adenomas. In addition, no significant differences were identified compared to patients who received LEV. The efficacy and safety of PER in preventing early seizures among patients with brain tumors were retrospectively evaluated. Perioperative administration of PER to patients with brain tumors may reduce the risk of early seizures without incurring serious side effects, showing no significant differences compared to patients who received LEV.

Hysterectomy for gynecological indication at the General Hospital of Kasenga, in the city of Uviran, in the Province of South-Kivu in the Est of the Democratic Republic of Congo

We conducted a retrospective and cross-sectional study. We collected the data over a period of one year. It took place over a period of time from January 25, 2021 to January 25, 2022 in the obstetrics gynecology departments of the General Hospital (GH) of KASENGA in the city of Uvira in the province of South Kivu in the East of the Democratic Republic of Congo (DRC). The main objective is to determine the frequency of hysterectomy in this part of DRC and to determine what would be the gynecological indications. Only patients who underwent hysterectomy for gynecological indication were included in our study. We found that the frequency of hysterectomies for gynecological indications compared to all surgical activity was 12.5%. The average age of our patients was 54.2 years. The indications were dominated by hysteroceles (44%) and uterine myomas (20%). The approach was vaginal in 52% and abdominal in 48%. The hysterectomies were total in 92% of cases and radical in 8% of cases. We did not note any major complications except parietal infections which were in 16% of cases. All patients received postoperative antibiotic prophylaxis. No anticoagulant treatment was prescribed. After this work we found that hysterectomy is frequent at the Reference Hospital (HR) of KASENGA with the main indication, hysterocele according to the different degrees. We did not have many complications and this would be due to the early antibiotic prophylaxis. The improvement of socio-economic conditions, awareness and early detection should improve the conditions of care.

The Association Between the Timing of Initiation of Pharmacologic Venous Thromboembolism Prophylaxis with Outcomes in Burns Patients.

Hospitalized burn patients are at increased risk for venous thromboembolism (VTE). Guidelines regarding thromboprophylaxis in burn patients are unclear. This study aims to compare the outcomes of early versus late thromboprophylaxis initiation in burn patients. In this 3-year analysis of 2017-2019 ACS-TQIP, adult(18-64years) burn patients were identified after applying inclusion/exclusion criteria and stratified based on timing of initiation of VTE prophylaxis: Early(<24 hours of admission); Late(>24 hours). Outcomes were deep venous thrombosis(DVT), pulmonary embolism(PE), unplanned return to operating room (OR), unplanned intensive care unit (ICU) admission, post-prophylaxis packed red blood cells (PRBC) transfusion, and mortality. Nine thousand two hundred and seventy-two patients were identified. Overall, median age was 41years, 71.5% were male, and median[IQR] injury severity score was 3[1-8]. 53% had second-degree burns, and 80% had less than 40% of total body surface area affected. Median time to thromboprophylaxis initiation was 11[6-20.6]hours. Overall VTE rate was 0.9% (DVT-0.7%, PE-0.2%). On univariable analysis, early prophylaxis group had lower rates of DVT(0.6% vs 1.1%, P = .025), and PE(0.1% vs 0.6%, P < .001). On multivariable regression, late prophylaxis was associated with 1.8 times higher odds of DVT (aOR = 1.8, 95% CI = 1.04-3.11, P = .03), 4.8 times higher odds of PE(aOR = 4.8, 95% CI = 1.9-11.9, P < .001), and 2 times higher odds of unplanned ICU admission(aOR = 2.1, 95% CI = 1.4-3.1, P < .001). Furthermore, early thromboprophylaxis was not associated with increased odds of post-prophylaxis PRBC transfusion(aOR = 1.1, 95% CI = 0.8-1.4, P = .4), and mortality(aOR = 0.68, 95% CI = 0.4-1.1, P = .13). Early VTE prophylaxis in burn patients is associated with decreased rates of DVT and PE, without increasing the risk of bleeding and mortality. VTE prophylaxis may be initiated within 24 hours of admission to reduce VTE in this high-risk patient population.

Early Venous Thromboembolism Prophylaxis in Patients with Trauma Intracranial Hemorrhage: Analysis of the Prospective Multicenter CLOTT Study.

The optimal time to initiate venous thromboembolism prophylaxis (VTEp) for patients with intracranial hemorrhage (ICH) is controversial and must balance the risks of VTE with potential progression of ICH. We sought to evaluate the efficacy and safety of early VTEp initiation after traumatic ICH. This is a secondary analysis of the prospective multicenter Consortium of Leaders in the Study of Thromboembolism (CLOTT) study. Patients with head AIS > 2 and with immediate VTEp held due to ICH were included. Patients were divided into VTEp ≤ or > 48 hours and compared. Outcome variables included overall VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), progression of ICH (pICH), or other bleeding events. Univariate and multivariate logistic regressions were performed. There were 881 patients in total, 378 (43%) started VTEp ≤48 hours (early). Patients starting VTEp >48 hours (late) had higher VTE (12.4% vs 7.2%, p = .01) and DVT (11.0% vs 6.1%, p = .01) rates than the early group. The incidence of PE (2.1% vs 2.2%, p = .94), pICH (1.9% vs 1.8%, p = .95) or any other bleeding event (1.9% vs 3.0%, p = .28) were equivalent between early and late VTEp groups. On multivariate logistic regression analysis, VTEp >48 hours (OR 1.86), ventilator days >3 (OR 2.00), and risk assessment profile score ≥ 5 (OR 6.70) were independent risk factors for VTE (all p < 0.05), while VTEp with enoxaparin was associated with decreased VTE (OR 0.54, p < 0.05). Importantly, VTEp ≤48 hours was not associated with pICH (OR 0.75) or risk of other bleeding events (OR 1.28) (both p = NS). Early initiation of VTEp (≤48 h) for patients with ICH was associated with decreased VTE/DVT rates without increased risk of pICH or other significant bleeding events. Enoxaparin is superior to unfractionated heparin as VTE prophylaxis in patients with severe TBI. Level IV; Therapeutic/Care management.