High Levels Of Comorbidity Research Articles

Preventing pressure sores after hip fracture.

Hip fractures commonly occur in older patients, with high levels of frailty and comorbidity. Many of these patients have limited mobility before their fracture, and even after surgery, their mobility may remain limited. It is therefore not surprising that they are at a high risk of developing pressure sores, particularly on their heels, and a variety of devices and interventions have been proposed to reduce this risk. Foam or air mattresses, designed to reduce contact pressure on the patient's whole body, are now routinely used in many healthcare systems. However, there is wide variation in their design. We developed the WHiTE 14;PRESSURE 3 trial to address the lack of evidence in this area. This is a three-arm multicentre randomized trial including health economic evaluation and recruiting patients from NHS hospitals in the UK. The trial compares standard strategies for the prevention of pressure sores with standard care plus a constant low-pressure device and with standard care plus a heel off-loading device. This annotation describes the development of this trial.

P-481. Characterization of People with HIV Who Are Virologically Suppressed with Treatment Experience Using a US Real-World Database

Abstract Background People living with HIV who are virologically suppressed with treatment experience (PWH-VSTE) are often prescribed complex multi-tablet and/or multi-dose antiretroviral (ARV) regimens with increased risk of poor clinical outcomes due to adherence challenges, adverse events, and/or drug interactions. This population is not well characterized, with no universal definition. We conducted a retrospective, observational analysis of a large US database to characterize PWH-VSTE and better understand this subset of PWH. Methods PWH with treatment experience (PWH-TE) with ≥ 2 ARV lines of therapy (LOT) were identified from the Veradigm Network electronic health record (EHR) database linked with claims during the study period, Jan 2015–Dec 2022. We defined VSTE as virologic suppression (HIV-1 RNA ≤ 200 copies/mL) during the LOT in which ≥ 1 of the following treatment criteria were met: (1) used ≥ 1 “complex” ARV regimen; (2) resistance to exactly 2 ARV classes out of nucleoside or non-nucleoside reverse transcriptase inhibitors (NRTI, NNRTI), integrase strand transfer inhibitor (INSTI), and protease inhibitor (PI); (3) prior exposure to exactly 2 ARV classes out of NNRTI, INSTI, and PI (Figure). For inclusion, PWH-VSTE were aged ≥ 18 years and had an HIV diagnosis, continuous claims enrollment, and EHR activity. We report the proportion of PWH-TE meeting VSTE-defining criteria, and their characteristics. Results Of 308,088 PWH-TE, 13,192 (4%) met ≥ 1 VSTE-defining criterion (9957 met Criterion 1 and 8272 met Criterion 3); 6907 (52%) were eligible for analysis (Figure). PWH-VSTE were mostly male (71%), Black (41%), aged 50–59 years (36%), using Medicaid (55%), from the South (39%), and had a mean (SD) Charlson Comorbidity Index of 6.1 (2.6) (Table). Among those with data during the baseline period (6-month period prior to index date), 48.2% (990/2052) had a viral load of ≤ 200 copies/mL. Resistance testing was done for 13.3% of PWH-VSTE during the baseline period, but only 0.2% had results available. Conclusion In this large, real-world database, PWH-VSTE comprised 4% of PWH-TE, were mostly male, and had a high level of comorbidities. Understanding the characteristics of PWH-VSTE will enable clinicians to better address the needs of this historically understudied population. Disclosures Samir K. Gupta, MD, Gilead Sciences, Inc.: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Katherine Cappell, n/a, Veradigm: Employee|Veradigm: Stocks/Bonds (Public Company) Kwanza Price, n/a, Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Mac Bonafede, PhD, Moderna, Inc.: Advisor/Consultant|Veradigm: employees|Veradigm: Stocks/Bonds (Public Company) Joshua Gruber, PhD MPH, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Dylan Mezzio, PharmD, Gilead Sciences, Inc.: employees|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Soodi Navadeh, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Robert Sedgley, n/a, Veradigm: employee Sorana Segal-Maurer, MD, Gilead Sciences, Inc.: Advisor/Consultant|Gilead Sciences, Inc.: Grant/Research Support|Gilead Sciences, Inc.: Honoraria|Janssen: Advisor/Consultant|Theratechnologies: Advisor/Consultant|ViiV: Advisor/Consultant

Post-traumatic stress disorder (PTSD) symptom clusters associated with an indicator of heart rate variability: The ADVANCE cohort study.

Heart rate variability (HRV) is governed by of sympathetic and parasympathetic regulatory systems. Post-Traumatic Stress Disorder (PTSD) may influence these systems and consequently affect cardiovascular functioning. The sample consisted of 860 UK male military personnel approximately half of who had sustained physical combat injuries in Afghanistan. HRV was measured via Root-Mean Square of Successive Differences (RMSSD) in normal heart beats and PTSD using a self-report questionnaire (Posttraumatic Checklist-Civilian version (PCL)). Associations between probable PTSD status (PCL score ≥ 50) and symptom clusters (avoidance behaviours, emotional numbing, hyperarousal and intrusive thoughts) with HRV were examined. Bootstrap inclusion frequencies and model averaging were employed prior to regression modelling to identify the most important symptom clusters associated with RMSSD. Probable PTSD status was not associated with log RMSSD [-11.6 % (95 % Confidence Interval (CI) -22.2 %, 4.1 %). Increases in severity of emotional numbing were associated with reductions in RMSSD, with a - 1.1 % (95%CI -2.1 %, -0.2 %) decrease in the geometric mean of RMSSD per point increase on the emotional numbing subscale. High levels of comorbidity with depression/anxiety; possible endogeneity/bidirectionality due to PCL including both psychological and physiological symptoms. Emotional numbing, the symptom cluster including symptoms such as anhedonia, cognitive dysregulation and feeling distant from other people, was associated with HRV whilst overall PTSD status was not. These results lend support to the hypothesis that different PTSD symptom clusters may have unique effects on the cardiovascular system, and that particular symptom clusters of PTSD or combinations thereof may be associated with distinctive cardiovascular profiles.

Use of antiepileptic drugs in mental disorders

Antiepileptic drugs (AEDs) are quite often used in psychiatric practice and are considered the drugs of choice for mental disorders, primarily recurrent and bipolar depression and mania, behavioral and anxiety disorders with signs of bipolar emotional dysregulation, mental disorders with dependence on psychoactive substances. The level of evidence for the use of AEDs varies, sometimes they are used outside the recommendations of the FDA, EMA, outside the instructions of the Pharmcenter of Ukraine. Currently, mood stabilizers such as valproate, lamotrigine, carbamazepine have the highest level of evidence. Most psychotropic drugs are recommended for use in the treatment of affective disorders (antipsychotics, antidepressants, lithium salts) and attention deficit hyperactivity disorders (psychostimulants, atomoxetine) from the age of 6, which explains the widespread use of valproate and lamotrigine in pediatric practice outside direct indications. Bipolar affective disorders have a high level of comorbidity with generalized anxiety and panic disorder, which sometimes demonstrate low sensitivity to benzodiazepine therapy, but respond well to valproic acid salt therapy. The use of gabapentin in anxiety disorders is based on the results of controlled studies. Anticonvulsants are widely used in alcohol and substance abuse, addictive disorders, emotional and behavioral disorders associated with withdrawal states. The therapeutic and side effects of AEDs are closely related to behavioral disorders in epilepsy. They can improve or worsen behavioral symptoms associated with signs of emotional bipolar dysregulation and attention deficit hyperactivity disorder. It is expected that the list of AEDs will continue to grow, and new proposals for use in psychiatric practice will appear.

Peer rejection and internet gaming disorder: the mediating role of relative deprivation and the moderating role of grit.

Internet Gaming Disorder (IGD) is a new behavioral addiction. A large number of empirical studies have shown that Internet Gaming Disorder has a high level of comorbidity with other diseases, including depression, anxiety, obesity, internalizing and externalizing behavioral problems, however, little is known about the mediating and moderating mechanisms underlying this relation. The current study adopted a three-time longitudinal study investing the mediating effect of relative deprivation on the association between peer rejection and IGD, and whether this mediating effect was moderated by the grit. A total of 1,065 students in China anonymously completed three-time longitudinal study questionnaires. The average age was 10.19 years (SD = 0.75) and the interval between measurements was 6 months.PROCESS for SPSS proposed by Hayes was used to test a moderated mediation model, with gender, age as covariates. T1 peer rejection positively predicted T3 Internet Gaming Disorder. Relative deprivation at T2 plays a complete mediating role between peer rejection at T1 and Internet gaming disorder at T3. At the same time, it was found that the personality trait of T3 grit plays a moderating role in the relationship between T2 relative deprivation and T3 Internet gaming disorder. This suggests that peer rejection is an important predictor of Internet Gaming Disorder, and that individuals with high levels of grit are less likely to become addicted to Internet games even if they experience relative deprivation. Measures of study variables were self-reported. Affected by factors such as social desirability, the research results may be biased. These findings emphasize relative deprivation as a potential mechanism linking peer rejection IGD. Grit was an important protective factor to weaken this indirect effect. Intervention programs aimed at reducing IGD may benefit from the current research.

An evaluation of Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR) in a youth outpatient eating disorders service: A protocol paper.

Avoidant/restrictive food intake disorder (ARFID) is a feeding and eating disorder for which there are very few evidence-based treatments. Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR) is a novel exposure-based treatment which is suitable for people aged ten and older. The primary aims of the study are to undertake a real-world evaluation of the feasibility, acceptability, and preliminary effectiveness of CBT-AR for young people aged 12-25years old in an outpatient eating disorders service where the patient population has high levels of psychiatric comorbidity. Clinicians, patients, and parents/guardians will be involved in the evaluation. Assessments will be carried out at baseline, during weekly sessions, at the end of each treatment stage, at end of CBT-AR treatment, and at 3-month follow-up. Assessments will measure ARFID symptoms, mood, quality of life, therapeutic alliance, and feedback on the treatment. The study will take place over a 12-month period and will evaluate the use of CBT-AR within real-life clinical practice conditions, noting how and why deviations from the treatment have occurred. The findings of this research will inform future ARFID treatment delivery and the implementation of CBT-AR at outpatient mental health services.

Optimal Stopping Ages for Colorectal Cancer Screening

Prior studies have shown that the benefits, harms, and costs of colorectal cancer (CRC) screening at older ages are associated with a patient's sex, health, and screening history. However, these studies were hypothetical exercises and not directly informed by data on CRC risk. To identify the optimal stopping ages for CRC screening by sex, comorbidity, and screening history from a cost-effectiveness perspective. This economic evaluation first validated the MISCAN-Colon (Microsimulation Screening Analysis-Colon) model against community-based CRC incidence and mortality rates for 2 subcohorts of the PRECISE (Optimizing Colorectal Cancer Screening Precision and Outcomes in Community-Based Populations) cohort. Subsequently, different CRC screening scenarios were simulated in older individuals. Cohorts of US adults aged 76 to 90 years varied by sex and comorbidity status (none, low, moderate, or severe). Statistical and sensitivity analyses were performed from March 2023 to May 2024. CRC screening histories including fecal immunochemical test (FIT) or colonoscopy, such as a negative colonoscopy result from 10, 15, 20, 25, or 30 years before the index age; 1 to 5 negative FIT results within 5 years of the index age, with different patterns of recency; or a combination of negative colonoscopy and negative FIT results. The main outcomes included estimated lifetime clinical outcomes, incremental costs, and quality-adjusted life-years gained (QALYG) associated with 1 additional FIT or colonoscopy. Optimal stopping age for screening, defined as the oldest age for which the incremental cost-effectiveness ratio was still below the willingness-to-pay threshold of $100 000 per QALYG, was evaluated. The first of the 2 PRECISE subcohorts used in validating the simulation model included 25 974 adults (15 060 females [58.0%]; 54.7% aged 76 to 80 years) with a negative colonoscopy result 10 years before the index date. The second subcohort consisted of 118 269 adults (67 058 females [56.7%]; 90.5% aged 76 to 80 years) with a negative FIT result 1 year before the index date. Older age, male sex, higher comorbidity levels, and recent CRC screenings were associated with reduced incremental benefit and cost-effectiveness of additional screening. For the reference cohort of 76-year-old females without comorbidities and a negative colonoscopy result 10 years before the index age, 1 additional colonoscopy cost $38 226 per QALYG. For cohorts with otherwise equivalent characteristics, associated costs increased to $1 689 945 per QALYG for females at age 90 years without comorbidities and a negative colonoscopy results 10 years before the index age, $51 604 per QALYG for males at age 76 years without comorbidities and a negative colonoscopy result 10 years before the index age, and $108 480 per QALYG for females at age 76 years with severe comorbidities and a negative colonoscopy result 10 years before the index age and decreased to $16 870 per QALYG for females without comorbidities and a negative colonoscopy result 30 years before the index age. The optimal stopping ages across different cohorts ranged from younger than 76 to 86 years for colonoscopy and younger than 76 to 88 years for FIT. In this economic evaluation, age, sex, screening history, comorbidity, and future screening modality were associated with the clinical outcomes, cost-effectiveness, and optimal stopping age for CRC screening. These results can inform guideline development and patient-directed informed decision-making.

Ожирение и депрессия у детей и подростков: проблема коморбидности и профилактики

<p><strong>The relevance:</strong> currently, scientists talk about the epidemic of obesity among children and adolescents, which is associated with significant risks and deterioration of mental and physical health of the young generation. <strong>Objective:</strong> to study association between depression and obesity in children and adolescents. The paper presents a literature review of the widely discussed problem of the relationship between depression and obesity, as well as the results of our own empirical study obtained on a sample of patients from the Center for Treatment and Prevention of Metabolic Diseases and Obesity, FGBU «National Medical Research Center for Endocrinology» of the Ministry of Health of Russia. <strong>Sample.</strong> The study involved respondents aged 7 to 17 years (M=12,5, SD=2,5), a total of 153 people with SDS BMI from 1,2 to 4,2 (M=2,8, SD=0,5), of which 52% were female and 48% were male. The study included a diagnostic interview with the child and parents, each child was asked to fill out the Children's Depression Inventory (Maria Kovacs 1992). The <strong>results</strong> suggest a high level of comorbidity of obesity and depressive symptoms among children and adolescents ¾ 52% of girls and 27% of boys who participated in the study have symptoms of depression of varying degrees of severity. Also, more severe forms of obesity were recorded in boys compared to girls at the initial application for specialized care, which indirectly indicates a greater concern for health and appearance on the part of girls and their families. The overwhelming majority of parents of children note unhealthy eating habits, low physical activity and sleep disorders in their children. It is <strong>concluded</strong> that it is necessary to raise awareness of children, parents, teachers and child specialists of different profiles about the relationship between depressive symptoms and obesity, as well as the importance of appropriate diagnosis and the development of comprehensive treatment and prevention programs for both obesity and depression.</p>

Exploring latent clusters in pediatric OCD based on symptoms, severity, age, gender, and comorbidity.

Given diverse symptom expression and high rates of comorbid conditions, the present study explored underlying commonalities among OCD-affected children and adolescents to better conceptualize disorder presentation and associated features. Data from 830 OCD-affected participants presenting to OCD specialty centers was aggregated. Dependent mixture modeling was used to examine latent clusters based on their age- and gender adjusted symptom severity (as measured by the Children's Yale-Brown Obsessive-Compulsive Scale; CY-BOCS), symptom type (as measured by factor scores calculated from the CY-BOCS symptom checklist), and comorbid diagnoses (as assessed via diagnostic interviews). Fit statistics favored a four-cluster model with groups distinguished primarily by symptom expression and comorbidity type. Fit indices for 3-7 cluster models were only marginally different and characteristics of the clusters remained largely stable between solutions with small clusters of distinct presentations added in more complex models. Rather than identifying a single classification system, the findings support the utility of integrating dimensional, developmental, and transdiagnostic information in the conceptualization of OCD-affected children and adolescents. Identified clusters point to the centrality of contamination concerns to OCD, relationships between broader symptom expression and higher levels of comorbidity, and the potential for complex/neurodevelopmental presentations.

Do mindfulness interventions cause harm? Findings from the Learning to Apply Mindfulness to Pain (LAMP) Pragmatic Clinical Trial.

Although mindfulness-based interventions (MBIs) are widely used in clinical and nonclinical settings, there has been little systematic study of their potential risks. To address this gap, we examined differences in psychological and physical worsening among participants in the usual care and intervention conditions of a 3-group, randomized pragmatic trial (Learning to Apply Mindfulness to Pain [LAMP]) that tested the effectiveness of 2 approaches to delivering MBIs to patients with chronic pain. The sample consisted of 374 male and 334 female patients with chronic pain enrolled in the LAMP trial who completed a 10-week follow-up survey, 61% of whom had a mental health diagnosis. Psychological and physical worsening was assessed by a checklist asking whether participants experienced specific symptoms since beginning the study. We used multivariable logistic regression models with imputed data to determine whether predicted probabilities of increased symptoms differed between usual care and the 2 MBIs. Participants in usual care were more likely to report experiencing increased psychological and physical worsening than were those in the MBIs, including an increase in disturbing memories; sadness, anxiousness, and fatigue; isolation and loneliness; and feeling more upset than usual when something reminded them of the past. MBIs do not appear to cause harm, in terms of increased symptoms, for this population of patients with chronic pain and high levels of mental health comorbidities. Preregistration with an analysis plan at www.ClinicalTrials.gov: NCT04526158. Patient enrollment began December 4, 2020.

CHANGES IN LIPID AND CARBOHYDRATE METABOLISM IN PATIENTS WITH OSTEOARTHRITIS WITH ACCOMPANYING ARTERIAL HYPERTENSION AND TYPE 2 DIABETES, DEPENDING ON BSMI VDR GENE POLYMORPHISM

It is known that Osteoarthritis (OA) is a common chronic disease of the musculoskeletal system, which leads to a significant loss of working capacity and disability of people of working age, which worsens the quality of life of the population and causes economic burden and losses to all countries of the world. In addition, OA is known as a disease with an inherent high level of comorbidity. Scientists single out diseases of cardiovascular diseases, digestive systems and metabolic disorders as those that are most often combined with OA and complicate the course of each other in manifestations, diagnostic and treatment processes. Today, modern science needs to understand the presence of a common genetic origin. It is known that the polymorphic variant of the VDR vitamin D receptor gene has a predisposition to common osteochondral diseases. However, the issue of participation in pathogenetic mechanisms of development and progression remains controversial. A polymorphic variant of the VDR gene has a predisposition to osteochondral diseases. However, its involvement in the pathogenetic mechanisms of the development and progression of osteoarthritis remains controversial, therefore The aim of the study is to investigate the specifics of the impact of comorbid pathology on carbohydrate and lipid metabolism and the state of the vascular wall in patients with osteoarthritis, taking into account the polymorphic variant of the VDR gene (Bsml, rs1544410). Object and research methods. 100 patients were examined and also divided into groups: 1st group – patients with OA; II – OA with arterial hypertension; ІІІ – OA, arterial hypertension (AG) and type 2 diabetes mellitus, a blood sample was taken and, depending on age, comorbidity, the presence of the polymorphic variant BsmI (rs1544410) of the VDR gene, indicators of carbohydrate and lipid metabolism, the level of end metabolites of nitric oxide and endothelin-1 were studied and the impact on radiological changes and the functional state of the knee joints was evaluated. Control – 30 people. Results of the study and their discussion. It has been established that osteoarthritis is characteristic of persons of working age. With increasing age, it is characteristic to be burdened by comorbid pathologies with worsening of the course of the main disease. Expected violation of carbohydrate metabolism was observed in the III group of patients, although dynamic probable changes were also in the II group (p<0.05). Lipid metabolism in the I group was probably higher than the group of control, but was within the physiological norm, while groups II and III had significant pathological changes compared to the indicators of the I group and practically healthy persons. Hypercholesterolemia became a trigger for a decrease in the total level of stable total nitrogen monoxide metabolites and an increase in endothelin-1, which forms endothelial dysfunction and leads to the progression of AG and worsening of the course of OA. After the genotyping and division into genotypes of the polymorphic variant BsmI of the VDR gene, conclusions were obtained about the unfavorable allele A in the exchange processes of the above indicators. Conclusions. Features of violations of carbohydrate and lipid metabolism, the condition of the endothelium, against the background of comorbidity and the presence of an unfavorable allele A of the BsmI polymorphic variant of the VDR gene should be taken into account in the complex diagnostic and treatment process of patients with OA.

Substance use and psychiatric phenotypes of youth experiencing homelessness: A cluster analysis.

Due to the complex interactions of psychopathology, psychosocial stressors, and risk behaviors, characterizing high-risk phenotypic groups of transitional-age youth experiencing homelessness (TAY-EH) for targeted interventions remains difficult. We aimed to uncover specific phenotypes of TAY-EH based upon psychiatric and substance use disorder (SUD) diagnoses, and to assess relationships between these phenotypes and negative outcomes including suicidality and high-risk behaviors. Participants (N = 140; 57% male, 54% Black) were individuals aged 16-25 years accessing support at a psychosocial agency in the U.S. Northeast. Data were gathered via structured assessment. Cluster analysis identified sub-groups of TAY-EH with differing diagnostic patterns. Bivariate analyses examined associations between cluster membership and target outcomes. A four-cluster solution was identified. Cluster 1 (Co-occurring; N = 33) was characterized by high levels of comorbidity (i.e., major depressive disorder (MDD), SUD, and notable levels of other diagnoses). Clusters 2 (MDD alone; N = 47) and 3 (SUD alone; N = 18) were characterized by single diagnoses. Cluster 4 (None; N = 42) was characterized by low levels of psychopathology. Clusters differed significantly on several variables including suicidality, adverse childhood experiences, and social connectedness. Comorbid MDD and SUD were most strongly associated with high-risk behaviors and suicidality. These results highlight the importance of diagnosis and targeted interventions for co-occurring MDD and SUD to address the crisis of early mortality and other negative outcomes among TAY-EH. This study is the first to identify specific high-risk psychiatric and psychosocial phenotypes among the highly complex group of TAY-EH based upon structured diagnostic assessments.

Tapestry of postnatal emotional disorders: exploring the interplay of anxiety and depressive disorders and their associated risk factors in Sudanese women.

This research aims to unravel the prevalence of postnatal emotional disorders with a focus on how postnatal anxiety remained under-estimated and often embroiled in postnatal depression. Out of 600 postnatal women invited to take part in this study from two prominent primary care clinics in Khartoum, 468 women agreed to participate in this study. Three questionnaires were utilized in this study, a Personal Information Questionnaire (PIQ), Hospital Anxiety and Depression Scale (HADS), and Beck depression Inventory (BDI). Multiple linear regression analysis applied to gauge risk factors with postnatal anxiety and depression. More than half (52.50%) of women showed evidence of both anxiety and depression using HADS, while only (20.9%) of cases were detected by BDI, showing evidence of moderate depressive disorder. A substantial proportion (28.4%) showed high levels of comorbidity of anxiety and depression in the category of moderate to severe symptoms. Main risks factors for postnatal disorders were past psychiatric illness (β = 0.25, p = 0.001), a family history of psychiatric illness (β = 0.15, p = 0.002), and stress due to the number of children (β = 0.32, p = 0.001). This study advances our understanding of postnatal emotional disorders, particularly highlighting the prevalence as well as correlates of postpartum anxiety. More importantly, this study highlights the importance of routine screen for emotional distress in postnatal women.

Non-HACEK gram-negative bacilli infective endocarditis: data from a retrospective German cohort study

Abstract Purpose Infective endocarditis caused by non-HACEK gram-negative bacilli (GNB-IE) is rare but associated with significant morbidity and case fatality. Evidence on optimal treatment and management is limited. We aimed to describe the characteristics and management of GNB-IE patients, investigating factors associated with disease acquisition and unfavorable outcomes. Methods We conducted a retrospective descriptive single-center study (tertiary care and referral hospital) between 2015 and 2021, including adult patients with definite GNB-IE. We reviewed demographic, clinical and microbiological data, focusing on predisposing factors, clinical outcomes and 1-year mortality. Results Of 1093 patients with probable or definite IE, 19 patients (median age 69 years) had definite GNB-IE, with an increasing incidence throughout the study period. Median age-adjusted Charlson Comorbidity Index score was 4 points. Prosthetic valve IE (PVIE) was present in 7/19 (37%) patients. Nosocomial acquisition occurred in 8/19 (42%) patients. Escherichia coli and Klebsiella pneumoniae were the most common pathogens. Beta-lactam (BL) based combination therapy was applied in 12/19 (63%) patients (58% BL + fluoroquinolone, 42% BL + aminoglycoside). Cardiac surgery was required in 8/19 (42%) patients (PVIE 71%, native valve IE 25%), primarily for embolism prevention and heart failure. Complications occurred in 14/19 (74%) patients. The in-hospital mortality rate was 21% (4/19); the one-year mortality rate was 44% (7/16). One-year mortality did not significantly differ between patients who underwent cardiac surgery and patients managed with anti-infective treatment alone (p = 0.633). Conclusions GNB-IE affects elderly patients with high comorbidity levels and recent health-care exposure. GNB-IE was associated with high complication rates and high mortality.

Aggressive Hyperkalemia Treatment in the Prehospital Setting

This is a case of profound unstable hyperkalemia encountered in the American pre-hospital 911 setting, with subsequent aggressive treatment and stabilization. Although hyperkalemia may be present in the prehospital setting, it is difficult to diagnose without laboratory testing or a reliable history of illness. It is frequently encountered in the pre-hospital setting, especially in communities with high levels of comorbidities and multiple dialysis centers. However, in the spectrum of hyperkalemia presentations, many of these patients are either early in their disease presentation or found when already in cardiac arrest. Early identification and rapid, aggressive treatment are paramount to decreasing morbidity and mortality in these patient populations. This case shows how aggressive prehospital critical care can have a significant impact on patient outcomes.

Low-Grade Inflammation Associated with Major Depression Subtypes: A Cross-Sectional Study.

Major depressive disorder (MDD) is associated with inflammation and a high level of comorbidities. Atypical depression (AD) is a MDD subtype based on DSM criteria, that could have specific underlying biological mechanisms. AD is associated with elevated cardiovascular (CVD) comorbidities, higher risk of suicide attempts, hypersomnia, and anxiety disorder. In this study, we aim to investigate if AD and polysomnographic parameters could be associated with low-grade inflammation (LGI). LGI is defined by a range from 3 to 10 mg/L of C-reactive protein levels. We carried out a retrospective cohort study in which 765 individuals with MDD were split into two groups: with and without LGI. Our results exhibit differences between the groups for the polysomnographic parameters, with the LGI group showing parameters already associated with inflammation such as reduced rapid eye movement sleep and elevated hypoxemia markers (identified as CVD risk factor). We found that AD is associated with LGI (OR 1.48; p = 0.047) after adjustment. Likewise, we found an LGI prevalence in AD higher (34.8%) than in MDD without atypical features (26.8%). Overall, these results confirm the low-grade inflammation feature of AD and highlight polysomnographic parameters associated with LGI that could also act as risk factors in this context.

А COMPREHENSIVE STUDY OF PATIENTS WITH ISCHEMIC HEART DISEASE: AGE, GENDER, AND COMORBIDITY ASPECTS

The purpose of the study was to analyze the clinical characteristics, comorbid status, individual biochemical indicators, and systemic inflammation activity in patients with ischemic heart disease (IHD) depending on age, gender distribution, and diagnosis influence.Materials and methods. The study included 144 patients with IHD, who were divided into two groups – the main and the control. The main group comprised 120 patients with stable angina pectoris (SAP) II-III functional class (FC). The control group consisted of 24 patients with STEMI. All patients underwent a comprehensive examination: general clinical, anthropometric, laboratory (complete blood count, biochemical analysis), and instrumental (office blood pressure measurement, heart rate, and echocardiography). The comorbid profile of patients with IHD was assessed using the Charlson comorbidity index. The severity of systemic inflammation syndrome in the selected patient groups was assessed by the cellular composition of peripheral blood upon admission to the hospital, and based on the obtained data, the values of leukocyte inflammatory markers were calculated.Results. Patients in the main group were younger than those in the control group (54.78 ± 1.11 vs. 63.50 ± 1.82) (p<0.001). A statistically significant predominance of men over women was found among the cohort of IHD patients (63.33% and 36.67%, respectively) (p<0.001), with a tendency towards male predominance among patients with SAP II-III FC compared to those with STEMI (p = 0.074). Patients in the main group compared to those in the control group had significantly higher left ventricular ejection fraction (p<0.001), systolic blood pressure (p<0.001), and diastolic blood pressure (p=0.001). In the control group compared to the main group, more cases of patients with high levels of comorbidity were found (p<0.001). Lower levels of creatinine, fibrinogen, prothrombin time, and glucose were observed in patients in the main group. Patients with SAP II-III FC compared to those with STEMI had lower levels of leukocyte inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR) (p<0.001), systemic immune inflammation index (SII) (p=0.002), systemic inflammation response index (SIRI) (p=0.007), and aggregate index of systemic inflammation (AISI) (p=0.011).Conclusions. The study underscores the need for an individualized approach to each patient with ischemic heart disease, considering their age, gender, and comorbid characteristics, as well as laboratory peculiarities, to improve therapy outcomes and prevent complications.

A New Start with HAART: Evaluating Breast Reconstruction in the Era of Highly Active Antiretroviral Therapy.

As HIV-positive individuals utilizing highly active antiretroviral therapy live longer, the burden of breast cancer increases in the population. Breast reconstruction is an integral aspect of surgical treatment for many patients after a breast cancer diagnosis, prompting this examination of the characteristics and outcomes of breast reconstruction in this growing patient population. Using Merative MarketScan Research Databases, a large multipayer database, HIV-positive adult patients who underwent autologous or implant-based breast reconstruction between 2007 and 2021 were identified using International Classification of Disease codes and Common Procedural Terminology codes. In both HIV-positive and -negative cohorts, patient demographics, procedure-related complications, and postoperative revisions were recorded. Shapiro-Wilk, chi-square, Wilcoxon-Mann-Whitney, and multivariable logistic regression tests were used for statistical analysis. Of 173,421 patients who underwent breast reconstruction, 1816 had an HIV diagnosis. HIV-positive patients were younger (P < 0.001), underwent surgery more recently (P < 0.001), more often underwent immediate breast reconstruction (P < 0.001), and had higher comorbidity levels (P < 0.001). There was a regional variation in which the patient cohorts underwent breast reconstruction. There was no significant difference in overall complication rates between patient groups, but HIV-negative patients more often underwent revision procedures (P = 0.009). When compared to their HIV-negative counterparts, breast reconstruction can be considered safe and efficacious in patients living with HIV. HIV-positive patients are a growing demographic who seek breast reconstruction, and surgeons must continue to further understand the unique implications of breast reconstruction in this population.

(115) SEXUAL SELF-ESTEEM IN TWO SAMPLES OF ADOLESCENT AND YOUNG ADULT CANCER SURVIVORS: A QUALITATIVE INVESTIGATION

Abstract Introduction As rates of survival from cancer continue to increase in adolescents and young adults, long term physical and psychological impacts are likely to rise. For those diagnosed with cancer during childhood or adolescence, one such late effect may be delayed sexual development. Delayed sexual development may manifest as issues of sexual functioning (i.e., the ability to successfully complete the sexual response cycle) as well as issues of sexual self-concept (i.e., how one navigates the world as a sexual being). These issues may, in turn, impact survivors’ self-esteem. These concerns are likely to be exponentially exacerbated when survivors identify as a member of a sexual and/or gender minority (SGM) group. Objective Based on empirical research and two studies from our team, we examine variables that impact the sexual self-esteem of AYA cancer survivors, particularly those that identify as members of an SGM group. Methods In our small pilot project, we conducted cognitive interviews to assess whether a novel model, adapted from sexual health frameworks established by Woods (1995) and Evan et al. (2006), applied to AYA cancer survivors. Following analysis of these interviews, we refined our model, and received funding for a larger qualitative study (n = 30) tailored to AYA cancer survivors who identify as members of an SGM group. Results Four cisgender female cancer survivors participated in this small qualitative study, which provided preliminary validation that variables such as body image, amount of sexual education, quality of interpersonal relationships, and sexual functioning, were all tied into one’s perception of their sexual self-esteem. Several additional potential variables were identified from these interviews, including amount of sexual equity (how much participants felt that their sexual activity was balanced between them and a partner), religiosity, negative self-evaluative emotions (e.g., guilt and shame), and SGM identity, that could influence sexual self-esteem. Preliminary analyses of our SGM-focused qualitative study have revealed high levels of asexuality and mental health comorbidities that may be affecting sexual self-esteem. Recruitment and analysis for this study is ongoing. Conclusions Results from these two studies will provide some of the first empirical research on sexual self-esteem in a population for which sexual health is vastly under researched. We anticipate that this work will lay the foundation for novel measurements and interventions for these individuals. By providing a voice to those who are underrepresented in research, we hope that this research may have high-impact in informing future interventions to become more holistic and culturally-informed to allow for studies to ensure they are reflecting all identities of cancer survivors. Finally, we anticipate that this research may be of significant benefit to oncology providers and clinicians to overhaul and adapt sexual education for patients in treatment, as well as inform areas of concern and assessment for these providers and clinicians, particularly among their SGM patients and survivors. Disclosure No.

Suicidal Ideation Status and Its Related Factors Among Older Adults in Yazd, Iran

Objectives: To assess the prevalence of suicidal ideation and identify the factors associated with it among the elderly population in Yazd during the year 2021. Design: A cross-sectional study. Setting(s): Tabriz, the capital city of the East Azerbaijan province in northwestern Iran. Participants: A total of 386 seniors aged 60 years and above, residing in Yazd, participated in this study. The sample consisted of 212 women and 174 men selected using the cluster random sampling method. Outcome measures: Data were collected via the Beck Scale for Suicide Ideation (BSSI). Results: Five percent of the participants have a high level of suicidal risk and readiness for suicide. Additionally, the mean score of suicidal ideation varied significantly based on demographic variables such as gender, occupation, education level, and income type (P &lt; 0.05). Moreover, the risk of suicidal ideation was higher among women compared to men, particularly among housekeepers compared to other occupational groups (P &lt; 0.05). Furthermore, elderly individuals who relied on support from their children and other supportive institutions as their source of income were more susceptible to suicidal ideation compared to others (P &lt; 0.05). In terms of education, elderly individuals with no education or only primary education had a higher risk of suicidal ideation compared to those with a high school diploma or higher education (P&lt;0.05). In addition, individuals with a history of psychiatric disorders, musculoskeletal diseases, high blood pressure, comorbidity, and high cholesterol levels obtained significantly higher scores for suicidal ideation compared to elderly individuals without these conditions (P&lt;0.05). Conclusions: The elderly individuals in Yazd exhibited a desirable level of suicidal ideation, with a low risk of suicide. However, the risk factors for suicidal ideation examined in this study highlight the need for increased attention by healthcare managers to the mental health of the elderly population.