Higher Number Of Patients Research Articles

Indicator-condition-guided HIV testing in rural DRC.

HIV testing services are a key component of the 95-95-95-0 goals. In many parts of the Democratic Republic of the Congo the availability of test kits is limited for multiple reasons. Targeted testing of patients with HIV indicator conditions is therefore the only feasible option in these settings. We introduced an indicator condition-guided HIV testing project in the Emergency Room of the Hôpital Géneral de Référence de Kikwit, DRC. We screened 1274 patients for indicator condition. In 94 (7.4%) patients, the treating physician diagnosed at least one HIV indicator. 34 (36.2%) tested HIV-positive (2.7% of screened patients). 52% of the newly diagnosed patients were lost to follow-up two months after the first diagnosis of HIV. In a resource-limited setting with insufficient availability of HIV-Tests, indicator-triggered testing is a useful tool to find a high number of HIV-positive patients. Loss to follow-up is one of the major challenges.

Burnout Syndrome among Healthcare Workers in Lithuania as a Former Soviet Country

Objective. Measure the prevalence of burnout syndrome (BOS) among the healthcare workers (HCW) in Lithuania and the factors influencing it.
 The respondents were asked to fill out an anonymous online questionnaire which included information on their gender, age, years of work experience, specialty, work hours per week, the average number of patients per day, salary, healthcare chain, and the healthcare sector they are working at. BOS was assessed by using the Copenhagen Burnout Inventory (CBI).Results. A total of 2 806 questionnaires were used in the final analysis. A high prevalence of BOS among the MS in Lithuania was noticed (74% of all respondents), which is more severe in comparison to foreign research. The most significant link with severe BOS was noticed among a high number of patients per day (22.69±14.96 versus 17.77±13.32, t=4.92), a large number of work hours per week (48.89±12.96 versus 46.34±10.77, t=2.54), and a younger age (59.27±14.06 versus 55.73±13.91, t=3.53). Doctors had the highest BOS score compared to nurses, residents, and other specialists (59.72±13.99 versus 57.33±14.13, t=2.4; 57.53±14.20, t=2.2; 54.06±15.22, t=5.67, respectively). No links between gender, years of work experience, salary, healthcare chain, healthcare sector, and BOS were observed.Conclusions. BOS is highly prevalent among Lithuania’s medical staff, and it is more prevalent than in most other EU and non-EU countries. A high number of patients per day, a large number of work hours per week, and a younger age were significantly linked with more severe BOS.

The parameter estimation of the COVID-19 death based on the Gumbel distribution through the multi-objective programming: Turkey case

Nearly all nations, including Turkey, were impacted by the 2019 new coronavirus (COVID-19) infections that Wuhan, China reported as the disease's first official case. Turkey is one of the most impacted nations in the globe because to the high number of infected patients. To comprehend the pattern of the virus's propagation and its impacts, it is crucial of examine the pandemic statistics of Turkey. The Gumbel distribution is used to model the maximum distribution of several samples with various distributions. Therefore, we used the Gumbel distribution to estimate the daily number of COVID-19-related deaths. In this study, based on the RMSE, R2, and Theil coefficient method's multi-objective programming approach, the parameter estimation of Gumbel distribution is proposed. A comprehensive Monte-Carlo simulation study was conducted to examine the performance of single-objective RMSE, R2, Theil’s coefficient and multi-objective RMSE-R2, RMSE-Theil, R2-Theil, RMSE-R2-Theil programming estimation methods. When the simulation results were analyzed, the case formed by the RMSE-R2-Theil estimator has the best Def value for all cases. The application of the real dataset containing COVID-19 death data is examined and it can be seen that Theil, RMSE-Theil, and R2-Theil were better estimators for winter data, while RMSE was a better estimator for autumn and autumn-winter data.

Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis

BackgroundAcute stroke treatment with intracranial thrombectomy and treatment of ipsilateral carotid artery stenosis/occlusion (“tandem lesion”, TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high, and antiplatelet therapy (APT) preventing restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the safety and 90-day outcome of patients receiving TL treatment under triple-APT, focused on stent-patency and possible disadvantageous comorbidities.MethodsPatients receiving TL treatment in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All patients received intravenous eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Duplex imaging was performed 24 h after treatment, at discharge and 90 days, and digital subtraction angiography was performed if restenosis was suspected.Results176 patients were included. Periprocedural complications occurred in 2.3% of the patients at no periprocedural death, and in-hospital death in 13.6%. Discharge mRS score was maintained or improved at the 90-day follow-up in 86%, 4.54% had an in-stent restenosis requiring treatment at 90 days. No recorded comorbidity considered disadvantageous for stent patency showed statistical significance, the duration of the endovascular procedure had no significant effect on outcome.ConclusionIn our data, TL treatment with triple APT resulted in a low restenosis rate, low rates of sICH and a comparably high number of patients with favorable outcome. Aggressive APT in the initial phase may therefore have the potential to prevent recurrent stroke better than restrained platelet inhibition. Comorbidities did not influence stent patency.

Development of a Diabetes Mellitus Diagnostic System Using Self-Organizing Map Algorithm: A Machine Learning Approach

Delivery of Health care services in developing nations has posed a huge problem to the world at large. The United Nations and the World Health Organization have been on the front burner sorting for ways of improving these problems to abate the yearly mortality rates which are caused largely by inadequate health facilities, poor technical know-how, and poor health care administration. One disease that has a high number of patients is diabetes. In Nigeria, out of a population of 200 million, diabetes kills over 2% yearly. To reduce this menace, early diagnosis and awareness are important. And automation of the medical diagnostic system is one of the sure ways of achieving these feet. This paper explores the potential of a self-organizing map algorithm; a machine learning technique in the development of a diabetes mellitus diagnostic system (DMDS). Data collected from 120 patients from the University of Port Harcourt Teaching Hospital (UPTH) was used in the training and validation of the model. The confusion matrix formula was used in testing the sensitivity and accuracy of the model which yielded 75.63% and 87.2% respectively which are within the accepted range, predefined by expert physicians. Keywords Artificial Intelligence, self-organizing map, diagnosis, neural networks, diabetes mellitus

Point of care lung ultrasonographic findings in patients with clinical diagnosis of severe childhood community acquired pneumonia in the tropics

Objectives: This study aimed at defining the Lung ultrasonographic (LUS) features of severe Childhood community-acquired pneumonia (CAP) in under-5s with clinical pneumonia, as well as the correlation between clinical and ultrasonographic findings. Materials and Methods: A prospective descriptive study conducted at the Children Emergency Ward of the University College Hospital (UCH), Ibadan, Nigeria over a 1-year period. Children aged 1month to 59 months, with clinical features of severe pneumonia were recruited for the study. LUS was done at the bedside. Ethical approval was obtained for the study. Results: There were 86 children with mean age ± SD of 13.59 ± 15.55 and 50 (58.1%) males. The highest number of patients (56, 65.1%) were in the 1-12-month age group. Ultrasonographic signs of pneumonia were detected in 68 (79.1%) of the children; 55(64%) had consolidation, 29(23.3%) showed florid B-lines and 20 (23.3%) had pleural fluid. Duration of cough, and crackles on auscultation were the only features that showed significant association with the LUS diagnosis of pneumonia. Conclusion: LUS is a good point of care diagnosis of CAP in under-5 children and it can be safely done at the bedside. It is therefore recommended as a first line imaging modality in children with clinical suspicion of CAP in the Tropics.

Efficacy of doxycycline therapy for macrolide-resistant Mycoplasma pneumoniae pneumonia in children at different periods

BackgroundThe prevalence of macrolide-resistant Mycoplasma pneumoniae has increased considerably. Treatment in children has become challenging. This study aimed to evaluate the efficacy of doxycycline therapy for macrolide-resistant Mycoplasma pneumoniae pneumonia in children at different periods.MethodsWe retrospectively analyzed the data of patients with macrolide-resistant Mycoplasma pneumoniae pneumonia hospitalized between May 2019 to August 2022. According to treatment, patients were divided into three groups: oral doxycycline treatment alone (DOX group), changed from intravenous azithromycin to oral doxycycline (ATD group), and intravenous azithromycin treatment alone (AZI group). ATD group cases were separated into two sub-groups: intravenous azithromycin treatment<3 days (ATD1 group) and ≥ 3 days (ATD2 group). Clinical symptoms were compared in each group and adjusted by Propensity score matching (PSM) analysis.ResultsA total of 106 were recruited in this study. 17 (16%) were in DOX group, 58 (55%) in ATD group, and 31(29%) in AZI group. Compared with ATD group and AZI group, the DOX group showed shorter hospitalization duration and fever duration after treatment, while higher rate of chest radiographic improvement. After using PSM analysis, shorter days to hospitalization duration (P = 0.037) and to fever duration after treatment (P = 0.027) in DOX + ATD1 group than in ATD2 group was observed. A higher number of patients in the DOX + ATD1 group achieved defervescence within 72 h (P = 0.031), and fewer children received glucocorticoid adjuvant therapy (P = 0.002). No adverse reactions associated with doxycycline was observed during treatment.ConclusionsChildren receiving early oral doxycycline had a shorter duration of fever and hospitalization in macrolide-resistant Mycoplasma pneumoniae patients.

Assessment of Factor VIII Activity and D-Dimer Levels in the Post-COVID Period.

Changes in the hemostatic system during COVID infection lead to hypercoagulability. Numerous studies have evaluated hemostatic abnormalities in COVID patients during acute infection, in the period of hospitalization. However, the hemostatic status following hospital discharge has not been sufficiently assessed. Considering the importance of FVIII and D-dimer levels as markers for the assessment of thrombosis, our study aimed to evaluate changes in these markers, as well as the influence of patient's age and clinical presentation of COVID infection on those hemostatic markers in the post-COVID phase. This prospective study (July 2020 to December 2022) included 115 COVID patients, 68 (59%) with asymptomatic/mild and 47 (41%) with moderate/severe clinical presentation. Patient follow-up included laboratory evaluation of FVIII and D-dimer levels at 1, 3, and 6 months following the COVID infection. Three months after the COVID infection, elevated FVIII was recorded in 44% of younger versus 65% of older individuals, p = 0.05, respectively, and 30 versus 57% (p = 0.008) 6 months post-COVID infection. With a focus on clinical presentation, a higher number of patients with moderate/severe COVID had elevated FVIII activity, but a statistically significant difference was observed only for the 6 months (32% mild vs. 53% moderate/severe, p = 0.041) post-infection time point. Following a COVID infection, an increase in FVIII activity suggests a continued hypercoagulable state in the post-COVID period and correlates with elevated D-dimer levels. This increase in FVIII is more pronounced in patients with moderate/severe clinical picture and those patients older than 50 years.

Factors that contribute to prolonged hospital stay after discharge among surgical patients in a tertiary hospital in North Central Nigeria

Background: Surgical practice has hospitalization of patients for surgery and treatment as an inherent part of it; after which the patients are found fit for discharge. There is however a group of patients who remain on bed even after they have been deemed fit for discharge. This study aimed to determine the number of days surgical patients classified as having prolonged stay remain in hospital after they were deemed fit for discharge and identify the reasons for this.&#x0D; Methods: Surgical patients still on bed more than 48 hours after they were discharged who consented to participate in the study were recruited.&#x0D; Results: A total of 341 patients were recruited. The mean duration of stay after discharge was 17.6± 13 days. The specialty with the highest number of patients was Neurosurgery. Lack of finance and absence of a caregiver were the causes (96.5% and 3.5% respectively). The top three suggestions by patients on how to reduce prolonged hospital stay were bill waiver for indigent patients, reduced cost of health care services and financial aid by philanthropists.&#x0D; Conclusion: The mean number of days patient remained in hospital after discharge was 17.6 days. Financial reasons and absence of a caregiver are the major reasons for prolonged hospital stay. There is a need for a multi-sectoral approach to improve enrollment in the National Health Insurance Scheme and provide social support for patients in need of care post-discharge to reduce the adverse effects of prolonged hospital stay on the hospital and patients.

Influences of Software Changes on Oxycodone Prescribing at an Australian Tertiary Emergency Department: A Retrospective Review.

Opioid prescribing and dispensing from emergency departments is a noteworthy issue given widespread opioid misuse and diversion in many countries, contributing both physical and economic harm to the population. High patient numbers and the stochastic nature of acute emergency presentations to emergency departments (EDs) introduce challenges for prescribers who are considering opioid stewardship principles. This study investigated the effect of changes to electronic prescribing software on prescriptions with an auto-populated quantity of oxycodone immediate release (IR) from an Australian tertiary emergency department following the implementation of national recommendations for reduced pack sizes. A retrospective review of oxycodone IR prescriptions over two six-month periods between 2019 and 2021 was undertaken, either side of a software adjustment to reduce the default quantities of tablets prescribed from 20 to 10. Patient demographic details were collected, and prescriber years of practice calculated for inclusion in linear mixed effects regression modelling. A reduction in the median number of tablets prescribed per prescription following the software changes (13.5 to 10.0, p < 0.001) with little change in the underlying characteristics of the patient or prescriber populations was observed, as well as an 11.65% reduction in the total number of tablets prescribed. The prescriber's years of practice, patient age and patient sex were found to influence increased prescription sizes. Reduced quantity of oxycodone tablets prescribed was achieved by alteration of prescribing software prefill parameters, providing further evidence to support systems-based policy interventions to influence health care providers behaviour and to act as a forcing function for prescribers to consider opioid stewardship principles.

An Observational Study in the Real Clinical Practice of the Treatment of Noninfectious Uveitis.

The aim of this study was to describe the characteristics of patients with uveitis associated with an immunologic or idiopathic disease that requires immunosuppressive treatment and the response to such treatments in real clinical practice. An observational, descriptive, longitudinal, and retrospective study of a cohort of patients diagnosed with noninfectious uveitis was performed. To assess the response to treatment, we evaluated the change in visual acuity, vitritis, and the presence of macular edema. We included 356 patients. Overall, 12% required treatment with systemic corticosteroids, and 66 patients (18.5%) required immunosuppressive/biological treatment, with methotrexate being the most used (55%). Immunosuppressive drugs were used in 59 cases (in 56 patients, as the first choice of treatment and for 3 patients as the second choice after treatment with biologics). Treatment with biologics was the first choice in 10 patients out of 66 (15%), and 34 (48%) required them at some time during the disease, with adalimumab being the most commonly used. Thirty-five patients (53%) needed to switch drugs due to a lack of response to the first one. There were no differences between different drugs in the resolution of vitritis and improvement in vision. The use of systemic corticosteroids and immunosuppressive/biologics was necessary for a high number of patients with noninfectious uveitis. In our series, tocilizumab was significantly more effective in the resolution of macular edema.

Early thrombus formation including hypo-attenuated leaflet thrombosis after surgical bioprosthetic aortic valve replacement.

To assess the occurrence, predictors, and outcomes of hypo-attenuated leaflet thickening (HALT) and thrombus outside the prosthetic valve following surgical aortic valve replacement. A total of 118 patients underwent surgical aortic valve replacement with bioprosthetic valves between July 2020 and June 2022. Sixty-two (52.5%) patients, which is a fairly high number of patients, underwent cardiac computed tomography and transthoracic echocardiography one week after surgery. Patients were divided into two groups, those with HALT (n = 14) and those without HALT (n = 48). Of the 62 patients who underwent cardiac computed tomography, HALT was observed in 14 (22.5%) patients during the very early postoperative phase. Reduced leaflet motion was observed in two of the 14 patients. The low-attenuation areas were located outside the prosthetic valve in 10 cases (71.4%) in the HALT group and in 14 cases (29.2%) in the non-HALT group. More than 50% of patients (57.1%) with HALT and 79.2% without HALT were administered warfarin. Neither in-hospital deaths nor postoperative thromboembolic events were observed during hospitalization. No patient had a mean pressure gradient > 20mmHg in either group. HALT was observed in one-fifth of the cases after surgical aortic valve replacement during the very early postoperative phase in an institution wherein administration of continuous heparin infusion after surgery is a standard practice. HALT did not affect the early prognosis or incidence of cerebral infarction.

Factors Associated with Severe Malaria in Children Under Five Years of Age at Mbarara Regional Referral Hospital, Uganda

Malaria continues to be a major public health problem. In 2013, about 198 million cases of malaria were reported globally with a percentage of 82% in the WHO African Region, 12% in South-East Asia region and 5% in the Eastern Mediterranean region, leading to 584,000 deaths worldwide, with 90% of the deaths occurring in African region, 7% in the South-East Asia region and 2% in East Mediterranean regions. Uganda has the sixth highest number of annual deaths from malaria in Africa, as well as some of the highest reported malaria transmission rates in the world. Malaria was one of the leading causes of ill health and deaths, with approximately 16 million cases and over 10,500 deaths reported in 2013. It remains one of the most important diseases in Uganda in terms of morbidity and mortality. This study was aimed at determining the factors associated with severe malaria in children less than five years admitted to Mbarara Regional Referral Hospital. Of the 73 participants sampled, all participated in the study (100% response rate), with most of the children lying within age range of 2-3 years (38.4%), (n=28) the least number were in the age group of 0-1years and &gt;3-4years of age that is 6.8 %. 57.5% of the patients with severe malaria were of male sex. Severe malaria was found to be more in second born children (43.8%). The highest number of patients with severe malaria had two siblings (39.7%), (n=29), with 53.4% (n=39) of the patients having onset of illness within two days from admission. Despite the effort put by the government on prevention of malaria there was a gap on utilization of mosquito nets and seeking health care within 24hours of onset of illness. Therefore, the health teams in the district and health workers in the hospital should sensitize people how to mosquito net as major preventive measure against malaria. Keywords: Malaria, Children, sub-Saharan Africa, Mosquito net, Health workers.

Acute Effect of Particulate Matter 2.5 (PM2.5) on Acute Upper Respiratory Tract Infection in Chiang Mai, Thailand

Background: Air pollution, especially PM2.5, is one of the most concerning problems around the world, leading to health problems. There are few studies on acute upper respiratory tract infection (URTI), especially in adults. Objective: To investigate the association between PM2.5 and acute URTI. Materials and Methods: Retrospective data analyses of patients between 2017 and 2019 who visited the outpatient department in Maharaj Nakorn Chiang Mai Hospital with acute URTI was performed. The authors also collected the daily data of PM2.5, PM10, O₃, NO₂, temperature, and humidity from the center of Chiang Mai Province. The Pearson correlation method was used to identify correlations between acute URTI and those variables. Results: The data of 104,711 patients with acute URTI were collected. Acute nasopharyngitis, acute pharyngitis, and acute tonsillitis were the three most common diseases. The highest level of PM2.5 each year was in January to February. The results were also the same for PM10, O₃, and NO₂. The present study revealed that PM2.5 had a significant correlation with number of acute respiratory infection patients, r=0.17 (p&lt;0.001), which meant higher level of PM2.5 was associated with higher number of patients. The results were also the same for PM10, O₃, and NO₂. For temperature and humidity, the results were the opposite correlations, which meant the higher the temperature and humidity, the fewer patients were observed that day. The present study also found the regression question, which was every 1 point higher of PM2.5, there would be 19% more patients that day. Conclusion: There was a relationship between pollution, especially PM2.5 and acute URTI. The higher level of PM2.5 is related to an increased number of URTI patients. It is the same results for PM10, O₃, and NO₂. Keywords: Fine particulate matter; PM2.5; Acute upper respiratory tract infections

Prevalence of Depression and Anxiety Symptoms Among Patients With Cancer in Najran, Saudi Arabia.

Depression and anxiety are associated with poor health consequences in patients with cancer, and these mental health issues may affect cancer treatment. They are frequently triggered by stress, and cancer is among the most stressful conditions experienced by a person. Depression and anxiety are related to several sociodemographic variables in patients with cancer. However, only a few studies have examined the prevalence of depression and anxiety symptoms in patients with cancer in Saudi Arabia. To detect the prevalence of depression and anxiety symptoms among patients with cancer at the Najran Oncology Center in Najran, Saudi Arabia, and determine the risk factors associated with these symptoms. A cross-sectional study was conducted from April 1, 2023, to September 30, 2023, on a convenience sample of patients diagnosed with cancer who were receiving chemotherapy at Najran Oncology Center, King Khalid Hospital, Najran, Saudi Arabia, and who agreed to participate in the study. The Hospital Anxiety and Depression Scale was used. Data on the demographic characteristics of the patients were collected using a self-administered questionnaire. Moreover, medical data were collected from the medical records of the patients. In total, 92 patients with various cancer diagnoses were recruited in this study. Among them, 51 and 41 were women and men, respectively. Moreover, 81 were married and 11 were either single, widow, or divorced. The mean age of the participants was 51.24 ± 15.15 years. The prevalence rates of depression and anxiety were 42.4% and 23.9%, respectively. There were significant associations between depression and marital status in patients with cancer-associated pain and those with a current history of chemotherapy. Furthermore, the association between anxiety and cancer-associated pain was significant. However, marital status was not associated with anxiety.Age, sex, family history of mental disorders, cancer duration, current cancer stage, and surgical interventions were not associated with the prevalence of depression and anxiety. Our findings underline the importance of identifying depression and anxiety in patients with cancer. Marital status, presence of pain, and current chemotherapy history were significantly associated with depression and pain with anxiety. Further studies with a higher number of patients with cancer should be conducted in Saudi Arabia and other Arab countries. Screening for depression and anxiety symptoms should be a part of the comprehensive evaluation of patients with cancer. Appropriate treatment interventions must be provided to patients with cancer who present with mental disorders.

Availability and Cost of Expensive and Common Generic Prescription Drugs: A Cross-sectional Analysis of Direct-to-Consumer Pharmacies.

Direct-to-consumer (DTC) pharmacies sell generic prescription drugs, often at lower prices than traditional retail pharmacies; however, not all drugs are available, and prices vary. To determine the availability and cost of generic drugs at DTC pharmacies. Cross-sectional study. Five national DTC pharmacies in April and May 2023. Each qualifying form of 100 generic drugs with the highest cost-per-patient (expensive) and the 50 generic drugs with the highest number of patients (common) in Medicare Part D in 2020 MAIN MEASURES: Availability of these drugs and the lowest DTC pharmacy price for a standardized drug strength and supply (e.g., 30 pills), compared to GoodRx retail pharmacy prices. Of the 118 expensive generic dosage forms, 94 (80%) were available at 1 or more DTC pharmacies; out of 52 common generic dosage forms, 51 (98%) were available (p < 0.001). Of the 88 expensive generics available in comparable quantities and strengths across pharmacies, 42 (47%) had the lowest cost at Amazon, 23 (26%) at Mark Cuban Cost Plus Drug Company, 13 (14%) at Health Warehouse, and 12 (13%) at Costco; for 51 common generic formulations, 16 (31%) had the lowest cost at Costco, 14 (27%) at Amazon, 10 (20%) at Walmart, 6 (12%) at Health Warehouse, and 5 (10%) at Mark Cuban Cost Plus Drug Company. For the 77 expensive generics with available GoodRx retail pharmacy prices, the median cost savings at DTC pharmacies were $231 (95% CI, $129-$792) or 76% (IQR, 53-91%); for 51 common generics, savings were $19 (95% CI, $10-$34) or 75% (IQR, 67-83%). Many of the most expensive generic drugs are unavailable at direct-to-consumer pharmacies. Meanwhile, less expensive, commonly used generics are widely available, but drug prices vary by pharmacy and savings are modest, requiring patients to shop around for the lowest cost.

A QoS-Aware IoT Edge Network for Mobile Telemedicine Enabling In-Transit Monitoring of Emergency Patients

Addressing the inadequacy of medical facilities in rural communities and the high number of patients affected by ailments that need to be treated immediately is of prime importance for all countries. The various recent healthcare emergency situations bring out the importance of telemedicine and demand rapid transportation of patients to nearby hospitals with available resources to provide the required medical care. Many current healthcare facilities and ambulances are not equipped to provide real-time risk assessment for each patient and dynamically provide the required medical interventions. This work proposes an IoT-based mobile medical edge (IM2E) node to be integrated with wearable and portable devices for the continuous monitoring of emergency patients transported via ambulances and it delves deeper into the existing challenges, such as (a) a lack of a simplified patient risk scoring system, (b) the need for architecture that enables seamless communication for dynamically varying QoS requirements, and (c)the need for context-aware knowledge regarding the effect of end-to-end delay and the packet loss ratio (PLR) on the real-time monitoring of health risks in emergency patients. The proposed work builds a data path selection model to identify the most effective path through which to route the data packets in an effective manner. The signal-to-noise interference ratio and the fading in the path are chosen to analyze the suitable path for data transmission.

Does PaCO2 correction have an impact on survival of patients with chronic respiratory failure and long-term non-invasive ventilation?

Background and objectiveNon-invasive ventilation (NIV) improves survival of patients with chronic respiratory failure (CRF). Most often, pressure settings are made to normalize arterial blood gases. However, this objective is not always achieved due to intolerance to increased pressure or poor compliance. Few studies have assessed the effect of persistent hypercapnia on ventilated patients’ survival. Data from the Pays de la Loire Respiratory Health Research Institute cohort were analyzed to answer this question. Study design and methodsNIV-treated adults enrolled between 2009 and 2019 were divided into 5 subgroups: obesity-hypoventilation syndrome (OHS), COPD, obese COPD, neuromuscular disease (NMD) and chest wall disease (CWD). PaCO2 correction was defined as the achievement of a PaCO2 < 6 kPa or a 20% decrease in baseline PaCO₂ in COPD patients. The endpoint was all-cause mortality. Follow-up was censored in case of NIV discontinuation. ResultsData from 431 patients were analyzed. Median survival was 103 months and 148 patients died. Overall, PaCO2 correction was achieved in 74% of patients. Bivariate analysis did not show any survival difference between patients who achievedPaCO₂ correction and those who remained hypercapnic: overall population: p = 0.74; COPD: p = 0.97; obese COPD: p = 0.28; OHS: p = 0.93; NMD: p = 0.84; CWD: p = 0.28. ConclusionModerate residual hypercapnia under NIV does not negatively impact survival in CRF patients. In individuals with poor tolerance of pressure increases, residual hypercapnia can therefore be tolerated under long-term NIV. Larger studies, especially with a higher number of patients with residual PaCO2 > 7 kPa, are needed to confirm these results.

Overview and Outcomes of Patients Hospitalised with COVID-19 Pneumonia in Rīga East University Hospital

Abstract The COVID-19 pandemic is still a burden to the global health care system, affecting its capacity to maintain essential health services. Even though specific treatment and prevention options are available, the SARS-CoV-2 virus keeps accumulating mutations over time and challenging the efficiency of vaccines, causing new outbreaks and increasing hospitalisation. Early studies suggest that mortality from COVID-19 is increased by age and certain comorbidities. Thus, the goal of this study was to analyse patients hospitalised with COVID-19 pneumonia in terms of age, sex, and comorbidities. Additionally, the influence of treatment with Remdesivir and vaccination on hospitalisation duration and disease outcome was also analysed. The results showed that lethal disease outcome is mainly increased by age and gender, where older and male patients are at a higher risk. There were less deaths in patients with primary arterial hypertension. Other comorbidities did not have a statistically significant influence on disease outcome. Among those who survived, a higher number of patients had been treated with Remdesivir. Vaccination did not have an impact on disease outcome. It could be concluded that older and male patients are the risk group with a worse disease outcome. Treatment with Remdesivir shows a positive effect on disease outcome, although further detailed analysis is necessary.

Does use of apalutamide enhance outcomes in combination with radiotherapy in metastatic hormone-sensitive prostate cancer? A real-world experience from the UK.

73 Background: Management of metastatic prostate cancer has undergone a significant change over the past decade, with the introduction of several novel agents and repurposing of others. Latest update from STAMPEDE trials shown prostate radiotherapy (RT) improves OS, without detriment in QoL in metastatic home sensitive prostate cancer mHSPC along with Docetaxel in those with low volume metastatic disease. There is no published data on impact of radiotherapy to prostate on Apalutamide treated mHSPC patients. Here we report our real-world experience of Apalutamide in mHSPC with radiotherapy. Methods: Patients with mHSPC (N = 266) from 5 UK centres, were treated with Apalutamide (240 mg) and ADT along with radiotherapy to prostate as per treating clinician’s discretion. The primary endpoint was objective rate (ORR) as determined by patients achieving a PSA decline of ≥90% (PSA90) and ≥50% (PSA50) and secondary endpoints included biochemical progression free survival (bPFS) and safety. Results: The median age for the whole cohort was 73.4 years (interquartile range 52 - 91), A total of 11.6% had received prior radical treatment (prostatectomy or radiotherapy for localised disease) and 88.4% had de novo metastatic disease. Median baseline PSA was 47 ng/ml (range 0.4-17100). The proportion of patients PSA90 and PSA50 at 3, 6 and 12 months is shown in the Table. Median PSA nadir was 0.1 ng/ml(rage 0.01- 48.2) and median time to reach nadir was 6 months (range 3-24 months). 13.5% (35) patients were treated with radiotherapy (RT) after at least 3 months (range 3 -6 months) of starting apalutamide. Patients received either a daily (55 Gy in 20 fractions over 4 weeks) or weekly (36 Gy in six fractions over 6 weeks) of radiotherapy (68 % vs 32%). Higher number of patients in RT group had achieved PSA90 compared to no radiotherapy cohort (97.14 % vs 87.3%, p =0.15). Patients treated with RT had median post treatment of PSA 0.01 ng/ml compared to 0.1 ng/ml in non RT group (p=0.0062). After median follow up of 8.4 months, proportion of patients shown biochemical progression in RT vs non RT group were 5.7 % vs 15 % respectively (p= 0.04). Patients with de novo metastatic disease have shown poor PSA response and higher chance of progression compared to patients who had initial radical treatment. Radiotherapy was well tolerated, with 17 % adverse events (Radiation Therapy Oncology Group grade 3–4) reported in radiotherapy group. Conclusions: Early experience of using apalutamide and radiotherapy in mHSPC showed improved PSA response and delayed progression. Treatment was well tolerated. Further follow up and clinical trials are needed to understand the impact on overall survival. [Table: see text]