High Percentage Of Patients Research Articles

The Impact of Psychedelic Drugs on Anxiety and Depression in Advanced Cancer or other Life-threatening Disease: A Systematic Review With Meta-analysis.

Life-threatening cancer or other diseases can induce anxiety and depressive symptoms. We performed a systematic review with meta-analyses of randomized controlled trials assessing patients with cancer or other life-threatening diseases using validated anxiety and depression scales. PubMed was searched up to November 15, 2022 and citations were applied to prespecified inclusion criteria. Disease rating scales for anxiety or depression included the State-Trait Anxiety Inventory (STAI) (STAI Trait [STAI-T], STAI-State [STAI-S]), Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS) (HADS-Anxiety [HADS-A]; HADS-Depression [HADS-D]), Profile of Mood States (POMS), and the Hamilton Rating Scale for Depression (HAM-D or GRID-HAM-D-17). Safety outcomes included assessments of blood pressure and heart rate. Five trials, predominantly in cancer patients, had data assessing anxiety and depressive symptoms. These trials found promising results for psychedelics versus placebo in several anxiety and depression scales but increases in blood pressure and heart rate also occurred. There were some concerns of risk of bias because it is difficult to truly randomize a psychedelic trial and there was a high percentage of patients in the trials who had used psychedelics in the past. There was high heterogeneity for all analyses that we could not explain. Although the results are promising, future trials are needed to assess the optimal psychedelic, dose, number of sessions required, and how psychedelic naïve patients would respond both psychologically and hemodynamically before this therapy can be considered for widescale clinical use.

Comparison Between Intrasylvian and Intracerebral Hematoma Associated with Ruptured Middle Cerebral Artery Aneurysms: Clinical Implications, Technical Considerations, and Outcome Evaluation

Subarachnoid hemorrhage (SAH) due to a middle cerebral artery (MCA) aneurysm rupture is often associated with an intracerebral hematoma (ICH) or intrasylvian hematoma (ISH). We reviewed 163 patients with ruptured MCA aneurysms associated with pure SAH or SAH plus ICH or ISH. The patients were first dichotomized according to the presence of a hematoma (ICH or ISH). Next, we performed a subgroup analysis comparing ICH versus ISH to explore their relationship with the most relevant demographic, clinical, and angioarchitectural features. Overall, 85 patients (52%) had a pure SAH, and 78 (48%) had presented with an associated ICH or ISH. No significant differences were observed in the demographics or angioarchitectural features between the 2 groups. However, the Fisher grade and Hunt-Hess score were higher for the patients with hematomas. A good outcome was observed in a higher percentage of patients with pure SAH compared with those with an associated hematoma (76% vs. 44%), although the mortality rates were comparable. Age, Hunt-Hess score, and treatment-related complications were the main outcome predictors on multivariate analysis. Patients with ICH appeared worse clinically compared with those with ISH. We also found that older age, a higher Hunt-Hess score, larger aneurysms, decompressive craniectomy, and treatment-related complications were associated with poor outcomes among the patients with an ISH, but not an ICH, which appeared, per se, as a more severe clinical condition. Our study has confirmed that age, Hunt-Hess score, and treatment-related complications influence the outcome of patients with ruptured MCA aneurysms. However, in the subgroup analysis of patients with SAH associated with an ICH or ISH, only the Hunt-Hess score at onset appeared as an independent predictor of the outcome.

The First Pulmonary Hypertension Registry in the United Arab Emirates (UAEPH): Clinical Characteristics, Hemodynamic Parameters with Focus on Treatment and Outcomes for Patients with Group 1-PH

The aim of this study is to present the first United Arab Emirates pulmonary hypertension registry of patients' clinical characteristics, hemodynamic parameters and treatment outcomes. This is a retrospective study describing all the adult patients who underwent a right heart catheterization for evaluation of pulmonary hypertension (PH) between January 2015 and December 2021 in a tertiary referral center in Abu Dhabi, United Arab Emirates. A total of 164 consecutive patients were diagnosed with PH during the five years of the study. Eighty-three patients (50.6%) were World Symposium PH Group 1-PH; nineteen patients (11.6%) were Group 2-PH due to left heart disease; twenty-three patients (14.0%) were Group 3-PH due to chronic lung disease; thirty-four patients (20.7%) were Group 4-PH due to chronic thromboembolic lung disease, and five patients (3.0%) were Group 5-PH. Among Group 1-PH, twenty-five (30%) had idiopathic, twenty-seven (33%) had connective tissue disease, twenty-six (31%) had congenital heart disease, and five patients (6%) had porto-pulmonary hypertension. The median follow-up was 55.6 months. Most of the patients were started on dual then sequentially escalated to triple combination therapy. The 1-, 3- and 5-year cumulative probabilities of survival for Group 1-PH were 86% (95% CI, 75-92%), 69% (95% CI, 54-80%) and 69% (95% CI, 54-80%). This is the first registry of Group 1-PH from a single tertiary referral center in the UAE. Our cohort was younger with a higher percentage of patients with congenital heart disease compared to cohorts from Western countries but similar to registries from other Asian countries. Mortality is comparable to other major registries. Adopting the new guideline recommendations and improving the availability and adherence to medications are likely to play a significant role in improving outcomes in the future.

The Effectiveness of an App (Insulia) in Recommending Basal Insulin Doses for French Patients With Type 2 Diabetes Mellitus: Longitudinal Observational Study.

For patients with type 2 diabetes (T2D), calculating the daily dose of basal insulin may be challenging. Insulia is a digital remote monitoring solution that uses clinical algorithms to recommend basal insulin doses. A predecessor device was evaluated in the TeleDiab-2 randomized controlled trial, showing that a higher percentage of patients using the app achieved their target fasting blood glucose (FBG) level compared to the control group, and insulin doses were adjusted to higher levels without hypoglycemia. This study aims to analyze how the glycemic control of Insulia users has evolved when using the app in a real-life setting in France. A retrospective observational analysis of data collected through the device in adult French patients with T2D treated with basal insulin and oral antihyperglycemic agents using the system for ≥6 months was conducted. Analyses were descriptive and distinguished the results in a subpopulation of regular and compliant users of the app. Glycemic outcomes were estimated considering the percentage of patients who achieved their individualized FBG target between 5.5 and 6 months following the initiation of device use, the frequency of hypoglycemia resulting in a treatment change over the 6-month period of exposure, and the evolution of the average hemoglobin A1c (HbA1c) level over the same period. Of the 484 users, 373 (77.1%) performed at least one dose calculation. A total of 221 (59.2%) users were men. When app use started, the mean age, BMI, HbA1c, and basal insulin dose were 55.8 (SD 11.9) years, 30.6 (SD 5.9) kg/m2, 10.1% (SD 2.0%), and 25.5 (SD 15.8) IU/day, respectively. Over a median use duration of 5.0 (95% CI 3.8-5.7) months, patients used the system 5.8 (SD 1.6) times per week on average, and 73.4% of their injected doses were consistent with the app's suggested doses. Among regular and compliant user patients (n=91, ≥5 measurements/week and ≥80% adherence to calculated doses), 60% (55/91) achieved the FBG target (±5%) at 6 months (5.5-6 months) versus 51.5% (145/282) of the other patients (P=.15). There was an increase in the proportion of patients achieving their target FBG for regular and compliant users (+1.86% every 2 weeks) without clear improvement in other patients. A logistic model did not identify the variables that were significantly associated with this outcome among regular and compliant users. In the overall population, the incidence of reported hypoglycemia decreased simultaneously (-0.16%/month). Among 82 patients, the mean HbA1c decreased from 9.9% to 7.2% at 6 months. An improvement in glycemic control as measured by the percentage of patients reaching their FBG individualized target range without increasing hypoglycemic risk was observed in patients using the Insulia app, especially among regular users following the dose recommendations of the algorithm.

Abstract P6-02-02: Challenges and Dilemmas Following a Traceback Approach for Genetic Counseling and Genetic Testing for Pathogenic Germline Mutations among High-Risk Patients Previously Diagnosed with Breast Cancer

Abstract Background: Accounting for almost 20% of all cancer cases, breast cancer continues to be the most common cancer and the leading cause of cancer-related deaths among females. In our region, almost 50% of breast cancer patients are diagnosed at age 50 or younger. Around 5-15% of breast cancers are hereditary and mostly related to BRCA1 or BRCA2 gene mutations. Risk-reducing interventions, like bilateral mastectomies and oophorectomies, are highly recommended for carriers of pathogenic variants. More recently, data had shown that specific breast cancer treatment may be informed by BRCA1 or BRCA2 mutation status. Until very recently, genetic testing and genetic counseling services were prohibitively expensive and were not available or routinely offered. Given the recently identified high prevalence of pathogenic variants among our patients, and the wider availability and the lower cost of genetic testing, an opportunity exists to look back and offer such patients the chance to do genetic testing. Patients with positive tests can then be counseled, along with their close family members, for appropriate risk-reducing programs. Methods: Using our hospital-based cancer registry, we identified patients with breast cancer who fulfilled at least one of 3 approved indications for genetic testing but never had it. Eligible patients were those diagnosed at age 45 or younger, patients with triple-negative (TN) disease diagnosed at age 65 years or younger, and those with close blood relatives with breast or ovarian cancers. Patients were initially contacted over the phone and then seen by one of the investigators in our genetic counseling clinics. Testing was performed using next-generation sequencing (NGS)-based multi-gene panel (MGP) on a peripheral blood sample at a referral lab. Results: A total of 377 eligible patients were identified. The median age (range) was 48 (31-75) years. Genetic testing was performed on 198 (52.5%) and results were reported on 192. Age ≤45 years (n= 157, 79.3%) and TN-disease (n= 59, 29.8%) were the most common indications for testing. In total, 20 (10.4%) patients were found to have pathogenic/likely pathogenic variants; mostly in BRCA2 (n=9) and BRCA1 (n=7). An additional 4 patients had TP53, PALB2, and ATM. Variants of uncertain significance (VUS) were identified in 53 (27.6%) patients. Following the visit to the genetic counseling clinic, an additional 41 (22.9%) patients agreed to test. The remaining 136 (36.1%) failed to be tested because of lack of updated contact information (n=54, 39.7%), living outside the country (n=19, 14.0%) or lack of insurance coverage (n=36, 26.5%). Fear of social stigma, lack of interest, or emotional stress were the reason for refusal among 24 (17.6%) patients. Conclusions: The Traceback approach may provide an opportunity to diagnose pathogenic/likely pathogenic variants among previously diagnosed patients with breast cancer. The high percentage of patients couldn’t be tested for manageable reasons while fear of social stigma and emotional stress continued to be important barriers, especially in societies like ours. Given the important implications of genetic testing and its availability and affordability, reaching out to untested high-risk patients raises an ethical and professional dilemma that needs to be addressed from the physician, patients, and insurance perspectives. Citation Format: Faris Tamimi, Baha’ sharaf, Osama Salama, Sarah Edaily, Suhaib Khater, Mais AlKyam, Lama Abujamous, Khansa Azzam, Hala Abu-Fares, Haneen Abaza, Hikmat Abdel-Razeq. Challenges and Dilemmas Following a Traceback Approach for Genetic Counseling and Genetic Testing for Pathogenic Germline Mutations among High-Risk Patients Previously Diagnosed with Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-02-02.

Abstract P1-06-06: Access to medical coverage in newly diagnosed Breast cancer patients a minority population during the COVID 19 pandemic

Abstract Background: Hispanics are among the most significant minorities in the United States, and assessing their health needs is vital in formulating health policies. The social, environmental, and biological background affect their morbidity and mortality, with cancer being the leading cause of mortality in Hispanics. Although implementing the Affordable Care Act improved access to health care, disparities and challenges in Hispanics’ access to health care remain. (1) In our study, we are trying to assess the COVID-19 pandemic implications on the socioeconomic status of Hispanics with newly diagnosed breast cancer and how that is affecting their outcome. Methods: This is a retrospective study demonstrating the nature of breast cancer screening, diagnosis, and management during COVID-19 lockdown and post-vaccine compared to the pre-COVID-19 era. The restrospective review was conducted at Mays Cancer Center in San Antonio, IRB approved by UT Health San Antonio. The data were abstracted from the medical record system (EPIC). Pearson’s Chi-squared and logistic regression tests were used to determine the relationship between time and stage at diagnosis and association with funding status Result: 696 subjects with newly diagnosed breast cancer were identified and divided into three cohorts: Cohort A: 264 pts in a pre-covid era: From 2018-February 2020, Cohort B: 171 patients during the covid-19 lockdown, and Cohort C: from April 2020-Dec-2020 with 261 patients in the post-vaccine era. A higher percentage of patients had Tis identified in Cohort A (26%) compared to Cohort B (19%) and Cohort C(12%) (p0.003). These numbers have changed to an increasing percentage of patients with T1 or T2. N0 or N1in Cohort B (62%) and Chohort C (68%), p0.003). Presentation of locally advanced (T3/T4 with any N) and metastatic disease remained relatively similar in all cohorts, with more metastatic cases at presentation in Cohort A (p0.003). Many patients of Hispanic ethnicity (OR 1.47, p0.1) were not funded by commercial insurance or Medicare. (OR 2.33, 95% CI 1.43, 3.77, p< 0.001). A high proportion of Hispanic ethnicity in post covid era (cohort B and C) OR 1.78, 95% CI (1.16,2.79) (p0.009) required neoadjuvant chemotherapy suggesting more advanced and possibly aggressive cancer histology. We observed that unfunded patients are less likely to have hormonal receptor-positive breast cancer (p0.001). Conclusion: Population health is likely affected by socioeconomic status, which eventually affects their health care. In a minority Hispanic population, low average income and educational attainment are likely the obstacles to getting timely appropriate health.(2) A higher proportion of Hispanic patients were not insured when compared to non-Hispanics leading possibly to more advanced and aggressive histologies at presentation.

Evaluation of factors that may influence the development of chronic kidney disease in patients with bipolar disorder treated with lithium.

IntroductionBipolar disorder (BD) is a serious and chronic mental disease of mood. Lithium is used for treatment and studies have demonstrated that it is the most efficient drug, reducing suicide risk in a high percentage of patients. However, this drug has well known side effects, such as kidney damage. Lithium could cause chronic kidney disease, specially with the presence of other risk factors.ObjectivesObservational and retrospective study of creatinine levels and glomerular filtration rates observed in blood analysis (follow-up period of 11 years). Sample size of 263 patients diagnosed of BD I and BD II in treatment with lithium. We used socio-demographic (age, sex) and clinic variables (diabetes mellitus, hypertension, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or diuretics) to generate bivariate and multivariate analysis.MethodsOur main objective is to analyze the deterioration of kidney function and the development of chronic kidney disease that chronic treatment with lithium can induce in patients with BD. Our secondary objective is to determine variables which could promote the development of chronic kidney disease, and to assess if these variables could be considered as risk factors during the treatment with lithium.Results11,3 % of patients in our study developed chronic kidney disease during monitoring. The deterioration of GFR in patients in treatment with lithium was significantly associated with female sex and NSAIDs consumption. A trend towards statistical significance was found regarding the use of diuretics (p=0,060). No statistical significance was found between diabetes mellitus, hypertension or type of BD and the deterioration of kidney function in our sample. An inverse association was found between the GFR decline and the age but no statistical significance was demonstrated.ConclusionsWe conclude that female sex and use of NSAIDs are predicting factors of GFR decline in patients with BD in chronic treatment with lithium. We must take into account these drugs or even avoid concomitant treatment (lithium and NSAIDs) in order to prevent chronic kidney disease. In addition to it, we should recommend careful use of diuretics during treatment with lithium because of risk of dehydration. Diabetes mellitus and hypertension have universally been associated to increase risk of development of chronic kidney disease. However, we have not found statistical significance in our study. Therefore, research should be done in order to determine specific risk factors in this group of patients and, consequently, optimize their treatment.Disclosure of InterestNone Declared

Telemedicine in Psychiatry: benefits and challenges of the the Home-Hospital Care system (COD20) project

IntroductionTelepsychiatry (TP) is the use of telecommunication technologies to provide psychiatric assessment, diagnosis, treatment, and consultation. During the COVID-19 outbreak, TP has shown potential for connecting with people unable to access traditional in-person services, and also enabling patients to receive mental health care safely from home. The Home Hospital care system (Cure Ospedaliere Domiciliari; COD20) is a video consultation service developed by the University of Milan.ObjectivesWe aimed at investigating the potential of Telemedicine (TM) in a sample of psychiatric patients.MethodsAs of now, 208 consecutive patients of an outpatient clinic belonging to ASST Fatebenefratelli-Sacco in Milan were interviewed through an online anonymous survey. Data collected were sociodemographic, job position, educational level, digital skills and both satisfaction degree and ease of use of the COD20 tool. Data were analyzed using SPSS v.27.ResultsAmong 208 patients, 87.7% had Internet access, 94.5% used a smartphone, 74% used a computer and 37% used a tablet. The levels of digital skills were considered intermediate-advanced in communication and information research for the majority of the cases. A high percentage of patients (80.8%) learned how to use electronic devices by themselves, while only 12.3% had an ECDL certificate. The most represented diagnoses were Mood Disorders (44.5%) and Anxiety Disorders (14%). The majority of the sample (54.8%) was visited using TM for clinical interviews: 24.7% of them used TM at least 10 times/year, and 19.8% more than 20 times/year. Among all the clinical interviews conducted using TM, 61% concerned psychiatric consultation, while 30% were dedicated to psychotherapy. The most used tool was the COD20 platform (21.9%): it was considered easy to use in 47.9% of cases, while 43.8% of patients would like to use it again in the future. The main reasons leading to the usage of TM were the difficulties in reaching the ambulatory (for 43.9%) and the workplace (for 30%).Image:Image 2:ConclusionsTM represents a valid implementation in the traditional clinical practice, and we showed it is well received in terms of appreciation and ease of use. The COD20 platform could increase access to care, and overcome barriers such as distance, travel costs and time management. TP contributes to develop a more inclusive healthcare process for patients, with better performance in terms of compliance.Disclosure of InterestNone Declared

Evolution of patients with bipolar disorder according to pharmacological treatment Pediatric Hospital "Juan Manuel Márquez" 2009-2011

To know the evolution, according to the pharmacological treatment received, of the patients admitted to the Psychiatric Ward of the "Juan Manuel Márquez" Paediatric Hospital, with Bipolar Disorder (TB) in the period from January 2009 to December 2011, the present study. The objective is to identify the evolution of the patients three, six and twelve months after hospital discharge according to the pharmacological treatment used. A retrospective longitudinal descriptive study was carried out between May 2012 and May 2013. 81 hospitalized patients with TB were studied. The source of information was their medical records and a semi-structured interview. The data was processed in SPSS version 15 and the results are presented in statistical tables. Three months after hospital discharge, the highest percentage of patients with satisfactory clinical status had treatment with Haloperidol alone, in second place Risperdal and Carbamazepine and in third place the combination of Haloperidol and Magnesium Valproate (Mg), while Six months was Haloperidol alone, followed by the combination of Olanzapine and Lithium Carbonate, Risperdal and Mg Valproate, one year after hospital discharge the combination of Olanzapine and Lithium Carbonate was found first, followed by Risperdal with Carbamazepine and of quetiapine alone. The treatments most associated with satisfactory clinical status were: Haloperidol alone, Quetiapine alone, as well as the combinations of Risperdal and Carbamazepine, Risperdal and Mg Valproate, Olanzapine and Lithium Carbonate, and Haloperidol with Mg Valproate.

Low level of antioxidant capacity biomarkers but not target overexpression predicts vulnerability to ROS-inducing drugs

Despite a strong rationale for why cancer cells are susceptible to redox-targeting drugs, such drugs often face tumor resistance or dose-limiting toxicity in preclinical and clinical studies. An important reason is the lack of specific biomarkers to better select susceptible cancer entities and stratify patients. Using a large panel of lung cancer cell lines, we identified a set of “antioxidant-capacity” biomarkers (ACB), which were tightly repressed, partly by STAT3 and STAT5A/B in sensitive cells, rendering them susceptible to multiple redox-targeting and ferroptosis-inducing drugs. Contrary to expectation, constitutively low ACB expression was not associated with an increased steady state level of reactive oxygen species (ROS) but a high level of nitric oxide, which is required to sustain high replication rates. Using ACBs, we identified cancer entities with a high percentage of patients with favorable ACB expression pattern, making it likely that more responders to ROS-inducing drugs could be stratified for clinical trials.

Trial of Globus Pallidus Focused Ultrasound Ablation in Parkinson’s Disease

BackgroundUnilateral focused ultrasound ablation of the internal segment of globus pallidus has reduced motor symptoms of Parkinson’s disease in open-label studies.MethodsWe randomly assigned, in a 3:1 ratio, patients with Parkinson’s disease and dyskinesias or motor fluctuations and motor impairment in the off-medication state to undergo either focused ultrasound ablation opposite the most symptomatic side of the body or a sham procedure. The primary outcome was a response at 3 months, defined as a decrease of at least 3 points from baseline either in the score on the Movement Disorders Society–Unified Parkinson’s Disease Rating Scale, part III (MDS-UPDRS III), for the treated side in the off-medication state or in the score on the Unified Dyskinesia Rating Scale (UDysRS) in the on-medication state. Secondary outcomes included changes from baseline to month 3 in the scores on various parts of the MDS-UPDRS. After the 3-month blinded phase, an open-label phase lasted until 12 months.ResultsOf 94 patients, 69 were assigned to undergo ultrasound ablation (active treatment) and 25 to undergo the sham procedure (control); 65 patients and 22 patients, respectively, completed the primary-outcome assessment. In the active-treatment group, 45 patients (69%) had a response, as compared with 7 (32%) in the control group (difference, 37 percentage points; 95% confidence interval, 15 to 60; P=0.003). Of the patients in the active-treatment group who had a response, 19 met the MDS-UPDRS III criterion only, 8 met the UDysRS criterion only, and 18 met both criteria. Results for secondary outcomes were generally in the same direction as those for the primary outcome. Of the 39 patients in the active-treatment group who had had a response at 3 months and who were assessed at 12 months, 30 continued to have a response. Pallidotomy-related adverse events in the active-treatment group included dysarthria, gait disturbance, loss of taste, visual disturbance, and facial weakness.ConclusionsUnilateral pallidal ultrasound ablation resulted in a higher percentage of patients who had improved motor function or reduced dyskinesia than a sham procedure over a period of 3 months but was associated with adverse events. Longer and larger trials are required to determine the effect and safety of this technique in persons with Parkinson’s disease. (Funded by Insightec; ClinicalTrials.gov number, NCT03319485.)

Awareness of Stroke Risk Factors, Warning Signs, and Preventive Behaviour Among Diabetic Patients in Al-Ahsa, Saudi Arabia.

Objectives This study aims to measure the level of awareness about stroke symptoms, risk factors, and preventive health practices that could be taken to reduce the risk of stroke among diabetic patients in Al-Ahsa, Saudi Arabia. Methods A cross-sectional study was conducted in Al-Ahsa, Saudi Arabia in 2020. The sample included a total of 202 male and female Saudi adults aged 18-65 years,with either type 1 or type 2 diabetes mellitus, and living in Al Ahsa, Saudi Arabia. The information was collected randomly through an online questionnaire distributed among patients after getting their contact information from relevant governmental and private diabetes clinics and after signing the informed consent. For awareness and knowledge items, each correct answer was scored one point and the total summation of the discrete scores of the different items was calculated. A diabetic patient with a score less than 60% of the total score was considered to have poor awareness while a score of 60% or more of the total score was considered a good level of awareness. Results A total of 87 (43.1%) participants had an overall good awareness level, while 115 (56.9%) had poor awareness levels. Around 40.6% of the study patients had heard about stroke, 61.9% knew that stroke affects the brain, and 24.3% reported that stroke is higher among males. As for factors associated with stroke, the most reported was high blood pressure (71.8%), followed by diabetes mellitus (69.3%). Exactly 65.8% of participants knew about the mechanism of ischemic stroke and 42.6% reported hemorrhagic stroke. A high percentage of patients (73.1%) realize that they could reduce their risk of stroke. Conclusion The findings of the current study showed that less than half (43.1%) of the Saudi patients with DM had a good awareness level regarding stroke and its related risk factors and warning signs. Older patients (aged 50-65 years) with high social levels (high education and income) and those with a family history of stroke had significantly higher awareness levels. Hypertension, DM, and smoking are the highest reported known risk factors of stroke, and speech disorders are the highest known stroke presentation to the respondents.

Serological Diagnosis of Respiratory Syncytial Virus by ELISA Technique among Children with Respiratory Tract Infections in Beiji City, Iraq

The study have been done to detect Human Respiratory syncytial virus (HRSV) infections among hospitalized children under 5 years old in Beiji city Salah-Aldin Governorate, in addition to identify the risk factors associated with the virus. Whole blood samples were taken from 300 hospitalized children between the end of October 2021, to the end of June 2022, each sample was analyzed for HRSV by immunoglobulin M (IgM) specific to HRSV determining from blood specimens in serum using enzyme-linked immune sorbent assay (ELISA) technique. Of the 300 serum samples, Respiratory syncytial virus (RSV) was found in 120 (40%), 63 (42%) females, and 57 (38%) males. The age group was more susceptible to infection between 7-12 months for RSV at a rate of 25%. The study revealed that 61.66% of children exposed to smoke from one or both parents was positive for RSV, while 38.33% showed negative results for the presence of RSV. Considering the type of feeding, the current study showed that RSV infection was demonstrated in a higher percentage in patients with bottle feeding 60%, while a low percentage was demonstrated in patients with breastfeeding at 13.3%. Our results indicated the prevalence of RSV among children after imposing vaccination and reducing non-pharmaceutical interventions.

Disparities in prostate cancer survival outcomes in Appalachian Kentucky.

39 Background: Prostate cancer (PC) is the most common male cancer in the United States and the second leading cause of cancer-related death. Our group previously reported that men from Appalachian Kentucky had worse survival outcomes compared to non-Appalachian Kentucky and general population. This survival difference could be mainly due to socio-economic disparities. However, several new treatments have been approved for metastatic PC (mPC) in the last decade and these current standard of care (SOC) therapies have significantly improved survival outcomes in mPC. Therefore, we aim to investigate whether the recent change in SOC treatments have improved overall survival (OS) in patients with Appalachian (App) Kentucky vs. Non-Appalachian (Non-App) Kentucky from 2004–2019. Methods: All male patients who were > 20 years old with primary diagnoses of prostate adenocarcinoma, listed in Kentucky cancer Registry (KCR), diagnosed between 2004 and 2019, were included in the study. Basic demographics and survival outcomes were compared for all stages of PC and between App and Non-App Kentucky. We also compared the survival difference between two time periods 2004- 2011 vs. 2012-2019. Kaplan Meir and multivariate Cox Regression were performed to compare patients’ overall survival (OS). Results: A total of 36,695 patients were included in this retrospective analysis, of which 74.3% were Non-App and 15.7% were App. Caucasians predominated in both groups (N-App 85% vs. App 97%). The majority of Kentucky patients were aged between 50-74 years (79%). App Kentucky was noted to have more poorly differentiated histology (44.4% vs 40.1%), high Gleason score (26.4% vs 20%), more distant disease at the time of diagnosis (8.3 vs 6.7%), and higher percentage of patients with smoking history (40.1% vs 34.9%) compared to Non-App, respectively. A higher proportion of Non-App Kentucky had private insurance (35%) at the time of cancer diagnosis compared to more patients enrolled in Medicare (56.6%) or Medicaid (4.7%) in App. There was a survival difference between App and Non-App Kentucky by univariate analysis (p<0.001). In multivariate Cox regression showed that Non-App patients had better OS (p<0.001; HR=0.92, 95%CI 0.87-0.96). Patients diagnosed in the years 2012- 2019 had better survival compared to patients in 2004 – 2011 group (p=0.01; HR=0.94, 95%CI 0.9-0.99). Other factors that contributed to better survival include younger age, lived in the metro area, had private insurance, being a nonsmoker, being lower stage, and receiving treatment. We got similar result for stage IV patients, but the App variable was not significant in the COX regression (p=0.2). Conclusions: Our study shows that Appalachian has worse outcomes compared than Non-Appalachian Kentucky based on population-based analysis from 2004-2019. Additional research is needed to understand the health care disparities in App Kentucky.

Relationship of obstructive sleep apnea with periodontal condition and its local and systemic risk factors

ObjectiveObstructive sleep apnea (OSA) and periodontitis share risk factors, such as age, obesity, stress, and cardiovascular events, which have a bidirectional cause-effect relationship through systemic inflammation. Our objective was to determine the relationship between OSA and the periodontal condition and its associated local and systemic risk factors.Material and methodsThis was an observational case-control study involving 60 patients. Local oral risk factors and the systemic condition of each patient were evaluated. All patients underwent polysomnography for the diagnosis of OSA. Chi-squared, one-way ANOVA, and Bonferroni’s tests were performed.ResultsA higher percentage of patients with periodontitis had severe OSA (66.66%); however, no statistically significant association was found between the two pathologies (p = 0.290). In terms of systemic risk factors, an association was found between arterial hypertension and severe OSA (p = 0.038), and in terms of local factors, an association was found between the use of removable prostheses and severe OSA (p = 0.0273).ConclusionIn the general population, patients with periodontitis showed a higher prevalence of severe OSA. Obesity and hypothyroidism were the most prevalent systemic findings in patients with OSA and periodontitis. Arterial hypertension and osteoarthritis were found to be associated with severe OSA. The local risk factors associated with periodontitis and severe OSA were removable partial dentures and misfit resins.Clinical relevanceTo study the factors that can facilitate the progression of OSA and periodontitis, physicians and dentists should be advised to provide comprehensive care for patients with both pathologies.

The Efficacy of Liposomal Bupivacaine in Regional Nerve Blocks for Below Knee Amputations.

Postamputation pain is highly prevalent. Opioids are often utilized postoperatively; however, they have significant side effects. Liposomal bupivacaine (LB) was introduced to extend nerve blocks from hours into days. Regional nerve blocks with LB for below knee amputation (BKA) is a novel approach which may reduce opioid use after surgery. A retrospective review was conducted for patients who had received LB nerve blocks compared to none for postoperative pain control in BKAs. Daily average opioid consumption was evaluated from the time in postoperative acute care unit until day of discharge in oral morphine equivalents (OME). 69 patients who underwent below knee amputations were reviewed. The mean average daily OME was lower in the LB group compared to control group(25.0 vs 50.5 OME, respectively; P = .002) A higher percentage of patients in the study group were categorized in the minimal opioid use when compared to the control group LB regional nerve blocks for the BKA population are considered a novel approach in pain control. Our exploratory study shows that patients who received LB nerve blocks may have decreased opioid consumption after surgery.

Incidence and Risk Factors for Clostridioides difficile Infections in Non-COVID and COVID-19 Patients: Experience from a Tertiary Care Hospital

(1) Background: The aim of this study was to assess the incidence and the risk factors for healthcare-associated Clostridioides difficile infection (HA-CDI) in patients with COVID-19 and without this infection. (2) Methods: A single-center, prospective observational study was conducted at the University Clinical Hospital Center in Belgrade, Serbia, from January 2019 to December 2021. The entire hospital was a COVID-dedicated hospital for 12 months during the study period. The incidence density rates and risk factors for HA-CDI in patients with and without COVID-19 are presented. (3) Results: The incidence rates of HA-CDIs were three times higher in patients with COVID-19. The HA-CDI-COVID-patients were younger (69.9 ± 12.6 vs. 72.5 ± 11.6; p = 0.017), admitted from another hospital (20.5% vs. 2.9; p < 0.001), had antimicrobial therapy before CDI (99.1% vs. 91.3%, p < 0.001), received two or more antibiotics (p = 0.030) during a longer period (p = 0.035), received proton pump inhibitors (95.9% vs. 50.0%, p < 0.001) during a longer period (p = 0.012) and steroids (32.8% vs. 20.4%, p < 0.001). During the last month before their current hospitalization, a higher percentage of patients without COVID-19 disease were hospitalized in our hospital (p < 0.001). Independent predictors for HA-CDIs in patients with COVID-19 were admission from another hospital (p = 0.003), the length of antibiotic administration (0.020), and the use of steroids in therapy (p < 0.001). The HA-CDI predictors in the non-COVID patients were older age (p = 0.017), advanced-stage renal failure (p = 0.005), chemotherapy (p = 0.003), and a low albumin level (0.005). (4) Conclusion: Higher incidence rates of HAI-CDIs in COVID-19 patients did not occur due to reduced infection control precautions and hygiene measures but due to antibiotic therapy and therapy with other drugs used during the pandemic.

Imaging-Guided De Novo Retrograde Ureteral Access and Stent Placement without Cystoscopy in Women

PurposeTo evaluate the feasibility of a new technique for imaging-guided de novo retrograde ureteral double J (DJ) stent placement without cystoscopy in women. Materials and MethodsEighty-four women referred for ureteral stent placement between April 2019 and January 2022 were included. In all the patients, the initial attempt for stent placement was performed in a retrograde fashion. Successful ureteral catheterization and DJ stent placement were considered as technical success. The fluoroscopy time required to catheterize the ureter and that for the entire procedure were recorded. Factors affecting the technical success rate and fluoroscopy time were examined. ResultsA total of 108 ureteral stent placement procedures in 84 women, with a mean age of 57.5 years (range, 19–85 years), were performed. The most common underlying pathologies were cervical (n = 33, 31%) and ovarian (n = 32, 30%) carcinomas. The most commonly involved segments of the ureter were the lower half (n = 44, 40%) and trigone (n = 39, 36%). The technical success rate was 81.5%, and it reached 93% in the case of lower-half ureteral obstruction. Distorted trigonal anatomy caused by external compression of the bladder wall by a mass was associated with a higher rate of technical failure (90.6% vs 47.8%; P < .001). The use of ultrasound guidance to guide the sheath to the ureteral orifice allowed for a significant decrease in the fluoroscopy time for ureteral catheterization (4.6 minutes ± 3.91 vs 2.26 minutes ± 2.32; P = .003) and that for the entire procedure (9.42 minutes ± 4.95 vs 5.93 minutes ± 4.06; P = .001). ConclusionsImaging-guided de novo retrograde ureteral catheterization and stent placement can be successfully performed in a high percentage of patients within a reasonable fluoroscopy time without the need for cystoscopy in women.

Abstract WP206: Acute Ischemic Stroke And Vocal Fold Paralysis: A Propensity Matched 20-year Analysis Of The National Inpatient Sample

Introduction: Lower cranial nerve motor dysfunction is a well-distinguished feature in acute ischemic stroke (AIS). As a result, patients can present with vocal dysfunction, including vocal fold paralysis (VFP). Few studies have examined VFP in AIS patients. Objective: To identify the incidence and characteristics of patients presenting with VFP after AIS. Methods: A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences &gt;0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for VFP on outcomes. Significance set at an alpha level of &lt;0.001. All analysis performed in R version 4.1.3. Results: 10,415,286 patients with AIS were included; 11,328 (0.1%) had VFP. At baseline, a higher percentage of patients with VFP were younger, male, insured by Medicaid, had a higher Elixhauser Comorbidity Score, and were more likely to have a tracheostomy and ventilator use (all p&lt;0.001). Following propensity matching, multivariate analysis revealed that patients with VFP were less likely to be discharged home (AOR 0.32; 95%CI: 0.18-0.57; p&lt;0.001) with no effect of VFP on in-hospital mortality, length of stay, or total hospital charges (p&gt; 0.001) Conclusion: This is the first study to report on national trends of patients with VFP after AIS, and we found that VFP patients were more male, younger, higher overall disease burden, and required more in-hospital procedures. Though rare, VFP causes significant morbidity for patients after AIS. Patients experience significant functional deficits at discharge, as represented by the low rate of home discharge.

Needs evaluation questionnaire for liver disease: a novel assessment of unmet needs in patients with chronic liver disease.

Patients with chronic liver disease face debilitating complications in their daily living and constantly report several types of unmet needs, but there is a paucity of validated questionnaires to assess these needs. In this study, we present the development of the Needs Evaluation Questionnaire for Liver Diseases (NEQ-LD) for the assessment of unmet needs in patients with chronic liver disease. Two hundred eighty-six outpatients with chronic liver diseases from a single tertiary referral center completed the NEQ-LD and related validity measures. Item response theory analyses were performed and demonstrated the strong psychometric properties of the questionnaire. Differential item functioning analyses showed that the scale functions equally across groups differing for age, sex, and presence of cirrhosis, suggesting the large applicability of the NEQ-LD for the assessment of unmet needs and between-group comparisons. Criterion validity measures provided evidence that unmet needs were positively associated with measures of depression and anxiety and negatively associated with measures of subjective well-being and physical and mental health. Unmet needs were expressed by a high percentage of patients, especially in the areas of information and dialogue with clinicians. One third of the sample reported material needs. Most of the items describing unmet needs were reported more frequently by patients with cirrhosis. Conclusion: We developed a reliable, valid, and largely employable instrument that can promote patient-centered care and facilitate support services in Hepatology.