High Percentage Of Patients Research Articles

The impact of COVID-19 on a Southern Chinese cohort with neuromyelitis optica spectrum disorders

BackgroundThere are few studies on risk factors for coronavirus disease 2019 (COVID-19) infection in patients with Neuromyelitis Optica Spectrum Disorders (NMOSD). The relationship between NMOSD relapse and COVID-19 needs to be evaluated. The objective of our study is to identify the risk factors of COVID-19 infection and NMOSD relapse among NMOSD patients with COVID-19. MethodA total of 379 NMOSD patients registered in a NMOSD database were included in this case-control study after the end of the COVID-19 quarantine and restriction policies on December 6, 2022 in China. Data were obtained from the database. Additional information was obtained by questionnaires and the Neurology out-patient clinic. The clinical characteristics of NMOSD patients with COVID-19 were described. Risk factors associated with COVID-19 infection and outcome among patients with NMOSD were analyzed. Risk factors associated with relapse in NMOSD patients with COVID-19 were also identified. Results239 (63.1%) NMOSD patients were infected with COVID-19. Patients with NMOSD who were infected with COVID-19, in comparison to those without COVID-19, were younger at the time of interview (median [IQR] age: 43.00 [32.00–55.00] vs 49.50 [35.25–56.00] years, P = 0.029), younger at NMOSD onset (median [IQR] age: 38.00 [27.00–51.00] vs 45.00 [32.00–52.75] years, P = 0.013), had abnormal visual evoked potentials before infection (73.4% vs 54.3% P = 0.029), had lower baseline Activities of Daily Living Scale (ADL) scores (median [IQR] ADL: 14.00 [14.00–16.00] vs 14.00 [14.00–19.00], P = 0.014) or lower baseline modified Rankin Scale (mRS) scores (1.12±0.749 vs 1.33±0.991, P = 0.037), and were less frequently treated with more than 10 mg prednisone or 8 mg methylprednisolone (25.0% vs 36.0%,p = 0.026). All 9 NMOSD patients who had symptomatic cerebral syndrome developed moderate/severe COVID-19. A higher percentage of patients with moderate/severe COVID-19 experienced more than one core clinical NMOSD symptoms (61.5% vs 55.1%, p = 0.044), compared to patients with mild COVID-19. Higher risk of NMOSD relapse among NMOSD patients with COVID-19 was associated with higher Expanded Disability Status Scale (EDSS) scores (median[IQR] EDSS: 2.00 [1.00–3.00] vs 1.50 [1.00–2.25], P = 0.037) and drug treatments disruption (21.6% vs 5.0% P<0.001). ConclusionsNMOSD patients with younger age, lower baseline ADL or mRS had higher incidence of being diagnosed with COVID-19 during pandemic. Glucocorticoid use may decrease the risk of COVID-19. NMOSD patients with symptomatic cerebral syndrome before the COVID-19 pandemic are associated with worse COVID-19 outcomes. Drug treatment disruption may result in relapse among NMOSD patients with COVID-19.

Zero x-ray pulmonary vein isolation with heliostar radiofrequency balloon: efficacy and safety

Abstract Introduction Single shot pulmonary vein isolation techniques are currently an attractive and effective alternative to point-by-point ablation. The Heliostar® radiofrequency balloon is capable of producing single shot isolation with reduced procedure times and high efficacy and safety. A particular feature of this new balloon is its ability to be visualized on the Carto 3® navigation system, which makes it possible to reduce or even eliminate the use of X-rays (XR) in this type of procedure. Objectives Our objective was to demonstrate the efficacy and safety of pulmonary vein isolation with Heliostar® radiofrequency balloon without the use of XR. Methods Twenty-five patients with paroxysmal (68%) or persistent (32%) atrial fibrillation were prospectively included in our centre and underwent pulmonary vein isolation with radiofrequency balloon. Ten cases were performed without XR (40%), and the remaining 15 (60%) using fluoroscopy. All cases were performed under general anaesthesia and using the Carto 3® navigation system. Electroanatomical mapping was performed pre and post ablation in all cases. Mapping was performed in sinus rhythm. In cases without XR, intracardiac echocardiography was used to guide the transseptal puncture and the rest of the procedure. Technical and clinical data were collected. Cases with and without XR were compared. Results There were no complications in either group. All veins were successfully isolated, with 56% first pass isolation in the non-XR group versus 68% in the XR group (non-significant difference). The vein with the highest percentage of first pass isolations was the left inferior vein in both groups. Procedure times were similar (median left atrial dwell time of 34 minutes in the non-XR group and 36 minutes in the XR group, non-significant difference). There was also no difference in the median time to isolation from the start of radiofrequency application in each vein (10 seconds in both groups). Left atrial size was normal in most patients, and ventricular function was preserved, with no differences between the two groups. The non-XR group had a higher number of patients with left main trunk, but the XR group had a higher percentage of patients with persistent forms of atrial fibrillation. Conclusion Zero-XR pulmonary vein isolation with Heliostar® balloon is possible and safe, with similar efficacy and first pass isolation rate, similar procedure time and no relevant complications in our series.

Does Centralization of Radical Prostatectomy Reduce the Incidence of Postoperative Urinary Incontinence?

BackgroundOn the basis of previous analyses of the incidence of urinary incontinence (UI) after radical prostatectomy (RP), the hospital RP volume threshold in the Netherlands was gradually increased from 20 per year in 2017, to 50 in 2018 and 100 from 2019 onwards. ObjectiveTo evaluate the impact of hospital RP volumes on the incidence and risk of UI after RP (RP-UI). Design, setting, and participantsPatients who underwent RP during 2016–2020 were identified in the claims database of the largest health insurance company in the Netherlands. Incontinence was defined as an insurance claim for ≥1 pads/d. Outcome measurements and statistical analysisThe relationship between hospital RP volume (HV) and RP-UI was assessed via multivariable analysis adjusted for age, comorbidity, postoperative radiotherapy, and lymph node dissection. Results and limitationsRP-UI incidence nationwide and by RP volume category did not decrease significantly during the study period, and 5-yr RP-UI rates varied greatly among hospitals (19–85%). However, low-volume hospitals (≤120 RPs/yr) had a higher percentage of patients with RP-UI and higher variation in comparison to high-volume hospitals (>120 RPs/yr). In comparison to hospitals with low RP volumes throughout the study period, the risk of RP-UI was 29% lower in hospitals shifting from the low-volume to the high-volume category (>120 RPs/yr) and 52% lower in hospitals with a high RP volume throughout the study period (>120 RPs/yr for 5 yr). ConclusionsA focus on increasing hospital RP volumes alone does not seem to be sufficient to reduce the incidence of RP-UI, at least in the short term. Measurement of outcomes, preferably per surgeon, and the introduction of quality assurance programs are recommended. Patient summaryIn the Netherlands, centralization of surgery to remove the prostate (RP) because of cancer has not yet improved the occurrence of urinary incontinence (UI) after surgery. Hospitals performing more than 120 RP operations per year had better UI outcomes. However, there was a big difference in UI outcomes between hospitals.

Clinical and radiologic differences between early onset, late onset, and very late onset adult multiple sclerosis

BackgroundPrevious studies suggested possible differences in clinical and radiologic characteristics between early-onset multiple sclerosis (EOMS) and late-onset MS (LOMS). However, differences between LOMS and very late onset MS (VLOMS) are largely unknown. MethodsWe performed a retrospective review of medical records of patients diagnosed with MS between 8/1/2017 and 3/1/2022 at the comprehensive MS center of the Froedtert and Medical College of Wisconsin. We included adult patients with MS diagnosis who were 60 years or older - VLOMS, 50–59 years old at diagnosis – LOMS, or were 18–30 years old at diagnosis – EOMS and had complete imaging and clinical records. Clinical presentation and location of demyelinating lesions at the onset of diagnosis were extracted and compared using the chi-square test, p<0.05. ResultsA total of 246 newly diagnosed patients were identified. Of which 54 were EOMS, 29 were LOMS, and 35 were VLOMS. The sex ratio was not different between groups. EOMS had a higher percentage of patients who self-identified as black, while LOMS had a higher percentage of patients who self-identified as white. LOMS and VLOMS showed significant differences in the presence of tremors and lesion distribution at the onset. Older onset patients were more likely to present with motor symptoms, sphincter dysfunction, fatigue, and tremor. EOMS was more likely to present with cerebellum and occipital lobe lesions, and lesions were more likely to show contrast enhancement on MRI at diagnosis. ConclusionOur findings revealed novel clinical and imaging characteristics differences between VLOMS and LOMS. The current classification of LOMS may benefit from revision to better align with chronological age classification for old age >60 instead of the current standard in the literature of >50 years.

Body Mass Index Impacts Indication But Not Outcomes of Thoracic Endovascular Aortic Repair

ObjectiveThere are limited studies looking at TEVAR outcomes in obese and overweight patients. Our objective was to determine the rate of complications, reintervention, and short-term mortality in normal weight, overweight, and obese patients undergoing TEVAR. MethodsPatients undergoing TEVAR at a large tertiary hospital from October 2007 to January 2020 were analyzed. Patients were stratified into three cohorts based on BMI: Normal (18.5 – 25 kg/m2), Overweight (25 – 30 kg/m2), and Obese (> 30 kg/m2). Primary outcomes were 30-day and 1-year survival. Intraoperative, in-hospital, and post-discharge complications were assessed as secondary outcomes using the Clavian-Dindo classification system. In addition, reinterventions associated with the index TEVAR procedure as a secondary outcome. ResultsAmong 204 patients fitting the study criteria, we identified 65 with normal BMI, 78 overweight, and 61 obese patients. Obese patients were younger than the overweight and normal BMI patients (mean age 62.2 vs. 66.7 vs. 70.7, respectively, p=0.003). In terms of TEVAR indication, the obese cohort had the highest percentage of patients with type b aortic dissection (36.4%), while the normal BMI cohort had the higher proportion of patients undergoing TEVAR for isolated thoracic aortic aneurysm (63.9%). Intraoperative complications did not significantly differ between cohorts. Postoperatively, in-hospital complications, post-discharge complications and thirty-day return to the operative room did not differ significantly between study cohorts. Odds of reintervention did not differ significantly between cohorts, both on univariate and multivariate analysis. Log-rank test of Kaplan Meier analysis revealed no difference in reintervention-free survival (p = 0.22). Thirty-day mortality and one-year overall survival were similar across cohorts. Both univariate and multivariate logarithmic regression revealed no difference in likelihood of 30-day mortality between the obese and normal cohort. ConclusionThere were no measurable differences in complications, reinterventions, or mortality, suggesting that vascular surgeons can perform TEVAR across a spectrum of BMI without compromising outcomes.

Clinical Outcomes and Cardiovascular Adverse Events of Patients with Acute Myeloid Leukemia Treated with Venetoclax Plus a Hypomethylating Agent or Low-Dose Cytarabine in the Veterans Health Administration: A National Retrospective Cohort Study

Background: Acute myeloid leukemia (AML) is the most common acute leukemia in adults with a median age at diagnosis of 68 years. Standard curative treatment consists of intensive induction chemotherapy followed by consolidation, allogeneic stem-cell transplantation, or both. However, older patients may be ineligible for intensive chemotherapy due to impaired performance status or significant comorbidities. For those medically unfit, the combination of venetoclax plus a hypomethylating agent (VEN + HMA) can be used based on the results of the phase 3 VIALE-A clinical trial (PMID: 32786187). With a median follow-up of 20.5 months, azacitidine-venetoclax achieved superior OS than azacitidine monotherapy (14.7 versus 9.6 months; HR 0.66; 95% CI 0.52-0.85; P&amp;lt;0.001). The only cardiac event reported was atrial fibrillation in 5% of patients. Our retrospective study explores real-world clinical outcomes and new cardiovascular adverse events of patients treated with venetoclax plus either azacitidine, decitabine, or LDAC (VEN + LDAC) in the Veterans Health Administration (VHA). Methods Medical records of 198 veterans who were patients in the VHA and treated with VEN + HMA or VEN + LDAC between January 1, 2016, and December 31, 2021, were randomly selected and reviewed. Patients with a diagnosis of AML who received front-line therapy were included. Patients with acute promyelocytic leukemia were excluded. Overall survival (OS) was defined as the period between the date of diagnosis and the date of death from any cause and was estimated using the Kaplan-Meier method. Cardiovascular adverse events were characterized as those that occurred from the first dose until 30 days after discontinuation of treatment. Results A total of 101 patients were included. The median age at diagnosis was 74 years, 98% were male, 48% presented with de novo AML, 64% had an Eastern Cooperative Oncology Group performance-status score ≤ 1, and 52% had poor cytogenetic risk according to the European LeukemiaNet (ELN) 2017 stratification. Azacitidine was used in 62% of patients, decitabine in 34%, and LDAC in 4%. Based on the common terminology criteria for adverse events (CTCAE) version 5, 28% of the cohort had grade ≥3 (≥G3) anemia, 36% ≥G3 thrombocytopenia, and 62% ≥G3 neutropenia. The median OS was 8.5 months (95% CI:6.4-12.3). Those who received azacitidine had an OS of 7.7 months (95% CI: 5.6 - 12.4) versus 10.7 with decitabine (5.3 - 19.9), however the difference was not significant (p=0.29). Twenty-five percent of patients experienced at least one new cardiovascular adverse event. Of those, 11% already had a cardiovascular comorbidity at baseline. The most common adverse events were atrial fibrillation in 9%, non-ST elevation myocardial infarction in 4%, cardiopulmonary arrest in 3%, cardiogenic pulmonary edema in 2%, and LVEF decrease in 2%. Conclusion This is the first study to analyze the OS and the array of new cardiovascular events of patients with AML treated with VEN + HMA or VEN + LDAC in the VHA. Our national retrospective cohort study showed an inferior median OS and more new adverse cardiovascular events in patients treated with VEN + HMA than what was seen in the VIALE-A study. This is likely due to the clinical design of the phase 3 trial. Furthermore, we had a higher percentage of patients with secondary AML and poor cytogenetic risk which are known adverse prognostic factors. The limitations of this study include its retrospective and observational nature with data that was created for patient care, not research, and might contain missing information. Besides, the VHA sites are exclusively located in the United States and the cohort is mainly composed of male patients which is not fully applicable to the general population. Further studies are needed to determine the real-world OS and profile of cardiovascular adverse events of venetoclax combination therapy.

High Incidence of Vitamin D Deficiency Among Patients Undergoing Hematopoietic Stem Cell Transplant and a Single Ultra-High Dose Vitamin D Replacement

Introduction: Vitamin D involves in several important human physiologic pathways from bone metabolism to inflammation and immune regulation. Patients who undergo hematopoietic stem cell transplant (HSCT) are at risk of developing vitamin D deficiency from various mechanisms and replacement of vitamin D in these patients can be challenging according to several reasons. In addition, vitamin D may potentially affect outcomes, overall health and quality of life after HSCT. An ultra-high dose vitamin D replacement was previously explored in pediatric HSCT patients but has never been investigated in adult patient population. In this study, we explored the incidence of vitamin D deficiency, the safety and efficacy of a single ultra-high dose vitamin D replacement including its effect on bone health among adult patients with hematologic malignancy undergoing HSCT. Patients and Methods: First, we looked at the retrospective cohort of patients who underwent HSCT between January 2017 and August 2022 to explore the incidence of vitamin D deficiency (25-hydroxy vitamin D level &amp;lt;20 ng/mL) in Thailand. Subsequently, we prospectively included adult patients with hematologic malignancy undergoing both autologous (ASCT) and allogeneic HSCT (alloHSCT) from September 2022 to June 2023. All patients received a single ultra-high dose vitamin D on the day of admission prior to the initiation of conditioning regimens. We reported the safety and efficacy of a single ultra-high dose vitamin D (Ergocalciferol; Vitamin D2) replacement as calculated by weight and pre-transplantation vitamin D level among these patients using the Stoss protocol previously described. The effect of an ultra-high dose vitamin D on bone turnover was also monitored. Results: In the retrospective cohort, 229 patients underwent HSCT (146 ASCT and 83 alloHSCT). Vitamin D deficiency was observed in 147 patients (64.6%) including 91 (62.3%) ASCT and 56 (67.5%) alloHSCT. The median 25-hydroxy (25-OH) vitamin D level was 17.6 (4.0-86.3) ng/mL comparable between autologous and allogeneic patients. In the prospective cohort, 45 patients underwent HSCT (27 ASCT and 18 alloHSCT). The median age of patients at the time of HSCT was 49 (23-67) years with 18 patients (40%) being male. The median pre-transplant 25-OH vitamin D level was 20.2 ng/mL with 22 patients (48.9%) (13 ASCT, 9 alloHSCT) meeting the criteria of vitamin D deficiency. The median dose of vitamin D2 used was 500,000 (300,000-600,000) IU. At day +28 post-HSCT, 40% of patients were able to attain 25-OH vitamin D level above 30 ng/mL comparable between ASCT and alloHSCT but significantly higher compared to the retrospective cohort. The time to neutrophil and platelet engraftment were 13 (9-26) days and 14 (9-33) days, comparable between the controlled retrospective cohort and high dose replacement prospective cohort. The median levels of parathyroid hormone (PTH) and bone turnover markers including osteocalcin, β-CrossLaps (β-CTx), and procollagen type I N-propeptide (PINP) at day+28 was 45.4 (19.4-152.2) pg/mL, 11.3 (6.0-16.8) ng/mL, 0.79 (0.1-13.0) ng/ml and 43.7 (19.7-133.7) mcg/L, respectively. Among patients who underwent alloHSCT, the incidence of cytomegalovirus reactivation and acute graft versus host disease was 72.2% and 11.1% (no grade 3-4), respectively. Figure 1 shows the kinetic of serum 25-OH vitamin D, Calcium, β-CTx and PINP of patients in the prospective cohort from baseline to day +28 post-HSCT. At all timepoints (day 0, +7, +14, +21, +28), the median level of vitamin D level was significantly higher whereas the median serum PINP level was significantly lower compared to the baseline level. There was no occurrence of hypercalcemia or bony events during the time of the study. Conclusion: Our study highlights a high incidence of vitamin D deficiency in HSCT patients. Utilizing a single ultra-high dose vitamin D is an effective and safe approach to replace vitamin D in adult patients undergoing HSCT. A high percentage of patients could maintain adequate vitamin D level during post-transplant period. PINP level was sustainably decreased after vitamin D replacement indicating a lower bone resorption. Whether this approach will translate into improved immune function, long-term bone health and outcomes compared to the conventional replacement strategy warrants further exploration in prospective randomized clinical trials.

Early Predictors of Severe Cytopenia Post CAR-T for Identification of Patients for Potential Stem Cell Collection

Background: Cytopenias are a common complication of and prolonged (beyond month 3 post CAR-T infusion), severe (grade 3 or higher) cytopenias can be difficult to manage. Stem cell boosts have been reported to restore hematopoiesis; however, stem cells would need to be available prior to CAR-T therapy for potential use post CAR-T. Most lymphoma patients and limited number of myeloma patients may have pre-collected stem cells in storage. Identifying patients at high risk for prolonged and severe cytopenia post CAR-T at the time of CAR-T evaluation (baseline), before leukapheresis, can help identify the patients for coordination of stem cell collection during CAR-T manufacturing and increase the likelihood that the collected stem cells would be used. In this study, we aim to identify clinical variables at the time of CAR-T evaluation, prior to leukapheresis, that are associated with severe cytopenias at month 3 post CAR-T infusion and identify patients who could be considered for pre-emptive stem cell collection prior to CAR-T therapy. Methods: We conducted a retrospective analysis of patients with multiple myeloma (MM) and non-Hodgkin lymphoma (NHL) who received CAR-T products at Mayo Clinic from 01/2016 to 06/2022. Patients with progressive disease in the first year post CAR-T were excluded from the analysis. Baseline (at CAR-T evaluation, prior to leukapheresis) variables were compared between those with and without severe cytopenia at month 3 post CAR-T. Severe cytopenias were defined as hemoglobin (Hg) &amp;lt; 8 g/dL, absolute neutrophil count (ANC) &amp;lt; 0.5 x 10 9/L, and/or platelet count (PLT) &amp;lt; 50 x 10 9/L. Statistically significant variables (p&amp;lt;0.05) by analysis were examined for statistical significance in multivariate analysis (MVA). Results: Among the 166 patients who received CAR-T (88 NHL, 78 MM) during the study period, 31 (18.67%) had a severe cytopenia at month . Twenty baseline variables were examined; HGB, PLT, ANC, and c-reactive protein (CRP) We devised a cytopenia risk score using 1 point each for Hg&amp;lt;10 or PLT&amp;lt;100k at baseline, with a range of 0 to 2. Demographics and clinical outcome by cytopenia risk score is shown in Table 1B. A higher percentage of patients with a score of 1 or 2 had a severe cytopenia at month 3 (Figure 1). In particular, there was a . In addition Conclusion: Baseline cytopenias before leukapheresis may identify patients with increased risk for severe cytopenias at month 3 post CAR-T. These patients can have continued slow hematopoietic recovery in the first year. Stem cell collection, if feasible, could be considered before CAR-T to alleviate post-CAR-T severe prolonged cytopenias.

Treatment Patterns and Outcomes of Patients with Acute Myeloid Leukemia (AML) from 2013 to 2022: A Connect ® Myeloid Registry Study

Introduction There has been a rapid evolution in diagnostic and management evaluation for AML, associated with the introduction of new therapies, some of which target specific mutations, over the past decade. The Connect ® Myeloid Registry (NCT01688011) is a multicenter, prospective, observational cohort study that began enrollment in December 2013 and represents a rich source of information to evaluate changes in disease course and outcomes over time in patients with myeloid diseases. We evaluated 10-year longitudinal data from patients with AML treated in real-world clinical practice at community and academic institutions to understand the evolution of diagnosis and treatment of patients with this myeloid condition. Methods Patients in the AML cohort were ≥ 55 years of age and newly diagnosed with AML according to the 2008 revised World Health Organization criteria and were grouped by year of diagnosis: 2013-2016 (Group 1; before commercial availability of numerous novel therapies including venetoclax, midostaurin, ivosidenib, enasidenib, gemtuzumab ozogamicin, and others), and 2017-2022 (Group 2; after availability of new therapies). Baseline demographic and clinical characteristics, treatment patterns, and outcomes were evaluated by group. Overall survival (OS) from the date of diagnosis was estimated by the Kaplan-Meier method. Results A total of 773 patients with AML (Group 1, n = 292; Group 2, n = 481) were assessed. Median (range) age was 70.0 years (55.0-91.0) in Group 1, and 71.0 years (55.0-97.0) in Group 2. Median OS was 11.0 months (95% confidence interval [CI]: 9.0-14.0) in Group 1, and 16.0 months (13.0-18.0) in Group 2 ( P = 0.039; Figure). A higher percentage of patients in Group 2 survived to 60 months compared with Group 1 ( Figure). Improved survival over time was primarily observed in patients &amp;lt; 75 years of age at diagnosis; median (95% CI) OS among patients &amp;lt; 75 years of age increased over time from 14.0 months (11.0-17.0) in Group 1 to 20.0 months (17.0-24.0) in Group 2 ( P = 0.022) but remained unchanged over time among patients ≥ 75 years of age (9.0 months [6.0-10.0] in Group 1; 9.0 months [6.0-13.0] in Group 2; P = NS). Rates of transplant increased significantly over time for younger patients; among those &amp;lt; 75 years of age at diagnosis, 45/201 (22%) in Group 1 received a transplant, compared with 99/318 (31%) in Group 2( P = 0.035). The proportion of patients receiving molecular testing increased over time from 68.8% in Group 1 to 86.9% in Group 2. The mean (standard deviation) number of mutations tested among those who underwent molecular testing also increased over time, from 6.1 (5.9) in Group 1 to 11.8 (7.4) in Group 2. Longer median (95% CI) OS was observed in patients who received molecular testing compared with those who did not: 14.0 months (11.0-17.0) versus 9.0 months (7.0-11.0) in Group 1; 16.0 months (13.0-19.0) versus 13.0 months (6.0-17.0) in Group 2. The proportion of patients receiving first-line treatment with intensive chemotherapy (IC) regimens was similar in the 2 time periods (Group 1, 51.0%; Group 2, 47.1%). Among patients not receiving IC, those in Group 2 increasingly received targeted therapies and venetoclax-based regimens and less-frequent low-intensity chemotherapy and supportive care. Conclusions In the AML cohort of Connect ® Myeloid, one of the longest-running US registries of myeloid diseases, we observed that patient characteristics at diagnosis were similar from 2013-2022. A statistically significant increase in median OS was observed over time. The increased rate of transplant, higher rates of molecular testing, and uptake of novel, targeted, treatments may have contributed to the improvement in survival. These results demonstrate the need for long-running, prospective observational studies to continue to understand rapidly changing treatment algorithms, combinations, and outcomes in AML.

2021 Epidemiological Survey of Dermatomycoses in Japan

This is a report of the results of the epidemiological survey on dermatomycoses conducted in 2021. A total of 9,442 patients with dermatomycosis were reported for one year. They include 8,151 (86.3%) with dermatophytosis, 796 (8.4%) with candidiasis, 484 (5.1%) with Malassezia infection, and 11 (0.1%) with deep cutaneous mycosis. In order, the most common types of dermatophytoses were tinea pedis (4,195 cases, 2,341 males and 1,854 females), tinea unguium (2,711 cases, 1,509 males and 1,202 females), tinea corporis (674 cases, 445 males and 229 females), tinea cruris (399 cases, 305 males and 94 females), tinea manus (125 cases, 78 males and 47 females), and tinea capitis (47 cases, 25 males and 22 females). The number of cases of tinea pedis and tinea unguium increased during the summer. A higher percentage of patients were aged 80 or older than in previous surveys. These findings may reflect the increasing percentage of elderly patients seen and the superannuation of the population. As in previous surveys, Trichophyton rubrum and Trichophyton interdigitale were the two most frequently isolated species of fungi causing dermatophytoses. Microsporum canis and Trichophyton tonsurans were the two species most often causing tinea capitis.Regarding cutaneous candidiasis, while candidal intertrigo was the most common in previous surveys, diaper candidiasis in the elderly was the most common in this survey. A background check revealed that this was because a facility included a semi-prophylactic approach to address diaper candidiasis occurring within the ward.Malassezia infections by Malassezia folliculitis clearly increased with each survey. The tendency of certain facilities with many reports of Malassezia folliculitis suggests that it is greatly affected by the presence of physicians familiar with the disease.

Are novel oral oncolytics underdosed in obese patients?

PurposeData on the effects of obesity on drug exposure of oral targeted oncolytics is scarce. Therefore, the aim of this study was to investigate the influence of body weight and body mass index (BMI) on trough levels of oral oncolytics with an exposure–response relationship. The oral oncolytics of interest were abiraterone, alectinib, cabozantinib, crizotinib, imatinib, pazopanib, sunitinib and trametinib.MethodsThis retrospective cohort study included patients treated with the selected oral oncolytics at the standard dose, with a measured trough level at steady state and with available body weight. The Spearman’s correlation test was used to determine the correlation between body weight and trough levels. The Fisher’s exact text was used to compare the frequency of inadequate trough levels between BMI categories.Results1265 patients were included across the different oral oncolytics. A negative correlation coefficient was observed between weight and trough levels for crizotinib (n = 75), imatinib (n = 201) and trametinib (n = 310), respectively, ρ = − 0.41, ρ = − 0.24 and ρ = − 0.23, all with a p-value < 0.001. For crizotinib, a higher percentage of patients with a body weight > 100 kg had inadequate trough levels. No statistically significant differences were observed in the frequency of inadequate trough levels between BMI categories.ConclusionHigher body weight was only correlated with lower plasma trough levels for crizotinib, imatinib, and trametinib. Therefore, patients with a high body weight may require dose escalation to obtain adequate target levels when treated with these oral oncolytics.

Epidemiological aspects of the incidence and mortality of cervical cancer (literature review)

A review of domestic and foreign literature was carried out. Statistical analysis of the available literature showed that at present, despite the improvement of screening programs around the world, there is a steady increase in the incidence and mortality of cervical cancer in women of reproductive age with a high percentage of patients with advanced forms, whose proportion is 32 %. The percentage of deaths during the year since the verification of the disease in 2020 was 12.6 %.In the structure of mortality in the Russian population, malignant diseases occupy the second ranking place, accounting for 13.6 % after diseases of the cardiovascular system – 43.9 %. Diseases of the female reproductive system account for 18.2 %. At the same time, cervical cancer in the overall structure of oncological morbidity occupies the 4th ranking place, and among the organs of the reproductive system – the 2nd place – 13.3 %, yielding to breast cancer (47.8 %). These figures reflect the lack of implemented programs aimed at reducing the incidence of cervical cancer.

Alterations in B and NK cells highly correlate with disease severity in children with COVID-19.

Children with coronavirus disease 2019 (COVID-19) present milder symptoms than adults and are at lower risk of hospitalization and life-threatening complications. However, the kinetics of lymphocyte subsets and serum immunoglobulins in the peripheral blood during COVID-19 infection remains unclear. In this study, it was aimed to determine the changes in hematological and immunological parameters, especially in the lymphocyte subsets, in the peripheral blood of children with different COVID-19 disease severity. The study was planned as a prospective cohort and included 68 children aged 0-18 years who were admitted to Ege University Faculty of Medicine Department of Pediatrics and diagnosed with COVID-19 infection between May 2020 and December 2021. In addition to demographic characteristics, clinical findings, and severity criteria, hematological, biochemical, and immunological laboratory (T/B lymphocyte subgroups, serum immunoglobulins) results were noted and examined if there were some correlations between disease severity and the laboratory values. In the study group, while 60.6% (n = 40) of the patients received treatment in the hospital, 10.6% (n = 7) needed intensive care treatment. Lymphopenia (35.3%) was more common than neutropenia (14.7%) in the COVID-19-infected children. CD19+ B cells were low in a very high percentage of patients (26.5%), and 16.2% had low levels of NK cells. Significant correlation between disease severity and CD19+lymphocytes, CD19+CD38+IgMlow lymphocytes, CD19+CD38+CD27highIgMhigh lymphocytes, CD19+CD81+ lymphocytes (p = 0.001, p = 0.008, p = 0.014, p = 0.025, and rs = 0.394, rs = 0.326, rs = 0.303, rs = 0.280, respectively), significant inverse correlation between disease severity and absolute lymphocytes counts and CD3-CD16+CD56+ lymphocytes (p = 0.004, 0.014, and rs = -0.353, rs = -0.304, respectively) were observed. The percentage of hospitalized patients with low CD3 levels (15%) was significantly higher than that of the outpatients with low CD3 levels. As the severity of the disease increased, the CD19+, CD19+CD38+IgMlow, CD19+CD38+CD27highIgMhigh, and CD19+CD81+ lymphocytes percentages increased, while the lymphocyte count and NK cell percentage decreased. Therefore, detecting these prognostic immunobiomarkers related to the severity of the disease may contribute considerably to management of the illness.

Evaluating the accuracy of a cataract surgery simulation video in depicting patient experiences under conscious anesthesia

PurposeTo evaluate the accuracy of a point-of-view cataract surgery simulation video in representing different subjective experiences of patients undergoing the procedure.MethodsOne hundred consecutive post-cataract-surgery patients were shown a short simulation video of the surgery obtained through a porcine eye model during the first postoperative week. Patients then answered a multiple-choice questionnaire regarding their visual and tactile intraoperative experiences and how those experiences matched the simulation.ResultsOf the patients surveyed (n = 100), 78% (n = 78) recalled visual experiences during surgery, 11% recalled pain (n = 11), and 6.4% (n = 5) recalled frightening experiences. Thirty-six percent of patients (n = 36) were interviewed after their second cataract surgery; there was no statistically significant difference between anxiety scores reported before the first eye surgery and second eye surgery (p = 0.147). Among all patients who recalled visual experiences (n = 78), nearly half (47.4%) reported that the video was the same/similar to their experience. Forty-eight percent of the patients recommended future patients to watch the video before their procedures, and more than a third (36%) agreed that watching the video before surgery would have helped them to relax.ConclusionsOur model reflects the wide range of subjective patient experiences during and after surgery. The high percentage of patients who found the video accurate in different ways suggests that, with more development, point-of-view cataract simulation videos could prove useful for educational or clinical use. Further research may be done to confirm the simulation’s utility, by screening the video for subjects before operations.

Predictive Factors for Subjective Vertigo Following Cochlear Implantation: A Regional Multicenter Cohort Study of 395 Patients.

Cochlear implantation (CI) is generally accepted as having a low rate of postoperative complications, but between 9.3% and 13% of cases experience vertigo postoperatively. This study aimed to examine patient, surgical, and device factors contributing toward the risk of postoperative vertigo. A retrospective review was conducted of adult patients who underwent cochlear implant in a regional area of New South Wales from 2007 to 2018. A total of 395 cochlear implant cases were included in the final study. The overall incidence of vertigo at 3 months of follow-up was 7.1% (n = 28/395). No difference was identified in this study between rates of postoperative vertigo between device factors, including implant make (Cochlear vs. Med-El), electrode shape (perimodiolar vs. straight), and electrode model. No significant difference was found also for surgical factors such as the number of electrode rings inserted, side of implantation, or surgical approach of tympanic ramp (round window insertion vs. cochleostomy).A higher percentage of patients with preoperative vertigo experienced vertigo postoperatively (18.4%, n = 7/38), compared with the population without preoperative vertigo (6.0%, n = 21/352) (p = 0.005). Patients with previous mastoid surgery also reported a higher rate of postoperative vertigo (20%, n = 9/45) compared with those who had not had mastoid surgery (5.43%, n = 19/350) (p = 0.006). The mean age of patients experiencing postoperative vertigo was higher than the population without postoperative symptoms (67 vs. 63). This study of a large multicenter population outlines that patient factors are more critical than surgical or device factors when considering risk factors for vertigo post-cochlear implant.

Preferences for the sequencing of first-line systemic treatments in metastatic hormone receptor-positive, HER2-negative breast cancer.

Metastatic breast cancer (MBC) is a diverse disease. Therapeutic options include hormonal therapy, chemotherapy, and targeted therapies. The optimal treatment sequence for patients with hormone receptor-positive (HR-positive), HER2-negative metastatic breast cancer remains unknown. This was a retrospective and prospective study. The data was collected from the medical records of patients in a tertiary healthcare center in Lebanon between the years 2016 and 2019, and patients were followed up for a 3-year duration. The main aim was to identify oncologists' preferences in the choice and sequence of treatment for newly diagnosed and/or recurrent cases of HR-positive, HER2-negative MBC. A total of 51 patients were included. 24 patients received chemotherapy, while 27 received endocrine therapy as first-line treatment after a diagnosis of MBC, with a median overall survival (OS) of 13 months and a median progression-free survival (PFS) of 12 months after first-line treatment with chemotherapy, compared to 27 months and 18 months with endocrine therapy. A higher percentage of patients have received chemotherapy in the first-line setting compared to the data reported in the literature, with the choice being multifactorial. Factors to consider in MBC management include the choice of first-line treatment, the optimal sequence of treatment, and the combination of available treatment options.

Effects of edaravone dexborneol on neurological function and serum inflammatory factor levels in patients with acute anterior circulation large vessel occlusion stroke.

The goal of this study is to evaluate and analyze the effects of edaravone (EDV) dexborneol on neurological function and serum inflammatory factor levels among patients with acute anterior circulation big artery blockage stroke. A total of 142 patients with acute anterior circulation large vessel occlusion (LVO) were randomly allocated to the study group (69 patients) or the control group (73 patients). In the study group, patients were treated with 37.5 mg EDV dexborneol twice a day for 10-14 days, based on the control group. The primary efficacy outcome was the National Institutes of Health Stroke Scale score change from baseline to 90 days and the proportion of modified Rankin Scale (mRS)score ≤1 at 90 days after randomization. The secondary outcome included the decrease in inflammatory factors at 14 days. The primary safety outcome was the incidence of hemorrhagic transformation assessed according to Heidelberg bleeding classification within 7 days. A higher percentage of patients with HIHSS score ≤5 at 90 days in the EDV dexcamphorol group was observed than in the control group (75.36% vs 64.38%; P = 0.015). A higher percentage of patients with mRS score ≤1 at 90 days in the EDV dexcamphorol group was observed than in the control group (63.77% vs 50.68%; P = 0.012). After treatment, the levels of IL-6 and hs-CRP were significantly lower following treatment and compared to the control group (P < 0.05). In patients receiving the EDV dexborneol group, a significantly decreased risk of radiographic intracranial hemorrhage was found compared with the control group (20.29% vs 39.73%; P = 0.0006). In conclusion, EDV dexborneol can improve the clinical outcomes of patients with acute anterior circulation LVO stroke, which can be used as an effective supplement to thrombectomy therapy.

Evaluation of functional, perioperative outcomes and common complications of robot-assisted vs open construction of orthotopic neobladder following a radical cystectomy in patients with bladder cancer: A systematic review

Introduction: Orthotopic neobladder (ONB) reconstruction following radical cystectomy for bladder cancer is a viable alternative to the formation of an ileal conduit. Although robotic surgery is gaining popularity, neobladder reconstruction is still most commonly done extra-corporeally (eONB) with a lower midline-laparotomy rather than intra-corporeal ONB (iONB) reconstruction. The novelty of a robotic approach has made several centres apprehensive to adopt this. This systematic review aims to compare functional outcomes as well as perioperative outcomes and common complications of robotic-assisted radical cystectomy with iONB versus eONB reconstruction. Materials and methods: A search of the literature from 2011 to 2021 was performed through PubMed, EMBASE, Medline and Scopus to identify articles comparing eONB formation with iONB formation. Urodynamic (UDS) outcomes (bladder volume, flow rate, post-voiding residual volume, continence rates and rate of clean intermittent catheterization (CIC) use) and perioperative outcomes (estimated blood loss, length of stay and operative time) were extracted as endpoints of interest. This review was registered with PROSPERO on 19 October 2022 (CRD42022366667). Results: Our searches identified 84 abstracts, of which 4 articles with 410 patients were eligible. Our results showed patients undergoing iONB had a higher bladder capacity and continence rate and achieved full continence much sooner than eONBs. iONBs, however, seemed to be left with higher residual volumes and a higher percentage of patients who needed CIC to void. Conclusion: Both perioperative outcomes and complications favoured the iONB technique; however, eONB seemed to give better functional outcomes. Level of evidence: Not applicable

THU333 Race Was Not A Predictor Of Poor Outcomes From COVID-19 At University Of Chicago Medicine Hospital

Abstract Disclosure: A. Rashied: None. J. Cursio: None. E.C. Hanlon: None. S. Pannain: None. University of Chicago Medicine (UCM) is a large, 800 bed, urban hospital located on the south side of Chicago that cares for a substantial number of African-American (AA) patients. The COVID-19 pandemic has impacted health drastically, especially for minorities (including AAs) and those with comorbid conditions. We examined COVID outcomes in our UCM patient population, including patterns by race, other demographic information (age, sex), and comorbidities, and the relationship with deaths, intensive care unit (ICU), and mechanical ventilator use. From the period March 2020 to February 2021, 61.6% (11,071/17,945) patients tested for COVID-19 at UCM were positive, and 52.8% (5,850/11,071) of these were hospitalized for further care. Of these hospitalized patients 3,171 were AA and 2,679 were all other races. AA had a higher percentage of patients who were female (62% vs 54%, p&amp;lt;0.0001), were older (49 vs 43 years, p&amp;lt;0.0001), had longer hospital stays (13.5 vs 13.0 days, p&amp;lt;0.0001), were admitted to the ICU (9% vs 4%, p&amp;lt;0.0001), and died (5% vs 2%, p&amp;lt;0.0001) compared to non-AA patients. In addition, the rates of comorbid conditions were higher for AAs compared to non-AAs for hypertension (52% vs 32%, p&amp;lt;0.0001), heart disease (15% vs 9%, p&amp;lt;0.0001), diabetes (36% vs 22%, p&amp;lt;0.0001), kidney disease (21% vs 8%, p&amp;lt;0.0001), and obesity (53% vs 40%, p&amp;lt;0.0001). To explore the relationship of race and death among patients hospitalized with COVID-19, a predictive model for death was estimated including age, race, gender, hospital stay in days, ICU length of stay, and indicators for obesity, heart disease, kidney disease, hypertension, and diabetes. The model shows that AA adults have a higher odds ratio (OR=1.08, p=0.71) for death than non-AA adults, however the p-value was insignificant. Instead, significant predictors of death included age (OR=1.058, p&amp;lt;0.0001) and kidney disease (OR=2.108, p=0.0002). Neither diabetes nor obesity were significant predictors of death in our cohort. Race was also not a predictor of mechanical ventilation or ICU status. However, obesity, diabetes and kidney disease were all significant predictors of requiring ventilation (all p&amp;lt;0.05). Moreover, age (OR=1.013, p=0.001), female gender (OR=0.687, p=0.002), kidney disease (OR=2.431, p&amp;lt;0.0001), and diabetes (OR=2.224, p&amp;lt;0.0001) were significant predictors of ICU admission. The model for death, ventilator, and ICU status for patients with COVID-19 at UCM show increased risks for AA versus non-AAs, however the odds ratios were insignificant. Instead, comorbidities like kidney disease were a significant predicator of death, as were obesity and diabetes for COVID-19 related ventilation and ICU admission. Thus, in our patient population that includes a significant number of AA adults, race was not a predictor of poor COVID-19 outcomes, but kidney disease, obesity, and diabetes were – irrespective of race. Presentation: Thursday, June 15, 2023

The Impact of Patients' Primary Language on Inpatient Gastrointestinal Bleeding Outcomes.

The impact of English proficiency on gastrointestinal bleeding (GIB) outcomes remains unclear. In this analysis, we compare inpatient GIB outcomes between patients with English as their primary language (EPL) and those with a primary language other than English (PLOE). Using the 2019 State Inpatient Databases for New Jersey, Maryland, and Michigan, we created an analysis cohort of GIB hospitalizations using International Classification of Diseases, 10th Revision codes. Patients were stratified by primary language (EPL vs PLOE) and type of bleeding (variceal upper GI bleeding [VUGIB], nonvariceal upper GI bleeding [NVUGIB], and lower GI bleeding (LGIB)]. Regression analyses were used to compare mortality, 30-day readmissions, and length of stay. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. P < 0.05 was considered statistically significant. In the cohort, 5.5%-10% of the patients spoke a primary language other than English. Endoscopy utilization was lower among patients with PLOE vs EPL for NVUGIB (17.2% vs 21.2%, P < 0.001) and LGIB (26.3% vs 29.2%, P = 0.027). Patients with PLOE had higher odds of dying of VUGIB (aOR 1.45, 95% CI 1.16-2.48) and LGIB (aOR 1.71, 95% CI 1.22-2.12). Patients with PLOE were also more likely to be readmitted after NVUGIB (aOR 1.75, 95% CI 1.64-1.81). However, after controlling for the percentage of patients with PLOE discharged from each hospital, the disparities in mortality and readmissions were no longer detected. Disparities exist in GIB outcomes among patients with PLOE, but these gaps narrow at hospitals with higher percentages of patients with PLOE. Cultural and linguistic competence may improve outcomes in this vulnerable group.