Higher Risk Of Adverse Effects Research Articles

Improving tremor response to focused ultrasound thalamotomy.

MRI-guided high-intensity focused ultrasound thalamotomy is an incisionless therapy for essential tremor. To reduce adverse effects, the field has migrated to treating at 2 mm above the anterior commissure-posterior commissure plane. We perform MRI-guided high-intensity focused ultrasound with an advanced imaging targeting technique, four-tract tractography. Four-tract tractography uses diffusion tensor imaging to identify the critical white matter targets for tremor control, the decussating and non-decussating dentatorubrothalamic tracts, while the corticospinal tract and medial lemniscus are identified to be avoided. In some patients, four-tract tractography identified a risk of damaging the medial lemniscus or corticospinal tract if treated at 2 mm superior to the anterior commissure-posterior commissure plane. In these patients, we chose to target 1.2-1.5 mm superior to the anterior commissure-posterior commissure plane. In these patients, post-operative imaging revealed that the focused ultrasound lesion extended into the posterior subthalamic area. This study sought to determine if patients with focused ultrasound lesions that extend into the posterior subthalamic area have a differnce in tremor improvement than those without. Twenty essential tremor patients underwent MRI-guided high-intensity focused ultrasound and were retrospectively classified into two groups. Group 1 included patients with an extension of the thalamic-focused ultrasound lesion into the posterior subthalamic area. Group 2 included patients without extension of the thalamic-focused ultrasound lesion into the posterior subthalamic area. For each patient, the percent change in postural tremor, kinetic tremor and Archimedes spiral scores were calculated between baseline and a 3-month follow-up. Two-tailed Wilcoxon rank-sum tests were used to compare the improvement in tremor scores, the total number of sonications, thermal dose to achieve initial tremor response, and skull density ratio between groups. Group 1 had significantly greater postural, kinetic, and Archimedes spiral score percent improvement than Group 2 (P values: 5.41 × 10-5, 4.87 × 10-4, and 5.41 × 10-5, respectively). Group 1 also required significantly fewer total sonications to control the tremor and a significantly lower thermal dose to achieve tremor response (P values: 6.60 × 10-4 and 1.08 × 10-5, respectively). No significant group differences in skull density ratio were observed (P = 1.0). We do not advocate directly targeting the posterior subthalamic area with MRI-guided high-intensity focused ultrasound because the shape of the focused ultrasound lesion can result in a high risk of adverse effects. However, when focused ultrasound lesions naturally extend from the thalamus into the posterior subthalamic area, they provide greater tremor control than those that only involve the thalamus.

Nutritional behaviours and lifestyle before and during covid-19 pandemic: based on data from Polish and Turkish surveys.

Students are a group particularly high risk of adverse effects from such restrictions introduced within counter transmission the SARS-CoV-2 pandemic. Fear felt of contracting the disease and social isolation can lead to consuming excessive amounts of energy with food, resulting in weight gain and eating disorders. The aim of the study was analysed selected lifestyle aspects of Polish and Turkish students before and during the COVID-19 pandemic and to determine the existence of differences between the lifestyles of these individuals during the two periods. The study was conducted at the turn of 2020-2021 among 435 students, including 331 Polish and 104 Turkish students. The research instrument was an original questionnaire created in a Google Forms, consisting of metric and a proper part regarding lifestyle before and during the pandemic. Prior to the actual study, in order to verify whether the research tool is understandable, a pilot study was conducted, which included 40 individuals. The Wilcoxon test was used to examine the differences between the lifestyle of students before and during the pandemic. A value of p<0.05 was considered statistically significant. Both before and during the pandemic, most Polish students ate 4-5 meals daily (52.9% and 47.7%, respectively), while most Turkish students ate 3 meals (47.1% and 38.5%, respectively). There were statistically significant differences in: duration of sleep (p=0.001), way of spending one's leisure time (p=0.001) and type of physical activity (p=0.001) among the Polish and Turkish students before and during the pandemic. The results of this study showed changes in the lifestyle of both Polish and Turkish students during the pandemic compared to the pre-pandemic period. This indicates the need to develop interventions to prevent harmful behaviour and their health consequences in the future.

Complications in pregnancies achieved by assisted reproduction.

Pregnancies resulting from assisted reproductive technologies (ART) have been documented to have a higher risk of adverse effects. To provide evidence on obstetric and perinatal complications associated with conceptions by ART versus spontaneous pregnancies. Comprehensive review of original articles published between 2010 and 2018 addressing the more common obstetric and perinatal complications in pregnancies resulting from in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), in comparison with spontaneous conceptions. Thirty-seven original articles, which reported on 26 cohort studies and 11 case-control trials, were included. IVF and ICSI conceptions were associated with a larger number of obstetric and perinatal complications such as low birth weight, prematurity, low weight for gestational age, admission to the neonatal intensive care unit, congenital malformations, C-sectionand premature rupture of membranes, among others. Pregnancies by ART are associated with an increased risk of obstetric and perinatal complications in comparison with spontaneous conceptions. Further research is needed to determine which aspects result in higher risk.

Knowledge, attitude, and practice towards COVID-19, among an elderly population in Sri Lanka: A cross-sectional study

Background: Elderly people are at high risk for adverse effects from SARS-CoV-2 infection. Therefore, to prevent and lower the fatality rate of COVID-19 among elderly people, determining the knowledge, attitude and practice of the elderly population towards COVID-19 is needed. Objectives: This study aimed to investigate the knowledge, attitude and practice (KAP) towards COVID-19, among an elderly population in Western province, Sri Lanka. Results: A descriptive cross-sectional study was conducted among 414 elderly persons in the Western province, Sri Lanka. Data were collected using a pre-tested, self-administered/interview-based questionnaire. SPSS version 26 was used for the analysis of the study. Among the total participants (n=414), most respondents (80.68%) had good knowledge regarding COVID-19. Most of the participants (76.81%) were in good attitude category regarding COVID-19. Regarding practices towards COVID-19, the majority of participants (87.19%) had a good practice level. Total knowledge level was significantly associated with attitude level p&lt;0.001 and practice level p&lt;0.001 towards COVID-19. Conclusion: Imparting knowledge, increasing good behavioral change, and strengthening preventive practices towards COVID-19 prevention is the best solution for pandemic control.

Comparison of the factors that influence the pattern of procurement and usage of antithrombotic drugs

Antithrombotics are used for many indications in prophylaxis and therapeutic treatment. It is often associated with a higher risk of adverse effects; hence a drug utilization evaluation is essential. The main aim was to describe the utilization of antithrombotic drugs. The specific objectives are to compare the pattern of procurement and usage of antithrombotic drugs, estimate the Defined Daily Dose (DDD), and to compare the usage of antithrombotic drugs with the WHO recommended standard. This was a retrospective study evaluating the utilization of antithrombotics at a public tertiary care hospital in the urban city of Klang Valley, Malaysia. A defined daily dose (DDD) per 1000 inhabitants/day was calculated to estimate patients with thromboembolic disorders receiving standard treatment on a daily basis. Expenditures on all antithrombotic drugs were also assessed. The DDD was examined for correlation with gender, race, and age group. Malaysian Clinical Practice Guideline on the Prevention and Treatment of Venous Thromboembolism was used as a tool to evaluate the quality of prescribing. During the study period, among anticoagulants prescribed, warfarin was the most commonly utilized for treatment and prophylaxis in various disciplines, with 1.82 DDD. Enoxaparin was the second most utilized anticoagulant, with 1.05 DDD, followed by tinzaparin, with 0.39 DDD. For antiplatelet drugs, acetylsalicylic acid was the most utilized antiplatelet with 8.5 DDD followed by clopidogrel (1.42 DDD) and ticlopidine (0.16 DDD). The utilization pattern for all the antithrombotic drugs was in accordance with the WHO DDD guidelines. The pattern of antithrombotic drug procured was based on the demand for the drug supplies. Age, gender, and race weredeterminant factors that influenced the choice of antithrombotic drugs and further affected the antithrombotic drug utilization pattern. Still, additional information regarding patient’s status and concomitant disease condition is needed to establish the impact of utilization of antithrombotics fully. DDD analysis is an excellent practice to be conducted at planned intervals. It is a tool to update the changing or even new pattern of drug usage, which will assist in the justification of rational use of drugs. The mean difference in terms of DDDs of the studied antithrombotic drugs impacts patient demographic characteristics, smokinghistory, presence of atherosclerotic diseases and peripheral artery diseases, comorbidity, patient compliance, and bleeding history. It is useful to evaluate trends and expenditures, which will ultimately avoid untoward adverse effects and unnecessary costs.

Evaluation of a Pharmacist-Driven Ambulatory Aspirin Deprescribing Protocol.

Recent guidelines indicate that aspirin affords less cardiovascular protection and greater bleeding risks in adults aged > 70 years. Deprescribing potentially inappropriate medications is particularly important in older adults, as this population experiences a high risk of adverse effects and polypharmacy. Limited data are available regarding targeted aspirin deprescribing approaches by pharmacists. The objective of this study was to implement and evaluate the success and feasibility of a pharmacist-led aspirin deprescribing protocol for older adults in a primary care setting. This prospective feasibility study in a US Department of Veterans Affairs ambulatory care pharmacy setting included patients aged ≥ 70 years with documented aspirin use. We reviewed 459 patient records and determined that 110 were eligible for deprescribing. A pharmacistinitiated telephone call was attempted for each eligible patient to discuss the risks and benefits of deprescribing aspirin. The primary outcome was the proportion of patients reached for whom aspirin was discontinued. Secondary outcomes included patient rationale for declining deprescribing and the time to complete the intervention. Of 94 patients reached, 45 (48%) agreed to aspirin deprescribing, 3 (3%) agreed to dose reduction, and 29 (31%) declined the intervention. An additional 17 (18%) had previously stopped aspirin, which led to a medication reconciliation intervention. Pharmacists spent about 2 minutes per record review and 12 minutes on each encounter, including documentation. Implementing a pharmacist-driven aspirin deprescribing protocol in a primary care setting led to the discontinuation of inappropriate aspirin prescribing in nearly half of older adults contacted. The protocol was well accepted by collaborating physicians and feasible for pharmacists to implement, with potential for further dissemination across primary care settings.

Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study

Background: Postoperative pain management in children can be effectively controlled using regional analgesic techniques. In general, neuraxial blocks pose a higher risk of adverse effects and complications in comparison to peripheral nerve blocks. Recently, both quadratus lumborum block (QLB) and erector spinae plan block (ESPB) have been used to achieve adequate postoperative analgesia in children. We compared the efficacy of both in postoperative pain management after laparoscopic abdominal surgery.&#x0D; Methodology: Eight five patients with laparoscopic abdominal surgery received either bilateral QLB or ESPB at the level of T8 transverse process with 0.5 ml/kg of 0.25% bupivacaine to achieve adequate postoperative analgesia. FLACC score was used to assess pain score after surgery and the need for rescue opioid analgesia.&#x0D; Results: The average dose of fentanyl was lower and the time to the first dose of rescue analgesic was longer in QLB group when compared to ESPB group. In addition, FLACC scores were significantly lower in QLB group in comparison to ESPB group at the 6th, 8th, 12th and 20th h after surgery.&#x0D; Conclusion: Quadratus lumborum block can provide longer and more effective postoperative analgesia in pediatric patients following laparoscopic abdominal surgery in comparison to erector spinae plan block.&#x0D; Citation: Taman HI, Saber HIES, Farid AM, Elawady MM. Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study. Anaesth. pain intensive care 2022;26(5):602-607; DOI: 10.35975/apic.v26i5.2017&#x0D;

S1190 Therapeutic Effect of Granulocyte Colony-Stimulating Factor Therapy for Acute-on-Chronic Liver Failure: A Meta-Analysis of Randomized Controlled Trials

Introduction: Acute-on-chronic liver failure (ACLF) is a condition characterized by acute decompensation of chronic liver disease, accompanied by the failure of one or more extra-hepatic organs and high short-term mortality. Currently, liver transplantation is the only definitive treatment for ACLF but it is not beneficial to all patients due to limited donors, expensive procedure and high risk of adverse effects, so granulocyte stimulating factor (G-CSF) is considered as an alternative treatment. However, its therapeutic effectiveness is still debaTable, so we aimed to conduct a meta-analysis to evaluate the clinical efficacy of G-CSF In patients with ACLF. Methods: MEDLINE and SCOPUS were queried from inception till June 2022 for randomized controlled trials (RCTs), without any restriction. RCTs evaluating effects of G-CSF on survival rates and occurrence of infection in patients with ACLF were incorporated. The results were reported using a random-effects meta-analysis and the Mantel-Haenszel risk ratio (RR).The Subgroup analysis was done to investigate the influence of study-level factors such as study setting, population and etiology on the outcomes of interest. Results: Thirteen studies (n = 13) were included in our meta-analysis. The total number of participants in our study was 913, and the median study duration was 3 months. Our pooled analysis demonstrates that G-CSF therapy significantly improved survival rates (RR 1.52; 95% CI 1.23 to 1.88; p = 0.0001; Figure) in patients with ACLD. In our subgroup analysis, G-CSF was found to be associated with an improved survival rate in patients with viral hepatitis (RR 1.47; 95% CI 1.27 to 1.69; p < 0.00001). In contrast, results for patients with alcoholic hepatitis were insignificant (RR 1.66; 95% CI 0.88 to 3.16; p< 0.12). Pooled analysis also showed that G-CSF therapy significantly reduces the occurrence rate of infection more than SMT (RR 0.58; 95% CI 0.39 to 0.86; p= 0.006). In the subgroup analysis for viral hepatitis patients, G-CSF therapy was also significantly beneficial in reducing the occurrence rate of infection (RR 0.56; 95% CI 0.35 to 0.89; p=0.01), but in patients with alcoholic hepatitis, results were insignificant (RR 0.55; 95% CI 0.31 to 0.99; p=0.05). Conclusion: Our findings indicate that G-CSF therapy is beneficial in improving survival rates and reducing the risk of infection in patients with ACLF. Hence, it can be used as an alternative treatment for patients with ACLF.Figure 1.: Survival rates in patients with alcoholic hepatitis and viral hepatitis

Exploring the effectiveness of demand-side retail pharmaceutical expenditure reforms

Increasing expenditures on retail pharmaceuticals bring a critical challenge to the financial stability of healthcare systems worldwide. Policy makers have reacted by introducing a range of measures to control the growth of public pharmaceutical expenditure (PPE). Using panel data on European and non-European OECD member countries from 1990 to 2015, we evaluate the effectiveness of six types of demand-side expenditure control measures including physician-level behaviour measures, system-level price-control measures and substitution measures, alongside a proxy for cost-sharing and add a new dimension to the existing empirical evidence hitherto based on national-level and meta-studies. We use the weighted-average least squares regression framework adapted for estimation with panel-corrected standard errors. Our empirical analysis suggests that direct patient cost-sharing and some—but not all—demand-side measures successfully dampened PPE growth in the past. Cost-sharing schemes stand out as a powerful mechanism to curb PPE growth, but bear a high risk of adverse effects. Other demand-side measures are more limited in effect, though may be more equitable. Due to limitations inherent in the study approach and the data, the results are only explorative.

Sequential rituximab therapy sustains remission of nephrotic syndrome but carries high risk of adverse effects.

Sequential rituximab (RTX) administration has emerged as an important strategy to sustain remission of disease in patients with difficult-to-treat nephrotic syndrome. We report the efficacy and safety of sequential therapy with two or more courses of intravenous RTX in 250 patients with difficult-to-treat steroid dependence (n=127) and calcineurin inhibitor (CNI)-dependent or CNI-refractory steroid resistance (n=123) managed at one center during 2015-2021. Subsets of patients were cross-sectionally tested for hypogammaglobulinemia, seroprotection against and hyporesponsiveness to vaccines for hepatitis B and tetanus, BK/JC viruria and human antichimeric antibodies (HACAs). Sequential RTX therapy, initiated at a median of 10years [interquartile range (IQR) 7.3-14.4], was administered for 1.8courses/person-year [95% confidence interval (CI) 1.7-2.0] over 2.0years (95% CI 1.2-3.0). Therapy was associated with postponement of relapses by a median of 3years in patients with steroid-sensitive disease and 2years in those with steroid resistance. Relapses were reduced by a mean of 2.0relapses/person-year (95% CI 1.8-2.2), enabling a reduction in prednisolone dose to 0.04mg/kg/day (95% CI 0.01-0.11) and withdrawal of additional immunosuppression in 154 (62%) patients. RTX-associated adverse events, occurring at 0.20events/person-year (95% CI 0.17-0.23), were chiefly comprised of infusion reactions (n=108) and infections (n=46); serious adverse events were observed in 10.8% patients, at 0.03events/person-year (95% CI 0.02-0.05). Hypogammaglobulinemia was observed in 35% of 177 patients and was moderate to severe in 8.5% of cases. Rates of seroprotection at baseline and response following vaccination were lower for hepatitis B [1.9% and 29.4% (n=52)] than tetanus [65.5% and 34.5% (n=58)]. BK/JC viruria, without viremia, was observed in 7.3% of 109 cases. A total of 19 of 107 patients (17.8%) had HACAs, which were associated with B cell nondepletion and serum sickness. Age at therapy of <9-10years was associated with a risk of early relapse, treatment failure and hypogammaglobulinemia following RTX therapy. Sequential therapy with RTX effectively reduces relapses in patients with difficult-to-treat steroid- and/or CNI-dependent or CNI-refractory nephrotic syndrome. Therapy is associated with high rates of hypogammaglobulinemia and infusion reactions.

A High-Throughput Clinical Laboratory Methodology for the Therapeutic Monitoring of Ibrutinib and Dihydrodiol Ibrutinib.

Ibrutinib (IBR) is an oral anticancer medication that inhibits Bruton tyrosine kinase irreversibly. Due to the high risk of adverse effects and its pharmacokinetic variability, the safe and effective use of IBR is expected to be facilitated by precision dosing. Delivering suitable clinical laboratory information on IBR is a prerequisite of constructing fit-for-purpose population and individual pharmacokinetic models. The validation of a dedicated high-throughput method using liquid chromatography–mass spectrometry is presented for the simultaneous analysis of IBR and its pharmacologically active metabolite dihydrodiol ibrutinib (DIB) in human plasma. The 6 h benchtop stability of IBR, DIB, and the active moiety (IBR + DIB) was assessed in whole blood and in plasma to identify any risk of degradation before samples reach the laboratory. In addition, four regression algorithms were tested to determine the optimal assay error equations of IBR, DIB, and the active moiety, which are essential for the correct estimation of the error of their future nonparametric pharmacokinetic models. The noncompartmental pharmacokinetic properties of IBR and the active moiety were evaluated in three patients diagnosed with chronic lymphocytic leukemia to provide a proof of concept. The presented methodology allows clinical laboratories to efficiently support pharmacokinetics-based precision pharmacotherapy with IBR.

Repurposing of substances with lactone moiety for the treatment of γ-Hydroxybutyric acid and γ-Butyrolactone intoxication through modulating paraoxonase and PPARγ.

GHB and GBL are highly accessible recreational drugs of abuse with a high risk of adverse effects and mortality while no specific antidotes exist. These components can also be found in the clinical setting, beverages, and cosmetic products, leading to unwanted exposures and further intoxications. As the structural analogue of GABA, GHB is suggested as the primary mediator of GHB/GBL effects. We further suggest that GBL might be as critical as GHB in this process, acting through PPARγ as its receptor. Moreover, PPARγ and PON (i.e., the GHB-GBL converting enzyme) can be targeted for GHB/GBL addiction and intoxication, leading to modulation of the GHB-GBL balance and blockage of their effects. We suggest that repurposing substances with lactone moiety such as bacterial lactones, sesquiterpene lactones, and statins might lead to potential therapeutic options as they occupy the active sites of PPARγ and PON and interfere with the GHB-GBL balance. In conclusion, this hypothesis improves the GHB/GBL mechanism of action, suggests potential therapeutic options, and highlights the necessity of classifying GBL as a controlled substance.

Public health emergency and psychological distress among healthcare workers: a scoping review

BackgroundPandemics and natural disasters are immensely stressful events for frontline healthcare workers, as they provide patient care to a population undergoing the impacts of the disaster while experiencing such impacts to their personal lives themselves. With increased stressors to an already demanding job, frontline healthcare workers are at a higher risk of adverse effects to their mental health. The current COVID-19 pandemic has already shown to have had significant impact on the mental health of healthcare workers with increased rates of burnout, anxiety and depression. There is already literature showing the utility of individual programs at improving mental health, however, interventions at the organizational level are not well explored. This scoping review aims to provide an overview and determine the utility of a systematic review of the current body of literature assessing the effectiveness of mental health interventions at the organizational level for healthcare workers during or after a public health emergency.MethodsElectronic databases such as Medline on OVID, CENTRAL, PsycINFO on OVID and Embase on OVID were searched. A targeted search of the grey literature was conducted to identify any non-indexed studies. The population, concept and context approach was used to develop the eligibility criteria. Articles were included if (1) they assessed the impact of interventions to improve wellbeing or reduce the distress on healthcare personnel, first responders or military actively providing medical care; (2) provided quantitative or qualitative data with clearly defined outcomes that focused on established mental health indicators or qualitative descriptions on distress and wellbeing, validated scales and workplace indicators; (3) focused on organizational level interventions that occurred in a public health crisis.ResultsThe literature search resulted in 4007 citations and 115 potentially relevant full-text papers. All except 5 were excluded. There were four review articles and one experimental study. There were no other unpublished reports that warranted inclusion.ConclusionsThere is a distinct lack of research examining organizational interventions addressing mental resilience and well-being in healthcare workers in disaster settings. A systematic review in this area would be low yield. There is a clear need for further research in this area.

Population pharmacokinetics model for escitalopram in Chinese psychiatric patients: effect of CYP2C19 and age.

Objective: To establish a population pharmacokinetic model in Chinese psychiatric patients to characterize escitalopram pharmacokinetic profile to identify factors influencing drug exposure, and through simulation to compare the results with the established therapeutic reference range. Methods: Demographic information, dosing regimen, CYP2C19 genotype, concomitant medications, and liver and kidney function indicators were retrospectively collected for inpatients taking escitalopram with therapeutic drug monitoring from 2018 to 2021. Nonlinear mixed-effects modeling was used to model the pharmacokinetic characteristics of escitalopram. Goodness-of-fit plots, bootstrapping, and normalized prediction distribution errors were used to evaluate the model. Simulation for different dosing regimens was based on the final estimations. Results: The study comprised 106 patients and 337 measurements of serum sample. A structural model with one compartment with first-order absorption and elimination described the data adequately. The population-estimated apparent volume of distribution and apparent clearance were 815 and 16.3 L/h, respectively. Age and CYP2C19 phenotype had a significant effect on the apparent clearance (CL/F). CL/F of escitalopram decreased with increased age, and CL/F of poor metabolizer patients was significantly lower than in extensive and immediate metabolizer patients. The final model-based simulation showed that the daily dose of adolescents with poor metabolizer might be as high as 15 mg or 20 mg and referring to the therapeutic range for adults may result in overdose and a high risk of adverse effects in older patients. Conclusion: A population pharmacokinetics model of escitalopram was successfully created for the Chinese population. Depending on the age of the patients, CYP2C19 genotype and serum drug concentrations throughout treatment are required for adequate individualization of dosing regimens. When developing a regimen for older patients, especially those who are poor metabolizers, vigilance is required.

Adverse effects of personnel protective equipment among first line COVID-19 healthcare professionals: A survey in Southern Tunisia.

BackgroundHealth care professionals (HCP) were obliged to wear personal protective equipment (PPE) during pandemic in order to minimize the risk of transmission of the emerging virus. The objective of the study was to estimate the prevalence of adverse effects related to the wear of PPE among HCP and to determinate their predictive factors.MethodsThis was a cross-sectional study including a representative sample of 300 randomized HCP at Hedi Chaker University Hospital Sfax, Tunisia, during the period August-September 2021. Data collection was carried out by an anonymous self-administered questionnaire.ResultsPPE related adverse effects were noted among 87 HCP with a prevalence of 57.2%. Multivariate analysis showed that factors independently associated with PPE adverse effects were female gender (Adjusted Odds Ratio (AOR) = 1.8; p = 0.048), chronic diseases (AOR = 0.29; p = 0.001) and previous infection with COVID-19 (AOR = 0.46; p = 0.004). Frequent use of bleach or other disinfection product without protection and use of hot water at work were independently associated with a high risk of adverse effects ((AOR = 2.22; p = 0.003) and (AOR = 2.83; p = 0.005), respectively). Similarly, a duration of use of PPE>4 h per day (AOR = 1.98; p = 0.039), as well as use of visors and/or glasses (AOR = 1.84; p = 0.045) were independently associated with PPE related adverse effects.ConclusionThe prevalence of adverse effects related to the wear of PPE was alarmingly high among HCP. Multiple risk factors were highlighted, notably professional aspects. Adequate and repetitive training for caregivers on the correct use of PPE remain essential to manage this problem.

Management of Pregnancy with Covid-19: A Systematic Review

Backgrounds: COVID-19 is a new virus that comes since 2019, and attacks the respiratory system. Pregnant women are at high risk for adverse effects from Covid-19 infection, because of the adaptive cardiopulmonary changes during pregnancy. During the COVID-19 pandemic, physiological changes during pregnancy are feared to increased maternal morbidity and mortality from COVID-19 infection. Safe and effective antenatal care is carried out through special management during the COVID-19 pandemic.Purpose: aim of study is to analyze symptoms, management of pregnancy, childbirth, neonatal, pharmacological therapy and COVID-19 vaccination in pregnant women.Methods: this research used systematic review method. The samples was obtained from ScienceDirect, Wiley and Pubmed database. The keyword are pregnant women, Covid-19, management pregnancy with Covid-19.Results: 10 original research articles was find and accordance with criteria. Management of COVID-19 pregnancy was regulated to reduce exposure the virus in mother and child population. Multidisciplinary health workers were needed to oversee the continuous care of mothers. COVID-19 vaccine in pregnant women was considered safe for mother and fetus.Conclusion: management or guidelines of COVID-19’s pregnancy was carried out continuously and comprehensively to reduce the high rate of morbidity and mortality. COVID – 19 vaccination was attempted as a preventive and protective measure for pregnant women.

Risk Assessment of the Pesticide Envidor with the Active Substance Spirodiclofen

Envidor is a new product in Norway containing the active substance spirodiclofen. The product is applied for use as an insecticide and acaricide in fruit, berries and ornamentals (field, glasshouses and tunnels). The Norwegian Scientific Committee for Food Safety (VKM) was asked by the Norwegian Food Safety Authority to perform a risk assessment on human health, environmental fate and ecotoxicological effects of the active substance and the product. The risk assessment of the product was finalized at a meeting November 25, 2010, by VKM’s Scientific Panel on plant protection products (Panel 2). VKM Panel 2’s conclusion is as follows: &#x0D; Both Envidor and the active substance spirodiclofen showed low acute oral -, dermal - and inhalation toxicities in animal studies, but showed skin sensitising properties. The estimated risk for operators is assessed as minimal provided adequate use of personal protective equipment. &#x0D; Spirodiclofen may have endocrine disrupting effects, but the in vivo data are not sufficient to make a firm conclusion at this point. Adrenals and other organs of the endocrine system, including the reproductive system, are target organs for chronic toxicity of spriodiclofen. Males seem to be more sensitive than females for adverse reproductive effects of spirodiclofen. Decreased testes and epididymides sizes, testes atrophy and decreased number of sperm were seen both in the parental and subsequent generation of rats. No teratogenic effect of spirodiclofen was seen. &#x0D; The disturbances in the endocrine system may account for the carcinogenic potential of spirodiclofen as evidenced by tumours in testicles, uterus and liver of animals. Spirodiclofen is not considered genotoxic. The Panel regards spirodiclofen to be carcinogenic and toxic to the reproduction in laboratory animals. &#x0D; Both spirodiclofen and its metabolites are rapidly degraded in soil, but while spirodiclofen has a low mobility due to high soil sorption, its metabolites are highly mobile. &#x0D; Use of Envidor with the proposed application regime implies a very high risk for adverse effects on bees and non-target arthropods due to exposure to the active substance spirodiclofen. The risk for adverse effects of spirodiclofen on other terrestrial organisms, and on aquatic organisms provided that a buffer zone of 30 m to surface water is applied, is considered to be minimal.

1505-PUB: Impact of Diabetes on Radiotherapy-Related Infection

Background and Purpose: Poor perioperative glucose control in diabetes patients is associated with infectious adverse effects (AEs) . Radical radiotherapy (RT) for head and neck (H&amp;N) cancer extensively destroys skin and the mucosa barrier function, and can be as invasive as surgery. In this study, the risk of radiation-induced acute infectious AEs was investigated in a cohort of diabetic patients given RT for H&amp;N cancer. Materials and Methods: Acute AEs associated with RT in diabetic patients treated between January 2017 and July 2021 at three institutions were retrospectively analyzed. Patients were included if they met the following criteria: confirmed diagnosis of type 1 or 2 diabetes mellitus, age &amp;gt; years, stable on glucose-lowering therapy before starting RT, and had undergone RT for pathologically proven malignancies. The endpoint was the rate of acute infectious AEs graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events v5.0. Results: A total of 216 patients were eligible for the present study (median follow-up, 15.6 months; range, 1.3-33.3 months; median age, 72 years; range, 33-90 years) . The median glycated hemoglobin (A1c) value at the start of RT was 7.4% (range, 4.1%-12.7%) . Grade ≥ 3 acute infectious AEs that occurred in 31 (14.4%) patients included mucosal infection, pneumonia, and sepsis. Five patients died due to infectious AEs that developed during or after RT. Concurrent chemoradiotherapy (CCRT) (OR, 2.0; 95%CI, 0.9-4.6; P = 0.08) tended to be a predictor of severe infectious AEs. The frequency of glucose control by diabetologists during CCRT was significantly lower than during RT alone (P = 0.001) . Conclusions: The incidence of severe infectious AEs was high in the present cohort of irradiated diabetic patients with H&amp;N cancer compared with historical data. Patients with CCRT had a higher risk of AEs, which should be considered before irradiation. Therapeutic intervention for glucose control by diabetologists during CCRT may lead to fewer severe infectious AEs. Disclosure K. Ito: None.

PECULIARITIES OF COVID-19 SUSCEPTIBILITY IN WOMEN WITH POLYCYSTIC OVARY SYNDROME

Polycystic ovary syndrome (PCOS) is the most common endocrinological disease among women of reproductive age, the prevalence of which reaches up to 15% in the world depending on the study population and the diagnostic criteria used. Purpose: analysis of existing medical research on the increased susceptibility to Covid-19, its form and features among women with PCOS, coverage of research on this topic to raise awareness of Ukrainian physicians in building proper prevention, modernizing approaches to diagnosis, treatment and avoidance of Covid-19 complications in women with PCOS and to disseminate material and further in form PCOS patients about possible risks of Covid-19. Results and discussion. Women with PCOS are characterized by a higher incidence of cardiovascular disease, kidney damade, non-fatty steatohepatitis, achieving a body mass index over 30 kg/m2 , diabetes and endometrial mucosal cancer. Metabolic syndrome characterized by hypertension, obesity, insulin resistance and dyslipidemia is found in 22.7% of women with PCOS. Given the high prevalence of various risk factors for PCOS, which coincide with the severity of Covid-19, it can be argued that women with PCOS are a critical group of patients with a potentially higher risk of adverse effects of Covid-19. Conclusions. Despite their young age and gender, women with PCOS are at increased risk for Covid-19. Women with cardiovascular and metabolic diseases in PCOS are a group of patients with a potentially higher risk of complications from Covid-19. Women with PCOS should first be informed about the need for vaccination and preventive measures during the Covid-19 pandemic, monitoring the treatment of existing pathologies and prompt medical attention for SARS-CoV-2 infection.

Congenital cytomegaly infection - current reports on prevention, diagnosis and effective therapy

Congenital CMV-cCMV- infection is the most common congenital viral infection in the world, especially in developing countries. It is a serious problem because it can contribute to the development of severe neurodevelopmental disorders and is also the main cause of sensorineural hearing loss. A high risk of adverse effects on the fetus occurs with CMV infection in early pregnancy, but infection can be transmitted from mother to fetus also in cases of secondary infections. Despite the high prevalence of up to 2% of all births, screening for CMV has not yet been established and diagnostic and therapeutic strategies have not been standardized. The aim of this article is to review the current reports on the early detection of congenital CMV, as well as effective methods of its prevention and the best treatment.&#x0D; Unfortunately, the literature review shows that there are no preventive measures other than proper hygiene during pregnancy. However, many clinical trials are currently underway to develop a CMV effective vaccine. Currently, the infection can be detected already at the stage of fetal life using PCR tests detecting the genetic material of the virus in the amniotic fluid. However, the treatment of already diagnosed congenital CMV is based on antiviral therapy for a period of 12 months, but only in symptomatic infants due to side effects such as neutropenia. Currently, the effectiveness of such treatment reduces the percentage of children with hearing loss and neurological disorders. Pregnant mothers should be educated on how to prevent infections, and doctors' task is to update data on the latest diagnostic and therapeutic recommendations.