History Of Active Smoking Research Articles

Graft Failure and Contralateral ACL Injuries After Primary ACL Reconstruction: An Analysis of Risk Factors Using Interpretable Machine Learning.

Anterior cruciate ligament (ACL) reconstruction (ACLR) can be successful in restoring knee stability. However, secondary ACL injury, either through graft failure or contralateral injury, is a known complication and can significantly impact the ability of a patient to return successfully to previous activities. To develop and internally validate an interpretable machine learning model to quantify the risk of graft failure and contralateral ACL injury in a longitudinal cohort treated with ACLR. Case-control study; Level of evidence, 3. An established geographic database of >600,000 patients was used to identify patients with a diagnosis of ACL rupture between 1990 and 2016 with a minimum 2-year follow-up. Medical records were reviewed for relevant patient information and 4 candidate machine learning algorithms were evaluated for prediction of graft failure and contralateral ACL injury in patients after ACLR as identified either on magnetic resonance imaging or via arthroscopy. Performance of the algorithms was assessed through discrimination, calibration, and decision curve analysis. Model interpretability was enhanced utilizing global variable importance plots and partial dependence curves. A total of 1497 patients met inclusion criteria. Among them, 140 (9.4%) had graft failure and 128 (8.6%) had a contralateral ACL injury after index surgery at a median follow-up of 140.7 months (interquartile range, 77.2-219.2 months). The best performing models achieved an area under the receiver operating characteristics curve of 0.70 for prediction of graft failure and 0.67 for prediction of contralateral ACL injury, outperforming a logistic regression fitted on the identical feature set. Notable predictors for increased risk of graft failure included younger age at injury, body mass index (BMI) <30, return to sports <13 months, initial time to surgery >75 days, utilization of allograft, femoral/tibial fixation with suspension/expansion devices, concomitant collateral ligament injury, and active or former smoking history. Predictors of contralateral ACL injury included greater preoperative pain, younger age at initial injury, BMI <30, active smoking history, initial time to surgery >75 days, history of contralateral knee arthroscopies, and involvement in contact sports. Less than 18% of all patients who undergo ACLR should be expected to sustain either a graft failure or contralateral ACL injury. Machine learning models outperformed logistic regression and identified greater preoperative pain, younger age, BMI <30, earlier return to higher activity, and time to surgical intervention >75 days as common risk factors for both graft failure as well as contralateral ACL injury after ACLR. Surgeon-modifiable risk factors for graft failure included allograft and femoral/tibial fixation with a suspension/expansion combination.

Passive smoker exposure as a risk factor of otitis media with effusion in children

Otitis media with effusion (OME) is a middle ear disorder often found in children and can cause hearing loss, delayed language acquisition, and behavioral disorders. Cigarette smoke exposure is one of the environmental factors that may raise the incidence of OME. This study aimed to identify the prevalence of OME and the risk of cigarette smoke to OME using urinary cotinine level examination, along with the characteristics of smoking history in the family. This cross-sectional study included 398 children aged 0-14 who underwent history taking, questionnaire completion, ear/nose/throat (ENT) examination, and tympanometry. OME patients based on ENT and tympanometry examination underwent urinary cotinine examination using lateral flow chromatographic immunoassay technique. Of the 398 children, five children were diagnosed with OME. The prevalence rate of OME was 1.3%. No OME patients were exposed to cigarette smoke based on urine cotinine levels of &amp;gt;200 ng/mL. However, based on history taking, one of five patients with OME is a passive smoker, with characteristics of active smoking history in the family one person (the father). In conclusion, there was no proportion of positive urinary cotinine levels in children with OME.

Profiling heart failure with preserved or mildly reduced ejection fraction by cluster analysis.

Significant knowledge gaps remain regarding the heterogeneity of heart failure (HF) phenotypes, particularly among patients with preserved or mildly reduced left ventricular ejection fraction (HFp/mrEF). Our aim was to identify HF subtypes within the HFp/mrEF population. K-prototypes clustering algorithm was used to identify different HF phenotypes in a cohort of 2570 patients diagnosed with HFmrEF or HFpEF. This algorithm employs the k-means algorithm for quantitative variables and k-modes for qualitative variables. We identified three distinct phenotypic clusters: Cluster A (n=850, 33.1%), characterized by a predominance of women with low comorbidity burden; Cluster B (n=830, 32.3%), mainly women with diabetes mellitus and high comorbidity; and Cluster C (n=890, 34.5%), primarily men with a history of active smoking and respiratory comorbidities. Significant differences were observed in baseline characteristics and one-year mortality rates across the clusters: 18% for Cluster A, 33% for Cluster B, and 26.4% for Cluster C (P<0.001). Cluster B had the shortest median time to death (90 days), followed by Clusters C (99 days) and A (144 days) (P<0.001). Stratified Cox regression analysis identified age, cancer, respiratory failure, and laboratory parameters as predictors of mortality. Cluster analysis identified three distinct phenotypes within the HFp/mrEF population, highlighting significant heterogeneity in clinical profiles and prognostic implications. Women were classified into two distinct phenotypes: low-risk women and diabetic women with high mortality rates, while men had a more uniform profile with a higher prevalence of respiratory disease.

Profile Of Congenital Heart Disease (CHD) Patients In Cirebon, Indonesia: Maternal Passive Smoking Risk

Background: Congenital heart disease (CHD) is the most common congenital disorder and a leading cause of infant mortality. Maternal pregnancy history is considered a potential risk factor for CHD. This cross-sectional study aimed to investigate the patient and maternal profile of CHD cases in Cirebon, Indonesia. Methods: The study was conducted at Hasna Medika Cardiovascular Hospital from November 2019 to March 2020, and data were collected through questionnaires and medical records. The study included 28 CHD patients, of whom 57.1% were female, and most had acyanotic CHD (82.1%). Results: None of the mothers had a history of active smoking, but all were exposed to passive smoking. Additionally, 17.9% of the samples had a history of fever during the first trimester, 17.9% took medication during pregnancy, and all consumed vitamins and supplements. Hormonal contraceptive failure accounted for 17.9% of CHD cases, while 7.1% of mothers had gestational hypertension. None of the mothers had gestational diabetes mellitus. Conclusions: The study suggests that passive smoking may be closely related to CHD, but further research is needed to confirm this association. Therefore, it is crucial for pregnant women to avoid exposure to cigarette smoke. Health promotion programs that educate the public about the risks of smoking during pregnancy and infancy are highly encouraged.

P419 Proximal Crohn’s disease location is associated with a more benign course of perianal Crohn’s disease (the PERIAPROX study)

Abstract Background Proximal Crohn’s disease (CD) location (L4 according to the Montreal Classification) is associated with a more severe course with higher risk of abdominal surgery. However, little is known about the relation with perianal disease. The aim of our study was to investigate the impact of L4 disease location on perianal disease incidence and clinical course. Methods A case-control study was conducted in the prospectively maintained ENEIDA database for all CD with and without L4 location between January 2005 and March 2023. Demographic data, disease characteristics, perianal disease diagnosis and evolution according to biologic therapy and surgery requirement were collected. Demographic data, CD characteristics, perianal disease diagnosis and course were analyzed. Cox proportional hazards and Kaplan-Meier methods were used for the analysis of perianal incidence, and biologic and surgery requirement. Results A cohort of 14022 CD patients were included in the analysis. The mean follow-up duration was 6.4 years (SD 4.9). L4 location showed a lower prevalence of perianal disease (18.0 vs 19.9%, p=0.018), with lower rate of fistulas (60.9 vs 66.1%, p=0.021) and perianal abscesses (33.5 vs 39.4%, p=0.013). Perianal disease and L4 were associated with male sex (OR 1.29, p&amp;lt;0.001), younger age (43 vs 44), and the structuring phenotype (OR 2.14, p&amp;lt;0.001). L4 location was associated with a lower incidence of perianal disease (HR 0.891, p=0.041), while proctitis was associated with a higher risk (HR=2.161, p&amp;lt;0.001). L4 location was also associated with a lower requirement for biologics (HR 0.712, p=0.023), along with advanced age (HR 0.988, p&amp;lt;0.001). Proctitis (HR 1.292) and a history of perianal surgery (3.373) were associated with a higher requirement for biologics. At univariate analysis, L4 location was associated with a lower requirement of surgery (HR 0.833), however at multivariate analysis this finding was not confirmed (p=0.525). Instead, a history of active smoking (HR 1.419), the use of biologics (HR 2.262), and CD penetrating pattern (HR 1.277) were associated with a higher requirement for perianal surgery. Conclusion L4 location is associated with a lower incidence of perianal disease and a more benign course with lower requirement for biologics and surgery.

Association between active and passive smoking and the clinical course of multiple sclerosis and neuromyelitis optica spectrum disorder

&lt;i&gt;Objective&lt;/i&gt;: Active and passive smoking are common environmental risk factors, but there is no definite conclusion about their effects on relapse and disability progression in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). &lt;i&gt;Methods&lt;/i&gt;: This was a retrospective cohort study. Patients were included from four centers. Demographic and clinical data were extracted from the clinical database, while data involving environmental exposures during daily life, relapse, and disability progression were obtained through telephone follow-up interviews. Determinants of relapse were assessed by Cox proportional models, and disability progression was assessed by linear regression. Kaplan‒Meier survival was used to estimate relapse within five years after the first attack. &lt;i&gt;Results&lt;/i&gt;: A total of 130 MS patients and 318 NMOSD patients were included in this study, and females accounted for 60% and 79.6%, respectively. MS patients with an active smoking history had a higher risk of relapse, for which the association became borderline significant after accounting for covariates (aHR=1.52, 95% CI=1.00, 2.31; &lt;i&gt;p&lt;/i&gt;=0.052). The relapse risk between ever-smokers who smoked more than 10 cigarettes per day and smokers who smoked less than 10 cigarettes per day was not significantly different (aHR=0.96, 95% CI=0.63, 1.47; &lt;i&gt;p&lt;/i&gt;=0.859). However, exposure to passive smoking was associated with a reduced risk of MS relapse (aHR=0.75, 95% CI=0.56, 1.00; &lt;i&gt;p&lt;/i&gt;=0.044) compared with never-exposed patients. No associations were observed between active smoking/passive smoking and the risk of NMOSD relapse, but patients with a history of smoking were associated with a lower annual progression rate by Expanded Disability Status Scale (EDSS) (aβ=−0.20, 95% CI=−0.38, −0.01; &lt;i&gt;p&lt;/i&gt;=0.036) and Multiple Sclerosis Severity Score (MSSS) (aβ=−0.23, 95% CI=−0.44, −0.03; &lt;i&gt;p&lt;/i&gt;=0.028). &lt;i&gt;Conclusion&lt;/i&gt;: Our research shows that active smoking increases the relapse risk of MS and has a negative impact on disability progression; thus, smoking cessation should be encouraged.

Hoarseness as A Window into the Complexity of Supraglottic Carcinoma: A Case Report and Literature Review

ABSTRACT Laryngeal carcinoma ranks among the most prevalent malignancies affecting the head and neck, with supraglottic carcinoma emerging as the predominant subtype, particularly in certain developing regions characterized by prevalent risk factors such as alcohol consumption and smoking. Hoarseness, characterized by a change in the voice, constitutes approximately 1% of all primary care consultations. The predominant etiologies include acute and chronic laryngitis, responsible for 42.1% and 9.7% of cases, respectively, followed by functional dysphonia, benign and malignant tumors, neurogenic factors, and the natural aging process. A 65-year-old male, with a history of active smoking, was referred from a primary healthcare center due to complaints of throat pain and worsening hoarseness that had persisted for one year. The significant airway obstruction observed in this patient underscores the importance of discussing available management options in such cases. It is crucial for primary care physicians to recognize the clinical signs presented by the patient promptly in order to initiate the appropriate management without delay. Regrettably, tend to seek medical attention at an advanced stage of the disease, resulting in a notably unfavorable overall survival rate. Keyword: Laryngeal Carcinoma, Supraglottic Carcinoma, Hoarseness, Survival Rate

The challenging patient in autologous breast reconstruction: obesity, breast ptosis and beyond.

Autologous breast reconstruction has consistently demonstrated excellent patient satisfaction, ideal aesthetic results, and a low risk of complications. With the increasing incidence of breast cancer diagnoses and higher reconstruction rates, surgeons encounter a broader spectrum of patients. Obese patients undergoing breast reconstruction are more likely to experience a surgical complication. While free tissue transfer carries a higher donor site complication rate, implant-based reconstruction carries a higher loss of reconstruction in this population. Additionally, autologous reconstruction consistently demonstrates better patient-reported outcomes. Oncoplastic reconstruction is an oncologically safe alternative to free tissue transfer and implant reconstruction which reduces the risk of complications and the risk of delaying adjuvant therapy. Particularly in obese patients for whom radiation is indicated based on tumor size or nodal involvement, oncoplastic reconstruction is maximally beneficial. The Goldilocks mastectomy is yet another alternative to free tissue transfer or implant reconstruction which carries an acceptable risk profile, especially when augmentation with tissue expander or implant is delayed and performed at a second stage. In patients with breast ptosis undergoing skin-sparing mastectomy, vertical skin reduction allows an acceptable aesthetic result while minimizing the risk for mastectomy flap necrosis (MFN), especially in comparison to Wise pattern skin reduction. If a nipple-sparing mastectomy (NSM) is to be performed in the setting of breast ptosis, a nipple delay or a pre-mastectomy reduction/mastopexy is the safest and most conservative approach, but can alter the timeline for primary cancer resection and therefore is predominantly performed in patients with a genetic predisposition or those undergoing a prophylactic mastectomy. Patients with obesity, breast ptosis, advanced age, active smoking history, prior radiation therapy, or abdominal procedures can carry an increased risk of complications and present a challenge to plastic surgeons. We review the most recent literature published regarding reconstruction in these patient groups and seek to provide practical information to help inform clinical decision-making and operative execution.

Combined effect of active smoking history and passive smoking during pregnancy on postpartum depression and anxiety

To explore the independent and combined effects of smoking and passive smoking during pregnancy on maternal depression, anxiety and depressive anxiety comorbidities. From August 2020 to February 2022, women who underwent 42-day postpartum examination in Changfeng Women&apos;s Center and Shuangfeng Hospital of Hefei were recruited. Their depression and anxiety symptoms were assessed using EPDS Scale and GAD Scale, respectively, and smoking and passive smoking status during pregnancy were collected. Multivariate Logistic regression was used to analyze the independent and combined effects of smoking and passive smoking during pregnancy on postpartum depression, anxiety and depression and anxiety comorbidities. A total of 2 447 parturients were included, whose mean age was(29.23±4.20) years old.58.6% of parturients lived in urban areas.97.2% parturients had unassisted reproduction and 73.5% pregnancy intention was spontaneous. Among them, 362(14.8%) had depression, 523(21.4%) had anxiety, and 270(11.0%) had depression and anxiety comorbidities. In an independent analysis of effects, maternal smoking during pregnancy was statistically associated with postpartum depression(OR=3.86, 95%CI 2.37-6.28), anxiety(OR =2.58, 95%CI 1.60-4.17) and depressive anxiety comorbidity(OR = 3.34, 95%CI 2.00-5.71). Maternal passive smoking during pregnancy was also positively associated with the risk of postpartum depression(OR = 1.56, 95%CI 2.00-5.71), anxiety(OR=1.71, 95%CI 1.24-2.37) and depression and anxiety comorbidities(OR = 1.52, 95%CI 1.02-2.28), and the higher the frequency of exposure to passive smoking, the higher risk of depression, anxiety, and depressive and anxiety comorbidities. No interaction between smoking during pregnancy and passive smoking exposure on postpartum depression(RERI = 0.69, 95%CI-4.62-6.00; AP = 10.84, 95%CI-73.37-95.04; S= 0.58, 95%CI 0.02-15.18), anxiety(RERI=0.27, 95%CI 0.05-0.49; AP=4.02, 95%CI-0.52-8.57; S=0.78, 95%CI 0.64-0.94) and depression and anxiety comorbidities(RERI = 0.07, 95%CI-0.25-0.39; AP=1.74, 95%CI-6.03-9.52; S=0.93, 95%CI 0.68-1.27)was observed. Both smoking and passive smoking during pregnancy were positively associated with the risk of postpartum depression, anxiety and depressive anxiety comorbidity.

Medication adherence in relation with physical activity in hypertensive patients : data from a behavioral cardiology unit

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Few studies have examined the relationship between exercise and adherence to antihypertensive medication, examining all possible factors contributing to blood pressure control. Purpose The purpose of our study was to access the possible dependence relationship among hypertensive patients visiting the Behavioral Cardiology Unit in a Tertiary Hospital. Methods The study population consisted of patients reporting to the Behavioral Cardiology Unit in a Tertiary Hospital during a period of 6 months in 2021. In terms of holistic approach, all patients underwent a thorough clinical in-depth interview, using the Morisky Medication Adherence Scale (MMAS8), the Frail Questionnaire Screening Tool (Frailty Score) and the Patient Health Questionnaire-4 (PHQ-4). All patients also provided full history of exercise (at least 150 minutes of physical activity or 75 minutes of intense activity per week), while completing the Duke Activity Status Index (DASI). Results The population consisted of 42 hypertensive patients, 54.8% of them were females, with a mean age of all patients at 55.8±15.2 years. Body Mass Index was averaging at 27.6 kg/m2. Salt consumption above the daily suggested amount (&amp;gt;5gr/day) was reported by 60% of patients, binge drinking by 43% of them, while 43% had a history of active smoking. High adherence was reported by 17 patients (46%), medium adherence by 14 (37.8%) and low adherence by 6 (16.2%). Results indicate a relationship between exercise and adherence to medication. More specifically, Chi-Square test showed statistical significance between exercise and medium medication adherence in MMAS8 (MMAS8: 6-7, p=0.033). Moreover, statistical analysis showed significant relationship between exercise, frailty and PHQ-4 score. Particularly, patients with absence of exercise showed higher level of PHQ-4 score (F=7.07, p=0.011). Conclusions Our study highlights the possible dependency relationship of exercise and adherence to medication. Results indicate that patients with good adherence to medication have better behavioral activation. There is need for further research in this domain, to confirm the findings.

(349) Risk Factors for Revision of Inflatable Penile Prosthesis among an Ethnically Diverse Urban Population

Abstract Introduction Inflatable Penile Prosthesis (IPP) is an increasingly popular surgical treatment for refractory erectile dysfunction. However, there is a feared complication of infection or need for revision surgery. While the risk, treatment, and prevention of infections following IPP placement has been studied, few studies have reported on the risk factors for revision of implant, particularly among a diverse urban population with high rates of comorbid conditions. Objective To identify risk factors for revision surgery after primary IPP implantation among an ethnically diverse urban population with high rates of comorbid conditions. Furthermore, to aid informed consent of patients with refractory erectile dysfunction considering IPP surgery. Methods This study was a retrospective review of patients receiving IPP implantation surgery at a large urban hospital between January 2015 and December 2021. The primary outcome was revision or removal of IPP due to infection, device malfunction, or other. Patient characteristics, implant characteristics, intraoperative factors, and 30-day outcomes were compared between groups via Chi-squared, student’s t-test, or Mann-Whitney U test. A multivariate cox regression survival analysis was used to identify risk factors for revision surgery. A Kaplan-Meier survival curve was calculated for identified risk factors. Results A total of 489 patients received IPP implantation within the study period with 50 (10.2%) requiring revision surgery. Twenty-two (44.0%) patients had removal or revision of IPP due to infection, 19 (38.0%) due to device malfunctions, and 9 (18.0%) due to other reasons. The average time to revision surgery was 8.7 +/− 2.03 months. History of smoking was identified as a risk factor for revision surgery (p&amp;lt;.01), with 23% of active smokers and 13% of former smokers requiring revision surgery. Active smokers had a 3-fold higher risk of requiring revision surgery (OR: 3.23 [0.35-1.32], p&amp;lt;.01). The use of Arista hemostatic agent, as opposed to Surgicel or Evicel, resulted in a more than 50% reduction in the risk of revision surgery (p&amp;lt;.01). However, this finding fell out of our model when adjusted for smoking status (p=.072). Other characteristics such as age, BMI, race, comorbid conditions, length of surgery, implant size, use of surgical drain, and 30-day outcomes were not associated with risk of revision surgery. Conclusions There is a mounting body of evidence associating history of smoking with revision surgery and infection following IPP implantation surgery. Patients with active smoking history should be counseled on the up to 3-fold increased risk of requiring revision surgery. Additionally, further studies should assess the use of hemostatic agents such as Arista in reducing risk of revision surgery. Disclosure No

MP19-10 FEASIBILITY AND COMPLICATIONS OF OUTPATIENT ROBOTIC RADICAL PROSTATECTOMY WITH LYMPH NODE DISSECTION

You have accessJournal of UrologyCME1 Apr 2023MP19-10 FEASIBILITY AND COMPLICATIONS OF OUTPATIENT ROBOTIC RADICAL PROSTATECTOMY WITH LYMPH NODE DISSECTION Spencer Liem, Dhaval Jivanji, Timothy Demus, Shuwei Peter Chang, Shimron Brown, and Jorge Pereira Spencer LiemSpencer Liem More articles by this author , Dhaval JivanjiDhaval Jivanji More articles by this author , Timothy DemusTimothy Demus More articles by this author , Shuwei Peter ChangShuwei Peter Chang More articles by this author , Shimron BrownShimron Brown More articles by this author , and Jorge PereiraJorge Pereira More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer is one of most common cancers in men. Outpatient robotic radical prostatectomy (RRP) is currently a topic of interest because of its ability to minimize costs while minimizing complications. However, few studies have analyzed the differences in outpatient RRP in patients undergoing concurrent lymph node dissections (LND) versus those without. As such, we compare the complication rates of inpatient versus outpatient RRP both with and without LND. METHODS: Using the National Surgical Quality Improvement Program Database (NSQIP), we identified total RRP with and without LND by current procedural terminology code, and reported patient co-morbidities, intra-operative or post-operative complications, and 30-day complication events from 2010-2020. We further divided this data into inpatient and outpatient surgeries. RESULTS: Between 2010-2020, a total of 79381 RRP were performed, 98.2% inpatient and 1.7% outpatient, of which 50% and 54% had LND respectively. Comparing patients undergoing outpatient RRP with LND versus those without LND, patients with LND had an average age of 63±7 years while patients without LND averaged 62±7 years. Mean operative time was 180.5±63.2 minutes and 187.6±72.9 minutes respectively. Patients undergoing outpatient RRP with LND were less likely to have an active smoking history (7.5% vs. 10.7%), or a history of hypertension (45.1% vs. 50.6%) but had higher rates of sepsis (0.8% vs. 0%) and superficial incisional infection (1.4% vs. 0.2%) when compared those without LND. All other complications and 30-day events such as unplanned readmission, reoperation rates, and mortality were similar in both groups. CONCLUSIONS: Patients undergoing outpatient RRP with LND had similar overall age and operative times as outpatient RRP without LND. Patients that had outpatient RRP with LND were less likely to have an active smoking history and hypertension but had higher rates of sepsis and superficial incisional infections. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e268 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Spencer Liem More articles by this author Dhaval Jivanji More articles by this author Timothy Demus More articles by this author Shuwei Peter Chang More articles by this author Shimron Brown More articles by this author Jorge Pereira More articles by this author Expand All Advertisement PDF downloadLoading ...

Tobacco Smoking-Related Mutational Signatures in Classifying Smoking-Associated and Nonsmoking-Associated NSCLC.

Patient-reported smoking history is frequently used as a stratification factor in NSCLC-directed clinical research. Nevertheless, this classification does not fully reflect the mutational processes ina tumor. Next-generation sequencing can identify mutational signatures associated with tobacco smoking, such as single-base signature 4 and indel-based signature3. This provides an opportunity to redefine the classification of smoking- and nonsmoking-associated NSCLC on the basis of individual genomic tumor characteristics and could contribute to reducing the lung cancer stigma. Whole genome sequencing data and clinical records were obtained from three prospective cohorts of metastatic NSCLC (N= 316). Relative contributions and absolute counts of single-base signature 4 and indel-based signature 3 were combined with relative contributions of age-related signatures to divide the cohort into smoking-associated ("smoking high") and nonsmoking-associated ("smoking low") clusters. The smoking high (n= 169) and smoking low (n= 147) clusters differed considerably in tumor mutational burden, signature contribution, and mutational landscape. This signature-based classification overlapped considerably with smoking history. Yet, 26% of patients with an active smoking history were included in the smoking low cluster, of which 52% harbored an EGFR/ALK/RET/ROS1 alteration, and 4% of patients without smoking history were included in the smoking high cluster. These discordant samples had similar genomic contexts to the rest of their respective cluster. A substantial subset of metastatic NSCLC is differently classified into smoking- and nonsmoking-associated tumors on the basis of smoking-related mutational signatures than on the basis of smoking history. This signature-based classification more accurately classifies patients on the basis of genome-wide context and should therefore be considered as a stratification factor in clinical research.

A Neural Network Model Using Pain Score Patterns to Predict the Need for Outpatient Opioid Refills Following Ambulatory Surgery: Algorithm Development and Validation.

Expansion of clinical guidance tools is crucial to identify patients at risk of requiring an opioid refill after outpatient surgery. The objective of this study was to develop machine learning algorithms incorporating pain and opioid features to predict the need for outpatient opioid refills following ambulatory surgery. Neural networks, regression, random forest, and a support vector machine were used to evaluate the data set. For each model, oversampling and undersampling techniques were implemented to balance the data set. Hyperparameter tuning based on k-fold cross-validation was performed, and feature importance was ranked based on a Shapley Additive Explanations (SHAP) explainer model. To assess performance, we calculated the average area under the receiver operating characteristics curve (AUC), F1-score, sensitivity, and specificity for each model. There were 1333 patients, of whom 144 (10.8%) refilled their opioid prescription within 2 weeks after outpatient surgery. The average AUC calculated from k-fold cross-validation was 0.71 for the neural network model. When the model was validated on the test set, the AUC was 0.75. The features with the highest impact on model output were performance of a regional nerve block, postanesthesia care unit maximum pain score, postanesthesia care unit median pain score, active smoking history, and total perioperative opioid consumption. Applying machine learning algorithms allows providers to better predict outcomes that require specialized health care resources such as transitional pain clinics. This model can aid as a clinical decision support for early identification of at-risk patients who may benefit from transitional pain clinic care perioperatively in ambulatory surgery.

PS-C08-10: RELATIONSHIP OF PHYSICAL ACTIVITY AND MEDICATION ADHERENCE IN HYPERTENSIVE PATIENTS: BEHAVIORAL CARDIOLOGY UNIT DATA

Objective: Few studies have examined the relationship between exercise and adherence to antihypertensive medication, examining all possible factors contributing to blood pressure control. The purpose of our study was to access the possible dependence relationship among hypertensive patients visiting the Behavioral Cardiology Unit in a Tertiary Hospital. Design and method: The study population consisted of patients reporting to the Behavioral Cardiology Unit in a Tertiary Hospital during a period of 6 months in 2021. In terms of holistic approach, all patients underwent a thorough clinical in-depth interview, using the Morisky Medication Adherence Scale (MMAS8), the Frail Questionnaire Screening Tool (Frailty Score) and the Patient Health Questionnaire-4 (PHQ-4). All patients also provided full history of exercise (at least 150 minutes of physical activity or 75 minutes of intense activity per week), while completing the Duke Activity Status Index (DASI). Results: The population consisted of 42 hypertensive patients, 54.8% of them were females, with a mean age of all patients at 55.8 ± 15.2 years. Body Mass Index was averaging at 27.6 kg/m2. Salt consumption above the daily suggested amount (&gt; 5gr/day) was reported by 60% of patients, binge drinking by 43% of them, while 43% had a history of active smoking. High adherence was reported by 17 patients (46%), medium adherence by 14 (37.8%) and low adherence by 6 (16.2%). Results indicate a relationship between exercise and adherence to medication. More specifically, Chi-Square test showed statistical significance between exercise and medium medication adherence in MMAS8 (MMAS8: 6–7, p = 0.033). Moreover, statistical analysis showed significant relationship between exercise, frailty and PHQ-4 score. Particularly, patients with absence of exercise showed higher level of PHQ-4 score (F = 7.07, p = 0.011). Conclusions: Our study highlights the possible dependency relationship of exercise and adherence to medication. Results indicate that patients with good adherence to medication have better behavioral activation. There is need for further research in this domain, to confirm the findings.

A Real-World Single-Institution Experience with Hypomethylating Agents Plus BCL-2 Inhibitor for the Treatment of Acute Myeloid Leukemia

Background: Acute myeloid leukemia (AML) is a heterogeneous clonal disease of myeloid progenitor cells resulting from alterations in cell differentiation, proliferation, and renewal. Treatment for young patients and those with favorable-to-intermediate risk remains a combination of cytarabine and anthracycline, while the optimal regimen for the elderly has yet to be established. First-line and salvage combination hypomethylating agents azacitidine or decitabine with BCL-2 inhibitor venetoclax (HMA+Ven) has shown promise for these patients and are becoming standard therapy. We present a cohort from our institution treated with HMA+Ven vs traditional therapy. We hypothesize HMA+Ven leads to improved overall survival (OS) and complete remission with or without count recovery (CR/CRi) compared to traditional therapy in the elderly and those with unfavorable risk as defined by the European LeukemiaNet (ELN-2017) risk stratification. Methods: 232 AML patients from Baylor St. Lukes Medical Center, and Michael E DeBakey VA Medical Center from 8/26/1997 to 7/31/2021 were reviewed. These patients were stratified by HMA+Ven vs. other standard treatment. Differential survival among groups was measured by Kaplan-Meier method. The independent effect of HMA+Ven against multiple intervening variables was evaluated by Cox proportional regression analysis. Chi-square and t-test detected potential intervening variables with impact on outcome. SAS software was used for analysis. Results: Those treated with HMA+Ven comprised 28 out of 227 patients (12.3%). Average age of patients was 65 (26-80) in the HMA+Ven group and 61.3 (20-93) in the other treatment group (p=0.05). Age, ELN-2017 risk stratification, and HMA+Ven treatment were predictors for survival (Table 1). OS in our cohort favors HMA+Ven vs other treatment (Fig. 1, 348 days vs 261 days, p=0.0004). Overall survival in the elderly population of interest favors HMA+Ven (270 days vs 135 days, p<0.0001). CR/CRi was superior for HMA+Ven in those age >60 (55% vs 24.7%, p=0.006) as well as those age >70 (55% vs 15.2% p=0.007). OS for those with adverse ELN-2017 stratification favors HMA+Ven (352 days vs 164 days, p=.002). Interestingly, overall survival trends for those with active smoking history favors HMA+Ven (p<0.0001). Lastly we found CR/CRi favors HMA+Ven for those with RUNX1 gene mutation (75% vs 25%, p=0.01). Conclusion: HMA+Ven demonstrated superior response in our elderly patients and those with unfavorable risk through OS as well as CR/CRi, compared to those treated with traditional therapy. This held true across all ELN-2017 risk categories when examined by cox regression models (Table 1) and was most notable in the adverse risk subgroup. The mechanism by which smoking may enhance HMA+Ven survival is uncharacterized and warrants investigation. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Frequency of Surgical Site Infection in Emergency Appendicectomy for Complicated Appendicitis

Objective: To find out the frequency of surgical site infections in emergency appendectomy for complicated appendicitis Method: This cross-sectional study was conducted at Khyber Teaching Hospital, MTI, Peshawar from November 20, 2021 to August 12, 2022. We included 131 patients, who had undergone emergency appendectomy for complicated appendicitis. The sampling technique was consecutive non-probability sampling. Confidence interval of 95% and 7% margin of error were considered. The patients with complicated appendicitis on appendicect-omy were included in the study. Demographic data (age, gender), history of active smoking or diabetes mellitus at admission, procedure duration, appendicitis-type according to surgical findings (grossly inflamed, gangrenous, perforated), BMI were noted. All the data were collected on a proforma (Annex 1). SPSS software (version 23.0) was used for data analysis. Results: Out of 131 patients, 88 (67.2%) were males and 43 (32.8%) were females with mean age of 33±2.3 years and mean BMI of 26±5. Frequency of surgical site infections among clean, clean-contaminated, contaminated, and dirty wound infections were 5/17 (29%), 20/67 (30%), 13/30 (43%), and 8/17 (49%) respectively. The overall frequency of surgical site infection was 46/131 (35%). Out of these 46 cases, 25 (54.3%) were superficial SSIs, 14 (30.4%) were deep SSIs and 07 (15.2%) were deep/space occupying SSIs. Conclusion: In our study, the frequency of surgical site infections is 35% which is higher compared to other studies conducted. So proper preoperative and postoperative cares should be taken to decrease the frequency or incidence of surgical site infection in the department.

Woman with Neck Swelling

Woman with Neck Swelling

Acute Exacerbation of COPD in the Elderly with Chronic Hypertension, Suspected Meniere's Disease and History of Active Smoking

Background: Chronic Obstructive Pulmonary Disease (COPD) is a clinical symptom consisting of a group of chronic, progressive, and ongoing respiratory conditions. Meniere's Disease (MD) is a disorder of the inner ear characterized by hearing loss, tinnitus, and vertigo. Objective: Cases of COPD and MD in the elderly. Case: A 72-year-old man came to the primary clinic with the main symptoms of acute shortness of breath and vertigo. On physical examination there was an increase in the respiratory rate and wheezing in both lung fields and on the chest X-ray there was empphysematous lung. Neurological examination revealed hearing and balance problems. The patient was diagnosed with COPD and MD, with a history of active smoking for 30 years, and did not regularly visit the hospital. In this case, comprehensive interventions were carried out including Patient Centered, Family Focused, and Community Oriented. Conclusion: COPD and MD are chronic diseases that can cause acute symptoms and can recur, so that if they occur in the elderly it can reduce quality of life and mortality. Comprehensive intervention is needed to prevent the recurrence of dyspnea, vertigo, and complications.

DEPENDENCY RELATIONSHIP OF EXERCISE AND MEDICATION ADHERENCE IN HYPERTENSIVE PATIENTS

Objective: Few studies have examined the relationship between exercise and adherence to antihypertensive medication, examining all possible factors contributing to blood pressure control. The purpose of our study was to access the possible dependence relationship among hypertensive patients visiting the Behavioral Cardiology Unit in a Tertiary Hospital. Design and method: The study population consisted of patients reporting to the Behavioral Cardiology Unit in a Tertiary Hospital during a period of 6 months in 2021. In terms of holistic approach, all patients underwent a thorough clinical in-depth interview, using the Morisky Medication Adherence Scale (MMAS8), the Frail Questionnaire Screening Tool (Frailty Score) and the Patient Health Questionnaire-4 (PHQ-4). All patients also provided full history of exercise (at least 150 minutes of physical activity or 75 minutes of intense activity per week), while completing the Duke Activity Status Index (DASI). Results: The population consisted of 42 hypertensive patients, 54.8% of them were females, with a mean age of all patients at 55.8 ± 15.2 years. Body Mass Index was averaging at 27.6 kg/m2. Salt consumption above the daily suggested amount (&gt;5gr/day) was reported by 60% of patients, binge drinking by 43% of them, while 43% had a history of active smoking. High adherence was reported by 17 patients (46%), medium adherence by 14 (37.8%) and low adherence by 6 (16.2%). Results indicate a relationship between exercise and adherence to medication. More specifically, Chi-Square test showed statistical significance between exercise and medium medication adherence in MMAS8 (MMAS8: 6–7, p = 0.033). Moreover, statistical analysis showed significant relationship between exercise, frailty and PHQ-4 score. Particularly, patients with absence of exercise showed higher level of PHQ-4 score (F = 7.07, p = 0.011). Conclusions: Our study highlights the possible dependency relationship of exercise and adherence to medication. Results indicate that patients with good adherence to medication have better behavioral activation. There is need for further research in this domain, to confirm the findings.