Iatrogenic Origin Research Articles

Socio-Cultural Representations and Therapeutic Itineraries of Parents of Autistic Children Followed in the INSP’s Children’s Mental Health Services

Pervasive developmental disorders (PDD) remain little known to populations in developing countries. In black Africa their social representations remain strongly influenced by local belief systems. The general objective of this study was to understand the perceptions and representations of Ivorian parents vis-à-vis PDD. This was a mixed (qualitative and quantitative) prospective cross-sectional study with a descriptive aim that involved a sample of 49 parents. The sampling was of the qualitative type by multiple cases with reasoned choice by saturation. Our results showed that male parents were mostly aged between 40 - 49 years (48.98%) with a higher level of education (67.34%) while mothers were mostly aged between 30 - 39 (61.22%) and a higher level (30.61%). Autistic children were negatively perceived by their parents: either as a source of psychological suffering (82.85%), or as mysterious children who sacrificed their parents (44.66%), or as “bobo” children (mute children in common Ivorian language) (16.66%) or like rude children (13.34%). The supposed origin of the disorder according to the parents was mystical-religious (60.94%); natural (25%); hereditary (6.25%). In 6.25% of cases, PDD were assumed to be of unknown or iatrogenic origin attributable to vaccination (1.56%). 75.51% of parents said that in addition to conventional medical therapies, they also used traditional therapies. The use of this therapeutic alternative would be linked to the perceptions and beliefs that feed the socio-cultural representations of our respondents.

Contribution of endoscopy in high sinus inclusions, a case report

Introduction: This paper will discuss the management of iatrogenic displacement of the third molar (3M) into the maxillary sinus through a specific case that we have encountered. Observation: This case reports the atypical clinical history of an ectopic intra sinusal 3M of iatrogenic origin, associated with an inflammatory cyst. A 52-year-old man presented with chronic sinusitis and an oral-sinus communication 30 yr after the displacement of his 3M into the maxillary sinus. A minimally invasive multidisciplinary management using endoscopy was proposed to the patient as well as an 18-month follow-up reporting a normalization of his initial sinus symptoms. Discussion: An analysis of the literature concerning intra sinusal teeth was carried out, whatever their etiology, in order to situate our case and to be able to propose the least invasive procedure for these patients. The different surgical approaches are analyzed as well as the effectiveness of a multidisciplinary management. Conclusion: In this case, the simultaneous oral and nasal approach enabled a minimally invasive procedure. The endoscope is now part of the surgeon's therapeutic arsenal, and the training of practitioners in its use could greatly facilitate procedures.

ACUTE KIDNEY INJURY IN HOSPITALIZED PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19) AND LITERATURE REVIEW

The coronavirus disease 2019 (COVID-19) outbreak has quickly become a global pandemic. Most patients with COVID-19 have mild symptoms, but develop severe symptoms as well, which can include acute respiratory distress syndrome, septic shock, and multiple organ failure. Renal involvement is common, with a clinical presentation ranging from mild proteinuria to progressive acute renal failure requiring renal replacement therapy (RRT). An understanding of the pathophysiology and mechanisms of kidney injury and ARI in the context of critical illness and COVID-19 We conducted a literature review to identify the impact of COVID 19 infection on the occurrence of acute renal failure. We specifically analyzed kidney functions in COVID-19 patients and their relationship to mortality. Only acute renal failure (ARI) directly linked to SARS-CoV 2 infection is considered other causes of renal failure of hemodynamic, iatrogenic or other origin are excluded.

Transarterial Embolization for Spontaneous Soft-Tissue Hematomas: Predictive Factors for Early Death.

The aim of this retrospective monocentric study was to assess the safety and efficacy of spontaneous soft-tissue hematoma transarterial embolization (TAE) and to evaluate predictive factors for early mortality (≤30 days) after TAE for spontaneous soft-tissue hematoma (SSTH). Between January 2010 and March 2022, all patients referred to our hospital for spontaneous soft-tissue hematoma and treated by emergency TAE were reviewed. Inclusion criteria were patients: ≥18-year-old, with active bleeding shown on preoperative multidetector row computed tomography, with spontaneous soft-tissue hematoma, and treated by TAE. Exclusion criteria were patients with soft-tissue hematomas of traumatic, iatrogenic, or tumoral origin. Clinical, biological, and imaging records were reviewed. Imaging data included delimitation of hematoma volume and presence of fluid level. Univariate and multivariate analyses were performed to check for associations with early mortality. Fifty-six patients were included. Median age was 75.5 [9-83] ([Q1-Q3] years and 23 (41.1%) were males. Fifty-one patients (91.1%) received antiplatelet agent and/or anticoagulant therapy. All 56 patients had active bleeding shown on a preoperative CT scan. Thirty-seven (66.0%) hematomas involved the retroperitoneum. Median hemoglobin level was 7.6 [4.4-8.2] g/dL. Gelatine sponge was used in 32/56 (57.1%) procedures. Clinical success was obtained in 48/56 (85.7%) patients and early mortality occurred in 15/56 (26.8%) patients. In univariate and multivariate analysis, retroperitoneal location and volume of hematoma were associated with early mortality. Retroperitoneal location and volume of hematoma seem to be risk factors for early death in the context of TAE for spontaneous soft-tissue hematoma. Larger multicenter studies are necessary to identify others predictive factors for early mortality and to anticipate which patients may benefit from an interventional strategy with TAE.

562 ACQUIRED CORONARY FISTULA IN A PATIENT WITH CONGENITAL AORTIC STENOSIS TREATED WITH PERCUTANEOUS VALVULOPLASTY

Abstract Introduction coronary fistulas are abnormal communications between coronary arteries and an adjacent structure (vessel or cardiac chamber). They can be congenital or acquired and have traumatic, spontaneous or iatrogenic origin. Aim we report the case of a coronaro-cameral fistula in an asymptomatic 23-year-old male, with a congenital aortic stenosis treated with two percutaneous valvuloplasties in the first year of life, who was evaluated in our Division of Cardiology. Methods transthoracic echocardiography and angio-CT with 3D reconstructions were performed. Results echocardiography showed a dilated ventricle with ipertrabeculated aspect and a mildly reduced ejection fraction (47% Simpson), a moderate mitral regurgitation, a moderate/severe aortic insufficiency (PHT 242 ms) and a moderate aortic stenosis (valvular area 1.1 cm2; Gr max/mid 98/61 mmHg). In parasternal long axis view we appreciated a non-echogenic space between the aortic root and the right ventricle, communicating with left ventricular cavity. Angio-CT allowed us to appreciate a fistula connecting left ventricular outflow tract and right coronary artery, which was markedly dilated and tortuous. Surgical correction was deemed necessary for the patient, because of the severity of coronary dilatation and aortic and ventricular disfunction. Conclusions acquired fistulas are rare findings which can complicate surgical and non-surgical interventions. They are more often right-sided, but left fistulas have also been described. Integrated imaging is particularly useful for correct definition of anatomy and for surgical planning.

Spinal navigation with preoperative computed tomography

Safe placement of posterior cervical-sacral pedicle screws, S2-Ala-iliac screws, iliac screws, transarticular screws C1/2, translaminar screws C2 or cervical lateral mass screws under the guidance of spinal navigation. All posterior spinal instrumentations with screws: instabilities and deformities of rheumatic, traumatic, neoplastic, infectious, iatrogenic or congenital origin; multilevel cervical spinal stenosis with degenerative instability or kyphosis of the affected spinal segment. There are no absolute contraindications for spinal navigation. Cervical spine: Prone position on agel mattress, rigid head fixation, e.g., with Mayfield tongs; if appropriate, closed reduction under lateral image intensification; thoracic + lumbar spine: prone position on acushioned frame; midline posterior surgical approach at the level of the segments to be instrumented; if necessary, open reduction; insertion of the cervical/upper thoracic screws under the guidance of spinal navigation; if necessary, posterior decompression; instrumentation longitudinal rods; if fusion is to be obtained, decortication of the posterior bone elements with ahigh-speed burr and onlay of cancellous bone or bone substitutes. In stable instrumentations, no postoperative immobilization with orthosis is necessary, removal of drains (if used) 2-3days postoperatively (postop), removal of the sutures 14days postop, clinical and x‑ray controls 3and 12months postop or in case of clinical or neurological deterioration. Numerous studies showed that the use of spinal navigation significantly reduces implant malplacement rates, complications, and revision surgery. Furthermore, intraoperative radiation exposure to the operation team can be reduced by up to 90%.

Healthcare Practitioners Knowledge of Shoulder Injury Related to Vaccine Administration (SIRVA).

Background: Vaccine pharmacovigilance is at the forefront of the public eye. Shoulder Injuries Related to Vaccine Administration (SIRVA) is a poorly understood Adverse Event Following Immunisation, with iatrogenic origins. Criteria for medicolegal diagnosis of SIRVA is conflicting, current literature and educational materials are lacking, and healthcare practitioner knowledge of the condition is unknown. Methods: A cross-sectional, convenience sampled survey, utilising a validated online questionnaire assessed practitioner knowledge of SIRVA, safe injecting, and upper limb anatomy, and preferred definition for SIRVA. Results: Mean scores were moderate for safe injecting knowledge (69%), and poor for knowledge of anatomy (42%) and SIRVA (55%). Non-immunising healthcare practitioners scored significantly (p = 0.01, and < 0.05, respectively) higher than immunising practitioners for anatomy (2.213 ± 1.52 vs. 3.12 ± 1.50), and safe injecting knowledge (6.70 ± 1.34 vs. 7.14 ± 1.27). Only 52% of authorised vaccinators accurately selected a 40 × 20 mm area recommended for safe injecting. Majority (91.7%) of respondents thought nerve injuries should be included in the diagnostic criteria for SIRVA. Discussion and conclusions: Greater education and awareness of SIRVA is needed in all healthcare disciplines. Consensus regarding SIRVA definition is paramount for accurate reporting and improved future understanding of all aspects of SIRVA.

A CASE OF DISSEMINATED TUBERCULOSIS IN A IMMUNOCOMPETENT PATIENT: TB MENINGITIS, PLEURAL TB, INTESTINAL/PERITONEAL TB

Disseminatedtuberculosis (TB)isdenedas thepresenceoftwo or more noncontiguous sites resulting from hematogenous dissemination of Mycobacterium tuberculosis, occurring as a result of progressive primary infection, reactivation of a latent focus with subsequent spread or rarely through iatrogenic origin. Nowadays, the term miliary TB also refers to progressive and widely spread forms of pulmonary TB. It entails a hematogenous spreadofthediseasetoseveral organ.

Outcome after Surgery for Iatrogenic Acute Type A Aortic Dissection.

(1) Background: Acute Stanford type A aortic dissection (TAAD) may complicate the outcome of cardiovascular procedures. Data on the outcome after surgery for iatrogenic acute TAAD is scarce. (2) Methods: The European Registry of Type A Aortic Dissection (ERTAAD) is a multicenter, retrospective study including patients who underwent surgery for acute TAAD at 18 hospitals from eight European countries. The primary outcomes were in-hospital mortality and 5-year mortality. Twenty-seven secondary outcomes were evaluated. (3) Results: Out of 3902 consecutive patients who underwent surgery for acute TAAD, 103 (2.6%) had iatrogenic TAAD. Cardiac surgery (37.8%) and percutaneous coronary intervention (36.9%) were the most frequent causes leading to iatrogenic TAAD, followed by diagnostic coronary angiography (13.6%), transcatheter aortic valve replacement (10.7%) and peripheral endovascular procedure (1.0%). In hospital mortality was 20.5% after cardiac surgery, 31.6% after percutaneous coronary intervention, 42.9% after diagnostic coronary angiography, 45.5% after transcatheter aortic valve replacement and nihil after peripheral endovascular procedure (p = 0.092), with similar 5-year mortality between different subgroups of iatrogenic TAAD (p = 0.710). Among 102 propensity score matched pairs, in-hospital mortality was significantly higher among patients with iatrogenic TAAD (30.4% vs. 15.7%, p = 0.013) compared to those with spontaneous TAAD. This finding was likely related to higher risk of postoperative heart failure (35.3% vs. 10.8%, p &lt; 0.0001) among iatrogenic TAAD patients. Five-year mortality was comparable between patients with iatrogenic and spontaneous TAAD (46.2% vs. 39.4%, p = 0.163). (4) Conclusions: Iatrogenic origin of acute TAAD is quite uncommon but carries a significantly increased risk of in-hospital mortality compared to spontaneous TAAD.

An Unusual Case of Left Ventricular Outflow Tract Pseudoaneurysm

Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare condition with a wide range of causes and various clinical outcomes. The causes range from infections, trauma to the chest wall, and iatrogenic origins. We present a unique case of idiopathic LVOT pseudoaneurysm in a patient with no obvious clinical risk factors. (Level of Difficulty: Advanced.)

Quality and Characteristics of 4241 Case Reports of Lactic Acidosis in Metformin Users Reported to a Large Pharmacovigilance Database.

Metformin-associated lactic acidosis (MaLA) occurs rarely and is thus difficult to study. We analysed 4241 individual case safety reports of lactic acidosis (LA) that implicated metformin as a suspected drug reported to the pharmacovigilance database of Merck KGaA, Darmstadt, Germany. The primary objective was to review reports for quality and completeness of data to support diagnoses of MaLA. We also explored the correlations between reported biomarkers, and associations between biomarkers and outcomes. Records were analysed for completeness in supporting diagnoses of LA or metformin-associated LA (MaLA), against commonly used diagnostic criteria. Correlations between indices of exposure to metformin and biomarkers of LA and mortality were investigated. Missing data was common, especially for plasma metformin. Clinical/biomarker evidence supported a diagnosis of LA in only 33% of cases (LA subpopulation) and of MaLA in only 9% (MaLA subpopulation). The metformin plasma level correlated weakly with plasma lactate (positive) and pH (negative). About one-fifth (21.9%) of cases reported a fatal outcome. Metformin exposure (plasma level or dose) was not associated with increased mortality risk (there was a suggestion of decreased risk at higher levels of exposure to metformin). Plasma lactate was the only variable associated with increased risk of mortality. Examination of concomitant risk factors for MaLA identified renal dysfunction (including of iatrogenic origin) as a potential driver of mortality in this population. Despite the high frequency of missing data, this is the largest analysis of cases of MaLA supported by measurements of circulating metformin, and lactate, and pH, to date. Plasma lactate, and not metformin dose or plasma level, appeared to be the main driver of mortality in the setting of LA or MaLA. Further research with more complete case reports is required.

UNIFIED ALGORITHM OF REHABILITATION OF PATIENTS WITH OCCLUSIONAL DISORDERS OF IATROGENIC GENESIS COMBINED WITH VERTICAL MALOCCLUSION

Malocclusion is common dental diseases. According to epidemiological studies, occlusal pathology in the vertical plane is 5-7% among all anomalies. Occlusial problems contribute to the violation of basic body functions such as breathing, speech, chewing, which significantly impairs the quality of life of patients.Orthodontic treatment of adult patients has its own characteristics associated with the presence of concomitant pathology, as well as the inability to correct some pathologies only by orthodontic treatment. In the case of severe occlusion, complicated by tooth loss, a combination of surgical, orthodontic and prosthetic methods can achieve the best results. The key to successful treatment of such patients is a detailed diagnosis and a well-developed rehabilitation plan. Occlusive disorders, especially those that have arisen or been provoked as a result of dental treatment, usually lead to changes in all parts of the dental system and a number of complications. These structural changes usually make it difficult or sometimes impossible to conduct orthodontic treatment without the use of a set of special preparatory measures.&#x0D; The aim of our study: to propose a unified algorithm for complex dental rehabilitation of patients with occlusive disorders of iatrogenic origin in combination with vertical malocclusion and to prove its effectiveness.&#x0D; During 2019-2020, 55 patients with occlusive disorders of iatrogenic genesis in combination with pathology of occlusion in the vertical plane aged 23 to 47 years (mean age 36.1 ± 5.2 years) were examined, including 32 women and 23 men. Depending on the complaints and clinical manifestations, patients were divided into three groups. The first included 16 people with muscular manifestations, the second - 18 with disorders of the temporomandibular joint (TMJ) manifestations, the third - 21 people who, in addition to manifestations of TMJ and muscles, had primary neuritic disorders. All patients before and 6 months after treatment underwent clinical and laboratory examinations, radiography, electromyography and digital occlusion analysis of T-scan.&#x0D; There was a complete disappearance or significant reduction of complaints and symptoms after 6 months of rehabilitation in all 3 groups of patients. The implementation of our complex rehabilitation algorithm has led to the normalization of the bioelectrical activity of the masticatory muscles according to electromyography research, which is one of the most important criteria for the transition to the next stage of treatment and replacement of temporary restorations with permanent ones. Positive dynamics in the position of the TMJ condyles (tested with Computed Tomography) after the use of occlusal splints was observed in all patients and served as a marker for deciding to move to the next stage of dental treatment, including orthodontic correction. Also, occlusal balancing and normalization of the balance of occlusal contacts under the control of digital occlusal analysis T-Scan III was achieved in all patients in the preparatory stage and then monitored and maintained at all subsequent stages of comprehensive rehabilitation.&#x0D; Our study showed that the proposed algorithm for comprehensive rehabilitation of patients with iatrogenic occlusive disorders in combination with vertical malocclusion increases the effectiveness of orthodontic treatment of such patients and significantly reduces the duration of treatment in all 3 groups. This sequence of diagnostic and therapeutic measures provides the best opportunities for the patient to achieve maximum functional and aesthetic results.

Iatrogenic genito-urinary fistula following cesarean birth in nine sub-Saharan African countries: a retrospective review

BackgroundGenito-urinary fistulas may occur as complications of obstetric surgery. Location and circumstances can indicate iatrogenic origin as opposed to pressure necrosis following prolonged, obstructed labor.MethodsThis retrospective review focuses on 787 women with iatrogenic genito-urinary fistulas among 2942 women who developed fistulas after cesarean birth between 1994 and 2017. They are a subset of 5469 women who sought obstetric fistula repair between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia. We compared genito-urinary fistula classifications following vaginal birth to classifications following cesarean birth. We assessed whether and how the proportion of iatrogenic genito-urinary fistula was changing over time among women with fistula, comparing women with iatrogenic fistulas to women with fistulas attributable to pressure necrosis. We used mixed effects logistic regression to model the rise in iatrogenic fistula among births resulting in fistula and specifically among cesarean births resulting in fistula.ResultsOver one-quarter of women with fistula following cesarean birth (26.8%, 787/2942) had an injury caused by surgery rather than pressure necrosis due to prolonged, obstructed labor. Controlling for age, parity, and previous abdominal surgery, the odds of iatrogenic origin nearly doubled over time among all births resulting in fistula (aOR 1.94; 95% CI 1.48–2.54) and rose by 37% among cesarean births resulting in fistula (aOR 1.37; 95% CI 1.02–1.83). In Kenya and Rwanda the rise of iatrogenic injury outpaced the increasing frequency of cesarean birth.ConclusionsDespite the strong association between obstetric fistula and prolonged, obstructed labor, more than a quarter of women with fistula after cesarean birth had injuries due to surgical complications rather than pressure necrosis. Risks of iatrogenic fistula during cesarean birth reinforce the importance of appropriate labor management and cesarean decision-making. Rising numbers of iatrogenic fistulas signal a quality crisis in emergency obstetric care. Unaddressed, the impact of this problem will grow as cesarean births become more common.

Immune-Mediated Inflammatory Diseases Diagnosed In Internal Medicine Department at the University Hospital Center of the Point G: An Epidemiological and Clinical Overview

Background: Immune-mediated inflammatory diseases (IMIDs) characterized by three nosological entities, autoimmune diseases, auto inflammatory diseases and inflammatory diseases of undetermined mechanism, share in common the inflammatory process but their clinical and biological expressions are extremely diverse. A panoramic study of IMIDs could contribute to identify the epidemiological, immuno-genetical, environmental, pathophysiological and clinical disparities. We aimed in this work to describe epidemiological and clinical aspects of all IMIDs diagnosed in internal medicine department. Methods: We retrospectively analyzed data from patients hospitalized for IMIDs between 2018 and 2019.Results: 921 patients hospitalized from 2018 to 2019, 205 patients (56.10% female) presented with immune-mediated inflammatory disease, of which two cases of associations, which is 207 cases of IMIDs (22.48%). IMIDs were dominated by inflammatory diseases of undetermined mechanism (113 cases) followed by autoimmune diseases (84 cases) and auto inflammatory diseases (10 cases). Organ-specific autoimmune diseases (72 cases) dominated the autoimmune diseases: type 1 diabetes (40 cases), Graves' disease (13 cases) versus systemic autoimmune diseases (12 cases): rheumatoid arthritis (04 cases), systemic lupus erythematosus (03 cases). There were no cases of monogenic forms. “organ-specific” polygenic forms (07 cases) dominated the polygenic auto-inflammatory diseases: gout (02 cases), ulcerative colitis (02 cases) versus "systemic" polygenic forms (03 cases): Horton's disease (01 case). Inflammatory diseases of undetermined mechanism were dominated by neoplasia (109 cases): Solid tumor (77 cases) [hepatocellular carcinoma (14 cases), breast cancer (09 cases)] and hematological malignancies (31 cases) [non-Hodgkin's malignant lymphoma (14 cases), chronic myeloid leukemia (8 cases)] followed by paraneoplastic syndromes (02 cases) and inflammatory diseases of iatrogenic origin (02 cases). Conclusion: IMIDs is frequently diagnosed in internal medicine and dominated by inflammatory diseases of undetermined mechanism followed by autoimmune diseases and auto inflammatory diseases.

Retrospective assessment of the patients with disseminated tuberculosis

Background: Disseminated tuberculosis (TB) is defined as the presence of two or more noncontiguous sites resulting from hematogenous dissemination of Mycobacterium tuberculosis, occurring as a result of progressive primary infection, reactivation of a latent focus with subsequent spread, or rarely through iatrogenic origin. Hence; the present study was undertaken for assessing the patients with disseminated tuberculosis. Materials &amp; methods: A total of 50 patients who reported to the department and were confirmed with diagnosis of disseminated tuberculosis in the past one year. Complete demographic and clinical data of all the subjects was enrolled. Clinical profile of all the patients was recorded. Assessment of all the results was done using SPSS software. Results: Fever, malaise, weight loss and poor appetite were seen in 66 percent, 30 percent, 24 percent and 20 percent of the patients respectively. Cough, dyspnea, myalgia and joint pain was seen in 20 percent, 12 percent, 14 percent and 18 percent of the patients respectively. On chest imaging, consolidation, fibrotic change, miliary lesion and nodular change was seen in 16 percent, 10 percent, 50 percent and 8 percent of the patients respectively. Conclusion: Majority of the patients demonstrate clinical findings suggestive of disseminated TB.

Algorithm for the management of laryngeal obstruction in pediatrics

The larynx is at the aerodigestive crossroads; any pathology that involves it will have an impact on breathing, swallowing and/or the voice. It`s divided into three regions: supraglottis (includes epiglottis, ventricular bands and laryngeal ventricles), glottis (space limited by the vocal cords) and subglottis (narrowest area of pediatric airway and the only point of larynx completely surrounded by cartilage: the cricoid ring). Laryngeal obstruction can present as a potentially fatal acute condition or as a chronic process. The main symptom is inspiratory or biphasic stridor. The etiology varies widely according to age and it may be of congenital, inflammatory, infectious, traumatic, neoplastic or iatrogenic origin. We describe the pathologies that cause laryngeal obstruction, either those that occur very often or those which are important for their severity, their guiding symptoms to the presumptive diagnosis, additional studies and treatment.

Sexual functioning in patients with cancer

IntroductionSexuality is a growing field in the context of the management of chronic diseases and cancer in particular. Cancer treatments and the traumatic nature of the cancer experience frequently elicit considerable sexual difficulties.ObjectivesTo assess the prevalence of sexual dysfunction (SD) in patients with cancer, and to determine the associated factors.MethodsThis was a cross-sectional study, conducted over 1 month, involving 100 cancer patients followed in the oncology department at the Habib Bourguiba University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. Sexual function was assessed with the “Female sexual Function Index” and the “International Index of Erectile Function”.ResultsThese results showed that half of the patients were female, and 70% of them were married. Their mean age was 51.96, and 68% of them were unemployed. Unemployment in men and treatment with chemotherapy were statistically associated with erectile dysfunction (p=0.049 and p= 0.001 respectively). treatment with radiotherapy was statistically associated with decreased desire in men (p=0.048). Depression correlated with a decreased orgasm (p=0.032) and erectile dysfunction (p=0.043) in men, mean score of IIEF (p= 0.019) and with a decreased sexual arousal (p=0.006) in women.ConclusionsSexual dysfunction is common in cancer patients. They can be of iatrogenic or psychological origin and can depend on the dynamics of the couple relationship. Training to raise awareness of the importance of sexuality first among cancer patients should be considered given the lack of communication between doctors and patients regarding sexuality issues.DisclosureNo significant relationships.

Mydriasis caused by ESCITALOPRAM: Case report

IntroductionSerotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants thanks to the overall safety and tolerability spectrum. However, they can cause different side effects that not all of them are well identified.ObjectivesWe intend to clarify the clinical presentation of mydriasis caused by Escitalopram.MethodsReporting the case of a patient suffering a major depressive disorder, that presented a mydriasis after adjusting her antidepressant medication. Then, we conducted a literature review using “PubMed” database and keywords “Mydriasis”, “escitalopram”, “SSRI”,” side effects”.ResultsA 29-year-old female with no past clinical history, presented in May 2021 a severe depression requiring an antidepressant treatment. Under 10 mg per day of escitalopram there was a partial remission of the symptoms, leading to increase the dose by another 10 mg. One month after taking 20 mg/day, she consults before the appointment suffering from a blurry vision and photophobia. Ophthalmologic examination showed a bilateral reactive half-mydriasis, eye pressure was 14 mmHg and fundus examination was normal. Iatrogenic origin of mydriasis was suspected. A gradual interruption of the medication lead to disappearance of the latter. A pharmacological investigation concluded to the suspension of escitalopram and to be vigilant if antidepressant medication would be needed.ConclusionsMydriasis is an uncommon side effect caused by SSRI that needs to be kept in mind by clinicians. Therapeutic patient education can help to detect abnormal side effects and treat them if needed.DisclosureNo significant relationships.

MO931: Serum Uric Acid—A Marker of Malnutrition and Mortality in Patients Undergoing Maintenance Haemodialysis

Abstract BACKGROUND AND AIMS Malnutrition in patients on maintenance haemodialysis (HD) develops along different pathways, and factors contributing to the development of malnutrition may be categorized as of iatrogenic and non-iatrogenic origins. Iatrogenic factors are an inadvertent consequence of dialysis for HD patients (e.g. removal of uremic solutes), whereas non-iatrogenic factors develop spontaneously from different factors accompanying the progression of kidney disease but are not related to the primary treatment (e.g. low dietary energy and protein intake). Malnutrition is prevalent in 28%–54% HD patients and is an important risk factor for mortality. The aim of our study was to investigate the impact of serum uric acid (SUA) and other non-invasive markers of malnutrition on the survival of maintenance HD patients. METHOD We performed a study on 77 HD patients without malignant disease who were observed from January 2016 until their death or January 2021. Their median age was 63.0 (IQR 19) years, and their dialysis vintage was 1449 (IQR 1848) days. We recorded past medical history, laboratory tests and basic demographic data and performed bioelectrical impedance analysis with BodyStat (BodyStat Ltd). Patients who were at risk for malnutrition, based on nutrition screening tools, received oral nutritional supplements (ONS). SUA was measured every 2 months and the mean value was used for analysis. Kaplan–Meier survival analysis and Cox's regression were performed. RESULTS Included patients (51.9% males) had diabetes mellitus (33.8%), arterial hypertension (87.0%), ischemic heart disease (24.7%), chronic obstructive lung disease (3.9%), liver disease (3.9%) and were smokers (14.3%). They received an ONS in 63.6%. During the observation period, 50.6% of them died. We created tertile groups (low, medium and high) based on mean SUA &amp;lt; 294 μmol/L, 294–337 μmol/L and &amp;gt; 337 μmol/L, respectively. The low group had significantly lower body mass index (BMI) (P = 0.044), total iron binding capacity (TIBC) (P = 0.001), phase angle (P = 0.003) and dry lean mass (DLM) (P = 0.048), however there were no significant differences in prescription of ONS (P = 0.092). Kaplan–Meier survival analysis showed significantly higher mortality for patients in the low tertile group (P = 0.004). In Cox's regression model, SUA remained significant when adjusted for age, sex, BMI and comorbidities (P = 0.026). However, when adjusting for other markers of malnutrition and receiving ONS, only phase angle, albumin, DLM, fat free mass index and TIBC remained statistically significant. CONCLUSION Low SUA levels in chronic HD patients are associated with lower survival and can help identify individuals who are at risk for malnutrition. Further studies should be done to guide possible interventions.

Unusual Localization of Fibroelastoma of the Heart in Patient with Previous Chest Radiotherapy

Cardiac papillary fibroelastoma is a rare, benign, slow –growing tumor of endocardium that my have a malignant propensity for live-threatening complications. The histogenesis remains controversial; an iatrogenic origin has been suggested. Localization in the left ventricular outflow tract is extremely rare. We describe a case of left ventricle fibroelastoma in patient with previous chest radiotherapy, seeming to support the iatrogenic hypothesis.