Median IQR Research Articles

Association between stroke subtypes and outcomes of endovascular therapy: a post-hoc analysis of the ANGEL-ASPECT Trial

ObjectivesOur study aims to examine the value of endovascular therapy (EVT) and its comparison to medical management (MM) in ischaemic stroke patients accompanied by large artery atherosclerosis (LAA) and non-LAAMethodsmodified...

The 1-min sit-to-stand test as a screening tool to assess exercise-induced oxygen desaturation in normoxemic people with interstitial lung disease

BackgroundIn patients with interstitial lung disease (ILD), exercise-induced desaturation during the 6-min walk test (6MWT), specifically nadir oxygen saturation (nSpO2) of ≤88 % is a negative prognostic marker. As the 6MWT is often impractical for ILD patients, the aim of this study is to compare the 1-min sit-to-stand test (1minSTS) with the 6MWT to detect exercise-induced desaturation. MethodsParticipants were recruited from a tertiary referral clinic with both tests performed on the same day. Utilising Bland-Altman analysis, the relationship between nSpO2 on 1minSTS and 6MWT was determined. An area under the receiver operating characteristic curve (AUC) determined the ability of nSpO2 on 1minSTS test to predict SpO2 ≤88 % on 6MWT. ResultsFifty participants completed the study (idiopathic pulmonary fibrosis n = 24, 48 %; connective tissue disease associated ILD n = 20, 40 %; other ILD n = 6, 12 %). Mean (SD) FVC%pred was 73 ± 16 %, mean DLCO%pred 57 ± 16 % and resting SpO2 99 ± 1 %. The 1minSTS resulted in less exercise-induced oxygen desaturation, with a median IQR nSpO2 of 95 % (89–98) and 93 % (85–96) respectively (p < 0.001). Moderate agreement was determined between the nSpO2 on both tests, with a mean difference of 3.2 % [-14 to +3.0 %]. The 1minSTS test accurately identified participants with nSpO2 ≤88 % on 6MWT (AUC 0.96). Oxygen desaturation ≤94 % during the 1minSTS test provided 100 % sensitivity and 87 % specificity for oxygen desaturation ≤88 % at 6MWT. ConclusionThis study demonstrates that exercise-induced oxygen desaturation during the 1minSTS test correlates with oxygen desaturation on 6MWT. The 1minSTS may be a practical screening tool for ILD patients who would benefit from further exercise testing.

Prognostic significance of 68Ga-FAPI PET/CT in patients with bone metastases in various cancers.

This study aimed to compare 18FDGPET/CT in patients who develop bone metastases due to various cancers and to investigate the prognostic significance of the 68FAPI-PET/CT SUVmax value for survival. Patients with bone metastases who underwent both 68Ga-FAPI PET/CTand18FDGPET/CT within a 1week period were included in this retrospective study. The effect of the SUVmax value of bone lesions on overall survival was analyzed. A total of 75 eligible patients with 139 bone lesions were included in this study. The median age of the patients was 55 (30-83) and 48(64%) patients were newly diagnosed. The primary lesion median 68Ga-FAPI PET/CT SUVmax value was higher than the median 18FDGPET/CT SUVmax (10.75 versus 6.7). Bone lesions 68Ga-FAPI PET/CT SUVmax median (IQR) were 7.8 (4.6-13.2), and 18FDGPET/CT SUVmax of bone lesions were 5.9 (3.8-8.2). More bone lesions were detected on 68Ga-FAPI PET/CT than on 18FDGPET/CT(median IQR 4 [1-9] versus 2 [1-6] (p = 0.014). The extra lesions observed on 68Ga-FAPI PET/CT were mostly sclerotic bone lesions (p = 0.001).68Ga-FAPI PET/CT SUVmax was significantly higher in vertebra and thorax lesions (p = 0.011 and p = 0.018, respectively). While the bone lesion 68Ga-FAPI PET/CT SUVmax affected the OS, the 18FDGPET/CT SUVmax value did not affect the OS (p < 0.001 and p = 0.079, respectively). In ROC analysis, a cut-off-off value of 68Ga-FAPI PET/CT SUVmax > 7.7 was found for OS (AUC: 0.619). The median OS in the group above the cut-off value was worse than that in the group below the cut-off value (32 versus 45) months (p = 0.002). In the multivariate analysis for OS, the 68Ga-FAPI PET/CT SUVmax of bone lesions was an important parameter, as well as cancer subtype, ALP level, and disease occurrence. 68Ga-FAPI PET/CT detected more bone lesions and higher SUVmax values than 18FDGPET/CT in various cancers. The prognostic value of the SUVmax value of 68Ga-FAPI PET/CT bone lesions was observed regardless of disease subtype.

OA36 Systemic juvenile idiopathic arthritis: the Great Ormond Street Hospital experience (2005-2021)

Abstract Background/Aims sJIA is a complex, systemic-inflammatory disorder. The proposed biphasic model of disease suggests that unchecked early auto-inflammation driven by increased innate immune activation, including dysregulation of IL-1 and IL-6, may lead to a state of chronic T-lymphocyte activation. This leads to an unfavourable balance of T-effector and regulatory cells that can drive chronic arthritis over time. It is therefore unsurprising that there is growing evidence to support instigation of IL-1 or IL-6 blockade as first-line treatment in sJIA. Early cytokine antagonist therapy could abrogate development of a population of these arthritis-causing T-cells to avert chronic systemic inflammation and arthritis. Aims: 1) describe clinical presentations, therapeutic interventions, complications, and remission rates at different time-points over disease course in sJIA; 2) identify potential therapeutic signals in patients with sJIA who received biologic treatment early in disease course compared to those who did not. Methods Retrospective review of all patients with sJIA at GOSH (02/10/05-21/10/21, inclusive). Data collected: patient demographics; clinical and laboratory data; treatment history; adverse events. Time-points for data collection: at diagnosis; 3-months; 1-year; last follow-up. Descriptive statistics reported as median and range or IQR for continuous variables, and as absolute frequencies and percentages for categorical variables. Comparisons of quantitative variables were made by Mann-Whitney U-test. Categorical data were compared using Fisher’s exact test (p-values&amp;lt;0.05 were considered significant). Results A total of 76 children (female n = 40, 53%) were diagnosed with sJIA; median age was 4.5 years (range 0.6-14.1). A biologic disease modifying anti-rheumatic drug (bDMARD) alone was commenced as first-line treatment in 28% (n = 21/76) of the cohort; however, at last review, 84% (n = 64/76) had received treatment with a bDMARD. Clinically inactive disease (CID) was achieved by 88% (n = 67/76) of the cohort at last review; however, only 32% (24/76) achieved treatment-free CID. At 1-year follow-up, CID was achieved in a significantly greater proportion of children who received treatment with a bDMARD within 3-months of diagnosis compared to those who did not (90% versus 53%, p = 0.002). Conclusion We propose a UK treatment-algorithm for children diagnosed with sJIA (see figure). We recommend reappraisal of the current NHS England commissioning policy. Disclosure C. Foley: None. D. McKenna: None. K. Gallagher: None. K. McLellan: None. H. Alkhdher: None. S. Lacassagne: None. E. Moraitis: None. C. Papadopoulou: None. C. Pilkington: None. M. Al Obaidi: None. D. Eleftheriou: None. P. Brogan: None.

Microwave versus endovenous laser in great saphenous vein ablation: a randomized controlled clinical study

Background Due to the global burden of varicose veins (VVs) and the impact on the quality of life (QoL) of patients, it is essential to search for better treatment modalities. Objectives The main objective of this research was to compare the efficacy, safety, and impact on the QoL of endovenous microwave ablation (EMA) and endovenous laser ablation (EVLA) for the management of varicose veins of the great saphenous vein (GSV). Methods A comparative, multicenter, single-blinded, parallel randomized controlled study conducted on 340 patients confirmed to have primary VVs of the GSV who were further randomized into two groups. The study group (n=170) received EMA, and the control group (n=170) received EVLA. Results Both the study group and the control group were comparable with regard to their baseline characteristics (P values &gt; 0.05). The study group and the control group were comparable with regard to the limb affected (P=0.184). Only 14.7% and 10.0% of the study group and the control group have both limbs affected. Both the study group and the control group were comparable with regard to CEAP classification (P=0. 068). The study group and the control group were significantly different with regard to operating time (P&lt;0.001). The operating time is less in the study group than in the control group. The median (IQR) and the mean±SD of the operating time was 7 (4) and 8.7±4.1 min in the study (microwave) group and 9 (5) and 10±3.9 min in the control group. Also, the study group and the control group showed 100% success at the 1-week evaluation as none of the cases in both groups suffered recanalization. At 6-month evaluation, only 1 case in the study group and 2 cases of the control group experienced recanalization; however, the difference is not significant (P=0.537). At the 12-month evaluation, the study group and the control group showed 100% success as none of the cases in both groups suffered recanalization. QoL is better in the study group than the control group at 6 months Aberdeen score (P=&lt; 0.001). The median IQR and the mean±SD of the postoperative Aberdeen score were 9 (2.7) and 9.3±1.7 in the study (microwave) group and 10.8 (3.4) and 10.8±1.8 in the control group. Moreover, the study group and the control group were comparable (P values &gt; 0.05) with regard to adverse events except for paresthesia (P-value = 0.025). About 11.2% of the control group experienced paresthesia versus only 2.9% of the study group. Conclusion In conclusion, EMA has a lower operating time than EVLA. EMA is as effective as EVLA for treating VVS of the GSV. EMA has fewer adverse events than EVLA. EMA has better QoL than EVLA ablation. However, the choice of treatment should be based on individual patient characteristics and the expertise of the treating physician.

The Effect of Epidural Analgesia on Quality of Recovery (QoR) after Open Radical Nephrectomy: Randomized, Prospective, and Controlled Trial.

No studies are currently evaluating the quality of recovery (QoR) after open radical nephrectomy (ORN) and epidural morphine analgesia. This was a randomized, prospective, and controlled study that explored the QoR on the first postoperative day after ORN. Eighty subjects were randomized into two groups. The first group received general anesthesia combined with epidural anesthesia and postoperative epidural analgesia with morphine and ropivacaine. The second group received general anesthesia and continuous postoperative intravenous analgesia with tramadol. Both groups received multimodal analgesia with metamizole. The primary outcome measure was the total QoR-40 score. The secondary outcome measures were QoR-15, QoR-VAS, and the visual analog scale (VAS) for pain, anxiety, and nausea. The median difference in the QoR-40 score after 24 postoperative hours between the two groups of patients was 10 (95% CI: 15 to 5), p < 0.0001. The median score and IQR of QoR-40 during the first 24 postoperative hours in the epidural group was 180 (9.5), and in the control group, it was 170 (13). The general independence test for secondary outcomes between groups was significant (p < 0.01). QoR-VAS was correlated with QoR-40 (r = 0.63, p ≤ 0.001) and with QoR-15 (r = 0.54, p ≤ 0.001). The total QoR-40 and QoR-15 alpha coefficients with a 95% CI were 0.88 (0.85-0.92) and 0.73 (0.64-0.81), respectively. There was a significant difference in the QoR between the epidural and the control groups after ORN. The QoR-40 and QoR-15 showed good convergent validity and reliability.

Potential role of salivary vitamin D antimicrobial peptide LL-37 and interleukins in severity of dental caries: an exvivo study

IntroductionVitamin D performs various functions as a hormone by promoting calcium absorption but plays a major role in innate immunity,cell differentiation, cell maturation through its genomic effects via vitamin D receptor. The immune response also plays a major role in tooth surface and supporting structure destruction and playing a major factor in high caries formation. The inflammatory cytokines are released has proinflammatory cytokines and stimulate cells in disease process. Therefore, in the present study we have evaluated the association of salivary vitamin D, LL-37, interleukins 6 and 17A in various levels of severity of dental caries.MethodEthical approval was obtained (NU/CEC/2020/0339), 377 individuals reporting to department of conservative dentistry and endodontics, AB Shetty memorial institute of dental sciences were included based on inclusion criteria. The individuals were further divided into caries free(N = 105) and caries active(N = 272) based on their caries prevalence. The salivary were collected and evaluated for vitamin D, LL-37,IL-17A and IL-6.Results were statistically analysed with SPSS vs 22 (IBM Corp, USA). Normally distributed data were expressed as mean ± SD. Skewed data were expressed as median and interquartile range. To compare (mean) outcome measures between the two groups unpaired independent t-test was applied and for values in median IQR, Mann Whitney U test was used. All statistical analysis for P value were two-sided and significance was set to P ≤ 0.05.ResultsThe study showed that, the salivary vitamin D statistically decreased with increasing severity of caries which showed that vitamin D plays an important role in prevention of caries. Antimicrobial peptide LL-37 was higher in caries free group but was not statistically significant, salivary IL-6 level was higher in caries active group but intergroup comparison did not show significant difference. Salivary IL-17A did not show statistically significant between caries active and caries free group.ConclusionThe salivary levels of vitamin D may play a vital role in prevalence of dental caries and its severity which can be a underlying cause in presence of other etiological factors.

A Survey of PICU Clinician Practices and Perceptions regarding Respiratory Cultures in the Evaluation of Ventilator-Associated Infections in the BrighT STAR Collaborative.

To characterize respiratory culture practices for mechanically ventilated patients, and to identify drivers of culture use and potential barriers to changing practices across PICUs. Cross-sectional survey conducted May 2021-January 2022. Sixteen academic pediatric hospitals across the United States participating in the BrighT STAR Collaborative. Pediatric critical care medicine physicians, advanced practice providers, respiratory therapists, and nurses. None. We summarized the proportion of positive responses for each question within a hospital and calculated the median proportion and IQR across hospitals. We correlated responses with culture rates and compared responses by role. Sixteen invited institutions participated (100%). Five hundred sixty-eight of 1,301 (44%) e-mailed individuals completed the survey (median hospital response rate 60%). Saline lavage was common, but no PICUs had a standardized approach. There was the highest variability in perceived likelihood (median, IQR) to obtain cultures for isolated fever (49%, 38-61%), isolated laboratory changes (49%, 38-57%), fever and laboratory changes without respiratory symptoms (68%, 54-79%), isolated change in secretion characteristics (67%, 54-78%), and isolated increased secretions (55%, 40-65%). Respiratory cultures were likely to be obtained as a "pan culture" (75%, 70-86%). There was a significant correlation between higher culture rates and likelihood to obtain cultures for isolated fever, persistent fever, isolated hypotension, fever, and laboratory changes without respiratory symptoms, and "pan cultures." Respondents across hospitals would find clinical decision support (CDS) helpful (79%) and thought that CDS would help align ICU and/or consulting teams (82%). Anticipated barriers to change included reluctance to change (70%), opinion of consultants (64%), and concern for missing a diagnosis of ventilator-associated infections (62%). Respiratory culture collection and ordering practices were inconsistent, revealing opportunities for diagnostic stewardship. CDS would be generally well received; however, anticipated conceptual and psychologic barriers to change must be considered.

In Hospital Mortality and Short-Term Outcomes of Acute Ischemic Stroke Patients Contracting SARS CoV-2 Infection: Experience from a Dedicated Stroke Unit in Bangladesh

Background: The influence of COVID-19 on in hospital mortality and short-term outcome of acute ischemic stroke is not well known. Objective: The purpose of the present study was to analyze the overall impact of COVID-19 patients and 30-day outcomes of acute ischemic stroke patients. Methodology: This was a hospital-based case-control study from February to May 2021 conducted in stroke unit of National Institute of Neurosciences and Hospital. Consecutive ischemic stroke patients contracting COVID-19 infection was considered as case group and similar patients, negative for SARS CoV-2 on RT-PCR from nasal swab were considered for control group following the inclusion and exclusion criteria. Results: A total number of 50 cases and 99 similar control were taken. Although a significant proportion of control group were male (76.8% vs 50%), there was similar age distribution in both groups. Diabetes and Multiple comorbid conditions and lymphopenia were significantly (p value of &lt;0.001) more common among the case (1% versus 22%, 28.3% versus 56% and 5.1% versus 54%) in contrast to hypertension and lymphocytosis which was more frequent in control group (42.4% versus 10% and 94.9% versus 46%). Though the cases had a significantly (p value &lt;0.001) higher NIHSS score at admission (median IQR 7 versus 13) and longer hospital stay (median IQR 6 days versus 14 days). Male stroke patients were 4.7 times more likely to die in-hospital compared to female patients. The risk of mortality were 5 times higher among cases. Conclusion: COVID positive stroke cases have more severe disease at admission and longer hospital stays and the risk of mortality is 5 times higher in COVID positive stroke cases with a significant male dominance. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):11-15

Management of Vestibular Schwannoma

Background Vestibular schwannoma (VS) is considered histologically a benign tumor and is currently preferred over the older term (Acoustic neuroma) as it usually arises from the inferior division of the vestibular nerve and not the acoustic nerve in the cerebellopontine angle. VS were one of the most common intra cranial tumors, comprising 8-10% of tumors in most series. Annual incidence is probably about 1.5 cases per 100,000 population, over the past couple decades this estimate has increased and the typical size at the initial diagnosis has decreased as a result of the advances in the MRI scans &amp; CT scan qualities, (VS) is found to be occurring among middle age groups with no gender prevalence in the fourth or fifth decade. Aim of the Work To evaluate the VS management especially partial resection of large VS followed by gamma knife. Patients and Methods This study is a retrospective prospective study. This study was carried out at Al-Demerdash University hospital, the authority of specialized institutes and teaching hospitals and international medical Centre (Gamma knife department). Time of the study: from March 2019 till March 2021. Results In this study we found that according to the demographic, characteristics &amp; personal history of the study group, it is noted that vestibular shwannoma is common among middle aged group (mean =41 years), with no substantial difference between genders (53% F &amp; 47% M), we found that as regard the clinical picture, most of patients suffered from hearing loss as a complaint (88%) of about 3.5 months duration (median IQR) while all the patients (100%) had a sensory neural sensory loss and verified by PTA, SDT &amp; word discrimination, tinnitus &amp; unsteadiness were found in 70% &amp; 50% respectively. This study has some limitations which are small populations of patients with vestibular schwannoma who generally have short follow-up. We include patients with heterogeneous tumors in regard to size and hearing status. Further studies needed with large populations to establish our results. Conclusion We concluded that considering the good tumor growth control and facial nerve function preservation as well as the possibility of preserving serviceable hearing and the low number of complications, subtotal resection followed by Gamma knife can be the treatment option of choice for large Vestibular schwannoma.

Comparative Analysis of Human Cystatin C Levels in Migraine without Aura and Healthy Controls

Objective: To compare the levels of human cystatin c (novel biomarker) as well as the association of other parameters in migraine patients without aura and healthy controls.&#x0D; Study Design: Cross-sectional, comparative study.&#x0D; Place and Duration of Study: The research was conducted at IMBB Physiology Department, University of Lahore, Lahore Pakistan, from May 2021 to Jun 2022.&#x0D; Methodology: After taking history, a detailed clinical examination was conducted of participants in both cases and controls of the study. A proforma was filled and a non-probability convenience sampling technique was used. The blood samples weredrawn, centrifuged to isolate serum and analyzed concentration of serum cystatin C levels were measured by using enzyme linked immunosorbent assay (ELISA). SPSS version 22 was used for statistical analysis. Mann-Whitney U test was used to determine the median IQR values of both groups and p-value&lt;0.05 was considered significant.&#x0D; Results: Among cases 19(47.5%) were male and 21(52.5%) were female. Mean age of cases and controls was 25.57±5.93 and 26.15±7.19 years. The most frequent occupation among cases and controls was student, doctors, nurses and house wives. Among cases only 3(7.5%) patients were currently smokers while among controls 3(7.5%) were currently smokers. Among cases body mass index of 11(27.5%) patients were 30 and 4(10%) participants in controls had body mass index as 30. The most frequent symptom was photophobia followed by nausea, phonophobia, vomiting and atypical features. All these features were significantly higher&#x0D; Conclusion: Study concluded that patients with migraine without aura have elevated levels of cystatin C in their

A national survey of knowledge, attitude, practice, and barriers towards pharmacovigilance and adverse drug reaction reporting among hospital pharmacy practitioners in the United Arab Emirates

BackgroundPharmacovigilance (PV) is an essential component of patient safety and pharmacists are expected to be aware of the PV processes and willing to report ADRs. This study assessed the hospital pharmacists’ knowledge, attitude, and practice toward PV, barriers faced by them in ADR reporting, and factors influencing ADR reporting.MethodA cross-sectional nationwide questionnaire survey was conducted among randomly chosen hospital pharmacists across UAE from March to July 2022. The filled questionnaires were assessed both descriptively [median (IQR scores), maximum 5 for Likert type and 1 for knowledge questions] and inferentially using the Mann–Whitney U test (for dichotomous variables) and the Kruskal–Wallis test (for variables with more than two responses) at alpha value = 0.05. Post hoc analyses and correlations were performed wherever applicable.ResultsOf the 342 respondents, the majority were knowledgeable about the concepts of PV (93.3%; n = 319) and ADRs (86.8%; n = 297). The overall median (IQR) knowledge score was 5 (3–7)/9. Knowledge levels within ‘qualification groups’ varied significantly (p-value < 0.001) and participants ‘between 10 and 14 years of experience’ had more knowledge than those ‘with < 5 years of experience’ (p-value < 0.001, Bonferroni test). The overall median (IQR) attitude score was 22 (20–24)/30. Most respondents (90.6%; n = 311) were willing to spare time to review patients’ ADR reports. The overall median (IQR) practice score was 17.5 (11–21)/24. Although 71.1% (n = 243) noticed ADRs during the previous year, only 53.2% (n = 182) reported an ADR, the reasons for underreporting being mainly due to a lack of proper training [median IQR score 4(4–5)/5]. The ‘clinical pharmacists’ engaged themselves more in pharmacovigilance than ‘pharmacists’ (p-value = < 0.001), and ‘inpatient pharmacists’ reported more ADRs than ‘pharmacists’ (p-value = 0.018); Bonferroni test. The overall median (IQR) barrier score was 26 (23–29)/40 and the common barrier was ‘lack of awareness about the national ADR reporting system 4 (4–5)’. The pharmacists in this study suggested incentives for reporting ADRs (69.3%; n = 237).ConclusionThe authors concluded professional training courses for practicing pharmacists and educational curriculums related to PV and ADR reporting processes are to be considered for future pharmacists in order to inculcate ADR reporting culture and practices.

Anti-Cytosolic 5'-Nucleotidase 1A in the Diagnosis of Patients with Suspected Idiopathic Inflammatory Myopathies: An Italian Real-Life, Single-Centre Retrospective Study.

Anti-cytosolic 5'-nucleotidase 1A (anti-cN1A) antibodies were proposed as a biomarker for the diagnosis of inclusion body myositis (IBM), but conflicting specificity and sensitivity evidence limits its use. Our study aimed to assess the diagnostic accuracy of anti-cN1A in a cohort of patients who underwent a myositis line immunoassay for suspected idiopathic inflammatory myopathies (IIM). We also assessed the agreement between two testing procedures: line immunoassay (LIA) and enzyme-linked immunoassay (ELISA). We collected retrospective clinical and serological data for 340 patients who underwent a myositis antibody assay using LIA (EUROLINE Autoimmune Inflammatory Myopathies 16 Ag et cN-1A (IgG) line immunoassay) and verification with an anti-cN1A antibody assay using ELISA (IgG) (Euroimmun Lubeck, Germany). The serum samples of 20 (5.88%) patients (15 females, 5 males, mean age 58.76 ± 18.31) tested positive for anti-cN1A using LIA, but only two out of twenty were diagnosed with IBM. Seventeen out of twenty tested positive for anti-cN1A using ELISA (median IQR, 2.9 (1.9-4.18)). Our study suggests excellent concordance between LIA and ELISA for detecting anti-cN1A antibodies. LIA may be a rapid and useful adjunct, and it could even replace ELISA for cN1A assay. However, the high prevalence of diseases other than IBM in our cohort of anti-cN1A-positive patients did not allow us to consider anti-cN1A antibodies as a specific biomarker for IBM.

700-P: Outcomes of a Diabetes Support Coach Intervention Implemented during the COVID-19 Pandemic

During the COVID-19 pandemic, people with diabetes reported increased diabetes distress and difficulty maintaining glycemic control. These challenges were exacerbated for racial minorities and those with low socioeconomic status. As part of a Project Extension for Community Healthcare Outcomes (ECHO) program, an intervention using 28 diabetes support coaches (DSCs), adults with diabetes who served as peer mentors and healthcare navigators, was implemented with underserved patients with type 1, type 2, and other forms of diabetes at 41 federally qualified health centers in FL and CA (intervention n=74, control n=363). Patients self-enrolled and engaged with DSCs via 1-1 weekly text messages, phone calls, or virtual meetings. Patients’ HbA1c was measured at baseline and 6-month follow-up. The Diabetes Distress Scale (DDS-17), Coronavirus Anxiety Scale (CAS-19), and a survey of diabetes technology use and COVID-19 outcomes were also administered. Descriptive statistics were computed for all metrics (n, %; median IQR for skewed data). Between-group comparisons were evaluated via Chi-Square tests for categorical data and t-tests for continuous data. Diabetes distress was significantly lower among the intervention group [DDS-17 score median=1.6] than controls [DDS-17 score median=2.1] (p=.0077). More patients in the intervention regularly used a continuous glucose monitor (CGM) (69.9% vs. controls: 38.8%, p&amp;lt;.001). There were no significant differences between groups in insulin pump use, HbA1c, COVID-19 anxiety, or other COVID-19 outcomes. The latter results were likely due to the COVID-19 survey evaluating structural outcomes like financial stability that were beyond the scope of the DSC intervention. Overall findings demonstrate that DSCs reduced diabetes distress and improved CGM use among underserved patients with diabetes. Support coaching is valuable for this population; further research is needed to improve their HbA1c levels and COVID-19 outcomes. Disclosure J.Maizel: None. S.C.Westen: None. K.K.Hood: Consultant; Cecelia Health. J.J.Wong: None. B.Dixon: None. S.L.Filipp: None. M.J.Gurka: None. A.F.Walker: None. M.J.Haller: Board Member; SAB Biotherapeutics, Inc., Consultant; Sanofi, MannKind Corporation. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. A.Addala: None. R.Lal: Advisory Panel; Provention Bio, Inc., Consultant; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Deep Valley Labs, Gluroo, Tidepool, PhysioLogic Devices, Morgan Stanley. L.Figg: None. M.Hechavarria: None. K.G.Malden: None. E.Sheehan: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust (G-2005-03934)

#4674 CLINICAL PROFILE OF PATIENTS WITH DIABETIC KIDNEY DISEASE ATTENDING NEPHROLOGY CLINICS IN A LOW-MIDDLE INCOME COUNTRY

Abstract Background and Aims Chronic kidney disease secondary to diabetes is a significant contributor to the global burden of disease, both financially and through a marked deterioration in the quality of life. Diabetic kidney disease (DKD) increases the likelihood of adverse outcomes such as infirmity, cardiovascular events, progressive multi-organ damage, impaired quality of life and reduced life expectancy. Pakistan, a low-middle income country, is ranked among the top 10 countries for absolute diabetes prevalence. Over 19 million Pakistani adults have diabetes, which amounts to 17.1% of the adult population in the country. There is a dearth of literature examining the quality of care of diabetic kidney disease (DKD) patients in Pakistan. The aim of the current study is to evaluate the clinical profile and the quality of care delivered to patients with DKD attending nephrology clinics at a large tertiary care hospital in Karachi, Pakistan. Method It was a cross-sectional observational study at Aga Khan University Hospital (AKUH), a private tertiary-care facility located in Karachi, Pakistan. The data used in the study was acquired from the Diabetic Kidney Disease outpatient-database, a registry of patients managed by AKUH. It was used to identify a cohort of patients, with DKD presenting to the nephrology clinic at AKUH from December 2018-January 2021 (n = 553). Results Mean age of the study participants was 61.7 + 11.0 years and 60.9% of the study participants were male. 80.5% (n = 445) were non-smokers and over three-quarters (n = 400) had a body mass index (BMI) &amp;gt; 25 which according to the Asian-Pacific BMI cut-offs classified them as obese. These patients had been living with diabetes for an average of 15 years (median IQR = 10-21) and 99% had type 2 diabetes mellitus. A total of 519 study participants (93.9%) had hypertension while 34.2% and 30.9% had dyslipidemia and ischemic heart disease (IHD), respectively. Almost two third of the participants (68.4%) had advanced CKD (stages 3b, 4and 5) at the time of presentation. Less than half of the study population (43.6%) had HbA1c &amp;lt; 7.0 percentage and only 34.9% attained systolic blood pressure (BP) target &amp;lt;130mm Hg while optimal diastolic BP (&amp;lt;80 mmHg) targets were achieved in 72.7%. Almost 70% of the study population were on insulin while 49.7% were receiving oral anti-diabetics. The most prescribed oral anti-diabetic was DPP4 followed by metformin and two thirds were on statins. Calcium channel blockers and beta-blockers were the most used antihypertensive drugs 53.5% and 52.6% respectively; half of the population was on diuretics, while 47.4% were taking Renin-angiotensin system (RAAS) blockers. Those who had eGFR&amp;gt; 60, only 60% of them were receiving RAAS blockade therapy. Women were more likely to be obese and to have higher systolic BP compared to men. Diastolic BP and HbA1c were similar in men and women. The use of statins was higher in men and use of calcium channel blockers and RAAS blockers was significantly higher in women. Conclusion The basis for DKD management is multifactorial risk factor reduction which is achieved by optimizing care through modifiable risk factors. In our study we identified potential gaps in the quality of care related to risk factor control, optimal glycemic and/or blood pressure targets and pharmacotherapy to delay the progression of DKD and minimize cardiovascular events. This highlights a major treatment gap in DKD prevention and management calling for greater quality improvement effort in Pakistan, which now has the third highest number of people living with diabetes in the world.

Clinico-topographic evaluation of anterior versus posterior acute ischemic stroke and correlation with early mortality-based scale prediction

Posterior circulation ischaemic strokes (PCIs) are a clinical syndrome associated with ischemia related to stenosis, in situ thrombosis, or embolic occlusion of the posterior circulation and differ from anterior circulation ischaemic strokes (ACIs) in many aspects. In this study, ACIs and PCIs were evaluated in terms of clinico-radiological and demographic aspects, and the relevance of objective scales to early disability and mortality was investigated. The definition of ACIS or PCIS was classified according to the Oxfordshire Community Stroke Project (OCSP). There are mainly two groups divided into ACIs and PCIs. ACIs were included as total anterior circulation syndrome (TACS), partial anterior circulation syndrome (PACS) (right and left), and lacunar syndrome (LACS) (right and left), and PCIs were posterior circulation syndrome (POCS) (right and left). Arrival NIH Stroke Scale/Score (NIHSS) and Glasgow Coma Scale (GCS) scores were evaluated in clinical assessment and modified SOAR Score for Stroke (mSOAR) was for early mortality-based scale prediction. All data were compared, and mean, IQR (if applicable) values and ROC curve analysis were determined. A total of 100 AIS patients, 50 of whom were ACIs and 50 were PCIs, were included in the study and were evaluated within the first 24h. Hypertension was the most common disease for both groups. The second most common was hyperlipidemia (82%) in the ACIs and diabetes mellitus (40%) in the PCIs. The frequency of right hemisphere ischemia was higher in ACIs (63.6%) and PCIs (48%). The mean NIHSS and GCS score (also median IQR) was higher in the right ACIs and the highest NIHSS mean was in the right partial anterior circulation syndrome (PACS) (respectively median (IQR): 9.5 (13) and median (IQR):14.5 (3)). The mean NIHSS and GCS score of bilateral posterior circulation syndrome (POCS) were the highest in PCIs (median (IQR):3 (17), (IQR):15 (4) respectively). The mSOAR mean was the highest in the right PACS in ACIs (median (IQR):2.5 (2)) and in bilateral POCs among PCIs (median(IQR):2(2)). The association of PCIs with hyperlipidemia and the male gender was interpreted, and anterior infarcts were found to cause higher early clinical disability scores. The NIHSS scale was effective and reliable, especially in anterior acute strokes, but also emphasized the necessity of using the GCS assessment together in the first 24h in the assessment of PCIs. mSOAR scale is a helpful predictor in estimating early mortality not only in ACIs but also in PCIs, similar to GCS.

Observed intervention effects for mortality in randomised clinical trials: a methodological study protocol

IntroductionIt is essential to choose a realistic anticipated intervention effect when calculating a sample size for a randomised clinical trial. Unfortunately, anticipated intervention effects are often inflated, when compared with...

Effects of empagliflozin in women and men with acute myocardial infarction: An analysis from the EMMY trial

ObjectiveWomen have a higher comorbidity burden and a lower survival rate after acute myocardial infarction (AMI) than men. This analysis aimed to investigate the impact of sex on the effect of treatment with the sodium glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin immediately after an AMI. MethodsParticipants were randomized to either empagliflozin or placebo and followed for 26 weeks after initiating the treatment no later than 72 hours after a percutaneous coronary intervention following an AMI. We analyzed the impact of sex on the beneficial effects of empagliflozin observed for heart failure biomarkers as well as structural and functional cardiac parameters. ResultsWomen had higher NT-proBNP levels at baseline (median 2117pg/mL, IQR 1383-3267 pg/mL versus 1137 pg/mL, IQR 695-2050 pg/mL; p < 0.001) and were older than men (median 61y, IQR 56-65y versus 56y, IQR 51-64y, p = 0.005). The beneficial effects of empagliflozin on NT-proBNP levels (Pinteraction = 0.984), left ventricular ejection fraction (Pinteraction = 0.812), left ventricular end systolic volume (Pinteraction = 0.183), or left ventricular end diastolic volume (Pinteraction = 0.676) were independent of sex. ConclusionsEmpagliflozin exhibited similar benefits in women and men when administered immediately after an AMI.

Neoadjuvant chemotherapy in patients undergoing neoadjuvant radiation for trunk and extremity soft tissue sarcoma.

Many patients with high-risk soft tissue sarcoma (STS) develop distant metastases. Meta-analyses suggest that chemotherapy confers a small survival benefit, though few studies focus on neoadjuvant chemotherapy (NCT). There has been more frequent use of neoadjuvant radiation therapy (NRT) in STS, but the utility of NCT for these patients remains unclear. Patients with stage II-III trunk/extremity STS who underwent NRT and resection were identified using the National Cancer Database (2006-2019). Predictors of NCT were analyzed using logistic regression. Change in rate of NCT use over time was assessed using log-linear regression modeling. Survival was examined using Kaplan-Meier (KM) and Cox proportional hazard modeling. Of 5740 patients, 25% underwent NCT. The overall median age was 62, 55% of patients were male, and 67% had stage III disease. The most common histological subtypes were fibrosarcoma/myxofibrosarcoma (39%) and liposarcoma (16%). Use of NCT decreased by 4.0% per year throughout the study period (p < 0.01). Predictors of NCT included younger age (median 54, IQR 42-64 vs. median 65, IQR 53-75, p < 0.01), treatment at an academic center (odds ratio [OR] 1.5, p < 0.01), and stage III disease (OR 2.2, p < 0.01). Histologic predictors of NCT included synovial sarcoma (52%) and angiosarcoma (45%). With a median follow-up time of 77 months, NCT was associated with improved 5-year survival compared to NRT alone on KM analysis (70% vs. 63%, p < 0.01). This difference persisted on multivariate analysis (hazard ratio 0.86, p = 0.027) and after propensity matching (70% vs. 65%, p = 0.0064). Despite risk of distant failure in high-risk STS, use of NCT has decreased over time in patients receiving NRT. In this retrospective analysis, NCT was associated with a modestly improved overall survival.

Prevalence and factors associated with potential substance use disorders among police officers in urban Tanzania: a cross-sectional study

BackgroundSubstance Use Disorders (SUDs) among Police Officers has been a concern to many professionals in the field of health, research and criminal justice since their work is subjected to higher levels of stress and hence more likely to use alcohol or tobacco as a coping mechanism. However, little is known about SUDs among Police Officers in Tanzania. Therefore, we assessed the prevalence and factors associated with SUDs among Police Officers in urban Tanzania.Materials and methodsA cross-sectional study was conducted between April and October 2019 among Police Officers in Dar es Salaam. Multistage cluster sampling technique was used to recruit study participants. The WHO-Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) version 3.0 was used to measure potential SUDs. Bivariate and multivariate analyses were performed to establish associations between potential SUDs and predictors of interest, and an alpha of 5% was used in sample size calculation.ResultsA total of 497 participants were enrolled, of these, 76.6% (376/491) were males, the median age (years) and IQR was 37.0 (30.0, 47.0). The prevalence of past three months use of alcohol and tobacco were 31.3% and 6.3%, respectively. About 13.3% (62/468) and 6.2% (29/468) of Police Officers met criteria for potential Alcohol Use Disorder (AUD) and potential Tobacco Use Disorder (TUD) respectively. In adjusted analysis, participants with depression had about two times increased odds for potential AUD (aOR: 2.27, 95% CI; 1.12 – 4.58, p = 0.023) than those with no depression. Potential AUD and depression were associated with about eight times (aOR: 8.03, 95% CI; 3.52 – 18.28, p < 0.01) and more than twice (aOR: 2.63, 95% CI; 1.12 – 6.15, p = 0.026) higher odds for potential TUD respectively.ConclusionSubstance use and potential substance use disorders particularly AUD and TUD are common among Police Officers in urban Tanzania. Depression was found to be an important factor for potential AUD and TUD among Police Officers and, a significant co-occurrence of potential AUD with potential TUD was observed. Findings from this study call for interventions, for example, the need to routinize the brief motivational interview services for alcohol and tobacco use among Police Officers.