Moderate Tosevere Research Articles

Efficacy of Topical Epinephrine in Preventing Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Meta-analysis.

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of ERCP. As the clinical effectiveness of topical epinephrine in preventing PEP is elusive, this work attempts to assess its impact on PEP prevention. The databases Embase, Web of Science, PubMed, and Cochrane Library were searched for randomized controlled trials (RCTs) and retrospective cohort studies (RCSs) on topical epinephrine in PEP prevention (data cutoff, November 2022). This study included a total of 10 research articles, involving 5683 patients, comprising 7 RCTs and 3 RCSs. The results of the meta-analysis indicated that epinephrine had no significant effect on preventing PEP or improving its severity. The meta-analysis results of RCTs subgroup revealed no significant difference in the incidence of PEP between patients receiving epinephrine treatment [alone/in combination with nonsteroidal anti-inflammatory drugs (NSAIDs)] vs. without epinephrine treatment (control group) (P = .23). However, patients treated with epinephrine alone experience a lower incidence of PEP compared to the control group (risk ratio [RR] = 0.28, 95% CI = 0.14-0.56, P = .0004). The treatment with epinephrine+NSAIDs vs. NSAIDs showed no significant difference (P = .95). The meta-analysis results of RCSs subgroup demonstrated a significant reduction in the incidence of PEP with the epinephrine+NSAIDs vs. NSAIDs (P < .05). Regarding the severity of PEP [mild, and moderate to severe (M-S)] in the RCT subgroup, the incidence of PEP was not reduced with epinephrine treatment (alone/in combination with NSAIDs) vs. control group. In the RCS subgroup, receiving epinephrine (alone/in combination with NSAIDs) reduced the incidence of mild PEP, while it had no effect on the incidence of M-S PEP. Epinephrine was not significantly effective in preventing PEP and improving its severity. The combined use of NSAIDs and epinephrine as a possible preventive measure requires further investigation into its efficacy.

Atopic Dermatitis and Abrocitinib: Unraveling the Therapeutic Potential

Abstract: Atopic dermatitis (AD) is a chronic immune-mediated skin condition seriously affecting both children and adults and impacting their quality of life. This complex condition involves genetic predisposition, immune system impairment, and environmental factors. The Janus kinase signal transducer and activator of transcription (JAK-STAT) pathway plays a key role in AD pathogenesis and progression. Abrocitinib presents a hopeful avenue for managing moderate to severe AD, offering significant symptom relief and potential long-term benefits. Its targeted approach to modulating the JAK-STAT pathway holds promise for improved AD management. This comprehensive review explores AD pathogenesis, the chemistry and clinical pharmacology of Abrocitinib, and its safety and efficacy in various trials.

Hydroxy Chloroquine Prophylaxis Experience in Doctor Community with COVID-19 in West Bengal

Background The Indian Council of Medical Research (ICMR)National task Force for COVID-19 reviewed the data on in-vitro testing of Hydroxy Chloroquine (HCQ)for antiviral efficacy against SARS-CoV-2, safety profile and recommended it’s use for prophylaxis among health care workers (HCWs). The efficacy of HCQ against Covid -19 has been the subject of contradictory results. Given the need for insights into the clinical outcomes and side effects among doctors on prophylaxis with hydroxychloroquine, we conducted a retrospective analysis of doctors treated at home or hospital with COVID-19 infection.MethodsThe data was collected by direct interview, electronic data transfer from COVID-19 positive doctors using real-time reverse transcription-polymerase chain reaction (RT-PCR) test from two medical colleges, friends and relatives of doctors who voluntarily provided their illness information during the period of August, 26 to Nov 25, 2020.ResultsA total of 117 doctors participated in study. Out of 117 covid positive doctors, 76 received no HCQ prophylaxis and 41 received prophylaxis till the onset of the symptom. Out of 117 positive doctors, 32(27%) developed moderate to severe (MS) illness. Nine doctors (22%) developed MS in HCQ group and none of them died. Out of no HCQ group 23(30%) developed MS illness and 7(9%) died. There was no statistically significant relation between use of HCQ and outcomes of disease. The most common (22%) side effect of HCQ prophylaxis was related to gastrointestinal system. Conclusions Hydroxy Chloroquine has a disease modifying effect on COVID-19 disease although it is not robust.

Factors Associated with Neuropathic Pain in Cancer Patients Admitted to a Palliative Care Unit

Introduction: Recognizing factors associated with pain in advanced cancer patients may favor a better multidisciplinary approach. Objective: To identify factors associated with the most prevalent type of pain in cancer patients admitted to a palliative care unit. Method: Cohort-study-based cross-sectional analysis of baseline data collected from cancer inpatients at the palliative care unit assisted by the physiotherapy service. Sociodemographic, clinical data and pain characteristics were obtained and analyzed according to the most prevalent type of pain at hospital admission. An odds ratio (OR) logistic regression was utilized as a measure of effect at a 95% confidenceinterval (95% CI). Results: A total of 62 patients were assessed, mostly women (69.3%) with less than 60 years old (67.7%), the most frequent tumor sites were gynecological (25.8%) and breast (16.1%). Local disease progression associated with metastasis was observed in 87.1% of all patients, with 50.0% presenting bone metastasis and 37.1%, a bone event. The most prevalent type was moderate tosevere (69.3%) neuropathic pain (51.6%), associated with the presence of a bone event (OR = 3.16; 95% CI: 1.01-9.90) and less than 60 years old (OR = 4.08; 95% CI: 1.91 -17.52). Conclusion: Neuropathic pain was the most prevalent pain in cancer patients receiving palliative care associated with the presence of bone events and less than 60 years old.

Association between anxiety, depression, and symptom burden in patients with advanced colorectal cancer: A multicenter cross‐sectional study

AbstractObjectivesPatients with advanced colorectal cancer (CRC) have multiple concurrent physical and psychological symptoms. This study aimed to explore the relationship between anxiety, depression, and symptom burden in advanced CRC.MethodsA multicenter cross‐sectional study was conducted in 10 cancer centers from geographically and economically diverse sites in China. A total of 454 patients with advanced CRC completed the Hospital Anxiety and Depression Scale and the MD Anderson Symptom Inventory. Multiple regression analysis was applied to explore the relationship between anxiety, depression and symptom burden.ResultsAbout one‐third of the patients showed symptoms of anxiety or depression. Patients with anxiety or depression reported significantly higher symptom burden than those without (p &lt; 0.001). Patients with anxiety or depression reported a higher proportion of moderate‐to‐severe (MS) symptom number than those without (p &lt; 0.001). About 52% of the patients with anxiety or depression reported at least three MS symptoms. The prevalence of MS symptoms was ranging from 7.3% (shortness of breath) to 22% (disturbed sleep), and in patients with anxiety or depression was 2–10 times higher than in those without (p &lt; 0.001). Disease stage (β = −2.55, p = 0.003), anxiety (β = 15.33, p &lt; 0.001), and depression (β = 13.63, p &lt; 0.001) were associated with higher symptom burden.ConclusionsAnxiety and depression in patients with advanced cancer correlated with higher symptom burden. Findings may lead oncology professionals to pay more attention to unrecognized and untreated psychological symptoms in symptom management for advanced cancer patients.

P1184 Two simple tools for assessing depression and anxiety in patients with Inflammatory Bowel Diseases

Abstract Background Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), can trigger the onset of depressive and anxiety symptoms. The evaluation of mental well-being in patients with a chronic medical condition is considered a good clinical practice and it is strongly recommended by the World Health Organization. Nevertheless, mental health is not routinely investigated in this context for several reasons, including lack of training by healthcare professionals, stigma associated to mental health and gender-relatedstereotypes. The objectives of our study were to assess the presence of depressive and anxiety symptoms inpatients affected by IBD using two simple validated questionnaires and to identify potential related factors, particularly gender differences. Methods We conducted a single center observational study evaluating anxiety and depressive symptoms in patients with IBD treated with biological therapy at the IBD Unit of Ospedale Policlinico of Milan during October 2022. We assessed depressive and anxiety symptoms using respectively the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) that are easy self-administered rating scales. Univariate analyses and regression models were applied for the purpose of the study. Results Among a total of 174 consecutive patients, 158 completed the questionnaires. The prevalence of moderate tosevere depression (PHQ-9 score &amp;gt; 9) in the total sample was 18.4%, and it was higher in CD than in UC (21% vs 9.7%). The prevalence of clinically significant anxiety symptoms (GAD-7 score &amp;gt; 9) was 24% (25.7% in CD and 19.3% in UC). Focusing on gender differences, similar prevalence of significant anxiety anddepression was observed between males (M) and females (F); respectively 18.6% M vs 17.6% F for depression (PHQ-9 &amp;gt; 9) and 22.2% M vs 25.4% F for anxiety (GAD-7 &amp;gt; 9). Of note, a relevant association was observed between younger age and higher GAD-7 (β =-0.639; p=0.021) and PHQ-9 (β =-0.604, p=0.055) scores. Conclusion Both males and females (especially younger) IBD patients in biological therapy are largely affected bysignificant depressive and anxiety symptoms. The administration of simple questionnaires like PHQ-9 andGAD-7 in routine clinical practice can facilitate early identification of patients requiring mental health support, this is crucial as psychiatric conditions can complicate the course of the disease and adherence to treatments.

Otorhinolaryngological symptoms in hospitalized patients with COVID-19 - single-medical-center study in Serbia

Introduction/Objective. The infectious condition named coronavirus disease 2019 (COVID-19) was caused by coronavirus2 (SARS-Cov-2). Patients with COVID-19 disease may have symptoms which can range from mild to severe clinical condition. The aim of this study was to observe and analyze the presence of otorhinolaryngology symptoms in hospitalized patients with moderate to severe COVID-19 disease. Methods. The descriptive clinical study analyzed data from medical records in 230 hospitalized patients with moderate to severe COVID-19 pneumonia at Zvezdara Clinical Hospital Center, Belgrade, Serbia. Otorhinolaryngology symptoms as well as generalized COVID-19 related symptoms were analyzed from medical records during the year 2021. SARS-CoV-2 virus infection was previously confirmed in all patients with positive polymerase chain reaction test and/or rapid antigen test. Results. The mean age of 230 patients included in this study was 64 years. The most common general symptoms were cough 72%, fever 52%, dyspnea 46%, malaise 46% while to a lesser extent were observed myalgia 19%, vomitus 3%, and diarrhea 3%. The distribution of otorhinolaryngological symptoms showed that the most frequent symptom was anosmia 22%, while the throat pain was present in 20% and ageusia in 19% of patients. The otorhinolaryngological symptoms which were present in lower frequencies were headache in 16% of patients, tinnitus in 6%, vertigo in 5%, and hearing loss in 3% of patients. Comorbidities were observed more often in patients older than 50 years. Hypertension was the most common chronic disease in 60%, followed by diabetes in 23%, chronic obstructive pulmonary disease in 7%, malignancy in 7%, hypothyroidism in 6%, and renal disease in 4% of patients. Conclusion. Otorhinolaryngological conditions that should be the subject of further post COVID survey are prolonged anosmia, ageusia or hypogeusia, auditory dysfunction and vertiginous complaints.

Correlation between clinical severity and quality of life in moderate to severe psoriasis patients: Real-world evidence

Background/Aim. Psoriasis is a chronic multisystem, inflammatory, and immune-mediated dermatological disease of a relapsing nature. Not only does it affect objective parameters such as skin and joints, with different intensity involvement and with changes and the degree of changes, but it also significantly affects the health-related quality of life (QoL). The aim of the study was to determine the clinical severity and QoL of patients with moderate to severe psoriasis and examine the association between those parameters before and after the treatment. Methods. This cross-sectional study included 183 patients diagnosed with moderate to severe psoriasis. The severity of the clinical picture was determined by calculating the Psoriasis Area and Severity Index (PASI) by a dermatologist, while the QoL was assessed using the Dermatology Life Quality Index (DLQI) questionnaire and psoriasis-related stress by the Psoriasis Life Stress Inventory (PLSI). Disease severity and QoL were measured at the baseline visit and after the 16th week of therapy. Results. The average PASI score at the beginning of therapy was 23.1 ? 6 .5, while after 16 weeks, this value was 4.36 ? 4.86. The DLQI score was 20.8 ? 5.0 at the start of therapy and 6.20 ? 6 .16 after 16 weeks, while the PLSI score was 35.37 ? 8.84 initially and 12.75 ? 12.82 after 16 weeks of therapy. A strong correlation was found between PASI and PLSI scores (r = 0.702, ? &lt; 0.001) in the 16th week of therapy, while the correlation between DLQI and PASI scores was moderate (r = 0.683, ? &lt; 0.001). No significant differences between PASI and DLQI scores were found (r = 0.080, ? = 0.284) nor between PASI and PLSI scores (r = 0.109, ? = 0.140) at baseline. Conclusion. Patients with severe psoriasis experience a significant reduction in their QoL, accompanied by a high level of psychosocial stress. Observed improvements in QoL have shown a moderate correlation, while lower levels of psychosocial stress have strongly correlated with the severity of the clinical presentation, which may indicate a complex interaction between psychological factors and physical health in patients with psoriasis.

Craniofacial phenotyping by photogrammetry in Chinese prepubertal children with obstructive sleep apnea.

This study aimed to examine the craniofacial phenotype of Chinese prepubertal children with and without obstructive sleep apnea (OSA) using a quantitative photographic analysis technique and to develop a prediction model for OSA diagnosis based on the photogrammetric data. Potential ethnic differences in the association between OSA and photogrammetric data between Chinese and Caucasian children were also examined. This was a cross-sectional study. Chinese children aged 5-12 years old, suspected to have OSA were recruited from our sleep clinic. Frontal and side photos were taken for craniofacial phenotyping by photogrammetry. Polysomnography was performed and participants were divided into three groups: non-OSA (obstructive apnea hypopnea index (OAHI) < 1/h), mild OSA (OAHI between 1/h and 5/h), and moderate-to-severe (MS) OSA (OAHI ≥ 5/h). Prediction models were built from 70% of training data using logistic regression and evaluated on the remaining 30% of test data for receiver operating characteristic (ROC) curve construction. This study included 90 participants (mean age: 8.2 ± 1.6 years, 67 males). Non-OSA, mild OSA, and MS OSA groups included 32, 31, and 27 participants, respectively. There were significant trends for an increasing maxillary-mandibular relationship angle (p = .002) and a decreasing anterior mandibular height to whole face length ratio (p < .001) with increasing OSA severity. A prediction model built with clinical measurements and the two photogrammetric features yielded an area under the ROC curve (AUC) of 0.81 (95% C.I.: 0.64-0.96). Craniofacial features obtained by photogrammetry are significantly different between OSA groups in prepubertal children. Increased maxillary-mandibular relationship angle is an OSA feature found in both Asian and Caucasian children.

An algorithm recommendation for the pharmacological management of allergic rhinitis in Ukraine: a consensus statement from an expert panel

Allergic rhinitis (AR) is increasing at an alarming rate in Ukraine. The clinical picture of AR in modern conditions is changing towards more severe and mixed forms. Allergic rhinitis, especially moderate to-severe, has a negative impact on patient quality of life, productivity, direct, and indirect costs. Achieving adequate symptom control is essential for successful AR management, and relies mostly on pharmacotherapy. Most patients use multiple medications to control symptoms faster and better, but symptoms may persist. With the advent of new combination therapies, such as the intranasal formulation of azelastine hydrochloride and fluticasone propionate in a single device (MP-AzeFlu) like Dymista®, most AR symptoms can be treated effectively. MP-AzeFlu acts synergistically and blocks two important pathophysiological pathways involved in the early- and late-phase reactions of the disease, providing rapid relief from all AR-associated symptoms. A total of 13 experts from Ukraine, Germany, and India participated in the development of this consensus statement. The lead author drafted the questions pertaining to diagnosis, management, treatment adherence, and real-life evidence of AR in Ukraine, and was agreed with the co-authors and expert panel. This consensus is obtained through guiding statements and recommendations based on literature evidences (recent research outcomes, randomized, and comparative studies), clinical practices and personal experience of using MP-AzeFlu in AR by allergist/ immunologists/ otolaryngologists from Ukraine. This consensus statement aimed to assist practitioners in selecting the appropriate treatment strategies, facilitate optimum use of MP-AzeFlu and provide symptomatic relief for patients with AR in the in Ukraine

Comparison of the Appendicular Emptying Velocity of Left Atrium in patient with moderate versus severe chronic rheumatic mitral stenosis measured by pulsed wave Doppler in Transesophageal echocardiography

Background: Left atrial appendage (LAA) is considered the “most lethal human appendage” as it causes significant mortality and morbidity in chronic rheumatic mitral stenosis patients due to cardiogenic cerebral infract. Presence of LAA dysfunction has been shown to be a strong predictor of thrombus formation and the risk of embolic event, even if no clot is found at the time of initial examination. LAA emptying velocity are measured by trans esophageal echocardiography (TEE) represent as a surrogate marker for left atrial(LA) function .LAA emptying velocities (contraction velocity) &lt; 20cm/s are associated with risk of spontaneous echo contrast(SEC), LAA thrombus, and subsequent cardio embolic events. So early detection of low emptying velocity without SEC or LA thrombus can reduce mortality &amp; morbidity related to cardio embolic stroke and also helps in further management procedure like cardio version etc. So we will compare LAA emptying velocity moderate versus severechronic rheumatic mitral stenosis patients in our population for further attention.&#x0D; Objective: To assess emptying velocity of LAA in patient with moderate versus severe chronic rheumatic mitral stenosis, from a Bangladesh health service perspective.&#x0D; Method: This was a cross sectional study which was conducted in UCC, BSMMU during the period of from February 2019 to September 2019 in Echo lab .&#x0D; Study Procedure: We were enrolled 33 CRHD with MS (moderate to severe) patients who underwent TEE and met inclusion &amp; exclusion criteria. The purpose of the study was explained to each subject &amp; informed written consent was obtained. After getting consent relevant history, physical examination and preprocedural investigation was obtained in predesigned structured data collection sheet. TEE was done with Vivid E9® machine. Pulse wave Doppler was position at the tip of the LAA and then emptying velocity of LAA moderate and severe were compared.&#x0D; Outcome measure: Among 33 patients, 3 patients were excluded due to outlier and inadequate data.. In chronic rheumatic mitral stenosis in moderate versus severe cases average LAA emptying velocities were significantly higher moderate CRHD with MS compare to severe CRHD with MS,(26.57±4.91;31.12±5.04), P=0.018.&#x0D; Conclusion:Appendicular emptying velocity of LAA significantly lower in severe CRHD with MS compare to moderate CRHD with MS and it has temporal relation with MS severity. It can be used as a reliable, simple and sami-invasive tool to early predict severity and prevent complication in CRHD with MS as well as for prophylactic measured taken.&#x0D; University Heart Journal 2022; 18(2): 73-79

Symptom burden, psychological distress, and symptom management status in hospitalized patients with advanced cancer: a multicenter study in China

The management of physical symptoms and psychological distress of cancer patients is an important component of cancer care. The purpose of this study was to evaluate the symptom burden, psychological distress, and management status of hospitalized patients with advanced cancer in China and explore the potential influencing factors of undertreatment and non-treatment of symptoms. A total of 2930 hospitalized patients with advanced cancer (top six types of cancer in China) were recruited from 10 centers all over China. Patient-reported MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9) scales and symptom management-related information were collected and linked with the patient's clinical data. The proportion of patients reporting moderate-to-severe (MS) symptoms and whether they were currently well managed were examined. Multivariable logisticregression models were applied to explore the factors correlated to undertreatment and non-treatment of symptoms. About 27% of patients reported over three MS symptoms, 16% reported over five, and 9% reported over seven. Regarding psychological distress, the prevalence of HADS-anxiety was 29% and that of PHQ-9 depression was 11%. Sixty-one percent of patients have at least one MS symptom without any treatment. Sex [odds ratio (OR)= 2.238, 95% confidence interval (95% CI) 1.502-3.336], Eastern Cooperative Oncology Group (ECOG; OR= 0.404, 95% CI 0.241-0.676), and whether currently undergoing anticancer treatment (OR= 0.667, 95% CI 0.503-0.886) are the main factors correlated with the undertreatment of symptoms. Age (OR= 1.972, 95% CI 1.263-3.336), sex (OR= 0.626, 95% CI 0.414-0.948), ECOG (OR= 0.266, 95% CI 0.175-0.403), whether currently undergoing anticancer treatment (OR= 0.356, 95% CI 0.249-0.509), and comorbidity (OR= 0.713, 95% CI 0.526-0.966) are the main factors correlated with the non-treatment of symptoms. This study shows that hospitalized patients with advanced cancer had a variety of physical and psychological symptoms but lacked adequate management and suggests that a complete symptom screening and management system is needed to deal with this complex problem.

Prevalence and factors influencing the occurrence of spasticity in stroke patients: a retrospective study

ABSTRACT Background To describe the prevalence and clinical characteristics of stroke patients withoutspasticity, and simultaneously analyse the factors related to post-strokenon-spasticity. Methods In this retrospective study, information on patients hospitalized in thedepartment of rehabilitation, Daping Hospital, over the past eight years wascollected. Demographic information and clinical characteristics werestatistically analysed. Results A total of 819 stroke patients with an average age of 61.66±13.72 years old wereanalysed, including 561 males (68.5%), and 258 females (31.5%). In this study,201 (24.5%) patients developed spasticity, and 618 (75.5%) patients had nospasticity. Patients without spasticity were older than those with spasticity.Patients with ischemic stroke and mild functional impairment were also lesslikely to have spasticity. Post-stroke spasticity may be related to age [oddratio (OR): 0.982; 95% CI:0.965 to 0.999; P = 0.042), hemorrhagic stroke (OR:1.643; 95% CI: 1.029 to 2.626; P = 0.038), National Institute of Health StrokeScale (NIHSS) Scores (OR: 1.132; 95% CI: 1.063 to 1.204; P = 0.000]. Conclusion Most stroke patients do not have spasticity, especially the elderly, patients withischemic stroke, and those with mild functional impairment, suggesting that notall upper motor nerve injuries lead to increased muscle tension. For youngindividuals, patients with hemorrhagic stroke, and those with moderate tosevere functional impairment, close follow-up is necessary to identify theoccurrence of spasticity early on and then formulate corresponding rehabilitationstrategies for prompt intervention.

An Observational Retrospective Matched Cohort Study of Healthcare Resource Utilisation and Costs in UK Patients with Moderate to Severe Osteoarthritis Pain.

IntroductionUsing data from patients residing in Salford, UK, we aimed to compare healthcare resource utilisation (HCRU) and direct healthcare costs between patients with moderate to severe (M-S) or severe osteoarthritis (OA) pain and those without OA.MethodsPatients with a M-S OA pain event within a period of chronic pain were indexed from the Salford Integrated Record (SIR) between 2010 and 2017. Patients with a severe pain event formed an OA subcohort. Patients in each OA pain cohort were independently matched to patients without OA, forming two control cohorts. HCRU, prescribed analgesic drugs, and total direct costs per UK standardised tariffs were calculated for the year post-index. Multivariable models were used to identify drivers of healthcare cost.ResultsThe M-S OA pain and control cohorts each comprised 3123 patients; the severe OA pain and control cohorts each comprised 1922 patients. Patients in both OA pain cohorts had a significantly higher mean number of general practitioner encounters, inpatient, outpatient, and accident and emergency visits, and were prescribed a broader range of analgesic drugs in the year post-index than respective controls. Mean healthcare costs of all types were significantly higher in the M-S and severe OA pain cohorts vs controls (total: M-S £2519 vs £1379; severe £3389 vs £1397). Paracetamol (M-S: 40% of patients had at least one prescription; severe: 50%) and strong opioids (34% and 59%) were the analgesics most prescribed to patients with OA pain. In all cohorts, multivariable models showed that a higher age at index, the presence of gout, osteoporosis, type 2 diabetes, or coronary artery disease, significantly contributed towards higher healthcare costs.ConclusionIn the population of Salford, UK, patients with M-S OA pain had significantly higher annual HCRU and costs compared with matched controls without OA; generally, these were even higher in patients with severe OA pain.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-022-00431-2.

A Retrospective Claims-Based Study Evaluating Clinical and Economic Burden Among Patients With Moderate to Severe Osteoarthritis Pain in the United States.

Background: There has been limited evaluation of medication adherence, healthcare resource utilization (HCRU), and healthcare costs over time in patients with osteoarthritis (OA), and stratification by pain severity level has not been reported. Assessing such longitudinal changes may be useful to patients and healthcare providers for tracking disease progression, informing treatment options, and employing strategies to optimize patient outcomes. Objectives: To characterize treatment patterns, HCRU, and costs over time in patients with moderate to severe (MTS) OA pain in the United States. Methods: We conducted a retrospective claims analysis, using IBM® MarketScan® databases, from 2013-2018. Eligible patients were aged ≥45 years with ≥12 months pre-index (baseline) and ≥24 months (follow-up) of continuous enrollment; index date was defined as a physician diagnosis of hip or knee OA. An algorithm was employed to identify MTS OA pain patients, who were propensity score matched with patients having non-MTS OA pain. Data were summarized using descriptive statistics and univariate analyses. Results: After propensity score matching, the overall OA pain cohorts consisted of 186 374 patients each: 61% were female, mean age was 63 years, and two-thirds (65.6%) were of working age (45-65 years). Sleep-related conditions, anxiety, and depression were significantly higher in the MTS OA pain cohort vs non-MTS (P<0.001). At baseline and 12- and 24-month follow-ups, receipt of prescription pain medications, HCRU, and direct medical costs were significantly higher in the MTS OA pain cohort (all P<0.01). Medication adherence was significantly higher in the MTS OA pain cohort for all medication classes except analgesics/antipyretics, which were significantly lower vs the non-MTS OA pain cohort (all P<0.0001). Conclusions: The burden of MTS OA pain is substantial, with patterns that show increasing medication use, HCRU, and costs vs non-MTS OA pain patients over time. Understanding the heterogeneity within the OA population may allow us to further appreciate the true burden of illness for patients in pain.

The Association between Hearing Impairment and Postural Stability in Older Adults: A Systematic Review and Meta-analysis.

There is growing evidence linking hearing impairment to higher falls risk through alterations in postural stability, with studies showing mixed results. The primary aim of this systematic review and meta-analysis was to determine the association between hearing impairment and postural instability in older adults, including differences based on severity of hearing impairment. This review was pre-registered in PROSPERO and performed in accordance with PRISMA guidelines across six databases. Primary research on adults aged 60 years and older with hearing loss and an objective measure of postural stability or gait were eligible for inclusion. Methodological quality was assessed using the modified Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. Data were analysed using meta-analyses and a narrative synthesis. Inclusion in the meta-analyses required clearly defined audiometrically-assessed hearing impairment, and two subgroups of participants: mild (25-40 dB HL) and moderate to-severe (>40 dB HL) hearing impairment. Twenty-five eligible studies (n = 27,847) were included in the narrative synthesis, with quality ratings ranging from unsatisfactory to very good on the modified NOS. Eight studies were included in the meta-analysis which showed individuals with moderate to-severe hearing impairment were significantly slower on the 5 x sit-to-stand test (mean difference[95%CI] = 0.50 s [0.04, 0.97], p = .03), had a slower gait speed (mean difference[95%CI] = -0.11 s [-0.16, -0.05], p < .001) and had lower total Short Physical Performance Battery scores (mean difference[95%CI] = -0.79[-1.17, -0.41], p < .001) than those with normal hearing. This review provides evidence there is an inverse association between increasing severity of hearing impairment and poorer postural stability across both the meta-analysis and narrative synthesis.

ROX Index Predicts Failure of HFNO Therapy in Patients of COVID-19 Pneumonia with Type I Respiratory Failure

Background: In the first half of 2020 COVID-19 disease has already converted into a global pandemic. Various treatment options were being tried all over the world. The ROX index (Respiratory rate – Oxygenation), defined as the ratio of peripheral oxygen saturation and fraction of inspired oxygen, to respiratory rate, is a simple bedside test to predict failure of HFNO Therapy and need for MV. Aim: The aim of the study was to evaluate the accuracy of the ROX index for Predicting the failure of HFNO Therapy and need for Intubation in Patients of COVID-19 Pneumoniawith type I respiratory failure. Methods: An observational study of consecutive patients admitted in ICU of the department of Anesthesiology, critical care and pain management in Govt. Medical college Srinagar (J&amp;K) over the period of six months with moderate tosevere type I respiratory failure treated with High Flow Nasal OxygenTherapy (HFNOT). One hundred and thirty four RT-PCR positive COVID-19 patients were enrolled. The following data were collected: medical history, clinical classification of COVID-19 infection, the ROX index measured daily and the outcome assessment. Results: We performed this observational study on 134RT-PCR positive COVID-19 patients. 70 (52.23%) patients with moderate to severe COVID-19 infection were intubated, 60% of them third day of admission, only 35% patients with moderate COVID-19 infection required intubation. Presence of comorbidities was directly associated with ROX index. At intubation, median (min-max) of ROX and PO2/FiO2 ratio was 4.02 (2.99–5.10) and 88.10 (58–106.15), respectively. ROX 1, 2, 3 indices were significantly as¬sociated with intubation (p &lt; 0.001 for each of them). COVID-19 clinical classification was sig¬nificantly associated with intubation (p &lt; 0.001). Conclusion: ROX index is a valuable, noninvasive tool to evaluate patients with moderate to severehypoxemic respiratory failure in COVID-19 treated with HFNOT. ROX is a simple noninvasive promising ......

Abstract 14045: Increased Fibrosis and Microvessel Disease in Allograft Endomyocardial Biopsies of Children With Chronic Graft Failure Due to Cardiac Allograft Vasculopathy

Introduction: The pathogenesis of chronic graft failure (CGF) in pediatric heart transplant recipients (PHT) is multifactorial and includes cardiac allograft vasculopathy (CAV). Prior research has shown that CGF can present as microvessel disease (MVD) and fibrosis on endomyocardial biopsies (EMB), however, optimal routine surveillance is not established. We analyzed EMB specimens to establish histopathologic findings of CGF represented by PHT with CAV. Hypothesis: PHT recipients with CGF secondary to CAV have increased fibrosis and MVD on EMB. Method: We performed a retrospective case-control study. PHT with moderate to severe (M-S) CAV diagnosed on cardiac catheterization between 2017-2020 were identified. EMB from time of M-S CAV diagnosis (CAV-EMB) was reviewed (excluding those with significant intercurrent rejection) and compared to their EMB prior to any CAV diagnosis (pre-CAV-EMB) and controls that were matched for age at and time since transplant (Tx) . Fibrosis was qualitatively graded on a scale of 0-5 and MVD was scored as number of capillaries with stenotic wall thickening (due to either endothelial cell swelling or medial hypertrophy) per fields of view. Results: Eight PHT with CAV-EMB and pre-CAV-EMB and 8 controls were identified. CAV-EMB group was 2.5 years (IQR: 0.9,8.0) old at time of Tx and 10.6 years post-Tx (8.3,15.5) at EMB. Pre-CAV-EMB was 1.8 years (1.1,2.8) prior to CAV-EMB. In the CAV, pre-CAV, and control groups median fibrosis score was 3.0 (2.0, 3.0) vs 2.0 (2.0, 3.0) vs 1.0 (0, 1.0) (p= 0.001) and MVD score was 2.1 (1.3, 2.9) vs 2.0 (1.6, 2.8) vs 0.5 (0.2, 0.7), respectively (p= 0.007). These were significantly different between pre-CAV-EMB vs controls (fibrosis p=0.003, MVD p=0.007) and CAV-EMB vs controls (fibrosis p=0.001, MVD p=0.005), but not between pre-CAV-EMB vs CAV-EMB. Furthermore, fibrosis and MVD scores were strongly correlated (r=0.78, p&lt;0.001). Conclusion: Histopathological evidence of increased fibrosis and MVD is noted in EMB with CGF secondary to CAV and these findings pre-date angiographic CAV diagnosis. Further studies in larger PHT cohorts are needed to assess time course of fibrosis and MVD to improve surveillance of CAV and CGF.

A Study of Incidence and outcome of Peripartum Cardiomyopathy in a Tertiary Care Teaching Hospital

Background: Heart failure in women associated with pregnancy and the peripartum period is now recognized as a distinctive form of cardiomyopathy. Its prevalence and mortality vary in different geographical locations. There is a paucity of data from our group of the population regarding peripartum cardiomyopathy hence we conducted the study to determine the incidence, aetiology of PPCM in our study group along with treatment and maternal outcomes. Methods: Patients with any parity and age, which are in their peripartum period i.e. one month before delivery or within five months of delivery. Patients presenting with moderate to severe breathlessness at rest or on exertion with palpitations, ankle oedema, or with signs and symptoms of heart failure. Documented systolic dysfunction with the echocardiographic finding of Ejection fraction of &lt;45% and or Fractional shortening &lt;30%, absence of another identifiable cause for the HF. Results: Overall incidence of PPCM in our institution is 9 per 1000 deliveries. Among n=67 PPCM cases, n=26 patients (38.80%) developed PPCM during pregnancy and n=41 patients (61.2%) during postpartum period. The majority of the patients n=49 cases (73.13%) had severe left ventricular systolic dysfunction (EF =30%) and n=10 (14.92%) had moderate left ventricular systolic dysfunction and n=8 had mild LV dysfunction. There was no significant statistical difference in the severity of LV dysfunction between primi and multiparous women. Conclusion: The main factors are advanced maternal age and multiparity. Twin pregnancies are also risk factors for the development of PPCM. Yet another important risk factor was Pre-eclampsia. There is no single explanation for the pathogenesis of PPCM that is relevant for all women. Recognition of symptoms of breathlessness, orthopnea, and pedal edema in the post-partum period with a history of preeclampsia should arouse a high degree of suspicion.

CMR predictors of secondary moderate to severe mitral regurgitation and its additive prognostic role in previous myocardial infarction

BackgroundWe aimed to determine predictors and the additive prognostic role of moderate to severe (MS) ischemic mitral regurgitation (MR) in myocardial infarction (MI). MethodsFour hundred twenty-two patients with previous MI underwent cardiac magnetic resonance (CMR) imaging for the assessment of left ventricular (LV) ejection fraction (EF), end-diastolic (EDV) and end-systolic volume (ESV), sphericity index, wall motion score index (WMSI), and late gadolinium enhancement (LGE). Echocardiography was performed to assess MR. ResultsThirty-eight had from moderate to severe MR (MS-MR group) and 384 did not (No MS-MR group). The S-MR group had higher LV volumes, sphericity index, WMSI, and LGE extent, and lower LVEF. At univariate logistic regression analysis, dilated volumes, SI >0.43, dyskinesia of inferolateral wall, papillary muscle (PM)-LGE, and LGE extent >16% were associated with MS-MR. At multivariate analysis, only SI (OR=5.7) and PM-LGE (OR=3) were independently associated with MS-MR. Considering only patients without LV dilatation, only dyskinesia in the inferolateral wall was a predictor of MS-MR (OR 34.8). Thirty cardiac events (cardiac death, appropriate implantable cardioverter-defibrillator firing, and resuscitated cardiac arrest) occurred during a median follow-up of 1,276 days. After adjusting the prognostic variables at univariate analysis by age (>65 years) and selecting those that were significant (EDV > 95 ml/m2, ESV >53 ml/m2, EF <30%, WMSI >1.65, LGE >12%, S-MR), only WMSI >1.65 and MS-MR remained an independent predictor of cardiac events. ConclusionsIncreased WMSI and PM-LGE in the overall population and inferolateral dyskinesia in patients without ESV dilatation are predictors of MS-MR; MS-MR and elevated WMSI have independent negative prognostic value.