Onset Of New Symptoms Research Articles

Prediction of treatment failure and early identification of tumor progression after Gamma-Knife radiosurgery in vestibular schwannoma: a retrospective cohort study

Abstract Background Microsurgical resection after failed radiosurgery (SRS) in vestibular schwannoma (VS) patients is associated with higher morbidity. Identifying factors that predict treatment failure (TF) is crucial. Additionally, distinguishing between pseudoprogression (PP) and true tumor progression (TP) can be challenging. This study aims to identify predictive factors for TF and investigate early features that differentiate PP from TP. Methods A retrospective analysis was performed on 705 patients with unilateral sporadic VS who underwent SRS between 1998 and 2020. Clinical data, including patient characteristics, symptoms, tumor volume, and onset of new symptoms after SRS, were recorded. The average follow-up was 4 years for the TP group (n=107) and 7 years 10 months for the remission group (n=598). Results TF was more common in women (p=0.04) and linked to lower OHATA class (p=0.03). Age, clinical symptoms, tumor volume and configuration (cystic vs solid) were not predictive of TF. TP-patients experienced significantly more new neurological symptoms (20.6% vs 8.4%, p<0.001), especially hemifacial spasm (p<0.001), which was associated with OHATA class (A>B>C>D>E, p=0.001). Relative tumor volumes (RTV) differed significantly between TP and tumor control (TC) groups, with the TP group showing higher RTV at both 12 months (TC=1.0±0.6, TP=1.4±1, p=0.002) and even more at 24 months (TC= 0.71±0.5, TP=1.5±0.7, p<0.001) after SRS. Conclusions Female sex and lower OHATA class were identified as independent predictors of TF. Hemifacial spasm occurrence after SRS was linked to TP. Failure of reduction of initial tumor volume (RTV>1) after 24 months was associated with TP with a high sensitivity and specificity, making PP unlikely.

Value of non-invasive remote monitoring in managing weight, symptoms, and reducing hospitalizations in heart failure patients : An analysis of a French cohort over one year

Value of non-invasive remote monitoring in managing weight, symptoms, and reducing hospitalizations in heart failure patients : An analysis of a French cohort over one year

Incidence and risk factors for delayed intracranial hemorrhage after mild brain injury in anticoagulated patients: a multicenter retrospective study

BackgroundAnticoagulated patients with mild traumatic brain injury (mTBI) and a negative cerebral CT on admission, commonly undergo a repeated CT scan after observation in the emergency department (ED) to detect delayed intracranial hemorrhage (ICH). However, the utility of this practice is controversial, with recent evidence suggesting that the risk of delayed ICH in these patients is low. This study aims to evaluate incidence, outcomes, and risk factors of delayed ICH in patients receiving direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) presenting to the ED with mTBI.MethodsA multicenter, observational, retrospective cohort study was conducted in the EDs of three hospitals in Northern Italy, from January 2017 to December 2021. All consecutive adult patients on DOACs or VKAs therapy, admitted for a mTBI, who underwent a second CT scan after 12–24 h from a negative first one, were enrolled.ResultsA total of 1596 anticoagulated patients were enrolled, 869 (54%) on DOACs and 727 (46%) on VKAs therapy. The median age was 84 [79–88] and 56% of patients were females. The incidence of delayed ICH was 1.8% (95% CI: 1.1-3.0%; 14/869 patients) for DOACs, and 2.6% (95% CI: 1.6–4.1%; 19/727 patients) for VKAs patients, with no cases requiring neurosurgical intervention. Vomiting after head injury and the onset of new symptoms during observation were associated with a higher risk of delayed bleeding (OR 4.8; 95% CI: 1.4–16.5, and OR 4.7; 95% CI 1.2–23.7, respectively). At a 30-day follow-up, 2% of patients had a new ED admission related to their previous mTBI, with no significant difference between the groups.ConclusionsDelayed ICH is uncommon among anticoagulated patients with mTBI and has minimal impact on their outcome. Routine performance of a second CT scan may be unnecessary and may be considered only in presence of high-risk clinical risk factors or signs of deterioration.

Improvements in clinical signs and symptoms of Parkinson’s disease using photobiomodulation: a five-year follow-up

BackgroundParkinson’s disease is a progressive neurodegenerative disease characterized by clinical motor signs and non-motor symptoms that severely impact quality of life. There is an urgent need for therapies that might slow, halt or even reverse the progression of existing symptoms or delay the onset of new symptoms. Photobiomodulation is a therapy that has shown potential to alleviate some symptoms of Parkinson’s disease in animal studies and in small clinical trials.ObjectiveTo assess long-term effectiveness of photobiomodulation therapy in a cohort of Parkinson’s disease individuals after five years of continuing therapy.MethodsEight participants of the initial 12 in a previously published study agreed to be reassessed after five years. Seven of these participants had continued home-based, self-applied photobiomodulation therapy three times per week for five years. One participant had discontinued treatment after one year. Participants were assessed for a range of clinical motor signs, including MDS-UPDRS-III, measures of mobility and balance. Cognition was assessed objectively, and quality of life and sleep quality were assessed using self-reported questionnaires. A Wilcoxon Signed Ranks test was used to evaluate change in outcome measures between baseline (before treatment) and after five years, with the alpha value set to 0.05.ResultsOf the seven participants who had continued photobiomodulation therapy, one had a preliminary diagnosis of multisystem atrophy and was excluded from the group analysis. For the remaining six participants, there was a significant improvement in walk speed, stride length, timed up-and-go tests, tests of dynamic balance, and cognition compared to baseline and nonsignificant improvements in all other measures, apart from MDS-UPDRS-III, which was unchanged and one measure of static balance (single leg stance, standing on the unaffected leg with eyes open) which declined. Five of six participants either improved or showed no decline in MDS-UPDRS-III score and most participants showed improvement or no decline in all other outcome measures. No adverse effects of the photobiomodulation therapy were reported.ConclusionsThis study provides a signal that photobiomodulation therapy might safely reduce important clinical motor signs and non-motor symptoms in some Parkinson’s disease patients, with improvements maintained over several years. Home-based photobiomodulation therapy has the potential to complement standard therapies to manage symptoms and potentially delay Parkinson’s symptom progression.Trial registrationAustralian New Zealand Clinical Trials Registry, registration number ACTRN12618000038291p, registered on 12/01/2018.

Symptoms of Depression, Eating Disorders, and Binge Eating in Adolescents With Obesity

Depression and eating disorders are heightened for adolescents with obesity. Clinical reviews alongside self-report questionnaires are important to ensure appropriate intervention. To evaluate changes in self-report symptoms of depression, eating disorders, and binge eating in adolescents with obesity during the Fast Track to Health trial. This was a randomized clinical trial conducted from 2018 to 2023. It was a multisite trial conducted at children's hospitals in Sydney, New South Wales, and Melbourne, Victoria, Australia, and included adolescents (13-17 years) with obesity (defined as adult equivalent body mass index ≥30; calculated as weight in kilograms divided by height in meters squared) and 1 or more related complications. Duration was 52 weeks including a very low energy diet for 4 weeks followed by intermittent energy restriction (IER) or continuous energy restriction (CER). Self-report symptoms of depression (Center for Epidemiologic Studies Depression Scale-Revised 10-Item Version for Adolescents [CESDR-10]; scores 0-30), eating disorders (Eating Disorder Examination Questionnaire [EDE-Q]; scores 0-6), and binge eating (Binge Eating Scale [BES]; scores 0-46) were assessed. Adolescents were screened for depression and eating disorders (weeks 0, 4, 16, and 52) and monitored for the onset of new symptoms of disordered eating during dietetic consults. Of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) enrolled, median baseline EDE-Q score was 2.28 (IQR, 1.43-3.14), median baseline CESDR-10 score was 9.00 (IQR, 4.00-14.50), and median baseline BES score was 11.00 (IQR, 5.00-17.00). There were no differences between groups for change in CESDR-10 (mean difference at week 52, 0.75; 95% CI, -1.86 to 3.37), EDE-Q (mean difference at week 52, 0.02; 95% CI, -0.41 to 0.45), or BES (mean difference at week 52, -2.91; 95% CI, -5.87 to 0.05). The within-group reductions at week 4 were maintained at week 52, for CESDR-10 and EDE-Q, indicating reduced symptoms of depression and eating disorders. Within-group reductions on the BES were maintained in the IER group only. Seventeen adolescents (12.1%) required support or referral for depression and/or disordered eating, including 7 (5%; 5 IER, 2 CER) adolescents who experienced the onset or reemergence of symptoms during the intervention. Results suggest that many treatment-seeking adolescents with obesity self-reported symptoms of depression and eating disorders. Although symptoms reduced for most, some required additional support. Obesity treatment is an opportune time to screen and monitor for depression and disordered eating. Australian New Zealand Clinical Trials Registry: ACTRN12617001630303.

The Impact of COVID-19 on Patients With Obsessive-Compulsive Disorder in Gulf Countries: A Narrative Review.

Gulf countries, like other parts of the world, were affected by the coronavirus disease 2019 (COVID-19) pandemic. Along with its biological effects, the pandemic has had serious psychological and social effects. The pandemic-associated general stress and the increased efforts of handwashing and general hygiene might trigger obsessive-compulsive disorder (OCD). The objective of this narrative review was to explore the influence of the COVID-19 pandemic on the prevalence, severity of symptoms, and accessibility of treatment for OCD in Gulf countries. A comprehensive literature search was conducted to review and collect research and/or reports on the prevalence, symptoms, diagnosis, and treatment adaptations and strategies of OCD during the ongoing COVID-19 pandemic in seven Arab Gulf countries. The search spanned from the onset of the crisis in 2020 to 2024. Peer-reviewed articles and reports were sourced from PubMed/Medline and Google Scholar, while abstracts presented at the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) congresses were also included in the review. A total of four studies from Saudi Arabia, two from the United Arab Emirates, and two from Qatar were retrieved for analysis. These studies focused on investigating the impact of the pandemic on OCD. Studies from Kuwait, Oman, and Bahrain reported a negative impact of the pandemic on mental health, yet no specific data were provided. The studies highlighted an increased prevalence of OCD symptoms, both in terms of the incidence of new symptoms and the exacerbation of existing pre-pandemic manifestations. Furthermore, individuals with pre-existing psychological disorders or OCD were particularly susceptible to the negative impact of the pandemic. A review of local studies and reports from the Arab Gulf region reveals a striking paucity of research on the impact of the COVID-19 pandemic on OCD. The pandemic has been associated with an increase in the prevalence of OCD, the onset of new symptoms, and the worsening and exacerbation of existing pre-pandemic obsessions and compulsions.

#314 Systemic lupus erythematous (SLE) and isolated multiple sclerosis: analysis of BAFF—VAR variant on gene TNSF13B

Abstract Background and Aims We report a case of young a woman (33 years old) affected by SLE since 2007. In this year, a renal biopsy showed class IV lupus nephritis and the patient received corticosteroids and immunosuppressant for 3 years. The patient remained thereafter in disease remission with normal renal function, no proteinuria and normal complement levels. In 2013 the patient performed brain MRI for sudden hearing loss. The MRI showed a pattern compatible with isolated multiple sclerosis (RIS), confirmed on subsequent radiographic checks. In 2023, due to the initial onset of renal failure, a new re-staging biopsy showed microscopic aspects compatible with class I/II lupus nephritis (INS/RPS Classification 2004, 2018); the activity index calculated with SLEDAI—2K was +4. A new brain MRI carried out without onset of new symptoms showed a new hyperintense region at the level of the head of the right caudate nucleus and enlargement of the intrasellar CSF content as per the condition of a “partially empty” sella. A genetic variant of the TNFSF13B gene was therefore suspected, since it is involved in encoding the cytochine and drug target B-cell activating factor (BAFF), associated with multiple sclerosis as well as SLE. We searched for the genetic variant in order to undertake target therapy early in our patient. Method We performed PCR amplification and direct sequencing of all coding exons plus all the intron-exon junctions of the analyzed gene, by automatic sequencer with SeqStudio Genetic Analyzer (analytical sensitivity and specificity >99%). Results We found the heterozygous presence of the BAFF-var variant in the 3' UTR region of the TNFSF13B gene (Heterozygous genotype for BAFF-var). This variant involves an insertion/deletion (GCTGT>A) at the level of the 3' UTR region with consequent production of an alternative polyadenylation site (APA). This APA leads to the formation of a shorter transcript (BAFF-var mRNA) which causes greater production of the encoded protein compared to the wild-type transcript (BAFF-WT mRNA). Conclusion The molecular analysis conducted highlighted the presence of the BAFF-var variant in heterozygosis which leads to increased levels of soluble BAFF in the serum, with consequent up-regulation of humoral immunity. It is reported in the literature1 that this variant is associated with both Multiple Sclerosis and SLE and may represent a valid therapeutic target being treatable with the monoclonal antibody Belimumab.

Perceived association of mood and symptom severity in adults with mitochondrial diseases.

Individuals with genetic mitochondrial diseases suffer from multisystemic symptoms that vary in severity from day-to-day and week-to-week, but the underlying causes of symptomatic fluctuations are not understood. Based upon observations that: i) patients and their families frequently report that stressful life events either trigger exacerbations of existing symptoms or the onset of new symptoms, ii) psychological states and stress hormones influence mitochondrial energy production capacity, and iii) epidemiological reports document a robust connection between traumatic/stressful life events and various neurologic disorders, we hypothesized that mitochondrial disease symptom severity may vary according to participant's mood. To investigate this we administered the Stress, Health and Emotion Survey (SHES) in 70 adults (majority white (84%) cisgender women (83%), ages 18-74) with self-reported mitochondrial diseases (MELAS, 18%; CPEO, 17%; Complex I deficiency, 13%). Participants rated the severity of each of their symptom(s) over the past year on either good or bad days. On days marked by more stress, sadness and other negative emotions, some but not all symptoms were reported to be worse, including fatigue, exercise intolerance, brain fog, and fine motor coordination. By contrast, on days marked by happiness and calmness, participants reported these and other symptoms to be better, or less severe. Other symptoms including diminished sweating, hearing problems, and dystonia were in general unrelated to mood. Thus, some individuals living with mitochondrial diseases, at times perceive a connection between their mood and symptom severity. These preliminary associative results constitute an initial step towards developing more comprehensive models of the factors that influence the clinical course of mitochondrial diseases.

Protocol for open-label, randomised, controlled trial of intensive surveillance vs. standard postoperative follow-up in patients undergoing surgical resection for oesophageal and gastric cancer (SARONG trial).

TPS416 Background: Despite recent improvements in oncological and surgical treatment for patients with oesophageal and gastric cancer, 60% of patients with locally advanced disease who are treated with a curative intent will develop tumour recurrence and die within three years of completing treatment. In the absence of robust scientific evidence national or international guidelines have failed to reach consensus on the optimal surveillance strategy after primary treatment of oesophageal or gastric cancer. Methods: The primary research question of the proposed randomised controlled trial (RCT) is does the routine use of a structured follow-up program with regular radiological and endoscopic investigations improve survival in patients who have had surgical treatment for oesophageal or gastric cancer with curative intent? We aim to assess whether structured follow-up, including radiological and endoscopic investigations after completing curatively intended treatment, improves survival in patients with oesophageal or gastric cancer. The secondary aims of this RCT are to determine the impact of a structured post-treatment surveillance upon the detection and treatment of cancer recurrence and health-related quality of life, including anxiety and to assess the cost-effectiveness. We will undertake a national prospective, multi-centre, randomised controlled trial of structured follow-up including radiological and endoscopic investigations versus standard clinical follow-up. The setting will be at least 24 large oesophago-gastric cancer UK cancer centres. We will aim to recruit 952 oesophageal and gastric cancer patients receiving surgical resection for curatively intended treatment of oesophageal or gastric cancer +/- neoadjuvant/adjuvant chemo(radio or immuno)therapy. At 4-12 weeks after surgery for oesophageal or gastric cancer, patients will be assessed for eligibility for inclusion in the trial. Patients will be randomised 1:1 to receive either intensive follow-up for up to 3-years, with clinical and computerised tomography (CT) investigation every 6 months, and an endoscopy at 12 months or to current standard NHS follow-up, i.e. clinical review at 6 and 12 months followed by targeted investigation as required based upon the onset of new symptoms. The primary outcome is 3-year all-cause mortality and secondary outcomes include health-related quality of life (including anxiety), 3-year disease-specific mortality, pattern and treatment of tumour recurrence, and cost-effectiveness of follow-up in both study arms. The findings of this RCT will inform national and international guidelines for patients with oesophageal and gastric cancer, as this will be the first RCT to provide robust evidence concerning the value of surveillance in this population. Clinical trial information: 14417629.

From Death to Life/Back to the Future: Detailed Premorbid Clinical and Family History Can Save Lives and Address the Final Diagnosis in Sudden Unexplained Deaths With Negative Autopsy.

Sudden cardiac death is a sudden, unexpected death developed by one of the many different causes of cardiac arrest that occur within 1 hour of the onset of new symptoms. Sudden unexplained death (SUD) comprises a normal heart at postmortem examination and negative toxicological analysis. SUD often arises from cardiac genetic disease, particularly channelopathies. Channelopathies, or inherited arrhythmia syndromes, are a group of disorders characterized by an increased risk of sudden cardiac death, abnormal cardiac electrical function, and, typically, a structurally normal heart. They share an underlying genetic etiology where disease-causing genetic variants may lead to the absence or dysfunction of proteins involved in the generation and propagation of the cardiac action potential. Our study aimed to evaluate the importance of next-generation sequencing in the postmortem investigations of SUD cases. In this study, 5 forensic SUD cases were investigated for inherited cardiac disorders. We screened a total of 68 cardiac genes for the sibling of case 1, as well as case 2, and 51 genes for cases 3, 4, and 5. Of the 12 variants identified, 2 likely pathogenic variants (16.7%) were the TMEM43 _ c.1000+2T>C splice site mutation and the SCN5A _ p.W703X nonsense mutation. The remaining 10 variants of uncertain significance were detected in the TRPM4 , RANGRF , A KAP9 , KCND3 , KCNE1 , DSG2 , CASQ1 , and SNTA1 genes. Irrespective of genetic testing, all SUD families require detailed clinical testing to identify relatives who may be at risk. Molecular autopsy and detailed premorbid clinical and family histories can survive family members of SUD cases.

Management of Patients Affected by Giant Cell Arteritis during the COVID-19 Pandemic: Telemedicine Protocol TELEMACOV

Giant cell arteritis (GCA) is the most common primary systemic vasculitis in western countries, prevalently affecting elderly people. Both early diagnosis and regular monitoring are necessary for the correct management of GCA. Following the outbreak of the COVID-19 pandemic, government decisions aiming at reducing the contagion led to reductions in health activities, limiting them to urgent cases. At the same time, remote monitoring activities have been implemented through telephone contacts or video calls carried out by specialists. In line with these deep changes affecting the worldwide healthcare system and in consideration of the high risk of GCA morbidity, we activated the TELEMACOV protocol (TELEmedicine and Management of the patient affected by GCA during the COVID-19 pandemic) in order to remotely monitor patients affected by GCA. The aim of this study was to evaluate the effectiveness of telemedicine in the follow-up of patients already diagnosed with GCA. This was a monocenter observational study. Patients with a previous diagnosis of GCA admitted to the Rheumatology Unit of the University Hospital “Città della Salute e della Scienza” in Turin were monitored every 6–7 weeks by means of video/phone calls from 9 March to 9 June 2020. All patients were asked questions concerning the onset of new symptoms or their recurrence, exams carried out, changes in current therapy, and satisfaction with video/phone calls. We performed 74 remote monitoring visits in 37 GCA patients. Patients were mostly women (77.8%) and had a mean age of 71.85 ± 9.25 years old. The mean disease duration was 5.3 ± 2.3 months. A total of 19 patients received oral glucocorticoids (GC) alone at the time of diagnosis with a daily dose of 0.8–1 mg/kg (52.7 ± 18.3 mg) of prednisone, while 18 patients were treated with a combination of oral steroids (at the time of diagnosis, the prednisone mean dose was 51.7 ± 18.8 mg) and subcutaneous injections of tocilizumab (TCZ). During the follow-up, patients additionally treated with TCZ reduced their GC dose more than patients treated with GC alone (p = 0.03). Only one patient, who was treated with GC alone, had a cranial flare and needed to increase the dosage of GC, which led to rapid improvement. Furthermore, all patients proved very adherent to the therapies (assessed by Medication Adherence Rating Scale (MARS)) and considered this type of monitoring very satisfactory according to a Likert scale (mean score 4.4 ± 0.2 on a 1–5 range). Our study shows that telemedicine can be safely and effectively used in patients with GCA under control as a possible alternative, at least for a limited period of time, to traditional visits.

Postacute Sequelae of COVID-19 and Adverse Psychiatric Outcomes: Protocol for an Etiology and Risk Systematic Review.

The postacute sequelae of COVID-19 (PASC) is a syndrome characterized by persistent COVID-19 symptoms or the onset of new symptoms following recovery from the initial or acute phase of the illness. Such symptoms often occur 4 or more weeks after being diagnosed with COVID-19. Although a lot of work has gone into understanding the long-term mental health effects of PASC, many questions related to the etiology and risk of this condition remain. This protocol is for a systematic review assessing the association between PASC and adverse psychiatric outcomes and whether people with PASC are at greater risk of developing an adverse psychiatric outcome than those without PASC. Various medical literature databases (eg, PubMed and EMBASE) will be searched for eligible articles, using predefined search criteria. Gray literature will also be explored. Epidemiological observational studies and secondary analyses of randomized controlled trials that report a quantitative relationship between PASC and at least one adverse psychiatric outcome will be included. The Population, Exposure of interest, Comparator, and Outcome framework will be used as a standardized framework for the inclusion criteria. The Joanna Briggs Institute critical appraisal tools will be used to assess methodological quality and critically appraise the risk of bias in included studies. A random-effects meta-analysis will be conducted if possible. A formal narrative synthesis will be performed if a meta-analysis is impossible due to substantial heterogeneity across studies. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to rate the cumulative certainty of the evidence for all outcomes. Ethical approval is not required. The study results will be published in a peer-reviewed journal. This study documents and addresses etiology, risk factors, and long-term symptoms of COVID-19 among people with PASC. It focuses on a key priority area for new evidence syntheses on the clinical management of COVID-19 and pandemic-related conditions. It will include evidence on nonhospitalized and hospitalized patients with a history of PASC. Substantial heterogeneity across studies may limit the ability to perform a meta-analysis. Findings will inform disease prevention, decision-making, health care policy, and clinical research (Reviewed by the Plan P #PeerRef Community). PROSPERO CRD42022308737; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=308737.

Impact of Pegcetacoplan on Paroxysmal Nocturnal Hemoglobinuria Symptoms in Patients Previously Treated with C5-Inhibitors

Impact of Pegcetacoplan on Paroxysmal Nocturnal Hemoglobinuria Symptoms in Patients Previously Treated with C5-Inhibitors

The latest recommendations for the pharmacological treatment of irritable bowel syndrome with diarrhea. Review

Irritable bowel syndrome (IBS) is a common disorder resulting from disturbances in gut‑brain interactions, with a worldwide prevalence of 4.1 % to 10.1 % in adults. Although IBS is not life‑threatening, it is associated with a significant disease burden, including reduced quality of life, increased rates of comorbid psychological disorders, and high economic costs. One of the main subtypes of IBS is IBS with diarrhea (IBS‑D). Recently published guidelines of the American Gastroenterological Association (AGA) for pharmacologic treatment of patients with IBS‑D have just been released, based on evidence from a systematic and comprehensive review of the literature, while considering only randomized controlled trials conducted in adults with IBS. A positive diagnosis of IBS‑D can be made on the basis of medical history and physical examination, evaluation of gastrointestinal symptoms (especially presence or absence of worrisome features), limited diagnostic testing, and use of symptom‑based Rome IV criteria. The presence of alarming signs, such as the onset of new symptoms after age 50 years, rectal bleeding not associated with hemorrhoids or anal fissures, unintentional weight loss, iron deficiency anemia, nocturnal diarrhea, a family history of colon cancer, inflammatory bowel disease, or celiac disease, requires a thorough evaluation. In the treatment of IBS‑D, drugs with different mechanisms of action and different effectiveness are used. According to the latest AGA recommendations, most of the drugs, widely used in the treatment of IBS‑D (in particular, antispasmodics, loperamide, antidepressants), have a low reliability of efficacy evidence. Drugs with significant evidence of effectiveness include rifaximin‑a, eluxadoline, and alosetron, but the last two are not registered and are not used in Ukraine. Thus, until now, the only drug available in Ukraine for the treatment of IBS‑D and its relapses with well‑proven efficacy, is rifaximin‑a (Alfa Normix, Xifaxan). Selective serotonin reuptake inhibitors are not recommended for patients with IBS‑D.

COVID-19 Pandemic Consequences among Individuals with Eating Disorders on a Clinical Sample in Poland—A Cross-Sectional Study

The COVID-19 pandemic and imposed restrictions had negative consequences on overall health among many populations. This study aimed to investigate the influence of the pandemic on eating disorders (ED) and mental health (MH) of individuals with confirmed ED diagnoses. A survey consisting of questions related to (1) diagnosis of COVID-19, (2) changes in ED symptoms and onset of new symptoms, (3) psychological and MH aspects regarding to the pandemic, (4) lifestyle changes, and (5) social media (SM) usage was distributed between April–June 2021. One hundred and ninety-eight individuals met all of the inclusion criteria (nfemales = 195, 98.48%; nother gender = 3, 1.52%). Of the participants, 78.79% reported worsening of their ED symptoms, 42.93% of them noticed an onset of new ED symptoms, and 57.58% believed that the pandemic had a negative impact on their ED treatment. Negative changes due to the pandemic on MH were reported by 88.89%. Of the participants, 91.92% increased their time spent on SM and 54.04% of them declared that it had a negative impact on their MH. Medical professionals should consider results while providing comprehensive psychological care, which can be crucial information in the application of the appropriate treatment strategy.

Newborn with Microcephaly.

Newborn with Microcephaly.

Protocols of Anesthesia Management in Parturients with SARS-CoV-2 Infection.

Background: Our hospital became a referral center for COVID-19-positive obstetric patients from 1 May 2020. The aim of our study is to illustrate our management protocols for COVID-19-positive obstetric patients, to maintain safety standards for patients and healthcare workers. Methods: Women who underwent vaginal or operative delivery and induced or spontaneous abortion with a SARS-CoV-2-positive nasopharyngeal swab using real-time PCR (RT-PCR) were included in the study. Severity and onset of new symptoms were carefully monitored in the postoperative period. All the healthcare workers received a nasopharyngeal swab for SARS-CoV-2 using RT-PCR serially every five days. Results: We included 152 parturients with COVID-19 infection. None of the included women had general anesthesia, an increase of severe symptoms or onset of new symptoms. The RT-PCR test was “negative” for the healthcare workers. Conclusions: In our study, neuraxial anesthesia for parturients’ management with SARS-CoV-2 infection has been proven to be safe for patients and healthcare workers. Neuraxial anesthesia decreases aerosolization during preoxygenation, face-mask ventilation, endotracheal intubation, oral or tracheal suctioning and extubation. This anesthesia management protocol can be generalizable.

Preferred mode of presentation: Symposium Title of Symposium: Impact of COVID 19 on the mental health of children and adolescents

The COVID 19 pandemic has affected everyone in one form or the other. Children and adolescents seem to be a vulnerable group considering their critical period of development. The pandemic has affected their daily routines. High rates of depression, anxiety and stress reaction has been observed in children and adolescents during the pandemic. Containment measures including closure of schools, isolation and restriction of outdoor activities have impacted their day to day activities. This can additionally lead to difficulties with social development and may in turn contribute to onset of various metal health issues in this age group. Besides onset of new symptoms, children already having mental health issues including psychiatric disorders and neuro developmental disorders may experience an exacerbation of pre-existing symptoms. Disruption of services including medical services, special schools and rehabilitation services also poses one of the major challenges. Witnessing the death of either parent, relatives or both parents to COVID is quite stressful and one of the major psychosocial issues which hasn’t been adequately addressed. This can further lead to mental health issues along with various economic and logistic issues including employment, homelessness, migration and poverty.Addressing these issues includes inter-sectoral coordination and there is pressing need to focus on mental health issues of children and adolescents in a more holistic manner.Order of presentation:Rajesh Sagar – Introduction and overviewPallavi Rajhans – Impact of the pandemic and containment measures on mental health of children and adolescents and on children with special needsBichitra N. Patra – Psychosocial impact of parental job loss, poverty and orphanhood on children and adolescents

Abstract 10523: Prevalence and Characteristics of Aortic Dissection in Out-of-Hospital Cardiac Arrest Patients with Pulseless Electrical Activity as an Initial Rhythm

Introduction: The utility of extracorporeal cardiopulmonary resuscitation (ECPR) for patients with pulseless electrical activity (PEA) is still unclear and the appropriate patient selection is necessary. We evaluated the characteristics of patients with aortic dissection (AD), which is a major contraindication for ECPR, among patients with PEA using a city-wide (population=120.000) prospective registry of patients who experience out-of-hospital cardiac arrest (OHCA) whom cause of death are assessed by post-mortem computed tomography (PMCT). Methods and Results: 1373 patients who experienced OHCA between 2008 and 2020, and 1,235 (90%) were assessed their cause of death by CT in the city. 359 patients with PEA as an initial rhythm were finally included to this study and 44 had AD (12%). Female (OR, 2.37; 95% confidence interval [CI], 1.25-4.52; P=0.008), sudden onset (OHCA within 60 min from the onset of new symptoms) (OR, 2.61; 95% CI, 1.20-5.70; P=0.015), and the prevalence of hypertension (OR, 3.16; 95% CI, 1.45-6.88; P=0.004) were independently associated with the presence of AD. Based on the number of these 3 factors, the risk of AD was stratified into 0% (score 0), 12% (score 1 or 2) and 34% (score 3). Furthermore, among patients underwent post-resuscitation electrocardiogram (n=166), inferior segment ST depression was significantly associated with AD (OR, 3.89; 95% CI, 1.17-12.9; P=0.027) and its absence allowed us to identify low risk (4%) group in patients with score 1 or 2 (Figure). Conclusions: The risk of AD for OHCAs with PEA was 12%, but stratification based on interview and electrocardiography allowed us to identify lower risk groups (0% or 4%).

S3656 Capecitabine-induced Acute Hepatic Encephalopathy

Introduction: Capecitabine is a prodrug metabolized in the liver to fluorouracil, which is a pyrimidine analog that inhibits DNA synthesis, making it useful in treating a variety of malignancies including the neuroendocrine type 1.Common side effects include fatigue, nausea, vomiting, palmar-plantar erythrodysesthesia, and dermatitis. Common lab abnormalities that follow capecitabine initiation include pancytopenia, anemia, transaminitis, and hyperbilirubinemia. Encephalopathy, dysarthria, ataxia, confusion, and mood changes have been reported in less than 5% of patients using this medication. Case Description/Methods: A 62-year-old male with a history of pancreatic cancer with metastasis to the liver, who presented to the emergency department with altered mentation a week ago. Symptoms included worsening fatigue, confusion, progressed to inability to perform activities of daily life. Of note, the he started on capecitabine as part of his chemotherapy regimen three days prior to the onset of new symptoms. Home medications included amlodipine, chlorthalidone, metoprolol succinate, octreotide weekly injection, and ondansetron as needed for nausea. Physical exam was significant for disorientation to time, asterixis, and slight dysarthria in addition to hepatomegaly, which is of chronic nature. Lab values were consistent with mild transaminitis as ALT and AST were 44 IU/L and 52 IU/L, respectively. Ammonia level was 139 mcmol/L. Urea nitrogen was 23 mg/dL and creatinine was 1.56 mg/dL which is at patient’s baseline. Acute hepatitis panel was negative and abdominal ultrasound showed innumerable metastatic lesions, seen on a previous MRI of the liver, but was not consistent with cirrhotic changes. Patient was admitted and started on lactulose for hepatic encephalopathy, which was thought to be drug-induced, due to capecitabine. Discussion: Hyperammonemia has not been reported in the literature as a side effect of capecitabine. Treatment does not differ from hepatic encephalopathy caused by cirrhosis. Patients are monitored clinically for resolution of symptoms and may require discontinuation of the medication to prevent recurrent episodes. Our patient was improving after the second day of lactulose and holding the offending agent. Hyperammonemia has not been reported in patients taking capecitabine. The purpose of this report is to alert practitioners of such complications as prompt recognition of encephalopathy and appropriate treatment is key to improve symptoms and alter a patient's chemotherapy if needed.