Personal Smoking History Research Articles

Pulmonary Embolism in Adipsic DI: Can Desmopressin Be a Contributing Factor?

Background: Adipsic DI (ADI) is a rare disease associated with various morbidities. One of them is venous thromboembolism (VTE). In literature there are less than 10 reported cases and scarce management orientations. Classically, in ADI, VTE risk is due to dehydration and acute hypernatremia. Desmopressin should also be considered as it has a known role in blood coagulation such as increasing platelet cohesion and promoting von Willebrand factor release. Clinical Case: A 51-year woman with past medical history of obesity class 3 and a craniopharyngioma surgically intervened 8 months before, underwent a second craniotomy due to recurrent lesion. Postoperatively the patient developed an ADI, hypopituitarism and impairement of higher brain functions namely short-term memory and sleep-wake cycles impairment. She was discharged on desmopressin 0.35mg/day, levetiracetam 1500mg/day, hidrocortisone 15mg/day, levothyroxine 75mcg/day and quetiapine 25mg/day. Two weeks after discharge, the patient was admitted to the emergency room with anorexia and malaise. Tests were consistent with PE: elevated D-dimmer levels and CT angiography revealing bilateral PE. Treatment with enoxaparin was initiated. There was no hemoconcentration or polycythemia; kidney and liver function were normal, and sodium of 148 mEq/L (135-145 mEq/L). Three days before she had normal sodium levels. Respiratory insufficiency, deep vein thrombosis and infection were excluded. The patient did not present signs of dehydration. Brain CT did not show acute alterations. There was no personal history of smoking or family history of thrombosis and the patient was not on bed rest in the previous couple of weeks. During hospital stay abdominal and pelvic CT did not reveal malignancies. The patient was discharged on enoxaparin and posteriorly underwent a mammogram and colonoscopy; both exams without relevant alterations. At the last follow-up visit, she remained hypocoagulated and with desmopressin, with no further episodes of thrombosis. Conclusion: We report for the first time a case of PE in an obese patient with ADI treated with desmopressin and without overt hypernatremia or dehydration. All previously published cases of VTE in ADI have occurred in patients presenting with moderate to severe hypernatremia (sodium 157-181 mEq/L) and some degree of dehydration at the time of the event. Obesity and a recent hospitalization may have contributed to the development of VTE but desmopressin should also be taken into consideration due to its known effects on coagulation. Thromboprophylactic treatment after pituitary surgery and during acute episodes of hypernatremia and dehydration is already warranted in ADI but we additionally suggest considering at least short-term thromboprophylaxis in obese patients with recent ADI diagnosis treated with desmopressin as they might have this additional increased thrombotic risk.

Early Osteoporosis in RYR1-Related Central Core Disease

Background: Central core disease(CDC) is a congenital neuromuscular myopathy with a wide range of phenotypic presentations, ranging from delayed motor development, frequent falls, and difficulty maintaining posture. CDC is a rare presentation of RYR1 (Calcium release channel gene) mutation, which is also linked with the etiology of malignant hyperthermia. Clinical Case: We present a case of a 57-year-old woman who was diagnosed with osteoporosis at age of 52 with a T score of -2.3 after she had a fragility fracture of the knee. She suffered from multiple falls from poor balance. Her most recent DXA bone density scan from December of 2018 showed a T score of -2.6. On genetic testing, she was found to have a RYR1 heterozygous mutation, on exon 28.c.3800C to G(p.P1267 Arg). This sequence change led to the replacement of proline with arginine at codon 1267 of RyR1 protein. None of her immediate and extended family members showed any signs of CDC. We assume that the loss of sufficient muscle strain on bone and the catabolic effect of RYR1 myopathy are major causes of osteoporosis in our patient, although menopause, personal history of smoking, and alcohol intake could also be contributing factors. Teriparatide along with daily Calcium and Vitamin-D was prescribed. Later on, denosumab injection was also added to the regimen. The patient still has at least one episode of unprovoked fall in a month, but luckily she has not had any more fractures. Conclusion: To our knowledge, this is the first case where early osteoporosis in RYR1 myopathy has been reported.

Evaluation of long-term quitters: who stays smoke free forever?

Smoking cessation is one of the most powerful health promotion tools in the Western world. Behavioral group therapies are regarded as very promising interventions in this field. Quitting rates are usually evaluated after 6-12months and lie between 30 and 45%. So far, there are no scientific data on potential protective indicators to remain successfully smoke free after this period. Therefore, the aim of this study was to detect the current smoking status of former participants of a cessation service in an urban German surrounding. We investigated reasons for relapses, quitting strategies, and psychosocial parameters. In 2019, 130 former patients (2011-2017; mean age 54years; 37pack/years; Fagerstroem = 5.75; 58.5% male, 41.5% female; 66% physical comorbidities; 35% psychiatric diagnoses) were invited to participate in amailed survey (including WHO5, SF12, self-efficacy scale) and were asked about their current smoking status, personal history of smoking, and individual experiences with stopping after the 1‑year abstinence date. A total of 53persons replied (RR 41%), 29 (54%) of whom are currently smoke free; 24relapsed intermittently or permanently, 9experimented with e‑cigarettes, and 2became dual users. Daily hassles as well as physical and mental challenges were the main reasons for relapsing. Due to the low response rate, conclusions are limited; however, the 1‑year abstinence rate might not be as reliable as thought so far; long-term "sober" nicotine addicts remain at risk of relapse.

Covid19 pandemic impacts on mental health of tunisian health care workers

Introduction Covid19 pandemic in Tunisia has disturbed the health system. Health care workers, who were in the frontline to face this disease, had experienced reactions of anxiety, depression and distress.ObjectivesTo assess the level of anxiety and depression among health care workers of regional hospital of Gabes (south of Tunisia) and its associated factors.Methods We conducted a cross-sectional study, from April 19, 2020, to May 5, 2020 on healthcare workers in Gabes regional Hospital. All hospital departments and units were included. We used a self-administered anonymous questionnaire containing sociodemographic and clinical data. Hospital Anxiety and Depression Scale (HAD) validated in the Tunisian dialectal version was used to assess anxiety and depression.ResultsAmong the 289 responding participants, 100 (34.6%) were frontline health care workers directly engaged in managing patients with coronavirus disease. Our study revealed that 43.6% of health care workers were suffering from anxiety and 44.3 % from depression. There was a significant association between anxiety and female gender (p<0.001), being married (p=0.006), mental health conditions (p<0.001) especially anxiety disorders (p<0.001) and depressive disorders (p=0.03), personal medical history of dysthyroidism (p=0.013) and smoking (p=0.005). Nurses experienced more likely anxiety symptoms than other occupation (p=0.021). There was significant relationship between depression and female gender (p<0.001), married status (p=0.02), age under 50 (p=0.032) and mental health conditions (p<0.001) such as anxiety disorders (p=0.001) and depressive disorders (p=0.013).ConclusionsIt is crucial to provide care for health care workers with mental health problems during their struggle with covid19.

Relationship between heavy metal exposure and type 2 diabetes: a large-scale retrospective cohort study using occupational health examinations

ObjectivesTo investigate the associations between heavy metal exposure and serum ferritin levels, physical measurements and type 2 diabetes mellitus (DM).DesignA retrospective cohort study.SettingChangwon, the location of this study, is a...

Acute ST-elevation myocardial infarction in a patient with polycystic kidney disease in Kano, Nigeria

A 37-year-old male patient known to have polycystic kidney disease (PKD) for the past 5 years presented with a 2-day history of severe chest pain at rest that was confirmed as acute inferior myocardial infarction (MI). He was a known hypertensive for the past 5 years with a difficult-to-control blood pressure, but with preserved renal function. He had no family history of similar illness and has no personal history of diabetes mellitus, dyslipidemia, smoking, alcohol consumption, or recreational drugs use. Apart from elevated blood pressure of 150/100 mmHg, physical examination was unremarkable. He was found to have dyslipidemia with high-density lipoprotein cholesterol of 0.87 mmol/l and hypertriglyceridemia (2.7 mmol/l), but other serum lipid fractions and fasting plasma glucose were within normal limits. His echocardiogram showed normal sizes of all cardiac chambers with preserved left ventricular (LV) function, inferior wall hypokinesia, and Grade I LV diastolic dysfunction, and he had no aortic aneurysm. He was admitted for 5 days, treated conservatively, and discharged after resolution of symptoms, troponin, and raised ST segments. To the best of our knowledge, this is the first report from Nigeria illustrating the rare association between PKD and acute MI in the young.

Methylation marks of prenatal exposure to maternal smoking and risk of cancer in adulthood.

Prenatal exposure to maternal smoking is detrimental to child health but its association with risk of cancer has seldom been investigated. Maternal smoking induces widespread and long-lasting DNA methylation changes, which we study here for association with risk of cancer in adulthood. Eight prospective case-control studies nested within the Melbourne Collaborative Cohort Study were used to assess associations between maternal-smoking-associated methylation marks in blood and risk of several cancers: breast (n = 406 cases), colorectal (n = 814), gastric (n = 166), kidney (n = 139), lung (n = 327), prostate (n = 847) and urothelial (n = 404) cancer and B-cell lymphoma (n = 426). We used conditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between cancer and five methylation scores calculated as weighted averages for 568, 19, 15, 28 and 17 CpG sites. Models were adjusted for confounders, including personal smoking history (smoking status, pack-years, age at starting and quitting) and methylation scores for personal smoking. All methylation scores for maternal smoking were strongly positively associated with risk of urothelial cancer. Risk estimates were only slightly attenuated after adjustment for smoking history, other potential confounders and methylation scores for personal smoking. Potential negative associations were observed with risk of lung cancer and B-cell lymphoma. No associations were observed for other cancers. We found that methylation marks of prenatal exposure to maternal smoking are associated with increased risk of urothelial cancer. Our study demonstrates the potential for using DNA methylation to investigate the impact of early-life, unmeasured exposures on later-life cancer risk.

Radiological surveillance of small unruptured intracranial aneurysms: a systematic review, meta-analysis, and meta-regression of 8428 aneurysms.

With the widespread use of imaging techniques, the possibility that an asymptomatic unruptured intracranial aneurysm (UIA) is detected has increased significantly. There is no established consensus regarding follow-up, duration, and frequency of such imaging surveillance.The objectives of this study include assessing the growth rate and rupture risk of small (less than 7mm) UIAs, identifying associated risk factors and providing an aneurysm surveillance protocol in appropriately selected patients. Systematic searches of Medline, Embase, and Cochrane Central were undertaken from database inception to March 2020 for published studies reporting the growth and rupture risks of small UIAs. Twenty-one studies reporting 8428 small UIAs were included in our meta-analysis. The pooled mean age was 61 years (95% CI: 55-67). The mean follow-up period for growth and rupture ranged from 11 to 108 months, with the pooled mean follow-up period across 14 studies being 42 months (95% CI: 33-51). Pooled overall growth rate was 6.0% (95% CI: 3.8-8.7). Pooled growth rates for aneurysms < 5mm and < 3 mm were 5.2% (95% CI: 3.0-7.9) and 0.8% (95% CI: 0.0-6.1), respectively. Pooled overall rupture rate was 0.4% (95% CI: 0.2-0.7). From the meta-regression analysis, having multiple aneurysms, smoking, hypertension, and personal history of SAH did not significantly predict growth, and a personal history of SAH, smoking, hypertension, and multiple aneurysms were not statistically significant predictors of rupture. Our findings suggest that small UIAs have low growth and rupture rates and very small UIAs have little or no risk for rupture. In the setting of incidental small UIAs, patients with multiple and/or posterior circulation aneurysms require more regular radiological monitoring.

P632 Apical mass after acute myocardial infarction

Abstract Funding Acknowledgements No financial support 53-year-old male, with a personal history of high blood pressure and current smoking. He presented in the emergency department with typical chest pain. The initial electrocardiogram showed a ST segment elevation in DI and AVL leads. An emergency coronariography was performed showing a single vessel disease with two tandem lesions on the first diagonal, which were treated with pharmacoactive stents. An echocardiography was performed, showing a mild apicolateral hypokinesia, with good contractility of the remaing segments. In addition, a rounded, pediculated and mobile mass in the apex was observed; the mass was hyperechogenic compared to the myocardium. In this setting, the differential diagnosis should include thrombus in context of acute coronary syndrome (despite a small infarction with early revascularization and good contractility of the segments involved) vs. tumoral mass. Anticoagulant treatment was maintained and a cardiac magnetic resonance (MR) was performed. The MR showed an apical round mass of 11 mm, with hyperintense signal in both T1- and T2-enhanced sequences in comparison to normal myocardium; although no contrast uptake was observed in early gadolinium enhancement sequence, the mass showed homogeneous enhancement in the late enhancement images, both with optimal TI and with long T1. These findings were suggestive of a benign tumoral mass of atypical location. In addition, a small anterior subendocardial enhancement with preserved ejection fraction was observed. A control echocardiogram after 5 weeks of anticoagulant treatment showed no changes in either size or characteristics of the mass. After risk-benefit assessment and according to patient preferences, surgical resection of the mass was decided by a mini-thoracotomy approach. A surgical piece was obtained, described as a mobile pediculated tumour with a granulated surface and mucinous aspect. The postoperative period was uneventful. Subsequently, the pathological study confirmed the diagnosis of papillary fibroelastoma of atypical location. This case summarizes the usefulness of MR to characterize cardiac masses and, in particular, to differentiate tumours from thrombus. Although in this setting (recent myocardial infarction) an apical thrombus was initially suspected, the MR exam correctly identified a contrast enhanced mass, which ruled out acute thrombus and suggested benign tumour. Abstract P632 Figure.

MON-505 An Atypical Case of Osteoporosis Related to Pregnancy and Lactation

Background: Osteoporosis is rare in premenopausal patients without predisposing risk factors. A few case reports have described vertebral or hip fractures in young females due to pregnancy and lactation associated osteoporosis (PLAO). A proposed mechanism for PLAO is maternal bone resorption during pregnancy due to inadequate calcium stores to meet both maternal and fetal demands as well as hormone mediated trabecular bone demineralization to supplement calcium in maternal milk. We present a case of PLAO in a postpartum patient who suffered multiple atraumatic fractures of her vertebrae, clavicle, rib, and pelvic rami. To our knowledge, this is a unique combination of fractures that has not been previously reported. Clinical Case: A 38 year-old gravida 2 para 2 female presented for evaluation of back pain that started two months after she delivered her second child and while breastfeeding. Relevant past medical history included left hip chondrosarcoma that was treated with hemipelvectomy five years prior, with a concomitant diagnosis of right hip fracture while breastfeeding her first child. Subsequent imaging had been negative for chondrosarcoma recurrence or metastases. Prior to her first pregnancy, there was no history of trauma, glucocorticoid use, personal or family history of fracture, smoking, or alcohol use. Spinal imaging revealed vertebral compression fractures at T9, T12, and L5. Bone biopsies were negative for malignancy. Retrospective review of imaging after the first delivery and during lactation revealed incidental right clavicular and left rib fractures. Evaluation for secondary causes of osteoporosis, including total corrected calcium, ionized calcium, alkaline phosphatase, parathyroid hormone, thyroid-stimulating hormone, serum protein electrophoresis, and 24-hour urine cortisol were all normal. 25-OH vitamin D level was 30 (30-100 ng/mL), bone-specific alkaline phosphatase (BSAP) was elevated at 21.6 (range 5.3-19.5 mcg/L), and collagen type I c-telopeptide (sCTx) was 342 (range 60-650 pg/mL). DXA revealed Z scores of -2.9, -3.1, and -2.6 at the lumbar spine, femoral neck, and total hip respectively. Calcium carbonate-vitamin D 1000 mg-400 IU twice daily and breastfeeding cessation were recommended, followed by zoledronate 5mg IV. Three months later, BSAP and sCTx had decreased to 11.8 and 101 respectively. The patient has since been fracture free. Discussion: PLAO is exceedingly rare. Initial manifestations may include low trauma or atraumatic fractures of non-weight-bearing sites such as the clavicle. The diagnosis may be delayed due to the initial presentation of non-specific pain in an otherwise healthy female without risk factors. Increasing awareness and pursuing further research into the etiology of this disorder could lead to the development of appropriate guidelines for prevention of fractures in these patients.

Smoking Cessation in COPD Patients by a Selective Partial Nicotinic Agonist

The fight against smoking through various smoking cessation methods could be very effective by early education especially in young people for preventing the occurrence or the severity of obstructive lung diseases. The aim of the study was to present the impact of varenicline, a selective partial nicotine agonist, in adults of 40-49 year-old, active smokers, recently diagnosed with COPD, from 2009 to 2011, in a Smoking Cessation Center of the Pulmonary Rehabilitation Clinic Iasi, Romania. There were included all male employees, without occupational exposure, active smokers, with a personal history of smoking �10 packs-year cigarettes, recently diagnosed with COPD, who inform consented to be enrolled for counseling and smoking cessation treatment provided by varenicline. All patients received COPD therapy, according to the current GOLD recommendations. The method of evalution the impact of smoking cessation methods consisted in the COPD Assessment Test (CAT) completed by cases before and after 12 weeks program of smoking cessation counseling and therapy and respiratory rehabilitation. The CAT is a short questionnaire, simple and validated tool of COPD symptoms assessment, measuring the severity of COPD on a patient�s quality of life. Results reveals an important decreasing of CAT score with important amelioration of symptoms especially in severe COPD patients. Counseling, smoking cessation and respiratory rehabilitation interventions have shown positive effects of smoking cessation with varenicline among young COPD patients 40-49 year-old.

Cluster Headache Clinical Phenotypes: Tobacco Nonexposed (Never Smoker and No Parental Secondary Smoke Exposure as a Child) versus Tobacco-Exposed: Results from the United States Cluster Headache Survey.

To present results from the United States Cluster Headache Survey comparing the clinical presentation of tobacco nonexposed and tobacco-exposed cluster headache patients. Cluster headache is uniquely tied to a personal history of tobacco usage/cigarette smoking and, if the individual cluster headache sufferer did not smoke, it has been shown that their parent(s) typically did and that individual had significant secondary smoke exposure as a child. The true nontobacco exposed (no personal or secondary exposure) cluster headache sufferer has never been fully studied. The United States Cluster Headache Survey consisted of 187 multiple choice questions related to cluster headache including: patient demographics, clinical headache characteristics, family history, triggers, smoking history (personal and secondary), and headache-related disability. The survey was placed on a website from October through December 2008. One thousand one hundred thirty-four individuals completed the survey. One hundred thirty-three subjects or 12% of the surveyed population had no personal smoking/tobacco use history and no secondary smoke exposure as an infant/child, thus a nontobacco exposed population. In the nonexposed population, there were 87 males and 46 females with a gender ratio of 1.9:1. Episodic cluster headache occurred in 80% of nonexposed subjects. One thousand and one survey responders or 88% were tobacco-exposed (729 males and 272 females) with a gender ratio of 2.7:1. Eighty-three percent had a personal smoking history, while only 17% just had parents who smoked with secondary smoke exposure. Eighty-five percent of smokers had double exposure with a personal smoking history and secondary exposure as a child. Nonexposed cluster headache subjects are significantly more likely to develop cluster headache at ages 40 years and younger, while the exposed sufferers are significantly more likely to develop cluster headache at 40 years of age and older. Nonexposed patients have a statistically significant higher frequency of a migraine family history. The exposed population is statistically significantly more likely to have a history of head trauma 19% vs the nonexposed population 10% (P = .02). Tobacco exposed are significantly more likely to transition from episodic to chronic cluster headache (23% vs 14%, P = .02). Cranial autonomic symptoms as well as agitation are more common in tobacco exposed. Nonexposed are less likely to have specific cluster headache triggers. Exposed are significantly more likely to be triggered by alcohol. Tobacco exposed are significantly heavier caffeine users than nonexposed. Nonexposed are significantly more likely to have cluster headache cycles that vary throughout the year than exposed (52% vs 40%, P = .02). Exposed are much more likely to develop cluster headache from 12 am to 6 am than non exposed. Exposed experience significantly more frequent attacks per day and longer duration cycles than nonexposed. A significantly larger percent of the exposed population (57%) has suicidal ideations with their syndrome than nonexposed (43%) (P = .003). In regard to disability, both subtypes are disabled by their headaches, but exposed have more work related disability and lost home-days from headache. Both subgroups have a poor overall response to preventive and abortive medication outside of inhaled oxygen and injectable sumatriptan. Cluster headache sufferers who were never exposed to tobacco (personal or secondary as a child) appear to present uniquely compared to the tobacco exposed subgroup. The tobacco exposed clinical phenotype appears to have a more severe syndrome based on attack frequency, cycle duration, and headache related disability. Tobacco exposure is associated with cluster headache chronification. The nonexposed subtype appears to have an earlier age of onset, higher rate of familial migraine, and less circadian periodicity and daytime entrainment, suggesting a possible different underlying pathology than in the tobacco exposed sub-form.

Perception of Lung Cancer Risk: Impact of Smoking Status and Nicotine Dependence.

The general population is nowadays well aware that tobacco smoking dramatically increases the risk of developing lung cancer. We hypothesized that a personal history of smoking and the level of nicotine dependence in current smokers may affect the perception of this risk among healthy individuals. The fourth French nationwide observational survey, EDIFICE 4, was conducted by telephone among a representative sample of individuals (N = 1602) aged between 40 and 75years. Interviewees were asked about their smoking habits, perception of the risk of lung cancer, and nicotine dependence (Fagerström test). Regardless of their smoking status or level of nicotine dependence, the majority (96%) of our study population (N = 1463) acknowledged that tobacco smoking is a major risk factor for lung cancer. For 34% of all respondents, smoking ≤ 10 cigarettes per day does not carry any risk of lung cancer. Only half the current smokers considered themselves to be at higher risk of lung cancer than the average-risk population. The majority of current cigarette smokers with a nicotine dependence considered themselves to be at higher risk for lung cancer while only 37% of non-nicotine-dependent individuals had the same perception (P < 0.01). Current smokers were more likely to consider a screening examination than former smokers and never-smokers. However, the intention to undergo screening was not significantly affected by the level of nicotine dependence. Awareness campaigns may first have to overcome misconceptions about light smoking and, secondly, to target specific populations (heavy smokers, those with a long history, highly dependent smokers).

Smoking-Related Stigma Expressed by Physiotherapists toward Individuals with Lung Disease.

Purpose: We determined the extent and nature of stigma exhibited by a sample of Canadian cardiorespiratory physiotherapists toward people with lung disease who had a smoking history. Method: A quantitative online survey was distributed to Canadian cardiorespiratory physiotherapists, and an anti-smoking attitudes questionnaire was used to measure explicit stigma. We used two case studies with questions to measure implicit stigma. The first involved a patient with chronic obstructive pulmonary disease (COPD) and a smoking history, and the second described a patient with COPD with no smoking history. Results: Of the respondents (n=50), 56% demonstrated mild explicit stigma and 44% demonstrated moderate to severe explicit stigma. The extent of explicit stigma was not associated with respondents' age, area of practice, personal smoking history, or family history of lung disease resulting from smoking. The results indicated no evidence of implicit stigma, and no significant differences were found between the participants' prospective treatments and their professional attitudes toward patient cases. Conclusions: Canadian cardiorespiratory physiotherapists demonstrated explicit stigma toward people with lung disease with a significant smoking history, but there was no evidence of implicit stigma. These findings suggest that further research is needed to investigate how stigma held by cardiorespiratory physiotherapists may affect the quality of care provided for patients with a smoking history.

Abstract C82: Correlates of enrollee retention in a community-based breast cancer screening program

Abstract BACKGROUND: Early detection of breast cancer with screening mammography reduces breast cancer mortality. Despite this knowledge, certain groups such as African American women who are uninsured, underinsured, live in urban areas and are of lower socioeconomic status are less likely to complete screening mammography in comparison to other ethnic/racial groups. Maryland's overall rate of breast cancer screening amongst women 40 years and older in 2012, was 55%. That rate dropped respectively to 26% and 27% in women with no usual source of health care and no insurance. This study aims to 1.) Descriptively analyze a no-cost breast cancer screening program targeted at uninsured and underinsured African American women residing in Baltimore and 2.) To identify individual level factors associated with program retention and breast cancer diagnosis. METHODS: We conducted a descriptive analysis of individual level data from women who received program services from 2001-2015. Program retention was equated to the number of breast cycles completed—one versus two or more breast cycles. A breast cycle was defined as initiation and completion of screening or completion of recommended follow-up services through diagnostic resolution after an abnormal screen. Data were analyzed using SAS 9.3 and SPSS 22 software. RESULTS: A total of 5,669 women had valid dates and cycle information available for the analysis. The mean age at enrollment was 50.3 years old. The program enrollees were 13% White; 85% African American; and 7.5% Hispanic. Uninsured women comprised 75% of program enrollees. A family history of breast cancer was reported by 14% of program enrollees and 2.1% of enrollees reported a personal history of breast cancer. Fifty-eight percent of women had completed at least one screening mammogram prior to program enrollment. A personal history of smoking was reported by 31% of enrollees. The median length of program retention was 1.7 years. 10,357 mammograms were provided to these women, with 75% of women completing 2 or more mammograms. Enrollees completed a range of 1-15 breast cycles during the analyzed period, with a median of 2 cycles per enrollee. Age, race by ethnicity, insurance, personal history of breast cancer and mammogram prior to program enrollment were statistically significantly associated with the number of breast cycles completed in the bivariate analysis. Cancer was diagnosed in 113 women. Multivariable logistic regression was performed to determine probability of cancer diagnosis. Controlling for age and other variables in the model, cancer was approximately 1.7 times more likely to be diagnosed in patients who completed only 1 cycle compared to those who completed ≥2 cycles (OR=1.7; 95% CI 1.2, 2.6; p&amp;lt;0.01). Patients with history of smoking were approximately 1.6 times more likely to be diagnosed with cancer compared to patients without such history (OR=1.6; 95% CI 1.1, 2.3; p&amp;lt;0.05). Seventy percent of women diagnosed with cancer had an early stage breast cancer. CONCLUSION: This community-based cancer screening program engaged women from its target population in breast cancer screening. Several factors associated with program retention were identified, this information can be used to direct future program outreach and planning efforts. Our findings suggests that program retention was associated with likelihood of breast cancer diagnosis, however, the initial program screen had the greatest association with breast cancer diagnosis. Citation Format: Shana O. Ntiri, Elena Klyushnenkova. Correlates of enrollee retention in a community-based breast cancer screening program. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C82.

Germline mutations in Japanese familial pancreatic cancer patients.

Clinicopathologic and genetic features of familial pancreatic cancer (FPC) in Asian countries remain largely unknown. The main purpose of this study was to determine the prevalence of FPC and to define causative FPC-predisposition genes in a Japanese cohort with pancreatic ductal adenocarcinoma (PDAC). We reviewed 1,197 patients with a pathologically proven PDAC and found that 88 (7.3%) were FPC patients who had at least one first-degree relative with PDAC. There were no significant differences between the FPC cases and sporadic cases in terms of gender, age, tumor location, stage, family history of any cancer except PDAC, and personal history of smoking, other cancers, diabetes mellitus and chronic pancreatitis. In the FPC patients, we then investigated the prevalence of germline mutations in 21 genes associated with hereditary predispositions for pancreatic, breast and ovarian cancers by means of the next-generation sequencing using a custom multiple-gene panel. We found that eight (14.5%) of the 54 FPC patients with available germline DNA carried deleterious mutations in BRCA2, PALB2, ATM, or MLH1. These results indicate that a significant fraction of patients with PDAC in Japan have a family history of pancreatic cancer, and some of them harbor deleterious causative mutations in known FPC predisposition genes.

Nasal and conjunctival screening prior to refractive surgery: an observational and cross-sectional study

ObjectivesTo investigate bacterial flora of clinically healthy conjunctiva and nasal cavity among patients prior to refractive surgery, as well as the characteristics of patients with methicillin-resistant Staphylococcus aureus (MRSA) colonisation.DesignObservational...

47-Year-Old Man With Pruritus

47-year-old man with a medical history of headaches and seasonal allergies presented to the primary care clinic in late fall for evaluation of diffuse pruritus of 6 weeks’ duration that had occurred after initiating a new diet. The diet mostly restricted foods like dairy, soy, nuts, grains, and processed foods, but he stated that he had substantially increased his consumption of coconut and various spices including turmeric. The itching was present over most of his body but most prominent on the inner thighs and most notable after a hot shower. He provided picturesfromrecent episodes thatillustrated linear excoriations on the thighs. When he showered in cooler water, the diffuse pruritus was still present but minimally improved compared with a hot shower. He had been using the same body soap for years but tried a new soap without relief from the itching. In addition, he changed laundry detergent from one he had used for years with no relief. He had no occupational or habitual exposures that are suspected to contribute to pruritus. Overthe-counter hydrocortisone cream applied to his thighs provided minimal relief. His weight had been stable, and he reported no constitutional symptoms. On physical examination, the patient was a

Obstructive sleep apnea among patients attending Family Medicine Centers, Military Hospital in Khamis Mushait city, Saudi Arabia

Background: Obstructive sleep apnea (OSA) is a prevalent condition affecting at least 2% to 4% of the adult population. Patients are not routinely screened for symptoms of OSA as a part of their initial medical evaluation. Objective: To identify the prevalence and correlates of individuals who are at risk of OSA among adults attending to family medicine centers in Military Hospital in Khamis Mushait city, KSA. Materials and Methods: A cross-sectional study was carried out utilizing the Berlin questionnaire to identify patients who are at high risk for OSA among adult attendees of family medicine centers in Military Hospital in Khamis Mushait city, KSA. The study was conducted between October 1st and December 31st, 2015. An interview questionnaire including in addition to Belin questionnaire, demographic and personal data, smoking, and medical history was utilized. In addition, anthropometric measures including body weight, height, body mass index (BMI), neck circumference (NC), and waist/hip ratio for central obesity were measured. Result: The study included 413 patients. Their age ranged between 18 and 93 years with a mean of 39.6 ± 13.5 years. Slightly more than half of them (217; 52.5%) were females. Approximately half of the participants (201; 48.7%) were obese and 124 (30%) were overweight. Sixty-one subjects, representing 14.8% participants were at high risk of sleep apnea syndrome. Snoring was present in 37.3% subjects. Results of multivariate logistic regression analysis revealed that females were less likely to be at high risk of sleep apnea syndrome compared to males (AOR = 0.24 95% CI: 0.10–0.54, p = 0.001). Obese subjects were at higher risk of sleep apnea syndrome compared to normal subjects (AOR = 12.67 95% CI: 3.00–53.55, p = 0.001). Current smokers were more likely to be at higher risk of sleep apnea syndrome compared to nonsmokers (AOR = 3.46 95% CI: 1.25–9.58, p = 0.017). Patients with history of chronic diseases were at higher risk of sleep apnea syndrome compared to those without history of chronic diseases (AOR = 2.96 95% CI: 1.50–5.81, p = 0.002). Conclusion: The study has shown that a considerable proportion of adults attending family medicine centers in Khamis Mushait, KSA are at higher risk for obstructive sleep apnea. Males, smokers, obese, and those with history of chronic diseases were at higher significant risk for OSA compared to their counterparts.

Relation of atherosclerosis risk factors with the number of involved coronary arteries in angiography

Introduction: Coronary artery disease is the first leading cause of mortality in modern societies and formed the first cause of health expenditure. Male gender, diabetes mellitus, hypertension, hyperlipidaemia, family history of ischemic heart disease, personal history of ischemic heart disease, age, height, weight and smoking are the main risk factors for atherosclerosis and coronary artery diseases. Despite the abundant existing information about relation of these risk factors and atherosclerosis, there are different results regarding the relationship between these risk factors and the number of involved coronary arteries. The aim of this study is to determine the relation of these risk factors of coronary atherosclerosis with the number of involved coronary artery in angiography. Material and Methods: In this cross-sectional study, a total of 300 patients during 8 months in ShahidMadani heart hospital were carried out as convenience sampling. Data was collected by questionnaire including age, sex, weight, height and body mass index, diabetes mellitus, hypertension, family history of coronary heart disease, smoking, drug addiction, occupation, place of residence and education were studied. Number of coronary arteries stenosis revealed by angiography. Data were analysed by software 17SPSS, Chi-square test, T test and ANOVA. Results: A total of 300 patients with a mean age of 63.3±11.2 year were enrolled. Collected data showed that 71% were male, 33.3% smokers, 57.3% hypertensive, 30% diabetic, 27.7% with hyperlipidaemia, 70.34% obese and 14% with a family history of heart disease. Frequency of one, two and three vessel involvement was respectively 30%, 32% and 38%. There was a statistically significant relationship between ages, history of ischemic heart disease with the number of involved coronary artery. But there was no significant relationship with gender, body mass index, smoking and drug addiction, hypertension, family history of heart disease, location and education level with number of involved coronary artery. Conclusions: Our study showed that despite the known role of conventional risk factors with the incidence and growth rate of atherosclerosis, but there is no direct correlation with some of these risk factors and the number of involved coronary arteries in coronary angiography