Presence Of Comorbid Conditions Research Articles

Ostomy prevalence and survival in elderly patients with stage III and IV rectal cancer.

Oncological strategies in the elderly population are often debated. The objective of this study was to investigate the survival rates and prevalence of ostomy in elderly patients operated on for stage III and IV rectal cancers. This retrospective multicentric population-based study included 151 patients aged ≥75 years with stage III and IV rectal adenocarcinoma who underwent surgery between 2007 and 2014. Multivariable logistic regression was used to assess the impact of different prognostic factors. The median age of the patients was 81 years (range: 75-97 years) with 40 patients >85 years of age. Age was significantly correlated with overall survival (OS) in both stage III and IV cancers (P < 0.001). For patients ≥80 years the presence of comorbid conditions was associated with a lower chance of survival (P=0.02). A digestive stoma was created in 67 (76.1%) patients with stage III cancer and 26 (29.54%) had a stoma reversal. A palliative derivative stoma was performed in half of patients with stage IV cancer. Adjuvant chemotherapy was independently associated with improved 5-year OS (P < 0.001). Age, comorbidities and adjuvant chemotherapy were independent predictors for OS. Resection of rectal tumors in fit elderly patients should be promoted; however, patients should be aware of the high risk of stoma. Geriatr Gerontol Int 2021; 21: 670-675.

Concomitant Medications and Comorbidities Affect Early Response in CML Patients Treated with Imatinib: A Retrospective Analysis of 340 Patients from the Polish Adult Leukemia Group (PALG) Registry

Background : It has been consistently shown that early molecular response is associated with positive long-term outcome in terms of overall survival and progression-free survival in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs). Achieving a BCR-ABL(IS) <10% at three months has thereby become an important goal of treatment. According to current European LeukemiaNet recommendations, the optimal treatment response is defined as BCR-ABL(IS) ≤ 10% at three months and BCR-ABL(IS)<1% and/or complete cytogenetic response (CCyR) at six months. Factors influencing the early response are still largely unknown.Our previous study demonstrated that more than half of newly diagnosed CML patients in Poland had comorbid conditions and received concomitant medications. TKIs are metabolized by the CYP3A4 isoenzyme and have been reported to be substrates of ABCB1 (MDR1) and ABCG2 (BCRP) transporters. Importantly, numerous commonly used drugs are transported and metabolized through the same pathways as TKIs. Drug interactions should therefore be considered when administering inhibitors or inducers of CYP3A4, ABCB1 and ABCG2 in combination with TKIs. Furthermore, it has been shown that the presence of comorbidities and the necessity of additional therapies may significantly affect treatment compliance.Objectives: The primary objective of the study was to investigate whether the presence of comorbidities and additional therapies affected early response in CML patients treated with imatinib.Patients and methods : We retrospectively analyzed patients with newly diagnosed CML who were receiving imatinib as the initial therapy for CML at nine Polish hematological tertiary care centers. Inclusion criteria were as follows: 1) age ≥18 years and 2) diagnosis of chronic phase CML between January 1st 2005 and December 31st 2014. Data on presence of comorbid conditions, concomitant drugs, cytogenetic and molecular response were anonymously collected through electronic case reports forms. Patients in whom therapy was changed because of imatinib intolerance were excluded. Influence of potential prognostic factors on probability of response at three and six months was tested by univariate and multivariate logistic regression.Results : We enrolled 340 patients with CML in the chronic phase, with median age 53 years (range, 41-62) where 50 % were males. According to the Sokal score, 190 patients (55.9%) were classified as low risk, 107 (31.5%) as intermediate risk and 43 (12.5%) as high risk. Overall, 142 (41.8%) patients reported no comorbidities, 121 (35.6%) reported one or two comorbidities and 77 (22.7%) had more than two comorbid conditions. The most common comorbidities were: hypertension (30%), hypercholesterolemia (16%), ischemic heart disease (10%) and diabetes (9%). One hundred thirty (38.2%) patients received no additional therapies, 110 (32.4%) patients received one or two therapies and 100 patients (29.4%) more than two. The most frequently used drugs were: beta blockers (22% of patients), ACE inhibitors (19%) and statins (15%). At three months, a molecular analysis was done in 194 patients and 144 (74%) achieved BCR ABL(IS) of less than 10%. At six months, 217 patients underwent molecular analysis and 305 had cytogenetic assessment. One hundred thirty five patients (62%) achieved BCR-ABL(IS) < 1% and 198 (65%) achieved CCyR. Multivariate analysis revealed that at three months patients who had a low Sokal score, more than two comorbidities and received more than two concomitant therapies, significantly more often achieved BCR-ABL <1% (p=0.013, p=0.054 and p=0.005 respectively). At six months, patients who received more than two concomitant medications still tended to have a higher probability of optimal response: BCR-ABL(IS) <1% (p=0.062) and CCyR (p=0.035). Other potential prognostic factors analyzed including patients' age, sex and BMI had no impact on the probability of optimal response.Conclusions: We found that comorbidities and concomitant therapies did not adversely affect early response to imatinib in CML patients. In contrast, patients with more than two additional therapies and comorbidities seem to more often achieve treatment goals. The potential explanations for these findings are drug interactions that increase imatinib exposure and better adherence to therapy of patients accustomed to systematic use of medications. DisclosuresGora Tybor:BMS: Honoraria, Speakers Bureau; Incyte: Honoraria, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau. Sacha:Incyte: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau; BMS: Honoraria, Speakers Bureau. Lewandowski:BMS: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Incyte: Honoraria, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau. Warzocha:BMS: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau. Jamroziak:Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Honoraria, Speakers Bureau; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria.

Mepolizumab improves clinical outcomes in patients with severe asthma and comorbid conditions

BackgroundComorbidities can complicate the management of severe asthma; therefore, the presence of comorbid conditions or traits often need to be considered when considering treatment options for patients with severe asthma. The aim of this analysis is to investigate the efficacy of mepolizumab in patients with severe eosinophilic asthma and comorbidities.MethodsThis was a post hoc analysis (GSK ID:209140) of data from the Phase IIb/III studies DREAM, MENSA, SIRIUS, and MUSCA. Patients aged ≥ 12 years with severe eosinophilic asthma were randomized to: mepolizumab 750, 250, or 75 mg intravenously or placebo (DREAM); mepolizumab 75 mg intravenously or 100 mg subcutaneously or placebo (MENSA); or mepolizumab 100 mg subcutaneously or placebo (SIRIUS and MUSCA) every 4 weeks for 24 weeks in SIRIUS and MUSCA, 32 weeks in MENSA or 52 weeks in DREAM. In this analysis the primary endpoint was the annual rate of clinically significant exacerbations; secondary endpoints were Asthma Control Questionnaire-5 score, St George’s Respiratory Questionnaire total score, and pre-bronchodilator forced expiratory volume in 1 s at study end. Subgroups were based on comorbidities at baseline.ResultsOverall, 1878 patients received placebo (n = 689) or mepolizumab (n = 1189). Across all comorbidity subgroups mepolizumab reduced the rate of clinically significant exacerbations by 44–68% versus placebo, improved Asthma Control Questionnaire-5 score by 0.27–0.59 points, and improved St George’s Respiratory Questionnaire total score by 5.0–11.6 points. Pre-bronchodilator forced expiratory volume in 1 s was improved by 27.1–286.9 mL in all but one comorbidity subgroup, the diabetes mellitus subgroup.ConclusionsMepolizumab reduces exacerbations, and improves asthma control, health-related quality of life, and lung function in patients with severe eosinophilic asthma despite comorbid conditions, including upper respiratory conditions, psychopathologies, cardiovascular conditions, gastroesophageal reflux disease, diabetes mellitus, and obesity.Trial registration: https://clinicaltrials.gov/ DREAM, MEA112997/NCT01000506; MENSA, MEA115588/NCT01691521; SIRIUS, MEA115575/NCT01842607; MUSCA, 200862/NCT02281318.

A retrospective study of drug related problems and contributing factors among type 2 diabetes mellitus patients on follow up at public health institutions of kemisse town, north east Ethiopia

BackgroundDrug related problems interfere with the desired treatment outcomes of type 2 Diabetes mellitus. This study was conducted to determine prevalence of drug related problems and associated factors among patients with type 2 Diabetes Mellitus in public health institutions of Kemisse town, northeast Ethiopia from May 01 to 30, 2019. MethodsInstitution based retrospective cross sectional study was conducted among type 2 Diabetes Mellitus patents on follow up at public health institutions of Kemisse town, northeast Ethiopia. ResultFrom the total of 156 patients included in the study, 126 (80.8%) patients have at least one drug related problem with a total of 149 drug related problems. The most prevalent drug related problems were need for additional drug therapy 60 (40.3%) followed by non-compliance 51 (34.2%) and unnecessary drug therapy 12 (8%). Identified causes of need for additional drug therapy were the need for prophylactic drug therapy (statins and antiplatelet), 83.3%; presence of untreated medical condition (Hypertension, diabetic nephropathy and diabetic foot ulcer), 11.7%; and the need for combination therapy for better efficacy, 5%. This study revealed that age ≥45 years (AOR = 5.59, 95% CI = 1.38–20.64, P = 0.016), presence of comorbid condition (AOR = 3.22, 95% CI = 1.75–13.47, P = 0.014 and emergency visit in the last one year (AOR = 5.08, 95% CI = 1.14–18.71, P = 0.033) were significantly associated with the occurrence of drug related problems. ConclusionA total of 149 drug related problems were identified in 80.8% of type 2 diabetes mellitus patients. The three most prevalent drug related problems were need for additional drug therapy 60 (40.3%) followed by non-compliance 51 (34.2%) and unnecessary drug therapy 12 (8%). Additionally, age ≥45 years (AOR = 5.59, P = 0.016), presence of comorbidity (AOR = 3.22, P = 0.014) and emergency visit in the last one year (AOR = 5.08, P = 0.033) were significantly associated with the occurrence of drug related problem.

Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis.

ABSTRACTBackgroundBased on a variety of studies conducted in recent years, some of the factors that might contribute to the negative treatment responses of some TMD patients have been elucidated.MethodsThis paper describes known vulnerability factors that make individuals susceptible to developing temporomandibular disorders (TMDs), as well as those that contribute to the perpetuation of such problems. In addition, the topic of iatrogenesis is discussed as a major contributor to the negative outcomes that can be seen in this field.ResultsAt the patient level, anatomical, psychosocial and genetic factors may contribute to individual vulnerability. The anatomy and pathophysiology of muscles, joints, disc and nerves may all be involved in predisposing to TMD symptoms, especially when the patients have pain elsewhere in the body. Among the psychosocial factors, some features may be elucidated by the DC/TMD axis II, while others (eg illness behaviour, Munchausen syndrome, lack of acceptance of non‐mechanical approaches) require careful evaluation by trained clinicians. Genetic predisposition to first onset TMDs and to chronification of symptoms has been identified for individuals with certain psychological traits, presence of comorbid conditions and certain abnormal clinical manifestations. Regarding iatrogenesis, sins of omission may influence the clinical picture, with the main ones being misdiagnosis and undertreatment. Joint repositioning strategies, occlusal modifications, abuse of oral appliances, use of diagnostic technologies, nocebo effect and complications with intracapsular treatments are the most frequent sins of commission that may contribute to chronification of TMDs. The patients who present with massive occlusal and jaw repositioning changes combined with persistent severe orofacial pain are not a rarity within TMD and orofacial pain canters; these patients are the most difficult ones to manage because of this horrific combination of negative factors.ConclusionsThe information presented in this paper will help clinicians to understand better why some individuals develop temporomandibular disorders, why some of them will progress to becoming chronic patients, and what the appropriate responses may be.

MO179ACUTE KIDNEY INJURY IN ELDERLY- PROGNOSTIC VALUES OF COMORBIDITY AND THE AGE FOR THE SHORT AND THE LONG TERM OUTCOME

Abstract Background and Aims Acute kidney injury (AKI) is defined by a rapid decline in glomerular filtration rate (GFR), resulting in disturbance of renal physiological functions including impairment of nitrogenous waste product excretion, loss of water and electrolyte regulation and loss of acid-base regulation. Coexisting disease and the structural and functional changes that occur during the aging process are disposing factors that increase the risk of AKI in elderly population. Method 101 elderly patients (≥ 65) who filling out one of the criteria of definition of AKI according to Kidney Disease Improving Global Outcome (KDIGO), were included in the study. Patients were divided into 2 groups by age, group &amp;lt;75 and group&amp;gt; 75 years old. In terms of outcome they were divided in group with short and 90-day survival. The burden of the simultaneous presence of comorbid conditions was estimated through the Charles Comorbid Index. (CHI) Results The mortality rate for the 90-day follow-up period after the AKI event was 45.5%. The intra-hospital mortality rate in adult patients with AKI was 22.8%.In our study the age was not confirmed as a risk factor for intra-hospital and 3-month outcome in elderly patients with AKI. The presence of comorbid conditions estimated through the Charles Comorbid Index (CHI), differed un-significantly between survivors and deceased patients with AKI (p = 0.39, p = 0.28 consecutive). Cox regression analysis confirmed the CCI score as a significant factor in survival in patients with ABO. (p = 0.036).The risk of letal outcome increases by 16.3% with each increase in this unit score. Cox regression analysis confirmed heart diseases as a significant prognostic factor for survival, increasing the risk of fatal outcome by about 2 times higher than patients without heart disease. Statistical analysis showed a significant difference in survival time, depending on the presence of heart disease as a comorbidity (p =0.037). Conducted Cox regression analysis showed that HR - for heart disease, as a comorbidity, is 1.837 95% CI (1.020 - 3.306) and p = 0.043. The death rate for patients with heart disease is about 2 times higher than patients without heart disease. Cumulative survival was higher in the group of patients without cardiomyopathy - 64.2% (0.07) compared to the group of patients with cardiomyopathy- 43.8% (0.07). Multivariate Cox regression analysis as significant independent predictors of survival in patients with ABO confirmed the diuresis (p = 0.029) and albumin (p = 0.006). Conclusion AKI survivors with high burden of comorbidities are at high risk for postdischarge death. Cardiomyopathy, as a risk factor, for two times increases the risk of death. CCI score is significant independent high-risk prognostic factors for poor outcome in elderly patients with AKI. Remain the recommendation for individual clinical approach, assessment and selection for the application of treatment taking into account the overall condition in adult patients with acute renal injury.

The impact of the COVID-19 pandemic on African American cancer survivors living in metropolitan Detroit.

12129 Background: COVID-19 has had profound direct and indirect effects on population health to date and long-term effects are anticipated. Vulnerabilities to the most serious consequences of infection include older age, obesity, African American race and the presence of comorbid conditions. African American cancer survivors represent a particularly high-risk group, therefore understanding the impact of the virus and our strategies to prevent its spread on this patient population is important. Methods: The Detroit Research on Cancer Survivors (ROCS) cohort is a unique effort to understand the determinants of poor outcomes in African American cancer survivors. Eligible participants were diagnosed with breast, prostate, colorectal, or lung cancer on or after 1/1/2013, or with endometrial or any other cancer before age 50 on or after 01/01/2016 and were identified through the Metropolitan Detroit Cancer Surveillance System cancer registry. To date, we have enrolled 4173 survivors. Full participation includes completion of a baseline survey, and collection of biospecimens, medical records and tumor tissue, if available. Participants are also followed annually for outcomes and changes in history. A supplemental survey focused on the impact of COVID-19 was offered to enrolled participants beginning in the spring of 2020. The results presented here include data from 890 survivors who also completed the ROCS COVID survey. Results: Nearly all ( &gt; 99%) survivors reported some change in their daily activities in an effort to reduce the risk of infection. At the time of survey, just over 1/3 of participants reported being tested for the virus and among those, 12% reported positive results. More than 40% of survivors reported some disruption in their access to medical care. A substantial ( &gt; 40%) proportion of survivors reported feeling anxious, depressed and/or isolated during the COVID-19 pandemic. Approximately 40% of patients reported changes in health behaviors as a direct result of the pandemic that are known to negatively affect survivorship outcomes (physical inactivity, smoking, alcohol use). Notably, 30% of survivors reported declines in physical activity and these declines were significantly associated with increased anxiety (p = 0.008), depression (p = 0.005) and poorer health-related quality of life (p &lt; 0.001). Conclusions: The influence of the COVID-19 pandemic on African American cancer survivors has been substantial, affecting both their physical and mental health and access to needed medical care. Coupled with changes in health behaviors as a direct result of the pandemic, these factors will likely affect outcomes in this high-risk patient population making further study and interventions necessary to mitigate the long-term impact of the pandemic on cancer outcomes.

Investigating reasons for discontinuation of first-line adjuvant chemotherapy among ovarian cancer patients in the midwestern United States.

e17523 Background: Receipt of surgery and adjuvant chemotherapy greatly impact survival outcomes for ovarian cancer, the deadliest gynecologic malignancy with a high recurrence/progression rate. Most patients receive first-line, platinum-based chemotherapy. Platinum-based chemotherapy causes severe side effects, including nephrotoxicity and myelosuppression. Evidence for other chemotherapeutic agents is lacking and options are limited for women who cannot tolerate first-line chemotherapy. We aimed to determine the prevalence of premature first-line chemotherapy discontinuation and to detail reasons for discontinuation. Methods: We used the population-based cohort, Patterns of Ovarian Cancer Care and Survival in the Midwestern Region of the United States—a CDC Investigation, comprised of women diagnosed with histologically confirmed, stage IB-IV ovarian cancer in 2010-2012 in the Midwestern United States (i.e., Iowa, Kansas and Missouri) between the ages of 18 and 89 years. We limited the cohort to patients who received cancer-directed surgery and initiated adjuvant chemotherapy. Chemotherapy lines, completion, and reasons for discontinuation were abstracted from patient medical records by cancer registrars using standardized protocols. Results: Nineteen percent (N= 107/559) of ovarian cancer patients who initiated adjuvant chemotherapy did not complete first-line treatment. Reasons for chemotherapy discontinuation included toxicity or other kinds of intolerance (39%), poor quality of life or comorbid conditions (19%) or exhibited no response (17%) (Table). No significant differences were observed between gynecologic oncologists and non-gynecologic oncologist chemotherapy providers (p=0.109). Conclusions: One in 5 women who initiated did not complete first-line chemotherapy. Reasons were varied and suggested that lack of tolerance is not the only factor in discontinuation. Lack of response and the presence of comorbid conditions are considerations that can be taken into account during decision-making processes for treatment. More clinical research into additional chemotherapy options that may be useful in these patients is necessary.[Table: see text]

Impact of Atrial Fibrillation on In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State: Analysis of National Inpatient Sample

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia and its negative prognostic impact on the morbidity and mortality of hospitalized patients has been well described. In patients with Hyperosmolar hyperglycemic state (HHS), mortality rates can reach up to 20% and poor outcomes have been reported in people with older age, presence of comorbid conditions and concurrent infections. However, the impact of atrial fibrillation on the hospital outcomes of patients admitted with HHS has not been well documented.Objective: We wanted to compare the outcomes for HHS hospitalizations for patients with and without Atrial fibrillation.Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 42 740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of Atrial Fibrillation as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total Hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders.Results: Out of the 42 740 hospitalizations with HHS, about 3 295 had Atrial Fibrillation. The in-hospital mortality for patients with HHS was 305 overall, out of which 60 patients had Atrial Fibrillation as secondary diagnosis. Compared with patients without Atrial Fibrillation, patients with Atrial Fibrillation had a similar in- hospital mortality (aOR 0.77, 95% CI 0.39–1.52, p=0.45) when adjusted for patient and hospital characteristics. Patients with HHS and Atrial Fibrillation had similar length of hospital stay, total Hospital charges, rate of Sepsis, Septic Shock, AKI, and ARF in comparison to patients without Atrial Fibrillation.Conclusion: Our study suggests that the presence of atrial fibrillation in hospitalized HHS patients is not associated with increased mortality or longer duration of hospital stay. This data is essential since it helps identify HHS patients with increased risk of complications. As previous reports have suggested that AF, especially of new onset in critically ill patients is a marker of increased disease severity, the lack of such impact in patients with HHS requires further studies.

Comorbidity Profiles and Lung Cancer Screening among Older Adults: U.S. Behavioral Risk Factor Surveillance System 2017-2019.

Rationale: Although lung cancer screening (LCS) with low-dose computed tomography (LDCT) is now recommended for those meeting standard risk factor-based eligibility criteria, the role of comorbidity in the uptake of LCS with LDCT in an older real-world U.S. population is not well established. Objectives: To examine the relationships between comorbidity, functional status, and LCS utilization in the United States. Methods: Using population-based data from the 2017-2019 Behavioral Risk Factor Surveillance System, we examined the association of comorbid conditions and functional limitations regarding activities of daily living with LCS utilization among participants that met the LCS criteria based on the U.S. Preventive Service Taskforce guidelines. We employed multivariable weighted logistic regression models to evaluate these associations, both overall and within subgroups defined by age (<65 yr vs. ⩾65 yr), sex, and smoking history. Results: Of 11,214 participants who met the eligibility criteria for LCS, 1,731 (16%) underwent LCS with LDCT. The majority were White (90%), male (55%), former smokers (52%), and living with at least one chronic comorbid condition (77%). More than 28% had three or more comorbid conditions, and approximately 40% of participants reported having some form of functional limitations. In the multivariable models, the likelihood of undergoing LCS with LDCT within the past year was positively associated with higher amount of comorbidity (⩾5 vs. 0: adjusted odds ratio, 2.34; 95% confidence interval [CI], 1.22-4.48) but not with functional limitations (⩾3 vs. 0: adjusted odds ratio, 1.00; 95% CI, 0.66-1.50). Conclusions: The presence of comorbid conditions is associated with a higher likelihood of undergoing LCS with LDCT. Because poor health status may diminish the benefits of screening, future research is needed to precisely characterize the health status of LCS-eligible individuals.

Clinical course and outcome of patients with COVID-19 in Mumbai City: an observational study

ObjectiveTo understand the outcome of hospitalised patients from Mumbai City, which had the highest number of COVID-19 cases in India.DesignObservational study with follow-up.SettingData extraction from medical records of patients with...

Chronic obstructive disease and comorbidities (literature review)

Chronic obstructive pulmonary disease (COPD) is a pulmonary disease characterized by irreversible airway obstruction. Systemic involvement of COPD, as well as interactions between COPD and its comorbidities justify the description of chronic systemic inflammatory syndrome. Most patients with COPD have at least one comorbid condition that further complicates the development and management of the disease. The most common comorbidities encountered in association with COPD are cardiovascular diseases, lung cancer, osteoporosis, cachexia, anxiety and depression, diabetes mellitus, metabolic syndrome, gastro-esophageal reflux (GERD), bronchiectasis, obstructive sleep apnea (OSA). Diagnosis and assessment of COPD severity can be difficult in the presence of comorbid conditions, so assessment of lung, cardiovascular and metabolic function, as well as the level of inflammatory circulating markers (C-reactive protein, fibrinogen), could help to establish the clinical concept. The presence of comorbidity should not change the treatment of COPD, and comorbidity should be treated according to normal standards, regardless of the presence of COPD. When COPD is part of a multi-morbidity care plan, care should be taken to ensure simplicity of treatment and to minimize polypharmacy. This review article of literature reflects an overview of the COPD comorbidities, as well as their influence on the quality of life and prognosis.

Discordance between the perceptions of clinicians and families about end-of-life trajectories in hospitalized dementia patients.

Due to the unpredictable dementia trajectory, it is challenging to recognize illness progression and the appropriateness of a palliative approach. Further confusion occurs during hospitalization where the presence of comorbid conditions complicates prognostication. This research examined clinicians and families' perceptions of dementia as a terminal condition in relation to end-of-life admissions. The study was based in the General Medicine units of one Australian public hospital. Medical, nursing, and social work clinicians were recruited to reflect multidisciplinary perspectives. Bereaved caregivers of deceased patients with dementia were interviewed 3 months following death. Qualitative research underpinned by a social constructionist epistemology and framed through complex systems theory. Semi-structured interviews generated data that illuminated perceptions of deterioration observed toward the end of life. Although participants anticipated general cognitive and physical deterioration associated with dementia, the emergence of comorbid illness made it difficult to predict the onset of the end of life. During a hospital admission, clinicians attributed the end of life to the advanced outcomes of dementia, whereas families described new medical crises. End-of-life admissions illuminated intersections between dementia and comorbidities rather than illness progression. In contrast with the perception that people with dementia lose awareness at the end of life, families drew attention to evidence that their loved one was present during the dying phase. Our findings challenge the dominant understanding of dementia trajectories. Bifurcations between clinicians and families' views demonstrate the difficulties in recognizing end-of-life transitions. Implications for the integration of palliative care are considered.

Prescribing Pattern and Medication Related Problems in Hospitalized Diabetic Patients: A Hospital-Based Study

Aim: To assess the drug-related problems (DRPs) and World Health Organization (WHO) core prescribing indicators among hospitalized diabetic patients.&#x0D; Methodology: A prospective, observational study was made among the diabetic inpatients of the General Medicine Department of a tertiary care hospital located in Tirupati, Andhra Pradesh, India. A suitable data collection form was used to collect the data pertaining to demographics, clinical variables, DRPs, and WHO prescribing indicators. Descriptive statistics like frequency, mean, and percentage were used to represent the demographics, distribution of DRPs, and prescribing indicators in the study. Inferential statistics like Chi-square test was employed to test the significant association between the demographics and occurrence of DRPs.&#x0D; Results: A total of 199 diabetic patients were enrolled in this study. The mean age of the study participants was 55.8±11.3. The study shows the prevalence of DRPs in diabetic in-patients was 48.7%. The most commonly identified DRPs are drug interactions (53; 45.3%), adverse drug reactions (24; 20.5%), and untreated indication (21; 17.9%). Patient characteristics like, advanced age (≥60 years), presence of co-morbid condition, comprising more than 5 drugs in prescription, and stay in the hospital for more than four days are significantly associated with the development of DRPs. Findings of WHO indicators show the average number of drugs, percentage of drugs prescribed by the generic name, percentage of encounters with an antibiotic, injection, and from essential drug list have deviated from standards of WHO.&#x0D; Conclusion: The prevalence of DRPs in diabetic in-patients was 48.7%. Drug interactions and adverse drug reactions are the most common DRPs found in our study. Developing the drug policy guidelines focused on factors associated with DRP and WHO prescribing indicators may reduce the burden of DRPs and improves patient outcomes.

English

BACKGROUND Tuberculosis (TB) is a curable and preventable disease. Emergence of multi drug resistance TB (MDR TB) threatens to undo the progress made towards control of TB. While treatment is available for MDR TB, it is of a long duration and is also more expensive and toxic. Understanding the various factors that are associated with MDR TB may help to formulate and implement effective preventive practices for control of MDR TB. We wanted to assess the various epidemiological factors among MDR TB cases registered under Revised National Tuberculosis Control Programme (RNTCP) in East Sikkim and study the current &amp; past TB treatment including adverse drug reactions. METHODS A community-based case control study was conducted over 4 months in the eastern district of Sikkim. MDR TB cases registered under Revised National Tuberculosis Control Programme (RNTCP) in the first two quarters of 2019 were compared with matched healthy controls. Data was collected by a door to door survey using a pre-designed and pre-tested questionnaire and analysed on Statistical Package for the Social Sciences (SPSS) 20. RESULTS A total of 62 cases (14 non-respondents) of MDR TB were identified and were matched with 63 controls. 30.5 % cases were young adults in the age group 15 to 25 years, 66 % of the cases reported being currently unemployed, 16 % were homemakers, 11 % of cases fell below poverty line. A higher proportion of cases as compared to controls reported a habit of skipping a meal, poor housing conditions and comorbidities than controls. A known history of contact with a case of tuberculosis was given by 11.3 % cases; 18 % cases gave a previous history of TB; about 51 % cases reported a delay in diagnosis which delayed treatment initiation. CONCLUSIONS Previous history of TB with history of relapse / failure, contact of MDR TB emerged as the most significant risk factors and presence of comorbid conditions like diabetes &amp; hypertension can be used to indicate higher risks of drug resistance. KEYWORDS Multi Drug Resistant Tuberculosis, MDR TB, Case control, Revised National Tuberculosis Control Programme, Sikkim

Abstract PS7-45: Insurance coverage, employment status, and financial wellbeing of young women diagnosed with breast cancer

Abstract Research Objective: The objective of this study was to evaluate the insurance, employment, and financial experiences of young (age ≤ 39 years) female breast cancer patients and assess factors associated with any changes in their financial situation. Previous literature has shown that younger women are more likely to be diagnosed with late-stage disease that requires more-intensive treatments, while significant medical expenditures, productivity losses, financial hardship, and changes in employment and work productivity have been found in patients of all ages. Methods: A sample of women who were diagnosed with breast cancer between the ages of 18 and 39 years and residing in the states of California, Florida, Georgia, and North Carolina were identified. The sample included women who were (1) diagnosed with ductal carcinoma in situ (D05.90; 8500/2) or invasive breast cancer (C50; 8500/3) between January 2013 and December 2014; (2) between the ages of 18 and 39 years at the time of diagnosis; and (3) alive at the time of data extraction. We contacted 3,659 women by mail; 2,927 were alive with deliverable addresses. Of those, 830 women returned completed surveys, yielding a response rate of 28.4%. The survey instrument included 66 questions on demographics, insurance status, employment history, out-of-pocket cost, and overall financial well-being. Multivariate analysis was used to identify factors associated with financial decline. Principal Findings: About half of the women (47.4%) reported that treatment expenditures were higher than anticipated, and almost two-thirds (65.3%) had not discussed treatment costs with their care team. Almost a third of the patients (31.8%) reported treatment nonadherence due to cost. Factors associated with not receiving recommended care included very young age (&amp;lt;35 years) at diagnosis, self-insurance, the presence of comorbid conditions, and a late-stage diagnosis. Conclusions: Young female breast cancer patients experienced considerable financial burden regardless of insurance coverage. Most respondents made employment decisions that would allow them to keep their health insurance coverage. Knowledge about the financial consequences of breast cancer can help patients factor cost and employment into treatment decisions. Implications for Policy or Practice: This study highlights the burdens that many young women with breast cancer face, regardless of employment or insurance status, raising the possibility of target policy intervention. The strengths of this study include a unique focus on young breast cancer patients, identification of patients from population-based cancer registries, and the utilization of multifaceted insurance/financial indicators. Citation Format: Florence Tangka, Sujha Subramanian, Madeleine Jones, Patrick Edwards, Tim Flanigan, Jenya Kaganova, Kevin Smith, Cheryll Thomas, Nikki Hawkins, Temeika Fairley, Gery Guy, Juan Rodriguez. Insurance coverage, employment status, and financial wellbeing of young women diagnosed with breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-45.

To evaluate different demographical and clinical characterstics in patients suffering from ARDS/ALI

Introduction: Acute lung injury (ALI) remains a significant source of morbidity and mortality in the critically ill patient population. Defined by a constellation of clinical criteria (acute onset of bilateral pulmonary infiltrates with hypoxemia without evidence of hydrostatic pulmonary edema). Pathogenesis of ALI is explained by injury to both the vascular endothelium and alveolar epithelium. Materials and Methods : This was a prospective, observational and cross-sectional study conducted in the medical ICU of Department of Pulmonology at tertiary care teaching hospital between May 2018 and April 2019. Patients with ALI/ARDS were identified through a prospective daily ICU surveillance, based on the American-European Consensus Conference criteria (AECC). Result : In our study, we had a total of 59 patient, out of which 43 survived. We had a mortally rate of 27.2%. Most of the patients were 25-60 years i.e., 23 out of 43, followed by Conclusions: Pneumonia and tropical diseases are the common risk factor for the ARDS/ALI. The presence of co-morbid conditions also affects the outcome of ALI/ARDS patients. MODS of >4, LIs >2 and APACHE II >2 had associated with higher mortality. Keywords: Acute respiratory distress syndrome (ARDS), Pulmonary edema, Acute respiratory failure.

Effectiveness of the live-attenuated herpes zoster vaccine 2 years after its introduction in Australia

BackgroundThe Australian National Herpes Zoster Immunisation Program commenced in November 2016 for people aged 70–79 years old in Australia but vaccine effectiveness (VE) in this setting has not previously been assessed. MethodsWe extracted records from two cohorts of patients aged 70–79 years in 2017 and 2018 respectively who were regular attenders in a nationwide general practice dataset, MedicineInsight. Cox proportional hazards models were used to estimate VE. Models were adjusted for potential confounders including age, sex, and other covariates. Analyses were also stratified by sex, presence of comorbid conditions and number of general practitioner (GP) visits in the previous year. ResultsThe 2017 cohort included 40,275 regular attenders and the 2018 cohort 41,735. Both cohorts had a mean age of 73.9 years and 52% were women. In 2017, among vaccinated people, over 9,688 person-years of follow-up, 35 cases of zoster were diagnosed giving an incidence of 3.6 per 1000 person-years compared to 8.7 per 1000 person-years (264 cases/30,317 person-years) among unvaccinated people. For 2018, among vaccinated people there were 66 incident zoster cases over 16,716 person-years giving an incidence of 3.9 per 1000 person-years compared to 6.3 per 1000 person-years (156 cases/24,782 person-years) among the unvaccinated. Overall, in the first year of the program, when the average time since vaccination was about 8 months, VE was 63.5% (95% CI: 47.5, 74.6) but this fell to 48.2% (95% CI: 30.0, 61.7) in the second year when the average time since vaccination was about 18 months. We found no difference in VE across age, sex, presence of comorbid conditions, and prior GP visit frequency (P-interaction > 0.05). ConclusionsVE was consistent with that estimated in other countries and international settings. However, our findings suggest waning effectiveness after the first year of the program. Further program evaluation is necessary.

Clinical Stratification of Pregnant COVID-19 Patients based on Severity: A Single Academic Center Experience.

This study aimed to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes. This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included. We stratified our study population in three groups: asymptomatic, symptomatic not requiring oxygen therapy, and patients requiring oxygen support to maintain oxygen saturation >94%. Relevant population characteristics, laboratory data, and maternal and neonatal outcomes were abstracted. A p-value <0.05 was considered statistically significant. Between March and July 2020, 91 women tested positive for SARS-CoV-2 upon admission to our labor and delivery unit. Among these, 61.5% were asymptomatic, 34.1% were symptomatic, and 4.4% required oxygen support. Our population was mainly Hispanic (80.2%), multiparous (76.9%), obese (70.3%), and with a median age of 27 years. Median gestational age at symptom onset or diagnosis was 36 weeks. Significant differences were found between gestational age and disease severity. Maternal characteristics including age, body mass index (BMI), and presence of comorbid conditions did not appear to influence severity of SARS-CoV-2 infection. Significant laboratory findings associated with increasing disease severity included decreasing hemoglobin and white blood cell count, lymphopenia, and increasing levels of inflammatory markers including CRP, ferritin, and procalcitonin. Maternal and neonatal outcomes did not differ among groups. No SARS-CoV-2 was detected by polymerase chain reaction testing in neonates of mothers with COVID-19. Pregnant patients with COVID-19 infection are predominantly asymptomatic. Patients appear to be at increased risk for more severe infection requiring oxygen support later in pregnancy. · The majority of pregnant patients with COVID-19 are asymptomatic and <1 in 20 require oxygen support.. · Women in the later stages of pregnancy may be at increased risk for severe infection.. · Anemia, leukopenia, CRP, ferritin, and procalcitonin are associated with increasing severity..

Clinical Characteristics and Outcome of Patients With Severe COVID-19 Pneumonia at a Public Sector Hospital in Karachi, Pakistan.

Introduction: In Pakistan, the first case of COVID-19 was reported in February of 2020, cases peaked in June, and by January 2021, approximately 500,000 confirmed cases and over 10,000 deaths have been reported. There is a lack of data in Pakistan of the demographics, clinical characteristics, and outcome of patients with COVID-19 pneumonia, particularly those with severe illness, which we aim to assess.Methods: This is a single-centered, observational study conducted at the COVID unit of the Shaheed Mohtarma Benazir Bhutto Institute of Trauma in Karachi, Pakistan. A manual medical record review of patients admitted from April 24, 2020 to August 24, 2020 was conducted, and all patients with polymerase chain reaction (PCR) positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) with moderate, severe, and critical COVID-19 pneumonia were included.Results: Of 299 patients, the median age was 60 years (50-65). Males accounted for 221 (73.9%). Most common symptoms were shortness of breath seen in 270 (90.3%) and fever in 225 (75.3%) patients. Diabetes mellitus (51.2%) and hypertension (50.3%) were the predominant co-morbidities. COVID disease was categorized on admission as moderate in 68 (22.7%), severe in 151 (50.5%), and critical in 80 (26.8%) patients. Survival analysis was done in 252 patients, all of whom received steroids, while tocilizumab was administered to 111 (44%) patients. Hundred (39.7%) patients received non-invasive ventilation (NIV), while 57 (22.6%) were placed on mechanical ventilation. Overall, 95 (37.7%) patients died. Factors associated with mortality included older age with those above 60 years more likely to die (odds ratio [OR]: 1.925; 95% CI: 1.148-3.228; pvalue: 0.009), presence of co-morbidities (OR 1.843; 95% CI: 0.983-3.456; p value: 0.070), development of cytokine release syndrome (CRS) (73 [56.2%] vs 57 [43.8%], p value: <0.001), acute kidney injury (31 [81.6%] vs 7 [18.4%], p value: <0.001), cardiac complications (12 [75%] vs 4 [25%], p value: 0.002), and sepsis (29 [87.9%] vs 4 [12.1%], p value: <0.001). Non-survivors were more likely to develop acute respiratory distress syndrome (ARDS), having been placed on NIV and mechanical ventilation. Laboratory parameters at final outcome found that in non-survivors, median total leukocyte count, C-reactive protein (CRP), neutrophil lymphocyte ratio (NLR), and lactate dehydrogenase (LDH) were higher, while absolute lymphocyte count and platelet counts were lower which were found to be statistically significant compared to survivors.Conclusion: In this study of patients with severe COVID-19 pneumonia at a public sector hospital in Karachi, Pakistan, most were males, and the average age was 60 years. Mortality was high, and associated factors included older age, presence of comorbid conditions, and the development of ARDS, CRS, and sepsis.