Clinical Practice For Prevention Research Articles

Primary prevention of venous thromboembolism with low molecular weight heparins in surgical patients – 2024: Council of Experts resolution

On March 15, 2024, in Moscow, the Russian Phlebological Association and the National Association of Specialists in Thrombosis, Clinical Hemostasiology and Hemorheology organized a meeting of the Council of Experts during the Russian Forum on Thrombosis and Hemostasis on the acute issues of venous thromboembolism (VTE) primary prevention using low molecular weight heparins (LMWH) in surgical patients with different body weight. The participants reviewed the relevance and prevalence of this problem in surgical practice, discussed risk factors and the frequency of VTE development, including bleeding in the postoperative period, and the Caprini risk score for complications. The discussion also focused on standard and personalized LMWH doses for primary prophylaxis of VTE in the perioperative period in surgical patients, depending on body weight, and the role of laboratory tests, including assessment of LMWH anti-Xa activity for monitoring the efficacy and safety of VTE primary prevention in clinical practice.

Impact of a program encouraging prevention in primary care on a daily and opportunistic basis

In France, clinical preventive practices are still underdeveloped and formalized, notably due to a lack of guidelines, despite the fact that a proactive and systematic prevention and health promotion strategy involving all healthcare professionals seems essential. The P3C program aims to encourage preventive clinical practices among healthcare professionals, and thus contribute to the emergence of a common culture of prevention.

Risk Management and Patient Safety in the Artificial Intelligence Era: A Systematic Review.

Healthcare systems represent complex organizations within which multiple factors (physical environment, human factor, technological devices, quality of care) interconnect to form a dense network whose imbalance is potentially able to compromise patient safety. In this scenario, the need for hospitals to expand reactive and proactive clinical risk management programs is easily understood, and artificial intelligence fits well in this context. This systematic review aims to investigate the state of the art regarding the impact of AI on clinical risk management processes. To simplify the analysis of the review outcomes and to motivate future standardized comparisons with any subsequent studies, the findings of the present review will be grouped according to the possibility of applying AI in the prevention of the different incident type groups as defined by the ICPS. On 3 November 2023, a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was carried out using the SCOPUS and Medline (via PubMed) databases. A total of 297 articles were identified. After the selection process, 36 articles were included in the present systematic review. The studies included in this review allowed for the identification of three main "incident type" domains: clinical process, healthcare-associated infection, and medication. Another relevant application of AI in clinical risk management concerns the topic of incident reporting. This review highlighted that AI can be applied transversely in various clinical contexts to enhance patient safety and facilitate the identification of errors. It appears to be a promising tool to improve clinical risk management, although its use requires human supervision and cannot completely replace human skills. To facilitate the analysis of the present review outcome and to enable comparison with future systematic reviews, it was deemed useful to refer to a pre-existing taxonomy for the identification of adverse events. However, the results of the present study highlighted the usefulness of AI not only for risk prevention in clinical practice, but also in improving the use of an essential risk identification tool, which is incident reporting. For this reason, the taxonomy of the areas of application of AI to clinical risk processes should include an additional class relating to risk identification and analysis tools. For this purpose, it was considered convenient to use ICPS classification.

Prevention of Preeclampsia in Saudi Arabia: Knowledge about Risk Factors and Aspirin Use among Obstetrical Care Physicians - A National Survey

Objectives: To assess the level of awareness among obstetrical care providers about preeclampsia prevention including risk factors, good practice in aspirin prophylaxis, and to analyze the associated factors. Methods: A cross-sectional study conducted among gynecologists and obstetricians, maternal and fetal medicine specialists, and internal or family medicine physicians working in public or private care centers whom involved in obstetric care in Saudi Arabia. An online-administered questionnaire was designed to assess familiarity of aspirin role in prevention of preeclampsia and fetal growth restriction including proper dose, timing of intake, gestational age to start and discontinuation of treatment as well as the risk factors of PE among set of 13 conditions. An awareness score was calculated and divided into two levels: adequate and inadequate familiarity and knowledge. Practice in PE prevention and attitude towards aspirin use, in addition to participants’ demographic and professional factors, were investigated and analyzed as profound factors. Results: Hundred sixty physicians were participated, 85% were obstetrician/gynecologists and 13.1 were maternal fetal medicine Specialists. Less than half of participants have adequate knowledge and awareness in aspirin role and a minority provided correct answers regarding the recommended aspiring dose, timing of intake, gestational age to start and discontinuation of treatment. However, knowledge about preeclampsia risk factors was relatively acceptable. Maternal fetal medicine specialist and physicians working in teaching hospitals were remarkably with better knowledge compared to their respective counterparts in primary and secondary centers. The existence of institutional guidelines about ASA use in pregnancy did not improve the knowledge level. Conclusion: The overall familiarity and knowledge in that regard was relatively poor, associating misconceptions about the risk factors and substantial gaps regarding the optimal timing and prescribing practice. Formal and continuous medical education curricula should be reviewed to promote good clinical practice in preeclampsia prevention as an essential dimension of maternal and fetal care.

Evaluating the long-term impact of large-scale trainings: an exposure based cross-sectional study on female genital mutilation-related knowledge, attitudes and practices among Sudanese midwives in Khartoum State

ObjectivesTo examine the long-term impact of large-scale training targeting midwives in a setting where they are the main female genital mutilation (FGM) practitioners. We hypothesised that trained midwives would have...

Predicting long-term survival after de novo cardioverter-defibrillator implantation for primary prevention: A population based study

BackgroundImplantable cardioverter-defibrillators (ICDs) reduce the risk of sudden cardiac death in patients with left ventricular dysfunction. While short-term mortality benefit of ICD insertion has been established in landmark randomized controlled trials, little is known about the long-term outcomes of patients with ICDs in clinical practice. In this paper, we describe the long-term survival of patients following de novo ICD implantation for primary prevention in clinical practice and determine the factors which help predict survival after ICD implant. MethodsRetrospective population-based study of all patients receiving a de novo ICD for primary prevention in Ontario, Canada from 2007 to 2011 using the Ontario ICD Database housed within ICES. Simple random selection was used to split the population into a derivation and internal validation cohort in a ratio of 2:1. Cox proportional hazards regression was used to determine predictors of interest and predict 10-year survival, model performance was assessed using calibration and validation. ResultsIn the derivation cohort (n = 3399), mean age was 65.3 years (standard deviation [SD] = 11.0), 664 patients were female (19.5 %) and 2344 patients (69.0 %) had ischemic cardiomyopathy. Ten year survival was 45.7 % (95 % confidence interval [CI] 44.0 %–47.4 %). The final prediction model included age, sex, disease factors (ischemic vs nonischemic cardiomyopathy, left ventricular ejection fraction) and patient factors (symptoms, comorbidities), and biomarkers at the time of ICD assessment. This model had good discrimination and calibration in derivation (0.79, 95 % CI 0.77, 0.81) and validation samples (0.78, 95 % CI 0.76, 0.79). ConclusionsA combination of demographic and clinical factors determined at baseline can be used to predict 10-year survival in patients with implantable cardioverter-defibrillators with good accuracy. Our findings help to identify individuals at risk of long-term mortality and may be useful in targeting future prevention strategies to enhance longevity in this high-risk population.

Plasmodium infections and associated risk factors among parturients in Jawi district, northwest Ethiopia: a cross-sectional study

BackgroundPregnant women have an increased risk of Plasmodium infections and disease. Malaria in pregnancy is a major public health problem in endemic areas. Assessment of the burden and risk factors of malaria in pregnancy across different malaria transmission settings is required to guide control strategies and for malaria elimination. Thus, the current study is generating such evidence from parturient women in northwest Ethiopia.MethodsA cross-sectional study was conducted among 526 pregnant women admitted to the delivery rooms of selected health facilities in Jawi district, northwest Ethiopia, between November 2021 and July 2022. Data on the socio-demographic, clinical, obstetric, and malaria prevention practices of pregnant women were collected using interviewer-administered questionnaires and from women’s treatment cards. Malaria was diagnosed by light microscopy, rapid diagnostic test, and multiplex real-time polymerase chain reaction. Risk factors for malaria were evaluated using bivariable and multivariable logistic regression models. A P-value of < 0.05 was considered statistically significant.ResultsAmong the examined parturient women, 14.3% (95% CI 11.4–17.5%) had Plasmodium infections. The prevalence of peripheral, placental, and congenital malaria was 12.2% (95% CI 9.5–15.3%), 10.9% (95% CI 8.2–14.1%), and 3.7% (95% CI 2.3–6.1%), respectively. About 90.6% of peripheral and 92% of placental Plasmodium infections were asymptomatic. Plasmodium infection at parturiency was independently predicted by maternal illiteracy (AOR = 2.03, 95% CI 1.11–3.74), primigravidity (AOR = 1.88, 95% CI 1.01–3.49), lack of antenatal care follow-up (AOR = 2.28, 95% CI 1.04–5.03), and history of symptomatic malaria during pregnancy (AOR = 4.2, 95% CI 2.32–7.59). Moreover, the blood group O phenotype was significantly associated with placental malaria among the primiparae.ConclusionsOverall, asymptomatic Plasmodium infections were prevalent among parturients in northwest Ethiopia. Maternal illiteracy, primigravidity, lack of antenatal care follow-up, and history of symptomatic malaria during pregnancy were the risk factors for malaria during parturiency. Thus, promotion of a healthy pregnancy through ANC follow-up, strengthening malaria prevention and control practices, and screening of malaria in asymptomatic pregnant women are suggested to reduce its burden in pregnancy.

Impact of the stepwise approach to cardiovascular disease prevention in patients with established ASCVD from the 2021 ESC Prevention Guideline

Abstract Background The European Society of Cardiology (ESC) 2021 Guidelines on Cardiovascular Disease Prevention in Clinical Practice advocate a stepwise approach for the treatment of cardiovascular (CV) risk factors to reduce CV-risk in patients with established atherosclerotic cardiovascular disease (ASCVD). The aim of this study was to evaluate CV-risk reduction and residual risk for recurrent CV-events based on stepwise risk factor management. Methods In patients with established ASCVD in the UCC-SMART (n = 8,997) and European parts of the REACH registry (n = 18,364) receiving usual care, 10-year risk of recurrent major CV-events was calculated using the SMART2 risk score. The effect of guideline recommended step 1 and 2 treatment options on this risk was modelled using best available evidence from meta-analyses and trials. Step 1 treatment recommendations were smoking cessation, use an antithrombotic drug, LDL cholesterol &amp;lt;1.8 mmol/L, systolic blood pressure (SBP) &amp;lt;140 to 130 mmHg, and in people with type 2 diabetes mellitus a GLP1-receptor agonist/SGLT2-inhibitor. Step 2 treatment recommendations studied were LDL cholesterol &amp;lt;1.4 mmol/L, SBP &amp;lt;130 mmHg, dual pathway inhibition, colchicine, eicosapentaenoic acid (EPA), and in people with type 2 diabetes mellitus a GLP1-receptor agonist/SGLT2-inhibitor in people with type 2 diabetes. Two scenarios were evaluated: one with perfect attainment (ideal) and one with empiric attainment rates (realistic). Results The baseline median 10-year residual CV-risk was 26% [14-41%] overall, and 20%, 27%, and 54% in the low, moderate, and pooled high and very high European risk regions, respectively. Baseline risk was lowest in patients with only coronary artery disease and highest in patients with polyvascular disease or comorbid diabetes mellitus. In the ideal scenario, CV-risk was reduced to 14% [9-22%] overall and, 11%, 15%, and 29% following step 1 and 6% [4-10], 5%, 9%, and 12% following step 2. In the realistic scenario, CV-risk was reduced to 24% [16-36%], 20%, 24, and 47% following step 1 and 10% [7-16%], 9%, 9%, and 19% following step 2. In the ideal scenario, 43%, 22% and 4% achieved a residual risk of &amp;lt;10% following step 1 and 87%, 83% and 38% following step 2 in each respective risk region. In the realistic scenario this was 7%, 1%, and 0% after step 1 and 59%, 56%, and 13% after step 2 (Figure shows the realistic scenario for the low risk region &amp; moderate risk region). Conclusion Despite the current standard of care, patients with established ASCVD remain at high residual CV-risk across all European risk regions. Step 1 treatment targets may lower this risk substantially, but only if attainment rates are higher than empirically achieved. Intensified Step 2 treatment options result in marked further reduction of residual CV-risk and should be encouraged to be considered in all patients with established ASCVD.Realistic scenario low risk regionRealistic scenario moderate risk region

Practical aspects of the use of intrathecal chemotherapy

IntroductionIntrathecal chemotherapy is frequently used in clinical practice for treatment and prevention of neoplastic meningitis. Despite its widespread use, there is little information about practical aspects such as the volume of drug to be administered or its preparation and administration. ObjectiveTo conduct a literature review about practical aspects of the use of intrathecal chemotherapy. MaterialsSearch in PubMed/ Medline using the terms „chemotherapy AND intrathecal“, analysis of secondary and tertiary information sources. ResultsThe most widely used drugs in intrathecal therapy are methotrexate and cytarabine, at variable doses. One of the aspects with higher variability among different studies is their potential combination with a glucocorticoid, the specific corticoid selected and its dose. The efficacy and toxicity of the different combinations have not been compared. Regarding preparation, it is worth highlighting the recommendation to adjust pH and osmolarity to the physiological range, with the aim of improving tolerability. The volume of administration can influence distribution, and recommendated range is between 5 and 12 mL. Overall, it is recommended to extract a similar volume of cerebrospinal fluid before administration. The position of the patient during and after administration can have an impact on distribution and toxicity; lateral decubitus or sitting position is recommended in the first case, and prone and/ or supine position in the second one. Most publications don't explain how the treatment has been prepared or administered, and the lack of standardization could affect results. ConclusionsThere is a great variability in practice when using intrathecal chemotherapy, despite being an effective therapy, accepted by all international groups. This uncertainty is not li-mited to the drugs and doses administered, but it also includes the manner of preparation and the administration technique. The heterogeneity In clinical practice can Influence the efficacy and toxicity of this therapy.

Experimental and morphological justification of the prevention of wound complications during fixation of the mesh to the abdominal wall tissues with composite

The aim of the study is to justify the prevention of wound complications during fixation of the mesh to abdominal wall tissues with cross-linked polyurethane (CP) composite in experimental animals. Маterials and methods. An experimental study was conducted on 60 male laboratory rats, which were divided into 3 groups. In group I (n = 21), the mesh and wound edges were fixed with CP composite with an antiseptic, in group II (n = 24) – with ligatures, in group III (n = 15) muscle incision was performed and the wound was sutured with ligatures. The animals were observed for 30 days, wound healing and the presence of complications were evaluated. Morphological examination was performed on days 7 and 30. Signs of mesh germination by connective tissue and presence of tissue inflammation around the mesh were evaluated. Results. The observation results showed that in group I, the incidence of complications and the duration of wound healing were lower comparing to groups II and III. In group I, seroma was detected in 1 (5.3 %) animal, in group II – in 7 (33.3 %), in group III – in 3 (23.1 %), infection of the wound in 1 (5.3 %) animal of group I, in 4 (19.1 %) of group II and in 2 (15.4 %) of group III. The term of wound healing in group I was 7 (6; 8) days, in group II – 13 (12; 14), in group III –11 (10; 12) days (p &lt; 0.05). The results of observation were confirmed morphologically, namely, in animals of group I, faster process of mesh germination with collagen fibers and wound healing were revealed, which was confirmed by the predominance of a fibrous component over the cellular one (р &lt; 0.05), and the formation of a connective tissue capsule around the CP with the germination of collagen fibers deep into the capsule. Conclusions. The use of the cross-linked polyurethane composite with an antiseptic to fix the mesh implant to abdominal wall tissues in laboratory animals confirms its higher efficiency compared to traditional ligature fixation, by increasing the fibrous component of connective tissue and reducing the cellular component and hemodynamic disorders in dynamics, by the germination of collagen fibers deep into the capsule in the areas of mesh fixation, reduced occurrence of seroma and duration of wound healing, which justifies its use in clinical practice for prevention of wound complications in allogernioplasty.

A comprehensive survey: prevention of female infertility by nutrition

There is an important relationship between nutrition and infertility in women. Most diseases that cause infertility in women can be prevented and treated with proper nutrition. The present study aims to determine the role of nutrition in women's fertility. Samples of this study are all articles published in magazines, books, and theses from the Web Of Sciences, PubMed, Medline, Elsevier, and Google Scholar search engines with the keywords of "female infertility," "nutrition," "diet," "fertility outcomes," "folate," "iron," "omega-3 fatty acids", and "Vitamin." In the beginning, 1052 articles were found, and after reviewing the STROBE checklist, 38 articles were selected. After reviewing the inclusion and exclusion criteria and evaluation, 23 articles were included in the study. Various studies showed that proper nutrition improves women's ovulation parameters and pregnancy outcomes. The reviewed studies suggested a balance between protein and carbohydrates, consuming foods with a low glycemic index, high fiber diet, eating five meals a day, daily consumption of essential fatty acids such as omega 3 and 6, use of organic materials, low-fat proteins, complex carbohydrates, folic acid, antioxidants, vitamins, and foods that cause regular ovulation such as cod liver oil, licorice plant, five-finger plant, thistle, and cinnamon. The results of this comprehensive study indicate that proper nutrition through adequate consumption of micronutrients can positively impact women's fertility. These findings highlight the potential contribution of diet interventions to clinical practice for infertility prevention and management.

Low Perception of Obesity as a Pathological Condition Among Italian Cardiologists.

Obesity is not only an important modifiable cardiovascular risk factor but also a chronic disease with relevant consequences on morbidity and mortality in the general population. According to European guidelines, cardiologists must recognize and treat it properly. To assess perception of obesity as a modifiable pathological condition and the importance to treat it in a real-world sample of cardiologists and residents in cardiology. A nationwide, web-based, epidemiological survey on the perception of obesity as a disease and as a modifiable cardiovascular risk factors was conducted in 137 medical doctors (cardiologists and residents in cardiology). Participants filled with their answers a questionnaire of 31 questions about perception of obesity and strategies on cardiovascular disease prevention in clinical practice. Of 137 individuals enrolled in our survey only 5 (3.6%) reported to measure waist circumference in their clinical practice and only 3 (2.2%) reported to measure waist-to-hip ratio. One-hundred-twenty participants (87.6%) would not prescribe an anti-obesity drug to a patient with grade II obesity. Sixty-eight (49.6%) participants have never read or heard of a clinical trial on obesity. On the other hand, 134 (97.8%) routinely measured blood pressure in their clinical practice, 129 (94.2%) would prescribe a statin for a hypercholesterolemic patient and 132 (96.4%) subjects have read/heard a clinical trial on type 2 diabetes in their life. Although obesity is a chronic disease and an important modifiable cardiovascular risk factor such as arterial hypertension, hypercholesterolemia, cigarette smoke and diabetes, cardiologists and residents in cardiology substantially underestimate it ignoring that it should be treated as a proper disease.

Chronic kidney disease: the missing concept in the 2019 EULAR/ERA-EDTA recommendations for lupus nephritis.

Chronic kidney disease (CKD) is diagnosed when glomerular filtration rate (GFR) falls below 60ml/min/1.73m2 or urinary albumin:creatinine ratio (UACR) reaches ≥30mg/g, as these two thresholds indicate a higher risk of adverse health outcomes, including cardiovascular mortality. CKD is classified as mild, moderate or severe, based on GFR and UACR values, and the latter two classifications convey a high or very high cardiovascular risk, respectively. Additionally, CKD can be diagnosed based on abnormalities detected by histology or imaging. Lupus nephritis (LN) is a cause of CKD. Despite the high cardiovascular mortality of patients with LN, neither albuminuria nor CKD are discussed in the 2019 European League Against Rheumatism (EULAR)/European Renal Association-European Dialysis and Transplant Association recommendations for the management of LN or the more recent 2022 EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases. Indeed, the proteinuria target values discussed in the recommendations may be present in patients with severe CKD and a very high cardiovascular risk who may benefit from guidance detailed in the 2021 European Society of Cardiology guidelines on cardiovascular disease prevention in clinical practice. We propose that the recommendations should move from a conceptual framework of LN as an entity separate from CKD to a framework in which LN is considered a cause of CKD and evidence generated from large CKD trials applies unless demonstrated otherwise.

Patterns of aeroallergen sensitization in asthma patients identified by latent class analysis: A cross-sectional study in China.

This cross-sectional study aimed to identify latent sensitization profiles of asthma patients in mainland China, unveiling the association between regional differences and sensitization patterns. 1056 asthma participants from 10 medical centers divided into eastern and western cohorts were clustered into four individual sensitization patterns, respectively, by using an unsupervised statistical modeling method, latent class analysis (LCA), based on the levels of 12 aeroallergens specific IgE reactivities. Moreover, differences in clinical characteristics and environmental exposures were compared in different sensitization patterns. Four distinct sensitization patterns in the two cohorts were defined as follows, respectively. Eastern cohort: Class 1: "High weed pollen and house dust mites (HDMs) sensitization" (8.87%), Class 2: "HDMs dominated sensitization" (38.38%), Class 3: "High HDMs and animal dander sensitization" (6.95%), Class 4: "Low/no aeroallergen sensitization" (45.80%). Western cohort: Class 1: "High weed pollen sensitization" (26.14%), Class 2: "High multi-pollen sensitization" (15.02%), Class 3: "HDMs-dominated sensitization" (10.33%), Class 4: "Low/no aeroallergen sensitization" (48.51%). Of note, the significant statistical difference in age, asthma control test score (ACT) and comorbidities were observed within or between different sensitization patterns. Exposure factors in different sensitization patterns were pointed out. Asthmatic patients with distinct sensitization patterns were clustered and identified through the LCA method, disclosing the relationship between sensitization profiles of multiple aeroallergens and geographical differences, providing novel insights and potential strategies for atopic disease monitoring, management and prevention in clinical practice.

Clinical utility of SARS-CoV-2 subgenomic RT-PCR in a pediatric quaternary care setting.

During active transcription, SARS-CoV-2 generates subgenomic regions of viral RNA. While standard SARS-CoV-2 RT-PCR amplifies region(s) of genomic RNA, it cannot distinguish active infection from remnant viral genomic material. However, screening for subgenomic RNA (sgRNA) by RT-PCR may aid in the determination of actively transcribing virus. To evaluate the clinical utility of SARS-CoV-2 sgRNA RT-PCR testing in a pediatric population. Retrospective analysis was performed on inpatients from February-September 2022 positive for SARS-CoV-2 by RT-PCR with a concomitant order for sgRNA RT-PCR. Chart abstractions were conducted to determine clinical outcomes, management, and infection prevention and control (IPC) practices. Of 95 SARS-CoV-2 positive samples from 75 unique patients, 27 (28.4%) were positive by sgRNA RT-PCR. A negative sgRNA RT-PCR test allowed for de-isolation in 68 (71.6%) patient episodes. Regardless of age or sex, a positive sgRNA RT-PCR result significantly correlated with disease severity (P=0.007), generalized COVID-19 symptoms (P=0.012), hospitalization for COVID-19 (P=0.019), and immune status (P=0.024). Moreover, sgRNA RT-PCR results prompted changes in management in 28 patients (37.3%); specifically, therapeutic escalation in 13/27 (48.1%) positives and de-escalation in 15/68 (22.1%) negatives. Taken together, these findings underscore the clinical utility of sgRNA RT-PCR testing in a pediatric population as we report significant associations between sgRNA RT-PCR results and clinical parameters related to COVID-19. These findings align with the proposed use of sgRNA RT-PCR testing to guide patient management and IPC practices in the hospital setting.

21-LB: Prevalence of Atherosclerotic Cardiovascular Diseases in Women with Type 2 Diabetes across the Middle East and Africa—Primary Gender Analysis of the PACT-MEA Study

Objectives: Contemporary data on cardiovascular (CV) burden in women with type 2 diabetes (T2D) is lacking, particularly in the Middle East and Africa where the incidence and prevalence of T2D is one of the highest globally. We report prevalence of ASCVD/ASCVD risk stratified by gender to identify opportunities for improving T2D care. Methods: PACT-MEA (PACT-MEA; NCT05317845) is a cross-sectional, observational study of adults (≥18 years) with T2D from 55 clinics in Bahrain, Egypt, Jordan, Kuwait, Qatar, South Africa, and United Arab Emirates. Medical history, demographics, clinical information, and laboratory values were collected from medical charts of patients at a clinic visit in 2022. We report the prevalence (95% CI) of established atherosclerotic cardiovascular disease (eASCVD) and ASCVD risk, the latter defined by the 2021 European Society of Cardiology (ESC) Guidelines on CV Disease Prevention in Clinical Practice (risk categories: moderate, high, very high [including eASCVD]). Prevalence estimates were weighted according to the size of the diabetes population in each country. Results: Of the 3,726 patients enrolled, 47% were female, with a median age of 59.0; 35% were &amp;lt;55 years old. Across the seven PACT-MEA countries, prevalence of eASCVD was 16.0% (95% CI: 13.4-18.6) among females and 26.6% (23.7-29.5) among males. Per ESC guidelines, 0.6% (0.0-1.2) of females were at moderate risk for ASCVD, 72.5% (69.0-75.9) were at high risk, and 26.9% (23.5-30.3) were at very high risk. Among males, 0.7% (0.0-1.5), 65.9% (62.4-69.4), and 33.4% (29.9-36.8) were at moderate, high, and very high ASCVD risk, respectively. Conclusions: We found 1 in 6 women with T2D in the Middle East and Africa have eASCVD and nearly all are at high/very high ASCVD risk. This highlights the need for better screening and timely management of T2D in women and men to minimize CV risk, as well as the importance of gender inclusiveness in clinical studies. Disclosure F. Alawadi: Research Support; Novo Nordisk. E. Mashaki ceyhan: None. H. M. Sabbour: Research Support; Novo Nordisk. S. Salek: None. G. Yadav: Employee; Novo Nordisk. S. Verma: Advisory Panel; Amgen Canada, AstraZeneca, Bayer Inc., Boehringer Ingelheim and Eli Lilly Alliance, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Novartis Canada, Novartis, Novo Nordisk, Novo Nordisk Canada Inc., Consultant; AstraZeneca, Other Relationship; Amarin Corporation, AstraZeneca, Bayer Inc., Boehringer Ingelheim and Eli Lilly Alliance, Boehringer Ingelheim International GmbH, Canadian Medical and Surgical Knowledge Translation Research Group, EOCI Pharmacomm, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Novartis Canada, Novo Nordisk, Novo Nordisk Canada Inc., Pfizer Inc., PhaseBio Pharmaceuticals, Inc., S &amp; L Solutions Event Management Inc, Sanofi, Sun Pharmaceutical Industries Ltd., Toronto Knowledge Translation Working Group, Research Support; Amarin Corporation, Amgen Canada, AstraZeneca, Bayer Inc., Boehringer Ingelheim International GmbH, HLS Therapeutics Inc., Novartis, Novo Nordisk, Pfizer Inc., PhaseBio Pharmaceuticals, Inc. S. H. Assaad-khalil: Board Member; AstraZeneca, Merck &amp; Co., Inc., Servier Laboratories, Sanofi, Consultant; AstraZeneca, Servier Laboratories, Sanofi, Merck &amp; Co., Inc., Research Support; Novo Nordisk, Eva Pharma. W. Almahmeed: None. N. Alamuddin: Consultant; Novo Nordisk, Speaker's Bureau; Novo Nordisk. H. Alkandari: None. J. A. Haddad: None. L. N. Husemoen: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. L. Lombard: None. R. A. Malik: None.

Genetic susceptibility to drug-induced liver injury

Drug-induced liver injury (DILI) risk prediction, diagnosis establishment, clinical management, and all other aspects are facing great challenges. Although the current understanding of its pathogenesis is still incomplete, research over the past 20 years has shown that genetic susceptibility may play an important role in the occurrence and development of DILI. In recent years, pharmacogenomics studies have further revealed the association between human leukocyte antigen (HLA) genes, some non-HLA genes, and hepatotoxicity from certain drugs. However, due to the lack of well-designed, prospective, large-sample cohort validation and low positive predictive values, there may still be some way to go before the current results can be truly translated into clinical practice for precise prediction and prevention of DILI risk.

Health outcomes of age at menarche in European women: a two-sample Mendelian randomization study.

Observational studies have shown an association between age at menarche (AAM) and the risk of gynecological diseases. However, the causality cannot be determined due to residual confounding. We conducted a Mendelian randomization (MR) study to evaluate the causal effect of AAM on several gynecological diseases, including endometriosis, female infertility, pre-eclampsia or eclampsia, uterine fibroids, breast cancer, ovarian cancer, and endometrial cancer. Single nucleotide polymorphisms were used as genetic instruments. The inverse variance weighted method was used as the primary approach and several other MR models were conducted for comparison. Cochran's Q test, Egger's intercept test, and leave-one-out analysis were conducted for sensitivity analysis. Radial MR analysis was conducted when detecting the existence of heterogeneity. After Bonferroni correction and thorough sensitivity analysis, we observed a robust causal effect of AAM on endometrial cancer (odds ratio:0.80; 95% confidence interval:0.72-0.89; P = 4.61 × 10-5) and breast cancer (odds ratio:0.94; 95% confidence interval:0.90-0.98; P = .003). Sensitivity analysis found little evidence of horizontal pleiotropy. The inverse variance weighted method also detected weak evidence of associations of AAM with endometriosis and pre-eclampsia or eclampsia. This MR study demonstrated a causal effect of AAM on gynecological diseases, especially for breast cancer and endometrial cancer, which indicates AAM might be a promising index to use for disease screening and prevention in clinical practice. Key messages What is already known on this topic - Observational studies have reported associations between age at menarche (AAM) and a variety of gynecological diseases but the causality has not been determined. What this study adds - This Mendelian randomization study demonstrated that AAM causally affects the risk of breast cancer and endometrial cancer. How this study might affect research, practice, or policy - The findings of our study imply that AAM could be a candidate marker for early screening of populations at higher risk of breast cancer and endometrial cancer.

STUDY OF BLOOD SEDIMENTATION UNDER A DILUTION OF DEXTRAN SOLUTIONS. BLOOD AS ACTIVE COLLOID SYSTEM

The dynamics of sedimentation of whole blood cells, as well as erythrocyte mass, has been studied during sequential dilution with dextran solutions in vitro. Nonmonotonic changes in the optical density of the boundary between erythrocytes sedimenting both in their own plasma and in model systems were revealed. The oscillations of both the average rate and the instantaneous rates of the process recorded at the cell sedimentation boundary confirm the non-linear and cooperative nature of erythrocyte sedimentation, which is associated with the formation and separation of phases between the cellular, liquid and gaseous components of blood. The structural rearrangement of this dynamic system can be modulated by various factors, for example, dextran solutions used in clinical practice for blood loss, for detoxification, treatment and prevention of thrombophlebitis and shock conditions. It was shown that both the degree of dilution of blood or model systems with dextrans and their molecular weight change the macro- and microkinetics of the process of erythrocyte sedimentation. These results are consistent with the phase hypothesis of sedimentation of blood cells as a biocolloid, and can also be used in clinical blood transfusion for selecting an individual dosage of infusion solutions.

Persistence to rivaroxaban therapy for stroke prevention in clinical practice in Italy: Rationale and design of the RITMUS-AF prospective observational cohort study

BackgroundNon-valvular atrial fibrillation (NVAF) is a cardiac rhythm disturbance that increases the risk of stroke and is highly prevalent in Europe and Italy, increasingly with advancing age. Oral anticoagulation is a key component of stroke prevention in patients with NVAF, yet withdrawal or interruption of anticoagulation may transiently increase the risk of embolic events. Treatment persistence to anticoagulation is an important metric but one that is not well studied in patients with NVAF in Italy. The RITMUS-AF study aims to evaluate the persistence with rivaroxaban treatment for stroke prevention in patients with NVAF in Italy. MethodsRITMUS-AF is a prospective, observational cohort study of patients with NVAF in hospital cardiology departments with a non–vitamin K antagonist oral anticoagulant surveillance program across all 20 regions of Italy. The study population comprises consecutively screened, consenting patients with NVAF naïve to and newly treated with rivaroxaban for stroke prevention in routine clinical practice. The target enrollment is 800 patients; each patient will be followed for a maximum duration of 24 months. The primary endpoint is the proportion of patients who discontinue rivaroxaban treatment. Secondary endpoints are reasons for rivaroxaban discontinuation, dose changes and reasons for changes, switches to alternative therapies and the reasons for these decisions, and self-reported adherence. Data analyses will be exploratory and descriptive. ConclusionRITMUS-AF will help to address the limited data in Italian clinical practice on treatment persistence and reasons for drug interruptions in patients with NVAF on rivaroxaban.