Reported Improvement In Symptoms Research Articles

S3353 Improvement in Paediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS) Syndrome Following Treatment With a Combination of Antibiotics and Fecal Microbiome Transplantation (FMT)

Introduction: Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) syndrome is a condition that impairs normal neurological brain function and is triggered by a streptococcal infection. It is characterised by an obsessive-compulsive disorder (OCD) tic disorder, or both and usually occurs suddenly between the age of 3-12 years. Other symptoms include mood changes, anxiety, attention deficit/hyperactivity disorder, trouble sleeping, and joint pain. Metagenomic profiles of those with PANDAS syndrome show an altered gut bacterial community. Commonly treatment involves antibiotics for streptococcal infection. Here, we report on the effects of fecal microbiota transplantation (FMT) on a set of identical twins with concomitant PANDAS syndrome. Case Description/Methods: Case 1: A male (16yrs) presented with slow transit type constipation with a colonic transit half clearance time of 70minutes. His medical history also showed he had PANDAS syndrome and later tested positive for Clostridium Difficile (C. difficile). The patient was treated with metronidazole before receiving a single dose of FMT which was transfused colonoscopically. At 1-month the patient tested negative for C. difficile. Post treatment he reported significant improvement in abdominal pain, bloating and constipation that lasted 2 years. Simultaneously he reported symptom improvement in anxiety, depression, and Rheumatoid Arthritis which are associated with PANDAS syndrome. Case 2: A male (16yrs) presented with severe constipation with a normal colonic transit half clearance time of 50minutes. Constipation prompted a worsening of symptoms of concomitant PANDAS syndrome which had previously been treated with steroids. After further testing he was found to have C. difficile for which he was prescribed metronidazole and vancomycin before receiving a single dose of FMT by colonoscopic infusion. At 1-month post treatment eradication of C. difficile was confirmed. Post treatment he reported experiencing improvement in constipation, diarrhoea, flatulence, and vomiting which lasted for 2 years. He also reported symptom improvement in Autism, OCD, and Rheumatoid Arthritis which are linked to PANDAS syndrome. Discussion: To the best of our knowledge these are the first cases of improvement in PANDAS symptoms after FMT treatment. Further study is required into the effects of FMT on PANDAS syndrome before FMT can be confirmed as a potential treatment.

Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study.

Post-acute sequelae of COVID-19 (PASC) includes a heterogeneous group of patients with variable symptomatology, who may respond to different therapeutic interventions. Identifying phenotypes of PASC and therapeutic strategies for different subgroups would be a major step forward in management. In a prospective cohort study of patients hospitalized with COVID-19, 12-month symptoms and quantitative outcome metrics were collected. Unsupervised hierarchical cluster analyses were performed to identify patients with: (1) similar symptoms lasting ≥4 weeks after acute SARS-CoV-2 infection, and (2) similar therapeutic interventions. Logistic regression analyses were used to evaluate the association of these symptom and therapy clusters with quantitative 12-month outcome metrics (modified Rankin Scale, Barthel Index, NIH NeuroQoL). Among 242 patients, 122 (50%) reported ≥1 PASC symptom (median 3, IQR 1-5) lasting a median of 12-months (range 1-15) post-COVID diagnosis. Cluster analysis generated three symptom groups: Cluster1 had few symptoms (most commonly headache); Cluster2 had many symptoms including high levels of anxiety and depression; and Cluster3 primarily included shortness of breath, headache and cognitive symptoms. Cluster1 received few therapeutic interventions (OR 2.6, 95% CI 1.1-5.9), Cluster2 received several interventions, including antidepressants, anti-anxiety medications and psychological therapy (OR 15.7, 95% CI 4.1-59.7) and Cluster3 primarily received physical and occupational therapy (OR 3.1, 95%CI 1.3-7.1). The most severely affected patients (Symptom Cluster 2) had higher rates of disability (worse modified Rankin scores), worse NeuroQoL measures of anxiety, depression, fatigue and sleep disorder, and a higher number of stressors (all P<0.05). 100% of those who received a treatment strategy that included psychiatric therapies reported symptom improvement, compared to 97% who received primarily physical/occupational therapy, and 83% who received few interventions (P = 0.042). We identified three clinically relevant PASC symptom-based phenotypes, which received different therapeutic interventions with varying response rates. These data may be helpful in tailoring individual treatment programs.

86 Short-Term Outcomes and Patient Perceptions After EMS Non-Transport During the COVID-19 Pandemic

86 Short-Term Outcomes and Patient Perceptions After EMS Non-Transport During the COVID-19 Pandemic

The α-Gal mammalian meat allergy as a cause of isolated gastrointestinal symptoms

The α-Gal mammalian meat allergy classically presents with urticaria, with or without gastrointestinal (GI) symptoms or anaphylaxis, but increasingly we are aware of patients with only GI symptoms. Here we describe patients presenting with isolated GI symptoms who had detectable IgE antibodies to α-Gal and reported symptom improvement on a mammal-restricted diet. Forty patients in the practice of a single gastroenterologist, and 35 patients in one allergy clinic were identified, with abdominal pain, diarrhea, and nausea the most common symptoms. Alpha-Gal IgE levels were lower than in a previously described cohort of patients who exhibited classic allergic reactions. This large case series suggests that α-Gal IgE is an important contributor to GI morbidity in areas where lone star tick bites are common. Symptom presentations in GI-AGS can be easily confused with other common GI conditions, and α-Gal IgE levels are often lower than those in patients with classic AGS.

The Effect of COVID-19 National Lockdown on the Time from Presentation to Surgery of Patients with Suspected Cauda Equina Syndrome: Two UK Tertiary Centers' Study

ObjectiveTo investigate if COVID-19 UK lockdown measures resulted in a delay in the presentation and treatment of patients with cauda equina syndrome (CES).MethodsThis is a multicenter retrospective study of patients with surgically treated CES across 3 time periods: April–May 2020 (first lockdown), August–September 2020 (no-lockdown group), and January–February 2021 (second lockdown). Data regarding duration of symptoms, time from referral to admission, time from admission to surgery, and postoperative outcomes were collected.ResultsA total of 56 patients (male: 26, female: 30, mean age: 44.3 years) were included in the study (n = 14, n = 18, and n = 24 in the 3 time periods, respectively). There was no difference in duration of symptoms across the time periods (12.6 days vs. 8.2 days vs. 3.8 days) (P = 0.16). Nearly all the patients were admitted within 48 hours of referral (n = 55, 98.2%). The majority of patients were operated on within 48 hours: first lockdown (n = 12, 85.7%), no-lockdown (n = 16, 88.9%), and second lockdown (n = 21, 87.5%). The length of hospital stay was significantly shorter in the second lockdown (3.3 days) versus the other 2 time periods (4.4 days and 6.4 days) (P = 0.02). Thirteen complications were present, with dural tear being the most common (n = 6, 10.7%). Majority reported symptom improvement (n = 53, 94.6%), with a similar number discharged home (n = 54, 96.4%).ConclusionDespite the pandemic, patients with CES were promptly admitted and operated on with good outcomes. Shorter duration of hospital stay could be attributed to adaptation of spinal services.

551 Bilateral Carpal Tunnel Syndrome Following AstraZeneca (AZD1222) COVID-19 Vaccination: A Case Report

Covid-19 infections correlate with peripheral neuropathy. Correlations extend to vaccination, with reports of polyradiculoneuropathy. We report a case of a 59-year-old right-hand dominant female presenting with bilateral carpal tunnel syndrome (CTS) nineteen days after AZD1222.BSSH diploma-qualified hand surgeon assessment identified increasing median nerve (MN) paraesthesia and upper limb pain. Symptoms occurred post-AZD1222 second dose administered 12-weeks after the first. Past medical history was unremarkable, and she had not contracted Covid-19. Examination found severe CTS-signs: thenar weakness, positive provocative tests (Phalen's and Tinel's) and 8mm MN static 2-point discrimination. Electrophysiology confirmed very severe wrist bilateral median neuropathies, with no evidence of widespread peripheral neuropathy. Left carpal tunnel decompression found a swollen MN bulging through the transverse carpal ligament. The patient reported symptom improvement 2 weeks post-operatively.This was reported using MHRA “yellow card” protocols as symptoms occurred within the period of neuropathic side effects. Proposed neuropathy mechanisms in Covid-19 include vasa nervorum microangiopathy. Post-vaccine effects could be connected to such changes in microcirculation implicated in CTS. Vaccines containing SARS-CoV-2 antigens enhance autoimmunity and may cause antibody-mediated effects on the synovial sheath, worsening symptoms in pre-existing CTS. Though we do not claim causality, emerging post-vaccination effects may include exacerbation. It is not uncommon for clinicians to diagnose CTS in patients with symptoms overlooked until an inciting event. With Covid-19 ‘boosters' the long-term strategy, vaccinations may increase neuropathy contribution. Increasing caseloads may present future challenges to hand surgeons managing CTS. Recording correlations may provide a basis for investigating CTS pathophysiology post AZD1222.

WE1.4 Laser haemorrhoidoplasty (LHP) is an efficacious alternative to excisional treatment of haemorrhoidal disease: Results from a single centre retrospective study

Abstract Purpose LASER haemorrhoidoplasty (LHP) is a novel procedure in the management of the symptomatic haemorrhoidal disease. LHP is a non-excisional procedure to treat haemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is abrupted by laser coagulation. Methods We conducted a retrospective review on 121 consecutive patients treated with LHP over 2018 to 2020 at a District General Hospital. A diode laser device is used to seal the terminal branches of the hemorrhoidal plexuses. Routine follow-up was at 12 weeks. Our aim was to investigate the efficacy and safety profile of LHP. Efficacy was associated with symptom resolution, the degree of patients’ perception of improvement, and the number of procedures required to treat recurrence. Safety was determined by more than one hospital follow-ups and complications necessitating treatment. Results Follow-up was achieved in 100 patients. 21 patients with incomplete data were excluded. The mean age was 45 years old. LHP was utilised in 2% of patients with grade I haemorrhoids, 24% with grade II, 67% with grade III and 7% with grade IV. At follow-up, 57% reported complete symptom resolution and 94% reported symptom improvement. Residual symptoms were observed in 29% of patients. Only 9% underwent a re-operation. 38% attended hospital for more than one outpatient visits and 5% of those required antibiotics to treat local infections. Conclusion LHP is a safe and efficacious non-excisional surgical alternative to the management of the haemorrhoidal disease. Our patients reported a high degree of symptom resolution and satisfaction. Key words haemorrhoids, benign anorectal conditions, bleeding, laser haemorrhoidoplasty

Alpelisib (ALP), a breast cancer therapy, for PIK3CA-related overgrowth spectrum (PROS): A real-world data approach to a rare disease indication.

e18694 Background: PIK3CA mutations seen in cancer also drive other disease, exciting interest in repurposing oncology therapies for non-oncology indications. ALP is a PI3Kα inhibitor approved for HR+, HER2– ABC with fulvestrant. Clinical benefit of ALP in PROS, a group of rare phenotypically varied disorders driven by mutations in PIK3CA, was found in 19 pts (Venot, 2018). EPIK-P1 (NCT04285723) collected real-world data (RWD) to confirm ALP’s efficacy and safety in PROS. In the primary analysis of the primary endpoint, 12/32 pts (37.5%; 95% CI, 21.1-56.3%) with complete cases responded (≥20% reduction in the sum of target lesion volume from index/treatment [tx] start). Adverse events (AEs) and tx-related AEs were experienced by 82.5% (n = 47) and 38.6% (n = 22) of pts, respectively. The most common tx-related AE was hyperglycemia (n = 7, 12.3%). No deaths were reported (Canaud, ESMO 2021 LBA23). Methods: EPIK-P1 retrospectively abstracted data from the medical charts of pts aged ≥2 y with PROS experiencing severe/life-threatening conditions receiving ALP under compassionate use. Secondary endpoints evaluated safety and clinical benefit. Results: 57 pts were enrolled and followed for a median of 18.1 mo. No pt in the primary analysis (complete cases, n = 32) had progressive disease (PD) at wk 24; 1 pt discontinued ALP prior to wk 24 and considered a nonresponder. Of the 12 responders, median duration of response (time from first documented response to first documented PD or death due to any cause) was not estimable. Median time to censoring (date of last adequate lesion assessment) was 63.3 wk (̃14.6 mo; range, 1 d-186.7 wk); 2 pts had no further imaging assessments, 10 pts did not experience an event and tx was ongoing at data cutoff. Time to censoring was &gt; 6 mo in 7 pts and &gt; 12 mo in 6 pts. 11/20 nonresponders (55.0%) had target lesion volume reduction ranging from 0.7 to 19.6%. No pt required rescue surgery between index and wk 24. At index all pts reported ≥1 PROS-related symptom (eg, fatigue, pain). At wk 24, 82.5% (n = 47) reported symptom improvement regardless of primary analysis response status (responders, 10/12, 83.3%; nonresponders, 16/20, 80.0%). Median daily dose was 50 mg for pediatrics and 250 mg for adults. Dose reductions or interruptions were experienced by 15.8% of pts (n = 9); AEs led to dose reductions and interruptions in 3.5% (n = 2) and 10.5% (n = 6) of pts, respectively. 52 pts (91.2%) remained on tx at data cutoff; among 5 pts (8.8%) who discontinued, pt decision was the leading cause. Conclusions: RWD from EPIK-P1 demonstrate alpelisib as well tolerated, providing clinical benefit to pts with PROS regardless of response status in the primary analysis of the primary endpoint. Continued RWD collection complements planned prospective, randomized, placebo-controlled studies, facilitating access to alpelisib as an emerging pharmacologic option for PROS. Clinical trial information: NCT04285723.

Lymphocyte-Predominant Esophagitis Rarely Improves With Proton Pump Inhibitor Therapy

Lymphocyte-predominant esophagitis (LPE) refines the diagnosis of lymphocytic esophagitis using the criteria of &gt;20 intraepithelial lymphocytes/HPF and excluding those with known causes of secondary lymphocytosis (gastroesophageal reflux disease and motility disorders). The primary aim of this study was to assess response of LPE to treatment. From 2008 to 2019, 62 LPE patients were identified. Demographics, symptoms, endoscopic findings, histology, and treatment responses were reviewed. Only 24% of LPE patients treated with proton pump inhibitors (PPI) reported symptom improvement and only 17% had endoscopic improvement. All LPE patients with autoimmune disease treated with steroids had symptom improvement and resolution of LPE. In this retrospective series LPE was frequently associated with autoimmune disease, and had limited response to PPIs but frequent response to steroids and/or treatment of the underlying disease.

0537 Symptom Improvement Reported with Some PAP Use in Non-adherent Pediatric Patients with OSA

Abstract Introduction Positive airway pressure (PAP) is commonly used in children to treat obstructive sleep apnea (OSA) when surgery is not an option or is ineffective1-3, but adherence is often poor. Observational studies suggest utilization of PAP improves symptoms, signs, and polysomnogram indices of OSA in at least 85% of children4-9. The Agency for Healthcare Research and Quality released the report “Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea”10. Conclusions of this report determined that the published evidence reviewed does not support that PAP affects long term outcomes. No pediatric studies were included in this report. Objectives of this study were to determine if pediatric patients with OSA who are non-adherent to PAP therapy report an improvement in symptoms with some use of PAP. Methods A retrospective chart review was performed on patients with OSA on PAP seen in the pediatric sleep clinic. Patients were considered adherent to PAP if usage was longer than 4 hours/night for 70% of nights or more. Follow up visits occurred around 3 months, 6 months, 1 year, and 18 months-2 years. Adherence data and reported improvement in symptoms were documented at each visit, and demographical information was obtained. Results 235 patients were included in the analysis (63.9% male, 32.3% female, 3.8% missing), with a mean age (SD) at PAP initiation of 12 years (4.5). The sample was predominately Caucasian (51.5%) or African American (38.3%), 85.9% were non-Hispanic, and 53.2% obese. The mean (SD) apnea-hypopnea index was 24.7(27.6)/hr. At first visit post-initiation, of the 138 patients that had adherence data available, 80.4% reported improvement in symptoms with PAP use. Of these patients, 55.86% were non-adherent but reported symptom improvement with some use of PAP. Visit 4 data was available for 74 patients. At visit 4, 91.9% reported improvement in symptoms. Of these, 48.53% were considered non-adherent but reported symptom improvement with some use of PAP. Conclusion Historically, PAP adherence in children has been relatively poor11. Utilizing PAP therapy to treat OSA may result in an improvement in symptoms when used in patients who are considered non-adherent to therapy. Support (If Any)

Prognostic factors determining long-term outcomes of conservative treatment for acute calcific periarthritis of the hand

Acute calcific periarthritis (ACP) of the hand is an uncommon disease that is usually self-limited. Although the conservative treatment is generally considered the primary intervention, the prognostic factors associated with long-term outcomes have yet to be identified. The purposes of this study were to investigate the long-term effects of conservative treatment and identify factors associated with long-term prognosis. We retrospectively reviewed 25 patients with a mean age of 46 years who were diagnosed with ACP of the hand and followed up over more than 2 years. Pain control with nonsteroidal anti-inflammatory drugs and activity restrictions were recommended for the initial treatment. Symptom persistence was defined as a visual analogue scale of more than 1. We compared patients with and without symptom persistence regarding potential prognostic factors such as age, gender, calcification size and type (type 1, amorphous and ill-defined; type 2, homogenous and well-defined), and joints and digits involved. Factors associated with symptom persistence were examined with multivariate analysis. At 2-year follow-up, 19 patients showed complete improvement, whereas 6 reported persistent symptoms. Symptom persistence was independently associated with the thumb involvement (odds ratio (OR), 149.77; 95% confidence interval (CI), 0.61-15.98; P=0.02) and calcification type 2 (OR, 27.68; 95% CI, 0.50-11.08; P=0.02). In our study, most patients with ACP of the hand reported symptom improvement with conservative treatment at 2 years of follow-up. Calcification of the thumb or calcification type (homogeneous with a well-defined margin) was independently associated with symptom persistence at 2 years.

Clinical Utility of Paediatric Endoscopy and Correlation between Endoscopic and Histological Findings

Background. The number of gastrointestinal endoscopies in children is rapidly increasing without evidence of a parallel increase in disease burden. The positive yield of paediatric endoscopies outside certain conditions is small but the impact of normal “negative” results on clinical management is poorly studied. Routine mucosal biopsy in all paediatric endoscopies is common practice. We aimed to assess the impact of normal endoscopy on patient care, defined by symptom improvement and discharge from hospital follow-up, and calculate the correlation between endoscopic and histological findings. Methods. Retrospective analysis of the first diagnostic endoscopy in children (2015–2019) from Evelina London Children’ Hospital, in London, UK. Endoscopy and histology findings were recorded. Symptoms and follow-up were reviewed up to six months after the endoscopy. Results. 362 children were included; 46.7% were female. Mean age 10.5 (±4.1) years, 66.3% underwent OGDs, and 33.7% underwent combined OGD and colonoscopies. 72.9% of endoscopies and 57.2% of all biopsies were normal. There was a strong positive correlation between endoscopic findings and biopsy results (phi 0.68 p &lt; .001 ). 31.2% of children reported symptom improvement and were discharged from further follow-up after undergoing endoscopy after 1.9 (±1.5) clinics, phi 0.2 p &lt; 0.001 between normal endoscopy and discharge. Conclusion. Negative endoscopy appears to influence clinical management and discharge from hospital follow-up in about a third of children undergoing endoscopy. The practice of routine biopsies in all paediatric endoscopies should be considered due to a strong positive correlation between normal endoscopies and normal biopsies.

Implementation of a Collaborated Antimicrobial Stewardship Program and Outpatient Parenteral Antimicrobial Therapy (OPAT) Unit-driven Monoclonal Antibody Therapy Program for COVID-19 at an NYC Hospital

ObjectivesThis study aimed to assess the processes and clinical outcomes of a joint collaboration between Antimicrobial Stewardship Program (ASP) and the outpatient parenteral antimicrobial therapy (OPAT) unit for delivery of monoclonal antibody therapy for mild-to-moderate COVID-19. MethodsWe carried out a retrospective, interim analysis of our COVID-19 monoclonal antibody therapy program. Outcomes included clinical response, incidence of hospitalization, and adverse events. ResultsA total of 175 patients (casirivimab-imdevimab, n = 130; bamlanivimab, n = 45) were treated between December 2020 and March 1, 2021. The median time from symptom onset was 6 (IQR 4, 8) days at time of treatment. Of 135 patients available for follow-up, 71.9% and 85.9% of patients reported symptom improvement within 3 and 7 days of treatment, respectively. A total of 9 (6.7%) patients required COVID-19–related hospitalization for progression of symptoms, all within 14 days of treatment. A total of 7 (4%) patients experienced an infusion-related reaction. ConclusionsASP-OPAT collaboration is a novel approach to implement an efficient and safe monoclonal antibody therapy program for the treatment of mild-to-moderate COVID-19.

Patient Experience of Antimuscarinic Treatment for Overactive Bladder: A Qualitative Exploration of Online Forum Content.

Antimuscarinic medications are often discontinued, and there is a paucity of data regarding patient experience of medications within this class. The objective of this study is to qualitatively explore patient experience of antimuscarinic medications used for overactive bladder using reviews on Drugs.com. We examined reviews prior to February 2, 2020 (available since 2008) for oral antimuscarinic medications. User content was reviewed qualitatively via inductive content analysis. Investigators coded third-party impressions, categorizing each review as positive, mostly positive, mostly negative, or negative. The prevalence of side effects, themes, and impressions are described, with comparisons by drug using χ2, Mann-Whitney U, and Kruskal-Wallis tests, as appropriate. Correlation between ordinal and categorical variables was performed using Tau and Spearman correlation coefficients, respectively. We analyzed 469 user reviews. 68.2% reported symptom improvement. The most common side effects were dry mouth (29%) and fatigue (10.7%). Fewer neurologic side effects were reported in the solifenacin (13.9%) and trospium (none) groups (P = 0.009). Tolterodine and trospium immediate release had lower rates of ears, nose, and throat side effects (22.5% and 26.2%, respectively, P = 0.001.) Analysis of themes suggested 2 domains driving overall satisfaction: improvement and side effects. Improvement was associated with a positive satisfaction score (ρ = 0.64, P < 0.001) and gestalt impression (ρ = 0.74, P < 0.001). The factors that most negatively affected these measures were persistent symptoms followed by gastrointestinal side effects (P < 0.001). Our data suggest important differences within this class of medication both in terms of side effects and patient satisfaction. Furthermore, symptom improvement is the leading factor for patient satisfaction, whereas gastrointestinal side effects are associated with dissatisfaction.

Impact of Long-Term Dienogest Therapy on Quality of Life in Asian Women with Endometriosis: the Prospective Non-Interventional Study ENVISIOeN

Several clinical trials in women with endometriosis demonstrated that dienogest reduces endometrial lesions and improves health-related quality of life (HRQoL). To assess HRQoL in dienogest-treated patients in real-world setting, we conducted a prospective, non-interventional study in 6 Asian countries. Women aged ≥18 years with clinical or surgical diagnosis of endometriosis, presence of endometriosis-associated pelvic pain (EAPP) and initiating dienogest therapy were enrolled. The primary objective was to evaluate HRQoL using the Endometriosis Health Profile-30 (EHP-30) questionnaire. The secondary objectives included analysis of EAPP, satisfaction with dienogest, endometriosis symptoms and bleeding patterns. 887 patients started dienogest therapy. Scores for all EHP-30 scales improved with the largest mean changes at month 6 and 24 in scale pain (−28.9 ± 27.5 and − 34 ± 28.4) and control and powerlessness (−23.7 ± 28.2 and − 28.5 ± 26.2). Mean EAPP score change was −4.6 ± 3.0 for both month 6 and 24 assessments. EAPP decrease was similar in surgically and only clinically diagnosed patients. From baseline to month 24, rates of normal bleeding decreased (from 85.8% to 17.5%) while rates of amenorrhea increased (from 3.5% to 70.8%). Majority of patients and physicians were satisfied with dienogest. Over 80% of patients reported symptoms improvement. 39.9% of patients had drug-related treatment-emergent adverse events, including vaginal hemorrhage (10.4%), metrorrhagia (7.3%) and amenorrhea (6.4%). In conclusion, dienogest improves HRQoL and EAPP in the real-world setting in women with either clinical or surgical diagnosis of endometriosis. Dienogest might be a promising first-line treatment option for the long-term management of debilitating endometriosis-associated symptoms.NCT02425462, 24 April 2015.

Etiology and management of epiphora in an underserved, minority population

Objective: There is value in understanding the common etiologies of epiphora within different patient populations as well as identifying barriers to adequate treatment and symptom relief. The primary goal of the study is to report common etiologies of epiphora and the impact of treatment in patients of a large, inner-city hospital. Methods: This is a retrospective review of 10 years of data from the charts of 516 adult patients. The most common diagnoses and interventions linked to this symptom were evaluated. Subjective symptom improvement and adherence to follow-up were also analyzed. Results: Three hundred (58.1%) patients carried a diagnosis of dry eye syndrome and, of these, 40.1% did not have other ocular findings to explain their epiphora. Conservative management (CM) was recommended to the majority (86.4%) of the study population. 27.5% of the 357 patients who received CM as the only intervention reported symptom improvement. 90.1% of patients who underwent DCR reported symptom improvement. Nearly half of the patients were lost to follow-up. Conclusion: Epiphora is a common symptom that may be multifactorial in etiology, making effective treatment a challenge. Reflex tearing secondary to ocular surface dryness was the most common etiology linked to epiphora in this study. Low rates of follow-up limit the ability to fully assess the impact of current interventions on symptoms. Addressing the socioeconomic barriers that lower patient adherence to follow-up should allow more effective treatment of epiphora.

Effects of Ankle Pumping Exercises on Limb Edema in Critically ill Patients with Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome (ARDS) is an acute respiratory disease in which the respiratory activity of the lungs is compromised due to secretion of fluid in the alveoli of lungs and thus depriving the blood stream with optimal oxygen supply. Objective: To determine the effects of ankle pumping exercises on limb edema in critically ill patients with acute respiratory distress syndrome Methods: A sample of 67 patients was selected by using non-probability convenient sampling from different hospital settings. Ventilated patients or those having endotracheal tube, age between 40-65 years, and either gender were included in the study. Results: The effect of Range of Motion (ROM) on ARDS patients was as high as 91 %. There were 61(91.0) responders who experienced edema reduced by ankle pumping 54(80.6) found prone position and 13(19.4) found supine position effective 53(79.1) having resonant sound and 14(20.9) with hyper stony dullness 24(35.8) person having added sound and 43(64.2) crepitus sound in this study. In this study, 20 out of 67 patients who were admitted to the intensive care unit (ICU) developed acute onset of severe dyspnea, hypoxemia, and cyanosis and decreased respiratory system compliance, despite supplemental oxygen and mechanical ventilation. Edema had been reduced by ankle pumping in 61 subjects. Conclusions: Patients with ARDS report improvement in symptoms with physiotherapy treatment, ROM exercises had remarkable effects on such patients.

The treatment of palmar hyperhidrosis - a systematic review.

Primary palmar hyperhidrosis (PH) can have a significantly negative impact on an individual's quality of life. Currently, there appears to be no review of the effectiveness of the different interventions for its management. A systematic review was performed using PRISMA guidelines, the Cochrane Database, and MEDLINE (OVID) to identify relevant studies published from 1997 to 2017. Of the 574 references yielded, six met the inclusion criteria and were analyzed for this review. Two studies evaluated the use of oral oxybutynin as an anticholinergic treatment for PH; this demonstrated high efficacy with over 80% of patients reporting symptom improvement; dry mouth was the most common adverse effect reported. One study looking at the use of iontophoresis reported 81% improvement in patients' symptoms. One randomized, double-blind, trial looked at the use of botulinum toxin A injections for the treatment of PH; it reported 90% of patients experienced an improvement in PH. The remaining two studies evaluated the use of endoscopic thoracic sympathectomy (ETS) in PH, and both reported over 95% patient symptom improvement. There are few good quality studies evaluating the treatment of primary PH. Based on the little available evidence, the interventions reviewed significantly improve the symptoms of PH. Anticholinergic medications are considered effective and safe. Both iontophoresis and botulinum toxin provided patients with symptom relief when administered regularly. ETS was reported as successful in the reduction of PH, however, it carries significant adverse effects such as compensatory sweating and the potential of complications associated with surgery.

MP52-13 THREE YEAR FOLLOWUP: PATIENTS HAVE POOR LONG-TERM COMPLIANCE RATES USING PERCUTANEOUS TIBIAL NERVE STIMULATION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (MP52)1 Sep 2021MP52-13 THREE YEAR FOLLOWUP: PATIENTS HAVE POOR LONG-TERM COMPLIANCE RATES USING PERCUTANEOUS TIBIAL NERVE STIMULATION Chris Du, William Berg, Rosen Jeong, Edwin Lee, Ellen Niu, Tal Cohen, and Jason Kim Chris DuChris Du More articles by this author , William BergWilliam Berg More articles by this author , Rosen JeongRosen Jeong More articles by this author , Edwin LeeEdwin Lee More articles by this author , Ellen NiuEllen Niu More articles by this author , Tal CohenTal Cohen More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002082.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous tibial nerve stimulation (PTNS) is an effective third line therapy used to treat refractory overactive bladder; however, it requires routine patient clinic visits for continued symptom relief. Currently, there is a lack of literature in real world long-term followup for patients utilizing PTNS. We sought to evaluate PTNS dropout rates and identify factors associated with compliance in an American population over a three year period. METHODS: We retrospectively queried our PTNS database for patients from 2014-2017. Patients’ PTNS therapy regimen was followed for three years. Demographic, relevant clinical, and visit data were collected. Primary reason for dropout was also identified. Multiple variables were assessed for association with dropout in patients who continued PTNS for 3 years versus those who did not. RESULTS: 146 PTNS patients were identified. 74% (108/146) completed initial therapy. 52% (76/146) continued with maintenance therapy. After 3 years, only 11% (16/146) patients still regularly undergo PTNS. Figure 1 demonstrates dropout rate of patients over 3 years. On both univariate and multivariate analysis, only continued symptom improvement (p<0.01, p<0.01) and any neurological history (p=0.049, p=0.04) were associated with continuing PTNS (Table 1). Primary reasons for dropout included progression/worsening of urinary symptoms (51), time commitment (12), request for alternative treatment (12), medical comorbidities (10), and insurance issues (7). The median duration of PTNS therapy was 147 days. There was no significant association found between continuing therapy for 3 years and gender, race, Medicare, smoking status, diabetes mellitus, median household income, nor distance to clinic. CONCLUSIONS: After 3 years, only 11% patients continue utilizing PTNS therapy. Despite reported symptom improvement, overall compliance remains low with this third line treatment for OAB. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e934-e935 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chris Du More articles by this author William Berg More articles by this author Rosen Jeong More articles by this author Edwin Lee More articles by this author Ellen Niu More articles by this author Tal Cohen More articles by this author Jason Kim More articles by this author Expand All Advertisement Loading ...

MP52-11 PATIENT-REPORTED ONSET OF SYMPTOM IMPROVEMENT FOLLOWING INITIAL INTRADETRUSOR ONABOTULINUMTOXINA INJECTIONS FOR OVERACTIVE BLADDER

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (MP52)1 Sep 2021MP52-11 PATIENT-REPORTED ONSET OF SYMPTOM IMPROVEMENT FOLLOWING INITIAL INTRADETRUSOR ONABOTULINUMTOXINA INJECTIONS FOR OVERACTIVE BLADDER Neil J. Kocher, Jacqueline Zillioux, Sarah Martin, Raymond R. Rackley, Sandip P. Vasavada, and Howard B. Goldman Neil J. KocherNeil J. Kocher More articles by this author , Jacqueline ZilliouxJacqueline Zillioux More articles by this author , Sarah MartinSarah Martin More articles by this author , Raymond R. RackleyRaymond R. Rackley More articles by this author , Sandip P. VasavadaSandip P. Vasavada More articles by this author , and Howard B. GoldmanHoward B. Goldman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002082.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intradetrusor onabotulinumtoxinA (BTX-A) is a common third-line therapy for treatment of refractory overactive bladder (OAB), however several gaps exist in pre- and post-procedural standard of care. Prior studies have demonstrated BTX-A efficacy at 2-3 weeks, but there are limited data documenting when patients should begin to note symptom improvement. We performed a prospective study evaluating several factors involved in the BTX-A patient care pathway. The primary aim of this abstract was to determine patient-reported temporal improvement in symptoms following initial BTX-A therapy. METHODS: A prospective, non-randomized study of patients with non-neurogenic, refractory urgency-frequency syndrome and urgency urinary incontinence undergoing first-time BTX-A injection under local anesthesia was performed. Intradetrusor injection of 100 units BTX-A was performed by one of 3 FPMRS-trained providers using a standard 20-site template. Patients were required to discontinue their OAB medication(s) at the time of BTX-A injection for 3 weeks and complete a daily Patient Global Impression of Improvement (PGI-I) diary during this time. Data were collected at 1 month, including final satisfaction score and adverse outcomes. Descriptive analysis was performed in R programming. RESULTS: 25 patients were included (24 female, 1 male). Median age was 75 years and BMI was 34.3. Figure 1 shows a jitter plot with loess smoothed fit of patient-reported PGI-I over time following BTX-A injection. 24 patients (96%) reported symptom improvement (PGI <4) by 3 weeks, with 19 patients (76%) documenting at least “much better” (PGI >2). Median time to first improvement (PGI <4) was 1 day, at least “much better” was 4 days, and median time to maximum patient improvement was 6 days. Median final satisfaction score was PGI 2 (“much better”). Adverse outcomes included UTI in 2 patients (8%) and incomplete emptying requiring transient intermittent catheterization in 1 patient (4%). CONCLUSIONS: Patients with refractory OAB undergoing first-time 100 units BTX-A injection reported median time to first improvement (PGI <4) at 1 day, at least “much better” at 4 days, and median time to maximum patient improvement at 6 days. These data may help further counsel patient expectations following initial BTX-A therapy. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e934-e934 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Neil J. Kocher More articles by this author Jacqueline Zillioux More articles by this author Sarah Martin More articles by this author Raymond R. Rackley More articles by this author Sandip P. Vasavada More articles by this author Howard B. Goldman More articles by this author Expand All Advertisement Loading ...