Secondary Risk Factors Research Articles

Dysphagia in people with dementia

AbstractBackgroundDysphagia is a common complication in multiple neurodegenerative disorders, influencing quality of life and long term prognosis. In dementia, data regarding prevalence of dysphagia and secondary complications such as aspiration pneumonia is not well understood.Aim of the study: to assess the prevalence of dysphagia and aspiration pneumonia in patients with dementia.MethodCross‐sectional study that included patients previously diagnosed with dementia, evaluated in the outpatient clinic or admitted in the Department of Neurology, County Clinic Hospital Brasov. We evaluated the patients using a standardized protocol that included the MMSE, MoCA scale, Gugging Swallowing Screen, fiberoptic evaluation of swallowing and FEDSS scale.Resultthere were 42 patients with dementia included in the study (57,14% females) with a mean age of 69.7 ±9,1 years. The mean MMSE score was 16.8 ± 4.4. Dysphagia was present in 9 patients (21.42%). Pneumonia was encountered in 33.3% of the dysphagic patients, and it was associated with high mortality. The major secondary risk factors for pneumonia were older age, obesity, smoking and diabetes. Patients with a lower score on the MMSE/MoCA scale had a higher risk of developing dysphagia and aspiration pneumonia. Mortality in the dysphagic group was higher when compared with the non‐dysphagic group (44.2% vs. 21.2%).ConclusionDysphagia has an important impact on the clinical outcome of the patients with dementia, increasing the risk of institutionalization and mortality and being associated with dependency and poor quality of life.

SH2B3 Mutations in Patients with JAK2-Negative Erythrocytosis

Introduction: Erythrocytosis is a common reason for referral to Hematology clinics. Molecular testing for JAK2 mutations, often by next-generation sequencing (NGS), has become part of the diagnostic workup of patients with erythrocytosis, increasing the molecular characterization of this previously undifferentiated patient population. A recent study (Bhai et al. 2022) found that 4% of patients referred for JAK2-negative erythrocytosis harboured variants in the SH2B3 gene, which encodes the LNK protein, a known negative regulator of JAK2/STAT5 signaling. The objective of this study was to characterize a cohort of patients with JAK2-negative erythrocytosis with SH2B3 mutations, evaluating clinical presentation, hematologic parameters, as well as cardiovascular and thrombotic outcomes. Methods: All adult patients referred to the London Health Sciences Centre, a tertiary care centre in Southwestern Ontario, for assessment of erythrocytosis (hemoglobin >160g/L in women; >165g/L in men) between January 1, 2018 and December 31, 2022 and who underwent NGS testing were reviewed. NGS testing was performed using the Oncomine Myeloid Research Assay (Thermofisher Scientific, MA, USA). Patients with JAK2, CALR, MPL, or BCR::ABL1 mutations were excluded. Patients without JAK2 mutations ( JAK2-negative) with variants in SH2B3 were further characterized. Clinical variables included risk factors for secondary erythrocytosis and occurrence of arterial/venous thrombotic events. Laboratory variables included complete blood count and white cell differential. Results: Sixteen patients with JAK2-negative erythrocytosis met inclusion criteria with mutations in SH2B3. All mutations in SH2B3 were characterized as Tier III variants (Variants of Uncertain Significance). Laboratory and clinical parameters in this patient population are presented in Table 1. Mean hemoglobin was 181 g/L, hematocrit 0.54 L/L, leukocyte count 7.2 x10 9 cells/L, and platelets 229 x10 9 cells/L. Secondary causes of erythrocytosis were identified in 13 (81%) patients: 10 (63%) reported active smoking or had a smoking history, 4 (25%) had obstructive sleep apnea, 2 (13%) had chronic obstructive pulmonary disease, 1 (6%) had a right-to-left cardiac shunt, 4 (25%) were on an SGLT2 inhibitor, and 1 (6%) reported testosterone use. Of note, one patient had a history of stroke and another had a myocardial infarction both of which predated the development of erythrocytosis and NGS testing. One patient had a recurrent deep vein thrombosis (DVT) at the time of NGS testing. Full molecular data and comparative analysis with other cases of JAK2-negative erythrocytosis will be presented at ASH. Discussion: SH2B3 mutations have been identified in rare cases of congenital erythrocytosis and implicated in the pathogenesis of erythropoiesis. To our knowledge, this is the largest cohort of patients with JAK2-negative erythrocytosis with variants in SH2B3 reported to date. This cohort showed similar laboratory parameters and prevalence of secondary risk factors for erythrocytosis as previously reported in the general population of patients with JAK2-negative erythrocytosis at our centre (Chin-Yee et al. 2022). Thrombotic outcomes were also similar, and lower than patients with polycythemia vera. Given the high prevalence of potential secondary causes of erythrocytosis in our cohort we cannot confirm that SH2B3 mutations are causally implicated in elevated hemoglobin in these cases. Nonetheless, we cannot exclude that SH2B3 variants may confer an additional risk factor for erythrocytosis in this patient population. Further research is required to elucidate the potential impact of SH2B3 variants in patients with JAK2-negative erythrocytosis.

The Confluence Model of Sexual Aggression: The role of pornography as a secondary risk factor

The Confluence Model of Sexual Aggression: The role of pornography as a secondary risk factor

Suspected Role of Long-term Anticonvulsant Use in the Development of Squamous Cell Carcinoma

Squamous cell carcinomas (SCC) are typically a tumor of advancing age (mean age at diagnosis: 70), with more than 80% of cases occurring among people aged 60 and older[1]. In addition, these cancers commonly appear on sun-exposed areas of the body such as face, ears, neck, non-hair bearing scalp, and dorsal aspect of extremities and hands[2]. Due to the rare presentation of the aforementioned case, involving a younger female patient with SCC on the hair-bearing scalp, secondary risk factors should be examined. Many commonly used anticonvulsants, including lamotrigine and valproic acid, have known photosensitizing properties[3]. In susceptible patients, the long-term interaction between photosensitizing medications and UV radiation elevates risk of damage from the sun and has the potential to increase the likelihood of developing skin cancer over time[4]. There have been minimal studies that examine a possible association between anticonvulsants and various skin cancers, though the topic remains controversial and without consensus. Among the known adverse effects lamotrigine are several cutaneous photosensitivity issues, including exaggerated sunburn, skin irritation, hypersensitivity and rash[5]. Valproic acid is often co-administered with lamotrigine for better management of epilepsy due to the synergistic effects. When given in combination, valproic acid has been found to significantly increase plasma levels and half-life oflamotrigine[6]. These increased lamotrigine levels and exposure could in turn increase the risk of photosensitivity reactions and additional sequelae, including skin cancers. We report a 45-year-old woman who developed SCC on the scalp with a 10-year history of anticonvulsant use including lamotrigine and valproic acid.

Abstract 15793: Impact of Cardiac Rehabilitation on Cardiovascular Disease Risk Factor Management at 1 and 3 Year Follow-Up

Introduction: Cardiac rehabilitation (CR) is a cornerstone of secondary prevention for cardiovascular disease (CVD). CR participation is associated with improvements in secondary CVD risk factor management. However, it is unclear if CR participation is associated with maintained improvements in CVD risk factor management following CR completion. Purpose: The aim of this study was to assess the impact of CR participation on CVD risk factor management at 1 and 3 years following CR completion. Methods: This retrospective study analyzed 911 patients (73% male) enrolled in the CR program at Mayo Clinic from 2013 to 2020. Patient demographics, clinical characteristics, and CVD risk factor management were examined pre and post CR as part of clinical practice and assessed passively at 1 and 3 years following CR. Secondary prevention CVD risk factor goals included total cholesterol (<200 mg/dL), HDL cholesterol (>40 mg/dL), LDL cholesterol (<100 mg/dL), triglycerides (<150 mg/dL), systolic and diastolic blood pressure (<130 and <80 mmHg), and body mass index (BMI) (18.5-24.9 kg/m 2 ). Results: The mean age was 66±12 years and on average 33±9 CR sessions were attended. Table 1 shows the percentage (%) of patients meeting the secondary prevention CVD risk factor goals. The % of patients meeting the goals for total cholesterol, LDL, triglycerides, and diastolic blood pressure were higher post than pre CR. There were no changes in the % of patients meeting the goals for total cholesterol or LDL at 1 and 3 year follow up compared to post CR. At 1 and 3 year follow up, there was a lower % of patients meeting the goals for systolic and diastolic blood pressure and triglycerides (at 1 year follow up only) than post CR. No changes were present in the % of patients meeting the goals for HDL and BMI at any timepoint (all, p>0.09). Conclusions: CR participation was associated with maintained improvements in lipid management, but not in triglycerides or blood pressure control at 1 and 3 years following CR.

Abstract 12735: Investigating Cardiac Function After Anthracycline Exposure in Childhood Cancer Survivors With Modifiable Cardiovascular Risk Factors

Introduction: Anthracycline exposure can lead to cardiac dysfunction, which may possibly be worsened by secondary cardiovascular risk factors (CVRFs), such as hypertension, hyperlipidemia, obesity and diabetes. The prognostic impact of CVRFs in childhood cancer survivors is largely unknown. Now with advanced cardiac imaging, it is now possible to identify how CVRFs might influence subclinical cardiac function. Hypothesis: Anthracycline-exposed childhood cancer survivors with CVRFs will demonstrate echocardiogram-based subclinical cardiac dysfunction more frequently than those without. Methods: This is a single-center, retrospective study. Inclusion criteria are: < 18 years old, history of anthracycline-containing chemotherapy and 2 echocardiograms performed. Exclusion criteria are: congenital cardiac disease, subsequent cancer relapse and inadequate imaging quality. Echocardiographic images were analyzed for longitudinal left ventricular strain, left ventricular ejection fraction (LVEF) and myocardial performance index (MPI). Wilcoxon rank-sum test was used to compare measures of cardiac function between patients with at least one CVRF (at time of cancer diagnosis) and patients without. Results: There were 111 patients identified with 49.5% having dysfunction at some point in time. CVRFs were identified in 19 patients with the majority of those being obese (52.6%). At baseline, there was a statistically significant difference in mean strain between those with CVRFs vs those without (-19.4% vs -21.3%). At 1-6 months after chemotherapy completion, LVEF was significantly reduced in those with CVRFs vs those without (48.7% vs 59.7%) as well as mean strain (-15.8% vs -20.0%). At >5 years after chemotherapy, there was a decrease in strain magnitude in those with CVRFs vs those without (-17.7% vs -20.5%) along with abnormal mean MPI (0.57 vs 0.44). Conclusions: Anthracycline-exposed pediatric cancer survivors with CVRFs demonstrate reduced cardiac function at baseline and both at near-and long-term follow-up. Further investigation is warranted to investigate the significance of these reduced echocardiographic measures and CVRFs among childhood cancer survivors to mitigate cardiac morbidity as they age into adulthood.

Updating approaches to patient management in the light of new European guidelines on arterial hypertension: analytical review

Data from epidemiological studies show a high prevalence of cardiovascular diseases, including arterial hypertension (AH) and the risk of complications, with changes in AH control and treatment techniques. The review article summarizes the main directions of the new European guidelines on hypertension, which help implement different patient groups in outpatient practice. Secondary risk factors for cardiovascular disease are revised in the new clinical guidelines. The recommendation outlines a diagnostic and therapeutic approach for resistant arterial hypertension, its associated phenotypes, and night-time hypertension. The use and position of renal denervation for antihypertensive treatment have been updated compared with previous recommendations. The new European clinical guidelines reflect a differentiated approach to target indicators of ambulatory blood pressure in different age groups, with functional levels of aging, comorbidity, and AH phenotypes, which is of great clinical importance for a primary care physician and can significantly reduce the risk of heart disease vascular complications.

Cost effectiveness of a protocol using palivizumab in preterm infants

ObjectiveThe main objective was to evaluate the cost-effectiveness of protocol use of palivizumab in premature established by consensus in our Hospital comparing it based on the recommendations of various Scientific Societies. As a secondary objective risk factors and severity of hospitalized patients attending the established protocol in our Hospital were analyzed. MethodsThe study period was 4 seasons with the expanded protocol (retrospective data) versus 2 with restricted or agreed protocol (prospective data). The perspective of the study was the Health System, including the costs of hospitalization and palivizumab our center. The calculation of the effectiveness was determined with the admission rate of premature patients stratified by weeks of gestational age <29, <32; and <35.For the analysis of risk factors and severity in patients admitted seasons with the new protocol are collected prospectively clinical data and environmental and social factors. ResultsIn the range of gestational age < 29 years old and < 32 greater effectiveness of the extended protocol was not demonstrated against the consensus. Only more effective for EG <35 in the accumulated data and comparing seasons 12/13 and 08/09 to 13/14 for individual data was observed. This range has an associated incremental cost effectiveness ratio of €53 250,07 (range: € 14793,39 to €90446,47 for singles data and €50525,53 (€28688.22 to €211 575,65) for accumulated. The establishment of this protocol in our center meant an average saving per season €169911,51.A cost-effectiveness of the extended protocol appropriate relationship is found if the cost of palivizumab per patient was less than €1206,67 (calculated for maximum use of the vial) and a higher rate of hospitalization of 9.21%.Children entering the season with the new protocol (season 12/13 and 13/14) are 63.4% in children under 3 months and 90% are term infants who do not belong to any population at risk, while many of them have associated risk factors you vary as have school-age siblings, rural residence, parental smoking, poor educational background of parents, lack of artificial feeding and family history of allergy. ConclusionsThe consensus protocol has not been a significant increase in hospitalization rates in preterm infants <32 weeks gestational age patients. In those <35 has been observed a higher rate of hospitalization, with a very unfavorable cost-effectiveness for all clinical scenarios valued relationship.

Behavioral Weight Loss Interventions for Overweight and Obese Cardiac Rehabilitation Patients: A Systematic Review.

The purpose of this systematic review was to identify evidence pertaining to the effectiveness of behavioral weight loss interventions for overweight and obese cardiac rehabilitation participants. A database search of PUBMED, CINAHL, PsycINFO, and PROSPERO yielded 10 eligible studies. Quantitative studies implementing behavioral weight loss interventions for overweight and obese adult cardiac rehabilitation participants were reviewed. Evidence supported the usefulness and effectiveness of behavioral weight loss interventions for overweight cardiac rehabilitation participants. With the limited number of studies and inclusion of quasi-experimental studies with comparative groups, it was not possible to determine the relative power of behavioral weight loss interventions across studies. In conclusion, behavioral weight loss interventions can be incorporated into cardiac rehabilitation or offered following cardiac rehabilitation to improve weight loss of overweight and obese cardiac rehabilitation participants. Findings reinforce national guidelines emphasizing the role of cardiac rehabilitation to address secondary cardiovascular disease risk factor modification, including integrating behavioral weight loss programs in cardiac rehabilitation, or referring overweight patients to weight management programs following completion of cardiac rehabilitation.

Effect of Secondary Infections and Risk Factors on the Outcome of Covid-19 Patients in the Intensive Care Unit

Effect of Secondary Infections and Risk Factors on the Outcome of Covid-19 Patients in the Intensive Care Unit

Coupled Analysis of Safety Risks in Bridge Construction Based on N-K Model and SNA

Bridge construction accidents are often caused by a variety of factors, so it is particularly important to explore the role mechanism of bridge construction accident risk factors to effectively prevent construction safety accidents and ensure the smooth construction of bridges. We collect the causes of bridge construction accidents in China from 2006 to 2023, take 126 typical cases as research samples, analyze the primary risk factors of bridge construction from four aspects (human factors, equipment factors, management factors, and environmental factors), establish a library of secondary risk factors with reference to the literature research, introduce the theory of risk coupling, and analyze the coupling mechanism and types of risk factors of bridge construction accidents. The N-K random Boolean network model (N-K model) quantifies the coupling relationship between risk factors, assesses the risk level, and uses social network analysis (SNA) to analyze the network of bridge construction accident risk factors. The results indicate that the more factors involved in risk coupling, the greater the safety risks in bridge construction. Human factors are susceptible to the influence of other elements, and environmental and management factors can directly or indirectly impact other factors. In addition, operational errors, a lack of supervision and management, inadequate safety inspections, poor management personnel, and insufficient technical capabilities are also key risk factors that need to be prevented and controlled.

Household secondary attack rates and risk factors during periods of SARS-CoV-2 Delta and Omicron variant predominance in the Republic of Korea.

The household secondary attack rate (SAR) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an important indicator for community transmission. This study aimed to characterize transmission by comparing household SARs and identifying risk factors during the periods of Delta and Omicron variant predominance in Republic of Korea. We defined the period of Delta variant predominance (Delta period) as July 25, 2021 to January 15, 2022, and the period of Omicron variant predominance (Omicron period) as February 7 to September 3, 2022. The number of index cases included was 214,229 for the Delta period and 5,521,393 for the Omicron period. To identify the household SARs and risk factors for each period, logistic regression was performed to determine the adjusted odds ratio (aOR). The SAR was 35.2% for the Delta period and 43.1% for the Omicron period. The aOR of infection was higher in 2 groups, those aged 0 to 18 years and ≥75 years, compared to those aged 19 to 49 years. Unvaccinated individuals (vs. vaccinated individuals) and individuals experiencing initial infection (vs. individuals experiencing a second or third infection) had an increased risk of infection with SARS-CoV-2. This study analyzed the household SARs and risk factors. We hope that the results can help develop age-specific immunization plans and responses to reduce the SAR in preparation for emerging infectious diseases or potential new variants of SARS-CoV-2.

Research on the risk evaluation of urban wastewater treatment projects based on an improved fuzzy cognitive map

To address the issues of ambiguous uncertainty and conflicting evidence in risk evaluation of wastewater treatment public-private partnership (PPP) project, a risk evaluation approach based on an evidence-based reasoning (ER)-improved fuzzy cognitive map (FCM) and 15 secondary evaluation indexes system are proposed. Then, ER is used to fuse expert opinions to obtain a correlation matrix. Finally, the rank evaluation results are obtained by FCM inference. External environmental risk (S), investment and financing risk (F) are the risk factors that have the greatest impact and sensitiveness on PPP wastewater treatment projects. For predictive analysis, the maximum project risk value was 0.5523 when the S value was set to 1, followed by the project risk value when the F value was set to 1. For diagnostic analysis, the greatest change in S value converged to 0.4978 when all risk factors were set to a neutral value of 0.5, while the greatest change in project risk was observed when all risk factors were set to 1. In addition, policy and legal risk, economic risk and market risk are the most sensitive risk factors among all secondary risk factors. The results are able to provide reliable project risk assessment solutions for project decision makers.

Evaluation Criteria for Psychosomatic Practice

To diagnose and treat somatic disorders while considering psychosocial factors, medical and psychological practices require a comprehensive and operationalized list of criteria. The Evaluation Criteria for Psychosomatic Practice (ECPP) has been developed to address this need. It builds upon the updated version of the Diagnostic Criteria for Psychosomatic Research (DCPR) by incorporating significant psychodynamic factors and restructuring its framework to better cater to the practical demands of clinical assessment, diagnosis, treatment planning, and outcome monitoring. It offers four axes for clinical evaluation that can be used together or separately, depending on the needs of diagnostic process, treatment, informing the patient, or research: psychosomatic symptoms and complaints, risk factors related to personality structure, triggers, and secondary risk factors. By utilizing the ECPP’s four axes, clinicians can gain a deeper understanding of how psychosocial factors impact the clinical picture and dynamics of somatic disorders and then effectively communicate this knowledge to patients, improving compliance and collaboration in treatment. Additionally, the ECPP’s framework allows for a balance of psychological, physical, and social treatment interventions that can be tailored to the specific needs of the patient, ultimately leading to better treatment outcomes.

Prevalence of Osteoporosis and Its Correlation With Common Secondary Risk Factors in Population from Rural Areas of South India

Background. Osteoporosis is a common metabolic disorder characterised by decreased bone mass and weakened micro-architecture of bone tissue. After 50 years of age, one in three women and one in five men experience osteoporotic fractures. This is projected to cause a yearly loss of 5.8 million healthy life years to disability. The number of patients who attend the outpatient clinic and emergency department of Sanjay Gandhi Institute of Trauma and Orthopaedics with fragility fractures has been increasing, hence to know the prevalence of osteoporosis in the general population who were asymptomatic, we decided to conduct a study in the rural areas of south India.&#x0D; Aims: 1) to estimate the prevalence of osteoporosis among the population above 50 years in rural areas of south India; 2) to determine the correlation between common secondary risk factors for osteoporosis like tobacco consumption, alcohol, diabetes, and hypertension.&#x0D; Results. The prevalence of osteoporosis in the rural population was more in females at 42.2%, whereas the males had a prevalence of 32.5%. Among the population with habits of tobacco consumption and alcohol consumption, the prevalence was 78% and 30.6% respectively. 20.2% of non-smokers and 39.7% of non-alcoholics were osteoporotic. Among the population with comorbidities, 53.6% of diabetes and 55.4% of hypertensives were osteoporotic. 33.7% of non-diabetics were osteoporotic, and 29.5% of hypertensives were osteoporotic. The correlation between osteoporosis and the individual risk factors ranged between weak negative to moderately positive (r = -0.2 to 0.5). The correlation between the combination of all the four risk factors and osteoporosis is weakly positive (r = 0.339), which is highly significant (p0.001).&#x0D; Conclusion. Overall, the findings of this study suggest that addictive habits such as tobacco and alcohol consumption may have a significant impact on bone health, with a higher prevalence of osteopenia and osteoporosis observed in individuals with these habits. Comorbidities such as diabetes and hypertension were also found to be associated with a higher prevalence of osteoporosis. These findings emphasize the importance of early detection and prevention of addictive habits and comorbidities to reduce the risk of osteopenia and osteoporosis. Furthermore, the study highlights the need for further research to fully understand the complex relationships between sociodemographic factors, addictive habits, comorbidities, and bone health.

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Introduction: Infections lead to mortality in up to 50% of patients (pts) with chronic lymphocytic leukemia (CLL). Immunoglobulin G (IgG) testing detects hypogammaglobulinemia (HGG; <500 mg/dL), a secondary immunodeficiency and risk factor for severe infections (SI) in pts with CLL. We hypothesized that increased IgG testing is associated with improved identification of HGG and reduced risk of SI in CLL. Methods: This retrospective study used de-identified patient data (structured data only) from the Mass General Brigham Research Registry. Eligible adults with CLL (diagnosed post-2010) had ≥12 months of clinical data and ≥3 visits/year. IgG levels and rates of HGG and SI pre- and post-immunoglobulin replacement therapy (IgRT) were compared. A multivariable logistic regression model examined the association of SI with IgG testing, controlling for IgRT, HGG, treatment, age, and sex. Results: Of 2842 pts with CLL and median (IQR) follow-up of 4.2 (2.2, 6.8) years, 1352 (47.6%) underwent IgG testing; 464 (34.3%) had HGG; 179 (6.3%) received IgRT; and 75.2% were treatment-naive. IgRT use (median [IQR] administrations of 2.0 [1.0, 4.0]) increased IgG levels (502.0 mg/dL [397.0, 615.0] vs. 367.0 mg/dL [245.0, 454.0]) and reduced rates of HGG (38.0% vs. 80.3%, p < 0.0001) and SI (33.7% vs. 51.0%, P=0.003) in the 12 months post-IgRT. IgG testing and IgRT use were independently associated with a significantly lower SI risk (Table). Pts with ≥3 versus 1-2 IgG tests were more likely to be identified with HGG (51.5% [321/623] vs. 19.6% [143/729], p < 0.0001), and pts with HGG who had ≥3 IgG tests were more likely to receive IgRT (32.7% [105/321] vs. 13.3% [19/143], p < 0.0001). Conclusions: Increased IgG testing was independently associated with lower risk of SI. Greater HGG risk awareness and more standardized IgG testing might reduce SI in pts with CLL. Study/writing support funder: Takeda Pharmaceuticals USA, Inc. Keywords: chronic lymphocytic leukemia (CLL), immunotherapy, late effects in lymphoma survivors The research was funded by: Analysis Group, Inc. conducted this study in collaboration with Takeda Pharmaceuticals USA, Inc. Under the direction of the authors, medical writing services were provided by Oxford PharmaGenesis Inc., and were funded by Takeda Pharmaceuticals USA, Inc. Conflict of interest: J. D. Soumerai Consultant or advisory role: Abbvie, AstraZeneca, Beigene, Bristol Myers Squibb, Roche, Seattle Genetics, TG Therapeutics, and Verastem Research funding: Adaptive Biotechnologies, Beigene, BostonGene, Genentech/Roche, GlaxoSmithKline, Moderna, Takeda, and TG Therapeutics Z. Yousif Employment or leadership position: Takeda Pharmaceuticals USA, Inc. and the University of California, San Diego. T. Gift Employment or leadership position: Takeda Pharmaceuticals USA, Inc. Stock ownership: Takeda R. Desai Employment or leadership position: Analysis Group, Inc. Analysis Group, Inc. Research funding: Takeda Pharmaceuticals L. Huynh Employment or leadership position: Analysis Group, Inc Research funding: Takeda Pharmaceuticals M. S. Duh Employment or leadership position: Analysis Group, Inc Research funding: Takeda Pharmaceuticals M. E. Sanchirico Employment or leadership position: Takeda Pharmaceuticals USA, Inc. Stock ownership: Takeda

Individualized assessment and optimization of post myocardial infarction care by introducing a hybrid clinic - A DGH experience

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Optimal secondary prevention remains key in improving cardiovascular outcomes post myocardial infarction. Barriers to achieving timely and individualized medical optimization include unavailability of close follow up’s, compliance to secondary prevention, and more recently, the impact of COVID pandemic on outpatient face to face clinic appointments. With the recent emphasis from the European Society of Cardiology on secondary prevention in addition to optimizing lipid therapy, a dedicated service for post MI patients to address individualized risks can provide a timely opportunity to improve holistic cardiovascular care. Purpose To assess established secondary prevention practices, we initially audited 52 patients who presented with ACS between Jan 2020 and July 2020. These patients were assessed for post MI care optimization at 6 weeks post discharge. Utilizing ESC guidelines as audit targets, in our 6-week post discharge audit, we identified that there was scope of ACE-inhibitor up titration in 55.8% of the patients, beta-blocker optimization in 9.6%, Lipid lowering agents in 15.4%, mineralocorticoid receptor antagonist addition in patients with impaired LV systolic function in 5.8% of the patients. 5% of patients with new diagnosis of diabetes required referral to specialist teams for diabetic medication initiation or optimization. These results provided an opportunity to introduce a structured post MI clinic that will allow individualized risk assessment on an outpatient basis. Method We proposed a one stop hybrid clinic where all patients discharged following a myocardial infarction received a consultation 6 – 8 weeks following a discharge. These patients were sent blood forms 2-3 weeks prior to their appointment for full blood count levels, renal functions, liver profile, HBa1c levels and lipid profile. Focus of this consultation was to assess and educate the patient on risk factors (smoking, diabetes, cardiac rehab program), assess and address compliance to secondary prevention medications and finally titrate medications to maximum tolerated doses whilst achieving ESC defined targets for secondary prevention (post MI target systolic BP&amp;lt;140mmHg in non diabetics and &amp;lt;130mmHg in diabetics, LDLc &amp;lt;1.4, smoking cessation, HBa1c &amp;lt;49). Where appropriately identified, referral to lipid specialist and diabetes specialist teams were made to provide holistic multi-disciplinary management. Results To understand the Impact made by the clinic we obtained patient list through local electronic records to filter those discharged with a primary diagnosis of myocardial infarction in 2022. An audit tool was created and data collection was performed including baseline characteristics as per table 1 and interventions made Table 2. Conclusion(s) By establishing the post MI clinic we were able to demonstrate efficient individualized assessment and optimization of secondary prevention risk factors and pharmacotherapy.

The cost effectiveness of potential risk factors for developmental dysplasia of the hip within a national screening programme

Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate a novel screening programme that included both the primary risk factors of breech presentation and family history, and the secondary risk factors of oligohydramnios and foot deformities. A five-year prospective registry study investigating every live birth in the study's catchment area (n = 27,731), all of whom underwent screening for risk factors and examination at the newborn and six- to eight-week neonatal examination and review. DDH was diagnosed using ultrasonography and the Graf classification system, defined as grade IIb or above or rapidly regressing IIa disease (≥4o at four weeks follow-up). Multivariate odds ratios were calculated to establish significant association, and risk differences were calculated to provide quantifiable risk increase with DDH, positive predictive value was used as a measure of predictive efficacy. The cost-effectiveness of using these risk factors to predict DDH was evaluated using NHS tariffs (January 2021). The prevalence of DDH that required treatment within our population was 5/1,000 live births. The rate of missed presentation of DDH was 0.43/1000 live births. Breech position, family history, oligohydramnios, and foot deformities demonstrated significant association with DDH (p < 0.0001). The presence of breech presentation increased the risk of DDH by 1.69% (95% confidence interval (CI) 0.93% to 2.45%), family history by 3.57% (95% CI 2.06% to 5.09%), foot deformities by 8.95% (95% CI 4.81% to 13.1%), and oligohydramnios nby 11.6% (95 % CI 3.0% to 19.0%). Primary risk factors family history and breech presentation demonstrated an estimated cost-per-case detection of £6,276 and £11,409, respectively. Oligohydramnios and foot deformities demonstrated a cost-per-case detected less than the cost of primary risk factors of £2,260 and £2,670, respectively. The inclusion of secondary risk factors within a national screening programme was clinically successful as they were more cost and resource-efficient predictors of DDH than primary risk factors, suggesting they should be considered in the national guidance.

Primary and Secondary Risk Factors Associated With Concussion Symptom Clusters in Collegiate Athletes: Results From the NCAA-DoD Grand Alliance CARE Consortium

There is a broad and diverse range of symptoms after a concussion, from irritability to nausea. This heterogeneity of symptoms is a challenge for clinicians managing the different presentations among injuries. Prior research has investigated the structure of postconcussive symptoms to determine if they can be grouped into clusters of related symptoms. The purpose of this study was to identify symptom clusters during the acute phase after a sports-related concussion using exploratory factor analysis and to understand the relationship between risk factors for postconcussion symptoms (ie, demographics, injury characteristics, mental health, and sleep qualities) and different symptom clusters. We hypothesized that certain factors would be predictive of specific symptom clusters. Cross-sectional study; Level of evidence, 3. Collegiate athletes (N = 1104) from the Concussion, Assessment, Research, and Education (CARE) Consortium completed the Sport Concussion Assessment Tool-Third Edition symptom assessment tool 24 to 48 hours after concussion. Exploratory factor analysis was conducted on the symptom evaluation to determine symptom clusters 24 to 48 hours after concussion. Regression analysis was used to examine the effects of pre- and postinjury characteristics. Exploratory factor analysis revealed a 4-cluster structure for acute postconcussive symptoms that explained 62% of the variance in symptom reporting: vestibular-cognitive, migrainous, cognitive fatigue, and affective. Delayed reporting, less sleep before assessment, female sex, and being hurt outside of competition (during practice/training) was correlated with increased symptoms for 4 symptom clusters. Depression predicted higher vestibular-cognitive and affective symptoms. Amnesia was correlated with higher vestibular-cognitive and migrainous symptoms, whereas migraine history was associated with more migrainous and affective symptoms. Symptoms can be grouped into 1 of 4 distinct clusters. Certain variables were associated with increased symptoms across multiple clusters and may be indicative of greater injury severity. Other factors (ie, migraine history, depression, amnesia) were associated with a more specific symptom presentation and may be mechanistically related to concussion outcomes and biological markers.

Abstract Number: LBA12 Cortical Venous Thrombosis As Cause Of Atypical Cortical Intracerebral Hemorrhage

Introduction Cortical venous thrombosis is a rare and underrepresented etiology for atypical cortical intracerebral hemorrhages (ICH). Cortical venous thrombosis poses a diagnostic challenge compared to dural venous sinus thrombosis. Venogram studies may show a dural sinus filling defect in cases but may not demonstrate thrombosed cortical veins, especially given their variable anatomy. Our aim was to identify cases of atypical cortical ICH in the absence of other secondary ICH risk factors that may have been associated with cortical venous thrombosis. Methods Retrospective chart review of cases of nonaneurysmal ICH over a 3‐year period at our comprehensive stroke center were reviewed. Imaging study and clinical data were reviewed to include only atypical cortical hemorrhages. All subjects were required to have computed tomography (CT) with thin 0.625 mm slices, CT angiogram (CTA) that included venous phases, diagnostic cerebral angiograms without identifiable vascular etiologies, and MR imaging. Atypical ICH was defined as cortical hemorrhage in the absence of vascular malformation, hematological disorders, suspected amyloid angiopathy, hypertension, trauma, dural venous sinus thrombosis, and other secondary etiologies. Social science statistics software was used for data analysis. Results From April 2019 to July 2022, out of 344 total ICH cases, 10 cases were deemed idiopathic despite rigorous investigation, including evaluation for venous sinus thrombosis. Six subjects were male. Mean age was 46.5 (95% CI 35.99, 57.02), and median NIHSS was 7 (95% CI 1.86, 12.54). Two of the ten patients were identified to have ICH‐adjacent hyperdense cortical vein on CT indicating thrombosis. On MRI brain, both patients had susceptibility weighted imaging (SWI) blooming within an adjacent cortical vein as well as hyperintense filling defect of veins on T2 sequence. Conclusions In our study population of atypical intracerebral hemorrhages, cortical venous thrombosis was identified in 20% of subjects. Cortical venous thrombosis may not represent a rare etiology in this unique patient population. Multimodal neuroimaging may be required to identify this underdiagnosed pathology.