Single Episode Research Articles

Life satisfaction and its influencing factors for bedridden patients with stroke

ObjectivesThis study aimed to evaluate the life satisfaction of bedridden patients with stroke and explore its relationship with demographic, social, and medical factors. Material and methodsThis multicenter cross-sectional study was conducted in two steps. The Longshi scale was used to select the study population and assess patients’ ability to perform activities of daily living. Subsequently, a multidimensional questionnaire was used to obtain the participants’ information and evaluate their level of life satisfaction. The chi-squared test and binary logistic regression methods were employed to analyze the factors influencing the life satisfaction of bedridden patients with stroke. ResultsA total of 3,639 bedridden patients with stroke were included in this study, of them, only 27.2% reported satisfaction with their current lives. Factors associated with higher life satisfaction include female sex, older age, and primary school education or lower (P<0.05). Patients who had experienced a single stroke episode had chronic diseases, and rated their health as good were more satisfied with their lives than those who did not. The results of the binary logistic regression confirmed that age, education, religion, household income, cohabitation, social participation, number of chronic diseases, self-rated health status, and disability level significantly influenced the life satisfaction of bedridden patients with stroke (P<0.05). ConclusionOur study showed that the overall life satisfaction of bedridden patients with stroke was low, with several factors influencing their life satisfaction. Therefore, effective measures should be implemented to improve life satisfaction and quality of life.

Stratifying early-onset emotional disorders: using genetics to assess persistence in young people of European and South Asian ancestry.

Depression and anxiety are the most common mental health problems in young people. Currently, clinicians are advised to wait before initiating treatment for young people with these disorders as many spontaneously remit. However, others develop recurrent disorder but this subgroup cannot be identified at the outset. We examined whether psychiatric polygenic scores (PGS) could help inform stratification efforts to predict those at higher risk of recurrence. Probable emotional disorder was examined in two UK population cohorts using the emotional symptoms subscale of the Strengths and Difficulties Questionnaire (SDQ). Those with emotional disorder at two or more time points between ages 5 and 25 years were classed as 'recurrent emotional disorder' (n = 1,643) and those with emotional disorder at one time point as having 'single episode emotional disorder' (n = 1,435, controls n = 8,715). We first examined the relationship between psychiatric PGS and emotional disorders in childhood and adolescence. Second, we tested whether psychiatric PGS added to predictor variables of known association with emotional disorder (neurodevelopmental comorbidity, special educational needs, family history of depression and socioeconomic status) when discriminating between single-episode and recurrent emotional disorder. Analyses were conducted separately in individuals of European and South Asian ancestry. Probable emotional disorder was associated with higher PGS for major depressive disorder (MDD), anxiety, broad depression, ADHD and autism spectrum disorder (ASD) in those of European ancestry. Higher MDD and broad depression PGS were associated with emotional disorder in people of South Asian ancestry. Recurrent, compared to single-episode, emotional disorder was associated with ASD and parental psychiatric history. PGS were not associated with episode recurrence, and PGS did not improve discrimination of recurrence when combined with clinical predictors. Our findings do not support the use of PGS as a tool to assess the likelihood of recurrence in young people experiencing their first episode of emotional disorder.

Retinal microvascular abnormalities in major depression.

The aim of our study was to find a possible association between retinal microvascular abnormality and major depression in a non-geriatric population. The participants with major depression were hospitalised at the University Hospital in Hradec Kralove, Department of Psychiatry. Retinal images were obtained using a stationary Fundus camera FF450 by Zeiss and a hand-held camera by oDocs. Fifty patients (men n=18, women n=32) aged 16 to 55 (men's average age 33.7±9.9 years, women's average age 37.9±11.5 years) were compared with fifty mentally healthy subjects (men n=28, women n=22) aged 18 to 61 (men's average age 35.3±9.2 years, women's average age 36.6±10.6 years) in a cross-sectional design. The patients were diagnosed with a single depressive episode (n=26) or a recurrent depressive disorder (n=24) according to the ICD-10 classification. Our results confirmed significant microvascular changes in the retina in patients with depressive disorder in comparison to the control group of mentally healthy subjects, with significantly larger arteriolar (P<0.0001) as well as venular (P<0.001-0.0001) calibres in major depression. According to the literature, acute and chronic neuroinflammation is associated with changes in microvascular form and function. The endothelium becomes a major participant in the inflammatory response damaging the surrounding tissue and its function. Because the retina and brain tissue share a common embryonic origin, we suspect similar microvascular pathology in the retina and in the brain in major depression. Our results may contribute to a better understanding of depression etiopathogenesis and to its personalized treatment.

Samara within the scope of “The Eighteenth Year” novel by A.N. Tolstoy

The article considers one of the aspects of depicting Samara in the novel by A.N. Tolstoy The Eighteenth Year (19271928), namely the use of Notes on the 1918 Czechoslovak Rebellion to show the battles on the city streets in June 1918, which are now kept as part of the writer's archive in the Manuscript Department of the A.M. Gorky Institute of World Literature under RAS. Tolstoy re-conceptualized the information and supplemented it with artistic images to describe the events and give them historical reliability. The article gives examples of the writer's work with documentary materials that were reflected both in the chronological context of the narrative and in single episodes of the novel.

Differential characteristics of bipolar I and II disorders: a retrospective, cross-sectional evaluation of clinical features, illness course, and response to treatment

BackgroundThe distinction between bipolar I and bipolar II disorder and its treatment implications have been a matter of ongoing debate. The aim of this study was to examine differences between patients with bipolar I and II disorders with particular emphasis on the early phases of the disorders.Methods808 subjects diagnosed with bipolar I (N = 587) or bipolar II disorder (N = 221) according to DSM-IV criteria were recruited between April 1994 and March 2022 from tertiary-level mood disorder clinics. Sociodemographic and clinical variables concerning psychiatric and medical comorbidities, family history, illness course, suicidal behavior, and response to treatment were compared between the bipolar disorder types.ResultsBipolar II disorder patients were more frequently women, older, married or widowed. Bipolar II disorder was associated with later “bipolar” presentation, higher age at first (hypo)mania and treatment, less frequent referral after a single episode, and more episodes before lithium treatment. A higher proportion of first-degree relatives of bipolar II patients were affected by major depression and anxiety disorders. The course of bipolar II disorder was typically characterized by depressive onset, early depressive episodes, multiple depressive recurrences, and depressive predominant polarity; less often by (hypo)mania or (hypo)mania-depression cycles at onset or during the early course. The lifetime clinical course was more frequently rated as chronic fluctuating than episodic. More patients with bipolar II disorder had a history of rapid cycling and/or high number of episodes. Mood stabilizers and antipsychotics were prescribed less frequently during the early course of bipolar II disorder, while antidepressants were more common. We found no differences in global functioning, lifetime suicide attempts, family history of suicide, age at onset of mood disorders and depressive episodes, and lithium response.ConclusionsDifferences between bipolar I and II disorders are not limited to the severity of (hypo)manic syndromes but include patterns of clinical course and family history. Caution in the use of potentially mood-destabilizing agents is warranted during the early course of bipolar II disorder.

Translation and validation of the Turkish forms of the International Depression Questionnaire (IDQ) and the International Anxiety Questionnaire (IAQ)

BackgroundThe 11th version of the International Classification of Diseases (ICD-11) included revised formulations of single episode depressive disorder (DD) and generalized anxiety disorder (GAD). Consequently, the International Depression Questionnaire (IDQ) and International Anxiety Questionnaire (IAQ) have been developed as self-report measures which directly align with the ICD-11 description of DD and GAD, respectively. ObjectiveThe current study sought to (1) test the factorial validity of the Turkish translations of the IDQ and IAQ, (2) evaluate their internal reliability, (3) determine how meeting diagnostic requirements for ICD-11 DD and ICD-11 GAD vary across different demographic variables, and (4) determine the convergent validity of the Turkish translations of the IDQ and IAQ. MethodsParticipants were a community sample of 1455 Turkish adults and largely comprised of university students. This study used confirmatory factor analysis (CFA) to test the latent structure of both scales. Prevalence rates of ICD-11 GAD and DD were also estimated, and differences in prevalence rates according to gender and relationship status were examined. ResultsThe CFA results indicated that both scales were unidimensional. Both scales demonstrated high levels of internal consistency. The prevalence of ICD-11 DD and GAD was 26.6 % and 28.5 %, respectively. Rates of probable ICD-11 DD and GAD were highest for females and single participants. Convergent validity was indicated by strong associations with external measures of depression and anxiety. ConclusionFindings from this study provide support for the validity and reliability of the Turkish versions of the IDQ and IAQ in a large community sample.

The Course Patterns and Diagnostic Shifts of Patients With Schizoaffective Disorder: A Retrospective Cohort Study.

Since its introduction, schizoaffective disorder (SAD) has been one of the most controversial diagnoses in psychiatry, both clinically and nosologically. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), SAD diagnostic criteria were changed, and instead of a cross-sectional diagnosis, a longitudinal approach covering the life course of the illness was adopted. In this study, the meaning of this conceptual shift in the diagnosis of SAD in clinical practice is investigated throughout the course of the illness for patients with SAD. Sixty-two inpatients diagnosed with SAD according to DSM-5 diagnostic criteria are included in this study. The course of the illness from its onset to the present is investigated retrospectively. The disease duration is 18.3 ± 9.1 years. The most common diagnoses in the first hospitalization are bipolar disorder (manic episodes) and psychotic disorder, not otherwise specified. Furthermore, the time that elapsed between the first psychiatric application of the patients and the diagnosis of SAD is 9.5 ± 7.3 years. Further, when the course of the illness is grouped according to the predominance of affective and psychotic disorders, recurrent affective disorders are observed most frequently (29.3%), followed by mixed-episode disorders and a shift from affective disorders to psychotic disorders (22.4%). It is found that SAD has a heterogeneous course, and affective disorder diagnoses are more dominant during the course of the illness. The clinical relevance of the longitudinal emphasis on the total duration of the illness in the DSM-5 is also demonstrated. The affective and psychotic dichotomy, based on Kraepelin, has failed to elucidate the course of the disease in clinical practice. Therefore, clinicians should meticulously evaluate the entire course of the illness for SAD and avoid conclusive judgments over a single episode.

Familial isolated hypoparathyroidism type 2: a case report with review of literature

Familial isolated hypoparathyroidism (FIH) is a rare group of genetic disorder associated with dysregulation of parathyroid hormonal axis characterized by refractory hypocalcaemia. Herein we report a 1 month 4 days old baby born out of consanguineous marriage presented with respiratory distress with single episode of convulsion, cause pointing towards hypocalcaemia. The hypocalcaemia symptoms were refractory despite repeated calcium gluconate. Laboratory parameters yielded evidence of hypoparathyroidism which was further strengthened by neuroimaging and skeletal imaging. The hypoparathyroidism was treated by oral calcitriol and calcium supplementation along with institution of phosphate binder. Whole genome exome sequencing revealed a novel nonsense mutation of glial cell missing transcription factor 2 (GCM2) gene variant c.109C&gt;T (p.Gin37Ter) establishing the diagnosis as FIH type 2. The calcium and phosphate normalized in further follow up. The new found locus and the novel variation of GCM2 gene adds another feather to the ever-evolving genetic conundrum of the disease.

Character composition: A new framework for TV serial drama characters

From an industry and craft perspective, despite the many manuals and ‘how to’ guides, feature film paradigms (notably three- to five-act structures) and character arc frameworks (e.g., the hero’s journey) dominate the discussions of character development in serial TV drama. The work of structure-based industry writers, notably Christopher Booker, Christopher Vogler, Linda Aronson and Craig Batty, focuses on feature films and this article will connect their influential frameworks and analyses with the practice of serial TV drama screenwriting. While there are several key screenwriting manuals specifically for writing television, particularly Pamela Douglas’s Writing the TV Drama Series (2018) and John Yorke’s Into the Woods (2014), these texts only briefly investigate long-form character development, instead focusing on single episodes. Therefore, expanding these ideas and examining the practice of long-form serial drama screenwriting across multiple episodes and seasons is necessary. What this article will arrive at is a new framework for criticism and creative practice: character composition.

A study of etiology and management of epistaxis in a tertiary center in Western Uttar Pradesh

Background: Epistaxis is a common condition but with diverse etiology dependent on geography, season, climate, and demography. Aims and Objectives: To describe the demographic, clinical, and etiological profile and management strategies of epistaxis cases at a tertiary center in U.P. (west). Materials and Methods: Patients were identified from the emergency and outpatient department, and their demographic and clinical details were noted. Local examination was performed, and necessary investigations were carried out. Management strategies were noted. Duration of hospital stay and mortality, if any, was documented. Descriptive analytics were used. Data were represented as numbers and percentages, mean±standard deviation, and median. Results: A total of 189 epistaxis patients were enrolled in the study. The mean age of patients was 32.89±17.92 (range 1–85 years). The sex ratio (M: F) was 2.71. Majority of patients presented to the emergency department (60.3%) within 1 day (64.6%), had single episode (66.7%), the presence of old clot (72%) and the anterior location of bleeding (91.5%). 119 (63%) cases required admission. Nasal endoscopy and computed tomography scan were performed in 49 (25.9%) and 24 (12.7%) cases, respectively. The most common etiology was trauma (49.2%), followed by idiopathic cause (14.8%), hypertension (12.7%), and others. Nasal packing and cauterization were required in 16.4% and 15.9% of cases, respectively. Surgery was required in 5 (2.6%) cases. A minuscule percentage of cases required blood transfusion. There was no mortality. Conclusion: Epistaxis is a common emergency with males predominating over females. Causes are varied. Most patients can be managed conservatively with favorable outcomes if timely intervention is done.

Management of urinary tract infections in the community: a clinical audit and patient survey.

Urinary tract infection (UTI) is a common ailment but can develop into sepsis. The outcomes related to UTI may potentially be affected by both patient and clinician management of UTI. To explore the circumstances around a single UTI episode to determine whether there are patient and clinician-related variables that may contribute to differences in management. Survey and clinical audit in 12 general practices in England. Patients (n = 504) completed a bespoke survey and their corresponding index UTI consultation was audited. The TARGET (Treat Antibiotics Responsibly, Guidance, Education and Tools) UTI audit toolkit was utilised. A significantly higher proportion of females compared with males used self-management measures. Increase in fluid intake was 78% for females aged <65 years and 71% for females aged >65 years compared with 53% for males (P<0.001, Χ2 test). Analgesic use was 50% for females aged <65 years and 41% for females aged >65 years compared with 36% for males (P = 0.036, Χ2 test). Males also indicated they lacked UTI knowledge when compared with females (P = 0.002, Kruskal-Wallis test). Males also claimed to have waited significantly longer for a consultation appointment (P = 0.027, Χ2 test). Antibiotics were prescribed in 98% of all cases, with adherence to clinical diagnostic guidelines lowest in females aged <65 years. Only 40% (89/221 of cases in this guideline sub-cohort [females aged >65 years]) would have been a UTI, according to TARGET criteria, following a medical record audit. UTI symptom management by clinicians is suboptimal; the presence or absence of symptoms is often insufficiently recorded in medical records. Additionally, suboptimal adherence to guidelines concerning urinalysis and microbiological investigation is common. Known increased clinical risks for males may be compounded by their more limited knowledge of (self)-managing UTI and their comparatively late presentation.

Persistent Bacterial Vaginosis and Risk for Spontaneous Preterm Birth.

The aim of this study was to determine the association between persistent bacterial vaginosis (BV) in pregnancy and risk for spontaneous preterm birth (sPTB). Retrospective data from IBM MarketScan Commercial Database were analyzed. Women aged between 12 and 55 years with singleton gestations were included and linked to an outpatient medications database and medications prescribed during the pregnancy were analyzed. BV in pregnancy was determined based on both a diagnosis of BV and treatment with metronidazole and/or clindamycin, and persistent treatment of BV was defined as BV in more than one trimester or BV requiring more than one antibiotic prescription. Odds ratios were calculated comparing sPTB frequencies in those with BV, or persistent BV, to women without BV in pregnancy. Survival analysis using Kaplan-Meier curves for the gestational age at delivery was also performed. Among a cohort of 2,538,606 women, 216,611 had an associated International Classification of Diseases, 9th Revision or 10th Revision code for diagnosis of BV alone, and 63,817 had both a diagnosis of BV and were treated with metronidazole and/or clindamycin. Overall, the frequency of sPTB among women treated with BV was 7.5% compared with 5.7% for women without BV who did not receive antibiotics. Relative to those without BV in pregnancy, odds ratios for sPTB were highest in those treated for BV in both the first and second trimester (1.66 [95% confidence interval [CI]: 1.52, 1.81]) or those with three or more prescriptions in pregnancy (1.48 [95% CI: 1.35, 1.63]. Persistent BV may have a higher risk for sPTB than a single episode of BV in pregnancy. · Persistent BV beyond one trimester may increase the risk for sPTB.. · Persistent BV requiring more than one prescription may increase the risk for sPTB.. · Almost half of antibiotic prescriptions treating BV in pregnancy are filled after 20 weeks gestation..

Assessment of prognostic markers of alopecia areata in pediatric patients

Alopecia areata (AA) is associated with impairment of psychological health being more pronounced in pediatric population. Hence, it becomes imperative to study the AA in pediatric population so that early diagnosis and adequate treatment can be initiated at early stage to prevent further morbidity associated with the condition. This observational study was conducted in the department of dermatology venereology and leprosy, SAIMS and PG institute, Indore, India after obtaining approval from the IEC. The study included 14 children with AA who visited the hospital over the period of 1 year. Results showed that Mean age of the patients was 8.8±3.423 years with M:F ratio of 3:4. AA subtotalis was found to be most frequent (57.1%). The mean duration of alopecia was reported to be 9.3±7.965 months. The most common finding was the presence of a single patch (35.7%) and 50% of subjects have had a single episode of the disease. 64.3% of children had involvement of multiple sites with scalp being the most common (85.7%). There is high prevalence of markers of disease severity and activity amongst pediatric patients with AA. High prevalence of nail changes, mark hair (64.3%), coudability hair (50.0%), yellow dots (42.8.0%), black dots (78.6%), S. vellus hair (28.6%) shows that children have high chance of AA progressing to severe forms. There is high prevalence of markers of disease severity and activity amongst pediatric patients with AA with AA subtotalis more common among children as compared to the patchy type.

Agriculture and crop dispersal in the western periphery of the Old World: the Amazigh/Berber settling of the Canary Islands (ca. 2nd–15th centuries ce)

AbstractThe Canary Islands were settled ca. 1,800 years ago by Amazigh/Berber farming populations originating in North Africa. This historical event represents the last and westernmost expansion of the Mediterranean farming package in Antiquity, and investigating it yields information about crop dispersal along the periphery of the Mediterranean world around the turn of the first millennium ce. The current study focuses on archaeobotanical evidence recorded in a series of pre-Hispanic/Amazigh sites of the Canary Islands (ca. 2nd–15th centuries ce). It offers new, unpublished archaeobotanical findings and direct radiocarbon datings of plant remains from the different islands. The general goal is to gain a better grasp of how the first settlers of the Canary Islands adapted their farming activities to the different natural conditions of each island. The results suggest a shared crop ‘package’ throughout the islands since at least the 3rd–5th centuries ce. This set of plants was likely introduced from north-western Africa and consists of Hordeum vulgare (hulled barley), Triticum durum (durum wheat), Lens culinaris (lentil), Vicia faba (broad bean), Pisum sativum (pea), and Ficus carica (fig). The crop ‘package’ probably arrived in a single episode during the initial colonisation and was not followed by any other plants. Subsequent to the initial settling and until the arrival of the European seafarers, the islands remained isolated from each other and from the outside world, a condition that over time led to a decline in crop diversity in all of the islands except Gran Canaria.

Cardiorespiratory fitness and cardiovascular risk among in-patients with depression compared to healthy controls.

Compared to the general population, individuals with depression have an increased risk for cardiovascular diseases. Nevertheless, little is known so far whether cardiorespiratory fitness (CRF) moderates this relationship. Therefore, we examined whether common physiological cardiovascular risk factors differ between patients with depression and healthy (non-depressed) controls, whether patients and controls differ in CRF, and whether higher CRF is associated with a lower cardiovascular risk in both patients and healthy controls. Additionally, we examined whether within the patient sample, cardiovascular risk factors differ between patients with mild, moderate and severe depression, and whether the relationship between symptom severity and cardiovascular risk is moderated by patients' CRF levels. Data from a multi-centric, two-arm randomized controlled trial (RCT) was analyzed, including 210 patients (F32, single episode: n = 72, F33, recurrent major depression: n = 135, F31-II, bipolar type II: n = 3) and 125 healthy controls. Waist circumference, body mass index, body fat, blood pressure, cholesterol levels, triglycerides, and blood glucose were considered as cardiovascular risk markers. CRF was assessed with a submaximal ergometer test. Differences between groups were examined via χ2-tests and (multivariate) analyses of covariance. Compared to healthy controls, patients with depression had a higher cardiovascular risk as evident from about half of the examined indicators. In the total sample, participants with good CRF had more favourable scores across nearly all risk markers than counterparts with poor CRF. For most variables, no interaction occurred between group and fitness, indicating that in patients and controls, similar differences existed between participants with poor and good CRF. Few differences in risk markers were found between patients with mild, moderate and severe depression, and no interaction occurred between depression severity and CRF. Patients with depression and healthy controls differ in several cardiovascular risk markers, putting patients at increased risk for CVDs. In contrast, people with good CRF show more favourable cardiovascular risk scores, a relationship which was observed in both healthy controls and patients with depression. Physical health of psychiatric patients should receive the clinical attention that it deserves. Lifestyle interventions targeting healthy diet and/or physical activity are recommended as a physically active and healthy lifestyle contributes equally to patients' mental well-being and cardiovascular health.

EEG Frontal Asymmetry in Unipolar and Bipolar Depression

Background: given the similarity of clinical manifestations of depressive disorder and depressive episodes within the framework of bipolar affective disorder, diagnostic errors are inevitable. Both overdiagnosis and underdiagnosis of bipolar affective disorder are too common, and it may take several years to establish a correct diagnosis. Despite the fact that it is impossible to completely eliminate diagnostic errors, it is important to reduce their likelihood by better understanding diagnostic criteria.The aim of this study was to study the indicators of frontal EEG asymmetry in patients with unipolar and bipolar depression, as well as to identify possible correlations with the severity of clinical symptoms. Patients and methods: we examined 30 patients with affective disorder in the framework of a single depressive episode or recurrent depressive disorder and 30 patients with bipolar affective disorder, the current episode of mild or moderate depression. The bioelectric activity of the brain was recorded and analyzed with the calculation of the spectral power of beta and alpha rhythm in the frontal cortex and the beta/alpha ratio was calculated.Results: it was found that patients with bipolar affective disorder had left-sided frontal asymmetry, the beta/alpha ratio was lower on the right than on the left (0.57 [0.41; 0.87] vs. 0.67 [0.43; 1.08], p = 0.007), while patients with unipolar depression had a bilateral pattern of frontal beta/alpha ratio (0.67 [0.45; 1.01] vs. 0.69 [0.45; 0.98], p = 0.441). Statistically significant negative associations were also found between the beta/alpha ratio in the right leads in patients with bipolar affective disorder and the duration of the disease (rs=–0.419, p=0.033).Conclusion: the study clearly showed that quantitative EEG indicators can be used as an additional tool for differentiating bipolar and unipolar depression.

#4062 PERITONEAL DIALYSIS CATHETER SURVIVAL: A TEN-YEAR SINGLE CENTER STUDY

Abstract Background and aims Timely insertion and adequate management of peritoneal dialysis catheter (PDC) related complications are crucial for the success of Peritoneal Dialysis (PD). The aim of the present study was to review the peritoneal dialysis catheter outcomes at our center and evaluate variables influencing catheter survival. Methods We conducted a retrospective study including 146 patients who had their first PD catheter implanted between 1st of August 2012 and 31st of July 2022 in our institution. The primary endpoint was PD catheter failure, defined as removal of the PD catheter due to catheter-related complications. Kaplan-Meier curves were used to estimate catheter survival. Cox regression model was used to identify factors that were independently associated with catheter survival. All demographic and clinical characteristics of the patients and PD complications were included as covariates. A p value of less than 0.05 was considered statistically significant. Results The study population included 85 men and 61 women, aged 55.1 $ \pm {\rm{\ }}$ 16.7 years. Mean follow-up was 26.5 +/- 22.7 months. Diabetes was the most common etiology of the stage 5 chronic kidney disease (n = 41, 28%), followed by chronic glomerulonephritis (n = 30, 20.5%). Ninety patients (61.2%) had one or more comorbidities and seventeen (11,6%) had previous abdominal surgery. In 98 patients (60.1%), the PDC was inserted using a mini-laparotomy approach, whereas the laparoscopic method was used in 54 patients (33.1%). Only 8 patients (4.9%) had their catheter placed percutaneously using the Seldinger technique. The total number of patients with one or more PD-related infectious complications during follow-up was 99 (67%): 51 patients (31%) had a single episode and 29 (17.8%) had multiple episodes of peritonitis; 34 patients (20.9%) had a single episode of PD catheter related exit site or tunnel infection, while 47 (28.8%) had more than 1 event. Sixty-six patients (45%) had PD-related mechanical complications, mostly due to outflow failure (19 patients with catheter migration, 11 with omental wrapping). The remaining non-infectious complications were hernia (n = 20, 13.7%), hemoperitoneum (n = 8, 5,5%), leakage (n = 4, 2.7%) and pleuroperitoneal shunt (n = 4, 2.7%). Fourteen patients required intervention due to mechanical complications, namely repositioning of the catheter with fluoroscopic technique in 8 patients and surgical repositioning in 6. Removal of the catheter was required in 49 patients (33.6%). The leading cause of catheter removal was infection (n = 29, 59%): peritonitis in 28 patients and refractory tunnel infection in 1. Mechanical complications were also a significant factor, accounting for 40.8% of the removals (n = 20). Overall PD catheter survival rates over 12, 24 and 36 months were 80.2%, 72.4% and 61.6%, respectively. PD catheter-related non-infectious complications was the only independent variable significantly associated with catheter survival (Hazard ratio 2.573; 95% CI 1.426–4.645). No significant association was observed between the PD catheter survival and other risk factors including age, diabetic status, comorbidities, previous abdominal surgeries, method of catheter insertion or infectious complications. Conclusions PDC non-infectious complications were the only independent factor significantly associated with catheter survival. Despite the significant number of infectious complications, including peritonitis, it was found that these complications did not result in a significant decrease in catheter survival. These findings highlight the crucial role of proper management of peritoneal dialysis catheter-related non-infectious complications for successful and long-term usage of PDC.

T2 Mapping of Patellar Cartilage After a Single First-Time Episode of Traumatic Lateral Patellar Dislocation.

In most cases, lateral patellar dislocation (LPD) is accompanied by chondral injury and may initiate gradual degeneration of patellar cartilage, which might be detected with a T2 mapping, a well-established method for cartilage lesions assessment. To examine short-term consequences of single first-time LPD in teenagers by T2 mapping of the patellar-cartilage state. Prospective. 95 patients (mean age: 15.1 ± 2.3; male/female: 46/49) with first-time, complete, traumatic LPD and 51 healthy controls (mean age: 14.7 ± 2.2, male/female: 29/22). 3.0 T; axial T2 mapping acquired using a 2D turbo spin-echo sequence. MRI examination was conducted 2-4 months after first LPD. T2 values were calculated in manually segmented cartilage area via averaging over three middle level slices in six cartilage regions: deep, intermediate, superficial layers, and medial lateral parts. ANOVA analysis with Tukey's multiple comparison test, one-vs.-rest logistic regression analysis. The threshold of significance was set at P < 0.05. In lateral patellar cartilage, a significant increase in T2 values was found in deep and intermediate layers in both patient groups with mild (deep: 34.7 vs. 31.3 msec, intermediate: 38.7 vs. 34.6 msec, effect size = 0.55) and severe (34.8 vs. 31.3 msec, 39.1 vs. 34.6 msec, 0.55) LPD consequences as compared to controls. In the medial facet, only severe cartilage damage showed significant prolongation of T2 times in the deep layer (34.3 vs. 30.7 msec, 0.55). No significant changes in T2 values were found in the lateral superficial layer (P = 0.99), whereas mild chondromalacia resulted in a significant decrease of T2 in the medial superficial layer (41.0 vs. 43.8 msec, 0.55). The study revealed substantial difference in T2 changes after LPD between medial and lateral areas of patellar cartilage. 2 TECHNICAL EFFICACY STAGE: 2.

Acute respiratory infections hamper training and competition in cross-country skiers, especially in those with asthma

ABSTRACT Acute respiratory infections (ARinf) are one of the leading causes that prevent athletes from training and competing. The aim of this study was to investigate the burden of ARinfs during one season among cross-country skiers. All Finnish cross-country skiers enrolled in the largest national competitions in winter 2019 (n = 1282) were sent a postal questionnaire. A higher proportion of skiers with than without asthma had to refrain from competitions because of ARinf (76.9% vs. 62.2%, p = 0.011) but there was no significant difference in refraining from training (91.2% vs. 83.8%, p = 0.084). In skiers with asthma, the median duration of a single ARinf episode was longer (5.0 days, IQR 3.8–6.8 vs. 4.0 days, IQR 3.0–6.7, p = 0.017), and they had more days of absence because of ARinf throughout the season (median 15 days (IQR 8–28) vs. 10 days (IQR 6–18), p = 0.006) in comparison to non-asthmatics. However, many of the skiers either trained (54.4%) or competed (22.5%) during an ARinf.

IMMU-19. NIVOLUMAB-INDUCED CNS DEMYELINATION IN A 15-YEAR-OLD WITH CLASSIC HODGKIN LYMPHOMA

Abstract INTRODUCTION Nivolumab associated neurologic immune-related adverse events (irAEs) have been reported in less than 1% of patients and mainly in the adult population. Here we present a pediatric case of nivolumab related CNS demyelination. Case description: 15-year-old male with nodular sclerosis stage III classic Hodgkin lymphoma was enrolled to receive chemotherapy following SWOG S1826 protocol. Eight weeks after the first dose of nivolumab, he had a single episode of seizure. Prolonged EEG showed no epileptiform discharges. Levetiracetam was initiated. Initial MRI showed a non-enhancing T2 hyperintense focal cortical thickening in the left primary motor cortex. CSF studies were significant for mild lymphocytic pleocytosis. One dose of nivolumab was held with subsequent doses given. Levetiracetam was continued and follow-up EEGs were normal. Repeat MRI done three months later showed multiple new parenchymal hyperintense lesions including in the anterior temporal lobe with central curvilinear enhancement, and faintly enhancing lesions in the left fusiform gyrus, juxtacortical white matter of the right middle temporal gyrus, and left superior cerebellar peduncle, findings consistent with CNS demyelination. At this time, CSF showed 9 WBCs (94% lymphocytes) and oligoclonal bands with negative cytology and flow cytometry making CNS lymphoma highly unlikely. The last two doses of nivolumab were held and he was started on methylprednisolone. The most recent MRI ten weeks after the last dose of nivolumab showed resolution of the abnormal findings. DISCUSSION There is limited published literature about neurologic complications of immune checkpoint inhibitors (ICPis) in the pediatric population. CNS demyelination and other neurologic irAEs should be suspected in patients presenting with new neurologic symptoms who started any ICPi within the past three months and after other causes including disease progression, metastasis, metabolic or infectious disorders have been ruled out. Treatment varies depending on severity but includes discontinuation of the ICPi and steroids.