Use Of Systemic Steroids Research Articles

Factors for progressive pulmonary fibrosis in connective tissue disease-related interstitial lung disease.

Progressive fibrosis can occur in connective tissue disease (CTD)-related interstitial lung disease (ILD) and make the prognosis worse. This study aimed to investigate factors related to progressive pulmonary fibrosis (PPF) phenotype in CTD-ILDs. Medical records of patients diagnosed as CTD and ILD at a single, tertiary hospital in South Korea were retrospectively reviewed. Patients whose lung functions were followed up for more than a year were included in analysis. PPF was defined as forced vital capacity (FVC) declined ⩾10% or diffusion capacity of carbon monoxide (DLco) ⩾15%. Of 110 patients with CTD-ILD, 24.5% progressed into PPF. Rheumatoid arthritis (RA) and Sjogren's disease accounted for more than 63% of PPF. Compositions of CTD type were similar between PPF and non-PPF. Clinical characteristics and proportion of usual interstitial pneumonia (UIP) pattern on chest images were also similar between PPF and non-PPF. Approximately 10% of patients in both groups were treated with anti-fibrotic agents. Use of systemic steroids and/or other immunomodulating agents lowered the risk of developing PPF in CTD-ILD patients after adjusting for gender-age-physiology score and smoking status (adjusted odds ratio: 0.25, 95% confidence interval: 0.07-0.85). About a quarter of CTD-ILD progressed into PPF. The use of immunomodulating agents lowered the risk of developing PPF. To improve outcomes of patients, future studies need to detect patients at higher risk for PPF earlier and set up clinical guidelines for treatment strategies in the process of PPF.

Temporal Triangular Alopecia: A Rare Entity

Congenital triangular alopecia (CTA) presents as a localized nonscarring patch of alopecia. It is likely to be confused with alopecia areata. The case is being reported to increase awareness and familiarize clinicians about this rare condition of CTA which closely mimics alopecia areata and also to prevent indiscriminate use of both topical and systemic steroids.

Systemic corticosteroid use and cardiovascular risk in patients hospitalized for pneumonia

BackgroundLimited data are available concerning cardiovascular risk with respect to adjunctive corticosteroid use in patients with pneumonia. We aimed to assess the associations between systemic corticosteroid use and the occurrence of major adverse cardiovascular events (MACEs) in patients hospitalized for pneumonia. MethodsAmong study participants enrolled via surveillance for severe acute respiratory infection from July 2016 to January 2017, the clinical course of patients with pneumonia was retrospectively investigated until December 2019. We evaluated the occurrence of in-hospital and after-discharge MACEs according to steroid use during hospitalization. ResultsOf the 424 patients hospitalized for pneumonia, 118 (28.8%) received systemic corticosteroids during hospitalization. The most common reason for steroid use was acute exacerbation of chronic lung disease (75.4%). Systemic steroid use was significantly associated with an increased risk of in-hospital MACEs; it was not associated with after-discharge MACEs. The risk of in-hospital MACEs was significantly greater in patients with more comorbidities, more severe pneumonia, and a higher inflammatory marker level; moreover, it was positively associated with duration and cumulative dose of steroid treatment. ConclusionSystemic corticosteroid use was associated with an increased risk of in-hospital MACEs in patients hospitalized for pneumonia.

Mortality Predictors in Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)

Objectives: To determine predicting factors for in-hospital outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) Methodology: A prospective cross-sectional validation study was performed in Jinnah Postgraduate Medical Center Karachi, Pakistan from 2019 to 2020 at the Chest Medicine department, a largest public tertiary care center in Karachi. All the patients with other inflammatory diseases such as malignancy, Arthritis, Inflammatory bowel diseases, connective tissue disorders, bronchiectasis (radiologically proven or history of phlegm expectoration >30 ml/day) or history of Tuberculosis were excluded. Patients with a recent history of use of antibiotic treatment or systemic steroids (prednisolone equivalent to >20 mg/day) in the preceding two months on medical record were also excluded from the study. Ethical Approval was taken from Institutional Research committee. All the patients who were presented to ER with Acute exacerbation of COPD was included in the study, AECOPD was defines Anthonisen criteria. Data was entered into SPSS version 21 for statistical analysis of the data. Results: Total 157 study participants were included into the study with predominance of male gender (n=106, 67.5%). The average age of study participants was 65.1 ± 11.41 years. Age was significantly higher among non-survivors than survivors (p=0.037). PH level at 4 hours was significantly lower in survivors (p=0.038). Heart rate (p=0.026) and respiratory rate (p=0.018) were significantly higher among non-survivors at 4 hours. Among NLR, PLR, PCO2, PO2 and HCO3, a higher sensitivity of 92.59% for NLR and lower specificity of 6.15% PCO2 was determined. None of these parameters had area under the curve significantly higher than 0.5. Multivariable logistic regression showed that age and PCO2 were independently predictors of mortality. Conclusion: The present study found that increasing age and PCO2 were significant predictors of mortality in in patients with acute exacerbation of chronic obstructive pulmonary disease. NLR has high sensitivity and low specificity in determining the mortality

Risk Factors for COVID-19 in Inflammatory Bowel Disease: A National, ENEIDA-Based Case-Control Study (COVID-19-EII).

(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case−control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March−July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3−5.9), occupational risk (OR: 2.9; 95%CI: 1.8−4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2−2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09−0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution.

Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis.

Risks of long-term steroid use in patients with ulcerative colitis (UC) outweigh the benefits, thus dosing should be tapered once a response is achieved. Colonoscopy is a key technique for assessing disease severity and optimizing treatment involving steroids. This retrospective longitudinal cohort study of patients with UC explored factors associated with the duration of systemic steroid use. The Japan Medical Data Center database, an employer-based insurance claims database, was used to select individuals initiating prednisolone, with a prescription issued between January 1, 2010, and January 31, 2018. The study included adults with a confirmed diagnosis of UC, who had received ≥1 year of continuous treatment with 5-aminosalicylic acid, biologics, or thiopurine. Factors associated with prednisolone duration were assessed using a multivariate regression model. Median duration of prednisolone treatment was 98 days, and colonoscopy was performed ≤1 month before or at the first prescription of prednisolone (index date) in 32.8% of patients (607/1,853). Shorter durations of prednisolone treatment were associated with colonoscopy ≤1 month before or at the index date and higher prednisolone dose at index date, with incidence rate ratios (IRRs) of 0.776 (95% confidence interval [CI], 0.682-0.884; P<0.001) and 0.998 (95% CI, 0.996-1.000; P=0.018), respectively. Charlson Comorbidity Index scores of 1 and ≥2 predicted longer prednisolone treatment (IRR, 1.332; 95% CI, 1.174-1.511; P<0.001 and IRR, 1.599; 95% CI, 1.357-1.885; P<0.001, respectively). Performing colonoscopy before or at the time of initiating steroid was associated with a shorter duration of steroid use in patients with UC.

Clinical Impact of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Associated Clostridioides difficile Infection Among Patients with Lung Cancer.

Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs)-associated Clostridioides difficile infection (CDI) among lung cancer patients have been reported in case reports and adverse events reporting system databases in the United States and Japan, but clinical data remained insufficient. This study aims to evaluate CDI in lung cancer patients receiving EGFR-TKIs. We conducted a retrospective cohort study using multi-institutional electronic medical records database. We included patients aged older than 20 years diagnosed with lung cancer and treated with EGFR-TKIs (gefitinib, erlotinib, afatinib). We defined EGFR-TKI initiation date as the index date and occurrence of diarrhea with CDI or without CDI as the event date. We followed patients from the index date until the event date, ICU admission, death, or 12/31/2019. We included 2242 diarrhea patients, 51 were EGFR-TKI with CDI cohort, and 2191 were diarrhea without CDI cohort. Patients who were concurrently taking antibiotics (hazard ratio [HR], 3.30; 95% CI, 1.67-6.5) and systemic steroids (HR, 4.9; 95% CI, 2.65-9.06) had an increased risk of CDI. First-generation EGFR-TKIs tended to be associated with an increased risk of CDI compared with afatinib (HR, 1.81, 95% CI, 0.94-3.47). EGFR-TKI with CDI had a higher ICU admission rate (HR, 3.42, 95% CI, 1.98-5.91) and mortality rate (HR, 2.34, 95% CI, 1.67-3.28) than diarrhea without CDI. Patients with CDI had higher ICU admission rates and mortality rates than those without CDI. Concurrent use of antibiotics and systemic steroids were risk factors for CDI among patients with lung cancer receiving EGFR-TKIs. Afatinib was not associated with a higher risk of CDI than first-generation EGFR-TKIs.

Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020-2021).

In hospitalized patients with COVID-19, bloodstream infections (BSI) are associated with high mortality and high antibiotic resistance rates. The aim of this study was to describe BSI etiology, antimicrobial resistance profile and risk factors in a sample of patients deceased with COVID-19 from the Italian National COVID-19 surveillance. Hospital charts of patients who developed BSI during hospitalization were reviewed to describe the causative microorganisms and their antimicrobial susceptibility profiles. Risk factors were analyzed in univariate and multivariate analyses. The study included 73 patients (71.2% male, median age 70): 40 of them (54.8%) received antibiotics and 30 (41.1%) systemic steroids within 48 h after admission; 53 (72.6%) were admitted to intensive care unit. Early steroid use was associated with a significantly shorter interval between admission and BSI occurrence. Among 107 isolated microorganisms, the most frequent were Enterococcus spp., Candida spp., Acinetobacter baumannii, and Klebsiella pneumoniae. Median time from admission to BSI was shorter for Staphylococcus aureus compared to all other bacteria (8 vs. 24 days, p = 0.003), and longer for Enterococcus spp., compared to all other bacteria (26 vs. 18 days, p = 0.009). Susceptibility tests showed a high rate of resistance, with 37.6% of the bacterial isolates resistant to key antibiotics. Resistance was associated with geographical area [adjusted odds ratio (AOR) for Central/South Italy compared to North Italy: 6.775, p = 0.002], and with early use of systemic steroids (AOR 6.971, p = 0.018). In patients deceased with COVID-19, a large proportion of BSI are caused by antibiotic-resistant bacteria. Early steroid use may facilitate this occurrence.

Bortezomib Maintenance After Allogeneic Transplantation in Newly Diagnosed Myeloma Patients Results in Decreased Incidence and Severity of Chronic GVHD

Allogeneic hematopoietic cell transplantation (HCT) has curative potential in myeloma but remains hampered by high rates of relapse and chronic graft-versus-host disease (GVHD). We hypothesized that bortezomib (BTZ) as maintenance therapy after allo HCT could not only decrease the incidence of relapse but also the incidence and severity of chronic GVHD. The primary endpoint of this study was to determine whether BTZ maintenance decreases the incidence and severity of chronic GVHD using National Institutes of Health (NIH) criteria. The secondary endpoints were to determine the immunosuppression burden, organ involvement and survival (overall survival, progression-free survival) in patients either receiving or not receiving BTZ. In this retrospective study, we compared the outcome of 46 myeloma patients who received BTZ after upfront tandem auto-allo HCT between 2008 and 2020 to 61 patients without maintenance. We explored the impact of BTZ maintenance on incidence and severity of chronic GVHD using the 2014 NIH criteria. At 2 years, incidences of overall (61.2% versus 83.6%; P=.001), and moderate/severe chronic GVHD (44.5% versus 77.0%; P=.001) were significantly lower in BTZ recipients who had less mouth (43% versus 67%; P=.018) and eyes (9% versus 41%; P=.001) involvement at initial diagnosis. We report a lower use of systemic steroids (45.1% versus 76.4%; P < .001), mycophenolate mofetil (15.5% versus 28.2%; P=.031) and tacrolimus (34.5% versus 70.6%; P < .001) in BTZ recipients. Probability of being alive and off systemic immunosuppressants at 3 years was 77% in BTZ recipients and 56% in controls (P=.046). To date, there is no difference in survival between both groups. In summary, BTZ maintenance improved incidence and severity of chronic GVHD and should be considered as a valid option in myeloma patients receiving upfront tandem auto-allo HCT.

ODP067 Long-term Systemic Steroid Use And Its Impact on In-hospital Outcomes Among Patients Admitted With Acute Pericarditis

Abstract Background Early use of systemic steroids in the acute setting of acute pericarditis has been associated with increased recurrence rate and a longer course of treatment. It is not clear if long-term systemic steroids use, has a similar unfavorable impact in patients admitted for acute pericarditis. Our study aimed to determine if the presence of long-term systemic steroid use as a comorbidity during admission for acute pericarditis, was associated with worse outcomes. Method: A retrospective cohort study was designed using data obtained from the 2016 to 2018 combined National Inpatient Sample (NIS) database. The international diseases classification code, tenth revision (ICD-10), was used to identify patients admitted with a principal diagnosis of acute pericarditis who were further dichotomized into 2 cohorts, based on the presence of a secondary diagnosis of long-term systemic steroid use. Primary outcomes of the study were, mortality rate, length of stay (LOS) and total hospital charge. Secondary outcomes assessed included rates of pericardial effusion, cardiac tamponade, cardiogenic shock, pericardial window, and cardiac arrest. A multivariate linear and logistic regression were used to adjust for confounders. Results Our sample included a total of 36,570 adult hospitalizations for acute pericarditis, out of which 2.24% had associated long-term systemic steroid use as a secondary diagnosis. There was a 3- fold increased odds of mortality among patients with long-term systemic steroid use compared to the group without, (2.44% vs 0.84%, AOR: 2.92, 95% CI: 1. 06 to 8. 01, p: 0. 038). Both length of stay (LOS) and total charge were increased among patients with long-term systemic steroid use compared to their counterpart cohort, with an adjusted mean difference of 0.2 days and 1,693.65 USD respectively but these did not meet statistical significance. There was no statistically significant difference in terms of secondary clinical outcomes including, pericardial effusions, cardiac tamponade, cardiogenic shock, rate of pericardial window and cardiac arrest between the two groups analyzed. Conclusion The presence of long-term corticosteroid therapy as a comorbidity during admission for acute pericarditis was associated with a 3–fold increased odds of mortality during hospitalization and there was a trend towards increased LOS and total charge among such patients, though the latter did not meet statistical significance. Further prospective studies need to be done on this topic to better improve understanding and to assess its impact on patient care. Presentation: No date and time listed

ODP062 Clinical Outcomes of Cardiogenic Shock Hospitalization Among Patients with Long-term Systemic Steroid Use

Abstract Background Cardiogenic shock is a state of immense stress, and our innate human response depends on a robust metabolic, neuroendocrine, and immunologic reserves. Long term use of systemic corticosteroids takes its toll on all aspects of this mechanism. Knowledge of how this basic physiology translates into clinical outcomes is scarce among patients with cardiogenic shock. Our study sought to identify such effects. Method: A retrospective cohort study was designed using data obtained from the 2016 to 2018 combined National Inpatient Sample (NIS) database. Adult patients (age &amp;gt;18) with principal admission diagnosis of cardiogenic shock were identified using the international diseases classification code, tenth revision (ICD-10), and separated into two cohorts based on whether they had a secondary diagnosis of long term systemic steroid use. Primary outcomes assessed were, mortality, length of stay (LOS) and total hospital charge. Secondary outcomes included rate of mechanical ventilation, mechanical circulatory support device use and cardiac arrest. Multivariate linear and logistic regressions were used to adjust for confounders. Results There was a total of 477,695 adult hospitalizations for cardiogenic shock, out of which 1. 06% had associated secondary diagnosis of long-term systemic steroid use. The presence of long-term systemic steroid use was associated with 15% increased odds of mortality, (36.63% vs 33.32%, AOR: 1.15, 95% CI: 1. 01 to 1.30, p: 0. 039). However, there was a significant reduction in both length of stay (LOS), (9.85 days vs 11.56 days, adjusted mean difference: -1.59 days, 95%CI: -2.41 days to - 0.77 days, p &amp;lt; 0. 001) and total charge (178,624.8 USD vs 240,859.3 USD, adjusted difference of -55,719.4 USD, 95% CI: - 70,348. 0 to -41,090.8) among patient with long-term systemic steroid use compared to the other cohort. Similarly, there was significantly reduced odds of both the rate of mechanical circulatory support device utilization (15.43% vs 20.32%, AOR: 0.99, 95%CI: 0.62 to 0.77, p: 0. 001) and rate of cardiac arrest (7.22% vs 9.31%, AOR: 0.78, 95%CI: 0.61 to 0.98, p: 0. 035) among patients with long term systemic steroid use. There was no difference in the rate of mechanical ventilation between the two groups. Conclusion the presence of long-term systemic steroid use as a comorbidity during hospitalization for cardiogenic shock was associated with an increased mortality but a reduction of LOS, total hospital charge, mechanical circulatory support device utilization and cardiac arrest. One can only hypothesize that the antiparallel relationship between mortality and the other primary and secondary outcomes could be brought about by earlier discharge from hospital due to death, thus truncating further needs for hospitalization and other interventions. This crucial paradox needs further studies to ascertain. Presentation: No date and time listed

EOSINOPHILIC CYSTITIS IN A PEDIATRIC PATIENT WITH X-LINKED CHRONIC GRANULOMATOUS DISEASE

<h3>Introduction</h3> Pediatric Eosinophilic Cystitis is an uncommon inflammatory disease associated with X-linked Chronic Granulomatous Disease (X-CGD)¹. We present a rare case of a teenage patient with refractory eosinophilic cystitis. <h3>Case Description</h3> Patient is a 14-year-old male with X-CGD, colitis, and complications from chronic steroid use, including bilateral cataracts, osteoporosis, and adrenal insufficiency. His colitis was well-controlled with vedolizumab when he presented for evaluation of new onset dysuria and intermittent scrotal pain that improved with voiding. Infectious workup was unrevealing. CT of abdomen and pelvis demonstrated asymmetric, irregular thickening, nodularity and enhancement of the left bladder wall and bladder base. Pathology from cystoscopy was significant for scattered eosinophils, suspicious for eosinophilic cystitis. He demonstrated mild peripheral eosinophilia (0.63 K/µL). He was started on intravesical dexamethasone 10mg, to minimize complications from systemic steroid use, and oral loratadine 5mg on intravesical treatment days. However, his symptoms did not resolve and intravesical dexamethasone was increased to 25mg then to 50mg. Loratadine was increased to 10mg daily. His bladder ultrasound normalized after 12 doses of intravesical dexamethasone and daily 10mg loratadine. Three weeks after loratadine was weaned to every other day, his urinary symptoms returned. Loratadine was increased to 10mg daily and he remained asymptomatic off steroids. <h3>Discussion</h3> Reported cases of pediatric eosinophilic cystitis are mostly in young children, only requiring a short course of intravesical steroids and oral antihistamine, unlike our patient^2,3. More research is needed to elucidate the history, optimal diagnosis and guide appropriate management of eosinophilic cystitis in pediatric X-CGD patients.

A CASE OF RECURRENT RESPIRATORY FAILURE AND EOSINOPHILIA CAUSED BY PAPILLARY RENAL CELL CARCINOMA

<h3>Introduction</h3> Eosinophilia with end organ manifestations secondary to solid tumors is not well described. <h3>Case Description</h3> A 57-year-old female with Aspirin Exacerbated Respiratory Disease had well controlled asthma on aspirin 325mg twice daily and inhaled corticosteroid/long-acting beta-agonist. Suddenly, over 2 months, her asthma significantly worsened requiring 5 emergency room visits and 3 hospitalizations. When placed on high-dose systemic steroids, her respiratory symptoms improved and her absolute eosinophil count (AEC) on 60mg prednisone was 0.2 × 10³/mL. However, when prednisone was tapered below 30mg daily, she twice required emergent intubation for hypercapnic respiratory failure, and her AEC increased to 1.25 × 10³/mL. Respiratory failure was ultimately attributed to status asthmaticus. Extensive eosinophilia workup was negative except chest computed tomography which incidentally demonstrated a new calcified renal mass. The patient underwent nephrectomy, revealing type 2 papillary renal cell carcinoma (RCC). To avoid continued high-dose systemic steroids, mepolizumab was initiated. Post-nephrectomy and on mepolizumab, her asthma remained well-controlled, and her corticosteroids were tapered off. Now, four months post-nephrectomy, mepolizumab has been discontinued and her asthma remains well controlled with an AEC of 0.15 × 10³/mL. <h3>Discussion</h3> To our knowledge, this is the first case of type 2 papillary RCC associated with peripheral eosinophilia. In particular, we suspect her malignancy was associated with an eosinophilia that was not completely responsive to steroids, leading to recurrent severe asthma decompensation. This rare case highlights how sudden changes in asthma control should prompt evaluation as to new underlying triggers and that AEC should always be interpreted in the context of systemic steroid use.

Clinical outcomes and prognostic factors of bronchiectasis rheumatoid overlap syndrome: A multi-institution cohort study.

The information regarding bronchiectasis with RA (BROS) is limited in Asia. The objective of this study was to investigate the clinical characteristics and outcomes of BROS in Taiwan. This multi-institute cohort study included patients with BROS from January 2006 to December 2017. The clinical, functional and microbiological data of these patients were retrieved from the Chang Gung Research Database. Respiratory failure and mortality were the primary outcomes. Severe exacerbation was defined as bronchiectasis- related hospitalizations or emergency department visits. A total of 343 patients with BROS were identified. One hundred and eight patients had severe exacerbation and exhibited significantly more previous exacerbations, a lower FEV1 and higher BACI score (11.1 vs. 7.5) than patients without severe exacerbation. The most prevalent species in sputum were Non-tuberculous mycobacteria (NTM) (14.8 %), Pseudomonas aeruginosa (14.2 %), and fungus (5.9%). 68.8% of BROS patients used disease modifying antirheumatic drugs (DMARD), 7.9% used biological DMARD. NTM and tuberculosis infection rates were higher in bDMARD group compared with nbDMARD group and others. Overall, the 3-year respiratory failure rate and mortality rate were 14.6 and 25.7% respectively. Patients with RA diagnosed before bronchiectasis had a significantly higher cumulative incidence of mortality in a 3-year follow-up than those with RA diagnosed after bronchiectasis. In Cox regression, age, higher RF value and systemic steroid use were independent risk factors for mortality in BROS. BROS patients with severe exacerbation had a high mortality rate in Taiwan. bDMARD is associated with a trend of increased risk of NTM and TB infections.

Systemic steroid administration combined with intratympanic steroid injection in the treatment of a unilateral sudden hearing loss prognosis prediction model: A retrospective observational study.

Idiopathic sudden sensorineural hearing loss (ISSNHL) is an emergency ear disease that is referred to as a sensorineural hearing loss of at least 30 dB in three sequential frequencies and occurs over a period of < 72 h. Because of its etiology, pathogenesis, and prognostic factors, the current treatment methods are not ideal. Previous studies have developed prognostic models to predict hearing recovery from ISSNHL, but few studies have incorporated serum biochemical indicators into previous models. The aim of this study was to explore the factors influencing the ISSNHL prognosis of combination therapy (combined intratympanic and systemic use of steroids, CT), among the patient population data, the serum biochemical indicators before the treatment, and the clinical features of ISSNHL. The new prediction model was developed through these factors. From November 2015 to April 2022, 430 patients who underwent CT at the Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Air Force Medical University for ISSNHL, were reviewed retrospectively. We found significant differences in age (P = 0.018), glucose (P = 0.035), white blood cell (WBC) (P = 0.021), vertigo (P = 0.000) and type (P = 0.000) with different therapeutic efficacies. Multivariate logistic regression analysis showed that age (OR = 0.715, P = 0.023), WBC (OR = 0.527, P = 0.01), platelet to lymphocyte ratio (PLR) (OR = 0.995, P = 0.038), vertigo (OR = 0.48, P = 0.004), course (time from onset to treatment) (OR = 0.681, P = 0.016) and type (OR = 0.409, P = 0.000) were independent risk factors for ISSNHL prognosis. Based on independent risk factors, a predictive model and nomogram were developed to predict hearing outcomes in ISSNHL patients. The area under the curve (AUC) value of the model developed in this study was 0.773 (95% CI = 0.730–0.812), which has a certain predictive ability. The calibration curve indicated good consistency between the actual diagnosed therapeutic effectiveness and the predicted probability. The model and nomogram can predict the hearing prognosis of ISSNHL patients treated with CT and can provide help for medical staff to make the best clinical decision. This study has been registered with the registration number ChiCTR2200061379.

S6.2d Dermatophytosis due to Trichophyton erinacei caused by contact with African hedgehogs as family pets

S6.2 Resurgence of dermatophytic infections, September 22, 2022, 4:45 PM - 6:15 PMObjectiveTo present a series of cases of various types of dermatophytosis caused by Trichophyton erinacei, caused by contact with African hedgehogs.MethodsPatients with clinical suspicion of ringworm caused by T. erinacei were included in the study. Each patient underwent a mycological study, with direct examinations (KOH), cultures in Sabouraud dextrose agar medium with and without antibiotics. With the cultures obtained, molecular identification was made using the PCR technique and Matrix Assisted Laser Desorption Ionization Time of Flight (MALDI-TOF) proteomics. Once confirmed, the patients were given treatment and follow-up. When the pets (hedgehogs) were accessible, they were cultured with a cytobrush and the quills removed.ResultsIn a period of 3.5 years, 16 verified cases were incorporated, 13 were females (72%) and 3 males (18%), the average age was 18.2 years, with the smallest case being 8 years old and the oldest 45 years old. The tineas manifested as follows: tinea manus 11 cases (68.7%); 2 respective cases of tinea corporis and tinea capitis (18.1 respectively) and one case of Majocchi's granuloma. The average evolution was 1.5 months with the case older than 3 months and the younger 15 days. All cases were given terbinafine at variable times and doses (according to weight and age) and clinical and mycological cure was obtained.DiscussionTineas can have epidemiological changes that are favored by a variety of factors, in general, pet ringworms are due to common domestic animals such as dogs and cats. Due to changing fashions, children and adolescents in recent years have changed pets such as hamsters, and recently hedgehogs, especially African variety (Atelerix albiventris) the latter may have T. erinacei as part of their skin microbiota, a similar dermatophyte or that was part of the T. mentagrophyes complex, in general of low virulence, however, its antigenic variants are little recognized by humans, which makes them present in a very inflammatory form, particularly in the hands, due to the handling of the animal, as well as the deeper inoculation (in the dermis) by the spikes left by the inoculum. So, they can generate deep tineas such as Majocchi's granuloma. In general, they respond well to systemic antifungals such as terbinafine and itraconazole, and sometimes the use of topical or systemic steroids is necessary.ConclusionsThis series of cases is a good example of how a change of habits when having pets can introduce new etiological agents that are poorly recognized antigenically, which give rise to more inflammatory and sometimes profound tineas.

1582P Real-world management of immune-related adverse events in the community setting

Immune checkpoint inhibitors (ICIs) are integral to the treatment of many cancers, often leading to improved survival outcomes and durable response. Immune-related adverse events (irAEs) differ in presentation and management from adverse events associated with other cancer therapies. This study describes the characteristics and management of irAEs in the community setting. This retrospective cohort study used electronic health record data from 2 community health systems (30+ hospitals, 500+ sites) from the Syapse Learning Health Network. Patients (pts) first exposed to ICIs between 1/1/2015 and 2/28/2019 were included with data cutoff of 3/1/2020. Pts with irAEs were identified using a 2-step screening process with a target cohort of ∼400 pts. Step 1: Technology-enabled screening using medication names, ICD codes, ER/hospitalization records and abnormal clinical labs. Step 2: Chart review by certified tumor registrars to confirm and characterize irAEs (attribution, severity, management and outcomes), with adjudication by a medical oncologist. 1382 pts were reviewed from a pool of 2129 pts with suspected irAEs, resulting in a cohort of 403 pts with irAEs. Lung cancer (60%) and melanoma (16%) were the most common histologies. The median time to irAE onset was 77 days. 91 pts (23%) had an ER/hospitalization visit due to irAE, with 43% of visits due to gastrointestinal irAE. irAE-related deaths occurred in 7 pts (1.7% of irAE cases). Systemic steroid use was documented in 236 pts (59%; duration of use 31 days).) Pts treated with steroids ≤24 hours of irAE onset had a higher resolution proportion at 3 months (0.7; 95% CI 0.6-0.8) than pts treated >72 hours (0.5; 95% CI 0.5-0.6). Of 78 pts with irAE related treatment discontinuation who were retreated with ICIs, half developed irAE recurrence.Table: 1582PICI Monotherapy (N = 328)ICI + Chemotherapy (N = 29)ICI + ICI (N = 46)All (N = 403)ICI initiation to irAE onset, days, median (IQR)84 (41-170)99 (13-140)24 (11-60)77 (33-150)Most common irAEsEndocrine115 (35%)6 (21%)16 (35%)137 (34%)Dermatologic77 (23%)7 (24%)21 (46%)105 (26%)GI81 (25%)11 (38%)25 (54%)117 (29%)Pulmonary45 (14%)3 (10%)1 (2%)49 (12%)ER/hospitalization68 (21%)10 (34%)13 (28%)91 (23%)Most common irAEs (ER/hospitalization patients)GI27 (40%)4 (40%)8 (62%)39 (43%)Pulmonary23 (34%)2 (20%)0 (0%)25 (27%)Treated with steroids188 (57%)16 (55%)32 (70%)236 (59%)Retreated with ICI62 (19%)2 (7%)14 (30%)78 (19%)Death (among patients with irAE)6 (2%)0 (0%)1 (2%)7 (2%) Open table in a new tab Pts with prompt recognition and management of irAEs experienced superior irAE resolution in a community setting.

33748 Real-world insights into quality improvement in atopic dermatitis care

Overview: We conducted a quality improvement (QI) program to identify and develop strategies to address challenges and opportunities for improvement in the case of patients with moderate-to-severe atopic dermatitis (AD). Methods: To identify gaps and inform team-based improvements in AD care, surveys on clinical practice trends and challenges were administered to 8 clinical teams (5 dermatology and 3 allergy-immunology practices). Teams then participated in audit-feedback sessions, led by AD expert faculty, to review their data and set action plans. Results: Surveys were collected from 86 health care providers (HCPs) (29% physicians, 19% physician assistants, 15% nurse practitioners, 37% nurses). On a 5-point Likert scale, most HCPs (62%) reported always assessing pruritus, although fewer HCPs always assessed sleep quality (26%) and mental health (19%). Most HCPs reported using oral steroids to treat flares (59%) and to bridge to maintenance therapy (43%). Among pediatric patients, top barriers to biologic therapy were patient/caregiver safety concerns (75%); needle phobia (55%); and cost (27%). Key challenges discussed in the audit-feedback sessions included assessment of disease severity and control; use of biologic therapies and systemic steroids; and shared decision-making. Teams designed action plans to integrate into workflows, including using tools to improve disease assessment; developing standardized documentation practices; creating patient education tools; utilizing steroid-sparing strategies; and improving communication with primary care providers. Conclusions: HCPs encounter several challenges in managing patients with AD. Expert-led audit-feedback sessions can help teams design strategies to address these challenges. Findings from this program can inform future education and QI activities.

Intravenous Corticosteroid Therapy for Acute Lumbar Radicular Pain.

Introduction: The efficacy of pharmacological interventions for acute lumbar radicular pain (ALRP) is limited, and systemic steroid use remains controversial. We evaluated the effectiveness and tolerance of systemic steroid use in a cohort of patients with ALRP. Methods: A retrospective cohort of 56 patients (including 24 females) were admitted with intractable ALRP resistance to conservative treatment of NSAIDs and opiates between the years 2016 and 2018. Medical records were studied for demographics, physical examination findings, Visual Analogue Score (VAS), IV steroids side effects, and recent imaging findings. All patients received a daily dose of IV 24 mg Dexamethasone until discharge, SNRB, or surgery. Results: The average IV steroid treatment was 3.9 (±2.8) days, with most patients showing significant pain relief allowing discharge (69.7%). SNRB was required in 19.6% and surgical intervention in 10.7% within the same admission. Multivariate analysis did not find any parameter to predict treatment failure (age, gender, motor/sensory deficit, CT/MRI findings). The motor deficit, positive straight leg raising (SLR), and dural sac compression on CT were higher in the intervention group but did not reach statistical significance. One patient required discontinuation of IV steroids due to elevated blood pressure. Conclusions: Despite the insufficient evidence in the literature, IV steroid treatment is still a viable option in ALRP treatment, with pain relief allowing discharge in 70% of patients and a low complication rate. Our study found daily 24 mg IV dexamethasone for ALRP to be an effective treatment and helpful in most patients admitted. This study supports the common practice used by spine units.

Awareness of Health care workers regarding Mucormycosis /Black fungus associated with global COVID - 19 pandemic in Rajasthan population – A Cross – sectional survey

IntroductionTogether with the ongoing serious Covid-19 second wave in India, a serious fungal infection,mucormycosis has been increasingly found in Covid-19 recovered patients. Current trendsindicate that the surge is higher in patient with co-morbidities. Health care facilities need tostrengthen their infection prevention and control (IPC) programmes to prevent healthcare-associated outbreaks.Therefore, we conducted a cross-sectional survey of health-care workers in Rajasthan toassess their awareness of Mucormycosis as a result of the global COVID-19 pandemic, aswell as to learn about the possible link between invasive fungal sinusitis (mucormycosis) andcoronavirus disease, as well as how to prevent and manage it.MethodologyA web based cross–sectional study was conducted using convenience sampling. A self-administered anonymous questionnaire was designed in English and sent to the studyparticipants via link of Google form through social media platforms and email. Total of 378HCPs responded to survey.ResultsOut of 378 HCPs, majority of them were female (68.8%) with age &amp;lt;30 years (73.3%) and ofthese respondents most were dentists (82.2%).In assessing awareness of mucormycosis, 66.7%of HCPs believed the cause of the highprevalence of mucormycosis during COVID-19 was due to the higher prevalence of diabetes,indiscriminate use of steroids, immunocompromised patients with co-morbidities, usage ofunhygienic humidifiers &amp;amp; o2 lines and tubes. 57.9% of HCPs surveyed agreed that carefuland supervised use of systemic steroids should be consistent with current practice and 62.2%of HCPs agree that we need dynamic surveillance and control of diabetes mellitus or pre-diabetes in our population.&#x0D; ConclusionFirst case of Covid-19-related Mucormycosis has now been found in Chile. Thus, it isimportant to recognise this infection at an early stage, so as to potentially reduce soft andhard tissue necrosis and severe complications and alert colleagues of this life-threateninginfection.