Term Prognosis Research Articles

Risk Factors of Colorectal Cancer Other than Genetic Factors at Jinnah Post Graduate Medical Center

Objective: To determine the association of different risk factors other than genetic factors in patients having colorectal carcinoma. Study Design: Case control study. Place and Duration of Study: Medical Oncology Department, Jinnah Postgraduate Medical Center, Karachi Pakistan, from Jan 2019 to Jan 2020. Methodology: A total of 200 patients of age more than 10 years of either gender were included in the study. Hundred were cases of newly diagnosed colorectal cancer and 100 were healthy controls. The data regarding socio-demographics and risk factors other than genetic risk factors was collected through pre-designed questionnaire. Results: The mean age of the cases was 42.76±15.02 & the controls were 39.42±14.03 years. After adjusting odds in multivariate analysis, physically inactive (OR=0.40; 95% CI: 0.16-0.98, p<0.05), low fruits and vegetable intake (OR=0.42; 95% CI: 0.22-0.82, p<0.05), processed meat intake (OR=2.00; 95% CI: 1.01-3.96, p<0.05) and fats intake (OR=5.12; 95% CI: 2.68-9.76, p<0.05) remained positively associated with colorectal carcinoma. Conclusion: Higher risk of developing colorectal carcinoma is associated with obesity, low fruits and vegetables intake, high red meat consumption, processed meat consumption, fats intake, physical inactivity and working during night. The initiative for screening would be helpful in determining the colorectal carcinoma at an early stage. Early diagnosis will increase the survival rate and help increasing long term prognosis of the colorectal carcinoma.

Magnetic resonance imaging of pulmonary hypertension.

Pulmonary hypertension is a rare but serious disease in children with potentially poor prognosis in the long term. Direct measurement of increased pressure in the pulmonary circulation requires right-heart catheterisation. Echocardiography is the imaging modality commonly used for suggesting the presence of pulmonary hypertension and estimating its severity. Recognition of structural and haemodynamic signs of increased pulmonary arterial pressure and pressure overload of the right ventricle at magnetic resonance (MR) imaging may contribute to the diagnosis of pulmonary hypertension and management of these patients. In this article, the structural, functional, and haemodynamic cardiovascular MR findings of paediatric pulmonary hypertension are reviewed. Typical diagnostic MR scenarios in children with suspected pulmonary hypertension or in children with disease associated with pulmonary hypertension are presented and discussed.

Abstract 4138815: Prognostic Implications of Glycemic Variability Assessed by Continuous Glucose Monitoring-derived Coefficient of Variation among Patients Hospitalized for Acute Heart Failure

Background: Recent findings indicate that high glycemic variability (GV) could increase the risk of adverse outcomes in patients with cardiovascular disease. With the advances in technology, the utility of continuous glucose monitoring (CGM) has grown during recent years, which can provide valuable information that is not captured by HbA1c. We used the glucose coefficient of variation (CV, calculated as the ratio of standard deviation divided by the mean glucose level) of the obtained CGM data to analyze GV. Aims: We aimed to analyze CGM-derived CV as an indicator of GV and to evaluate prognostic implications of CGM-derived CV in patients hospitalized for acute heart failure (HF). Methods: Patients hospitalized for HF who had not been diagnosed diabetes were performed 75g-oral glucose tolerance test (OGTT). CV was evaluated using CGM system for at least 72 consecutive hours after being able to have meals stably during hospitalization. The primary outcome was a composite of cardiovascular death or re-hospitalization for HF. Patients were divided into two groups based on the median value of CV. Results: We prospectively analyzed 130 patients (mean age: 76±10 years, male 56%) admitted for acute HF. Following the 75g-OGTT, only 21% of the entire cohort exhibited normal glucose tolerance. During the median follow up period of 905 days, Kaplan–Meier curve analysis revealed that the cumulative incidence of the primary outcome event was significantly higher in patients with CV above median than in those with CV less than median (51.7% versus 24.4%, Log-rank P=0.01)(Figure). Multivariate Cox proportional analysis demonstrated that the risk of CV per 1% increment for the primary outcome was significant adjusted for history of diabetes, CGM-derived mean glucose level, and HbA1c level (hazard ratio: 1.06, 95% confidence interval 1.03–1.09). Conclusions: CGM-derived CV was associated with long term prognosis of patients hospitalized for HF with or without diabetes.

Correlation between LDL/HDL-cholesterol ratio and long term prognosis after acute coronary syndrome and severity of coronary artery disease

Abstract Introduction Dyslipidaemia is an important correctable risk factor for coronary artery disease (CAD). Many studies have confirmed that the lower the low-density lipoprotein cholesterol (LDL-C) levels are, the lower is the CAD morbidity and mortality rates (1). However, many patients who achieved low levels of LDL-C still experience a major adverse cardiovascular event (MACE) because of the other residual risk factors. Therefore, there is a constant need for better stratification of patients who are at higher risk for novel MACE following their first acute coronary syndrome (ACS). Evidence increasingly suggests that the ratio of LDL-C/HDL-C might be a new and better marker of cardiovascular disease, as it simultaneously evaluates the levels of both LDL-C and HDL-C (2). Purpose The aim of this study was to investigate the prediction value of LDL-C/HDL-C ratio for long term prognosis after ACS as well as its correlation with CAD severity. Methods We included patients hospitalized at out centre with ACS from January 2017 to January 2024. Demographic data, data on LDL-C and HDL-C levels on admission and calculated Syntax score were used. Syntax score is a comprehensive angiographic scoring system which determines complexity by using coronary anatomy and lesion characteristics (3). Follow-up data were collected either by clinical follow-up visits or by telephone interviews. The MACE was defined as the composite of cardiovascular death, acute coronary syndrome and need for elective or urgent percutaneous or surgical revascularization. Results This registry-based study included 2471 patients with ACS, median age of 64 (interquartile range 56-73) years, 31% female. Total of 1099 patients (44%) had non-ST elevation ACS and 1372 (54%) had ST elevation myocardial infarction (STEMI). Median Syntax score was 13 (IQR 7-20.5), with 1494 (61%) patients having low Syntax score (≤16), 508 (21%) patients medium (16-22), and 448 (18%) high score (>22), respectively. Median follow up was 17 (3-27) months. LDL-C/HDL-C ratio correlated significantly with cardiovascular death, with weak coefficient (2.94 vs. 2.54 p<0.001; rho=0.102, p<.0001), however did not correlate with MACE (2.88 vs. 2.92, p=0.188, rho=0.06, p=0.77). This remained identical when tested for patients with STEMI and non-STE ACS. In addition, LDL-C/HDL-C ratio did not correlate with CAD severity as assessed with Syntax score (low 2.92 vs. medium 2.83 vs. high 2.86, p=0.597; rho=0.4, p=0.09). Conclusion Our data suggest that LDL-C/HDL-C ratio cannot be used as a relevant predictor of post-ACS long-term MACE or cardiovascular death, nor it can be correlated with CAD severity. Further studies are needed to establish the real value of LDL-C/HDL-C ratio as a post-ACS predictor.

Regadenoson stress echocardiography: a road ahead

Abstract Introduction Drugs used in stress echocardiography (SE) have important limitations due to side effects and contraindications. Since its approval in 2008, Regadenoson has seen a significant increase in usage. This is largely attributed to its good safety profile and diagnostic accuracy, making it the preferred drug for stress tests in many European centers. However, despite its expanding use and major advantages, current guidelines don't place it as the first choice for SE, probably because the reported experience with this drug remains limited. The aim of the present study was to assess the safety and short-medium term prognosis of patients who underwent Regadenoson SE. Methods Retrospective observational study. Patients who underwent Regadenoson SE between 2017 and 2023 were included. Safety was assessed by monitoring immediate adverse effects following Regadenoson infusion and the need for using an antidote (Aminophylline). A positive test result was defined by the occurrence of any of the following: wall motion abnormalities, left ventricle dilatation, electrocardiographic changes or symptoms of ischemia. During the follow up, we registered the incidence of ischaemic events (admission for unstable angina, acute myocardial infarction (AMI) or cardiovascular (CV) death) and other CV events such as admission for heart failure (HF) and stroke. Additionally, we evaluated patients in both groups who underwent coronary angiography (by computerized tomography or coronary catheterization) during the follow up period. The groups with negative SE (NSE) and positive SE (PSE) were compared. Results The total number of patients was 344, with a median follow up of 29 months. Basal population characteristics and events by group (NSE and PSE) are shown in Figure 1. We needed to use the antidote in only one case, because of ventricular bigeminism, with no other major adverse effects reported. SE was positive in 37 (11%) patients. In this group, patients were more likely to present ischaemic events (16% vs. 3%, p<0.01) and admissions for HF (24% vs. 5%, p <0.01), compared to the NSE one. In those who underwent coronary angiography, revascularization was needed in 14 patients of the PSE group, and only in 7 of the NSE group (38% vs 2%, p < 0.05). The indications for these last cases were persistent angina in 5 patients (2 of them with history of coronary artery disease) and revascularization following an AMI in 2 patients. (Figure 2). Conclusions The probability of an ischaemic event after a negative Regadenoson SE remains very low, unlike positive studies. Regadenoson SE showed to be both safe in assessing ischemic cardiomyopathy and very useful for its prognostic value. These findings encourage its expanding use in the stress echo lab.

Efficacy and Safety of Chlortalidone and Hydrochlorothiazide in Prevention of Cardiovascular Diseases.

The variance between guideline recommendations and real-world usage might stem from the perception that chlorthalidone poses a higher risk of adverse effects, although there is no clear evidence of disparities in cardiovascular outcomes. It is crucial to assess both the clinical cardiovascular effects and adverse reactions of both drugs for clinical guidance. In this study, we present a comprehensive and updated analysis comparing the efficacy and safety of chlorthalidone (CHLOR) versus hydrochlorothiazide (HCTZ) for the prevention of cardiovascular diseases through lower the blood pressure. We conducted a systematic literature search using reputable databases including PubMed, Embase, Cochrane, and Web of Science up to April 2023, to identify studies that compared the efficacy and safety of CHLOR versus HCTZ for the long term prognosis of cardiovascular disease. This analysis represents the most up-to-date and systematic evidence on the comparative efficacy and safety of CHLOR and HCTZ for cardiovascular diseases. Our review included a total of 6 eligible articles with a cohort of 368,066 patients, of which 36,999 were treated with CHLOR and 331,067 were treated with HCTZ. The primary diagnosis studied in six articles was hypertension. Initial features between the two different groups were comparable across every possible outcome. These papers followed patients using the two drugs over a long period of time to compare the differences in the occurrence of cardiovascular disease, and the results were as follows, the confidence interval is described in square brackets, followed by the p-value: We measured the outcomes of myocardial infarction with an odds ratio (OR) of 0.80 [0.56, 1.14], p = 0.41, heart failure with an OR of 0.86 [0.64, 1.14], p = 0.05, cardiovascular events with an OR of 1.85 [0.53, 6.44], p = 0.34, non-cancer-related death with an OR of 1.02 [0.56, 1.85], p = 0.45, death from any cause with an OR of 1.95 [0.52, 7.28], p = 0.32, complication rate, stroke with an OR of 0.94 [0.80, 1.10], p = 0.45, hospitalization for acute kidney injury with an OR of 1.38 [0.40, 4.78], p = 0.61 and hypokalemia with an OR of 2.10 [1.15, 3.84], p = 0.01. Pooled analyses of the data revealed that CHLOR was associated with a higher incidence of hypokalemia compared to HCTZ and the results were statistically significant. CHLOR and HCTZ are comparable in efficacy for prevention cardiovascular diseases, with the only difference being a higher incidence of hypokalemia in patients using CHLOR compared to those using HCTZ. Considering the potential heterogeneity and bias in the analytical studies, these results should be interpreted with caution.

Long term follow-up of bilateral internal thoracic artery use in young coronary artery bypass grafting patients: 29 year single surgeon experience.

Improved long term survival has demonstrated by grafting left internal thoracic artery (LITA) to the left anterior descending artery (LAD). This study investigated the prognostic benefits of BITA versus single LITA with common anastomotic configurations of BITA. Elective patients age below 60years, undertaken by a single surgeon, between 1992 and 2014 were explored. Cox regression models were fitted to investigate prognostic benefits of BITA. Specific comparisons were made with BITA subgroups who received LITA to LAD or RITA to LAD to establish long-term prognostic difference with the use of the RITA to LAD as compared to the LITA to LAD anastomosis. Comparisons were made with other BITA configurations to establish long-term difference in survival as a result of the actual targets bypassed with BITA grafts. Both groups had similar baseline patient characteristics. Following risk adjustment, the use of a second ITA conferred a significant 48% reduction in long-term mortality to BITA group [HR 0.52 (95%CI: 0.36-0.74) p < .001]. The use of the RITA to LAD, instead of LITA, resulted in no difference in the long-term prognostic benefit. The targets grafted with second ITA conferred a significant prognostic benefit for common configurations it was used in for bypass surgery. The use of BITA confers long term prognostic benefit to patients. Grafting RITA to LAD instead of more common LITA to LAD made no difference in long term prognosis when compared to CABG patients with single ITA. The use of a second ITA conduit in common configurations for CABG confers prognostic benefits irrespective of distal target grafted.

Meta-Analysis of Long Term Prognosis of Non-Operative Active Surveillance vs Completion Thyroidectomy after Hemithyroidectomy for Pathologically Proven Low Risk Papillary Thyroid Carcinoma

Abstract Background Differentiated thyroid cancer (DTC) includes papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) and encompasses approximately 94% of all thyroid cancers. The majority of DTC carries an excellent prognosis, with 10-year survival rates of over 90% and when examining the subset of low risk DTC (approximately 48% of all thyroid cancers), 10-year survival rates are in the order of 98%, irrespective of management algorithms. Aim of the Work The goal of the current study was to evaluate active surveillance versus total thyroidectomy in patients with low papillary thyroid carcinoma. Patients and Methods These studies included 35579 cases who were divided into 2 group: 15929 cases in hemithyroidectomy group and 19650 cases in thyroidectomy completion group. About 1265 articles were identified and after exclusion of article which did not fulfill the inclusion criteria, 18 research articles were enrolled in the current study. Results The patients' age range was between 40 and 50 years, with a higher incidence of PTC reported in the 3rd and 4th decades of life. Most patients were females, with no significant differences between the two groups. The mean tumor size was approximately 0.5 cm, and most tumors were smaller than 3 mm. Only two studies reported a significant difference in tumor size between the two groups, with larger tumors found in the TT group. Other studies reported no significant difference between the two groups. Conclusion Hemithyroidectomy with active surveillance is a good option for treatment low risk papillary thyroid cancers with lower postoperative complications rate, comparable recurrence rate and overall mortality rate. In spite that, 10- year DFS rates were lower with hemithyroidectomy.

Impact of Successful Antegrade &amp; Retrograde CTO PCI on Short Term Prognosis

Abstract Background Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) carries risk of complications and should be attempted when the anticipated benefits exceed the potential risks. The primary indication for CTO-PCI is symptom improvement. However, the impact of CTO PCI on angina and subsequent incidence of major adverse cardiovascular event (MACE) rate remains controversial. Objective Our aim was to study the impact of the antegrade and retrograde approaches for elective CTO PCI on the procedural success rate &amp; short-term MACE. Patients and Methods The current study was a prospective cohort study that included a total of 80 patients who were referred to our center (Ain Shams University Hospitals) for elective CTO PCI and underwent technically successful CTO PCI. Data was collected on patient arrival to our department and then the patients were observed during hospital admission to record any In-Hospital MACE. These patients were then followed up for 6 months to record improvement or worsening of their symptoms and to assess occurrence of any MACE including hospitalization and undergoing symptom driven coronary angiography. Results The mean age of our patients was 56±9.6 years and 91% of the patients were men. Seventy- seven % of patients were done via an ante-grade approach and 23% were done via a retro-grade approach with an overall procedural success rate of 91.25% (Antegrade 93.5%, Retrograde 83.3%). The overall mean procedure time was 102 minutes, the mean contrast volume used was 371 ml and the mean cumulative Air Kerma dose was 7.2 Gy. The retrograde group required longer procedure times, larger volumes of contrast and higher exposure to radiation. The overall in-hospital MACE was 8.75%. 81.25% of patients in our study showed an improvement in the grade of their exertional dyspnea or angina within the 6-month follow-up period. 16.25% of patients in our study needed re-hospitalization within a 6-month period after PCI. The overall Target lesion re-vascularization rate at 6 months was 8.75%. Three out of the 7 patients (42.86%) who suffered from in-hospital MACE developed another Major adverse cardiac event during the 6 months follow up period. This was a higher percentage than the patients who did not suffer from in-hospital MACE and was statistically significant. Conclusion Technically successful CTO PCI in a well-equipped center with highly qualified CTO operators resulted in high procedural success rates and low incidence of short-term MACE.

Ventral Slot Surgery for Management of Ganglioneuroma and IVDD in a Cat

Abstract A Shorthair castrated 8-year-old tomcat was brought to a veterinary hospital for slowly progressive onset of tetraplegia developing within last 14 days. The clinical and blood examinations at admission showed no abnormalities, the neurological examination showed severe cervical pain and tetraplegia with lower motor neuron deficits on thoracic limbs and normal withdrawal with increased patellar reflexes on pelvic limbs. Deep pain perception was present on all four limbs. The neuroanatomic localisation was C6-T2 lesion. Magnetic resonance imaging of the cervical spine demonstrated severe spondylosis deformans, degeneration of multiple IVD, and ventral extradural right sided spinal cord compression at the level C7-T1. Mildly hyperintense on T2-weighted and STIR, mildly hypointense on T1-weighted pre-contrast, and homogeneously contrast-enhancing mass on T1-weighted post-contrast images was observed at this area. This article describes an interesting case of a tumor in a cat localised in the cervicothoracic spinal segment extradurally compressing the spinal cord and causing severe neurological dysfunction. These clinical symptoms were successfully treated through a ventral slot surgery, the tumor was well circumscribed and comfortably removable through this approach. This rare tumor is considered benign and prognosis is favourable after surgical removal due to its non-invasive growth pattern. After surgery, the cat was observed continuously for a few months and the recovery was sufficient with no recurrence of neurological symptoms by now. This case is worth attention mainly because, despite the serious clinical presentation, it has a good long term prognosis and does not require a complex surgical approach.

Orthodontic management of traumatized teeth: a survey among orthodontists

BackgroundInformation on previous traumatic dental injuries is important as they can lead to increased complications during orthodontic treatment and impact the treatment planning and outcomes. The aim of this study was to assess the knowledge of Jordanian orthodontists in orthodontic management of traumatized permanent teeth.MethodsCross-sectional survey among active registered orthodontists using a questionnaire distributed by hand.ResultsThe study included 139 orthodontists. Nearly half of orthodontists treated between one to three patients with a history of traumatic dental injuries in the past 3 months. Only 43.2% of the participant asked routinely about history of trauma. A vast discrepancy in times waited before orthodontic movement and in the orthodontic management approach of traumatized teeth was noted. A statistically significant negative relationship between age and knowledge level was found (p = 0.002). A significantly higher level of knowledge was found among participants who had fellowship or board certification than those having the high diploma degree (P-0.032) and also who had treated patients with history of dental trauma in the last 3 months than those who did not (p = 0.001).ConclusionsThe knowledge of the surveyed orthodontists in both the recommended observation period before orthodontic treatment and management approaches of traumatized teeth during orthodontic treatment was insufficient. Years of clinical experience significantly affected knowledge, with older participants having lower levels of knowledge. Orthodontists who treated patients with history of dental trauma in the last 3 months had significantly higher knowledge in orthodontic management of traumatized teeth. Orthodontists needs to be aware of the proper timing and strategies on orthodontic management of traumatized permanent teeth to improve the long term prognosis and to reduce further complications during orthodontic treatment through proper management.

Cystic lung in sarcoidosis: Clinico-radiologic characteristic and evolution.

Sarcoidosis can manifest with atypical findings on chest computed tomography (CT). Cysts are a rare manifestation of lung sarcoidosis. The aim of the study was to describe a series of patients with cystic sarcoidosis and their clinical-radiological characteristics and progression. In this retrospective, bicentric study we recruited all patients affected by sarcoidosis with lung cystic lesions at chest CT. We collected clinical characteristics, pulmonary tests and tracked number, distribution and size of the cysts at diagnosis and at the last evaluation. Twelve patients (6 males, median age 53 years) were identified (prevalence: 1.9%; 95% Confidence Interval: 0.8%-2.9%). All patients presented multiple cystic lesions (median number: 14 [range: 2-216]) with a bilateral distribution in 10/12, micronodules and nodules in 11/12 and fibrotic lesions in 4/12. Seven patients had normal lung function test, three had an obstructive syndrome, one had a restrictive syndrome and one had coexistence of both. During follow-up (median: 10 years [range 1-16 years]), an increase of the number of cysts was observed in four patients. At last evaluation, 3/12 patients experienced a decline of forced vital capacity >10% and 3/12 patients a decline of diffusing capacity for carbon monoxide (DLCO) >10%. A lower DLCO at diagnosis, and the presence of nodules or fibrotic lesions on CT were associated with an increase in the number of cysts. Cystic lung lesions are rare in patients with sarcoidosis and do not influence long term prognosis.

A retrospective study: Long term prognosis in adults with PA-VSD-MAPCAs

BackgroundPulmonary Atresia, Ventricular Deptal Defect, and Major Aortopulmonary Collateral Arteries (PA-VSD-MAPCAs) is a congenital cyanotic heart defect with poor prognosis. Due to its complex and highly variable anatomy, the best treatment plan is not clear. We aimed (1) to investigate the survival of PA-VSD-MAPCAs patients according to the underlying original anatomy and treatment strategy, and (2) to evaluate life expectancy between patients with or without severe hypoplastic native pulmonary arteries (NPAs) after surgical versus non-surgical treatment. MethodsA prospectively established database of 169 PA-VSD-MAPCAs patients treated and followed up at University Hospitals Leuven was accessed. Patients were divided into three groups according to the treatment strategy. Kaplan-Meier survival curves were plotted, and Log Rank tests were used for comparison. ResultsThe overall mean survival for patients with PA-VSD-MAPCAs was 38.5 years (95%-CI: 33.1–43.9). Patients with complete intracardiac repair had the longest mean survival of 43.8 years (95%-CI: 38.1–49.6) versus the other groups (p < 0.001). A longer mean event-free survival time was found in patients with normal, well-developed NPAs (p = 0.047). Finally, patients with poorly developed or absent NPAs had worse survival rates when a surgical approach was followed. Systemic-pulmonary shunt placement or unifocalisation had limited effect on prognosis in the absence of total repair (p = 0.167). ConclusionsPatients with PA-VSD-MAPCAs who underwent complete intracardiac repair and/or with well-developed native pulmonary arteries had the best prognosis. Our analyzed data suggest that incomplete surgical repair resulted in survival rates comparable to those seen with a non-surgical approach.

Long-term gender disparities in new-onset heart failure after acute coronary syndrome.

A paucity of studies addressed sex-related differences in clinical outcomes in the long term following acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). In these patients, it remains uncertain whether heart failure (HF) might exert a differential impact on the prognosis in the long term. We queried a large-scale database of ACS patients undergoing PCI. The primary endpoint was new-onset HF. Secondary endpoints included mortality, myocardial infarction, re-PCI and ischaemic stroke. Propensity score matching was generated to balance group characteristics. A total of 3334 patients after propensity score matching were analysed. Follow-up was assessed at the 5year term. At 5year follow-up, HF risk increased significantly in males versus females {17.9% vs. 14.8%, hazard ratio [HR] [95% confidence interval (CI)]=1.22 [1.03-1.44], P=0.02}. At 5year follow-up, mortality was significantly higher in the male cohort as compared with the female cohort [HR (95% CI)=1.23 (1.02-1.47), P=0.02]. On landmark analysis, differences in mortality emerged after the first year and were maintained thereafter. Ischaemic outcomes were comparable between cohorts. Following ACS, males experienced a greater long-term risk of developing new-onset HF as compared with females. This difference remained consistent across all prespecified subgroups. Mortality was significantly higher in males. No differences were observed in ischaemic outcomes. New-onset HF emerges as a primary contributor to long-term gender disparities after ACS and a strong predictor of mortality in men with HF.

HeartFailure Specialist Care and Long-Term Outcomes for Patients Admitted With Acute HeartFailure.

For patients with acute heart failure (HF), specialist HF care during admission improves diagnosis and treatments. The authors aimed to investigate the association of HF specialist care with in-hospital and longer term prognosis. The authors used data from the National HeartFailure Audit from January 1, 2018, to December 31, 2022, linked to electronic records for hospitalization and deaths. All-cause mortality was the primary outcome measure and in-hospital mortality the secondary outcome measure. Data for 227,170 patients admitted to hospital with HF (median age: 81 years; IQR: 72-88 years), were analyzed. Approximately 80% of acute HF admissions received support from HF specialists. Thirty-nine percent of patients (n=70,720) were seen by a multidisciplinary team (HF physicians and HF specialist nurses [HFSNd]), 22% (n=40,330) were seen by HFSNs alone, and the remaining 39% (n=71,700) were seen exclusively by specialist HF physicians. At discharge, more patients who received HF specialist care were prescribed medical therapy for HF and had specialized follow-up. Conversely, diuretic agents were prescribed to fewer patients. HF specialist care was independently associated with a higher rate of prescribing HF therapies at discharge and a lower likelihood of receiving diuretic therapy (OR: 0.90 [95%CI: 0.86-0.95]; P< 0.001). HF specialist care was associated with better long-term survival (HR: 0.89 [95%CI: 0.87-0.90]; P< 0.001) and lower in-hospital mortality (OR: 0.92 [95%CI: 0.0.88-0.97]; P<0.001). Receiving HF specialist care during admission for HF is associated with a higher rate of implementation of medical therapy, fewer discharges on diuretic therapy, and lower in-hospital and long-term mortality across the left ventricular ejection fraction spectrum, especially for patients with heart failure with reduced ejection fraction.

EVALUATION OF CLINICAL RESULTS OF SURGICAL RESECTION OF SYNOVIAL OSTEOCHONDROMATOSIS IN THE SHOULDER: A RETROSPECTIVE STUDY

Synovial osteochondromatosis of the shoulder is a rare condition and its details remains unclear. Aim of this study was to evaluate the clinical results of surgical resection and histopathological characteristic of SOC of the shoulder. Ten shoulders with SOC were retrospectively assessed for demographic characteristic, history of trauma, presence of osteochondral loose bodies, inferior humeral osteophytes and acromial spurs. Visual analog scores for pain and functional scores using Constant scores were compared pre and post operatively. Resected lesions were histo-pathologically differentiated between primary and secondary SOC. The average age of patients was 39.8+/- 15.7 year; four female and six patients was male in our study. Average duration of symptoms was 11.5+/-8.11 months. Three shoulders has osteochondral lesion in subacromial space (30%) and seven in glenohumeral joint (70%). Five shoulders (71%) show inferior humeral osteophytes out of seven shoulders with lesion in glenohumeral joint. All three shoulder (100%) with SOC in the subacromial space had spur formation. One shoulder have primary SOC while other nine had secondary SOC. Average Visual analog scale pain score graded from 0 (no pain) to 100 mm( maximal pain) was 47.5+/-11.32 mm. The Constant score was improved from preoperative score 51.6+/-8.34 points to postoperative score 78.7+/-11.62. No case show recurrence of new loose bodies, acromial spur and inferior humeral osteophytes. Our study showed that resection of SOC successfully relieved the pain and clinical symptoms. Primary SOC is less common than secondary SOC and histopathological identification is needed to differentiate between both types. Thus further investigations required to determine long term prognosis SOC in the shoulder. KEYWORDS: osteochondromatosis, shoulder joint, synovium

18F]FDG-PET/CT atypical response patterns to immunotherapy in non-small cell lung cancer patients: long term prognosis assessment and clinical management proposal.

To determine the long-term prognosis of immune-related response profiles (pseudoprogression and dissociated response), not covered by conventional PERCIST criteria, in patients with non-small-cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICPIs). 109 patients were prospectively included and underwent [18F]FDG-PET/CT at baseline, after 7 weeks (PETinterim1), and 3 months (PETinterim2) of treatment. On PETinterim1, tumor response was assessed using standard PERCIST criteria. In the event of PERCIST progression at this time-point, the study design provided for continued immunotherapy for 6 more weeks. Additional response patterns were then considered on PETinterim2: pseudo-progression (PsPD, subsequent metabolic response); dissociated response (DR, coexistence of responding and non-responding lesions), and confirmed progressive metabolic disease (cPMD, subsequent homogeneous progression of lesions). Patients were followed up for at least 12 months. Median follow-up was 21 months. At PETinterim1, PERCIST progression was observed in 60% (66/109) of patients and ICPI was continued in 59/66. At the subsequent PETinterim2, 14% of patients showed PsPD, 11% DR, 35% cPMD, and 28% had a sustained metabolic response. Median overall survival (OS) and progression-free-survival (PFS) did not differ between PsPD and DR (27 vs 29 months, p = 1.0; 17 vs 12 months, p = 0.2, respectively). The OS and PFS of PsPD/DR patients were significantly better than those with cPMD (29 vs 9 months, p < 0.02; 16 vs 2 months, p < 0.001), but worse than those with sustained metabolic response (p < 0.001). This 3-group prognostic stratification enabled better identification of true progressors, outperforming the prognostic value of standard PERCIST criteria (p = 0.03). [18F]FDG-PET/CT enables early assessment of response to immunotherapy. The new wsPERCIST ("wait and see") PET criteria proposed, comprising immune-related atypical response patterns, can refine conventional prognostic stratification based on PERCIST criteria. HDH F20230309081206. Registered 20 April 2023. Retrospectively registered.

Rare presentations of Acute Acquired Demyelinating Syndromes (ADS) among children

Acute demyelinating syndromes (ADS) in children presents with neurological symptoms with a pathology involving either single central nervous system (CNS) location (mono focal ADS) or multiple sites (poly focal ADS), with or without encephalopathy. It is a diagnostic dilemma requiring a high index of suspicion. A thorough clinical examination with neuroimaging and cerebrospinal fluid (CSF) analysis is needed for making a diagnosis. Clear cut guidelines regarding long term management and prognosis is lacking. Myelin oligodendrocyte glycoprotein (MOG) antibody must be done in all suspected cases as it helps in prognosticating and counselling parents. Recurrence is rare, recovery is usually complete and most children respond to pulse high dose methylprednisolone injection. In this case series we map out different unique presentations of acute ADS with and without Myelin oligodendrocyte glycoprotein (MOG) antibody positivity among children from a tertiary care hospital in central Kerala, India.

Impact of non-typical LBBB on CRT response

Abstract Introduction Cardiac resynchronization therapy (CRT) benefits have been established in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) who have a broad QRS and remain symptomatic despite optimized medical therapy. Responders typically are female, with LBBB and broader QRS. It remains uncertain to what extent do patients with non-LBBB QRS complex morphology respond to CRT and also if there are differences among various types of intraventricular conduction delays. Purpose To evaluate the impact of non-typical left bundle branch block (LBBB) on reverser remodeling and clinical events. Methods Single center, observational, retrospective study including patients (pts) who implanted CRT in the context of HFrEF, from 2015 to 2020. Evaluation of QRS morphology analysis was conducted. CRT response was defined by a reduction of LVESV≥15% or an increase in LVEF≥10%. Predictors of CRT response were evaluated with Chi-square and Mann- Whitney analysis. Impact on reverse remodeling and clinical outcomes was performed with Kaplan-Meyer analysis. Results A total of 361 pts were included for analysis, of which 184 had non-typical LBBB. Pts had a mean age of 71±9years old, the majority of pts were female (61%), and almost half were ischemic (47.8%). EGC evaluation prior to CRT implantation, revealed an atypical LBBB in 83 (45.1%) pts, typical RBBB in 23 (12.5%) pts, atypical RBBB 94.(9%) pts and nonspecific intraventricular conduction delay in 69 (37.5%) pts. During a mean time of follow-up of 2.9 ±2.4years, 33 pts (18%) had hospitalizations due to HF and 68 (37%) died. In this cohort, 78 pts (42.4%) were deemed as responders, who presented a better clinical outcome when compared to non-responders (p &amp;lt; 0.001, HR 2.629 [95% CI 1.635-4.225]. There was no difference among the four types of intraventricular conduction analyzed in respect to degree of CRT response – figure 1. Regarding clinical events during follow-up, there was once again no significant difference among the different patterns of non-typical LBBB– figure 2. In this subset population we found no independent predictors of CRT response, although non-responders were significantly older than responders (72±8 vs 69±10 years-old (p=0.016). Conclusion Although pts with non-typical LBBB morphology display a lower therapy response to CRT than reported for LBBB pts, the rate of response is not negligible and represents a protective factor for clinical outcomes. Different types of intraventricular conduction delay present no difference regarding long- term prognosis or reverse remodeling.Survival according to CRT response

#2705 Hypertension as a risk factor for mortality and the development of chronic kidney disease after an episode of acute kidney injury in the elderly

Abstract Background and Aims Acute kidney injury (AKI) is a real public health problem due to its severity and its consequences in the short, medium and long term. Hypertension is a very common disease in our country. The association between hypertension and acute and chronic renal failure is not well studied in our country, and given the lack of data, we proposed to carry out this study and even more so the elderly, who are fragile subjects with multiple illnesses. Method We undergone a retrospective study which was carried out in the nephrology department of Fattouma Bourguiba hospital in Monastir. We included patients aged &amp;gt; 65 years, who had an AKI with full recovery who had been hospitalized between January 2002 and December 2015. Our study aimed to assess the impact of hypertension on mortality and the development of chronic kidney disease (CKD) after an episode of AKI. Results Our population was made up of 67 men and 60 women, 30.1% had multiple comorbidities. Pre renal Aki represented the predominant mechanism of AKI which was retained in our study with a rate of 40% and dehydration as the main aetiology in 70 patients. In the short term, 15 patients had progressed to CKD. The mean overall survival in our study was 159 months with a high risk of mortality in elderly (patients aged &amp;gt;65 years), who had multiple comorbidities, hypertensive, diabetics, with vascular disease, Charlson Comorbidity index &amp;gt;5, who presented with hyperkalaemia &amp;gt;5.5 and pre renal mechanism of the AKI episode. In the medium term and the long term, 4 and 2 patients developed CKD respectively. Hypertension was a factor in poor prognosis and mortality in elderly subjects after an episode of acute kidney injury (p=0.005). Conclusion Hypertension is a real public health problem impacting the short, medium and long term prognosis of patients who have had an episode of AKI with full recovery.