Tertiary Level Hospital Research Articles

Effects of Abstinence from Opioid on Sexual Functioning in Men with Opioid Use Disorder: An Observational Study

Objective: Sexual dysfunction amongst persons with opioid use disorder (OUD) is quite prevalent. Research about the effects of abstinence from opioids on sexual functioning is scarce. The aim of this study is to assess the sexual functioning among men with OUD and examine the effects of abstinence from opioids on sexual functioning. Methods: An observational study was conducted at a tertiary-level multi-specialty public-funded hospital in northern India. A total of 50 men with OUD underwent a self-report–based assessment of sexual functioning using the International Index of Erectile Function (IIEF-15). Five sub-domains of IIEF-15 (i.e., erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction) were assessed at baseline, two weeks and eight weeks of abstinence from opioids. Results: A total of 44 participants out of 50 reported significant dysfunction. Most of them reported dysfunction in the domains of overall satisfaction (88%, n = 44) and sexual desire (72%, n = 36). After eight weeks of abstinence from opioids, 10 participants out of 44 reported improvement on mean assessment scores. The improvement was noted as follows: erectile function (8%), orgasmic function (2%), sexual desire (8%), intercourse satisfaction (8%) and overall satisfaction (16%) as compared to baseline. There was significant improvement in the subdomain of sexual desire ( p value .05) over the course of eight weeks of abstinence compared to baseline. Conclusion: Abstinence from opioids leads to improvement in sexual functioning over a period of eight weeks of abstinence in men with OUD.

Enhancing nutritional formula expiry monitoring: A quality improvement project in a tertiary-level hospital in Riyadh, Saudi Arabia.

Nutrition is a vital part of any treatment plan. This may include providing nutritional formulas during hospitalization and afterward. However, reported incidents showed that we had issues with nutritional formula expiry monitoring at our hospital with low compliance to Joint Commission International Standards (MMU.3.1): "There is a process for storage of medications and nutritional products that require special consideration." Therefore, a "Nutritional Formula Expiry Monitoring" project was created to decrease hospital safety incidents related to expired nutritional formulas from an average of 28 in 2015 to zero by 2018. A quality improvement model was developed to map the existing formula processes. Several proposed ideas were tested including performing a hospital-wide audit to examine possible risks and practices, developing a hospital policy, flow charts, forms, and audit tools, and providing educational presentations. A total of 40 units in the hospital were included in the implementation. After implementing all the change ideas, the system for monitoring the expiry of the nutritional formula was standardized, and the number of reported incidents related to the nutritional formula decreased from 28 in the third quarter of 2015 to one in the first quarter of 2018. This project provided step-by-step instructions for improving storing, delivering, and monitoring of nutritional formula. Consequently, the incidences of expired formula and cost wasting were successfully decreased, which increased safe administration and prevented patients from receiving expired nutritional formula. This project can be implemented in various healthcare settings.

Oxidative Stress in Prediabetic Young Adults.

Background Malondialdehyde (MDA) and nitric oxide (NO) are considered specific biomarkers for oxidative stress. Oxidative stress in prediabetics with an augmented potential for the onset of diabetes is at least partly responsible for the various complications of diabetes. Evidence shows that the early features of cell injury are due to transient acute elevations in blood glucose. This study aims to determine whether oxidative stress in prediabetic young adults increases the risk of developing diabetes. Aim and objectives We envisaged a study to determine whether the parameters representing oxidative stress are deranged in prediabetics. Materials and methods The study was conducted on prediabetic young individuals from 18 to 35 years, screened from the tertiary-level hospital, and a similar group of non-prediabetic young individuals identified from the same in a tertiary-level hospital in India. Results We observed significant elevations inprediabetics in the following oxidative stress parameters: MDA (P= <0.001), and NO (P= <0.001); indicating that these parameters were significantly higher among the prediabetics than the controls. We also observed significantly greater body weight, waist circumference, and BMI among the prediabetics than the controls. Conclusion Early identification and appropriate treatment of hyperglycemia in prediabetics is essential, as impairments in pancreatic beta-cell functioning and resistance to insulin are already present before the onset of type 2 diabetes mellitus (T2DM). Owing to the high potential for mortality and morbidity due to cardiovascular diseases (CVDs) as a complication of diabetes, treatment plans must be put in place early enough so that complications can be prevented. Inflammation and oxidative stress may be viewed as valuable targets to hinder the evolution of T2DM from prediabetes.

Investigating the Prevalence, Gender Predilection, and Inheritance Patterns of Genodermatoses: A Tertiary Hospital Study.

Genodermatoses encompass a spectrum of hereditary skin disorders stemming from mutations in genes pivotal for skin development, structure, and function. This study investigated the prevalence, gender predilection, and inheritance patterns of genodermatoses in a tertiary-level hospital through a one-year observational study. Among 157,051 dermatology outpatient department patients, 105 cases of genodermatoses were diagnosed, yielding a prevalence rate of 0.067%. Hamartoneoplastic syndromes and inherited disorders of cornification were the most prevalent subgroups, with neurofibromatosis type 1 and tuberous sclerosis complex 1 leading within these categories. The average age at presentation varied among different subgroups. A 2:1 male-to-female ratio was observed across all subgroups. Autosomal dominant inheritance was predominant. A positive family history in 46 cases and consanguinity among parents in 28 instances was reported. Genodermatoses pose diagnostic challenges due to their clinical complexity and rarity, which is compounded by limited epidemiological data. Molecular diagnosis advancements offer insights into genotype-phenotype correlations and facilitate genetic counseling and prenatal diagnosis (PND). Raising awareness among healthcare professionals and the public is critical for improving the quality of life for affected individuals.

An incidental finding of a hemoglobin E variant in a diabetic patient with an abnormal glycated hemoglobin level: a case report

BackgroundGlycated hemoglobin is a well-known marker for evaluating long-term glycemic control. However, the accuracy of glycated hemoglobin measurement can be affected by the presence of hemoglobin variants, which makes the determination and interpretation of glycated hemoglobin values in terms of glycemic control not only difficult but also misleading. Here we present the first ever case of a patient with type 2 diabetes with hemoglobin E from Nepal, diagnosed incidentally because of spurious glycated hemoglobin levels.Case presentationA 45-year-old Hindu Mongolian female with a history of type 2 diabetes for around 9 years but not very compliant with follow-ups was referred to our facility for plasma fasting and postprandial blood glucose levels and glycated hemoglobin. Fasting and postprandial blood sugars were found to be high. A consistent very low glycated hemoglobin by two different high-performance liquid chromatography (HPLC) methods compelled us to call the patient for a detailed clinical history and for the records of investigations done in the past. The patient has been a known case of type 2 diabetes for around 9 years and presented irregularly for follow-up visits. Around 4 years ago, she presented to a healthcare facility with fatigue, severe headaches, pain in the abdomen, discomfort, and dizziness for a couple of months, where she was shown to have high blood glucose. She was referred to a tertiary-level hospital in Kathmandu, where she was prescribed metformin 500 mg once daily (OD). Due to her abnormal hemoglobin A1c reports, she was then sent to the National Public Health Laboratory for repeat investigations. Her blood and urine investigations were sent. Complete blood count findings revealed high red blood cell and white blood cell counts, a low mean corpuscular volume, and a high red cell distribution width-coefficient of variation. Other parameters, including serum electrolytes, renal function tests, liver function tests, and urine routine examinations, were within normal limits. A peripheral blood smear revealed microcytic hypochromic red cells with some target cells. Hemoglobin electrophoresis showed a very high percentage of hemoglobin E, a very low percentage of hemoglobin A2, and normal proportions of hemoglobin A and hemoglobin F. A diagnosis of homozygous hemoglobin E was made, and family screening was advised.ConclusionsClinicians should be aware of the limitations of glycated hemoglobin estimation by ion exchange high-performance liquid chromatography in patients with hemoglobin E and other hemoglobin variants. If the clinical impression and glycated hemoglobin test results do not match, glycated hemoglobin values should be determined with a second method based on a different principle, and glycemic status should be confirmed through alternative investigations, preferably those that are not influenced by the presence of hemoglobin variants (for example, boronate affinity chromatography, fructosamine test, glycated albumin test, the oral glucose tolerance test, continuous glucose monitoring, etc.). Consistent or even doubtful results should also raise the suspicion of a hemoglobin variant, which should be confirmed through further evaluation and investigations.

Sexual dysfunction in selective serotonin reuptake inhibitors receiving patients attending psychiatric outpatient department at tertiary level hospital in Pokhara: a cross sectional study

Sexual dysfunction in selective serotonin reuptake inhibitors receiving patients attending psychiatric outpatient department at tertiary level hospital in Pokhara: a cross sectional study

Femoral artery Pseudo-aneurysm: Presentation, Causation and Outcome in Cardiothoracic Vascular and Transplant Centre of a Tertiary Level Hospital in Nepal

Background: Peripheral arterial pseudo-aneurysms are of varied etiology and are quite common presenting from simple swelling to life threatening hemorrhage and sepsis. Our study aimed at evaluating our Institute’s experience with femoral artery pseudo-aneurysm over a span of 2 years with particular focus on the various range of presentations, causative factors and management outcomes. Methods: Retrospective analysis of medical records of patients with diagnosis of femoral arterial pseudo-aneurysm who underwent surgery was done. Data was collected retrospectively from Anesthesia and vascular surgery records as well as administrative records. Results: Over the duration of 2 years we found a total of 135 cases of femoral artery pseudo-aneurysm treated in our center. Intravenous drug abuse (112) followed by catheter induced (11) was the commonest etiology. Demographics showed a propensity towards the youth with most cases in the 20-30 age group (78, 58%) followed by 30-40 (35, 25%). A painful swelling with tenderness (91) was the commonest presentation. All patients underwent surgical treatment with 62 (45 %) patients undergoing ligation and the same numbers undergoing pseudo-aneurysm repair, 62 (45%). 78 (58%) patients had an uneventful recovery. However 18 cases had to undergo limb amputation and 7 patients lost their lives due to various complications. Conclusion: Our study found that femoral artery pseudo-aneurysms present with various etiology and presentation, poses a huge challenge to the clinicians for surgery and management of its complications.

Double-balloon Enteroscopy, in the diagnosis and management of GI tract diseases at a tertiary level hospital.

Double-balloon Enteroscopy, in the diagnosis and management of GI tract diseases at a tertiary level hospital.

Underdiagnosis of umbilical hernias in CT scans in a multicenter study - the radiologically neglected pathology and its surgical implications.

Umbilical hernias (UH) have a higher prevalence than previously considered. With the high workload radiologists must endure, UH can be missed when interpreting a computed tomography scan (CT). The clinical implications of its misdiagnosis are yet to be determined. Unreporting could lead to content lesions in surgical approaches and other potential complications. The aim was to determine the prevalence of UH using CT scans, and the incidence of radiological reporting. A multicenter, cross-sectional study was performed in four tertiary-level hospitals. CT scans were reviewed for abdominal wall defects at the umbilicus, and radiological reports were examined to compare findings. In the case of UH, transversal, anteroposterior, and craniocaudal lengths were obtained. A total of 1557 CTs were included, from which 971 (62.4%, 95% CI 0.59-0.64) had UH. Out of those, 629 (64.8%, 95% CI 0.61-0.67) of the defects were not included in the radiological report. Smaller UH (x̄: 7.7 × 6.0mm) were more frequently missed. Of the reported UH, 187 (54.7%) included at least one axis measurement, 289 (84.5%) content description, and 146 (42.7%) whether or not there were complication signs. There is a high prevalence of UH, and a high incidence of under-reporting. This raises the question of whether this is a population-based finding or the norm worldwide. The reason of under-reporting and the clinical implications of these must be addressed in further studies.

Spectrum of neurodegenerative disorders in neurology outpatient department: A cross-sectional study.

Neurodegenerative disorders (NDDs) are a growing global health concern with a rise in prevalence with the aging population, leading to increased healthcare utilization and costs. Understanding its prevalence is crucial for effective diagnostics and resource allocation, especially in developing nations with limited resources. This study aims to explore the frequency and types of NDDs, while also collecting demographic, clinical, and neuro-radiological data from patients with NDDs attending a tertiary care hospital in Nepal. This was a single-center based cross-sectional descriptive study conducted at a Neurology outpatient department in a tertiary level hospital in Nepal in which patients aged 18 and above diagnosed with NDDs (May 2023-July 2023) were included. Data were collected and analyzed in SPSS Inc. This study has been presented by the STROBES guidelines. The mean age of the 71 patients included in the study was 65.6 ± 13.3 years. Parkinsonian disorder (n = 41, 57.7%) was the most common NDD diagnosed. Patients belonging to the age group 60-79 years represented 62% of all outpatient visits. Tremors of the upper extremity and impairment of memory were the most commonly encountered first symptoms at onset. Predominant cognitive changes in our study were memory impairment and mood changes. Extrapyramidal features such as gait disturbance, resting tremor, rigidity, and bradykinesia were present. More than half of the patients had age-related cerebral atrophy on neuroimaging followed by chronic small vessel ischemic changes. Diagnosing NDDs poses challenges, and our study underscores Parkinsonian disorder, specifically Parkinson's disease, as the prevailing neurodegenerative condition in our population. Emphasizing its prevalence among the elderly, particularly with tremors as the primary presenting symptom, highlights the necessity for targeted interventions in this demographic.

Demographic Profile and Outcome of Paediatric Solid Tumor Patients, in a Tertiary Level Hospital in Bangladesh

Demographic Profile and Outcome of Paediatric Solid Tumor Patients, in a Tertiary Level Hospital in Bangladesh

Análisis a tres años de resultados, seguridad y progresión en pacientes con glaucoma de ángulo abierto o hipertensión ocular, intervenidos de microcirugía trabecular

AimTo evaluate the efficacy, safety, structural and functional progression following the insertion of iStent inject ® implants in patients with open-angle glaucoma or ocular hypertension at a tertiary-level hospital. Materials and methodsA retrospective study included 98 eyes (57 males and 41 females) with open-angle glaucoma or ocular hypertension, which underwent iStent inject W® implantation (Glaukos, Corporation, CA) between December 2018 and December 2022. Differences in intraocular pressure (IOP), the number of hypotensive eye drops used, and structural and functional tests were assessed between preoperative values and subsequent reviews during a follow-up period of one (n=98), two (n=55), and three years (n=15) after surgery. ResultsAmong the 98 eyes studied, 85% were diagnosed with open-angle glaucoma (50% mild, 32% moderate, and 18% severe) and 15% with ocular hypertension. There was a statistically significant reduction in IOP compared to preoperative values for all visits except the 1-month (p=0.36) and 3-year (p=0.39) visits. Visual acuity increased from 0.39±0.25 to 0.72±0.24 (p<0.01), considering that a significant portion of the interventions included cataract surgery. Before surgery, 66% of the sample used 2 or more hypotensive medications. Post-surgery, the number of hypotensive medications decreased (from 1.88±0.84 to 0.21±0.59 at 3 years) (p<0.01), with an 88.9% reduction in the number of medications over three years. After surgery, 75% of cases did not require any medication.Regarding structural and functional tests, thickness of retinal nerve fiber layers (RNFL (p=0.35), excavation / papilla ratio E/P (p=0.31), visual function index(VFI (p=0.06), and deviation mean (MD (p=0.06) showed no statistically significant differences post-intervention. However, standard deviation of the pattern (DSM) did exhibit differences, decreasing from 5.46±4.03dB to 5.34±3.48dB (p=0.02). ConclusionThe results of this study suggest that the iStent inject W® technique constitutes an effective and safe option for tension control and glaucoma treatment.

Incidence, Associated Factors, and Behavioral Consequences of Intraoperative Awareness and Dreams During General Anesthesia Among Adult Patients: A Prospective Cohort Study.

Background The intraoperative awareness with recall phenomenon involves the memory of intraoperative events. The reported incidence is 0.001%. Awareness is rare intraoperatively but has profound implications. This research aimed to study intraoperative awareness and dream experiences in the Omani population undergoing general anesthesia. Methods This prospective cohort study involving 300 adult patients was conducted at a tertiary-level hospital between July and December 2021. Awareness was assessed in the post-anesthesia care unit and then at home on the seventh day and one month telephonically using a modified Brice questionnaire. The study's primary outcome was the incidence of IOA and dreams in adult Omani patients undergoing GA. The secondary outcome was identifying the factors associated with intraoperative awareness and dreams under GA. Results In this study, the incidence of awareness was 0.3%while 7.6% of patients reported intraoperative dreams. The patient who experienced IOA underwent an endoscopic retrograde cholangiopancreatography under GA with neuromuscular blockade and had a prolonged recovery. A total of 49.33% developed psychological effects postoperatively; anxiety, irritability, fear of surgery, change in memory, and repetitive nightmares were the most common ones. Because of the limited sample size, no factor associated significantly with these outcomes was found. Conclusion This study observed a higher incidence of intraoperative awareness and dreams. Awareness might be due to prolonged recovery and the use of neuromuscular blocking agents, but a focused study is required to confirm this finding. The incidence of intraoperative dreams and postoperative psychological effects of GA was also high. It may be worth exploring these findings with larger population-based research.

Real-world data of cancer-associated venous thromboembolism in a tertiary-care hospital in India.

e23298 Background: Cancer-associated venous thromboembolism (VTE) is a leading cause of morbidity and mortality in patients with various malignancies. Anticoagulation is crucial for preventing and treating thrombosis associated with cancer. However, its use faces challenges due to increased risks of bleeding, recurrent thrombosis and complexities in dosing, particularly in patients with concurrent comorbidities. Prophylactic anticoagulation is under-utilized and the cost of low- molecular-weight heparin (LMWH) and direct oral anticoagulants is a major barrier in developing countries. Methods: It was an ambispective observational study. All the cancer-associated thrombosis patients attending the thrombosis clinic at a tertiary-level referral hospital based in north India between 2018 and 2023 were analysed. Patient demographics, disease-related and treatment-related parameters were collected and analysed. The study was approved by the Institute Ethics Committee. Results: A total of 1312 patients attended the thrombosis clinic during study period, of which 139 (10.59%) cases were Cancer-associated VTE. The median age was 48 years and 61.2% were female. Most of VTE (54.6%) occurred within 6 months of cancer diagnosis and only 7% occurred after 3 years. Gynaecological malignancies (25.18%) and adenocarcinomas (21.58%) were the most common site and histological type of cancer respectively. Common risk factors observed for VTE development were: active cancer (80.3%), active chemotherapy (36.7%), cancer surgery (15.1%). Lower limb thrombosis was the most commonly seen type (46%), while abdominal and pulmonary thrombosis were seen in 17% and 7.9% respectively. Out of total patients, 124 (89.2%) patients received anticoagulation. Low molecular weight heparin (LMWH) was used as an initial anticoagulation in majority (52.41%) and direct oral anticoagulant (DOACs) was used as long term anticoagulation in 54% of patients. In 26 patients, anticoagulation was interrupted, the major reasons being bleeding and thrombocytopenia. There was no significant difference in frequency of bleeding with use of different anticoagulants (P = 0.48). Conclusions: Most cases of cancer associated VTE occur shortly after cancer diagnosis. Prophylactic anticoagulation is still underutilized in our patients with cancer. Early suspicion and prompt treatment can improve quality of life in such patients.

Questionnaire survey and analysis of drug clinical research implementation capabilities of breast cancer treatment departments in Chinese hospitals.

e23257 Background: Clinical research competence determines the quality of clinical research and the reliability of research findings and is vital in the development of new antitumor drugs and the diagnosis and treatment of breast cancer. Our study aimed to explore the clinical research implementation capabilities of breast cancer treatment departments in China and to analyze the differences among regions, departments and different hospital classifications. Methods: This was a department-based cross-sectional study conducted in the form of electronic questionnaires in China from 7th August to 31st August 2023; this study was initiated by the breast cancer expert committee of the National Cancer Center (NCC). The questionnaire was designed on the Wenjuanxing platform. Our study was conducted among the first batch of breast cancer standardized diagnosis and treatment quality control pilot centers, which includes 200 hospitals selected by the NCC on the basis of the level of breast cancer diagnosis and treatment, surgery volume and other factors. The centers cover 30 provinces, and all of them are tertiary-level general hospitals or cancer hospitals. Results: A total of 127 questionnaires from 122 hospitals were ultimately included in the analysis. Medical personnel involved in the clinical research of 118 (92.9%) departments received good clinical practice (GCP) training. A total of 89.3% (109/122) underwent centralized institutional review board (IRB) review. The steps of the approval process from research initiation to completion lasted 2-4 weeks or longer. The majority of departments initiated or participated in 2 or fewer clinical research projects over the past year. Among the differences between different departments, the Department of Medical Oncology had a better qualification profile and process and greater number of initiated and participated clinical studies than did the Department of Surgical Oncology. There were more patients enrolled in registered clinical trials in specialized cancer hospitals than in general hospitals (50 and below, 50-200, and more than 200 patients from specialized cancer hospitals vs. general hospitals: 39.1%, 52.2%, and 8.7% vs. 76.9%, 16.4%, and 6.7%, respectively; p = 0.001). For needs and problems, most of the departments were strongly willing to undertake clinical research and receive professional training; the most common problem in the process of conducting studies was patient recruitment. Conclusions: Most departments generally exhibited complete capabilities for implementing clinical research. Improvements in implementation efficiency, quality and quantity of research and patient recruitment are still needed. Professional training and communication, as well as the recommendation and implementation of clinical research, are required in future development.

Autonomy and Respect among Postnatal Mothers during Maternity Care in a Tertiary Level Hospital

Background: Lack of respectful maternity care act as more powerful deterrents to skilled birth care utilization than other more commonly recognized deterrents such as geographic and financial obstacles. Ensuring high level of respectful maternity care encourage the women to utilize facility-based care, which is essential for improving maternal and neonatal health. Thus, the objective of the study is to find out autonomy and respect during maternity care among the postnatal mothers in a tertiary level hospital. Methods: A descriptive cross-sectional study was conducted among 214 postnatal mothers receiving child birth services from the facility were selected by using non-probability purposive sampling technique. Analysis of data was done by using descriptive statistics (number, percentage, mean, standard deviation) and chi- square test was used for association between autonomy and respect and selected socio-demographic variables. Results: The study result indicated that (74.8%) of the respondents had high level of autonomy. Similarly, (71%) of the respondents reported that they experience high level of respect. A significant association was present between autonomy of postnatal mothers with caste (p=.027) and parity (p=.005) and a significant association was present between respect of postnatal mothers with type of delivery is with p value (.001). Conclusions: Hence, level of autonomy and respect tends to be high among postnatal mothers during maternity care and is associated with caste, parity and type of delivery. Continuous professional development programme for all cadres of health personnel should be conducted in respectful maternity care of maternity ward.

Perceived stress and its associated factors among pregnant women attending antenatal clinic in a tertiary level hospital

Background: Stress has been found widely prevalent among women during the time of pregnancy. Researches in different societies indicate a link between prenatal maternal stress and adverse obstetric, fetal, and neonatal outcome. Therefore, this study was carried out to assess perceived stress levels and associated factors with it among pregnant women.Methods: A descriptive cross-sectional study was carried out from November 2022 to March 2023 among 264 pregnant women attending the Obstetrics/Gynaecology outpatient department of Nepal Medical College and Teaching Hospital. Pregnancy Stress Rating Scale (PSRS) was adopted to measure perceived stress levels among pregnant women. Data were collected through face-to-face interview techniques. Descriptive statistics and logistic regression analysis were used for data analysis.Results: In this study, 11.4% (95% CI= 7.8% - 15.8%) of pregnant women had high levels of stress. Variables such as ethnicity, education of respondents and respondents’ husbands, status of pregnancy (pregnancy intention), and gender preference were associated with high levels of perceived stress in bivariate analysis. While, only those respondents having male gender preference for the upcoming baby was associated with a high level of stress (AOR= 3.07; 95% CI = 1.26 –7.48) in multivariate analysis.Conclusions: Approximately one out of nine pregnant women had a high level of stress in this study. Respondent’s gender preference for male babies was associated with high levels of stress in multivariate analysis. Therefore, early recognition of antenatal stress and its management is crucial.

A six-year comprehensive review of eye cytology cases received at a tertiary level hospital.

Ocular cytology is an effective method of diagnosing infective, benign, and malignant ocular disease processes due to easy accessibility and rapid turnaround time. However, these specimens pose significant diagnostic challenges due to rarity of the specimen type, sparse diagnostic material available for ancillary workup, and unfamiliarity of the diagnostic entities by the cytopathologist. This study conducted a 6-year comprehensive review of 65 eye cytology cases received at a tertiary level hospital. Cytopathologic diagnoses of "negative for malignancy" and "atypical" were categorized as negative findings (70.8%, n = 46) and diagnoses of "suspicious for malignancy" and "positive for malignancy" were categorized as positive findings (23.1%, n = 15). A 44.6% (n = 29) of cases had subsequent histopathology and/or flow cytometry diagnoses. Premalignant and malignant lesions detected on histopathology were considered as significant findings. Statistical analysis was performed to evaluate the concordance of ocular cytology with associated histopathology and/or flow cytometry diagnoses. The accuracy of final cytology-histopathology and/or cytology-flow cytometry diagnoses in this cohort of cases is 86.2%. The sensitivity and specificity of ocular diagnosis by cytology are 66.6% and 100%, respectively. The positive and negative predictive values of ocular diagnosis by cytology are 100% and 80.9%, respectively. Ocular cytology is a fast, effective, and sensitive method for diagnosing ocular pathology specimens. Familiarity with these specimen types by cytopathologists can help in diagnosing ocular diseases effectively on small, challenging cytologic preparations.

#2875 Experience in the use of plasmapheresis as a therapeutic tool in acute pathologies in a tertiary level hospital

Abstract Background and Aims Apheresis is a therapeutic modality which purpose is the elimination from plasma of the pathogenic components of a disease or its clinical manifestations. Plasmapheresis is an apheresis technique used in the treatment of various diseases with varying degrees of proven clinical efficacy. The aim of our work is to describe the experience in the use of plasmapheresis in different acute pathologies in our center, and if there are factors that favor the clinical response to treatment. Method Retrospective cohort study. We included plasmapheresis performed in the years 2017-2022. Variables such as age, sex, etiology, type of replacement performed, number of sessions, and American Society for Apheresis (ASFA) classification, among others, were collected. We defined response to treatment as partial or total clinical remission. Results We included 72 patients who received plasmapheresis during 2017-2022. Mean age 54 ± 18 years. 56.9% male. Disease etiology was neurological in 56.9%, nephrological in 36.1% and hematological in 6.9%. Between 2017-2019, 39.7% of the plasmapheresis were performed, while the remaining 60.3% were between 2020-2022. The number of sessions was 5.3 ± 2. 59.6% were performed with albumin, 29.2% with fresh frozen plasma and 13.9% with albumin and fresh frozen plasma. The ASFA indication was category I in 68.1%. 23.6% presented some complication, the most frequent being febrile in 6.9%, systemic infection and allergic reaction in 5.6%. A response to treatment was observed in 75%. Antibodies were positive before starting plasmapheresis in 29.2%, decreasing to 16.7% 3 months after treatment. There was recurrence in 19.4%, 16.7% received more cycles of plasmapheresis and there was 11.1% mortality due to disease. In patients with response to treatment, a higher percentage of response was observed in those diseases of non-nephrological origin (70.4% vs. 29.6%, p 0.04), lower percentage of complications (16.7% vs. 83.3%, p 0.01) and lower mortality associated with the disease (3.7% vs. 96.3%, p 0.001). Conclusion Plasmapheresis is a therapeutic plasma exchange technique that is increasingly used in our hospital, with a greater increase in recent years. It is a therapeutic option that should be considered in many occasions as first line or adjuvant treatment, with a low rate of complications and clinical improvement in most patients. Despite this, studies with a larger number of patients are required to increase and consolidate the existing evidence on the use of these procedures.

#847 Experience with therapeutic apheresis in a tertiary level hospital over the last 25 years

Abstract Background and Aims The main purpose of therapeutic apheresis is the extraction and elimination from plasma of those components considered to be responsible for the pathogenesis of a disease, the replacement of deficient factors and the improvement of the function of the reticuloendothelial system and certain inflammatory mediators. Currently, it constitutes a good therapeutic alternative for the treatment of a wide variety of diseases of different specialties, where conventional treatment has not been successful or the desired response has not been obtained. In general, apheresis is a beneficial technique, well tolerated and with few complications. Requests for apheresis are increasingly frequent from different areas of daily clinical practice. Method Descriptive-retrospective cohort study, in which all the apheresis sessions performed in our department between January 1997 and February 2023 were analyzed. The aim of this study is to describe the experience with plasmapheresis performed by nephrologists in patients with different diseases. We analyzed the following variables: sex, age, underlying disease and indication according to the American Society for Apheresis (ASFA) classification, apheresis technique and number of sessions performed. In the last 5 years (2018-2023) we also evaluated: plasma replacement, vascular access and complications during the performance of the technique. Results During the period January 1997-February 2023 a total of 2483 sessions were performed. Of the sessions, 76% were plasmapheresis, 20.5% granulocytapheresis and 3% lipid apheresis. Apheresis was performed in 199 patients, 57% men (114), 42.5% women (85), with a mean age of 51 years. The average number of sessions per patient during the follow-up of their disease was 13 sessions. The main causes for which apheresis was performed were neurological diseases, 34.5% of the cases, including Myasthenia Gravis (41%), Guillain-Barré (29%). In second place, autoimmune nephrological diseases in 27%, rejection of transplanted organs in 27%, hematological diseases in 7.5% and metabolic diseases in 3.5%. Almost 70% of the indications corresponded to ASFA grade I and II evidence criteria. Focusing on the last 5 years, the services from which we were requested to perform the technique were mainly Neurology, Hematology, Digestive and Internal Medicine. The pathologies treated by apheresis were: 39% neurological diseases, 39% renal pathology (50% autoimmune diseases and 50% due to rejection of a transplanted organ) and 17% hematological diseases. According to ASFA criteria, the prevalent category was ASFA I (32%), followed by ASFA III (31%), ASFA II (24%), and finally ASFA IV (9.8%). Plasma replacement was performed with albumin in 63.4% of the cases, with fresh plasma in 22% of the cases and with both in 9.8% of the sessions. In relation to the technique, the complications observed were infrequent (14%), being fundamentally paresthesia, nausea, allergic reactions of a self-limited nature and with adequate control with premedication in subsequent sessions. Other less frequent complications were: hypotension or catheter dysfunction. Conclusion