Total Number Of Patients Research Articles

Demographic and survival data of patients with primary diffuse large B-cell lymphoma of the head and neck: A single center experience.

e19069 Background: Head and neck malignancies account for around 10% of lymphomas, with diffuse large B-cell lymphoma (DLBCL) being the most prevalent histologic subtype. Head and neck lymphoma is as the second most pervasive location for extra-nodal lymphoma, following the gastrointestinal system. This study focused on examining the demographic characteristics, main localization distribution, and survival rate of patients with head and neck lymphoma at the Çukurova University Medical Oncology Clinic. Methods: We conducted a retrospective analysis of 97 individuals diagnosed with single-center, head, and neck diffuse large B-cell lymphoma (DLBCL) from 2011 to 2020. Data pertaining to patients was acquired from electronic medical records. The patients were categorized based on anatomical localization, and survival rates and survival data were computed for each primary localization. Results: Out of the total number of patients, 48 (49.5%) were female, and 49 (50.5%) were male. The patients had a median age of 59.5 years. Waldeyer's ring was the most frequent site of primary head and neck tumor localization in patients with DLBCL, accounting for 42.4% of cases. The distribution of anatomical sites was as follows: nasopharynx accounted for 30.8%, nasal cavity accounted for 10.3%, thyroid accounted for 6.2%, parotid accounted for 5.2%, oral cavity accounted for 3.9%, and other anatomical sites accounted for 1.2%. Based on the Ann Arbor staging approach, 65% of the patients were classified as stage I-II. The 3-year survival rate was 71%, while the 5-year survival rate was 61%. The overall survival of individuals with nasopharyngeal lymphoma was considerably shorter when compared to those with non-nasopharyngeal lymphomas (p=0.0372). Conclusions: We conducted a thorough analysis of the data pertaining to lymphomas characterized by diffuse large B-cell lymphoma (DLBCL) occurring in the head and neck region. The study found that when the nasopharynx is affected, it is linked to a worse prognosis and may necessitate more intensive treatment. Our work is a retrospective study conducted at a single center. However, future investigations with a more significant number of participants and a prospective design is necessary.

Blood-based colorectal cancer (CRC) screening implementation into clinical practice in the outpatient clinical setting in the Appalachian highlands.

TPS10622 Background: Maximizing colorectal cancer (CRC) screening participation relies on tests that are acceptable, accessible, and patient-centered. While colonoscopy or stool-based tests have traditionally been the standard of care (SOC), they often present challenges related to timely completion and patient adherence. Blood-based tests (BBTs) detecting circulating tumor DNA (ctDNA) offer a quicker, less invasive alternative to previous methods of screening. While the BBTs exhibit comparable sensitivity and specificity to the existing noninvasive SOC, their user-friendly nature holds the potential to enhance adherence. This study aims to explore the implementation of a BBT and its impact on patient acceptability and adherence to CRC screening. The study focuses on the Appalachian population, known for higher CRC incidence1 and mortality rates2 compared to the general US population. Methods: The trial is being conducted at two primary care clinics. It consists of two phases over a 6-month period, aiming to enroll over 300 patients. Participants aged 45-84 years, identified as average risk for CRC according to USPSTF guidelines, and who have opted to be screened for CRC and are willing to participate in the study will be eligible. Exclusion criteria consist of higher-than-average risk for CRC according to the USPSTF standards. During Phase 1 (control period), patients meeting inclusion criteria will be offered SOC (colonoscopy and/or stool-based test) for 3 months followed by Phase 2 (intervention period) where a BBT in addition to SOC will be offered for another 3 months. Informed consent will be obtained prior to any study procedures. The BBT used for the study has a sensitivity of 83% and specificity of 90%. Patients who agree to BBT will undergo a single blood draw of 40 mL. Phase 1 has concluded with enrollment of 75 patients, while Phase 2 is currently ongoing and actively recruiting participants. Upon completion of study, an EMR review will be conducted on participants to evaluate screening rates before and after implementing the BBT and to assess adherence. The primary endpoint of the study involves calculating the total number of consented patients who opted for and completed either BBT or SOC during the interventional period compared to the total number of patients who opted for SOC during the control period. Final data analysis is expected by July 2024.

Assessing secular trends in lung cancer stage in the United States community oncology setting from 2013 to 2023.

11178 Background: Detecting disease at an early stage is critical to improving lung cancer (LC) survival, as reflected in guidelines recommending screening with low dose computed tomography for individuals at high risk by clinical societies including the NCCN (2011) and US Preventive Services Task Force (2013, updated 2021). Presenting stage distribution may also be impacted by healthcare utilization changes following the COVID-19 pandemic. Real-world data (RWD)-based investigations are important complements to national cancer registries to provide insight into this potentially changing diagnostic landscape, especially given utilization, practice and referral patterns unique to community settings. We thus assessed LC stage from 2013-23 in a large, nationally representative sample of community oncology practices leveraging RWD. Methods: This is a retrospective observational cohort study of patients within The US Oncology Network and non-Network practices, which include a nationally representative network of over 3,700 providers and more than 1 million patients seen annually in community-based oncology practices. All adult (≥18 years) patients diagnosed with non-small cell LC (NSCLC) or small-cell LC (SCLC) who had a first observed stage available in the community oncology setting within 2013 to 2023 were included. Demographics and medical history data were sourced from structured data fields in iKnowMed, an oncology-specific electronic health record system. Time trends of patient diagnosis and characteristics were descriptively evaluated. Results: The analysis included 98,806 patients with LC (84,023 [85.0%] NSCLC and 14,783 [15.0%] SCLC). Approximately half were female (49.7% and 50.3% in each disease), three-fourths were White (72.7% and 77.0%, respectively), and mean ages at diagnosis were 69.9 and 68.1 years. From 2013 to 2023, there was an increase in the total number of patients observed in the database with a documented stage, from 7,159 to 9,115 (27.3% increase) for NSCLC and from 1,162 to 1,595 (37.3% increase) for SCLC. This was largely driven by an absolute increase in advanced stage diagnoses. The proportion of patients diagnosed with Stage IV NSCLC increased from 43.3% in 2013 to 49.3% in 2023, while the proportions of Stage 0/I and II diagnoses decreased. A similar trend was observed for SCLC, with 60.3% of patients diagnosed with Stage IV in 2013 compared to 68.2% in 2023. The proportion of Stage IV NSCLC cancers increased in the pandemic period, from 48.0% in 2019 to 51.6% in 2020 and 50.6% in 2021. Conclusions: Over the last decade, the proportion of advanced stage LC cases has increased, possibly reflecting changes in referral patterns and utilization specific to the community setting, including those related to the COVID-19 pandemic. The burden of advanced disease highlights the need for continuous investment in advanced-stage treatments as well as early detection efforts.

A systematic review of racial disparity in pivotal poly (ADP-ribose) polymerase (PARP) inhibitor trials.

e13737 Background: Breast cancer is the most common cancer diagnosed worldwide. Breast cancer related mortality has decreased in the US, however this did not extend equally to African American women (AAW). According to CDC mortality rate from breast cancer in AAW is 20% higher than other ethnic groups. Younger age at diagnosis in AAW, higher incidence of triple negative breast cancer (TNBC), and higher incidence of AA males with breast cancer suggest genetic predisposition plays an important role in the disparate outcomes based on race. In an unbiased analysis of TNBC cases, the prevalence of pathogenic germline BRCA 1 & 2 mutations are twice as high as in breast cancer overall. Poly (ADP-ribose) polymerase (PARP) inhibitors have proven to be effective in germline BRCA 1 and BRCA 2 mutation associated breast cancer. However, data regarding the enrollment of racial and ethnic minorities in these pivotal trials that lead to the approval of these drugs is limited. Methods: We examined the demographic data reporting in Phase II/ III clinical trials of PARP inhibitors in breast cancer from 2016 to 2023. In order to highlight the disparities in the enrollment of minority groups we calculated an enrollment percentage of various racial groups in these trials. We conducted a systematic review of Phase II/III clinical trials of PARP inhibitors in BRCA 1 & 2 mutated breast cancer reported studies with sources from PubMed, Embase, Scopus, Clinicaltrials.gov, CENTRAL and Cochrane. 56 full text studies were identified, out of which 14 met inclusion criteria. The total number of patients included was N=5,067. Five trials did not include racial data. Results: Among trials that reported race and ethnicity (N=4004), the enrollment percentage was lowest for racial and ethnic minorities. AA: 3.4%, N=136. Non- Hispanic Whites were the most common to be enrolled: 71.05%, N=2845, Asians were 16.53% N= 662, Hispanics 2.03 %; N=83 and other 6.17%, N=247. Conclusions: Racial minorities are consistently underrepresented in all the pivotal PARP inhibitor trials and contributing to the race-based disparities in breast cancer. [Table: see text]

Yolk sac tumor of the liver: Presentation, diagnosis, and treatment review.

e16371 Background: Yolk Sac Tumor of the Liver (YSTL) is an extremely rare extragonadal germ cell tumor with gonadal origin and histology which presents in the liver. While uncommon, this tumor is often misdiagnosed due to the similarities between YSTL, HCC, and Hepatoblastoma (HB). As this cancer can present with serious mortality, our review aimed to evaluate clinical findings, diagnostic workup, and treatments in patients with YSTL. Methods: We performed a literature search in PubMed from 1950 to October 2023 using filters English language and full text with keywords “Yolk sac tumor of the liver”, “Endodermal Sinus tumor of liver”, “Hepatic Yolk sac tumor”, and “Hepatic Endodermal sinus tumor”. We also conducted a combined search query with all these search terms and “primary”. Patients were included in the study if they had primary YSTL and no other malignancy. Results: Our results looked at 19 patients ranging from 15 months to 64 years with median age being 27 years, including 13 female (68%) and 6 male (32%) patients, percentages reflect the total number of patients. The key presenting symptom in adults was abdominal pain (55%), while the key presenting symptom in children was abdominal distention (63%). All patients in the study had a diagnostic workup that included imaging and pathology. Imaging included CT Abdomen (68%) and MRI (37%), in 58% of patients a solitary mass was seen on imaging, while in 42% of patients multiple hepatic masses were seen. Histology workup mainly noted Shiller Duval Bodies(SDBs)(76%). Molecular Markers included AFP(42%), Alpha-1 anti-trypsin(A1AT)(26%), SALL4(21%), Pancytokeratin(PK)(11%), and Placental-like alkaline phosphatase(PALP)(11%). Treatment included chemotherapy(58%), surgery(47%), transplant(11%), and trans-arterial chemoembolization(5%). Out of the 11 patients who were treated with chemotherapy, 91% received the bleomycin, etoposide, and cisplatin (BEP) regimen. The remaining 9 % of patients received a regimen of cisplatin, adriamycin, and pepleomycin. Conclusions: YSTL is a unique tumor presenting in patients of all ages, tending to present vaguely often with abdominal pain or distension. Diagnostic workup often includes abdominal imaging (MRI and CT Abdomen) and pathology with a focus on SDBs on histologic examination and stains like AFP, A1AT, SALL4, etc. Treatment often focuses on surgery and chemotherapy, notably BEP. Though both HCC and HB traditionally present as a multifocal liver mass on imaging along with positive staining for AFP and PK, our study helps differentiate this tumor from others by emphasizing the importance of SDBs in diagnosis and highlighting new molecular markers to help make the diagnosis easier.

Effect of war on radiotherapy in Ukraine and how to help.

1513 Background: The full-scale Russian invasion of Ukraine on February 24th, 2022 brought the largest humanitarian disaster to the heart of Europe since the World War II. In this work, we describe the impact of the full-scale Russian invasion on the radiation therapy (RT) services in Ukraine and suggest how to help. Methods: We collected the information on operation of RT centers in Ukraine during the war. In addition, in 2023 an annual survey was conducted by Grigoriev Institute for Medical Radiology in Kharkiv for the IAEA DIRAC database. The survey was sent to 41 RT centers in Ukraine requesting information on equipment, staffing, and patient volume. Due to the war conditions the data provided in the survey is limited to the un-occupied territories. Results: After the initial Russian invasion of Ukraine in 2014 and occupation of Crimea and parts of Donbas, Ukraine lost access to 7 RT centers with 18 external beam radiotherapy (EBRT) machines (17% of total). Just before the full-scale invasion in 2022, there were a total of 44 Co-60 machines (57%) and 33 linear accelerators (43%) in the unoccupied territories. As a result of the full-scale invasion of Ukraine in 2022, almost all RT centers suspended operation in the first weeks of war. The most challenging period for RT in Ukraine was in March when Kyiv (where 20 EBRT machines are located) was partially surrounded by the occupiers. Based on the DIRAC survey, compared to 2021 data, in 2022 the number of radiation oncologists decreased on average by 2.9%, medical physicists by 6.7%, and therapists by 6.5% but there was a large variation in staffing levels depending on the region and its proximity to war. The workload in the RT centers close to the combat zone almost halved, while increasing by 10 - 60% in the western and central Ukraine. The total number of patients treated with EBRT decreased by 11% and brachytherapy by 21%. Brachytherapy services sustained the most interruption (47% decrease in LDR and 18% decrease in HDR patient volume) due to inability to perform source exchanges. Overall, approximately 5,500 less patients were treated in 2022 compared to 2021. Despite the ongoing war, Ukrainian cancer centers installed 8 new linear accelerators, with 5 linear accelerators pending installation. In addition, the Ministry of Heath of Ukraine has recently purchased 15 linear accelerators to replace the aging Co-60 machine fleet as the future source exchanges might not be possible. There is an acute need in helping Ukraine transition from Co-60 to modern IMRT/VMAT linear accelerators. Conclusions: Radiotherapy in Ukraine sustained significant damages since the 2014 Russian invasion, which was exacerbated further by the full-scale invasion in 2022. To support the vitality and absorptive capacity of RT services in Ukraine, the democratic world can help by donating equipment, hardware, software, and participating in training of Ukrainian RT professionals as they transition to modern and high-quality RT care for Ukrainian cancer patients.

Isolated cardiac sarcoidosis: a case report

Introduction. Ventricular arrhythmias are a risk factor for sudden cardiac death. Abnormalities of cardiac rhythm and conduction may be the only subjective manifestation of isolated cardiac sarcoidosis, which occurs in 25% of the total number of patients with this disease.Brief description. We present a case of isolated cardiac sarcoidosis in a young female patient, the main clinical manifestation of which was attacks of palpitations caused by ventricular tachycardia and episodes of cardiogenic shock without a cardiovascular history. Echocardiography and contrast-enhanced cardiac magnetic resonance imaging (MRI) revealed asymmetric left ventricular hypertrophy and focal myocardial masses. Cardiac tumor and sarcoidosis were suspected. The final diagnosis was based on the results of histological and immunohistochemical analysis of endomyocardial biopsies documenting sarcoidosis. No systemic manifestations of sarcoidosis were found.Discussion. The case demonstrates the potential of a comprehensive paraclinical study in the diagnosis of cardiac sarcoidosis and its differential diagnosis with other cardiac pathologies.Conclusion. Cardiac sarcoidosis is difficult to diagnose and requires histological verification in patients with LV hypertrophy and arrhythmias, and physicians should be aware about this rare disease with unfavorable prognosis without specific treatment.

Early detection of lung adenocarcinoma on CT scan

Background: Lung cancer is the most common human malignancy and the principal cause of cancer-related death worldwide. Nowadays, adenocarcinoma is the most common histologic form, making up over half of all cases Objective: To determine the early detection of lung adenocarcinoma on CT scan Methods: A cross-sectional study was conducted at Jinnah Hospital Lahore Pakistan, which was performed between September 2020 to October 2023, The name of CT scan machine which was used in our study was Toshiba 64 slice and its slice thickness was 0.5 mm. Iodine based contrast is used. The total number of patients in our study were 150. The number of Male patients were 61 and female were 89. For all patients, we did diagnostic tests CT test . BMI parameter of every patients we took. We also took detailed history from the patients about the signs and symptoms. We did both the Lung window and the Mediastinal window. Data was tabulated and analyzed by SPSS version 26. Result: In a current study total 150 patients were enrolled. The minimum age of patients were 43 years and the maximum age of the patients were 77 years. The mean age were 59.60±7.877 years. The minimum BMI of patients were 26 (Kg/m2) and the maximum BMI were 34 (Kg/m2). The mean BMI were 28.55±3.740 (Kg/m2). The minimum size of the Lung Adenocarcinoma of patients were 0.3 cm and the maximum size of Lung Adenocarcinoma of patients were 2.8 cm. The mean size of the lung adenocarcinoma were 1.413±0.627 cm. The stage of lung adenocarcinoma in the age group of 41-50 years 1A1 were 8, 1A2 were 7 and 1A3 were 2 . The total patients with age 41-50 years were 17. The stage of lung adenocarcinoma in the age group of 51-65 years 1A1 were 34, 1A2 were 47 and 1A3 were 19. The total patients with age 51-65 years were 99. The stage of lung adenocarcinoma in the age group of >66 years 1A1 were 6, 1A2 were 11 and 1A3 were 17. The total patients with age >66 years were 34. P-value of stages of lung adenocarcinoma in age group was 0.03. The stage of lung adenocarcinoma 1A1 in male patients were 17 and female were 31. The stage of lung adenocarcinoma 1A2 in male patients were 28 and female were 36. The stage of lung adenocarcinoma 1A3 in male patients were 16 and female were 22. Total male patients were 61 and females were 89.P-value of stages of lung adenocarcinoma in gender was 0.04. Conclusion: We concluded that routine CT examination could detect more lung cancer at an early stage, especially adenocarcinoma, and detect patients with less aggressive features. The main advantage of the CT scan is, its non-invasive, painless diagnostic test as compared to biopsies. The chance of spreading of cancer cell is reduced. In our study females were more as compared to males.

Surgical marker navigation system in breast conserving surgery and excision of non-palpable lesions: first Spanish single-center experience.

Due to the establishment of screening mammography for breast cancer detection, the number of non-palpable lesions has increased. Thus, an optimal localization system is mandatory for the excision of non-palpable breast tumors. The aim of the study is to report the feasibility Surgical Marker Navigation (SMN) system Sirius Pintuition® for the excision of non-palpable breast tumors and non-palpable axillary lymph nodes. A retrospective observational study of patients undergoing breast-conserving surgery and lymph node excision guided by SMN between December 2022 and May 2023 was performed. A total of 84 patients underwent excision of non-palpable breast tumors (77; 91.7%) or non-palpable axillary lymph-nodes (7; 8.3%) using SMN. In total, 94 markers were placed, in 74 patients (88.1%) only one marker was placed, whereas in 10 patients (11.9%) two markers were placed to correctly localize the lesion in the operating room. Most markers were placed using ultrasonographic guidance (69; 82.1%). Seventy-seven patients underwent breast-conserving surgery (91.7%) and 7 (8.3%) lymph node excision. In 10 cases (11.9%), the marker was accidentally displaced during surgery due to the use of magnetized instruments, although the specimen could be removed. In sum, all the markers were removed from the patients, although the marker retrieval rate, as we defined it (percentage of patients in whom the initial excised specimen contained the marker divided by the total number of patients), was 88.1%. The use of Sirius Pintuition® SMN for non-palpable breast tumors and non-palpable lymph nodes is feasible, with a retrieval rate of 88.1%.

OBESITY AND HERNIA – ALGORITHM AND EVIDENCE

Abstract Materials and Method Obesity with abdominal wall hernia is always a concern for the patient and surgeon. BMI is an inflammatory state and very high risk of recurrence, surgical site infection, or Subacute Obstruction, if we decide to do Metabolic surgery and Hernia together or defer the Hernia surgery. IPOM Plus was done with dual mesh with three port technique by Laparoscopy or Robotic for Hernia and Sleeve Gastrectomy Conclusion We compared our data and found that Hernia repair and Metabolic surgery can be done in the same sitting with favourable hernia and favourable obesity. Data Concomitant Bariatric with Hernia repair. (January 2008 to December 2021). Total number of patients: 21. BMI: 46.26 +/- 6.6. No. of Sleeve Gastrectomy: 19/ IPOM/ No Recurrence/ No SSI. No. of Gastric Bypass: 1/ PR/ No Recurrence. No. of MGB: 1/ PR/ 3 years later IPOM + Repair. Mean hospital stay: 2.5 days. No. of Post op Mesh infections: 0.

Unveiling the patterns: exploring social and clinical characteristics of frequent mental health visits to the emergency department-a comprehensive systematic review.

Frequent presenters (FPs) are a group of individuals who visit the hospital emergency department (ED) frequently for urgent care. Many among the group present with the main diagnosis of mental health conditions. This group of individual tend to use ED resources disproportionally and significantly affects overall healthcare outcomes. No previous reviews have examined the profiles of FPs with mental health conditions. This study aims to identify the key socio-demographic and clinical characteristics of patients who frequently present to ED with a mental health primary diagnosis by performing a comprehensive systematic review of the existing literature. PRISMA guideline was used. PubMed, PsycINFO, Scopus and Web of Science (WOS) were searched in May 2023. A manual search on the reference list of included articles was conducted at the same time. Covidence was used to perform extraction and screening, which were completed independently by two authors. Inclusion and exclusion criteria were defined. The abstracts of 3341 non-duplicate articles were screened, with 40 full texts assessed for eligibility. 20 studies were included from 2004 to 2022 conducted in 6 countries with a total patient number of 25,688 (52% male, 48% female, mean age 40.7years old). 27% were unemployed, 20% married, 41% homeless, and 17% had tertiary or above education. 44% had a history of substance abuse or alcohol dependence. The top 3 diagnoses are found to be anxiety disorders (44%), depressive disorders (39%) schizophrenia spectrum and other psychotic disorders (33%). On average, FPs are middle-aged and equally prevalent in both genders. Current data lacks representation for gender-diverse groups. They are significantly associated with high rates of unemployment, homelessness, lower than average education level, and being single. Anxiety disorder, depressive disorder, and schizophrenia spectrum disorders are the most common clinical diagnoses associated with the group.

Treatments for Olfactory Dysfunction in COVID-19: A Systematic Review.

Introduction Olfactory dysfunction (OD) has emerged as a notable symptom among coronavirus disease 2019 (COVID-19) patients, with its prevalence varying among different populations. Recognizing the need to provide therapeutic solutions for these individuals, the present study seeks to comprehensively review the current evidence on potential underlying mechanisms and treatment modalities to manage OD in COVID-19 patients. Objective To review the recent evidence on treatments for OD in COVID-19. From the beginning of the study until August 2nd, 2023, we conducted a systematic search on four electronic databases, PubMed, Scopus, Embase, and Web of Science, to find relevant publications. Data Synthesis In the present study, 37 articles were selected for data extraction and included in the final review. The total number of patients was of 3,560 (2,098 female and 1,462 male subjects). The predominant disorders reported were hyposmia, anosmia, and parosmia. In most of the studies, the pre and postintervention assessments were the same, except for one study, in which the pre-intervention assessment of the disorder was through the SST, Sniffin' Sticks Test (SST), and the post-intervention assessment was through the Visual Analog Scale (VAS) and the 22-item Sinonasal Outcome Test (SNOT-22). The findings suggest olfactory training (OT), ivermectin, palmitoylethanolamide, luteolin, and systemic corticosteroids, in combination with topical corticosteroids, are potential therapies for COVID-19 patients with olfactory impairment. Conclusion Although the review suggested several medications for OD treatment, further research must delve into the specific impact of OT, a non-pharmacological modality, regarding the mitigation of OD. By continuing to investigate and refine these therapeutic approaches, we can better support COVID-19 patients and improve their quality of life while navigating the challenges posed by OD.

First-line pharmacological treatment of vasovagal syncope based on syndrome phenotype

Abstract Background/Introduction The pharmacological treatment of recurrent vasovagal syncope (VVS) remains suboptimal. A significant proportion of patients exhibit a specific, stress-related personality trait, defined as anxiety sensitivity; fluoxetine treatment seems more effective than placebo in initial studies, underpinning the importance of central mechanisms in VVS pathophysiology. In addition, midodrine is a proposed treatment for the hypotensive VVS phenotype (class IIb ESC indication), implying that peripheral mechanisms may be more important in the hypotensive VVS phenotype. Purpose The purpose of this study was 2-fold: a) to classify recurrent VVS episodes based on history, initial examination (including anxiety sensitivity questionnaire results) and head-up tilt testing into i) central type, ii) peripheral type, and b) to study the effect of fluoxetine in patients with recurrent central-type syncope as well as the effect of midodrine in patients with peripheral-type syncope. Methods Sixty-eight consecutive patients with at least 2 VVS episodes during the preceding 6 months and a positive head-up tilt test were studied, in a 2:1 randomized, single-blind, placebo-controlled way. They were initially classified into i) patients with central-type VVS, and ii) those with peripheral-type VVS based on history, clinical examination, tilt test characteristics, as well as a positive or negative 16-item anxiety sensitivity screening questionnaire. The first group (n=33) was randomized to fluoxetine vs placebo, while the second group (n=31) to midodrine vs placebo. During 2 years of follow-up, and after a 1-month blanking period, we assessed i) syncope/presyncope-free time in patients receiving fluoxetine (or midodrine) vs similar-type patients assigned to placebo treatment, ii) total number of patients who experienced syncope or presyncope between the respective groups. Results Fluoxetine vs placebo. In the intention-to-treat analysis the fluoxetine group exhibited more syncope-free time (14% vs 48%, p <0.05) and similar results were observed regarding presyncope (22% vs 57%, p <0.05). A significant difference was also observed between the two groups regarding the total number of patients who experienced syncope or presyncope during follow-up. Midodrine vs placebo. Midodrine was more effective than placebo regarding presyncope (presyncope-free time 19% vs 45%, p<0.05), while a non-significant difference was observed regarding syncope. However, a significant difference was observed between the two groups regarding the total number of patients who experienced syncope or presyncope during follow-up (p<0.05). Conclusions Fluoxetine or midodrine seem superior to placebo as a first-line pharmacological treatment for recurrent VVS and a central or peripheral phenotype, respectively. Each substance may be an effective first-line pharmacological treatment for patients specifically selected by a simple, initial clinical assessment of VVS phenotype.

The effect of antiphospholipid antibodies on the frequency of extrasystoles in men with coronary heart disease and and myocardial infarction

Abstract Background Coronary heart disease (CHD) is one of the most socially significant diseases of the cardiovascular system. Acute myocardial infarction (MI) develops 10 years earlier in men than in women. Manifestation of MI in young men quite often happen without clinically significant stenosis of coronary vessels. And fatal arrhythmias are one of the main causes of death in patient with cardiovascular diseases. Purpose To evaluate the clinical and pathogenetic significance of antiphospholipid antibodies (aPL) in patients with MI and disorders of rythm. Methods 107 patients men (average age 51.2 ± 6.15 years) with CHD and MI were examined. The content of aPL IgG - antibodies to cardiolipin, phosphatidylserine, phosphatidylinositol, phosphatidylacetate in the blood serum were determined by enzyme-linked immunosorbent assay and electrocardiography Holter monitor 24 hours tests were done. Results aPL IgG were detected in 56 patients (52,3% of the total number of patients with MI), it concentration threshold 10 GPL U/ml in blood serum. The median age of first acute MI in men 56 years, according to the literary data. In our investigation average age of aPL positive patients is 44.8 ± 5.47 years. They had first MI on average 12 years earlier than general population. The level of aPL IgG in blood serum was higher in 1,7 times (19,3 ± 7,32 GPL U/ml and 11,4 ± 5,41 GPL U/ml (p <0.05) in patients with recurrent MI compared to one MI. Also the results of the study showed that the highest prevalence of polytopic extrasystoles is observed among aPL positive CHD patients with recurrent MI (68,3%) compared to one MI in anamnesis (26,3%). Moreover, 23.2% of people who had recurrent MI had ventricular extrasystole of high gradations. It is important to note, that іn patients with first Q-MI levels of aFL IgG were in 1.27 times higher (p<0.05) than in patients with first non-Q-MI. And the frequency of the polytopic extrasystoles was on 38% higher (p<0.01) іn patients with first Q-MI compared to patients with first non-Q-MI. Conclusion The results obtained by us indicate the possible involvement of the autoimmune factor, in particular aPL IgG, in the pathogenesis of CHD. Positive correlation of aPL IgG with the frequency of rhythm disorders indicates the severity of condition in men with CHD and MI in anamnesis and need for further research.

P.127 Quality of life (QoL) using EORTC QoL-C30 and BN20 among patients who underwent brain tumor resection in a tertiary hospital in Saudi Arabia

Background: Quality of life (QoL) is the awareness of individuals’ well-being in life in physical, personal, mental and social wellbeing and needs to be addressed in brain tumor patients. Methods: A retrospective study conducted in 2017 in a single academic center that included patients diagnosed with brain tumors in a 10 year period. The assessment of the QoL was done using the European Organization for Research and Treatment of Cancer (EORTC), a standardized model (QLQ-C30) that assess several domains (Global Health, Physical function, Role functioning, Emotional Functioning, Cognitive functioning, social functioning and symptoms domain) and Brain cancer model (BN20) to assess symptoms to evaluate all aspects of wellbeing. Results: The total number of patients included in this study is 76 patients with no gender predilection. The most common brain tumor was meningioma by 40% followed by glioma/ others. More than half of the brain tumor patients had a WHO grade I (65%), intermediate grading grade II (15%) and higher grading grade III/IV (20%). The scales and measurements of functioning in life were low in all types of brain tumors. Conclusions: Quality of life in brain tumor patients seemed poor regardless of the type. Further prospective studies are needed to assess QoL worldwide.

#620 Remaining life expectancy of Korean hemodialysis patients: how much longer can they live?

Abstract Background and Aims Hemodialysis (HD) patients have a higher mortality rate compared to general population. However, no study has investigated life expectancy in Korean HD patients so far. Therefore, this study aimed to calculate the remaining life expectancy among Korean maintenance HD patients and compare it to those of general population as well as HD patients from other countries. Method Baseline data were retrieved from HD quality assessment data from October to December 2015. Among the total number of patients who were alive at the beginning of 2016 (20,537 men and 14,404 women), a total of 22,439 (12,848 men and 9,591 women) were still alive at the end of 2021 while 12,502 (7,689 men and 4,813 women) were deceased during 6 years of follow-up. We used the life table method to calculate the expected remaining years of life in two-year increments. Results The mean age of the patients was 60.5 ± 12.4 years, and 58.7% were male. The average duration of HD was 5.63 ± 5.11 years. The most common cause of end-stage kidney disease was diabetes mellitus (42.0%), followed by hypertension (27.1%) and glomerulonephritis (10.9%). The remaining life expectancy for 60-year-old patients were 11.64 years for men and 14.64 years for women. The average remaining lifetimes of the HD population were only about a half of the general population (Fig.). Diabetic patients demonstrated shorter life expectancy compared to the patients with hypertension or glomerulonephritis. The remaining life expectancy of Korean HD patients was similar to that of Japanese and was almost double that of HD patients in Western countries such as Europe and United States. Conclusion HD population showed shorter life expectancy compared to the general population. Asian HD population seemed to demonstrate better patient survival compared to other countries. Longitudinal analysis should be warranted to analyze the effect of advanced dialysis technology upon improved survival rate among HD population.

#2617 Impact of CKD screening in high‑risk populations and guideline-directed therapy on RRT, CV events, and mortality in Europe: an IMPACT CKD analysis

Abstract Background and Aims Despite the rising and substantial burden of chronic kidney disease (CKD), there is a lack of recognition of CKD as a health priority in Europe. This contributes to underdiagnosis of CKD despite the potential for early detection and effective intervention to delay progression to late-stages (associated with costly and resource-intensive renal replacement therapy [RRT; i.e., dialysis and transplantation]). Further, diagnosed patients are undertreated when compared to current and upcoming CKD guidelines, leading to increased risk for progression to RRT and cardiovascular (CV) or other events. Early detection and intervention in high-risk populations, such as those with diabetes mellitus (DM) and hypertension (HTN) have shown cost-effectiveness; however, the broader implications of these strategies on CKD progression and clinical outcomes in a European context remains underexplored. Our study aims to illustrate the clinical benefit of targeted screening followed by an optimal compliance to guideline-directed treatment use to provide insight into potential CKD policies across Europe. Method Four country populations (Germany, Netherlands, Spain, United Kingdom [UK]) were simulated for 10-years (baseline: 2022; simulated years: 2023-2032) using the validated IMPACT CKD model to compare two scenarios: targeted screening for people with DM and/or HTN followed by 90% compliance to guideline-directed therapy versus current practice (i.e., underdiagnosis without screening and low treatment rates). Annual targeted screening was modelled using estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing. Initiation of therapies for people with diagnosed CKD was based on Kidney Disease Improving Global Outcomes guidelines. A 90% compliance to guideline-directed therapies was assumed to approximate maximum clinical benefit. Current practice was modelled based on the observed diagnosed rate without screening and the observed treatment rate in each country. The incremental population initiated on recommended therapies were modelled to experience a multiplicative treatment effect on GFR decline, CV events, and acute kidney injury (AKI) events. The model projected CKD and RRT prevalence, incidence of CV and AKI events with results shown for year 10 (2032), as well as cumulative all-cause mortality over the simulated 10-years. Results Results compare the high-risk population screening followed by guideline-directed treatment scenario to continuation of current practices for the four countries (Fig. 1). The identification of undiagnosed CKD, as well as lower rates of progression due to guideline-directed treatment was associated with a small rise in the number of total CKD patients, with increases in stage 1-2 by 3.5% to 5.0%, and stage 3-5 by 0.2% to 1.2%. There was a reduction in the number of undiagnosed CKD stage 1-2 patients by 49.2% to 71.6%, and stage 3-5 by 60.2% to 69.8%. The largest reductions were predicted for CV events (44.6% to 49.1%) followed by dialysis (22.6% to 41.9%). The strategy resulted in a decrease in cumulative 10-year all-cause mortality between 4.5% to 9.1% in CKD patients. Conclusion The study predicted significant clinical benefits from targeted CKD screening followed by guideline-directed interventions across all four European countries. Notably, this approach was forecasted to reduce undiagnosed CKD cases, dialysis, CV events, and mortality. These findings underscore the potential of acting earlier on CKD to mitigate the future CKD burden.

#260 Epidemiology of immunoglobulin A nephropathy (IgAN) in Germany

Abstract Background and Aims Immunoglobulin A nephropathy (IgAN) is a rare kidney disease characterized by proteinuria, persistent micro- or macrohematuria, and arterial hypertension. It can take a variety of courses from long-term minor symptoms to rapid progressive loss of kidney function with terminal renal failure. Epidemiological measures often refer to the proportion of IgAN among patients with glomerulonephritis instead of the entire population. Therefore, we estimated the prevalence and incidence of IgAN in Germany. Method Statutory health insurance (SHI) claims data from a large German database (InGef research database) with approximately four million insurees was retrospectively analyzed. The database represents about 5% of the German population and is representative of the German demographic and clinical structure in terms of age, gender, region, morbidity, mortality, and medication usage. As there is no specific IgAN code in ICD-10-GM and coding practices vary between physicians, two algorithms with different sets of codes were developed to estimate a lower and upper bound of the 1-year prevalence and incidence from 2017-2022. The lower bound considered specific diagnosis codes which usually rely on biopsies (N00.3, N02.3, N06.3). The upper bound included a broader field of specific and unspecific codes (N00.3, N02.3, N02.5, N02.7, N02.8, N02.9, N06.3, N06.8) that are potentially used by physicians to diagnose IgAN. Identified patients were described in terms of age and gender. Results were extrapolated to the German overall population, and a trend for the upcoming five years was estimated by applying the mean prevalence and incidence from the years 2017 to 2022 to the forecasted German population for the years 2023 to 2027. Results In 2022, the 1-year prevalence of IgAN ranged from 5 (lower bound) to 38 (upper bound) per 100 000 individuals in Germany. This corresponds to approximately 4 000 and 32 200 affected patients in Germany, respectively. There was no significant change from 2017 to 2022 with mean rates ranging from 4 (lower bound) to 38 (upper bound) per 100 000 individuals in Germany. The number of prevalent patients in Germany is expected to slowly increase in the coming years due to a forecasted increasing German overall population. About 57% of the prevalent IgAN patients in 2022 were male and the mean age was 59 years for the upper bound. For the lower bound about 73% of the prevalent IgAN patients in 2022 were male and the mean age was 53. The 1-year incidence of IgAN in 2022 ranged from 0.2 (lower bound) to 0.6 (upper bound) per 100 000 individuals in Germany. Extrapolation to the German population resulted in 164 to 538 newly diagnosed IgAN patients, respectively. Both the lower and the upper bound remained stable from 2017 to 2022 with slight fluctuations and a mean incidence rate of 0.2 (lower bound) and 0.6 (upper bound) per 100 000. The trend estimation showed steady numbers of incident patients in Germany until 2027 with a minor tendency towards an increase. About 86% (lower bound) and 83% (upper bound) of the incident IgAN patients in 2022 were male and the mean age was 36 years (lower bound) and 44 years (upper bound). Conclusion Estimating the epidemiology of IgAN is challenging as physicians use different ICD codes for diagnosis. To capture the uncertainty, an upper and lower bound of the prevalence and incidence were assessed as a minimum and maximum of patient numbers. Overall, IgAN was shown to be a rare disease with a prevalence of less than 50 per 100 000 in Germany. The upper bound of the incidence rate dropped in 2020 which may be associated with the onset of the global COVID-19 pandemic in March 2020, but the rate picked up in 2021 and the lower bound did not indicate an effect caused by the pandemic. Due to the forecasted rising population in Germany until 2027, the total number of prevalent and incident IgAN patient is expected to increase slowly.

#226 Outcome of intermittent hemodialysis vs. continuous kidney replacement therapy for acute kidney injury: observational prospective multi-center study

Abstract Background and Aims Continuous hemodialysis in hemodynamically stable acute kidney injury (AKI) patients may impact outcome differently compared to intermittent hemodialysis, although this issue is controversial. We look at differences in AKI outcomes between patients treated with intermittent hemodialysis (IHD) and patients treated with continuous kidney replacement therapy (CKRT) modalities in in Kuwait. Method Clinically and hemodynamically stable adult inpatients with native kidneys (i.e., did not need inotropic support or mechanical ventilation) who received IHD or CKRT for AKI, in seven public hospitals in Kuwait between 1/January to 31/December 2021 were recruited. CKRT was selected due to lack of access to water treatment in patients wards in some of the participating hospitals. Demographics, comorbidities, dialytic and non-dialytic management data, and 30-day kidney and patient outcome data for, were prospectively collected and analyzed. Results Total number of AKI patients not on inotropic support and not mechanically ventilated who received dialysis during study period was 229 (age: 59.9 years; males: 60.3%; baseline eGFR: 56 ml/min). IHD (group 1) was performed in 27.1% of the cohort whereas CKRT (group 2) was performed in 72.9%. There was no statistically significant difference between the two groups in age (58.4 for IHD and 59.9 for CKRT, p=0.6), baseline eGFR (55 ml/min for IHD and 56.4 for CKRT, p=0.8), sex ratio, incidence of diabetes, hypertension or cardiovascular disease, or cause of AKI. However, renin angiotensin aldosterone system inhibitors (RAASi) were precipitating factors for AKI more significantly in the IHD group (25.8% vs. 6% for CKRT, P ≤ 0.001). Intensive care unit (ICU) contributed 21% of cases (14.5% for IHD and 23.4% for CKRT, insignificant p value of 0.1). Also, there was no statistically significant difference in receiving intravenous fluids between the two groups (71% for IHD vs. 71.5% for CKRT, p=0.8), however, more patients in the IHD group received diuretics (62.9% vs 43.1% for CKRT, p=0.008). Dialysis vascular access was right internal jugular vein in 59% (75.8% FOR IHD vs. 52.7% for CKRT) followed by femoral vein in 35% of cases (19.4%). Extracorporeal membrane oxygenation (ECMO) was used in only two cases in the CKRT group. Of the total cohort, 21.8% died, with no difference between the two groups (16.1% for IHD vs 24% for CKRT, p=0.2). Partial recovery was higher in IHD group (30.8% vs.17.3%, p=0.046) and complete recovery higher in CKRT group 33.1% vs 13.5%, p=0.009). eGFR at 30 days was 53.2 ml/min with no statistically significant difference between the two groups (44.6 for IHD vs 56.1 for CKRT, p=0.15). Conclusion The IHD group and the CKRT group were statistically similar in basic characteristics and received similar lines of management, except for the diuretics. At 30 days, they had similar death rates but CKRT group had higher rates of complete recovery than the IHD group. This is in line with published literature that suggest CKRT may not improve mortality but may improve kidney recovery.

#1471 The role of genealogy in patients with CKD in primary health care

Abstract Background and Aims Improving the risk prediction of adverse outcomes of chronic kidney disease at the level of primary care physicians, through early diagnosis of chronic kidney disease, can help reduce the progression of the disease, improve the clinical condition of patients and the prognosis of the disease, reduce the number of patients with terminal stage, reduce disability rates and reduce lethality. The aim of our study is to explore the role of genealogical analysis in patients with CKD at the primary care level. Method In primary healthcare settings, 217 patients with CKD were under observation, with an average age of 46.17±0.63 years, predominantly of Uzbek nationality. A control group of 20 healthy people of Uzbek nationality of the same age without signs of CKD. After compiling the legend of 217 families, a pedigree was compiled and a genealogical analysis was carried out. In order to identify the severity of CKD, the data obtained were compared with the results of an analysis of pedigrees of individuals (n=20) in a healthy population. Using the genealogical method, 893 first-degree relatives (parents, siblings) of patients with CKD were examined for the presence of renal pathology. A detailed pedigree was compiled, which included information about diseases in 2-3 generations of the family. Genetic material was collected from both parental lines by cross-questioning both parents, and sometimes grandparents. A total of 1761 people were analyzed in the model population. Results The data obtained were compared with the generalized family response of 20 practically healthy people, in the model population of which 172 people were analyzed, of which the incidence of renal pathology was 2.13%. A comparative analysis of a generalized family portrait of patients with CKD with a generalized family portrait of a population of practically healthy people revealed a more frequent incidence of renal pathology in relatives with CKD (11.07%%). In families of probands, renal pathology in generations in relation to the total number of patients of each concentration is III - 7.49%; II - 11.06%; I- 17.43%. The burden in the population of practically healthy people was observed significantly less: III - 0%; II- 0.15%; I- 0%. It turned out that renal pathology more often affects first-degree relatives (130 (14.56%), which in relation to the total number of patients in this concentration is 7.38%. Hereditary burden of renal pathology was observed more often on the father's side in 46 (10.60±0.34%) than on the mother's side in 19 (4.38±0.34%). Conclusion The results of our study indicate a significant prevalence of CKD in families of probands, but with a predominance of first-degree relatives being affected. Pedigree analysis confirms the absence of a monogenically inherited disease, such as simple recessive or dominant inheritance. Along with this, the widespread prevalence of renal pathology in the population suggests that only a predisposition to the development of CKD is inherited. Thus, according to our data, it is necessary to recommend the study of genealogical analysis of patients at the level of primary healthcare. Moreover, this is more accessible in primary health care with family doctors.