Total Severity Score Research Articles

Abstract 13351: Firefighter Coronary Atherosclerotic Burden Compared to Non-Firefighters

Introduction: Cardiovascular (CV) disease is the leading cause of death for on-duty firefighters. According to the National Fire Protection Association (NFPA), 44% of all fatalities were due to sudden cardiac deaths, and 90% of which were due to coronary artery disease. Furthermore, firefighters are prone to occupational behaviors, conditions, and environmental exposures that may increase their adverse outcomes. In this study, we will attempt to explore the atherosclerotic differences between firefighters and non-firefighter individuals. Methods: 302 firefighters from the Los Angeles fire department who underwent coronary computed tomography angiogram from 2008 to 2021 were matched 1:1 for age, gender, race, diabetes mellitus (DM), hyperlipidemia (HLD), hypertension (HTN), and past smoking to a control cohort for comparison of semi-quantitative coronary plaque burden. Each coronary segment was assessed by a semi-quantify plaque severity (0 for no plaque, 1 for minimal or mild, 2 for moderate, 3 for severe) and luminal stenosis (0: none, 1: <30%, 2: 30-49%, 3: 50-69%, 4: 70-99% and 5:100%). The total plaque severity score (TPS) was calculated by the sum of the individual segment plaque severity score. The total segment stenosis score (TSS) was calculated by adding all the individual segment stenosis score (SSS). Segment involvement score (SIS) was calculated by summing the total number of coronary segments with plaque. Results: Mean (SD) age was 51.3 (6.6); 2% were diabetic; 34% had hyperlipidemia; 19% were hypertensive; 10% were prior smokers in each cohort. The Fire Fighter cohort had significantly higher coronary calcium scores (mean 42.5 vs 12); p<0.0001, TPS at 3 (IQR (1,6) vs 2 (IQR (0,5)); p<0.0001, TSS 3 (IQR (1,5) vs 2 (IQR (0,5)); p<0.0001 , and SIS 2 (IQR (1,4) vs 2 (IQR (0,4)); p<0.0001. Conclusions: After matching for age, gender, race, DM, HTN, HLD, and past smoking. Firefighters had more plaque burden, more stenosis, and more diffuse disease when compared to nonfirefighters, illustrating the occupational effects on the atherosclerotic process

Test-Retest Reliability and Efficacy of Individual Symptoms in Concussion Management.

(1) To determine test-retest reliability of individual Sport Concussion Assessment Tool-Third Edition (SCAT-3) symptom scores and symptom severity scores, (2) to examine the specificity/sensitivity of individual SCAT-3 symptom severity scores acutely (24-48 hours) postconcussion, and (3) to develop a model of symptoms best able to differentiate concussed from nonconcussed student athletes and cadets. Prospective, longitudinal, and cross-sectional. Twenty-six civilian schools and 3 US service academies. Collegiate student athletes (n = 5519) and cadets (n = 5359) from the National Collegiate Athletic Association-Department of Defense Grand Alliance: Concussion Assessment, Research and Education Consortium, including 290 student athletes and 205 cadets, assessed 24 to 48 hours postconcussion. Concussed and nonconcussed student athlete and cadet groups. Sport Concussion Assessment Tool-Third Edition individual symptom severity scores, total symptom scores, and symptom severity scores. Results indicated poor test-retest reliability across all symptom scores (intraclass correlation coefficient = 0.029-0.331), but several individual symptoms had excellent predictive capability in discriminating concussed from nonconcussed participants (eg, headache, pressure in the head, and don't feel right had area under the curve >0.8, sensitivity >70%, and specificity >85%) regardless of baseline testing. These symptoms were consistent with Chi-square Automatic Interaction Detector classification trees with the highest mean probability. Findings support the excellent diagnostic accuracy of honest symptom reporting, notwithstanding the known limitations in symptom underreporting, and suggest that there may be added value in examining individual symptoms rather than total symptom scores and symptom severity scores alone. Finally, findings suggest that baseline testing is not necessary for interpreting postconcussion symptom scores.

Chest X-Ray Findings and Severity Score of Patients with Respiratory Symptoms in COVID-19 Intensive Care Unit of a Teaching Hospital

Background: Chest X-rays are important for tracking the progression of lung abnormalities, particularly in critically ill COVID-19 patients in the intensive care units (ICU). We aimed to assess correlation of chest X-ray findings with the COVID-19 disease severity and outcome. Methods: This prospective observational study was conducted at B & C Teaching Hospital, Birtamode from 15 March to 15 July 2021. All diagnosed COVID-19 patients admitted in the ICU for respiratory distress with oxygen saturation < 90% and evaluated by portable X-rays were enrolled. The radiographic findings were evaluated for the distribution and patterns of affection, and the total severity score was calculated using RALE scales of 0 - 8 and Brixia scales of 0 - 18. The scores were then compared between the expired and improved patients. Results: The age of patients (mean ± SD) was 48.2 ± 13.84 years. During the first four days of hospitalization, there was no significant difference in Brixia score (p = 0.793) or RALE score (p = 0.842) between expired and improved patients.The differences in both (Brixia and RALE) scores grew with each passing day (p < 0.05). The Brixia and RALE severity scores had a strong positive correlation at various stages of disease in both expired and improved patients. (r > 0.75, p < 0.001). Conclusion: In resource limited setting, the severity scores (RALE or Brixia) can be used as a quantitative method of the extent of COVID-19 pneumonia, correlating with an increased risk of ICU admission.

Attitudes toward Alzheimer's disease and dementia caregiving and health outcomes: Racial and ethnic differences

This study aimed to explore racial/ethnic differences in the attitudes toward Alzheimer's Disease (AD) and dementia caregiving among midlife women who were family caregivers of persons living with AD (MWPLAD) in the U.S. and examine the associations of the attitudes to their health outcomes. This was a cross-sectional online survey study among 172 MWPLAD. The instruments included: the Attitude toward AD and Related Dementias Scale, the Questions on Attitudes toward AD Caregiving, the Social Readjustment Rating Scale, the EQ-5D-5L and the Midlife Women's Symptom Index. Multiple linear regression analyses were conducted. There were significant racial/ethnic differences in caregivers’ attitudes toward dementia caregiving, health-related quality of life, and total severity scores of symptoms (p < .01). Controlling for covariates including race/ethnicity, caregivers’ positive attitudes toward dementia caregiving were significantly associated with their health outcomes (p ≤ .05). Interventions for MWPLAD need to consider racial/ethnical differences in their attitudes toward dementia caregiving.

Saliva Cortisol as a Biomarker of Injury in Youth Sport-Related Concussion.

Increasing rates of sport-related concussion (SRC) in youth impose a significant burden on public health systems and the lives of young athletes. Accurate prediction for those likely to develop persistent post-concussion symptomology (PPCS) using a fluid biomarker, reflecting both acute injury and recovery processes, would provide the opportunity for early intervention. Cortisol, a stress hormone released through the hypothalamic-pituitary-adrenal (HPA) axis following injury, may provide a missing physiological link to clinical recovery. This cohort study investigated the change in saliva cortisol following SRC and the association between cortisol and symptom burden in pediatric ice hockey players. Further, the association between cortisol levels and medical clearance to return to play was explored. In total, cortisol samples from 233 players were included; 165 athletes (23.6% female) provided pre-injury saliva and 68 athletes (19.1% female) provided post-SRC saliva samples for cortisol analysis. Quantile (median) regressions were used to compare cortisol between pre-injury and post-SRC groups, and the association between total symptoms (/22) and symptom severity scores (/132) reported on the Sport Concussion Assessment Tool (SCAT)3/SCAT5 and post-SRC cortisol (adjusting for age, sex, history of concussion, and time from injury to sample collection). Results demonstrated significantly lower saliva cortisol in post-SRC athletes compared with the pre-injury group (β = -0.62, 95% confidence interval [CI; -1.08, -0.16], p = 0.009). Post-SRC cortisol was not significantly associated with the SCAT3/SCAT5 symptom totals or symptom severity scores; however, females were found to report more symptoms (β = 6.95, 95% CI [0.35, 13.55], p = 0.040) and greater symptom severity (β = 23.87, 95% CI [9.58, 38.15], p = 0.002) compared with males. Exploratory time-to-event analysis revealed a point estimate suggesting a potential association between low cortisol levels and days to medical clearance to return to play. Although preliminary, these findings suggest that the HPA axis may be dysregulated post-SRC. Further, our exploratory analysis and case presentation of post-injury outliers highlight the need to further research cortisol as a prognostic biomarker to inform individualized sex-specific care after SRC.

Update on Posttraumatic Stress Disorder and Implications for Acute and Critical Care APRNs.

Update on Posttraumatic Stress Disorder and Implications for Acute and Critical Care APRNs.

Obsessive Compulsive Disorder with Porn Addiction during the COVID-19 Pandemic

COVID-19 Pandemic is an unprecedented humanitarian crisis that has affected the mental health of individuals immensely. OCD was among the mental health conditions that emerged with the new norm that is associated with repeated hand wash, social distancing and testing to confirm COVID-19. Nissen et al. (2020) found that there was a significant positive correlation between total OCD severity scores and the occurrence of OCD aggressive and sexual symptoms. [6] The COVID-19 lockdown translated into physical isolation, driving individuals to waste time online with no definite purpose, spending longer, abnormal durations of time online when bored, leading to increased consumption of online pornography. Since March 2020, during the lockdown period, Pornhub has seen a worldwide increase in pornography use of 11.6% compared to the previous average days. [9]

Correlates of suicidality among standard rating scales and the Columbia-Suicide Severity Rating Scale (C-SSRS) in adolescents undergoing transcranial magnetic stimulation

Background: Suicide is a leading cause of death in adolescents and young adults.1 This study sought to examine correlations among suicide items of standard rating scales for depression and Columbia-Suicide Severity Rating Scale (C-SSRS)2 scores in adolescents participating in a transcranial magnetic stimulation study. Methods: This study examined data from adolescent patients (N=103) enrolled in a double-blind randomized control trial of transcranial magnetic stimulation (TMS). Total scores and respective individual items assessing suicidality from the Hamilton Depression Rating Scale (HAM-D)3, Montgomery-Asberg Depression Rating Scale (MADRS)4, and Children’s Depression Rating Scale-Revised scale (CDRS-R)5 were compared with C-SSRS total severity and total intensity scores using Pearson correlation coefficients at the end of acute treatment. Results: The suicidality item of the HAM-D scores showed a positive association with C-SSRS total severity and intensity scores at the end of acute treatment for ITT sample (n=103) (r = 0.83; p-value= <0.0001, r = 0.86; p-value=<0.0001), respectively. Similarly, associations were demonstrated with the CDRS-R Item 13 scores and the MADRS scores. Conclusions: Accurate and reliable assessments of suicidality are an ongoing challenge for clinical trials and practice. Suicidality measures of HAM-D and CDRS-R correlated with the C-SSRS suicide assessment scale. These measures can potentially contribute to assessing suicidal risk and be helpful as an outcome measure to monitor treatment response in various clinical settings. Further studies should compare the sensitivity and specificity of suicidality items of HAM-D and CDRS-R. Conflicts of Interests: Dr. Croarkin has received research support from the National Institute of Mental Health, Magventure, Neuronetics, NeoSync, and Pfizer. He has received material support from and provided consultation to Myriad Neuroscience. He has consulted for Procter & Gamble Company. Dr. Elmaadawi receives research support from Duke University and the University of North Western. He receives research funding from Neurocrine, Inc, and Neuronetics. Dr. Aaronson has received research support from Compass Pathways and Neuronetics and serves as a consultant to LivaNova, Neuronetics, Janssen, Genomind, and Sage Therapeutics. He serves on speaker boards for Janssen and Sunovion. Dr. Holbert has received material support (equipment) from Neuronetics. He is also a speaker for Neuronetics. Dr. Demitrack is a consultant to Neuronetics, Inc. and a full-time employee of Trevena, Inc. Dr. Strawn has received research support from Allergan, Neuronetics, Otsuka, the National Institute of Mental Health, National Institute of Child Health and Development, and National Institute of Environmental Health Sciences as well as the Yung Family Foundation. He receives royalties from Springer Publishing and received honoraria from CMEology and Neuroscience Educational Institute. He receives royalties from UpToDate. Finally, he received material support from and provided consultation to Myriad Genetics, Intracellular Therapeutics, and the FDA. The other authors have no disclosures. Funding: This study was funded by Neuronetics, Inc.

A-223 Preliminary Investigation of Convergent Validity and Utility of the Texas Postconcussion Symptom Inventory

Abstract Objective: The Texas Postconcussion Symptom Inventory (TPSI) is a novel, 66-item, self-report instrument with empirically-derived indices that provides a summed total score to assess recovery following concussion. This study evaluated convergent validity of the TPSI with the Sport Concussion Assessment Tool Post-Concussion Symptom Scale (PCSS), and examined differences in symptom scores between recovered and non-recovered adults to assess its utility in measuring post-concussion symptoms. Method: Adults (N=37; Mage=41.6; Female=59.5%; White=89.2%) diagnosed with concussion were recruited from a larger concussion study (ConTex) to complete the TPSI and PCSS three months after initial clinical evaluation. Convergent validity was assessed using nonparametric correlation analyses between total symptom severity scores on the PCSS and TPSI for all subjects. Independent sample t-tests examined whether the TPSI total symptom score differed between the adults reporting lingering symptoms (N=19) and those who had recovered (N=18). Results: Total TPSI symptom score strongly correlated with the PCSS total symptom score (ρ = .867; p&amp;lt;.001). Non-recovered adults (MTPSI = 55.61; SDTPSI = 26.38) reported significantly higher symptom scores than recovered adults (MTPSI = 34.64; SDTPSI = 22.69) on the TPSI t(35) = 2.59, p = .014, d = 0.85, 95% CI, [4.53, 37.32]. Conclusion(s): The TPSI demonstrated strong convergent validity with a common clinical postconcussion symptom instrument and identified significant differences in symptom reporting between recovered and non-recovered adults after a concussion. Future research will build upon these preliminary results and determine the utility of the TPSI in the acute stage following concussion as well as in tracking recovery.

A-16 More than Total Symptom Severity: Identifying Subtypes of Persistent Post-Concussion Symptoms using Normative Data

Abstract Objective: Prior factor analyses have supported the multidimensionality of post-concussion symptoms, but the symptom total score is often interpreted alone in practice. This study examined the added value of norm-referenced post-concussion symptom subscales to detect different subtypes of symptom presentations following concussion. Method: Adolescent student-athletes (N = 1008; 15.3 ± 1.4 years-old; 66.7% boys) with one or more prior concussions, at least 6 months post injury, completed the Post-Concussion Symptom Scale at preseason baseline. Severity ratings on four symptom subscales (i.e., cognitive, sleep-arousal, physical, and affective) were compared to normative data matched on gender and preexisting health conditions. The frequencies at which participants were elevated on one or more symptom subscales were calculated. Results: In the total sample, 21% of student-athletes were elevated on only one symptom subscale, 11% on two subscales, 8% on three subscales, and 6% on four subscales. Among student-athletes with a single elevated subscale, all symptom domains had similar frequencies of elevation. No differences in symptom elevations were found based on gender or number of prior concussions. Conclusion(s): A single-domain symptom elevation was the most common post-concussion symptom presentation among a cohort of adolescent student-athletes, with 26% of student-athletes elevated on a single subscale but not the total symptom score. These findings indicate that there are subtypes of post-concussion symptom presentations that would be missed through an interpretation of a total symptom severity score alone.

Therapist-Supported Internet-Delivered Exposure and Response Prevention for Children and Adolescents With Tourette Syndrome

The availability of behavior therapy for individuals with Tourette syndrome (TS) and chronic tic disorder (CTD) is limited. To determine the efficacy and cost-effectiveness of internet-delivered exposure and response prevention (ERP) for children and adolescents with TS or CTD. This single-masked, parallel group, superiority randomized clinical trial with nationwide recruitment was conducted at a research clinic in Stockholm, Sweden. Out of 615 individuals assessed for eligibility, 221 participants meeting diagnostic criteria for TS or CTD and aged 9 to 17 years were included in the study. Enrollment began in April 2019 and ended in April 2021. Data were analyzed between October 2021 and March 2022. Participants were randomized to 10 weeks of therapist-supported internet-delivered ERP for tics (111 participants) or to therapist-supported internet-delivered education for tics (comparator group, 110 participants). The primary outcome was change in tic severity from baseline to the 3-month follow-up as measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS). YGTSS-TTSS assessors were masked to treatment allocation. Treatment response was operationalized as a score of 1 ("Very much improved") or 2 ("Much improved") on the Clinical Global Impression-Improvement scale. Data loss was minimal, with 216 of 221 participants (97.7%) providing primary outcome data. Among randomized participants (152 [68.8%] boys; mean [SD] age, 12.1 [2.3] years), tic severity improved significantly, with a mean reduction of 6.08 points on the YGTSS-TTSS in the ERP group (mean [SD] at baseline, 22.25 [5.60]; at 3-month follow-up, 16.17 [6.82]) and 5.29 in the comparator (mean [SD] at baseline, 23.01 [5.92]; at 3-month follow-up, 17.72 [7.11]). Intention-to-treat analyses showed that the 2 groups improved similarly over time (interaction effect, -0.53; 95% CI, -1.28 to 0.22; P = .17). Significantly more participants were classified as treatment responders in the ERP group (51 of 108 [47.2%]) than in the comparator group (31 of 108 [28.7%]) at the 3-month follow-up (odds ratio, 2.22; 95% CI, 1.27 to 3.90). ERP resulted in more treatment responders at little additional cost compared with structured education. The incremental cost per quality-adjusted life-year gained was below the Swedish willingness-to-pay threshold, at which ERP had a 66% to 76% probability of being cost-effective. Both interventions were associated with clinically meaningful improvements in tic severity, but ERP led to higher response rates at little additional cost. ClinicalTrials.gov identifier: NCT03916055.

The efficacy of combined therapy of qingfeiPaidu capsule and lianhuaqingwen capsule nursing interventions for hospitalized patients with COVID-19: A retrospective study of medical records.

Coronavirus disease-19 (COVID-19) caused a global pandemic burden, affecting hundreds of thousands of individuals, having life-threatening outcomes. Traditional Chinese Medicine plays a crucial role in the treatment of patients with COVID-19. The purpose of this study was to investigate the efficacy of combined therapy of qingfeiPaidu (QFPD) capsule and lianhuaqingwen (LHQW) capsule nursing interventions in the treatment of patients with COVID-19. A total of 318 patients with COVID-19 were enrolled and randomly received QFPD (n = 106), LHQW (n = 106), and QFPD-LHQW (n = 106). The clinical characteristics of COVID-19, the total lung severity scores, and blood laboratory indices were recorded in each patient in each group before treatment and at the end of treatment.The outcomes demonstrated that QFPD-LHQW group shortened the length of hospitalization, decreased C-reactive protein, creatine kinase, creatine kinase-myocardial band, lactate dehydrogenase, and blood urea nitrogen levels, and improved clinical symptoms, pulmonary inflammation, and prognosis. At the end of treatment, inflammation, immune function, circulating white blood cells, total lymphocyte count, and glutamic-oxaloacetic transaminase levels improved dramatically in 3 groups compared with baseline. All patients met the discharge criteria after 30-day treatment in 3 groups. Combined therapy of QFPD and LHQW demonstrated significant anti-inflammatory effects compared with those of only QFPD or LHQW in patients with mild and moderate COVID-19. The combined therapies may alleviate clinical symptoms of COVID-19 patients by improving inflammation and immune function.

Natural history of lower urinary tract symptoms in treatment-seeking women with pelvic organ prolapse; the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN)

The association of pelvic organ prolapse with overactive bladder and other lower urinary tract symptoms, and the natural history of those symptoms are not well characterized. Previous cross-sectional studies demonstrated conflicting relationships between prolapse and lower urinary tract symptoms. This study primarily aimed to determine the baseline association between lower urinary tract symptoms and prolapse and to assess longitudinal differences in symptoms over 12 months in women with and without prolapse. Secondary aims were to explore associations between lower urinary tract symptoms and prolapse treatment. We hypothesized that: (1) prolapse is associated with the presence of lower urinary tract symptoms, (2) lower urinary tract symptoms are stable over time in patients with and without prolapse, and (3) prolapse treatment is associated with lower urinary tract symptom improvement. Women enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network Observational Cohort Study with adequate 12-month follow-up data were included. Prolapse and lower urinary tract symptom treatment during follow-up was guided by standard of care. Outcome measures included the Lower Urinary Tract Symptoms Tool total severity score (in addition to overactive bladder, obstructive, and stress urinary incontinence subscales) and Urogenital Distress Inventory-6 Short Form. Prolapse (yes or no) was defined primarily when Pelvic Organ Prolapse Quantification System points Ba, C or Bp were >0 (beyond the hymen). Mixed-effects models with random effects for patient slopes and intercepts were fitted for each lower urinary tract symptom outcome and prolapse predictor, adjusted for other covariates. The study had >90% power to detect differences as small as 0.4 standard deviation for less prevalent group comparisons (eg, prolapse vs not). A total of 371 women were analyzed, including 313 (84%) with no prolapse and 58 (16%) with prolapse. Women with prolapse were older (64.6±8.8 vs 55.3±14.1 years; P<.001) and more likely to have prolapse surgery (28% vs 1%; P<.001) and pessary treatment (26% vs 4%; P<.001) during the study. Average baseline Lower Urinary Tract Symptoms Tool total severity scores were lower (fewer symptoms) for participants with prolapse compared with those without (38.9±14.0 vs 43.2±14.0; P=.036), but there were no differences in average scores between prolapse groups for other scales. For all urinary outcomes, average scores were significantly lower (improved) at 3 and 12 months compared with baseline (all P<.05). In mixed-effects models, there were no statistically significant interactions between pelvic organ prolapse measurement and visit and time-dependent prolapse treatment groups (P>.05 for all regression interaction coefficients). The Lower Urinary Tract Symptoms Tool obstructive severity score had a statistically significant positive association with Pelvic Organ Prolapse Quantification System Ba, Bp, and point of maximum vaginal descent. The Lower Urinary Tract Symptoms Tool total severity scale had a statistically significant negative association with Pelvic Organ Prolapse Quantification System Ba and point of maximum vaginal descent. No other associations between prolapse and lower urinary tract symptoms were significant (P>.05 for all regression coefficients). Symptom differences between prolapse groups were small: all regression coefficients (interpretable as additive percentage change in each score) were between -5 and 5 (standard deviation of outcomes ranged from 14.0-32.4). Among treatment-seeking women with urinary symptoms, obstructive symptoms were positively associated with prolapse, and overall lower urinary tract symptom severity was negatively associated with prolapse. Lower Urinary Tract Symptoms Tool scores improved over 12 months regardless of prolapse status, including in those with treated prolapse, untreated prolapse, and without prolapse.

Total Severity Score (TSS) comparison in vaccinated and unvaccinated patients during the fourth wave (December 2021 - January 2022) of COVID-19 in Italy.

This study aims at comparing the severity score assessed using high-resolution computed tomography (HRCT) in vaccinated and unvaccinated COVID-19 patients. From the first of December 2021 to first of February 2022, we conducted a single-center retrospective analysis on COVID-19 patients who accessed ED services. The hospital in question is a level II facility with a catchment area of around 200,000 people. According to the Italian recommendations, patients were divided into four groups based on the CT score of Micheal Chung. The sum of acute inflammatory lung lesions involving each lobe was scored as 1 (0-25%), 2 (26-50%), 3 (51-75%) or 4 (76-100%) on a visual quantitative assessment of CT. The total severity score (TSS) was determined by summing the five lobe scores. The study included 134 patients divided into two groups: 67 vaccinated and 67 unvaccinated people. 53 people had incomplete (single dose/double dose) immunization, while 14 people completed the vaccination cycle. It was discovered that the mean CT severity score was lower in fully vaccinated patients compared to partially vaccinated or unvaccinated patients. The mean CT score was significantly lower in fully vaccinated patients aged 60 compared to older patients. The mean CT score was higher in unvaccinated patients compared to fully vaccinated patients. Individuals who received three doses of COVID-19 vaccination had lower CT severity scores than patients who received only one dose of vaccine or no vaccines at all.

Predictive Factors of Severe Behçet's disease: A Longitudinal, Prospective Cohort Followed Between 1981–2020

IntroductionBehçet's disease (BD) is a systemic vasculitis of unknown cause. The spectrum of the disease ranges from mucocutaneous manifestations to other organ diseases with relevant morbidity. Associations between disease severity and male sex, earlier age at onset, and the presence of erythema nodosum have been described. ObjectivesTo evaluate clinical factors associated with manifestations of severe disease in a single-center cohort. MethodsA longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic between 1981 and 2020. Severe BD was defined as a Krause total clinical severity score >4 points. ResultsWe included 243 patients, of whom 31% were male, with an average follow-up time of 14.6 years. Regarding organ manifestations, all patients had mucous manifestations (N=243, 100%), 133 (55%) skin, 104 (43%) joint, 71 (29%) ocular, 48 (20%) vascular, 47 (19%) neurological, 22 (9%) gastrointestinal and 1 (0.4%) cardiac involvement by BD. One hundred fifty-six (64%) patients were classified as having severe BD. Severe BD was more frequent in men (OR=2.004, p=0.024), increasing with age (OR=1.021 per year, p=0.037), in the presence of skin manifestations (OR=4.711, p<0.001), specifically erythema nodosum (OR=8.381, p<0.001), and pseudofolliculitis (OR=2.910, p<0.001).In the multivariate model, variables independently associated with severe BD were male gender (Adjusted OR=1.961, p=0.047), erythema nodosum (Adjusted OR=8.561, p<0.001) and pseudofolliculitis (Adjusted OR=2.372, p=0.007). DiscussionMale gender, erythema nodosum, and pseudofolliculitis were independently associated with severe BD forms and therefore should serve as warning signs to the clinician.

Predictive Factors of Severe Behçet's disease: A Longitudinal, Prospective Cohort Followed Between 1981-2020.

Behçet's disease (BD) is a systemic vasculitis of unknown cause. The spectrum of the disease ranges from mucocutaneous manifestations to other organ diseases with relevant morbidity. Associations between disease severity and male sex, earlier age at onset, and the presence of erythema nodosum have been described. To evaluate clinical factors associated with manifestations of severe disease in a single-center cohort. A longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic between 1981 and 2020. Severe BD was defined as a Krause total clinical severity score >4 points. We included 243 patients, of whom 31% were male, with an average follow-up time of 14.6 years. Regarding organ manifestations, all patients had mucous manifestations (N=243, 100%), 133 (55%) skin, 104 (43%) joint, 71 (29%) ocular, 48 (20%) vascular, 47 (19%) neurological, 22 (9%) gastrointestinal and 1 (0.4%) cardiac involvement by BD. One hundred fifty-six (64%) patients were classified as having severe BD. Severe BD was more frequent in men (OR=2.004, p=0.024), increasing with age (OR=1.021 per year, p=0.037), in the presence of skin manifestations (OR=4.711, p<0.001), specifically erythema nodosum (OR=8.381, p<0.001), and pseudofolliculitis (OR=2.910, p<0.001). In the multivariate model, variables independently associated with severe BD were male gender (Adjusted OR=1.961, p=0.047), erythema nodosum (Adjusted OR=8.561, p<0.001) and pseudofolliculitis (Adjusted OR=2.372, p=0.007). Male gender, erythema nodosum, and pseudofolliculitis were independently associated with severe BD forms and therefore should serve as warning signs to the clinician.

The Effect of Maintenance Treatment with Erdosteine on Exacerbation Treatment and Health Status in Patients with COPD: A Post-Hoc Analysis of the RESTORE Dataset.

PurposeTo explore the effect of erdosteine on COPD exacerbations, health-related quality of life (HRQoL), and subjectively assessed COPD severity.Patients and methodsThis post-hoc analysis of the RESTORE study included participants with COPD and spirometrically moderate (GOLD 2; post-bronchodilator forced expiratory volume in 1 second [FEV1] 50‒79% predicted; n = 254), or severe airflow limitation (GOLD 3; post-bronchodilator FEV1 30‒49% predicted; n = 191) who received erdosteine 300 mg twice daily or placebo added to usual maintenance therapy for 12 months. Antibiotic and oral corticosteroid use was determined together with patient-reported HRQoL (St George’s Respiratory Questionnaire, SGRQ). Patient and physician subjective COPD severity scores (scale 0‒4) were rated at baseline, 6 and 12 months. Data were analyzed using descriptive statistics for exacerbation severity, COPD severity, and treatment group. Comparisons between treatment groups used Student’s t-tests or ANCOVA as appropriate.ResultsAmong GOLD 2 patients, 43 of 126 erdosteine-treated patients exacerbated (7 moderate-to-severe exacerbations), compared to 62 of 128 placebo-treated patients (14 moderate-to-severe exacerbations). Among those with moderate-to-severe exacerbations, erdosteine-treated patients had a shorter mean duration of corticosteroid treatment (11.4 days vs 13.3 days for placebo, P = 0.043), and fewer patients required antibiotic treatment with/without oral corticosteroids (71.4% vs 85.8% for placebo, P < 0.001). Erdosteine-treated GOLD 2 patients who exacerbated showed significant improvements from baseline in SGRQ total scores and subjective disease severity scores (patient- and physician-rated), compared with placebo-treated patients regardless of exacerbation severity. Among GOLD 3 patients, there were no significant differences between treatment groups on any of these measures.ConclusionAdding erdosteine to the usual maintenance therapy of COPD patients with moderate airflow limitation reduced the number of exacerbations, the duration of treatment with corticosteroids and the episodes requiring treatment with antibiotics. Additionally, treatment with erdosteine improved HRQoL and patient-reported disease severity.

A-23 Neurorehabilitation of Equestrians with Post-Concussive Syndrome Decreases Symptom Severity

Abstract Purpose: The literature shows the risk of concussion for equestrians is equivalent to or greater than athletes in contact sports with approximately half of all equestrians reporting one or more concussions in their career. Despite this, the majority of equestrians do not receive care for their concussion which can lead to chronic neuropsychological symptoms and post-concussion syndrome. Methods: A neurorehabilitation clinic treated 6 equestrians, 100% female with an average age of 40.5 years (+/−9.5), with post-concussion syndrome following head injuries received while riding. A 5-day, multi-modal neurorehabilitation program was administered in 10 one-hour treatment sessions. Each session consisted of a patient-specific combination of photobiomodulation, repetitive peripheral somatosensory stimuli, neuromuscular reeducation, vestibular rehabilitation, orthoptic exercises, cognitive exercises, and/or off-vertical axis rotation utilizing a multi-axis rotational chair. Results: On intake, average overall symptom severity score of the SCAT5 graded symptom checklist was 44.17 (+/−23.90), and average severity of emotional domain symptoms (Nervousness/Anxiety, Irritability, Sadness, More Emotional) was 6.67 (+/−4.80). On exit, the average emotional domain symptom severity score decreased by 67.50% (2.17 +/−2.14) while the average total symptom severity score decreased by 57.74% (18.67 +/−14.60). Conclusions: The results show that neurorehabilitation was beneficial at decreasing overall symptom severity in equestrians with post-concussion syndrome, especially symptoms within the emotional domain. The authors suggest further research be performed with a more diverse and larger population and further concussion education be provided to equestrians to promote seeking care following a head injury.

Cluster Analysis on Gastrointestinal Symptoms during Menopausal Transition.

The purpose of this secondary analysis was to determine the clusters of midlife women by gastrointestinal (GI) symptoms and to explore differences in the clusters by race/ethnicity. This analysis used the data from two internet-based studies among 1,054 midlife women. The analysis was conducted with the data on background characteristics, health and menopausal status, and GI symptoms (collected using the GI Symptom Index for Midlife Women). The data were analyzed using factor analyses, hierarchical cluster analyses, chi-square tests, multinomial logistic regression analyses, and analyses of covariance. Three clusters were adopted: Cluster 1 (with low total numbers and severity scores of symptoms; 46.0%), Cluster 2 (with moderate total numbers and severity scores of symptoms; 44.0%), and Cluster 3 (with high total numbers and severity scores of symptoms; 10.0%). Only in Cluster 2, there were significant racial/ethnic differences in individual GI symptoms. These results provide directions for future GI symptom management among midlife women.

Immigration transition and gastrointestinal symptoms during menopausal transition: midlife women in the US.

This study aimed to explore the associations of immigration transition to gastrointestinal (GI) symptoms experienced during the menopausal transition among 974 midlife women in the US. The data from 974 midlife women from 2 national Internet survey studies were used for this secondary analysis. Only the data related to background characteristics and, health/menopausal status, immigration transition, and the Gastrointestinal Symptom Index for Midlife Women were included. The data were analyzed using descriptive and inferential statistics including analyses of covariance, logistic regression analyses, and hierarchical multiple regression analyses. There were statistical differences in total numbers and total severity scores of total GI symptoms between immigrants and nonimmigrants (F = 7.08 and 6.20, respectively; both P < 0.05); Immigrants had fewer total numbers and lower total severity scores of GI symptoms than nonimmigrants. All immigration transition variables including immigration status, the length of stay in the US, and the acculturation level accounted for 11.8% of the total numbers (F = 32.79, P < 0.001) and 12.5% of the total severity scores of GI symptoms (F = 35.10, P < 0.001). However, only immigration status (being nonimmigrant) was a significant factor that was associated with greater total numbers and higher total severity scores of GI symptoms (β = 0.62, P < 0.001 and β = 0.65, P < 0.001, respectively). This study supports that immigration status is a significant factor that influences GI symptoms during the menopausal transition.