Obstructive Type Research Articles

THE USE OF STATINS FOR THE TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND TYPE 2 DIABETES

Relevancy. The combination of chronic obstructive pulmonary disease and type 2 diabetes is studied insufficiently. The incomplete treatment regimen hinders the solution to this problem by including statins in the complex treatment of patients with chronic obstructive pulmonary disease combined with type 2 diabetes mellitus.
 Objective: to evaluate the effectiveness of including statins in the complex treatment of patients with chronic obstructive pulmonary disease secondary to type 2 diabetes mellitus.
 Materials and methods. Examination of patients with chronic obstructive pulmonary disease (COPD), including 64 patients with concomitant type 2 diabetes, was conducted on the basis of the pulmonology department of the Chernivtsi Regional Clinical Hospital in 2016-2020. Patients were divided into two groups – the main and the control. Patients with COPD with concomitant type 2 diabetes in the main group (49 patients) were prescribed atorvastatin at a dose of 20-40 mg once a day. The control group (15 COPD patients with concomitant type 2 diabetes) received essential treatment without atorvastatin. Patients received basic therapy depending on the group of patients (A, B, C and D) and the prevalence of shortness of breath or the frequency of exacerbations, long-acting bronchodilators (long-acting β2-agonists and/or long-acting anticholinergic drugs). A separate group of patients received a combination of a long-acting β2-agonist with an inhaled glucocorticosteroid. Some patients were prescribed roflumilast and antibactereal drugs from the group of macrolides (azithromycin or erythromycin). In the presence of sputum, patients were prescribed mucolytic drugs (Lazolvan, ACC, carbocisteine, erdosteine). In case of exacerbation, patients received a short course glucocorticosteroids parenterally, antibacterial drugs (for infectious exacerbation), nebulizer therapy. The effectiveness of therapy was evaluated after six months of treatment using the following diagnostic methods: clinical data (dyspnea, cough, sputum production - according to the BCSS scale; and shortness of breath, cough, sputum production and its color - according to the Paggiaro scale), the number of hospitalizations per year, the number emergency medical calls. Mathematical processing of the obtained data was carried out using programs BioStat 2009 Professional, version 5.8.4.3 (AnalystSoft Inc.), SPSS (Statistical Package for Social Science Statistics) 16.0, Statistisa 10.0 StatSoft Inc., Microsoft Excel 2010. Before testing statistical hypotheses were determined coefficients of asymmetry and kurtosis using the Hahn-Shapiro-Wilkie test to analyze the normality of the distribution of values ​​in randomized samples.
 Results. When analyzing clinical data in treatment dynamics with atorvastatin, it was found that according to the BCSS, shortness of breath in patients of the main group significantly decreased. Cough in COPD patients with concomitant type 2 diabetes treated with atorvastatin decreased by 25.3% at the end of treatment. A decrease in sputum production was observed in two groups of patients, and the changes were significant. Reduction of the frequency of exacerbations per year, the number of emergency calls, and the number of hospitalizations per year in the dynamics of atorvastatin treatment were also observed in COPD patients with concomitant type 2 diabetes.
 Conclusion. the use of atorvastatin in the complex treatment of COPD patients with concomitant type 2 diabetes resulted in a decrease in the frequency of exacerbations per year, the number of emergency calls, and the number of hospital admissions per year.

Association between positive airway pressure therapy adherence and health care resource utilization in patients with obstructive sleep apnea and type 2 diabetes in the United States.

There is a complex interplay between obstructive sleep apnea (OSA) and type 2 diabetes. There are minimal data regarding the effects of treating OSA with positive airway pressure (PAP) therapy on outcomes and health care resource utilization (HCRU) in patients with OSA and type 2 diabetes. We investigated the impact of PAP adherence on HCRU and costs in this population. A retrospective analysis was conducted with a cohort of OSA patient from a US administrative claims dataset linked to objective device data (AirView, ResMed Corp., San Diego, California). Propensity score matching was used to control for potential imbalance in baseline covariates between PAP-adherent and -nonadherent patients. Newly diagnosed patients with OSA aged ≥ 18 years with type 2 diabetes were included. PAP adherence was defined as meeting Centers for Medicare and Medicaid Services compliance criteria in all 8 90-day periods over 2 years. HCRU was based on the number of all-cause doctor visits, emergency room visits, inpatient hospitalizations, and PAP equipment and supplies. In years 1 and 2 of PAP therapy, HCRU was significantly lower in adherent vs nonadherent patients (number/patient for emergency room visits 0.68 ± 1.47 vs 0.99 ± 1.91 [year 1], 0.69 ± 1.43 vs 0.95 ± 1.89 [year 2]; for hospitalizations 0.16 ± 0.58 vs 0.22 ± 0.62 [year 1], 0.15 ± 0.51 vs 0.21 ± 0.74 [year 2]; all P < .001). Changes in estimated total 24-month payments were higher for nonadherent patients ($2,282, 95% confidence interval: $1,368, $3,205). Consistent use of PAP therapy over 2 years was associated with decreased HCRU in patients with OSA and type 2 diabetes, strongly suggesting a role for screening and treating OSA in type 2 diabetes. Sterling KL, Cistulli PA, Linde-Zwirble W, etal. Association between positive airway pressure therapy adherence and health care resource utilization in patients with obstructive sleep apnea and type 2 diabetes in the United States. J Clin Sleep Med. 2023;19(3):563-571.

Adenotonsillar Hypertrophy: The Relationship Between Obstruction Type and Attention in Children.

We aimed to investigate the attention function, which is a parameter of cognitive functions, at different obstruction types (adenoid and tonsil hypertrophy, adenoid hypertrophy only, tonsillar hypertrophy only, and normal) of oral cavity and nasopharynx, and the relationship between obstruction level, type, and attention (N = 80). To evaluate attention function, Stroop test has been performed. Eighteen-item Quality of Life (OSA-18) and Brouillette Symptom Score questionnaires have been completed with each child's parents. Significant and positive relation has been found between Brouillette Symptom Score, OSA-18 score, and each 5 sections of Stroop test's points. It has been shown that children with adenotonsillar hypertrophy (ATH) are negatively affected in terms of obstructive symptoms and quality of life. At the situation of obstructive pathology, the Stroop test durations are affected negatively. Results are supporting that quality of life and attention parameter are affected negatively at children with ATH.

Prevalence and Characteristics of Sleep Apnea in Intensive Care Unit Survivors After SARS-CoV-2 Pneumonia.

Sleep apnea (SA) was reported as possibly exacerbating symptoms of COVID-19, a disease induced by SARS-CoV-2 virus. The same comorbidities are common with both pathologies. This study aimed to estimate the prevalence, characteristics of SA and variation in AHI three months after severe COVID-19 requiring intensive care unit (ICU) admission. A prospective cohort of patients admitted to ICU for severe COVID-19 underwent an overnight home polygraphy 3 months after onset of symptoms, as part of a comprehensive follow-up program (pulmonary function tests, 6-minute walk tests and chest CT-scan). Patients with an apnea hypopnea index (AHI) ≥5 were considered as having SA. We performed a comparative descriptive analysis of 2 subgroups according to the existence, severity of SA and indication for effective SA treatment: patients with absent or mild SA (AHI <15) vs patients with moderate to severe SA (AHI ≥15). Among 68 patients included, 62 (91%) had known comorbidities (34 hypertension, 21 obesity, 20 dyslipidemia, 16 type 2 diabetes). It has been observed a preexisting SA for 13 patients (19.1%). At 3 months, 62 patients (91%) had SA with 85.5% of obstructive events. Twenty-four patients had no or a mild SA (AHI <15) and 44 had moderate to severe SA (AHI ≥15). Ischemic heart disease exclusively affected the moderate to severe SA group. Except for thoracic CT-scan which revealed less honeycomb lesions, COVID-19 symptoms were more severe in the group with moderate to severe SA, requiring a longer curarization, more prone position sessions and more frequent tracheotomy. SA involved 91% of patients in our population at 3 months of severe COVID-19 and was mainly obstructive type. Although SA might be a risk factor as well as consequences of ICU care in severe COVID-19 infection, our results underline the importance of sleep explorations after an ICU stay for this disease.

Predictors of Unrelieved Symptoms in All of Us Research Program Participants With Chronic Conditions.

Over half of American adults are diagnosed with a chronic condition, with an increasing prevalence being diagnosed with multiple chronic conditions. These adults are at higher risk for having unrelieved, co-occurring symptoms, known as symptom clusters. To identify symptom phenotypes of patients diagnosed with four common chronic conditions, specifically, cancer, chronic obstructive pulmonary disease, heart failure, and/or type 2 diabetes mellitus, and to understand factors that predict membership in symptomatic phenotypes. We conducted a retrospective, cross-sectional analysis using participant responses (N=14,127) to All of Us Research Program, a National Institutes of Health biomedical database, survey questions. We performed hierarchical clustering to generate symptom phenotypes of fatigue, emotional distress, and pain and used multinomial regression to determine if demographic, healthcare access and utilization, and health-related variables predict symptom phenotype. Four phenotypes, one asymptomatic or mildly symptomatic and three highly symptomatic (characterized by severe symptoms, severe pain, and severe emotional distress), were identified. The percentage of participants belonging to the severe symptoms phenotype increased with the number of chronic conditions. Most notably, foregoing or delaying medical care and rating mental health as poor or fair increased the odds of belonging to a highly symptomatic phenotype. We found meaningful relationships between demographic, healthcare access and utilization, and health-related factors and symptom phenotypes. With the increasing trends of American adults with one or more chronic conditions and a demand to individualize care in the precision health era, it is critical to understand the factors that lead to unrelieved symptoms.

Innovative Endoscopic Management of a Duodenal Web Using Balloon Dilatation and a Gastrojejunal Tube in an Infant with Complex Esophageal Atresia.

Introduction: Congenital partial duodenal obstruction (CPDO) is a rare type of intestinal obstruction, including webs and stenoses. Treatment has usually been operative by laparoscopy or laparotomy. Some have proposed endoscopic treatment due to a higher surgical risk in patients with CPDO. However, restenosis seems to be frequent after simple balloon dilatation. Material and Methods: We report on a patient with CPDO and complex esophageal atresia in whom we used a gastrojejunal tube to keep the lumen open after endoscopic balloon dilatation over a guidewire. Results: Follow-up endoscopy showed no evidence of restenosis. During the third endoscopy, the opening could be dilated to 15 mm without any complications and the gastrojejunal tube was removed. Since then, there were no clinical signs of obstruction, and no further endoscopic intervention was necessary. Discussion and Conclusion: Using a gastrojejunal tube after endoscopic balloon dilatation of a duodenal web may lower the risk of restenosis. This technique should be considered in patients with comorbidities and considerable surgical risk that have a gastrostomy in place.

Sulfonylurea Use in Patients with Type 2 Diabetes and COPD: A Nationwide Population-Based Cohort Study.

We conducted this study to investigate the long-term outcomes of sulfonylurea (SU) use in patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2D). We used propensity-score matching to identify 6008 pairs of SU users and nonusers from Taiwan's National Health Insurance Research Database from 1 January 2000 to 31 December 2017. Cox proportional hazard models were used to compare the risks of mortality, cardiovascular events, non-invasive positive pressure ventilation, invasive mechanical ventilation, bacterial pneumonia, lung cancer, and hypoglycemia between SU users and nonusers. In the matched cohorts, the mean follow-up time for SU users and nonusers was 6.57 and 5.48 years, respectively. Compared with nonusers, SU users showed significantly lower risks of mortality [aHR 0.53(0.48-0.58)], cardiovascular events [aHR 0.88(0.81-0.96)], non-invasive positive pressure ventilation [aHR 0.74(0.6-0.92)], invasive mechanical ventilation [aHR 0.57(0.5-0.66)], and bacterial pneumonia [aHR 0.78(0.7-0.87)]. A longer cumulative duration of SU use was associated with a lower risk of these outcomes. This nationwide cohort study demonstrated that SU use was associated with significantly lower risks of cardiovascular events, ventilation use, bacterial pneumonia, and mortality in patients with COPD and T2D. SU may be a suitable option for diabetes management in these patients.

Abstract 12633: Factors Affecting Quality of Life Among Patients With Hypertrophic Cardiomyopathy

Background: Hypertrophic cardiomyopathy (HCM) is the most common genetically determined chronic condition with various clinical symptom and course. Recently, illness perceptions have been known to influence mental health outcomes in patients with HCM. However, limited studies exist on HRQoL and its determinant factors including psychosocial components in patients with HCM. This study aimed to identify factors affecting HRQoL in patients with HCM. Methods: A total of 101 patients with HCM (mean age, 59±12 years; men,74.3%; obstructive type, 43.6%) participated in the study at their regular visits to the outpatient clinic of a university affiliated hospital in Seoul, from July to December, 2020. A questionnaire including the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) as a measure of physical and mental HRQoL, Korean Illness Perception Questionnaire, Health Promoting Lifestyle II, Patient Health Questionnaire-9 (PHQ-9), and Korean activity scale index (KASI) was used. Multivariable linear regression analysis was conducted to assess determinants of HRQoL. Results: The mean physical component score (PCS) of HRQoL was 47.15±7.66 and mental component score (MCS) was 51.41±8.61. Lower physical functional capacity (β=-.398, p&lt;.001) and higher cyclical timeline beliefs of illness perception (β=-.230, p=.039) were independently associated with lower PCS with 35.9% explanatory power (p&lt;.001). Women (β=-.218, p=.032), depression (β=-.307, p=.004), and stress management (β=.240 p=.042) were identified as independent predictors of MCS with 39.7% explanatory power (p&lt;.001). Conclusions: This study shows the important role of illness perception in determining the physical HRQoL in patients with HCM. Interventions aimed at changing Illness perception and reducing depression may be promising approaches to improve HCM patients’ HRQoL.

Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes: population based cohort study

ObjectiveTo determine whether the use of glucagon-like peptide 1 (GLP-1) receptor agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors, and sodium-glucose co-transporter-2 (SGLT-2) inhibitors, separately, is associated with a decreased risk of...

Prevalence of Gastric Ulceration in Horses with Enterolithiasis Compared with Horses with Simple Large Intestinal Obstruction.

Enterolithiasis is a well-documented cause of colic in horses, especially in some geographic areas such as California and Florida. This retrospective case-control study aims at comparing the prevalence of gastric ulcers in horses affected by enterolithiasis to that in horses affected by other types of large intestinal obstruction. Two hundred and ninety-six horses were included in the study sample. Horses that had surgery for the removal of one or more enteroliths were included in the study as cases. Patients that had surgery for large intestinal simple obstructions other than enterolithiasis (large colon displacement, non-strangulating large colon torsion, and large and small colon impactions) were selected to match case horses for age, sex, and breed and included as controls. A total of 101/148 horses with enteroliths (68%) had gastric ulcers diagnosed during hospitalization, compared with 46/148 of matched controls (31%). There was a significant association between enterolithiasis and gastric ulceration (odds ratio 4.76, p &lt; 0.0001), and a greater prevalence in Thoroughbreds as compared with other breeds (odds ratio 22.6, p &lt; 0.0001). We concluded that enterolithiasis is significantly associated with gastric ulceration (p &lt; 0.0001). The association is stronger in Thoroughbreds.

FORWARDS-1: an adaptive, single-blind, placebo-controlled ascending dose study of acute baclofen on safety parameters in opioid dependence during methadone-maintenance treatment—a pharmacokinetic-pharmacodynamic study

BackgroundTreatment of opiate addiction with opiate substitution treatment (e.g. methadone) is beneficial. However, some individuals desire or would benefit from abstinence but there are limited options to attenuate problems with opiate withdrawal. Preclinical and preliminary clinical evidence suggests that the GABA-B agonist, baclofen, has the desired properties to facilitate opiate detoxification and prevent relapse. This study aims to understand whether there are any safety issues in administering baclofen to opioid-dependent individuals receiving methadone.MethodsOpiate-dependent individuals (DSM-5 severe opioid use disorder) maintained on methadone will be recruited from addiction services in northwest London (NHS and third sector providers). Participants will be medically healthy with no severe chronic obstructive pulmonary disease or type 2 respiratory failure, no current dependence on other substances (excluding nicotine), no current severe DSM-5 psychiatric disorders, and no contraindications for baclofen or 4800 IU vitamin D (placebo). Eligible participants will be randomised in a 3:1 ratio to receive baclofen or placebo in an adaptive, single-blind, ascending dose design. A Bayesian dose-escalation model will inform the baclofen dose (10, 30, 60, or 90 mg) based on the incidence of ‘dose-limiting toxicity’ (DLT) events and participant-specific methadone dose. A range of respiratory, cardiovascular, and sedative measures including the National Early Warning Score (NEWS2) and Glasgow Coma Scale will determine DLT. On the experimental day, participants will consume their usual daily dose of methadone followed by an acute dose of baclofen or placebo (vitamin D3) ~ 1 h later. Measures including oxygen saturation, transcutaneous CO2, respiratory rate, QTc interval, subjective effects (sedation, drug liking, craving), plasma levels (baclofen, methadone), and adverse events will be obtained using validated questionnaires and examinations periodically for 5 h after dosing.DiscussionStudy outcomes will determine what dose of baclofen is safe to prescribe to those receiving methadone, to inform a subsequent proof-of-concept trial of the efficacy baclofen to facilitate opiate detoxification. To proceed, the minimum acceptable dose is 30 mg of baclofen in patients receiving ≤ 60 mg/day methadone based on the clinical experience of baclofen’s use in alcoholism and guidelines for the management of opiate dependence.Trial registrationClinicaltrials.gov NCT05161351. Registered on 16 December 2021.

Short-term outcomes of patients transferred from non-acute care centers with sick sinus syndrome

Abstract Background Non-acute care centers, such as nursing homes and urgent care clinics, are a staple of healthcare systems worldwide. The short-term prognostic outcomes of patients transferred from a non-acute care center to an acute healthcare facility for further management have been less studied. Purpose In this study, we examine the in-hospital outcomes of patients with sick sinus syndrome who are transferred to an acute care hospital from a non-acute care center. Methods This was a retrospective cohort study comparing adult patients who were transferred to a hospital from a non-acute center with regular, non-transferred hospital admissions between 2016 to 2018. We queried the National Inpatient Sample database to identify patients admitted with a principal diagnosis of sick sinus syndrome. We analyzed the categorical and continuous variables by Pearson's chi-squared and Student t-test respectively. Multivariable logistic regression, adjusted for age, gender and comorbidities was used to compare mortality. The comorbidities adjusted for included atrial fibrillation, atrial flutter, first and third-degree atrioventricular block, heart failure, hypertension, obstructive sleep apnea and type 2 diabetes mellitus. Results 120,300 patients met our inclusion criteria. Patients transferred from non-acute care centers had 2.63 times higher odds of suffering in-hospital mortality compared to regular hospital admissions (aOR 2.63, 95% CI: 1.54–4.49; p&amp;lt;0.001). When separated by race, non-acute care transfers had higher mortality rates amongst Asian (6.9% vs 0.7%, p&amp;lt;0.001), Hispanic (4.8% vs 0.8%, p&amp;lt;0.001) and White (1.8% vs 0.6%, p&amp;lt;0.001, Figure 1) patients as well as longer hospital stays (4.7 vs 4.0 days, p&amp;lt;0.001, Table 1). Furthermore, these patients had higher rates of comorbidities such as atrial fibrillation, atrial flutter, heart failure and chronic kidney disease, but decreased rates of hypertension, type 2 diabetes mellitus and first and third-degree atrioventricular block (Table 1). Non-acute care transfers were also more likely to have a pacemaker placed (1.5% vs 0.9%, p&amp;lt;0.001). In terms of operative complications, non-acute transfers were more likely to have intraoperative cardiac arrest (0.1% vs 0.03%, p&amp;lt;0.005, Table 1). There was no significant difference between our two cohorts in postoperative complications such as cardiac arrest and intracerebral infarction. Conclusion Patients who were transferred to an acute care hospital from a non-acute care center with sick sinus syndrome had higher odds of suffering in-hospital mortality compared to regular hospital admissions. These patients were also at increased risk of intraoperative cardiac arrest. Our findings illustrate that non-acute care transfers require additional support in the acute care setting. This study highlights the need for further health policy discussion and an increased emphasis on medical resource reallocation to support this vulnerable population. Funding Acknowledgement Type of funding sources: None.

Prognosis of hypertrophic cardiomyopathy in Japanese patients with an implantable cardioverter defibrillator -focus on apical hypertrophic cardiomyopathy

Abstract Background Patients with hypertrophic cardiomyopathy (HCM) are at high risk of lethal arrhythmias, and implantable cardioverter defibrillators (ICD) are widely used for prevention of sudden cardiac death (SCD). Apical HCM is a phenotype variant of HCM, with hypertrophy predominantly affecting apex, that was initially described 30 years ago. Apical HCM patients may have different clinical prognosis compared with other subsets of HCM. In previous studies, apical HCM patients seem to have a more benign prognosis than other types of HCM. However, little is known about the long-term outcomes of apical HCM patients and there are many unclear points. Moreover, there are few reports about the clinical prognosis in apical HCM patients with an ICD. Objective The aim of this study is to identify the difference between the prognosis of apical and the other types of HCM patients with an ICD. Methods We retrospectively analyzed the database of our ICD clinic. All subjects underwent ICD implantation between October 2006 and September 2018. We classified HCM patients into LV outflow tract obstruction (LVOTO) and midventricular obstruction (MVO), apical HCM and other non-obstructive types. We divided all the patients into apical and other types of HCM, and examined their background, incidence of appropriate ICD therapies, hospitalization for heart failure, electrical storm and death. Results A total of consecutive 64 Japanese HCM patients with an ICD (follow-up period, 86±24 months; age, 65±14 years; male sex, 83%; left ventricular ejection fraction, 56±14%; LV max wall-thickness, 19±7mm; LV apical aneurysm, 9.4%; 5-year risk of SCD, 4.4±2.1) were enrolled in this study. We classified them into 14 apical HCM and 50 other types of HCM patients. The clinical characteristics and major clinical events of these patients are shown in the Table 1. During the follow-up periods, there were no significant differences in the incidence of electrical storm, hospitalization for heart failure and death between the 2 groups (p=0.11; p=0.60; p=0.39). Appropriate ICD therapies occurred in 6 of 14 (43%) patients with apical HCM and 5 of 50 (10%) patients with other types of HCM (p=0.010). The risk factors of patients with apical HCM patients are shown in Table 2. Conclusions Appropriate ICD therapy was more prevalent in patients with apical HCM, compared to patients with other types of HCM. Aggressive intervention such as catheter ablation for ventricular tachycardia and ventricular fibrillation may be considered in patients with apical HCM and higher score of 5-year risk of SCD. Further studies are needed to clarify the manifestations and long-term outcome of apical HCM patients. Funding Acknowledgement Type of funding sources: None.

Transcatheter aortic valve replacement in patients with a concomitant aortic aneurysm

Abstract Background Although there is extensive literature present on transcatheter aortic valve replacement (TAVR), there is limited data on TAVR patients with a concomitant aortic aneurysm. Purpose In this study, we investigate the short-term, in-hospital outcomes of patients undergoing TAVR with and without an aortic aneurysm. Methods This was a retrospective cohort study comparing adult patients undergoing TAVR with and without an aortic aneurysm from 2016 to 2018. We queried the National Inpatient Sample database to identify patients admitted for a principal procedure of TAVR, principal diagnosis of aortic stenosis and secondary diagnosis of aortic aneurysm. We analyzed the categorical and continuous variables by Pearson's chi-squared and Student t-test respectively. Multivariable logistic regression, adjusted for age, gender and comorbidities, was used to compare mortality. The comorbidities adjusted for included coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, hypertension, obesity and type 2 diabetes mellitus. Results 109,170 patients met our inclusion criteria. Patients undergoing TAVR with an aortic aneurysm had 1.97 times higher odds of suffering in-hospital mortality compared to TAVR patients without an aortic aneurysm (aOR 1.97, 95% CI: 1.05–3.73; p=0.036). When separated by race, patients with an aortic aneurysm had higher mortality rates amongst White (3.4% vs 1.7%, p&amp;lt;0.001) and Hispanic (5.2% vs 2.6%, p=0.11, Figure 1) patients. TAVR patients with an aortic aneurysm were predominantly male and had higher average Charlson Comorbidity Index scores (Table 1). Furthermore, these patients also had higher rates of comorbidities such as coronary artery disease, chronic obstructive pulmonary disease and prior myocardial infarction, but decreased rates of chronic kidney disease, hypertension, obesity and type 2 diabetes mellitus (Table 1). In terms of operative complications, TAVR patients with an aortic aneurysm were more likely to have intraoperative cardiac arrest (1.1% vs 0.4%, p&amp;lt;0.001, Table 1). There was no significant difference between our two cohorts in postoperative cardiac arrest and postoperative cerebral infarction. Conclusion Patients undergoing TAVR with an aortic aneurysm had higher odds of suffering in-hospital mortality compared to patients undergoing TAVR without an aortic aneurysm. These patients are also at an increased risk of intraoperative cardiac arrest. Surgical intervention with a concomitant aortic aneurysm poses its own unique set of clinical challenges. Our findings emphasize the importance of risk-benefit analysis and collaborative discussion amongst the medical team prior to choosing the appropriate treatment modality. Additional studies should explore if certain races are at increased risk of operative complications and mortality. Funding Acknowledgement Type of funding sources: None.

Comparison of Dental Occlusion in Children with Mouth Breathing and Different Types of Pharyngeal Lymphoid Tissue Obstruction

Background: The relationship between malocclusion and respiration has been debated for decades. Aim: The aim of this study is to assess dental occlusion in relation to mouth breathing and different types of pharyngeal lymphoid tissue obstruction in children. Settings and Design: This was a cross-sectional study of 200 children aged between 6 and 12 years who were clinically examined and divided into two groups: mouth breathers and nasal breathers. Materials and Methods: The children were subjected to otorhinolaryngologic examination to identify the type of pharyngeal obstruction. Dental interarch relationship and pharyngeal tissue obstruction were diagnosed and appropriate cross tabulations were done. Statistical Analysis Used: The data collected were statistically analyzed using the SPSS version 15.0 software. Results: Statistically significant association was found between type of breathing and pharyngeal lymphoid tissue obstruction (P = 0.001), dental occlusion and type of breathing (P = 0.001), and pharyngeal lymphoid tissue obstruction and dental occlusion (P = 0.001). Higher prevalence of crossbite, deep bite, and Class II malocclusion was seen in children with adenotonsillar hypertrophy as well as mouth breathing habit. Conclusion: Obstructive tonsils and adenoids are risk factors for the development of malocclusion. Early detection and correction of airway obstruction can help in proper growth of the dentofacial region.

CHARACTERISTICS OF BLACK AND LATINO PATIENTS WITH SEVERE ASTHMA ON BIOLOGIC THERAPY IN A COMMUNITY CLINIC

CHARACTERISTICS OF BLACK AND LATINO PATIENTS WITH SEVERE ASTHMA ON BIOLOGIC THERAPY IN A COMMUNITY CLINIC

BILATERAL PNEUMOTHORAX, PNEUMOMEDIASTINUM, AND SUBCUTANEOUS EMPHYSEMA: A CASE OF A RARE SYNCHRONOUS TRIAD IN ASTHMA EXACERBATION

BILATERAL PNEUMOTHORAX, PNEUMOMEDIASTINUM, AND SUBCUTANEOUS EMPHYSEMA: A CASE OF A RARE SYNCHRONOUS TRIAD IN ASTHMA EXACERBATION

ASSESSMENT OF THE LONG-TERM SAFETY AND EFFICACY OF DUPILUMAB IN CHILDREN WITH ASTHMA (LIBERTY ASTHMA EXCURSION STUDY)

ASSESSMENT OF THE LONG-TERM SAFETY AND EFFICACY OF DUPILUMAB IN CHILDREN WITH ASTHMA (LIBERTY ASTHMA EXCURSION STUDY)

PHYSIOLOGICALLY BASED PHARMACOKINETIC (PBPK) MODELING OF THE COMBINATION OF IVACAFTOR AND LEFAMULIN IN PATIENTS WITH CYSTIC FIBROSIS

PHYSIOLOGICALLY BASED PHARMACOKINETIC (PBPK) MODELING OF THE COMBINATION OF IVACAFTOR AND LEFAMULIN IN PATIENTS WITH CYSTIC FIBROSIS

CLINICAL IMPACT OF ESCALATIONS TRIGGERED BY REMOTE PATIENT MONITORING IN COPD

CLINICAL IMPACT OF ESCALATIONS TRIGGERED BY REMOTE PATIENT MONITORING IN COPD