Uncontrolled Comorbidities Research Articles

Embracing the change: Resuming advanced trauma training in the COVID-19 era

BackgroundTrauma is slowly regaining its pre-COVID-19 status in terms of prevalence. Advanced trauma training cannot be deferred indefinitely in the current pandemic owing to defense requirements and disaster preparedness in vulnerable regions. Advanced Trauma Life Support (ATLS) India resumed ATLS and Advanced Trauma Care For Nurses (ATCN) courses at one civilian and one military site. MethodsStakeholders of respective centers for advanced trauma training deliberated over safe means to resume ATLS and ATCN. Meticulous screening of all participants and pre- and post-course tracking were deemed the most important components for the safe resumption of courses. ‘Paperless’ course, ‘open-air’ skill stations, ‘payment protection’, ‘buddy system’, point of care sanitizer installation, packed food, and potable beverages were major organizational changes. Participants above 60 years and with uncontrolled comorbidities were not enrolled. ResultsTwo ATCN, one ATLS (civilian), and one combined ATLS-ATCN (military) were conducted. 78 delegates trained by 32 faculties and 13 personnel. All underwent daily thermal scanning and smartphone application-based COVID-19 tracking. Manikins were utilized instead of moulages and instructors took up the role of nursing assistants in Initial Assessment. Exit exams were conducted with full PPE precautions at the military site and mask-distancing precautions at the civilian site. High fidelity simulator was used at one station at the civilian site. Expenses at the civilian site per course were USD 570 lower than conventional courses. There was no incidence of COVID-19 in any of the 123 participants at 14 days follow up. ConclusionWith stringent participant selection and moderate precautions, ATLS and ATCN can be resumed safely in the current COVID-19 pandemic. To the best of our knowledge and after a thorough search of published English literature, this is the first paper reporting on resuming Advanced trauma training in the COVID-19 era.

A Study of Intraperitoneal Onlay Mesh Repair Using Barbed Sutures for Abdominal Incisional Hernia

Objective We investigated the validity of our intraperitoneal onlay mesh (IPOM) Plus technique with barbed sutures. Background Laparoscopic intraperitoneal onlay mesh repair has become a proven method for treating abdominal incisional hernias in recent years. There have been a few reports on the utility of IPOM Plus, which is IPOM + celiorrhaphy, although this method has not been widely discussed. We adopted the IPOM Plus technique with barbed sutures at our hospital and investigated the validity of this technique. Methods We included 7 patients who underwent IPOM Plus repair from 2015 to 2017 at our hospital. We excluded patients with a hernia hilum <2 cm or ≥10 cm, age < 20 years old, PS3 or more, and uncontrolled comorbidity. The hernial orifice was closed laparoscopically using barbed sutures and subsequently secured by tacking on an onlay mesh. Results The median hernial orifice size of the 7 patients was 45 mm (25 to 55 mm). Hernia onset occurred after laparotomy in all cases. In one case, an abdominal incisional hernia recurred after IPOM used to treat the condition 15 years earlier. The mean duration of surgery was 80.5 minutes (53 to 126 minutes), and the median pain scale score was 3 points (0 to 3 points), indicating little pain. None of the patients reported persistent postoperative pain. The mean duration of the postoperative hospital stay was a median of 3.5 days (2 to 5 days). Both short- and long-term outcomes indicated that no recurrence or complications, such as bulging or seroma, occurred. Conclusions IPOM Plus with intracavitary abdominal suturing using barbed suture for abdominal scar hernia repair may be a valid surgical procedure.

Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial

Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial

Abstract 13481: South Asian-specific MYBPC3 25bp Intronic Deletion Carriers Demonstrate Hypercontractility and Impaired Diastolic Function Under Exercise Stress

Introduction: A 25bp intronic deletion in MYBPC3 ( Δ25bp ), present in 6% of US South Asians, is a risk allele for late onset left ventricular (LV) dysfunction and hypertrophy. Hypothesis: Asymptomatic Δ25bp carriers have detectable subclinical pathology to development of LV hypercontractility and impaired relaxation. Methods: To evaluate Δ25bp carriers for changes in cardiac function with bicycle exercise stress echocardiography and continuous cardiac monitoring, 16 Δ25bp male carriers (51±2 years) and 10 age- and sex-matched non-carrier (NCs) controls (50±3 years) participated in this pilot study. Of 16 Δ25bp carriers, six carried an additional pathogenic variant D389V in MYBPC3 . Included subjects had no uncontrolled comorbidities. Regression analysis and two-way ANOVA were performed, and 95% confidence interval (CI) and p values were reported. Results: Baseline echocardiographic parameters as well as baseline and monitored exercise heart rate and blood pressure were similar in both groups. The estimated effect of exercise stress and genotype showed that Δ25bp carriers had significantly higher ejection fraction (%) (CI: 4.03±1.64; p<0.0001) and higher LV outflow tract peak velocity (m/s) (CI: 0.15±0.06; p<0.0001) in comparison to NCs. Additionally, stress-induced LV end diastolic diameter did not increase in Δ25bp carriers as compared to NCs with a significant difference between the groups (CI: 0.22±0.11; p=0.0002). E/A ratio, a marker of diastolic function, significantly decreased with exercise in Δ25bp carriers (slope: -0.002; p=0.005) but showed non-significant change in the NCs (slope: -0.0006; p=0.428). Right ventricular systolic excursion velocity s' (m/s) as a marker of right ventricle function increased similarly in both groups, although tricuspid annular plane systolic excursion (cm) increased more dramatically in carriers (slope: 0.004; p=0.0002). Sub-analysis of Δ25bp vs Δ25bp + D389V did not reveal any differences. Conclusions: LV hypercontractility under exercise stress conditions with evidence of diastolic impairment at high workloads is evident among asymptomatic carriers of MYBPC3 Δ25bp allele, suggesting MYBPC3 Δ25bp as a risk allele with sub-clinical pathology prior to late onset LV dysfunction in South Asians .

Cirmtuzumab Consolidation for Treatment of Patients with Detectable CLL on Venetoclax

Background: Venetoclax (Ven)-based regimens are highly effective in treating patients with chronic lymphocytic leukemia (CLL), effecting clearance of detectable minimal residual disease (MRD) in many patients after just 1 year of therapy. Approximately, 30% of patients fail to clear detectable MRD within this time period and risk developing, progressive disease (PD) despite continued Ven therapy. Moreover, these patients have a relatively short progression free survival (PFS) after stopping fixed-duration therapy. Therefore, development of consolidation strategies to eradicate detectable MRD and/or to mitigate the risk of PD in patients who fail to clear MRD after 1 year of Ven-based therapy is of vital clinical importance. In particular, patients who fail to clear MRD after 1 year of Ven-based therapy harbor CLL cells with high-level expression of ROR1, an oncoembryonic protein expressed by a broad array of incurable malignancies. Patients who are refractory to MRD-clearance on Ven-based therapies have gene-expression signatures reflective of high-level ROR1-signaling, which can be inhibited by the anti-ROR1 mAb, Cirmtuzumab (Choi et al., Cell Stem Cell. 2018; 22: 951-959). Prior studies demonstrated that Cirmtuzumab and Ven have at least additive activity in promoting cytotoxicity of CLL cells in vitro (Rassenti et al. PNAS. 2017;114(40):10731-10736). As such, cirmtuzumab may be an effective consolidation strategy for patients who fail to clear MRD following completing 1 year of Ven-based therapy. Study Design and Methods: Study Design: We initiated a single center, phase 2 Simon's two-stage-designed study to determine the efficacy of Cirmtuzumab plus Ven combination therapy in patients who fail to clear detectable MRD (defined as > 0.01% of the blood mononuclear cells, as assessed by flow cytometry) after ≥1 year of Ven-based therapy (NCT04501939). Enrolled patients will receive cirmtuzumab at 600 mg IV, q14 days for 2 doses and then monthly thereafter. Patients will continue oral Ven at 400mg daily and be monitored for safety and PD. Following 6 months of Cirmtuzumab + Ven, patients will be assessed for MRD in the blood. At the discretion of the treating physician, patients may continue combination treatment for up to one year (Figure 1). Major Eligibility Criteria: Patients must have a diagnosis of CLL with detectable MRD after having received ≥ 12 months of Ven-based treatment . Patients will be excluded from the study if they have an uncontrolled medical co-morbidity, which compromises their capacity to complete the study, or if they are receiving treatment for CLL with agents other than Ven. End Points: The primary end-point of the proposed study is clearance of detectable MRD in the blood after 6 months of cirmtuzumab + Ven therapy. Secondary end-points include safety and time to next CLL treatment. Exploratory end-points include changes in gene expression in leukemia cells, including analysis of archival pre-Ven treatment samples, when available. Statistical Methods: We used a Simon's two-stage minimax design at 5% significance level to test the scientific hypothesis that 6 cycles of cirmtuzumab + Ven will achieve undetectable MRD (a 'response') in more than 5% of patients, against the null hypothesis of less than a 5% response rate. In the first stage, we plan to accrue 12 patients. If none of these patients respond at 6 months, the study will close. Otherwise, we will accrue an additional 4 patients for a total of 16 patients. If three or more patients respond, the primary endpoint of the trial will have been met, demonstrating an MRD clearance rate greater than 5%. The trial is designed to have 80% power to provide such evidence at the 5% significance level if the true rate of clearance of MRD is 25% or greater. Disclosures Heyman: Oncternal Therapeutics, INC: Research Funding. Choi:Pharmacyclics/Abbvie: Research Funding; Genentech: Consultancy. Jamieson:Forty Seven Inc: Patents & Royalties; Bristol-Myers Squibb: Other. Kipps:Genentech/Roche: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; VelosBio: Research Funding; Oncternal Therapeutics, Inc.: Other: Cirmtuzumab was developed by Thomas J. Kipps in the Thomas J. Kipps laboratory and licensed by the University of California to Oncternal Therapeutics, Inc., which provided stock options and research funding to the Thomas J. Kipps laboratory, Research Funding; Celgene: Honoraria, Research Funding; Ascerta/AstraZeneca, Celgene, Genentech/F. Hoffmann-La Roche, Gilead, Janssen, Loxo Oncology, Octernal Therapeutics, Pharmacyclics/AbbVie, TG Therapeutics, VelosBio, and Verastem: Membership on an entity's Board of Directors or advisory committees; Gilead: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pharmacyclics/ AbbVie, Breast Cancer Research Foundation, MD Anderson Cancer Center, Oncternal Therapeutics, Inc., Specialized Center of Research (SCOR) - The Leukemia and Lymphoma Society (LLS), California Institute for Regenerative Medicine (CIRM): Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau.

Combination of Ibrutinib with Rituximab (IR) in Previously Untreated Older Patients with Mantle Cell Lymphoma (MCL) - a Phase II Clinical Trial

Combination of Ibrutinib with Rituximab (IR) in Previously Untreated Older Patients with Mantle Cell Lymphoma (MCL) - a Phase II Clinical Trial

Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

Solicitousness Towards Elderly Oncology Patients During the COVID-19 Crisis: A Viewpoint

COVID-19 has been declared as public health emergency. The severity of this illness seems more peculiar in patients having compromised physiological reserves like elderly, infants, pregnant women and in those with preexisting or uncontrolled comorbidities. The elderly patients, in particular, have additional risks which are related to both malignancy and ageing, hence such an infection could be life-threatening. Further, the available clinical experiences have shown that cancer patients with COVID-19 infection have more severe illness with very serious complications that may require intensive care. Hence, taken together into account it becomes pertinent to highlight on elderly oncology patients during the COVID-19 crisis. The viewpoint thus, takes into consideration the association and impact of COVID-19 pandemic on elderly oncology patients and also emphasises on possible treatment alterations to be adapted, during the COVID-19 crisis.

Obesity and Higher Risk for Severe Complications of Covid-19: What to do when the two pandemics meet.

The coronavirus disease 2019 (COVID-19) pandemic has spread around the globe, infecting more than ten million individuals, with more than 500,000 dead; about one half of the infected people have recovered. Despite this fact, a subgroup of individuals affected by COVID-19 is at greater risk of developing worse outcomes and experience a high rate of mortality. Data on the association between obesity and COVID-19 are growing; the available studies, have reported a high prevalence of overweight and obesity in patients experiencing a severe COVID-19 course, with serious complications requiring hospitalization and admission to intensive care units. This paper attempts to highlight potential mechanisms behind the greater vulnerability to COVID-19 of individuals with obesity. The presence of uncontrolled chronic obesity-related comorbidities, particularly pulmonary diseases, can present a primary fertile soil for respiratory tract infection. Combined with immune system impairments, such as alteration in the T-cell proliferation and macrophage differentiation, and the high pro-inflammatory cytokine production by the adipose organ, this may worsen the general condition toward a systemic diffusion of infection. Prevention remains the first line of intervention in these patients that can be achieved by adhering to social distancing and adopting hygiene precautions, combined with a healthy lifestyle. Patients with obesity require preferential access dedicated to primary care services to ensure they are regularly taking their medications for the treatment of any concurrent chronic diseases. Finally, their physicians must promptly manage any medical signs or symptoms in the case of suspected severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection to prevent the risk of severe outcomes.

Medication Adherence Barriers: Development and Retrospective Pilot Test of an Evidence-Based Screening Instrument.

Adherence to a prescribed medication regimen is often critical to successful comorbid disease management and decreased risk for adverse outcomes. The barriers that result in nonadherence are often multilayered and complex, making them difficult to address in an outpatient clinic setting. The primary objective of this project was to develop an evidence-based observational screening instrument and determine its potential to identify barriers to medication adherence. Medication adherence barriers were divided into five categories. These barriers provided the foundation for the screening instrument. To pilot test the instrument, a retrospective, quasiexperimental, observational comparison study was designed. The pilot study evaluated retrospective data of the Oncology Care Model (OCM). Of 250 OCM patient records, 184 (74%) revealed potential medication adherence barriers for patients with uncontrolled comorbid illness or events.

Epidemiology of atrial fibrillation in northeast China: a cross-sectional study, 2017–2019

ObjectiveTo evaluate the epidemiology of atrial fibrillation (AF) in northeast China.MethodsThis cross-sectional survey using a multistage, stratified and cluster random sampling method was conducted in Liaoning Province between September 2017...

Validity and Reliability of the Assessment Tool for Asthma (ATA) Questionnaire: the ATA Study.

A multicenter trial was designed to validate the "Assessment Tools for Asthma (ATA)" questionnaire, a newly developed questionnaire, which evaluates both asthma control and risk factors associated with asthma control with a single instrument. This cross-sectional study involved 810 cases from 14 clinics in 9 Turkish cities. The ATA questionnaire and Asthma Control Test (ACT) were administered. The Visual Analog Scale (VAS) was used to evaluate the control status of 100 randomized cases. ATA is an eight-item physician-administered questionnaire. It comprises the following two sections-ATA1, assesses symptomatic control criteria, and the remaining section, queries the flare-up of asthma, control of comorbidities, treatment adherence, and inhaler technique. The mean scores for ATA1, ATA total, VAS, and ACT were 24.7±14.8, 53.8±19, 7.1±3, and 18.8±5.5, respectively. According to the ATA questionnaire, among all patients, 34.3% had controlled, 18.8% had partly controlled, and 46.9% had uncontrolled asthma. Furthermore, 16.6% patients had flare-ups between visits, 96.4% patients had uncontrolled comorbidity, 17% patients had irregular asthma treatment, and only 8.4% patients used the incorrect inhaler technique. The ATA questionnaire showed internal consistency (Cronbach's alpha coefficient=0.683). ACT, ATA1, and two specialists' evaluations using VAS correlated strongly with the ATA total scores (Spearman correlation coefficient (r) values: 0.776, 0.783, and 0.909, respectively; p-values: p<0.001, p<0.001, and p<0.001, respectively). According to Receiver Operating Characteristic analysis, the cut-off value of ATA was 50 (sensitivity=84.4%, specificity=82.40%). The validated ATA questionnaire may be a practical tool for physicians in asthma management.

Efficacy of chronomodulated chemotherapy for palliation of hematemesis in inoperable gastric cancer: A single-institutional retrospective study

Context:Aside abdominal discomfort and pain, upper gastrointestinal bleeding (UGIB) significantly disgraces the quality of life (QoL), especially in inoperable gastric cancer patients. Although, in early stages, it is infrequent and often ignored, but in advanced stages, its aggressiveness often deteriorates patient's hemoglobin (Hb) level and performing status.Aim:The aim of this study is to correlate the change in (1) the frequency of episodes of UGIB, (2) its severity in terms of Common Terminology Criteria for Adverse Events (CTCAE) grade for UGIB, and (3) Hb level with the successful completion of successive cycles of palliative chemotherapy where it becomes invariably the only modality to palliate the cancer disease.Setting and Design:This single-institutional retrospective observational study included seventy gastric carcinoma patients with a chief complaint of frequent hematemesis. They were divided according to the cause behind inoperability or irresectability: (1) Metastatic disease, (2) locally advanced irresectable disease, (3) uncontrolled comorbidities, (4) poor GC (PGC), and (5) refused to give surgical consent.Subjects and Methods:Following baseline evaluation and prechemotherapy workups, patients were subjected to three-weekly chronomodulated modified EOX regimen. Relevant parameters, i.e., (1) average episodes per-week (AEP) score, (2) Hb, and (3) average CTCAE grade value for UGIB were recorded after every cycle.Results:At 12-week follow-up, there was a significant decrease in mean AEP score from baseline (from 2.6691 ± 0.7047 to 1.5033 ± 0.6272) for the entire cohort (P < 0.001). Maximum benefit in terms of mean Hb (increase by 1.0737% above baseline) took place for PGC group (P < 0.001). Mean CTCAE grade value for the entire cohort decreased from baseline by 0.6428, which was statistically significant with a P < 0.001.Conclusions:PGC group was maximally benefited considering all three parameters. Though surgery defines the mainstay of treatment for gastric carcinoma, yet in inoperable cases, only chronomodulated chemotherapy significantly affects the severity of UGIB and thus may improve QoL.

Frontline Treatment with Ibrutinib with Rituximab (IR) Combination Is Highly Effective in Elderly (≥65 years) Patients with Mantle Cell Lymphoma (MCL) - Results from a Phase II Trial

Frontline Treatment with Ibrutinib with Rituximab (IR) Combination Is Highly Effective in Elderly (≥65 years) Patients with Mantle Cell Lymphoma (MCL) - Results from a Phase II Trial

Vascular Complications in Patients with Type 2 Diabetes: Prevalence and Comorbidities in 6 Countries of Latin America (A Cohort of the Discover Study Program)

Objective: To provide real world observational data about glucose control, the burden of diabetes, comorbidities, and cardiovascular risk factors among patients initiating second-line therapy in Latin America (LA). Methods: This report is a cross-sectional analysis of the LA cohort of the DISCOVER study, describing the regional prevalence of microvascular and macrovascular complications in Mexico, Costa Rica, Panama, Colombia, Argentina, and Brazil. Results: One thousand six hundred and sixteen patients were included in 69 investigational sites. Hemoglobin A1c was >7% (42 mmol/mol) in 81.3% of subjects. Macrovascular complications were reported by 13.8% of the subjects. Microvascular conditions were reported in 15.2% of the subjects. The prevalence of hypertension and of hyperlipidemia was 55.5% and 45.9%, respectively. Blood pressure, total cholesterol, and low-density lipoprotein were out of target levels in 38.5%, 51.2%, and 81.7% of the patients, respectively. Overweight or obesity was reported in 83.8% of the cases. Conclusion: Our study shows that patients with type 2 diabetes in LA are not reaching their glucose, lipids, blood pressure, and weight targets. The prevalence of microvascular (15.2%), macrovascular (13.8%), and uncontrolled comorbidities in patients at an early stage of the disease (initiating a second-line therapy) highlights the need for more aggressive risk factor screening as well as treatment in LA. Abbreviations: CV = cardiovascular; CVD = cardiovascular disease; DM = diabetes mellitus; HbA1c = hemoglobin A1c; LA = Latin America/Latin American; LDL = low density cholesterol; T2DM = type 2 diabetes mellitus.

EP1.16-37 Correlation of Serum Albumin and CRP Levels with Chemotherapy Toxicity in Patients of Metastatic Lung Cancer

significant proportion of patients of lung cancer present with metastatic disease. Chemotherapy is often offered as first line treatment if patients does not have driver mutations in a specific targetable oncologic pathway and is fit to receive systemic therapy. Systemic inflammation associated with advanced cancer is often regarded as one of the factors for poor prognosis in lung cancer patients. High level of CRP and low levels of albumin are regarded as markers of systemic inflammation and prior studies have shown poor survival in such patients. It has also been shown that systemic inflammation alters the metabolism of chemotherapeutic agents resulting in either treatment failure or increased toxicity, both of which can lead to poor outcomes. This study aims to identify if increased systemic inflammatory response leads to enhanced toxicity with chemotherapeutic agents used in palliative setting in patients of metastatic lung cancer, and in turn poorer survival. Trial design Objectives Primary objective – Correlating chemotherapy toxicity with patients’ baseline albumin and CRP levels Secondary objective - Correlating CRP and Albumin levels with PFS and OS Materials and Methods Study Design - Patients with a tissue diagnosis of lung cancer will be prospectively enrolled in the study after informed consent. All clinically relevant details will be entered in a clinical proforma. Site and duration of study - Kidwai Cancer Institute; June 2018 to Dec 2019 Sample size – All patients meeting the inclusion criteria between the study time period will be included Inclusion Criteria Patients of Metastatic Biopsy Proven Lung Cancer Age 18 – 80 Planned for chemotherapy with a platin Doublet Albumin > 2.0 Exclusion Criteria Presence of targettable driver mutations Any other Synchronous / Metachronous cancer Any other uncontrolled medical comorbidities Statistical Analysis The Mann-Whitney U test and the χ2 test will be used to determine statistically significant differences 1/10/2019 #337: Correlation of Serum Albumin and CRP Levels with Chemotherapy Toxicity in Patients of Metastatic. https://cpaper.ctimeetingtech.com/elcc2019/submission/preview/print?publication_id=337 2/2 Kaplan-Meier method will be used to assess survival curves; Log-rank test to evaluate the statistical significance of differences and Cox proportional hazards model for multivariate analysis of the effect of clinicopathological factors on survival. This study aims to identify if increased systemic inflammatory response leads to enhanced toxicity with chemotherapeutic agents used in palliative setting in patients of metastatic lung cancer, and in turn poorer survival.

P: 54 Diagnosis of Covert Hepatic Encephalopathy Is Influenced by Multiple Non-cognitive Variables That Varies by Testing Strategy

BACKGROUND: Covert hepatic encephalopathy (CHE) is a serious complication on cirrhosis that manifests as an amnestic cognitive dysfunction. Diagnosis is based on examining cognitive functions, but results are influenced by multiple non-cognitive factors such as sleep and medications but data regarding the influence of other non-cognitive covariates is limited. We aimed to examine the potential non-cognitive variables that could influence testing on the psychometric hepatic encephalopathy score (PHES) and the encephalapp stroop. METHODS: Patients between ages 20-75 years were enrolled from clinic between 2012–2018. Those with severe uncontrolled psychiatric comorbidities were excluded as were those actively abusing alcohol or drugs. All patients underwent testing for CHE based on 2 testing strategy as recommended by the AASLD/EASL guidelines. Demographics and details of comorbidities were collected. CHE was diagnosed based on published norms. Appropriate t tests and logistic regression were done. Dependent variable was CHE on PHES and Stroop. RESULTS: We enrolled a total of 257 patients with mean age 61.1 ± 8.3, 72% were males, HCV was he predominant etiology 96 (37.3%). Median BMI was 29 (26, 34). Median education was 13 (12, 16) years. Median MELD was 11 (7.25, 15) with median childs score of 6 (5, 8). Charlson comorbidity score (CCI) was 5 (4, 6). Eighty five (33%) had a history of prior OHE and were on lactulose (13), rifaximin (9) or both (63), 95 (37%) had ascites with 58 (61%) controlled on diuretics and 17 (18%) had a h/o SBP. 41 (16%) had a h/o variceal bleeding. In terms of comorbidities 34.2% had Diabetes Mellitus, 58% had Hypertension, 11% had Coronary artery disease, 14% had hypothyroidism, 2% had CHF, 2.3% had COPD, 30% had depression and 87% were controlled on medications. 2.3% had post traumatic stress disorder (PTSD) and were on medications. 14% were on chronic narcotic medications. On cognitive testing 109 (42.4%) had CHE with a median PHES score of −3 (−7, 0) whereas 206 (80%) tested positive on encephalapp stroop. On univariable analysis hypertension was found to be significant only for stroop. On multivariable analysis age and prior OHE were predictive for both tests but for the Encephalapp stroop hypertension was found to be independently predictive (Table 1). CONCLUSION: The diagnosis of CHE can be influenced by other non-cognitive variables and these vary between individual testing strategies probably due to the differential effects that these systemic conditions have on cerebral/subcortical functions. Physicians must take into consideration these covariates while interpreting CHE testing based on these 2 tests.

High prevalence of stroke and uncontrolled associated risk factors are major public health challenges in rural northeast China: A population-based study.

Stroke has become a major burden and public health problem in rural China. We aimed to comprehensively assess the current status of stroke burden as well as the associated risk factors in rural northeast China. This population-based, cross-sectional study was conducted in 10,926 adults (response rate 85.3%) aged ≥40 years residing in rural northeast China. A multistage cluster sampling method was used to select the representative sample. The prevalent stroke cases were considered as stroke survivors on 31 August 2017. Stroke was diagnosed according to the World Health Organization's recommendations and was classified as ischemic stroke and hemorrhagic stroke based on the results of computed tomography or magnetic resonance imaging. The status of related risk factors was also evaluated. Of the 10,926 participants, 731 were diagnosed with stroke (602 patients with ischemic stroke, 151 with hemorrhage stroke, and 22 with both ischemic stroke and hemorrhage stroke). The crude prevalence of overall stroke, ischemic stroke, and hemorrhage stroke was 6690.5, 5509.8, and 1382.0 per 100,000 people, respectively, and the age-standardized rate was 4903.8, 4041.7, and 990.9 per 100,000 people. Among the overall stroke population, 13.4% were living with consequences of stroke. Hypertension (86.7%), dyslipidemia (37.2%), and diabetes (24.5%) were highly prevalent in stroke participants. However, most of those comorbidities remained uncontrolled (93.7, 44.7, and 88.9%, respectively). The burden of stroke in rural northeast China was substantial, with a high prevalence of stroke, recurrence, and disabilities. Uncontrolled comorbidities will likely contribute to recurrence and worsening disabilities in the coming decades. Strategies of long-term management of stroke and related risk factors are urgently required in rural northeast China.

Prevalence of clinically significant incidental findings by whole-body fludeoxyglucose F 18 positron emission tomography/computed tomography scanning in moderate-to-severe psoriasis patients participating in clinical trials

There has been an increase in the number of psoriasis treatments being investigated in clinical trials. Patients may have undiagnosed issues at the start of a study which may become identified during follow-up as incident medicinal conditions. The prevalence of incidental findings in patients with moderate-to-severe psoriasis presenting for clinical trials is unknown. Determine the prevalence of incidentalomas and rate of malignancy identified by fludeoxyglucose F 18 (FDG) positron emission tomography/computed tomography (PET/CT) imaging in clinical trial patients with moderate-to-severe psoriasis. A cross-sectional secondary analysis of patients with moderate-to-severe psoriasis who underwent FDG PET/CT scans at the baseline visit, before randomization, for 3 phase 4 clinical trials on vascular inflammation in psoriasis. Only patients without active infection, malignancy, or uncontrolled comorbidities were eligible for the clinical trials. A total of 259 healthy patients with moderate-to-severe psoriasis underwent an FDG PET/CT scan as part of the study procedures. In all, 31 patients (11.97%) (95% confidence interval [CI], 8.28-16.56) had clinically significant incidentalomas on the baseline FDG PET/CT scan. Univariate logistic regression demonstrated that with every increase of 10years of age, there was an approximate 30% increased risk of discovery of an incidentaloma (odds ratio, 1.30; 95% CI, 1.01-1.68). Of those patients with findings suggestive of malignancy (n=28), 6 were confirmed to have cancer, resulting in a 2.31% (95% CI, 0.9-5.0) prevalence of malignancy. The positive predictive value of a true cancer was 31.58% (range, 21%-54%). Generalizability and lost to follow-up. Incidentalomas on FDG PET/CT imaging are common in otherwise healthy, asymptomatic patients with moderate-to-severe psoriasis in clinical trials. Our results can help inform interpretation of clinical trial safety data and emphasize the importance of compliance with cancer screening recommendations.

Health-related Quality of Life of Patients with Type 2 Diabetes Mellitus at A Tertiary Care Hospital in India Using EQ 5D 5L.

Objective:To assess the health-related quality of life of Type 2 Diabetes mellitus patients attending outpatient departments of a tertiary hospital using EQ-5D-5L.Methods:The study was conducted at a tertiary care hospital in India. The quality of life of patients with type 2 Diabetes mellitus, age 18 years and older, attending outpatient departments of Medicine and Endocrinology was assessed with the help of EQ-5D-5L, a measure of self-reported health related quality of life. Data was analyzed to obtain EQ-5D-5L scores for the five dimensions and EQ VAS score. Correlation of EQ VAS score with different variables was analyzed.Results:Out of total 358 participants, 208 had comorbidities, hypertension being the most common. Mean age was 60.71 ± 11.41 years and 216 (58.9%) were female participants. Out of five dimensions, Mobility, Self-care, Usual activities, and Pain/discomfort were most affected in age group 71 years and above while anxiety/depression affected age group 18–30 years the most. Mean EQ VAS score was 78.83 ± 15.02. Female participants had significantly higher EQ VAS score (P = 0.00) than male participants. EQ VAS score showed significant negative correlation with uncontrolled state of diabetes (P = 0.000). There was significant difference in EQ VAS score between patients with and without comorbidities. (P =0.004) Cronbach alpha for EQ-5D-5L was 0.76.Conclusion:The results suggest that EQ-5D-5L is a reliable measure for assessing health related quality of life of patients with Type 2 Diabetes mellitus. Type 2 Diabetes adversely affects the quality of life of patients. Uncontrolled disease and comorbidities can further compromise the quality of life.