Alternative Therapy Use Research Articles

Real-world evaluation of CYP2C19 guided antiplatelet therapy in patients undergoing intracranial aneurysm repair.

Aim: To evaluate the feasibility and impact of using CYP2C19 genotype to guide selection of antiplatelet therapy in patients undergoing intracranial aneurysm treatment with a flow diversion stent in a real-world clinical setting.Patients & methods: A single-center, retrospective, observational cohort study was conducted in 112 patients undergoing intracranial aneurysm repair with flow-diversion stenting from 2014 to2021. Data were abstracted from health records. The frequency of clopidogrel or alternative therapy (ticagrelor or prasugrel) use was compared across CYP2C19 status (intermediate or poor metabolizer [IM/PM] vs. normal, rapid, or ultrarapid metabolizer [NM/RM/UM]).Results: In the study population, CYP2C19 genotype testing was performed on 110 (98.2%) patients; of these, 106 (97.2%) had results available prior to the stent procedure and 28 (25.5%) were IM/PMs. Alternative therapy was used more frequently in IM/PMs compared with NM/RM/UMs (57.1 vs. 8.5%, respectively, p<0.0001). The frequency of thromboembolic events over 12months did not significantly differ across clopidogrel-treated IM/PMs, clopidogrel-treated NM/RM/UMs and patients on alternative therapy (p=0.352); although, event numbers were low.Conclusion: A pre-emptive CYP2C19 genotyping strategy to guide antiplatelet therapy selection in intracranial aneurysm repair patients is feasible in a real-world clinical setting. Larger studies are needed to assess the impact on clinical outcomes.

Is there an Association between Complementary and Alternative Medicine use and Trust in Physicians in Patients with Rheumatic Diseases?

Generally, patients with chronic rheumatic diseases use complementary and alternative medicine (CAM) in addition to their conventional treatments to manage their health. Discussing these treatments with their physician is still rare, which might be directly related to patients' trust toward them. The primary objective of this study was to assess the association between patients' trust in their physician and the use of complementary and alternative medicine among patients with chronic inflammatory rheumatic diseases. As secondary objectives, to estimate the prevalence of CAM use, and to identify the associated factors with their use and with trust in physicians. This is a cross-sectional study, which included patients with established chronic inflammatory rheumatic diseases, at the University Hospital Center in Tangier. The questionnaire included demographic and clinical information, use of conventional therapy, complementary and alternative therapy, as well as interpersonal trust in patient-physician relationships using the Trust in Physician Scale (TPS). A regression analysis was conducted to identify factors associated with CAM use and with trust in physicians. The study included 189 patients. 57.14% of patients reported using complementary medicine at least once, most patients were women (77.78%), mean age was 46.67 ± 13.25 years with an average course of the disease of 11.11 ± 9.23 years. The most frequently used CAM treatments were cupping therapy, massage and the ingestion of a mixture of plants. Mean ± SD Trust in Physician Scale was 47.64 ± 7.2. There was no significant difference between CAM users vs. non-users (48.08 ± 6.9 vs 47.04 ± 7.4; p = 0.35). In uni and multivariate analysis, a low level of education was significantly associated with the use of CAM. However, no statistically significant difference was found with trust in physicians (OR = 1.020, 95% CI (0.978-1.063), p = 0.354). CAM therapy is common in patients with chronic inflammatory rheumatic diseases. No statistically significant association was found with trust in physicians, it was rather observed with level of education.

Antifungal Potential of Bioactive Metabolites Produced by Pseudomonas aeruginosa against Candida Species

Abstract: Background: The frequency of fungal infections targeting immune-suppressed patients has been prominently rising day by day. Among these infections, Candidiasis is one of the most common life-threatening systemic fungal infections in recent years. These infections are challenging to treat because of the inconvenience of effective antifungal drugs. Therefore, the insufficiency of current drug regimens coupled with constant mutations by the fungi to develop drug resistance can pose a potential problem for future anti-fungal treatments. This frequent increase in drug-resistant fungi has directed attention toward the use of alternative therapy from natural sources. Objective: This study aimed to evaluate Pseudomonas aeruginosa for its antifungal potential against Candida species. Materials and Methods: This study was conducted at the Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan during 2021-2022. For the detection of the antifungal compound, a clinical isolate P. aeruginosa HS 28 (identified conventionally as well as by 16S r RNA analysis) was screened for its bioactivity against Candida species by using agar well diffusion technique. The growth kinetics as well as the effect of different physical and chemical factors were also determined in the study. The compound was also partially purified by ammonium sulfate precipitation. Result: This antifungal compound showed good inhibitory activity against Candida species such as Candida albicans, C. glabrata, C. tropicalis, C. krusei, etc. This compound retained its stability at a high range of temperatures, and varying pH. Moreover, its bioactivity was also conserved when treated with organic solvents, chloroform vapors, metal salts, and different surfactants/detergents. The growth kinetics analysis illustrated that the maximum production of antifungal compounds occurred in the log phase of growth and extended supreme until the late log phase. Furthermore, the highest saturation of this protein was achieved at the concentration of 60% ammonium sulfate. Conclusion: The overall results indicated the promising antifungal potential of the compound produced by Pseudomonas aeruginosa HS 28 against Candida species.

Relationship between coronavirus anxiety, resilience, and attitudes toward complementary and alternative treatment among patients admitted&lt;br /&gt; to the COVID-19 Outpatient Clinic

&lt;b&gt;Aim&lt;/b&gt;: During the COVID-19 pandemic, the studies showed an increase in complementary and alternative therapy use. This study aimed to determine the relationship between coronavirus anxiety, resilience, and attitudes toward complementary and alternative treatment among patients admitted to the COVID-19 outpatient clinic.&lt;br /&gt; &lt;b&gt;Material and methods&lt;/b&gt;: This is a descriptive and relational study. The sample consisted of 364 patients who applied to the pandemic outpatient clinic of a training and research hospital in Turkey. Data were collected using the Coronavirus Anxiety Scale, Brief Resilience Scale, and Scale for Attitudes toward Complementary and Alternative Medicine. The Mann–Whitney U test, the Kruskal–Wallis test, and the Spearman correlation test were used in data analysis.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;: There was a moderate and negative correlation (r = −0.332) between attitudes toward complementary and alternative medicine and coronavirus anxiety, and a moderate and positive correlation (r = 0.348) between attitudes toward complementary and alternative medicine and resilience (p &amp;lt; 0.01). Additionally, there was a moderate and negative correlation between coronavirus anxiety and resilience (r = −0.667; p &amp;lt; 0.01).&lt;br /&gt; &lt;b&gt;Conclusion&lt;/b&gt;: In the COVID-19 pandemic process, it is essential to follow up on patients' complementary and alternative medicine use, inform them, and determine their causes.

Patient delay in initiating treatment after breast cancer diagnosis: A cause for concern

Objectives Delayed presentation, diagnosis, and treatment negatively impact the survival of breast cancer patients. This study aimed to describe the time to initiation of treatment after breast cancer diagnosis and causes of delay to help identify targets for future interventions. Material and Methods A prospective study was carried out on breast cancer patients who had delay initiating two major oncologic treatments (chemotherapy and mastectomy) between July 2018 and June 2021. Data were analyzed by SPSS version 23.0. Results Sixty-two of 146 patients (42.5%) delayed initiating oncologic treatments. All patients were females, and their ages ranged from 21 to 70 years, with a median age of 48 years (mean 46.9 ± 10.3 years). Median durations of symptoms at presentation and between diagnosis and commencement of treatments were 6 and 10 months, respectively. The mean lump size at presentation and before treatment were 8.2 cm and 15.4 cm, respectively. Early versus advanced breast cancer was 21 (33.8%) vs. 41 (66.1%) at presentation and 2 (3.2%) vs. 60 (96.8%) before treatment. Major reasons for delayed treatment include the use of alternative therapy (48.4%), financial problems (24.2%), fear of surgery (9.7%), chemotherapy side effects (8.1%), and family interference (4.8%). The length of delay was not affected by the patient’s age, marital status, or level of education (p &gt; 0.05). Conclusion Patients had longer delays in initiating treatments after breast cancer diagnosis. Focusing on causes of secondary patient delay is equally as important as early detection and diagnosis.

Factors contributing to flares of ulcerative colitis in North India- a case-control study

BackgroundUlcerative colitis is a relapsing and remitting disease that may be associated with flares. The causes of flares in the Indian setting are not well recognized.MethodsThe present prospective case-control study was conducted at a single center in North India. Cases were defined as patients admitted for flare of ulcerative colitis, while controls were patients in remission enrolled from the outpatient department. The basis of the diagnosis of flare was a simple clinical colitis activity index (SCCAI) of ≥ 5 and endoscopic activity, while remission was based on SCCAI < 4 and a normal fecal calprotectin. A questionnaire evaluating recent infections, stress, drug intake (antibiotics, pain medication), adherence to therapy, and use of complementary and alternative therapy (CAM) was administered.ResultsWe included 84 patients (51 with flare and 33 in remission) with a median age of 38 years, of whom 47 (55.9%) were males. The two groups were similar for baseline parameters, including age (38, 23–50 and 38, 25.5–48.5 years), male gender (52.9% and 60.6%), extent of disease, extraintestinal manifestations (21.6% and 12.1%), use of 5-aminosalicylates (76.5% and 90.9%). The thiopurine use was lower in those having a flare (15.7% and 36.4%). Amongst the predictors of flare, the recent infections (39.2% and 30.3%), recent travel (31.4 and 27.3%), eating outside food (47.1% and 39.4%), consumption of milk products (88.2% and 75.8%), use of pain medication (43.1% and 33.3%) and recent stress (62.7% and 60.6%) were similar between cases and controls. The rates of antibiotic use (29.4% and 6.1%), lack of adherence (50.9% and 15.2%), and intake of CAM (70.6% and 33.3%) were higher in those with flare. Patients attributed a lack of adherence to the cost of therapy, presumed cure (due to lack of symptoms), and fear of adverse effects.ConclusionLack of adherence to inflammatory bowel disease therapies and recent CAM and antibiotic intake was higher in patients with flares of UC. The study makes ground for educational intervention(s) promoting knowledge and adherence to IBD therapies.

Health-related quality of life and its determinants among patients with psoriasis at a referral hospital in Northwest Ethiopia.

This study assessed health-related quality of life (HRQoL) and its determinants among patients with psoriasis having follow-ups at the University of Gondar Comprehensive Specialized Hospital (UoGCSH). A cross-sectional institutional-based study was conducted at the dermatologic clinic of UoGCSH from June to August 2022. Four hundred eligible patients with psoriasis were included in the study using a systematic random sampling technique. The Dermatology Life Quality Index (DLQI) measurement scale was used to assess HRQoL. The relationship between HRQoL and independent predictor variables was investigated using bivariable and multivariate logistic regression analyses. Statistical significance was defined as a p-value of <0.05 at the 95% CI. Of the 422 study subjects approached, 400 respondents with psoriasis were included in the final analysis. The mean (±SD) age was 39.8 (±17.2) years, and 56% were women. The most commonly prescribed medications were topical corticosteroids (68.3 %). The mean (±SD) DLQI was 13.05 (7.82). More than three-fourths (78.5%) of the patients' HRQOL was affected, and its severity ranged from very large to extremely large. Being male (adjusted odd ratio) (AOR) = 0.373, 95% CI (0.171, 0.773), the use of alternative therapy (AOR) = 0.237, 95% CI (0.114, 0.494), duration of diseases (AOR) = 0.184, 95% CI (0.061, 0.557), duration on medication (AOR) =3.75, 95% CI (1.32, 10.73), presence of comorbidity (AOR) = 6.199, 95% CI (1.921, 20.00), and income were found to have a significant association with poor HRQoL. Psoriasis patients had reduced HRQoL, which was lower than that of the normal population. The study identified that several variables contributed to this reduced HRQoL. Predictors that take into account interventions were essential for preserving patients' HRQoL.

Examination the relationship between the health literacy of patients with type 2 diabetes and the use of complementary and alternative medicine

Background: Health literacy and the use of complementary and alternative medicine are two important factors that should be evaluated the management of type 2 diabetes.&#x0D; Objectives: To examine the relationship between the health literacy of patients with type 2 diabetes and the use of complementary and alternative medicine.&#x0D; Methods: This cross-sectional study was carried out with 1076 patients with type 2 diabetes. The data were collected using a descriptive information form and the Health Literacy Scale.&#x0D; Results: It was found that 61.4% of the patients used complementary and alternative treatments. Patients’ total score from the Health Literacy scale was 48.90±19.92. The use of complementary and alternative therapy increased in the presence of another chronic disease or diabetic neuropathy and decreased with increased age and health literacy (R2 =050; Model: x2= 40.656, p=0.00).&#x0D; Conclusions: It was determined that the health literacy of patients with type 2 diabetes was not enough and that the use of complementary and alternative treatments was high. With the increase in patients' health literacy, the use of complementary and alternative medicine decreased. It is recommended that health professionals evaluate patients’ health literacy and use of complementary and alternative therapies and provide counselling to ensure effective diabetes self-management.&#x0D; Keywords: Health literacy; complementary and alternative medicine; type 2 diabetes mellitus.

Heterogeneity in hormone-dependent breast cancer and therapy: Steroid hormones, HER2, melanoma antigens, and cannabinoid receptors

Breast cancer is the most frequently diagnosed cancer and the leading cause of death by cancer among women worldwide. The prognosis of the disease and patients’ response to different types of therapies varies in different subgroups of this heterogeneous disease. The subgroups are based on histological and molecular characteristics of the tumor, especially the expression of estrogen (ER) and progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Hormone-dependent breast cancer, determined predominantly by the presence of ER, is the most common type of breast cancer. Patients with hormone-dependent breast cancer have an available targeted therapy, however, tumor cells can develop resistance to the therapy, which is a major obstacle limiting the success of treatment and enabling relapse to metastatic disease. The complicated crosstalk of both tumor-intrinsic and exogenous factors may contribute to endocrine resistance, although the underlying molecular details are still enigmatic. For example, the expression of the melanoma antigen genes (MAGE) correlates with a worse clinical prognosis and therapy resistance in many types of cancers, including breast cancer. Recent studies suggested that cancers co-opt MAGEs’ physiological functions to promote therapy resistance and potentially metastasis development. The response to the therapy can be also affected by the concurrent use of alternative therapy, e.g., cannabinoid use is popular among breast cancer patients. Cannabinoids interact with endogenous estrogen function, however, how they interfere with breast cancer therapy is still poorly understood. In this review, we summarize the role of ER, PR, and HER2 in hormone-dependent breast cancer; provide current knowledge of MAGEs and cannabinoid receptors in breast cancer; ultimately discuss the potential interlacement of their signaling paths which may underlay diverse responses to therapies in breast cancer patients simultaneously using cannabinoids. These interactions are poorly understood but critical for the advancement of conventional and complementary treatment options for patients, particularly the ones with metastatic disease.

Use of complementary and alternative medicines in ENT outpatient department of tertiary care hospital in Southern Rajasthan

Background: Complementary and alternative medicine (CAM) use is highly gaining popularity along with main treatment streams these days. Physicians cannot ignore this fact and should question and counsel patients about pros and cons of CAM for cure of different ailments. Aim and Objectives: The objective of the study was to know about use of CAM among patients visiting Ear, Nose, and Throat (ENT) outpatient department (OPD) in tertiary care hospital of Southern Rajasthan. Materials and Methods: An observational cross-sectional study was conducted in ENT OPD for 2 months. Two hundred and fifty patients were considered for the study. Semi-structured questionnaire was prepared and made to be filled by the patients during their visit to ENT OPD after taking informed consent. Various questions were asked like extent of use of alternative therapies, type of CAM used by the patients, patient’s knowledge about ADRs and drug interactions, reasons for which alternative medicine might have been used. Results: Among 250 patients, CAMs were used by 36 patients. The most common CAMs were either Ayurveda or Homoeopathy medicines or both. The majority of patients obtained their information from family and friends. Maximum patients used these alternative medicines for relief of cough and hoarseness of voice. Conclusion: The study throws light on use of alternative drug therapy and streams of medicine along with routine hospital treatment among patients visiting ENT OPD. This knowledge helps to understand about patients’ alternative approach to diseases, about self-medication, patient’s belief about different types of therapies and also ignorance of possible health hazards, side effects, and complications due to use of concomitant main and alternative medicines for treatment purposes.

Evaluation of Potential Racial Disparities in CYP2C19-Guided P2Y12 Inhibitor Prescribing After Percutaneous Coronary Intervention.

Black patients suffer worse outcomes after percutaneous coronary intervention (PCI) than White patients. Inequities in antiplatelet prescribing may contribute to this health disparity. We compared P2Y12 inhibitor prescribing by race following CYP2C19 genotyping to guide antiplatelet therapy selection after PCI. Patients from 9 sites that performed clinical CYP2C19 genotyping after PCI were included. Alternative therapy (e.g., prasugrel or ticagrelor) was recommended for CYP2C19 no-function allele carriers, in whom clopidogrel is predicted to be less effective. The primary outcome was choice of P2Y12 inhibitor (clopidogrel vs. alternative therapy) based on genotype. Of 3,342 patients included, 2,448 (73%) were White, and 659 (20%) were Black. More Black than White patients had a no-function allele (34.3% vs. 29.7%, P= 0.024). At hospital discharge following PCI, 44.2% of Black and 44.0% of White no-function allele carriers were prescribed alternative therapy. At the time of the last follow-up within 12 months, numerically fewer Black (51.8%) than White (56.7%) no-function allele carriers were prescribed alternative therapy (P=0.190). However, the difference was not significant after accounting for other factors associated with P2Y12 inhibitor selection (odds ratio 0.79, 95% confidence interval 0.58-1.08). Alternative therapy use did not differ between Black (14.3%) and White (16.7%) patients without a no-function allele (P=0.232). Among real-world patients who received CYP2C19 testing after PCI, P2Y12 inhibitor prescribing rates did not differ between Black and White patients. Our data suggest an absence of racial disparity in genotype-guided antiplatelet prescribing among patients receiving CYP2C19 testing.

Temporal Trends of Alternative Therapy Use before, during and after Cancer Treatment: Results from the Multi-Institutional Complementary and Alternative Medicine Exposure in Oncology (CAMEO) Study

<h3>Purpose/Objective(s)</h3> Complementary and alternative medicine (CAM) use has been well-documented among cancer patients, with increasing public awareness of non-traditional treatments in the era of COVID-19. However, the temporal trends in usage at the patient level have not been well defined. We sought to characterize trends in what CAM interventions patients used before, during and after cancer treatment. <h3>Materials/Methods</h3> An NCI-designated cancer center and a comprehensive cancer center prospectively enrolled adult cancer patients onto a cross-sectional survey assessing CAM use between 2020 and 2021. The survey evaluated perceptions and use of CAM, including vitamins/minerals, herbal supplements and alternative medicines, diets, and mind/body therapies. Types of CAM utilized were self-reported by use before, during and after primary cancer treatment. Differences in utilization were analyzed with two-proportion z-tests. <h3>Results</h3> Among 749 patients enrolled, 578 (77%) reported using CAM. Among CAM users, the most popular interventions used at some point included multivitamins (60%), vitamin D (58%), prayer (48%), vitamin C (35%), massage (33%), meditation (28%), fish oil (24%), probiotics (21%), turmeric (20%), CBD products (19%), chiropractic manipulation (17%), marijuana (16%) and vegetarian diet (12%). Vitamin use nearly universally declined over the before → during → after period, for example multivitamin (52% → 39% → 31%, p<0.01), vitamin D (37% → 42% → 30%, p<0.01), and calcium (21% → 24% → 15%), p<0.01). No vitamin consumption increased after treatment compared to before. Multiple herbal supplements increased during treatment but stayed higher than pre-treatment levels, including CBD (5.4% → 13% → 8.2%, p<0.01), marijuana (6.0% → 12% → 7.9%, p<0.01) and turmeric (9.1% → 13% → 9.3%). Many specialized diets were adopted during treatment but were not continued afterward, including vegetarian (5.4% → 8.3% → 5.5%), vegan (2.2% → 5.2% → 2.2%), ketogenic (3.3% → 4.3% → 2.6%), alkaline (1.2% → 3.6% → 1.9%) and raw food (0.9% → 1.4% → 0.3%). Mind/body intervention use also nearly universally decreased over the before to after period, such as chiropractic manipulation (16% → 7.4% → 5.9%, p<0.01), yoga (12% → 12% → 9.2%) or pilates (34.2% → 2.2% → 1.6%). Some increased during treatment but decreased after, like acupuncture (8.0% → 12% → 5.9%, p<0.01) or meditation (18% → 23% → 15%, p<0.01), with the largest decrease being in prayer (43% → 44% → 32%, p<0.01). <h3>Conclusion</h3> Although CAM use is known to be common, the patterns of use before, during and after treatment have not been well-defined. Herbal supplements were the most likely to continue to be used after cancer treatment. General health maintenance, wellness and mind/body interventions largely decreased below pre-treatment levels after treatment, regardless of utilization during treatment.

PB1871: PROGNOSTIC SIGNIFICANCE OF THE NOTCH1 GENE MUTATION AND OTHER LABORATORY FACTORS IN CHRONIC LYMPHOCYTIC LEUKEMIA

Background: An important stage in the management of patients with CLL is the prediction of the course of the disease in order to assess the need for an earlier onset of therapy and the use of alternative therapy on an individual basis, depending on the detectable prognostic markers. Aims: To determine the interrelationship of clinical-laboratory (as well as molecular-genetic) prognostic markers with various courses of CLL. Methods: We have examined 107 patients diagnosed with CLL in SI «RRC RM&HE» from 2017 to 2020. This cohort was divided into 2 groups: 1st group (49 patients) without signs of progression of CLL, and the 2nd group (58 patients) with clinical signs of disease progression after 3 years of observation. The median age in the 1st group was 61 years, in the 2nd - 62 years. The material for the study was venous blood. To determine the immunophenotype of tumor cells we used the flow cytofluorimeter FacsCanto II. Detection of β2-mg, TK and TPA was performed using the chemiluminescent analyzer. To determine the mutations of the NOTCH1 gene (34th exon), SSCP-PCR was used, followed by direct sequencing of DNA samples with conformational polymorphism. We used nonparametric statistics methods calculated in the Statistica 10.0. Statistically significant differences were considered for p<0.05. Results: Patients in group 1 differed from patients in group 2 in levels of β2-mg-1.8 and 3.5 μg/L (p<0.001) and LDH-220 and 326 U/L (p<0.002). TK levels (p<0.001) and TPA (p<0.011) were also significantly higher in group 2 (7.7 and 49.8 IU/L) compared with patients in group 1 (4.2 and 34.3 IU/L). According to immunophenotyping data, statistically significant differences were obtained on the Zap70 marker: in the 1st group the median was 10.1%, in the 2nd group - 21.6%. As a result of molecular genetic analysis, mutations in the NOTCH1 gene were identified in 14 patients. It was found that patients without progression at the time of inclusion in the study in the presence of mutations in the NOTCH1 gene had a statistically significantly shorter progression-free survival (mean 33.4 months (95% CI [22.0-44.8]) compared with patients without mutations (59.2 months (95% CI [54.1–64.3]) (p=0.018), which indicates the association of NOTCH1 mutations with a poor prognosis for disease progression in patients with CLL. Summary/Conclusion: It was found that markers such as LDH, β2-mg, TK, TPA, ZAP70 and NOTCH1 gene mutation have certain prognostic significance, which was confirmed by comparing their levels in patients with and without CLL progression after 3 years of observation. We can use NOTCH1 gene mutation as an additional factor in predicting the course of CLL. Knowledge of reliable prognostic markers may allow to initiate in-time treatment or to adjust therapy for patients with high-risk CLL with a probable increase in their life span.

The use of complementary and alternative therapy by advanced cancer patients receiving palliative care at home

Introduction: The purpose of this study was to evaluate the use of complementary and alternative therapies (CAT) by palliative care patients treated at home in Poland. Patients and methods: A total of 241 adult patients with advanced or metastatic cancer who were qualified for palliative care provided at home filled out the CAT screening tool. Data were analysed to assess CAT use association with several variables. Results: 82.16% of individuals who completed the survey declared using CAT at least once in the last 12 months. Self-help practices were the most used CAT category (74.47%), it was followed by herbal medicine and dietary supplements (62.66%) and visits to CAT providers (41.91%). CAT use was more prevalent among women, patients with basic education, and patients currently married and widowed. The most common reason pointed for using CAT was to improve well-being (35.4%). 50.5% of CAT users declared that they find used therapy helpful or very helpful. The study revealed an exceptionally high prevalence of spiritual practices (self-prayer, spiritual healing) in comparison to previous European studies conducted among the cancer patient population. Conclusions: The study indicated that usage of CAT among advanced cancer patients treated at home is significant, with a higher prevalence of spiritual practices than reported in previous studies among cancer patients in Europe.

Automated Susceptibility Testing With Vitek 2 Compared to MicroScan Reduces Vancomycin Alternative Therapy For Methicillin-Resistant Staphylococcus Aureus Bacteremia

Variability in minimum inhibitory concentration (MIC) with automated susceptibility testing instruments may influence methicillin-resistant Staphylococcus aureus (MRSA) treatment. The purpose of this study was to evaluate the difference in vancomycin MIC values and the impact on vancomycin alternative therapy for MRSA bacteremia using the MicroScan and VITEK 2 automated systems. This was a retrospective multicenter cohort study of adult patients with MRSA bacteremia. Patients were stratified by susceptibility testing with MicroScan (May 2013-December 2016) or VITEK 2 (June 2017-February 2020). The primary outcome was vancomycin alternative therapy use. Secondary endpoints included MRSA MIC, 30-day mortality, 30- and 90-day readmission, and hospital length of stay (LOS). A total of 193 patients were included for analysis: 89 in the MicroScan group and 104 in the VITEK 2 group. Vancomycin alternative therapy use was higher in the MicroScan group than the VITEK 2 group (56.2% vs 20.2%; p <0.001). Median MIC value was 2 mg/L and 1 mg/L for MicroScan and VITEK 2, respectively (p <0.001). Median hospital LOS was shorter in the VITEK 2 period (16 vs 12 days; p=0.02). Thirty-day mortality (10.1% vs 7.7%; p=0.555) and 90-day readmission (34.8% vs 29.8%; p=0.457) did not significantly differ between MicroScan and VITEK 2 groups. VITEK 2 use was associated with lower reported vancomycin MICs and less use of vancomycin alternative therapy.

Race and Sex Influence Use of Complementary and Alternative Therapy in Knee Osteoarthritis

Race and Sex Influence Use of Complementary and Alternative Therapy in Knee Osteoarthritis

Prevalence, profile and associations of cognitive impairment in Ugandan first-episode psychosis patients

IntroductionThe MATRICS consensus cognitive battery (MCCB) is the gold standard for neuropsychological assessment in psychotic disorders but is rarely used in low resource settings. This study used the MCCB to determine the prevalence, profile and associations of various exposures with cognitive impairment in Ugandan first-episode psychosis patients. MethodsPatients and matched healthy controls were recruited at Butabika Hospital in Uganda. Clinical variables were first collated, and after the resolution of psychotic symptoms, a neuropsychological assessment of seven cognitive domains was performed using the MCCB. Cognitive impairment was defined as two standard deviations (SD) below the mean in one domain or 1SD below the mean in two domains. Descriptive statistics determined the prevalence and profile of impairment while regression models determined the association between various exposures with cognitive scores while controlling for age, sex and education. ResultsNeuropsychological assessment with the MCCB found the burden of cognitive impairment in first-episode psychosis patients five times that of healthy controls. The visual learning and memory domain was most impaired in first-episode psychosis patients, while it was the working memory domain for the healthy controls. Increased age was associated with impairment in the domains of the speed of processing (p < 0.001) and visual learning and memory (p = 0.001). Cassava-rich diets and previous alternative and complementary therapy use were negatively associated with impairment in the visual learning (p = 0.04) and attention/vigilance domains (p = 0.012), respectively. There were no significant associations between sex, history of childhood trauma, or illness severity with any cognitive domain. ConclusionA significant burden of cognitive impairment in Ugandan first-episode psychosis patients is consistent with prior data from other contexts. However, the profile of and risk factors for impairment differ from that described in such work. Therefore, interventions to reduce cognitive impairment in FEP patients specific to this setting, including dietary modifications, are required.

65. Impact of an Antibiotic Side-Chain-Based Cross-Reactivity Chart on Antibiotic Use in Patients With β-lactam Allergies and Pneumonia

Backgroundβ-lactam antibiotics with dissimilar R-group side chains are associated with low cross-reactivity. Despite this, patients with β-lactam allergies are too often treated with alternative antibiotic therapy. An institutional β-lactam side-chain-based cross-reactivity chart was developed and implemented to guide in antibiotic selection for β-lactam allergies patients. MethodsThis single center, retrospective, cohort study analyzed the impact of the implementation of the cross-reactivity chart for patients with documented β-lactam allergies with pneumonia. Study time periods were defined as January 2013 to October 2014 prior to implementation of the chart (historical cohort) and January 2017 to October 2018 (intervention cohort) following institutional implementation and adoption. The primary outcome was the incidence of β-lactam utilization between time periods. Propensity-weighted scoring and interrupted time-series analyses compared outcomes across time periods. ResultsA total of 341 and 623 patient encounters were included in the historical and intervention cohorts, respectively. There was a significant increase in the use of β-lactams for treatment of pneumonia (70.4% vs 89.3%; p < 0.001) and the use of any alternative therapy decreased between cohorts (58.1% vs. 36%; p < 0.001) (Figure 1). β-lactam use per patient significantly improved between cohorts in patients with mild, Type 1 IgE-mediated hypersensitivity reactions (HSRs) and in patients with unknown reactions. There was no difference in overall HSRs between cohorts (2.4% vs. 1.45; p = 0.628), or in patients who received β-lactam antibiotics (1.3% historical group vs 1.1% intervention group; p = 0.467). Median alternative antibiotic days of therapy (3 vs. 2; p = 0.027) and duration of therapy per patient (3 days vs. 2 days; p = 0.023) decreased between cohorts. There was a significant increase in mortality while healthcare facility-onset Clostridioides difficile infections decreased between cohorts.β-Lactam vs. Alternative Therapy Use per Patients by Calendar Quarter ConclusionImplementation of a β-lactam side-chain-based cross-reactivity chart significantly increased the utilization of β-lactams in patients with pneumonia without increasing HSRs. Disclosures All Authors: No reported disclosures

Antibiotic Use in Patients With β-Lactam Allergies and Pneumonia: Impact of an Antibiotic Side Chain-Based Cross-Reactivity Chart Combined With Enhanced Allergy Assessment.

Backgroundβ-lactam antibiotics with dissimilar R-group side chains are associated with low cross-reactivity. Despite this, patients with β-lactam allergies are often treated with non-β-lactam alternative antibiotics. An institutional β-lactam side chain–based cross-reactivity chart was developed and implemented to guide in antibiotic selection for patients with β-lactam allergies.MethodsThis single-center, retrospective cohort study analyzed the impact of the implementation of the cross-reactivity chart for patients with pneumonia. Study time periods were defined as January 2013 to October 2014 prior to implementation of the chart (historical cohort) and January 2017 to October 2018 (intervention cohort) following implementation. The primary outcome was the incidence of β-lactam utilization between time periods. Propensity-weighted scoring and interrupted time-series analyses compared outcomes.ResultsA total of 341 and 623 patient encounters were included in the historical and intervention cohorts, respectively. There was a significantly greater use of β-lactams in the intervention cohort (70.4% vs 89.3%; P < .001) and decreased use of alternative therapy (58.1% vs 36%; P < .001). There was no difference in overall allergic reactions between cohorts (2.4% vs 1.6%; P = .738) or in reactions caused by β-lactams (1.3% vs 0.9%; P = .703). Inpatient mortality increased (0% vs 6.4%; P < .001); however, no deaths were due to allergic reactions. Healthcare facility–onset Clostridioides difficile infections decreased between cohorts (1.2% vs 0.2%; P = .032).ConclusionsImplementation of a β-lactam side chain–based cross-reactivity chart and enhanced allergy assessment was associated with increased use of β-lactams in patients with pneumonia without increasing allergic reactions.

The Effect of Urtica Dioica Extract on Blood Lipids Profile in Patients with Type 2 Diabetes: A Randomized Double-blinded Clinical Trial

Background: Diabetes is an endocrine disorder that is strongly associated with cardiovascular disease. The use of alternative therapy has recently increased and medicinal plants are one of the alternative therapies for diabetic patients. This study aimed to evaluate the protective effect of Urtica dioica (Nettle) on lipid profile in patients with type 2 diabetes (T2D). Method: This parallel randomized double-blinded clinical trial was conducted on 60 men and women with T2D for an 8-week period. The participants were randomly assigned to received 100mg/kg/day extract of Urtica Dioica (UG) and the placebo group (PG). Blood triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDLc) and high density lipoprotein cholesterol (HDLc) were measured at baseline and end of the study. The data were analyzed using SPSS 16.0 and P &lt; 0.05 was considered significant. Results: The mean difference of total cholesterol showed no significant difference in the UG compared to the PG which were -10.56±40.5 and -19.5± 35.9 (P = 0.14), respectively. The study also showed no significant difference between TG and LDLc in the UG compared to the PG (-39.8±171.5 vs. -23.37±72.3 (P = 0.68) and -3.16±33.4 vs. -11.2±35.6 (P = 0.15), respectively). The mean difference of HDLc in the UG and PG were -2.68±8.11 and 2.62±10.6 (P = 0.05), respectively, indicating a significant increase in the UG compared to the PG. Conclusion: The results demonstrated that consumption of 100mg/kg/day extract of UD for 8 weeks by increasing HDL concentration can decrease the risk of cardiovascular disease in patients with T2D.