Year Increase In Age Research Articles

THE EFFECT OF AGE AND CONCOMITANT SURGERY ON STRENGTH IN ADOLESCENT ATHLETES WITH PRIMARY QUADRICEPS TENDON ACL RECONSTRUCTION

Background:Knee extensor strength deficits occur after ACL reconstruction (ACLR). Prior studies have reported that age affects quadriceps strength after ACLR, however strength deficits in relation to age have not been assessed among adolescents. Isokinetic dynamometric strength testing is a tool frequently used to assess strength post-operatively in order to identify these deficits.Purposes:1) To examine the effect of age on isokinetic extensor and flexor deficits among adolescents who were 5-10 months post-ACLR. We hypothesized that age would be inversely related to extensor strength deficit. 2) To determine if extensor or flexor strength deficits exist between adolescents post-ACLR with and without concomitant meniscus surgery. We hypothesized that those with concomitant meniscus surgery would demonstrate greater deficits in flexor and extensor strength.Methods:Study participants completed isokinetic testing within 5-10 months after primary quadriceps tendon ACLR, but before return to sport. The protocol consisted of assessing peak torque at 60, 180, and 300 degrees/s, through a limited range of knee extension and flexion. Our primary outcome variables were peak torque percent deficit of involved leg compared to uninvolved leg for flexion and extension. To address purpose 1, we constructed a series of multivariable regression models, where age was the independent variable, peak torque flexor/extensor deficits at each testing speed was the dependent variable, and sex and weight were covariates. To address purpose 2, we compared peak torque extensor and flexor deficits between those with and without concomitant meniscus surgery using independent samples t-tests.Results:A total of 44 completed the study protocol. There were no significant demographic differences between those with and without concomitant meniscus surgery (Table 1). The relationship between age at surgery and peak torque extensor deficits at 300d/s demonstrated a linear but non-significant association (Table 2; Figure 1). For every year increase in age, the expected deficit at 300d/s increased by approximately 3%. Patients who underwent isolated ACLR demonstrated significantly greater flexor deficits than those who underwent ACLR with concomitant meniscus surgery when tested at 180d/s and 300d/s (Table 3).Conclusion:Contrary to our first hypothesis, extensor deficits at 300d/s demonstrated an apparent association with older age. We observed a steady increase in strength deficit at 300d/s associated with increasing age. Contrary to our second hypothesis, no significant differences were found in extensor strength between those with and without meniscus surgery. Additionally, those with concomitant meniscus surgery demonstrated significantly less flexor deficit than those without meniscus surgery.Table 1.Demographics characteristics of patients who did and did not undergo concomitant meniscus surgery during ACL reconstruction. Data are presented as mean (sd) or n (%). Variable ACL reconstruction + meniscus surgery (n=25) Isolated ACL reconstruction (n=19) P value Age (years)16.0 (1.4)15.7 (1.5)0.51Sex (female)15 (60%)14 (74%)0.52Sport type played during injury(contact/collision sport)22 (88%)15 (79%)0.44Height (cm)166.3 (9.5)164.6 (10.8)0.58Mass (kg)70.1 (19.4)60.2 (11.6)0.06Dominant leg (right)24 (96%)18 (95%)0.99Table 2.Regression models assessing the association between age at the time of surgery and peak flexor and extensor deficits at the three testing speeds, while adjusting for sex and weight.Testing Speedβ coefficientStandard Error95 % confidence intervalP value Extensor Deficits 60 degrees / s0.681.60-2.56, 3.920.67180 degrees / s2.611.55-0.53, 5.740.10300 degrees / s2.981.57-0.21, 6.160.06 Flexor Deficits 60 degrees / s0.381.27-2.18, 2.930.77180 degrees / s-0.221.54-3.34, 2.910.89300 degrees / s-1.071.91-4.94, 2.800.58Figure 1.Scatterplot describing the relationship between age at surgery and peak torque extensor deficits when tested at 300 degrees/s (r = 0.24).Table 3.Comparison of isokinetic outcomes between patients who underwent concomitant meniscus surgery during ACL reconstruction compared to those who underwent isolated ACL reconstruction. Data are presented as means (sd).VariableACL reconstruction + meniscus surgery(n=25)Isolated ACL reconstruction(n=19)P valueExtensor Deficits60 degrees / s28.2 (14.9)27.5 (11.8)0.87180 degrees / s21.4 (14.2)22.8 (12.6)0.73300 degrees / s17.8 (14.8)20.2 (13.0)0.58Flexor Deficits60 degrees / s6.9 (12.3)8.7 (9.2)0.59180 degrees / s*-3.7 (14.1)5.2 (9.9)0.02300 degrees / s*-6.4 (15.1)6.8 (17.5)0.01 *Patients who underwent isolated ACLR demonstrated significantly greater flexor deficits than those who underwent ACLR with concomitant meniscus surgery when tested at 180 degrees/s and 300 degrees/s.

Prevalence and predictors of HIV screening in invasive cervical cancer: a 10 year cohort study

BackgroundInvasive cervical carcinoma is associated with a human immunodeficiency virus (HIV) prevalence of >0.1%, and screening is recommended and cost-effective for cancer populations exceeding this threshold. HIV status is also...

68 Application of the Modified Hospital Length of Stay Predictor

Abstract Introduction Developing formulas to predict accurate length of stay (LOS) is challenging in burn patients as many complex variables can effect LOS. A recently published article in 2016 provided new formulas (NFs) to predict hospital LOS. Our goal is to compare our patients actual LOS (ALOS) to the NFs published, the traditional 1day/%TBSA rule, and to the hospital expected LOS (ELOS) based on patients CMI/DRGs. Methods Data was collected from Jan ‘16 to Dec ‘18 on all patients >18 years of age using NTRACS burn registry. We excluded deaths, non-burns, readmissions, any records with missing information, and any patients transferred to another acute care hospital. We performed multiple regression to examine the relationship between LOS with age, inhalational injury (INHINJ), and TBSA on all patients. We divided this population into three groups per the NFs recommendations: 1) INHINJ; 2) without INHINJ < 40 years old; 3) without INHINJ >40 years old. Using these three groups, we calculated the difference between ALOS to 1) the traditional LOS formula, 2) the NFs as established in the 2016 article, and to 3) the hospitals ELOS metrics. For acuity comparison, we also calculated average CMI in each study group. The NFs published are as follows: Results The multiple regression model with all three variables (Age, % TBSA, and INHINJ) produced R² = 0.321, F(3,883) = 139.23, p < .05. INHINJ, age, and TBSA had significant positive regression, indicating an increase or presence of all three variables will lengthen LOS. The regression equation is: LOS = (-3.93) +1.71(AGE) +1.11(TBSA) +15.81 (Inhalation). Every year increase in age increased LOS by 1.71 days. Every 1% increase in TBSA increased LOS by 1.11 days. Presence of INHINJ (0= no INHINJ; 1= INHINJ) increased LOS by 15.81 days. Table 1 depicts the mean ± SD of the difference in LOS (predicted - actual) for the three predictive models of LOS. Negative values indicate underestimation of LOS and positive values indicate overestimate of LOS. Conclusions Application of the predictive LOS formulas has underestimated LOS in this population, with the exception of the NFs to predict LOS on patients >40 years old without INHINJ. Furthermore, an R² value of 0.32 indicates that the variables utilized in this study do not account for 68% of the variation we see. This is further exemplified by the wide standard deviations, particularly in the INHINJ group. Applicability of Research to Practice Directly Applicable.

664 Risk Factors for the Development of Transaminitis in Pediatric Burn Patients Treated with Oxandrolone

Abstract Introduction Oxandrolone is an anabolic steroid that is the standard of care for burn patients experiencing hypermetabolism. Previous studies have demonstrated the benefits of oxandrolone, including increased body mass and improved wound healing. One of the common side effects of oxandrolone is transaminitis, occurring in 5–15% of patients, but little is known about associated risk factors with the development of transaminitis. A recent multicenter study in adults found that younger age and those receiving concurrent intravenous vasopressors or amiodarone were more likely to develop transaminitis while on oxandrolone. The purpose of this study was to determine the incidence and identify risk factors for the development of transaminitis in pediatric burn patients receiving oxandrolone therapy. Methods This was a multicenter, retrospective risk factor analysis that included pediatric patients with thermal burn injury (total body surface area [TBSA] > 10%) who received oxandrolone over a 5-year time period. The primary outcome of the study was the development of transaminitis while on oxandrolone therapy, which was defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >100 mg/dL. Secondary outcomes included mortality, length of stay, and change from baseline ALT/AST. Results A total of 55 pediatric patients from 5 burn centers met inclusion criteria. Of those, 13 (23.6%) developed transaminitis, and the mean time to development of transaminitis was 17 days. Patients who developed transaminitis were older (12 vs 6.4 years, p = 0.01) and had a larger mean %TBSA (45.9 vs 34.1, p = 0.03). The odds of developing transaminitis increased by 23% for each 1 year increase in age (OR 1.23, CI 1.06–1.44). The use of other concurrent medications was not associated with an increased risk of developing transaminitis. Renal function and hepatic function was not associated with the development of transaminitis. There was no significant difference in length of stay and mortality. Conclusions Transaminitis occurred in 23.6% of our study population and was associated with patients who were older and had a larger mean %TBSA burn. Older pediatric patients with larger burns who are receiving oxandrolone should be closely monitored for the development of transaminitis. Applicability of Research to Practice Future research is needed to identify appropriate monitoring and management of transaminitis in oxandrolone-treated pediatric burn patients.

Vitamin D status in an Australian patient population: a large retrospective case series focusing on factors associated with variations in serum 25(OH)D

ObjectivesTo investigate whether sex, age, medical specialty and seasonal variations in serum concentration of 25-hydroxy vitamin D (25(OH)D) are evident among an Australian patient population.DesignRetrospective study analysing the results of...

Human Metapneumovirus Infection in Hospitalized Children.

Most children are exposed to human metapneumovirus (HMPV) by the age of 5 y. This study aimed to describe the morbidity associated with HMPV infections in a cohort of children in the Midwest of the United States. This was a retrospective 2-center cohort study including children (0-17 y old) hospitalized with HMPV infections at 2 tertiary care pediatric hospitals from 2009 to 2013. Demographics, chronic medical conditions, viral coinfections, and hospitalization characteristics, including the need for respiratory support, high-flow nasal cannula, CPAP, bi-level positive airway pressure, invasive mechanical ventilation, pediatric ICU admission, acute kidney injury (AKI), use of extracorporeal membrane oxygenation, and length of stay, were collected. In total, 131 subjects were included. Those with one or more comorbidities were older than their otherwise healthy counterparts, with a median age of 2.8 y (interquartile range [IQR] 1.1-7.0) compared to 1.3 y (IQR 0.6-2.0, P < .001), respectively. Ninety-nine (75.6%) subjects required respiratory support; 72 (55.0%) subjects required nasal cannula, simple face mask, or tracheostomy mask as their maximum support. Additionally, 1 (0.8%) subject required high-flow nasal cannula, 1 (0.8%) subject required CPAP, 2 (1.5%) subjects required bi-level positive airway pressure, 15 (11.5%) subjects required invasive mechanical ventilation, 4 (3.1%) subjects required high-frequency oscillatory or jet ventilation, and 4 (3.1%) subjects required extracorporeal membrane oxygenation. Fifty-one (38.9%) subjects required pediatric ICU admission, and 16 (12.2%) subjects developed AKI. Subjects with AKI were significantly older than those without AKI at 5.4 y old (IQR 1.6-11.7) versus 1.9 y old (IQR 0.7-3.5, P = .003). After controlling for the presence of at least one comorbidity and cystic fibrosis, each year increase in age led to a 16% increase in the odds of AKI (P = .01). The median length of stay for the entire cohort was 4.0 d (IQR 2.7-7.0). Children hospitalized with HMPV may be at risk for AKI. Risk of HMPV-associated AKI appears to increase with age regardless of severity of respiratory illness or presence of comorbidities.

Assessment of prevalence and load of torquetenovirus viraemia in a large cohort of healthy blood donors

ObjectivesTorquetenovirus (TTV) is an emerging marker of functional immune competence with the potential to predict transplant-related adverse events. A large-scale epidemiological study was performed to understand how basal values vary in healthy individuals according to age and gender. MethodsWe tested plasma from 1017 healthy blood donors aged 18–69 years. The presence and load of TTV were determined by a real-time PCR assay. A sub-cohort of 384 donors was tested for anti-cytomegalovirus IgG antibodies, and 100 participants were also tested for TTV viraemia on a paired whole blood sample. ResultsThe overall prevalence of TTV was 65% (657/1017) with a mean (±SD) growth of 5 ± 4% every 10 years of age increase, but stably higher in males (465/690, 67%) than in females (192/327, 59%). Mean (±SD) TTV load was 2.3 ± 0.7 Log copies/mL with no sex difference. TTV viraemia showed modest increases along 10-year age intervals (mean ± SD: 0.3 ± 0.1). TTV viraemia in donors sampled 2 years later remained stable (mean ± SD: 2.3 ± 0.8 versus 2.2 ± 0.7 Log copies between samples). Twenty-six per cent (9/34) of blood donors with TTV-negative plasma scored positive when whole blood was tested, and the donors with positive plasma showed a mean (±SD) 1.4 ± 0.5 Log increase in copy numbers when whole blood was tested. ConclusionsThis study establishes the mean value of TTV viraemia in plasma in healthy blood donors and suggests that ageing causes only minimal increases in TTV viraemia.

Adherence to antiretroviral treatment and quality of life among transgender women living with HIV/AIDS in São Paulo, Brazil

ABSTRACT This study focused on factors associated with antiretroviral therapy (ART) adherence and quality of life among transgenderwomen in Sao Paulo, Brazil, using univariable and adjusted analysis. Adherence was evaluated with a self-report tool and with HIV viral load (VL) measurement. PROQOL-HIV was used to assess quality of life. 106 TGW with median 41 years old were included; most were white (56%) and had >10 years of education (57%). Median time since HIV/AIDS diagnosis was 10 years. Overall, participants had high T CD4+ counts (median 659 cells/mm3) and most (75%) had undetectable HIV VL. 85% were considered adherent using self-report (95%CI 77-91), whereas 72% (95%CI 62-80) were considered adherent when self-report and undetectable HIV VL were analyzed jointly. Older age was associated with higher ART adherence; each year increase in age was associated with 5% higher odds of adherence (p = 0.021). Quality of life ranged from good-excellent in 5 of 8 domains. Younger age, lower education, higher time since HIV diagnosis, comorbidities, illicit drugs use and depression were associated with lower PROQOL scores in specific domains in univariable analysis, while depression was also associated with lower total PROQOL score even after adjustment for age, comorbidities and time since HIV diagnosis (p = 0.048).

Association between depression and anxiety among the COPD patients in a Nepalese community hospital: a cross sectional study

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disabling illness characterized by persistent airflow limitation affecting physical, psychological and social aspect of the individual. Amongst the associated co morbidities, depression and anxiety has been identified as common modifiable psychiatric comorbidities of COPD which impacts the patient’s quality of life. &#x0D; Objectives: To establish the prevalence of depression and anxiety among the COPD patient and determine the association between them.&#x0D; Methodology: The cross sectional study was conducted at Dhulikhel Hospital. We used a convenient sampling method to recruit seventy three COPD participants admitted in the Medicine ward. We interviewed the participants to evaluate anxiety and depression using the Nepali version of Hospital Anxiety and Depression Scale questionnaire. We considered positive result of anxiety and depression when the Hospital Anxiety and Depression score was above eight. &#x0D; Results: Depressive and Anxiety symptoms were observed in 30 % and 33% of the participants respectively. Similarly 20% of the participants had both the symptoms of depression and anxiety. The association between depression and anxiety was found to be highly significant (p&lt;0.001). In the multivariate model the odds of depression and anxiety was nine percent increase with every one year increase in age after adjusting for gender and duration of illness. (adjusted OR: 1.07; CI 1.00- 1.17; p-value: 0.03). In an unadjusted model depression was significantly associated to every year increase in age (unadjusted OR: 1.07; CI: 1.00- 1.13; p-value: 0.03)&#x0D; Conclusion: Depression and anxiety is prevalent among COPD patient at Dhulikhel hospital with one fifth of the patient demonstrating both depression and anxiety symptoms.

Intergenerational Transmission of Culture among First- and Second-Generation Immigrants: The Case of Age at First Birth and Nonmarital Childbirth

This paper uses immigration as a semi-natural experiment to investigate the intergenerational transmission of culture. The culture is proxied by rates of nonmarital birth-giving and age at the first birth in the immigrant's home country. Using the Current Population Survey, Decennial Censuses, and the American Community Survey covering the years 1980-2019, It finds that average outcomes in the home country can explain a statistically significant portion of immigrants' behavior. Conditional on the individual, family, and home-country economic and demographic controls, a 1% increase in average rates of nonmarital fertility in mother's country of birth is associated with a 0.32% increase in nonmarital birth rates among second-generation women. A one year increase in age at motherhood in mother's birthplace leads to 0.23 years increase in age at first birth among second generations. Cohort analysis for both generations confirms the robustness of the estimates. The results show that cultural factors associated with nonmarital birth-giving and age at the first birth can transmit from one generation to the next.

Asthenopia Among University Students: The Eye of the Digital Generation.

Background:Asthenopia or eye strain is one of the major medical problems that students face during their academic years.Objectives:The aim of this study is to determine the prevalence of asthenopia among a sample of university students attending various majors and to identify the risk factors for its development.Methods:This is a cross sectional study conducted on students attending various faculties at the American University of Beirut during the spring semester of 2019. Students were asked to fill a self-administered anonymous questionnaire that inquired about demographics, use of digital devices, symptoms of asthenopia, possible risk factors and protective measures. A bivariate analysis was performed to correlate asthenopia with the different variables. A multivariate analysis was then conducted to determine the extent of contribution of the different variables to asthenopia after controlling for confounding variables.Results:The prevalence of asthenopia was found to be 67.8% with blurred vision being the most reported symptom (27.0%). A bivariate analysis was used to assess the association between asthenopia and the following variables: demographics, digital device use, reasons for using digital devices, and preventive methods. Age, being a continuous variable, was analyzed using an independent t- test. For the variables that were found to be have a p-value < 0.2, a multiple logistic regression was performed. Old age was found to be a protective factor for asthenopia, with 0.693 times reduction in asthenopia for every increase in year of age. Using the device for communication for less than four hours (p=0.012), using the device for less than four hours per day (p=0.000) and pattern of using the device for less than three years (p=0.023) were significant in being negatively associated with asthenopia. As for preventative measures that protect users from digital eyestrain, we found that using eye drops (p=0.004; OR=0.375) and taking regular breaks (p=0.000; OR= 0.399) were protective factors whereas using adjustable screens was a risk factor (p=0.000; OR=3.083).Conclusion:Asthenopia was found to be of non-negligible prevalence among this sample of university students. The results of this study highlight the importance of establishing awareness campaigns and encourage the introduction of targeted screenings for asthenopia among college students.

Psychological impact of COVID-19 on ophthalmologists-in-training and practising ophthalmologists in India.

Purpose:To evaluate the psychological impact of the COVID 19 crisis on ophthalmologists-in-training and practising ophthalmologists during lockdown in India.Methods:An online survey was completed by ophthalmologists and ophthalmology trainees during the lockdown. The information collected included demographics (age, gender), domicile (state, union territory), current professional status (in training or practising), type of practice (solo, group, institutional, governmental, non-governmental), marital status (married, single), impact of COVID-19 on their training or practice, and impact on income and ability to meet living expenses. Psychological distress was assessed using the Patient Health Questionnaire-9 (PHQ-9).Results:In all, 2,355 ophthalmologists responded. Mean age was 42.5 (range, 25-82 years; SD, 12.05) years. Of these, 1,332 (56.7%) were males; 475 (20.2%) were still not in practice; 366 (15.5%) were single; 1,244 (52.8%) felt that COVID-19 would impact on their training or professional work; and 869 (37%) had difficulty in meeting their living expenses. The mean PHQ-9 score was 3.98 (range, 0-27; SD, 4.65). In terms of psychological impact, 768 (32.6%) had some degree of depression; mild in 504 (21.4%), moderate in 163 (6.9%), and severe in 101 (4.3%). Multivariable analysis showed that depression was significantly higher at younger age. The odds of depression decreased by 3% with 1 year increase in age. It was higher in non-practicing ophthalmologists, especially those who were considerably worried about their training or professional growth, and those with difficulty in meeting living expenses.Conclusion:A strikingly high proportion of ophthalmologists are psychologically affected and may require personalized mental health care.

Quantitative Study of Factors Associated with Breast Cancer among Women Reporting to a Tertiary Care Hospital in Karnataka

Introduction: Numerous epidemiological studies performed throughout the world have confirmed the role of many risk factors. However, evidence suggests that international variation in the burden of breast cancer reflects differences in the patterns of risk factors. Hence this study is undertaken to assess the risk factors associate with breast cancer in a district in Karnataka.&#x0D; Method: This is a Case control study to assess the risk factors associated with breast cancer among cases attending radiation unit of Hassan institute of medical sciences during 2019.&#x0D; Results: There was a significant association of breast cancer with menarche attained at or less than age 13 years (OR=2.43, CI: 1.09-5.4, p&lt;0.029), usage of oral contraceptive (OR=2.04: CI 1.61-2.42; p&lt;0.1), and menopause attained before age 50 (OR=5.2: CI2.2-12.2; p&lt;0.00). Our study also found that for every year increase in age for 1st birth, controls not being diseased decreased by 26% was statistically significant (OR=0.76; CI:0.61-0.89; p&lt;0.002) and for every parity added, controls not being deceased increased by 1.13 time (OR=1.13; CI:0.69-1.8;p&lt;0.6).&#x0D; Conclusion: District cancer control programme should advice women, to consume non-vegetarian food in moderation, promote physical activity form early age to maintain ideal body mass index.

Disease activity impacts disability progression in primary progressive multiple sclerosis

BackgroundAlthough solid information on the natural history of primary progressive multiple sclerosis (PPMS) is available, evidence regarding impact of disease activity on PPMS progression remains controversial. ObjectiveTo describe the clinical characteristics, presence or absence of MRI activity, and natural history of a PPMS cohort from two referral centers in Argentina and assess whether clinical and/or radiological disease activity correlated with disability worsening. MethodsRetrospective study conducted at two MS clinics in Buenos Aires, Argentina, through comparative analysis of patients with and without evidence of disease activity. ResultsClinical and/or radiologic activity was presented in 56 (31%) of 178 patients. When stratified by age at onset, we found that for every 10 years of increase in age at onset, risk of reaching EDSS scores of 4 and 6 increased by 26% and 31%, respectively (EDSS 4: HR 1.26, CI 95%: 1.06–1.50; EDSS 6: HR 1.31, CI 95%: 1.06–1.62).Patients who presented clinical exacerbations reached EDSS scores of 6, 7 and 8 faster than those without associated exacerbations (p = 0.009, p = 0.016 and p = 0.001, respectively). Likewise, patients who presented gadolinium-enhancing lesions during the course of disease reached EDSS scores of 7 earlier (p = 0.002). ConclusionOlder age at onset and presence of clinical and/or radiological disease activity correlated with accelerated disability progression in this cohort of PPMS patients.

Opportunities and barriers for providing HIV testing through community health centers in mainland China: a nationwide cross-sectional survey

BackgroundPrimary care may be an avenue to increase coverage of HIV testing but it is unclear what challenges primary healthcare professionals in low- and middle-income countries face. We describe the HIV testing practices in community health centres (CHCs) and explore the staff’s attitude towards further development of HIV testing services at the primary care level in China.MethodsWe conducted a national, cross-sectional survey using a stratified random sample of CHCs in 20 cities in 2015. Questionnaires were completed by primary care doctors and nurses in CHCs, and included questions regarding their demographics, clinical experience and their views on the facilitators and barriers to offering HIV testing in their CHC. Multivariate logistic regression was conducted to examine the association between staff who would offer HIV testing and their sociodemographic characteristics.ResultsA total of 3580 staff from 158 CHCs participated. Despite the majority (81%) agreeing that HIV testing was an important part of healthcare, only 25% would provide HIV testing when requested by a patient. The majority (71%) were concerned about reimbursement, and half (47%) cited lack of training as a major barrier. Almost half (44%) believed that treating people belonging to high-risk populations would scare other patients away, and 6% openly expressed their dislike of people belonging to high-risk populations. Staff who would offer HIV testing were younger (adjusted odds ratio (aOR) 0.97 per year increase in age, 95% confidence interval (CI):0.97–0.98); trained as a doctor compared to a nurse (aOR 1.79, 95%CI:1.46–2.15); held a bachelor degree or above (aOR 1.34, 95%CI:1.11–1.62); and had previous HIV training (aOR 1.55, 95%CI:1.27–1.89).ConclusionsImproving HIV training of CHC staff, including addressing stigmatizing attitudes, and improving financial reimbursement may help increase HIV testing coverage in China.

BODY MASS INDEX AND ALBUMIN LEVELS ARE ASSOCIATED WITH PULMONARY FUNCTION PARAMETERS IN PEDIATRIC SUBJECTS WITH CYSTIC FIBROSIS.

ABSTRACTObjective: To evaluate the association of body mass index (BMI) and albumin with pulmonary function in cystic fibrosis (CF) pediatric subjects.Methods: This is a cross-sectional study with clinically stable CF’s subjects. Clinical (pulmonary function) and nutritional evaluation (body mass index and albumin) were performed. Univariate analysis was performed using simple linear correlations. Regression analysis was performed using an exit level of p<0.05.Results: Seventy-eight CF’s subjects (mean age 12.8±3.8 years) with mean albumin 4.2±0.4 mg/dL, predicted forced expiratory volume in 1 second (FEV1%) 80.8±22.6 and BMI median percentile 51.2 (1.3-97.7). In the multiple regression models, albumin, age and BMI percentile were associated with pulmonary function. Subjects with lower than 25 BMI percentile had 12.2% lower FEV1%. An albumin increase of 0.1 mg was associated with 2.7% increase in predicted FEV1%, and one year increase in age was associated with reduction in 1.2% of predicted FEV1%.Conclusions: BMI percentile, albumin and age were independently associated with predicted FEV1% in a tertiary referral hospital.

Tacrolimus variability is associated with de novo donor-specific antibody development in pediatric renal transplant recipients.

Donor-specific antibody (DSA) is a risk factor for antibody-mediated rejection and shortened graft survival. We investigated the role of intrapatient variability in tacrolimus trough levels on graft outcomes (i.e., de novo DSA, rejection, graft loss) in pediatric renal transplant recipients. This was a single-center retrospective study which included 38 pediatric renal transplant recipients. Intrapatient tacrolimus variability was defined using the coefficient of variation (CV; SD/Mean × 100) for all levels obtained after 3months post-transplant. CV cut-points of 30%, 40%, and 50% were used in the analyses. The median CV 43.1% (35.0%, 58.6%). Out of 38 patients, 19 (50%) developed de novo DSA. In the logistic regression model, after adjusting for age, rejection history, maintenance immunosuppression, and CV, for every 10% increase in tacrolimus variability, the odds of developing de novo DSA increased by 53% (p = 0.048, CI 1.0005, 1.11). Age at transplant was also an independent risk factor for DSA development; every 1year increase in age was associated with a 31% increase in the odds of developing DSA (p = 0.03, CI 1.03, 1.67). At a CV cut-point ≥ 30%, higher tacrolimus variability was associated with an increased incidence of allograft rejection (0% vs 42%, < 30 and ≥ 30% respectively, p = 0.07). As there were few graft loss events (n = 4) in our study population, an association could not be determined between tacrolimus variability and graft loss. Tacrolimus variability and age at transplant were identified as independent risk factors for de novo DSA development. There was an association between tacrolimus variability and rejection in pediatric renal transplant recipients. Adding the assessment of tacrolimus variability to current monitoring methods may be an important step towards improving graft outcomes.

The Prognostic Factors for Early Fatal Outcome in Patients with Multiple Myeloma

Introduction: Survival of Multiple Myeloma (MM) patients has improved in recent decades due to the advent of novel agents and broader utilization of stem cell transplant. Fatal outcomes occur mostly after multiple lines of therapy due to increasingly resistant disease. Indeed, early mortality after diagnosis is unusual in front line treatment MM trials, where patients are often selected on the basis of good performance status and absence of organ dysfunction. The real world incidence of early deaths is largely unknown. Hereby, we analyze the factors impacting early mortality in the National Cancer Database (NCDB) which covers more than 70% of MM patients in United States. Methods: Patients with MM diagnosed from 2005-2014 were identified in the NCDB. Early mortality (EM) was defined as death within six months of MM diagnosis. The effect of demographic and clinical factors, insurance type, distance to treatment facility, medical facility and facility volume on the probability of EM was estimated by univariate logistic model. The effect of these factors on the probability of EM was further estimated by multivariable logistic regression. The overall performance of multivariable logistic regression was evaluated using the receiver operating characteristic curve (ROC) analysis. The difference of continuous measurements between groups was examined using t-test. The association between categorical variables was examined using Chi-square test. All tests are two-sided and p-value ≤ 0.05 were considered statistically significant. Results: 90,258 patients with ICD-O 9732 were included. 49949 (55%) were male. EM was reported in 15729 (17%) within the first 6 months after MM diagnosis. Median age at diagnosis was 67 years (19-90). 15729 patients (17%) died in the first 6 months after diagnosis. There was no significant change in the percentage of EM over the years from 2005-2014. 11963 (76%) of patients with EM were older than 65 years while 3766 (23%) patients were less than 65 years. 12300 (78.1%) of the patients with EM were white and 2822 (17.9%) were African American. In a multivariable analysis, variables that confer the worst prognosis were increasing age, higher charlson co-morbidity score, lower annual median income of less than 30,000, and being treated in a community hospital. Controlling the effects of other factors (charlson co-morbidity score, hospital type and transplant), the odds ratio of EM was 1.04 per year increase of age (p&amp;lt;0.0001), 0.52 with treatment in academic center compared to community hospital (p&amp;lt;0.0001). Conclusion: Taken together our data suggest almost 1 out of 6 MM patients died at the first 6 months after diagnosis. Therefore, EM remains high in MM and a major barrier for continued improvement in survival outcomes. In addition to well-known MM-specific determinants of survival, socioeconomic factors were significantly associated with early mortality. Disclosures Malek: Adaptive: Consultancy; Medpacto: Research Funding; Janssen: Speakers Bureau; Sanofi: Consultancy; Celgene: Consultancy; Takeda: Consultancy; Amgen: Speakers Bureau.

Bleeding Risk in a Cohort of Ambulatory Cancer Patients Receiving Outpatient Prophylactic Anticoagulation for Venous Thrombosis Prevention

Background: Recent clinical trials have evaluated the safety and efficacy of direct oral anticoagulant (DOAC) therapy for venous thromboembolism (VTE) prophylaxis in cancer outpatients at high risk for thrombosis. Bleeding risk in these trials were approximately 2% over the first 6 months of therapy. For individual patients, the utility of prophylactic anticoagulation (AC) depends on an acceptable safety profile between bleeding and thrombosis. We investigated whether ambulatory cancer patients on contemporary cancer-directed therapies and prophylactic AC had an increased risk of major bleeds over the first 6 months of therapy. Methods: As part of a single-center prospective cohort study, we assessed consecutive ambulatory patients initiating cancer-directed treatment, risk-stratified these patients for VTE using the Khorana score and educated them about VTE. High risk patients (Khorana score ≥3) were offered prophylactic AC. Major bleeding events and minor bleeding events (based on ISTH standard definitions) were prospectively captured via billing code screening and confirmed by physician review of the medical record. Logistic regression was used to compare the odds of developing a major bleed within 6 months in those who received prophylactic AC compared to those that did not. Results: A total of 1,210 patients were enrolled from October 2015 - June 2018, of which, 640 were women (52.9%). The most common cancers were gastrointestinal 270 (22%), lung 213 (18%), and breast 198 (16%). There were 393 patients (32%) with a Khorana score of 0, 706 (58%) with a Khorana score of 1-2, and 111 (9%) with a score of ≥3. A total of 421 patients received any AC (LMWH or DOAC). Of these, 282 received a prophylactic dose anticoagulant and 139 were receiving a full dose anticoagulant prior to enrolling for other medical reasons. Prophylactic dose anticoagulants prescribed included apixaban in 107 (41%), rivaroxaban in 6 (2.3%), enoxaparin in 119 (45.7%), and other heparin products in 50 (19.2%). A total of 27 (2.33%) major bleeds and 22 (1.81%) minor bleeds occurred within the first 6 months of starting therapy. Of these bleeding events, 8 (2.8%) occurred in those on prophylactic AC, and 6 (4.3%) occurred in those on full dose AC. The odds ratio (OR) of developing a major bleed on any type of AC was 1.78 [CI 0.817-3.88]. The OR of major bleeding on prophylactic AC was 1.49 [CI 0.64-3.479]. The OR of major bleed was highest in lung cancer patients on prophylactic AC (OR 2.81, CI 1.27-6.25). Men, when compared to women, were more likely to bleed on prophylactic AC in the first six month (OR 0.2; CI 0.07-0.52). The OR for major bleed with each 1 year increase in age was 1.02 (CI 0.99, 1.06). The OR of bleeding with a high risk Khorana score (≥3) compared to a lower score was 1.04 (CI 0.73-1.50). Conclusion: During the first six months of therapy, prophylactic AC was associated with an increased risk of major bleeding events in patients on cancer-directed therapy. In this study, the rate of major bleeding was similar as compared to published clinical trials. Neither age nor higher Khorana score were associated with an increased risk of major bleeds in patients on prophylactic AC. The finding that men, when compared to women, and patients with lung cancer may have an increased risk of major bleeding while on prophylactic AC and cancer-directed chemotherapy suggests these groups may warrant both increased education and monitoring to ensure safety while on prophylactic AC. Disclosures No relevant conflicts of interest to declare.

Analysis of influencing factors of trough serum vancomycin concentrations in critically ill neurosurgical patients

To evaluate trough serum vancomycin concentrations and identify their influencing factors in critically ill neurosurgical patients. A retrospective study was conducted. Adult patients who received vancomycin with at least one appropriate monitoring of trough serum vancomycin concentration and admitted to neurosurgical intensive care unit (ICU) of the First Affiliated Hospital of Sun Yat-sen University from November 2017 to July 2019 were enrolled. General information including gender, age, comorbidities, etc., trough serum vancomycin concentrations, vancomycin dosage, duration of vancomycin therapy, urine output, serum creatinine (SCr), concurrent medications (including mannitol,diuretic, vasopressors, non-steroidal anti-inflammatory drugs, polymyxin, aminoglycosides and contrast medium, etc.) were collected for analysis. Trough serum vancomycin concentrations were evaluated and their influencing factors were analyzed by multiple linear regression method. In total, 81 trough serum vancomycin concentration data sets obtained from 28 patients were evaluated. (1) The initial daily dose of vancomycin was 2.00 (2.00, 2.00) g/d. After 4-6 doses, the trough serum vancomycin concentration obtained from initial blood draw was 10.99 (6.98, 16.25) mg/L, of which only 17.9% (5/28) achieving targeted concentrations (15-20 mg/L), 71.4% (20/28) subtherapeutic level and 10.7% (3/28) supratherapeutic level. (2) The duration of vancomycin therapy was 8.0 (6.0, 15.0) days. With average daily dose of 2.00 (1.75, 3.00) g/d, targeted trough vancomycin concentrations were achieved in only 30.9% (25/81) of all cases, subtherapeutic concentrations in 49.4% (40/81) and supratherapeutic concentrations in 19.7% (16/81). (3) There were significant differences in age, comorbidities, vancomycin dosage, diuretics use and mannitol dosage, etc. among different vancomycin concentration groups. Multiple linear regression analysis suggested that the trough serum vancomycin concentration increased by 0.14 mg/L [95% confidence interval (95%CI) was 0.06-0.22] for every 1 year increase in age, increased by 7.22 mg/L (95%CI was 2.08-12.36) in patients with multiple comorbidities (concomitant hypertension, diabetes and coronary heart disease) compared with those without comorbidities, increased by 2.78 mg/L (95%CI was 0.20-5.35) in patients treated with diuretics compared with those without diuretics. The effect of other variables was not statistically significant. It suggested that age, multiple comorbidities (concomitant hypertension, diabetes and coronary heart disease), and diuretic usage affected trough serum vancomycin concentrations. Targeted trough serum vancomycin level is not often achieved in neurosurgical ICU patients following standard dosing. Younger patients are associated with lower trough serum vancomycin concentrations, while diuretic usage, combined with multiple comorbidities are associated with higher trough serum vancomycin concentrations.