Short-Term Infection Risk and Clinical Impact in Immune Thrombocytopenia After Treatment

Abstract Abstract 4652 Patient with refractory ITP have increased mortality compared with the normal population. Apart from major bleeding, infection was a major risk of death of these patients.1However, infections after diagnosis of immune thrombocytopenia are less addressed in the literature and its clinical impact on outcome of patients with ITP has not been well-addressed. This study aimed to characterize risk of infection events after diagnosis of ITP and its impact on outcome of these patients. We retrospectively evaluated 239 patients (109 men, 130 women; medium age: 63 yr) diagnosed between Jan 1, 1997 to Aug 31, 2011. Every patient received at least steroid treatment according to platelet count or bleeding symptoms after diagnosis. Infection event occurred in 59 patients (24.7%) within 6 months after diagnosis. Multivariate analysis revealed that age (>65 yr) was the most important risk factor regarding to infection (p=0.048, 95% CI 1.005 to 4.007). 1-year mortality rate after ITP diagnosis was significantly higher in those patients with infection after steroid treatment (p<0.001). We conclude that elderly patients with ITP are more prone to infections which have negative impact on post-diagnosis 1 year survival. Table 1. The Demographic and Clinical Characteristics of Patients With Immune Thrombocytopenia Patient characteristic All patients (n=239) Sex, no. of patients (%) Male 109 (45.6%) Female 130 (54.4%) Medium age, y 63.0 (18∼97) Medium follow-up period, months 19.08 (0.1∼155) Thrombocytopenia1 no. of patients (%) 195 (81.6%) Severe 44 (18.4%) Moderate 20 (8.4%) Evan's syndrome, no. of patients (%) 19 (7.9%) Splenectomy, no. of patients (%) 35 (14.6%) Comorbidity, no. of patients (%) 74 (31%) DM 12 (5%) HTN 8 (3.3%) CKD 12 (5%) CHF 8 (3.3%) CVA 96 (40.2%) COPD 59 (24.7%) Any 13 (5.4%) Infectious event, no. of patients (%) 11 (4.6%) Total patient 2 (0.8%) Mortality, no. of patients (%) Total numbers Death due to infection Death due to bleeding 1. Moderate thrombocytopenia= platelet counts between 30.0 × 109/L and 100.0 × 109/L; severe thrombocytopenia counts below 30.0 × 109/L. Table 2. Clinical Characteristics of Infection Events Patient characteristic All events (n=70) Infectious event, no. (%) Total event 70 Pneumonia 31 (44.2%) UTI 13 (15.6%) Herpes zoster 9 (12.8%) Cellulitis 7 (10.0%) Others1 10 (14.3%) Pathogens no. of event Events with definite cultured pathogen 29 Staphylococcus aureus 8 Klebsiella pneumonia 6 Yeast2 6 Pseudomonas aeruginosa 5 Acinetobacter baumannii 4 Stenotrophomonas maltophilia 4 E. coli 3 Enterobacter spp. 3 Others3 5 Infection event date 1st month 23 (32.9%) 2nd month 17 (24.3%) 3rd month 7 (10.0%) 4th month 8 (11.4%) 5th month 6 (8.5%) 6th month 9 (12.9%) 1. Other infection includes oral candidiasis (2), cholangitis (1), fungemia (1), bacteremia (1), intraabdominal abscess (1), facial abscess (1), osteomyelitis (1), pseudomembranous colitis (1), acute suppprative periodontitis (1). 2. Including Candida albicans and Aspergillus. 3. Other pathogen including Streptococcus agalactiae (1), Serratia spp (1) Clostridium dificile (1), Chryseobacterium meningosepticum (1), gram positive cocci (1). Table 3. Baseline Characteristics of Patients with or without Infection Character No infection (n=180) Infection (n=59) p value Sex 0.006* M 73 (40.6%) 36 (61.0%) F 107 (59.4%) 23 (39.0%) Age 0.616 Medium 57 73 Range 18∼90 23∼97 Thrombocytopenia 0.268 Moderate 36 (20.0%) 8 (13.6%) Severe 144 (80.0%) 51 (86.4%) Evan's syndrome 14 (7.8%) 6 (10.2%) 0.565 Splenectomy 13 (7.2%) 6 (10.2%) 0.468 Cormobidity DM 21 (11.7%) 14 (23.7%) 0.023* HTN 51 (28.3%) 23 (39.0%) 0.125 CKD 6 (3.3%) 6 (10.2%) 0.037* CHF 5 (2.8%) 3 (5.1%) 0.393 CVA 8 (4.4%) 4 (6.8%) 0.476 COPD 4 (2.2%) 4 (6.8%) 0.095 Any 64 (35.8%) 31 (52.5%) 0.022* ANC<1000 49 (27.2%) 26 (44.1%) 0.016* Response1 0.001* CR+PR 151 (83.9%) 38 (64.4%) NR 29 (16.1%) 21 (35.6%) 1. Response: complete response (CR) partial response (PR) no response (NR). Table 4. Multivariate Analysis for the Short Term (Within 6 Months) Infection Risk in Patient with ITP Dependant variable Odds ratio P value 95% confidence interval Lower bound Upper bound Age >65 2.205 0.048* 1.005 4.077 ALC<1000 1.807 0.066 0.961 3.399 Any cormobidity 1.374 0.357 0.699 2.699 Disclosures: No relevant conflicts of interest to declare.

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A Study in the Clinical Characteristics of Stenotrophomonas Maltophilia Bacteremia in Hematological Patients

Blood ◽

10.1182/blood.v126.23.4631.4631 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4631-4631

Author(s):

Haiyan Bao ◽

Jia Chen ◽

Xiaojin Wu ◽

Xiao Ma ◽

Chengcheng Fu ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Respiratory Failure ◽

Stenotrophomonas Maltophilia ◽

Clinical Characteristics ◽

Univariate Analysis ◽

P Value ◽

Hematological Diseases ◽

Factors Associated

Abstract Introduction: Stenotrophomonas maltophilia is an important nosocomial pathogen, particularly in immunocompromised patients, especially in patients with hematologic diseases. Methods: We reviewed the clinical characteristics and prognosis of patients with S. maltophilia bacteremia over a five-year period from January 2010 to December 2014. Species identification was performed using the automated Vitek 2 compact system (bioMe rieux). Results: The incidence of S. maltophilia bacteremia was 25.1 per 10 000 admissions in our study. Thirty-four patients (median age: 34 years; 64.7% males) with S. maltophilia bacteremia were analyzed. The S. maltophilia bacteremia related 30-day mortality was 44.1%. Risk factors associated with mortality in patients with S. maltophilia infection in the univariate and multivariate analysis were represented in Tables I and II. In the univariate analysis, risk factors included T>39.0¡æ, septic shock, respiratory failure and non-remission after treatment for primary hematological diseases (P <0.05). In the multivariate analysis, respiratory failure and non-remission status after treatment forhematological diseases were independent prognostic factors for mortality. In vitro susceptibility was higher to ciprofloxacin(82.4%), ceftazidime(70.6%), sulbactam and cefoperazone(58.8%), which was shown in Table III. Conclusion: Combination regimens with ciprofloxacin and ceftazidime, or sulbactam and cefoperazone could be alternative treatment. Novel antibiotics are required for treatment of S. maltophilia infection, as well as infection control practices of environmental reserves, rapid detection of pathogens, risk stratification strategy and appropriate treatment for primary hematologic malignancies, which might conjointly contribute to better survival outcome of S. maltophilia bacteremia. Univariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Table 1. Factor Mortality HR 95%CI P-value Withfactor Withoutfactor T>39.0¡æ 75% 16.7% 2.490 1.318-4.704 0.005 Septic shock 90.0% 25.0% 2.544 1.473-4.393 0.001 Respiratory failure 100% 20.8% 4.672 2.366-9.225 0.000 Treatment outcome for hematological diseases Remission 10.0% 85.7% 0.247 0.116-0.526 0.000 HR, hazard ratio; CI, confidence interval; HSCT, Hematopoietic stem cell transplantation Table 2. Multivariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Factor HR 95%CI P-value Respiratory failure 2.688 1.297-5.569 0.008 Remission after treatment for hematological diseases 0.367 0.153-0.879 0.025 HR, hazard ratio; CI, confidence interval Table 3. Susceptibility pattern of the 34 patients with Stenotrophomonas maltophilia bacteremia Antimicrobial agents S (%) I (%) Ceftazidime 24(70.6%) 1(2.9%) Cefoperazone 19(44.1%) 6(17.6%) Sulbactam and Cefoperazone 20(58.8%) 5(14.7%) Piperacillin 7(20.6%) 6(17.6%) Piperacillin-Tazobactam 11(32.3%) 7(20.6%) Amikacin 6(17.6%) 0(0%) Ciprofloxacin 28(82.4%) 1(2.9%) S, susceptible; I, intermediately susceptible. Disclosures No relevant conflicts of interest to declare.

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Clinical characteristics of patients with a periorbital mass after autologous fat injection for facial augmentation and short-term outcomes of steroid treatment

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2015.07.002 ◽

2015 ◽

Vol 68 (11) ◽

pp. 1498-1503 ◽

Cited By ~ 5

Author(s):

Saem Lee ◽

Jung Hye Lee ◽

Hye Sun Choi

Keyword(s):

Clinical Characteristics ◽

Steroid Treatment ◽

Fat Injection ◽

Short Term ◽

Autologous Fat ◽

Facial Augmentation

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P203 Incidence, characteristics and determinants of severe infections in patients with anti-neutrophil cytoplasm antibody-associated vasculitis receiving rituximab therapy: a single centre study

Rheumatology ◽

10.1093/rheumatology/keab247.198 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Francesco Dernie ◽

Nadia Ahmad ◽

Raashid Luqmani ◽

Joel David

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Regression Analysis ◽

Severe Infection ◽

Infection Risk ◽

P Value ◽

Risk Of Infection ◽

Electronic Patient Records ◽

Increased Risk ◽

Severe Infections

Abstract Background/Aims The efficacy of rituximab in managing anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is well-established; however its associated complications, including risk of developing serious infections, are less well characterised. Identifying infection risk factors may help to improve care of patients with AAV receiving rituximab. We characterised severe infections in a cohort of patients over a three-year period and identified factors affecting their risk of developing severe infections. Methods Electronic patient records were interrogated over a retrospective period (August 2016-August 2019) to compile baseline data and episodes of severe infection. Differences between groups were determined using appropriate parametric or non-parametric methods. Risk factors for severe infections were identified through multivariate binomial logistic regression analysis. Variables with an event count of ≥ 5 and a p-value ≤0.1 at univariate level were entered into the final multivariate analysis, where p ≤ 0.05 was taken as significant. Results Fifty patients were included. 24 (48%) were male, and 26 (52%) female. Average age was 60 years (range 25-90). 36 (72%) had GPA, 2 (4%) MPA, 1 (2%) EGPA, and 11 (22%) had overlap or undefined AAV. 14 (28%) patients developed at least one severe infection (≥grade 3, CTCAE criteria), giving an incidence of 15.4 severe infections per 100 person-years. The 18 severe infection events included 10 (56%) respiratory tract, 5 (28%) sepsis/neutropenic sepsis, 1 (6%) cellulitis, 1 (6%) complicated UTI and 1 (6%) recurrent wound infection. Patients who developed severe infections had lower immunoglobulin levels (IgG<6g/L, 36% vs 6%, p = 0.009), concomitant COPD (21% vs 3%, p = 0.029), and lower rates of concomitant co-trimoxazole use (7% vs 44%, p = 0.012) compared to patients not developing severe infections. Regression analysis of demographic, baseline blood markers and concomitant therapy data was performed to identify risk factors for developing severe infections (Table.1). Hypogammaglobulinaemia increased risk of infection (OR = 8.782, 95%CI=1.194-64.605, p = 0.033), while co-trimoxazole decreased risk of infection (OR = 0.096, 95%CI=0.009-0.996, p = 0.050). P203 Table 1:Univariate analysisMultivariate analysisVariablesOR95% CIP valueOR95% CIP valueAge (years)1.0320.994-1.0720.105Sex (male)0.3200.084-1.2130.0940.2860.057-1.4350.128Creatinine1.0050.987-1.0240.577eGFR0.9750.945-1.0060.109CRP1.0010.989-1.0120.899ESR1.0030.960-1.0460.908Neutrophils0.9730.789-1.2010.802WBC0.9590.780-1.1800.694Lymphocytes0.8700.420-1.8050.709CD190.4780.000-2000.9670.862CD19%0.9870.906-1.0750.767CD30.3140.055-1.7750.190CD3%0.9960.941-1.0550.902CD40.3920.034-4.4870.451CD4%1.0110.959-1.0660.675CD80.0530.001-4.7440.200CD8%0.9850.914-1.0610.689IgG0.8900.749-1.0570.185Hypogammaglobulinemic?8.6111.423-52.0910.0198.7821.194-64.6050.033IgM0.8360.350-1.9970.686IgA1.0890.787-1.5070.607BMI0.9460.858-1.0430.262COPD*9.5450.899-101.3380.061DM0.8330.147-4.7230.837Hypertension0.4330.082-2.2910.325CV disease0.000-0.999AKI0.4580.088-2.3780.353Latent TB0.3710.022-6.3830.495DI2.6920.157-46.2640.495Hypothyroidism0.000-1.000RA5.8330.484-70.2440.165OP2.6920.157-46.2640.495OA0.000-1.000SLE0.000-1.000AIH0.000-1.000CKD0.000-1.000Co-trimoxazole use0.0960.011-0.8150.0320.0960.009-0.9960.050Cumulative dose of RTX0.6690.392-1.1410.140Did patient have prior RTX before Aug 2016?0.6940.194-2.4870.575Yearly influenza vaccine between 2016-2019 (patients for whom vaccine records exist on EPR)1.3850.188-16.2770.796Average length of follow-up (days)1.0010.999-1.0030.360Prednisolone cumulative dose1.0001.000-1.0000.843Prednisolone average dose0.9920.991-1.0800.852MTX cumulative dose1.0000.999-1.0010.701MTX average dose1.0200.696-1.4960.918HCQ cumulative dose1.0001.000-1.0000.331HCQ average dose0.9850.964-1.0060.162LFN cumulative dose1.0001.000-1.0000.855LFN average dose0.8510.605-1.1990.357MMF cumulative dose1.0010.999-1.0020.263MMF average dose3.9960.402-39.7260.237AZT cumulative dose1.0001.000-1.0000.372AZT average dose0.9440.878-1.0140.116*too few events for progression to multivariate analysis. Conclusion The incidence of severe infections in patients with AAV receiving rituximab is significant. Our results support the monitoring of IgG levels to identify patients who may be more susceptible to infection, as well as the prescription of prophylactic co-trimoxazole to reduce overall severe infection risk. Disclosure F. Dernie: None. N. Ahmad: None. R. Luqmani: None. J. David: None.

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Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic fistula

10.21203/rs.3.rs-42715/v2 ◽

2020 ◽

Author(s):

Hiromichi Kawaida ◽

Hiroshi Kono ◽

Hidetake Amemiya ◽

Naohiro Hosomura ◽

Mitsuaki Watanabe ◽

...

Keyword(s):

Multivariate Analysis ◽

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Conventional Group ◽

P Value ◽

Short Term ◽

Drainage Fluid ◽

The Third ◽

Modified Method ◽

Soft Pancreas

Abstract Background: Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD.Methods: In total, 120 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and August 2020 were retrospectively analyzed. We divided these patients into two groups depending on the time PD was performed: a conventional group (n=67) and a modified group (n = 56).Results: The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (5.4% vs 22.4%, p-value < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group became less than half (1696 vs 650 U/L). Multivariate analysis showed that the modified method was the independent predictors to prevent clinical POPF (p-value = 0.002).Conclusions: Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.

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P819Post-procedural cholesterol and inflammatory risk in acute myocardial infarction patients undergoing percutaneous coronary intervention

European Heart Journal ◽

10.1093/eurheartj/ehz747.0418 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Chen ◽

C Liu ◽

P Zhou ◽

Y Tan ◽

Z Sheng ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Multivariate Analysis ◽

Cardiovascular Risk ◽

Coronary Intervention ◽

P Value ◽

Short Term ◽

Percutaneous Coronary

Abstract Objective This study sought to depict the combined association of post-procedural cholesterol and inflammatory risk with clinical outcomes among acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) and pick out patients with highest comprehensive risk. Methods A total of 4802 AMI-PCI patients were divided into quartiles according to post-procedural low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP) level respectively and in combinations for risk analysis. Univariate and adjusted multivariate analysis with Cox model were performed. Hazard ratio (HR) for short-term (90 days) and long-term (1 year) were compared for major adverse cardiovascular events (MACE), including cardiac death, recurrent myocardial infarction and ischemic stroke. Results A significant change in the hazards of 90-day MACE was seen among patients in the highest quartile of post-procedural LDL-C [HR: 0.526 (0.291, 0.951), p=0.034] and highest quartile of CRP [HR: 2.119 (1.150, 3.920), p=0.016]. For 1-year outcomes, only a trend for increasing risk was seen in patients with higher post-procedural CRP (p-trend = 0.016). Combination analysis for cholesterol/inflammatory risk showed that patients lying simultaneously in the lowest quartile of LDL-C and highest quartile of CRP gained the highest risk in the 90-day [HR: 3.16 (1.124, 8.886), p=0.029] and 1-year [HR: 2.515 (1.153, 5.486), p=0.020] follow up. Hazard ratios (HR) for short-term (90 days) and long-term (1 year) primary outcomes according to cholesterol and inflammatory risk 90 days 1 year Type of risk Unadjusted HR (95% CI) P value Adjusted HR (95% CI) P value P for trend Unadjusted HR (95% CI) P value Adjusted HR (95% CI) P value P for trend LDL, mmol/L Quartile 2 0.742 (0.441, 1,248) 0.260 0.663 (0.390, 1.125) 0.128 0.033 0.722 (0.364, 1.125) 0.150 0.683 (0.435, 1.072) 0.097 0.251 Quartile 3 0.653 (0.381, 1.121) 0.122 0.597 (0.344, 1.038) 0.068 0.850 (0.557, 1.229) 0.453 0.850 (0.550, 1.312) 0.462 Quartile 4 0.517 (0.288, 0.928) 0.027 0.526 (0.291, 0.951) 0.034 0.673 (0.427, 1.061) 0.088 0.708 (0.444, 1.131) 0.149 CRP, mg/L Quartile 2 1.365 (0.717, 2.599) 0.334 1.295 (0.654, 2.522) 0.448 0.007 1.063 (0.656, 1.722) 0.805 0.998 (0.608, 1.636) 0.992 0.016 Quartile 3 1.306 (0.681, 2.502) 0.442 1.279 (0.654, 2.499) 0.472 0.999 (0.612, 1.630) 0.996 0.968 (0.586, 1.597) 0.897 Quartile 4 2.354 (1.312, 4.221) 0.004 2.119 (1.150, 3.920) 0.016 1.657 (1.069, 2.570) 0.024 1.528 (0.967, 2.413) 0.069 Multivariate analysis was adjusted for age, sex and traditional cardiovascular risk factors. Combined cholesterol/inflammatory risk Conclusion AMI-PCI patients with lower post-procedural LDL-C and higher CRP might encounter greater cardiovascular risk. Patients with the lowest LDL-C and highest CRP gained extremely high risk and required special attention.

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Perbandingan Expanded Curb-65 Terhadap Curb-65 dan Psi Dalam Memprediksi Luaran Pasien Cap

Jurnal Endurance ◽

10.22216/jen.v4i3.4916 ◽

2019 ◽

Vol 4 (3) ◽

pp. 608

Author(s):

Suyastri Suyastri ◽

Irvan Medison ◽

Deddy Herman ◽

Russilawati Russilawati

Keyword(s):

Logistic Regression ◽

Multivariate Analysis ◽

Prospective Study ◽

Pneumonia Severity Index ◽

Severity Index ◽

Accurate Method ◽

P Value ◽

Pneumonia Severity ◽

Advantages And Disadvantages ◽

Care Decision

Tingkat keparahan CAP adalah poin penting pengambilan keputusan perawatan pasien. Beberapa metode telah digunakan untuk menilai tingkat keparahan pneumonia seperti Pneumonia Severity Index (PSI), CURB-65, SMART-COP dan Expanded CURB-65. Metode tersebut memiliki kelebihan dan kekurangan. Expanded CURB 65 diusulkan menjadi metode yang lebih akurat untuk mengevaluasi keparahan pneumonia dan memprediksi kematian pasien CAP. Tujuan penelitian ini memprediksi keakuratan Expanded CURB 65 dibandingkan CURB 65 dan PSI. Penelitian kohort prospektif pada pasien CAP yang dirawat di RSUP Dr. M.Djamil Padang dari April sampai Oktober 2019. Tingkat keparahan CAP pada pasien dinilai menggunakan PSI, CURB 65, Expanded CURB 65, kemudian hasilnya dievaluasi berdasarkan keparahan. Data dianalisis menggunakan regresi logistik dengan CI 95% dan nilai p <0,05 dianggap signifikan. Hasil penelitian pada 90 pasien sebagian besar laki-laki usia 53 tahun dengan komorbiditas terbanyak keganasan. Uji Pearson Chi aquare menunjukkan tidak ada hubungan antara tingkat keparahan berdasarkan CURB 65 dan luaran pengobatan (CI 95%, nilai p = 0,104). Sementara, PSI dan Expanded CURB 65 memiliki hubungan yang signifikan antara tingkat keparahan dan luaran (CI 95%, p=0,081 dan CI 95%, p= 0,046, masing-masing). Analisis multivariat menemukan Expanded CURB 65 lebih akurat dalam memprediksi luaran pasien CAP rawat inap (kappa =0,108 dan AUC=0,422). Severity of CAP is very important for site care decision inpatients. Several methods have been used to assess the severity of pneumonia such as Pneumonia Severity Index (PSI), CURB-65, SMART-COP and Expanded CURB-65. Those methods have advantages and disadvantages. Expanded CURB 65 is proposed to be more accurate method for evaluating pneumonia severity and predicting mortality in CAP. The aim of this study was to investigate the accuracy of Expanded CURB 65 compare to CURB 65 and PSI. Cohort prospective study was conducted for CAP patients who were hospitalized at RSUP Dr. M.Djamil Padang from April to October 2019. Patients was assesed for severity using PSI, CURB 65, Expanded CURB 65, then we evaluated it’s outcome. The data were analyzed by logistic regression with CI 95% and p value <0,05 considered as statistically significant. We found 90 patients that predominantly males with an average age of 53 years, and the most common comorbidity is malignancy. There was no relationship between pneumonia severity by CURB 65 and outcome (CI 95%, p=0.104). PSI and Expanded CURB 65 had significant relationship between severity and outcome (CI 95%, p=0.081and CI 95%, p=0.046, respectively). Multivariate analysis showed the expanded CURB 65 was more accurate for predicting the outcome of CAP inpatients (kappa=0.108 and AUC= 0.422).

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POS0826 SKIN LIMITED IGA VASCULITIS IN ADULTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1383 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 666.1-666

Author(s):

A. Hočevar ◽

J. Ostrovrsnik ◽

K. Perdan-Pirkmajer ◽

M. Tomsic ◽

Z. Rotar

Keyword(s):

Clinical Characteristics ◽

Systemic Disease ◽

Elevated Serum ◽

Skin Lesions ◽

Current Smoker ◽

P Value ◽

Symptom Duration ◽

Iga Vasculitis ◽

Reactive Protein

Background:IgA vasculitis (IgAV) could be limited to skin or evolve into a systemic disease, affecting characteristically joints, gastrointestinal tract and/or kidneys.Objectives:We aimed to look for differences between adult IgAV patients with disease limited to skin compared to systemic IgAV.Methods:Medical records of histologically proven adult IgAV cases, diagnosed between January 2010 and December 2020 at our secondary/tertiary rheumatology centre were analyzed.Results:During the 132-month observation period we identified 328 new IgAV cases (59.5% males, median (IQR) age 64.3 (45.1; 76.1) years). Ninety-four (40.2%) patients had skin limited disease, and the rest systemic IgAV.Clinical differences between skin limited and systemic adult IgAV are presented in table 1. Adults with IgAV limited to skin were significantly older, had less commonly skin lesions above the waistline and a lower level of C reactive protein compared to patients with a systemic disease. There were no differences in the frequency of skin necroses between the compared IgAV subgroups. The frequency of potential vasculitis triggers (prior infections, new medications, malignancy) was similar between the compared subgroups.Table 1.Clinical characteristics of IgA vasculitis patients with skin limited and systemic diseaseClinical characteristicsSkin limited IgAV (94)Systemic IgAV (234)P valueMale gender (%)54.361.50.263Age (years)*68.0 (55.0-80.5)61.5 (41.7-75.8)0.007Current smoker (%)13.821.80.123Antecedent infection (%)28.733.80.434New medication23.423.51.0History of cancer12.810.70.569Symptom duration (days)*7 (5-21)8 (5-14)0.756Purpura above waistline36.255.60.002Skin necroses (%)52.145.70.329ESR /mm/h) *32 (18-52)34 (17-53)0.873CRP (g/l) *13.5 (1-32)30 (11-68)<0.001Elevated serum IgA (%)50.649.10.892Legend: * median and IQR;Follow up data were available for 250 (76.2%) patients. During the follow up of median (IQR) 12.5 (6.8 – 22.4) months 35 patients relapsed (13/70 (18.6%) with skin limited IgAV and 22/180 (12.2%) with systemic IgAV, p= 0.224).Conclusion:Skin limited IgAV was associated with older age and less extensive skin puprura in adults. However, relapses of purpura were as common as in systemic IgAV.Disclosure of Interests:None declared

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Instructions for masking the taste of medication for children

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/1715163516669383 ◽

2016 ◽

Vol 150 (1) ◽

pp. 52-59 ◽

Cited By ~ 4

Author(s):

Régis Vaillancourt ◽

Yen Truong ◽

Shazya Karmali ◽

Amanda Kraft ◽

Selina Manji ◽

...

Keyword(s):

High School ◽

Health Literacy ◽

School Health ◽

Clinical Impact ◽

Pediatric Hospital ◽

Structured Interviews ◽

Short Term ◽

Low Health Literacy ◽

Health Literacy Level ◽

Literacy Level

Background: Medications that taste unpleasant can be a struggle to administer to children, most often resulting in low adherence rates. Pictograms can be useful tools to improve adherence by conveying information to patients in a way that they will understand. Methods: One-on-one structured interviews were conducted with parents/guardians and with children between the ages of 9 and 17 years at a pediatric hospital. The questionnaire evaluated the comprehension of 12 pictogram sets that described how to mask the taste of medications for children. Pictograms understood by >85% of participants were considered validated. Short-term recall was assessed by asking participants to recall the meaning of each pictogram set. Results: There were 51 participants in the study—26 (51%) were children aged 9 to 17 years and 25 (49%) were parents or guardians. Most children (54%) had health literacy levels of grade 10 or higher. Most parents and guardians (92%) had at least a high school health literacy level. Six of the 12 pictogram sets (50%) were validated. Eleven of 12 pictogram sets (92%) had a median translucency score greater than 5. All 12 pictogram sets (100%) were correctly identified at short-term recall and were therefore validated. Conclusion: The addition of validated illustrations to pharmaceutical labels can be useful to instruct on how to mask the taste of medication in certain populations. Further studies are needed to assess the clinical impact of providing illustrated information to populations with low health literacy.

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Procedural and remote outcome among patients undergoing urgent trans-catheter aortic valve implantation

European Heart Journal ◽

10.1093/ehjci/ehaa946.2586 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Berkovitch ◽

A Segev ◽

A Finkelstein ◽

R Kornowski ◽

H Danenberg ◽

...

Keyword(s):

Multivariate Analysis ◽

Hospital Mortality ◽

Mortality Rates ◽

P Value ◽

Complication Rates ◽

Increased Risk ◽

Procedural Complication ◽

Elective Procedure ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Severe aortic stenosis patients suffer frequent heart failure decompensations events often requiring hospitalization. In extreme situations patients can be found with pulmonary edema and cardiogenic shock, unresponsive to medical treatment. Urgent trans-catheter aortic valve implantation (TAVI) has emerged as a treatment option for these high-risk patients. Methods We investigated 3,599 patients undergoing TAVI. Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N=3,448) and those who had an urgent TAVI (N=151). Peri-procedural complications were documented according to the VARC-2 criteria. In hospital and 1-year mortality rates were prospectively documented. Results Mean age of the study population was 82±7, of whom 52% were female. Peri-procedural complication rates was significantly higher among patients with an urgent indication for TAVI compared to those having an elective procedure: valve malposition 3.6% vs. 0.6% (p-value=0.023), valve migration 3.2% vs. 0.9% (p-value=0.016), post procedure myocardial infarction 3.7% vs. 0.3% (p-value=0.004), and stage 3 acute kidney injury 2.6% vs. 0.5%, (p-value=0.02). Univariate analysis found that patients with urgent indication for TAVI had significantly higher in hospital mortality (5.8% vs. 1.4%, p-value<0.001). similarly, multivariate analysis adjusted for age, gender and cardio-vascular risk factors found that patients with urgent indication had more than 5-folds increased risk of in-hospital mortality (OR 5.94, 95% CI 2.28–15.43, p-value<0.001). Kaplan-Meier's survival analysis showed that patients undergoing urgent TAVI had higher 1-year mortality rates compared to patients undergoing an elective TAVI procedure (p-value log-rank<0.001, Figure). Multivariate analysis found they had more than 2-folds increased risk of mortality at 1-year (HR 2.27, 95% CI 1.53–3.38, p<0.001 compared to those having an elective procedure. Conclusions Patients with urgent indication for TAVI have higher in-hospital mortality and higher peri-procedural complication rates. However, if these patients survive the index hospitalization, they enjoy good prognosis. Kaplan-Meier's survival analysis Funding Acknowledgement Type of funding source: None

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