Significance of Postoperative Membranous Urethral Length and Position of Vesico-Urethral Anastomosis for Short Term Continence Recovery Following Robot-Assisted Laparoscopic Radical Prostatectomy

Background We assess whether short term recovery of urinary incontinence following robot-assisted laparoscopic radical prostatectomy (RARP) is associated with preoperative membranous urethral length (MUL) and position of vesico-urethral anastomosis (PVUA). Methods Clinical variables including PVUA and pre- and postoperative MUL were evaluated in 251 patients who underwent RARP from August 2019 to February 2021. Continence recovery was defined as no pad or one security liner per day assessed by patient interview at least 6 months follow-up. Univariate and multivariate logistic regression analyses were used to assess variables associated with continence recovery at 3 months after the operation. Results Continence recovery rates at 3 and 6 months were 75% and 84%, respectively. Lower BMI (<25 kg/m2) (p = 0.040), longer preoperative MUL (≥9.5mm) (p = 0.013), longer postoperative MUL (≥9mm) (p <0.001), higher PVUA (<14.5mm) (p = 0.019) and shorter operating time (<170min) (p = 0.013) were significantly associated with continence recovery at 3 months in univariate analysis. Multivariate analysis revealed that postoperative MUL (OR 3.75, 95% CI 1.90 – 7.40, p <0.001) and higher PVUA (OR 2.02, 95% CI 1.07 – 3.82, p = 0.032) were independent factors for continence recovery. Patients were divided into three groups based on the multivariate analysis, with urinary continence recovery rates found to have increased in turn with rates of 43.7% vs. 68.2% vs. 85.0% (p <0.001) at three months. Conclusions PVUA and postoperative MUL were significant factors for short term continence recovery. Preservation of urethral length might contribute to continence recovery after RARP.

Incidence and risk factors associated with development of oxalipatin-induced acute peripheral neuropathy in colorectal cancer patients

Introduction Oxaliplatin utilized in colorectal neoplasms treatment could induce acute peripheral neuropathy (APN) which is a dreadful and frequent adverse event. The objective of this study is to estimate incidence of APN induced by oxaliplatin cumulative incidence in cancer patients colorectal and to describe the distribution of the APN incidence according to demographic and clinical characteristics, as well as according to oxaliplatin cumulative dose. Material and methods This is a prospective descriptive study which took place from June to December 2018 at the Salah Azaiz Institute, Tunis. Demographic data, clinical data and data on oxaliplatin administration were collected from patient interview, medical files and pharmaceutical databases. Results The APN (grade 1, grade 2 and grade 3) cumulative incidence during the period of six months of follow up was 86% (95% CI [0.7815–0.9132]). While 38.3% (95% CI [0.29–0.48]) of the patients had grade 2 or 3 neuropathy. The search for factors associated with the risk of grade 2 and 3 NAP revealed trend significant association with diabetes (adjusted RR = 5.7 (IC95% [0.9- 37.3]; p = 0.07). Moreover, there was significant association with oxaliplatin cumulative dose (≥421 mg/m2) to increase the risk of APN grade 2 and 3 (adjusted RR = 7.8; [2.7–22.7]; p = 0.0001). Furthermore, significant association with obesity to increase the risk of APN grade 2 and 3 (adjusted RR = 5.3 [1.1- 25.4]; p = 0.04) was found. Among the patients included, 31.1% experienced oxaliplatin dose reduction and in the majority of cases this reduction is due to neurotoxicity (90.9%). Conclusion The high incidence of oxaliplatin-induced APN remains an embarrassing and handicapping side effect. Our study has shown that oxaliplatin cumulative dose (≥421 mg/m2), diabetes and obesity are risk factor for the development of grade 2 and 3 APN.

DEVELOPMENT OF AN AUTOMATED SYSTEM FOR DIAGNOSING EYE DISEASES BASED ON PRODUCTION RULES

В статье рассматриваются вопросы диагностики заболеваний органов зрения и его придаточного аппарата. Медико-социальное значение болезней органов зрения и его придаточного аппарата в современных условиях велико и определяется, прежде всего, их крайне высокой частотой среди различных контингентов населения. Так как зрение является для человека важнейшим из всех органов чувств, без которого невозможна полноценная жизнь, необходимо вовремя выявлять различные патологии и применять незамедлительные меры лечения. Одним из средств повышения эффективности диагностики заболеваний глаз является автоматизация обработки диагностических данных с использованием современных технологий, а именно компьютерной системы поддержки принятия решений. Данная статья посвящена разработке автоматизированной системы диагностики заболеваний глаза на основе продукционных правил. Следует отметить, что процесс медицинского офтальмологического исследования занимает значительное время на различного рода лабораторные анализы, инструментальную диагностику, опрос больного или физического исследования. Автоматизированная компьютерная система диагностики глазных заболеваний предназначена для автоматического установления по характерным признакам таких диагнозов как острый конъюнктивит, острый ирит, острый приступ глаукомы и катаракта. Разработанная программа, реализованная в системе визуального объектно-ориентированного программирования С++, представляется пользователям как консультант для автоматизации работы, что позволит повысить эффективность процесса диагностики заболеваний органов зрения и его придаточного аппарата The article deals with the diagnosis of diseases of the organs of vision and its accessory apparatus. The medical and social significance of diseases of the organs of vision and its accessory apparatus in modern conditions is great and is determined, first of all, by their extremely high frequency among various contingents of the population. Since vision is the most important of all sense organs for a person, without which a full life is impossible, it is necessary to identify various pathologies in time and apply immediate treatment measures. One of the means to increase the effectiveness of the diagnosis of eye diseases is the automation of diagnostic data processing using modern technologies, namely a computer decision support system. This article is devoted to the development of an automated system for diagnosing eye diseases based on production rules. It should be noted that the process of medical ophthalmological examination takes considerable time for various kinds of laboratory tests, instrumental diagnostics, patient interview or physical examination. The automated computer system for the diagnosis of eye diseases is designed to automatically establish the characteristic signs of such diagnoses as acute conjunctivitis, acute iritis, acute attack of glaucoma and cataract. The developed program, implemented in the C++ visual object-oriented programming system, is presented to users as a consultant for automating work, which will increase the efficiency of the process of diagnosing diseases of the visual organs and its accessory apparatus

1093. Bypassing Penicillin Skin Testing in favor of Direct Oral Challenge: A Pharmacy-driven Inpatient Program

Background Patient interview, penicillin skin testing (PST) and/or an oral challenge can be used to evaluate penicillin allergies. Programs favor PST prior to oral challenge, but there is interest in bypassing PST and directly oral challenging for logistical and financial reasons. Data on the safety and efficacy of a direct challenge in the inpatient setting when the index reaction is moderate to severe (e.g. swelling of throat, angioedema, anaphylaxis) is lacking. Methods Adult patients (≥18 years) admitted with a penicillin allergy were evaluated for eligibility between September 2019 and June 2021. Pregnant patients were excluded, while critically ill patients and those on anti-histamine medications were evaluated if clinical need was high. Institutional protocols allowing for patients to be challenged without PST if reaction was more than 10 years ago were used. Data collected included the number of patients challenged and delabeled, number of patients who had moderate to severe index reactions, number of patients who were relabeled without cause, and number of patients who declined further testing. Results Two hundred twenty-five patients were evaluated; 11 patients declined testing. Two hundred four patients were delabeled (95%) among those fully evaluated. One hundred twelve patients were delabeled by interview and chart review alone (52%), 99 by oral challenge (46%), and 2 by PST and oral challenge (1%). Twenty-nine patients with moderate to severe reactions were challenged and 27 were delabeled. Ten patients could not be delabeled due to mild or delayed reactions to challenge or subsequent treatment, including 2 patients with severe index reactions who had mild challenge reactions and required no rescue medications. No patients required epinephrine during challenge. Five patients were relabeled and then delabeled again as no new reaction had occurred. Conclusion Penicillin allergies can be removed with a pharmacy-driven algorithm that prioritizes direct challenges when appropriate even when the index reaction was moderate to severe. Risks of a reaction are low, and reactions tend to be mild. Given well-documented benefits of delabeling patients for the patient and the institution, more hospitals should consider starting such services. Disclosures All Authors: No reported disclosures

Qualitative interviews to improve patient-reported outcome measures in late-onset Pompe disease: the patient perspective

Background Late-onset Pompe Disease (LOPD) is a rare, heterogeneous disease manifested by a range of symptoms varying in severity. Research establishing the frequency of these symptoms and their impact on patients’ daily lives is limited. The objective of this study was to develop a conceptual model that captures the most relevant symptoms and functional limitations experienced by patients with LOPD, to inform the development of new patient-reported outcome (PRO) tools. Methods A preliminary conceptual model was constructed following a literature review and revised through interviews with expert clinicians to identify important and relevant concepts regarding symptoms and impacts of LOPD. This preliminary model informed the development of a qualitative patient interview guide, which was used to gather the patient perspective on symptoms and impacts relating to LOPD or its treatment (including symptom/impact frequency and levels of disturbance). Patient interviews aided further refinement of the conceptual model. The findings from the patient interviews were triangulated with the literature review and clinician interviews to identify the most relevant and significant effects of LOPD from the patient perspective. Results Muscle weakness, fatigue, pain, and breathing difficulties (especially while lying down) were the most common and highly disturbing symptoms experienced by patients. Limitations associated with mobility (e.g., difficulty rising from a sitting position, getting up after bending) and activities of daily living, (e.g., reduced ability to participate in social/family activities or work/study) were the most frequently reported impacts with the highest levels of disturbance on the patient’s daily life. These identified symptoms and impacts were included in the new conceptual model of disease. Conclusions This qualitative patient interview study, also informed by a literature review and clinician interviews, identified the most frequent and relevant symptoms and the functional impact of LOPD on patients. The study interviews also captured the patient-preferred language to describe symptoms and impacts of LOPD. The results from this study can be used to develop future PRO instruments that are tailored to the specific symptoms and impacts experienced by patients with LOPD.

Characteristics of genitourinary tuberculosis in Sri Lanka: A retrospective cohort study

BackgroundAlthough genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains very low. Furthermore, the characteristics of GUTB in Sri Lanka have not been published due to paucity of data. Therefore, we aimed to study the clinical and imaging characteristics, treatment modalities and outcomes of GUTB in Sri Lanka. MethodsA retrospective analysis was performed based on patients treated by a single urological surgeon in two consecutive centres over a period of 21 years. All patients (n=82, males = 45 (54.9%), median age: 51 years; range: 26 - 75) with a microbiological and/or histological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6- 96). Data were obtained from direct patient interview, hospital notes and clinic files. ResultsCommonest prominent symptoms at presentation included haematuria (n=13, 15.8%) and scrotal manifestations (n=12, 14.6%). Mantoux was either positive (>10mm) (n=62/70) or equivocal (>5mm) (n=8/70). Erythrocyte sedimentation rate (ESR) was available in 69 patients and was >30 in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent a cystoscopy and 73.8% (n=31) had abnormal findings. Microbiological diagnosis was feasible in 42 (51.2%) and rest were diagnosed histologically. Commonest organs involved were kidney (64.6%, n=53), ureters (51.2%, n=42), bladder (43.9%, n=36) and testis/epididymis (14.6%, n=12). One patient had prostate TB. All were treated primarily with anti-TB drugs however, 50 (61%) had indications for some form of therapeutic intervention. The majority of interventions were reconstruction surgeries (n=20, 24.4%) followed by excision surgeries (n=19, 23.2%) and drainage procedures (n=11, 13.4%).Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder and 3 patients developed end-stage renal failure. Two patients had relapse of infection. ConclusionCT-Urography, cystoscopy and histopathology are essential adjuncts to diagnose GUTB. Most ureteric strictures, non-functioning kidneys and epididymal masses needed surgical treatment. Long-term follow up is essential to detect progressive renal dysfunction.

A novel patient-reported outcome instrument assessing the symptoms of paroxysmal nocturnal hemoglobinuria, the PNH-SQ

Background Patient-reported outcome measures (PROs) used to measure symptoms of patients with paroxysmal nocturnal hemoglobinuria (PNH) in trials do not measure PNH symptoms comprehensively and do not assess daily fluctuations in symptoms. Following a literature review and consultation with a PNH expert, we drafted the PNH Symptom Questionnaire (PNH-SQ) and a patient-centric conceptual model of PNH symptoms and impacts. We then interviewed 15 patients with PNH to assess comprehensiveness of symptom capture from the patient perspective and to cognitively debrief the PNH-SQ. Patient interview data were also used to finalize the PNH conceptual model. Results Participants mentioned 27 signs or symptoms of PNH spontaneously or after being probed; 93% reported experiencing ≥ 1 PNH symptom. Concept saturation was reached for all PNH symptoms. Further, interviews confirmed the instrument captured the most common PNH symptoms, including fatigue (87%), abdominal pain (60%), and difficulty swallowing (47%), with fatigue ranked as the most bothersome symptom. The interviews demonstrated that participants understood the items of the PNH-SQ (90–100%); considered the symptoms relevant (> 50– > 90%); the recall period appropriate (> 80–100%); and the response options suitable (> 80–100%). Participants also suggested changes regarding item redundancy and relevance; this feedback was used to finalize the instrument. Conclusions The finalized PNH-SQ assesses the presence and severity of 10 symptoms—abdominal pain, chest discomfort, difficulty sleeping, difficulty swallowing, difficulty thinking clearly, fatigue, headache, muscle weakness, pain in the legs or back, and shortness of breath—over 24 h. The PNH-SQ is a content-valid questionnaire suitable for assessing daily symptom presence and severity in PNH clinical trials.

Prevalence of Diseases in Elderly Patients with Medication Related Problems

Introduction: The elderly population commonly known as geriatrics constitute nearly 21% of the world population. With the increasing age, the human body undergoes physiologic changes, leading to pharmacokinetic and pharmacodynamic alterations, hence making this sector of the patients more prone to medication related problems. Medication related problems are any unwanted events or circumstances that occur during the drug therapy which has the potential to interfere with the desired goals of health outcomes. Methods: A community based observational study was conducted in different places of Dakshina Kannada district for a duration of 6 months by enrolment of 150 patients aged above 60 years of either sex diagnosed with any disease except for cancer and bed ridden patients. The data was collected with the help of patient interview forms and was analysed. Results: Out of the 150 patients, 107 patients were identified with medication related problems. The total number of identified medication related problems were 196. From this study it was found that the medication related problems were more prevalent in cardiovascular disorders and endocrine disorders. As hypertension and diabetes mellitus are the most common diseases found among the elderly, the risk factors for developing medication related problems in such patients include the need of additional drug therapy or adequate monitoring of the clinical outcomes. Conclusion: It was found that the geriatrics suffering from multiple co-morbidities, undergoes multiple drug therapies thereby leading to medication related problems. Hence in order to ensure optimum care, a targeted approach is essential. Keywords: Medication related problems, Geriatrics, Hepler-Strand classification.

Depression and Anxiety as Important Aggravating Factors of Pain in Morton’s Neuroma

This report represents a case of Morton’s Neuroma with episodic severe sharp pain. Initially, the patient was prescribed Naproxen 500 mg twice per day, anti-inflammatory topical cream, as well as massage. In a follow up visit, the patient was still experiencing frequent episodic sharp pain. In detailed patient interview, it was revealed that she has depression and anxiety and suffers from social isolation, which was concurrent with episodes of severe pain. Therefore, she was referred to a psychologist and a community support group and started practicing body relaxation techniques such as guided imagery and breathing exercises. The new treatment strategy had a major impact on improving her symptoms. This report aims to illustrate that depression and anxiety can be one of the main aggravating factors in episodic pain in Morton’s neuroma and removing psychosocial contributors of pain has the potential to decrease the need for more invasive interventions.

An Impact of Patient-physician Communication Curriculum on Students of Korean Medical School

Objectives: This study aims to evaluate the impact of patient-physician communication curriculum on students of Korean medical school in terms of cognitive, affective, and psychomotor level of communication skills. Methods: A communication curriculum was developed considering COVID-19 pandemic situation. Lectures, peer role-play, open interview with standardized patient (SP), discussion and feedback were conducted by online, and face-to-face 1:1 SP-interview was performed. Scores of written test, peer role-play of medical communication, SP-interview, self-evaluation on one’s interview with real patients in clinical clerkship, and questionnaire of importance were collected and analyzed. Results: Converted to 100 point scale, the mean score of written test (cognitive level) was 91.2 while that of importance questionnaire (affective level) was 77.5. The mean scores of psychomotor level were 72.5, 77.5, and 62.5 for peer role-play, SP-interview, and real patient interview in clerkship, respectively. Conclusions: Students’ performance is lower in higher level of competence. Curriculums should provide more opportunities of practices to students, and include evaluation focusing on performance skills.