KNEE INJURIES PREVALENCE IN BRAZILIAN JIU-JITSU: EPIDEMIOLOGICAL STUDY

ABSTRACT Objective: To evaluate the epidemiological and clinical characteristics of knee injuries in Brazilian Jiu-Jitsu (BJJ) practitioners. Methods: Cross-sectional study, using a mixed questionnaire, based on the Referred Morbidity Index. Results: 198 amateur and professional BJJ fighters, of both sexes, aged between 18 and 60 years, participated in the study. The majority (88%) of the fighters had only one knee injury (p < 0.001). In total, 29.8% proportion of knee injuries (p < 0.001) was identified, which were mainly from the medial collateral ligament (38%), caused by a sprain mechanism (86%) and conservative treatment (65%). Conclusion: A high prevalence of knee injuries in JJB fighters was found, compared to other sports that also perform rotational movements and have great body contact, such as mixed martial arts (MMA), judo, soccer, basketball and handball. Some JJB strikes, such as the key and the projection, can cause greater knee joint stress, both in the attacking fighter and in the opponent. The knowledge of the epidemiological characteristics of sports injuries is important in the elaboration of prevention and training protocols more specific to the sport and for the understanding of the complex mechanisms involved with this outcome in sport. Level of Evidence IV, Case Series.

382. Vitamin D Supplementation and Covid 19: Results from the U.S. N3C Data Enclave

Background It is estimated that 18% of adults in the U.S. take Vitamin D supplements. Some observational studies suggest that vitamin D supplementation activates the innate immune system and reduces the incidence and severity of viral infections. During the SARS-CoV-2 pandemic, vitamin D supplements were touted as a potential therapy to prevent the disease and/or complications. However, supportive evidence is lacking. Methods The National COVID Cohort Collaborative (N3C) enclave is the largest COVID-19 data base with nearly 1.4 million positive patients at 56 sites in the U.S. We performed a retrospective analysis of vitamin D supplementation, either prescribed before or during hospitalization for SARS-CoV-2. Results 137,399 people took vitamin D supplements out of 1.4 million. Females prescribed vitamin D outnumbered males by almost 2:1, whereas in non-users there were no sex differences. Most supplement users were older than 50. African Americans constituted 13% of the non-users, but 23% of those prescribed vitamin D. Infected individuals with any vitamin D supplementation, pre-Covid, post-Covid or both, had a 6.66% mortality rate vs 2% mortality in non-users. Similarly, nearly a third of the supplement users were hospitalized compared to 11% in the non-users. The Charlson Co-Morbidity Index was 3.0±3 (SD) in users vs 1.0±2 (SD) in non-users. Conclusion 10% of SARS-CoV-2 infected patients were taking vitamin D. They tended to be older, more likely to be African American and have significant co-morbidities. Hospitalization and mortality were higher among those taking Vitamin D in this cohort. Vitamin D is widely used to prevent and treat SARS-CoV-2 but without evidence of efficacy. Disclosures Sally L. Hodder, M.D., Gilead (Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Viiv Healthcare (Grant/Research Support, Advisor or Review Panel member)

The Big Five Model in Bipolar Disorder: A Latent Profile Analysis and its Impact on Longterm Illness Severity

Background Using a personality typing approach, we investigated the relationship between personality profiles and the prediction of longterm illness severity in patients with bipolar disorder (BD). While previous research suggests associations between BD and traits from the NEO-FFI profiles, the current study firstly aimed to identify latent classes of NEO-FFI profiles, and, secondly, to examine their impact on the longterm prognosis of BD. Methods Based on the NEO-FFI profiles of 134 euthymic patients diagnosed with BD (64.2% female, mean age = 44.3 years), successive latent profile analyses were conducted. Subsequently, a subsample (n = 80) was examined prospectively by performing multiple regression analysis to evaluate the longitudinal course of the disease (mean: 54.7 weeks) measured using a modified Morbidity Index. Results The latent profile analyses suggested a 3-class model typifying in a resilient (n = 68, 51%), vulnerable (n = 55, 41%) and highly vulnerable (n = 11, 8%) class. In the regression analysis, higher vulnerability predicted a higher longterm Morbidity Index ( R 2 = .28). Conclusions Subgroups of patients with BD share a number of discrete personality features and their illness is characterized by a similar clinical course. This knowledge is valuable in a variety of clinical contexts including early detection, intervention planning and treatment process.

255 Relationship Between Acute Urinary Retention Episode and Risk of Death in Men

Introduction Acute urinary retention (AUR) is a urological emergency, with incidence increasing with age, being highest amongst men over 70 years. Such adverse events need to be managed properly to avoid complications. Studies have highlighted the association between urinary retention and death. Advancing age and co-morbidities are the two significant factors determining the outcomes of these patients. Aim The main outcome measure will be the death rate within 12 months of retention episode, irrespective of if first or subsequent episodes of retention. Method A total of 231 patients attended emergency department from January to June in the years of 2016 to 2018 with AUR. A total of 42 patients died following episode of urinary retention. Hospital records of these patients were examined with regards to their age at retention, date of retention and date of death. Co-Morbidities, details of any resulting admission and outcome of trial without catheter were also recorded. Results A total of 42 (17.9%) had died. 24 out of 42 (10.2%) died within twelve months of their episode of urinary retention; this represents 57% of all total death relating to this cohort. 16 (66.7%) cases of the 24 that died within 12 months were noted to have ASA of 3 and Charlson co-morbidity index of &gt; 1. 15 (62.5%) cases of that died within 12 months also had long term catheter. Conclusions The management of AUR whilst aimed at immediate relief of retention and preventing possible complications, holistic patient approach should be adopted. Multi-disciplinary team involvement should be instituted as appropriate.

The Marsden Morbidity Index: The Derivation and Validation of a Simple Risk Index Scoring System Using Cardiopulmonary Exercise Testing Variables to Predict Morbidity in High Risk Patients Having Major Cancer Surgery.

BackgroundMorbidity and mortality risk prediction tools are increasingly being used as part of preoperative assessment of patients presenting for major abdominal surgery. Cardiopulmonary exercise testing (CPET) can predict which patients undergoing major abdominal surgery are at risk of complications. The primary aim of this study was to identify pre-operative variables including those derived from CPET, that were associated with inpatient morbidity in high risk patients following major abdominal cancer surgery. Secondary aims were to use these variables to derive and validate a morbidity risk prediction tool.MethodsWe conducted a retrospective cohort analysis of consecutive adult patients who had CPET as part of their pre-operative work-up for major abdominal cancer surgery. Morbidity was a composite outcome, defined by the Clavien-Dindo score and/or the Postoperative Morbidity Survey (POMS) score which was assessed on postoperative day 7. A risk prediction tool was devised using variables from the first analysis which was then applied prospectively to a matched cohort of patients.ResultsA total of 1398 patients were included in the first phase of the analysis between June 2010 and May 2017. Of these, 540 patients (38.6%) experienced postoperative morbidity. CPET variables deemed significant (p<0.01) were Anaerobic Threshold (AT), Maximal Oxygen Consumption at Maximal Exercise Capacity (VO2 Max) and Ventilatory Equivalent for Carbon Dioxide at Anaerobic Threshold (AT VE/VCO2). In addition to the CPET findings and the type of surgery the patient underwent, eight premorbid variables that were associated with post-operative morbidity were identified. These include age, WHO category, body mass index (BMI), prior transient ischaemic attack (TIA) or stroke, chronic renal impairment, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and cancer stage. Both sets of variables were then combined to produce a validated morbidity risk prediction scoring tool called the Marsden Morbidity Index. In the second phase of the analysis, this tool was applied prospectively to 424 patients between June 2017 and December 2018. With an area under the curve (AUC) of 0.79, this new model had a sensitivity of 74.2%, specificity of 78.1%, a positive predictive value (PPV) of 79.7% and a negative predictive value of (NPV) of 79%. ConclusionOur study showed that of the CPET variables, AT, VO2 Max and AT VE/VCO2 were shown to be associated with postoperative surgical morbidity following major abdominal oncological surgery. When combined with a number of preoperative co-morbidities commonly associated with increased risk of postoperative morbidity, we created a useful institutional scoring system for predicting which patients will experience adverse events. However, this system needs further validation in other centres performing oncological surgery.

509 POTENTIALLY INAPPROPRIATE MEDICATION USE AND MORTALITY IN PATIENTS WITH COGNITIVE IMPAIRMENT

Introduction Potentially inappropriate medications (PIMsare associated with falls, hospitalisation, and cognitive decline. Few studies have investigated the association between PIMsrelated to cognitive impairment (PIMCog) and mortality in dementia or mild cognitive impairment (MCI). Methods This was a retrospective observational study. Patients diagnosed with MCI or dementia (DSM-IV criteria) presenting to a tertiary-referral memory clinic from 2013–2019 were eligible. The primary outcome was all-cause death. Secondary outcomes were vascular death and non-vascular death defined according to formal certification. The primary exposure variable of interest was PIMCog, defined as any medication in the Beers 2015 or STOPP criteria, classified as potentially inappropriate for patients with cognitive impairment. Anticholinergic burden was measured using the anticholinergic cognitive burden (ACB) scale. Polypharmacy was defined as ≥5 medications. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs). Results There were 418 patients included (n = 261 dementia, n = 157 MCI). The median age was 79 (interquartile range {IQR} 74–82) and median follow-up was 809 days (IQR 552–1,571). One or more PIMCog was prescribed in 141 patients (33.4%). PIMCog use was associated with all-cause mortality after adjustment for age, sex, dementia severity, Charlson Co-morbidity Index, chronic obstructive pulmonary disease, congestive cardiac failure, and peripheral vascular disease. (HR 1.96, 95% CI 1.24–3.09). PIMCog use was associated with vascular death (HR 3.28, 95% CI 1.51–7.11) but not with non-vascular death (HR 1.40 95% CI: 0.78–2.52). Neither an ACB ≥3 (HR 0.87, 95% CI: 0.46–1.64) or polypharmacy (HR 1.87, 95% CI: 0.67–5.24) were associated with death. Conclusion The burden of PIMCog use in patients with cognitive impairment is high. PIMCog use is independently associated with all-cause mortality and vascular death. This is a potential modifiable risk factor for death in patients with neurocognitive disorders. Further research is required to independently validate this finding.

P482 Safety and efficacy of ustekinumab for Crohn’s disease in the elderly population

Background The rising incidence of inflammatory bowel disease (IBD) worldwide and an ageing population has led to a marked increase in elderly IBD patients. Anti-tumour necrosis factor (TNF) agents are associated with an increased risk of serious infections and treatment discontinuation among elderly IBD patients but little is known about non anti-TNF biologics in this cohort. We aimed to examine safety and efficacy of ustekinumab in elderly Crohn’s disease (CD) patients. Methods Patients ≥60 years old commencing ustekinumab for CD were included in this retrospective multi-centre cohort study. We gathered data on adverse events, Harvey Bradshaw Index (HBI) and concomitant steroid therapy. The primary outcome was serious infections, defined as requiring hospitalisation. Efficacy was assessed by serial HBI measurement and treatment persistence. Results 70 patients were included, with a median age of 68 years (range 60–87), a male:female ratio of 9:5 and a median Charlson co-morbidity index of 4 (range 2–9). 44 (62.9%) had prior anti-TNF exposure and 15 (21.4%) previous vedolizumab. Median treatment duration was 12 months (range 2–48), with a total of 84 patient years. 31 patients (41.3%) had steroids at initiation, and 33 (47.1%) required a course of steroids at a later date. Seven patients (10%) had a combined 9 serious infections, of which 1 was life threatening requiring organ support. Incidence of serious infections was 0.107 per patient year. A further 18 patients had a combined 22 non-severe infections (Table 1). The overall infection rate was 0.417 per patient year. Charlson co-morbidity index was numerically higher among those who developed severe infections (median 5, range 3–7 vs. median 4, range 2–9, P=NS). 3 patients developed a malignancy; non-Hodgkin’s lymphoma, melanoma and prostate cancer. Mean HBI improved from 8.13 at baseline to 4.64 at 6 months and 4.10 at last follow up (both P&lt;0.0001). Treatment persistence rate was 61.4% (N=43) and 36 (51.4%) were steroid-free. Reasons for discontinuation were primary non-response (42%), adverse event (32%), secondary loss of response (10%), malignancy (10%) and lack of funding (5%). Conclusion Ustekinumab was safe and effective in a cohort of elderly CD patients. Infections were mostly mild, not resulting in therapy discontinuation. The risk of serious infection was low at 0.107 per patient year of treatment.

577 Risk Factors Analysis for Contralateral Neck of Femur Fracture in Elderly Population

Introduction Neck of femur fracture (NOFF) carries significant morbidity, mortality, and cost implication to the health system. Subsequent contralateral fracture(SCNOFF) further decreases patient performance and increases healthcare burden. The aim of this study was to identify and evaluate potential risk factors and effects of SCNOFF. Method Retrospectively analysed NOFF database from 2012 to 2019 was. Inclusion criteria were patients over 60 years with low energy fractures. Polytrauma, pathological and atypical fractures were excluded. Results There were 114 patients (4.18%) with contralateral hip fractures out of 2727 total NOFF patients. Mean age was 82 years old for the first hip fracture and 85 years for the second. Average time interval between fractures was 36 months. During the two admissions, mean decline in Abbreviated Mental Test Score(AMTS) was 0.4, deterioration of Clinical Fragility Score and Charlson Morbidity Index were from 4.5 to 5.9 (P &lt; 0.0001), and from 5.4 to 6.1 respectively. Mobility was dropped by one level. institutional residency was increased from 23 to 46 (P &gt; 0.0014). Conclusions There is a drastic decline in clinical frailty, mobility status and increase residential dependency following a subsequent fracture. Our findings demonstrate the importance of emphasizing preventive measures to reduce the incidence of SCNOFF.

297 Risks of Delaying De-Obstruction of an Acutely Infected Obstructed Urinary Tract

Introduction We investigated patients with acute urinary tract obstruction in a DGH to ascertain which factors predispose to CKD and mortality. Method Over five months there were 37 nephrostomy/stent cases, 18 female, 3 mortalities. Median age was 55.5 (18-93). Retrospective data was used in a multiple regression analysis. Input variables included the intervention indication, admission Creatinine, Charlson Co-morbidity Index, and intervention delay. Output variables were length of hospital stay, renal function and 90-day mortality. Results Positive urine cultures (p = 0.035) and co-morbidity (p = 0.018) were associated with CKD. Nephrostomy patients (p = 0.031) were associated with AKI post-procedure. Delay in disobstruction (p &lt; 0.01) and delay-length (p = 0.026) were significantly associated with longer hospital stays. AKI severity on admission (p = 0.047) and intervention delay (p = 0.045) increased risk of 90-day mortality, with positive blood cultures (p = 0.071) trending towards significance. Malignant obstruction neared a significant association with CKD (p = 0.08) and 90-day mortality (p = 0.075). Conclusions The severity of presentation and delay in intervention all contribute to poorer outcomes and a longer admission. Co-morbid patients with malignant obstruction had a higher risk of 90-day mortality. Therefore, in those with poor baseline, are we intervening inappropriately?