Patient reported outcomes for phosphomannomutase 2 congenital disorder of glycosylation (PMM2-CDG): listening to what matters for the patients and health professionals

Background

Congenital disorders of glycosylation (CDG) are a growing group of rare genetic disorders. The most common CDG is phosphomannomutase 2 (PMM2)-CDG which often has a severe clinical presentation and life-limiting consequences. There are no approved therapies for this condition. Also, there are no validated disease-specific quality of life (QoL) scales to assess the heterogeneous clinical burden of PMM2-CDG which presents a challenge for the assessment of the disease severity and the impact of a certain treatment on the course of the disease.

Aim and methods

This study aimed to identify the most impactful clinical signs and symptoms of PMM2-CDG, and specific patient and observer reported outcome measures (PROMs and ObsROMs, respectively) that can adequately measure such impact on patients’ QoL. The most burdensome signs and symptoms were identified through input from the CDG community using a survey targeting PMM2-CDG families and experts, followed by family interviews to understand the real burden of these symptoms in daily life. The list of signs and symptoms was then verified and refined by patient representatives and medical experts in the field. Finally, a literature search for PROMs and ObsROMs used in other rare or common diseases with similar signs and symptoms to those of PMM2-CDG was performed.

Results

Twenty-four signs/symptoms were identified as the most impactful throughout PMM2-CDG patients’ lifetime. We found 239 articles that included tools to measure those community-selected PMM2-CDG symptoms. Among them, we identified 80 QoL scales that address those signs and symptoms and, subsequently, their psychometric quality was analysed. These scales could be applied directly to the PMM2-CDG population or adapted to create the first PMM2-CDG-specific QoL questionnaire.

Conclusion

Identifying the impactful clinical manifestations of PMM2-CDG, along with the collection of PROMs/ObsROMs assessing QoL using a creative and community-centric methodology are the first step towards the development of a new, tailored, and specific PMM2-CDG QoL questionnaire. These findings can be used to fill a gap in PMM2-CDG clinical development. Importantly, this methodology is transferable to other CDG and rare diseases with multiple signs and symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13023-022-02551-y.

Maternal care experience and postpartum depressive symptoms among migrant and native in Portugal

Background

Migration is a risk factor for both, poor maternal experience with healthcare services (MEHCS) and postpartum depressive symptoms (PPDS), a matter of concern due to their adverse consequences. We aimed to assess the association between MEHCS and PPDS taking into account the migration status.

Methods

This is part of a population-based study (baMBINO project), enrolling native (PT; n = 1568), permanent migrant (PM; n = 676) and temporary migrant (TM; n = 757) women recruited at delivery (2017-2019) in 32 Portuguese public hospitals. MEHCS was assessed based on 39 items of the Migrant Friendly Maternal Care Questionnaire asking about how women have experienced maternal care during pregnancy, during delivery and after birth. Items were grouped into 9 components each one assessing a different issue of MEHCS. For each component women were classified as having “good” or “less than good” experience. PPDS were assessed using the Edinburgh Postnatal Depression Scale (cut-off≥12). Multivariate logistic regression model was fitted to estimate the association between MEHCS and PPDS. Adjusted odds ratio (aOR) and respective 95% confidence interval were obtained.

Results

PPDS were reported by 3.8%, 5.8% and 8.2% of PT, PM and TM women, respectively (p < 0.001). After adjustment, 4 out 9 components of MEHCS appeared related with PPDS, such that women reporting less than good experience with “understanding information” (aOR=1.72 95%CI:1.14-2.60), “decisions according to maternal wishes” (aOR=1.56 95% CI:1.04-2.34), “time waiting for healthcare” (aOR=1.50 95%CI:1.04-2.18) and “healthcare provider's attitudes during pregnancy” (aOR=1.58 95%CI:1.01-2.47) showed higher odds of PPDS than women reporting good experience.

Conclusions

Further than the migration status, poor experience with some issues of maternal care seems play a role in the risk of PPDS

Key messages

Hemostasis of the radial artery after coronary angiography: a scoping review

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Nowadays, most interventional cardiology procedures are made via radial artery. There is significant variability of haemostasis methods, devices, and protocols. All of them try to avoid radial artery occlusion while maintaining patent haemostasis. Summarizing the available evidence about haemostasis of the radial artery after coronary angiography will allow us to challenge our current practice.

Purpose

The focus of this scoping review is to map the literature on haemostasis of the radial artery after coronary angiography. To date, no previous reviews addressing this purpose have been found.

Methods

This review follows the Joanna Briggs Institute methodology for scoping reviews. Two reviewers will independently perform the study selection regarding their eligibility. Data extraction will be accomplished using a researcher's developed tool to address the objectives and reviews questions. Any disagreements arisen between the reviewers will be resolved by discussion or consulting a third reviewer. Data synthesis will be presented in tabular form and a narrative summary that align with the review's objective. Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension to scoping reviews guidelines will be used to report the results. A set of relevant electronic databases and grey literature will be searched.

Results

Twenty-four studies were included, of various types: randomized clinical trials, case-reports, case series, narrative reviews. Three methods were described: compression devices, compression band and haemostatic patch. Sometimes more than one method is used, and there are various protocols that vary according to the institutional practice.

Conclusion

There are multiple radial artery haemostasis methods and protocols currently in use after a coronary angiography with no method overwhelmingly predominant. Few were associated with clearly defined haemostasis protocols, even though these protocols exist, often associated with compression devices. The institutional practice plays a decisive role on the use and modification of these protocols, with no clear evidence to support it. Such variability in protocols might have a detrimental effect in having a standardized one that can be used across various institutions/countries, facilitating broader multicentric studies.

Lactiplantibacillus plantarum 299v (LP299V®): three decades of research

This review aims to provide a comprehensive overview of the in vitro, animal, and clinical studies with the bacterial strain Lactiplantibacillus plantarum 299v (L. plantarum 299v; formerly named Lactobacillus plantarum 299v) published up until June 30, 2020. L. plantarum 299v is the most documented L. plantarum strain in the world, described in over 170 scientific publications out of which more than 60 are human clinical studies. The genome sequence of L. plantarum 299v has been determined and is available in the public domain (GenBank Accession number: NZ_LEAV01000004). The probiotic strain L. plantarum 299v was isolated from healthy human intestinal mucosa three decades ago by scientists at Lund University, Sweden. Thirty years later, a wealth of data coming from in vitro, animal, and clinical studies exist, showing benefits primarily for gastrointestinal health, such as reduced flatulence and abdominal pain in patients with irritable bowel syndrome (IBS). Moreover, several clinical studies have shown positive effects of L. plantarum 299v on iron absorption and more recently also on iron status. L. plantarum 299v is safe for human consumption and does not confer antibiotic resistance. It survives the harsh conditions of the human gastrointestinal tract, adheres to mannose residues on the intestinal epithelial cells and has in some cases been re-isolated more than ten days after administration ceased. Besides studying health benefits, research groups around the globe have investigated L. plantarum 299v in a range of applications and processes. L. plantarum 299v is used in many different food applications as well as in various dietary supplements. In a freeze-dried format, L. plantarum 299v is robust and stable at room temperature, enabling long shelf-lives of consumer healthcare products such as capsules, tablets, or powder sachets. The strain is patent protected for a wide range of indications and applications worldwide as well as trademarked as LP299V^®.

Process mining tools: where should we build another PCI centre to reduce STEMI mortality?

Introduction

The expected delay of transport between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy in ST-segment elevation myocardial infarction (STEMI). The central region of Portugal has heterogeneity in PCI assess due to geographical reasons. However, this data is usually presented numerically without providing a visual distribution of patients.

Purpose

We aimed to analyse the impact of distance to PCI centres on mortality in patients with STEMI through visual maps of patients' flow by using an experimental process mining tool, integrated in EIT Health's project PATHWAYS.

Methods

Using the Portuguese Registry of Acute Coronary Syndromes (ProACS), we retrospectively assessed patients with an established diagnosis of STEMI, geographical presentation specified, reperfusion option identified (PCI, fibrinolysis or no reperfusion), short-term outcomes defined as discharge or in-hospital death. With the 2 317 patients that fulfilled the criteria, we used a process mining tool to build national and regional models that represent the flow of patients in a healthcare system, enhancing differences between groups.

Results

Colour gradient in nodes and arrows changes from green to red, with green representing a lower number of patients as opposed to red. In the national model, most patients from all regions had PCI. Mortality was similar between PCI and fibrinolysis groups (4%) but higher in those without reperfusion (9%). In the central region model, one third of the patients were more than 120 minutes away from a PCI centre. Despite that, almost one third of these patients had PCI instead of fibrinolysis. In this model, fibrinolytic therapy had higher in-hospital survival rate than PCI (98% vs. 94%). Overall mortality was higher in the central model compared with the national model (6.92% vs. 5%). Central region had less PCI (53% vs. 73%), more fibrinolysis (15% vs. 7%) and more patients with no reperfusion (32% vs. 20%).

Conclusion

In the ProACS registry, mortality was higher in the central region compared with national data. Even though global interpretation of these findings is limited by underrepresentation from certain central areas, process mining offers an easily understandable view of patients flow. With its statistical upgrade and continuous development, this tool will facilitate the analysis of big data and comparison between groups.

Funding Acknowledgement

Type of funding source: Public grant(s) – EU funding. Main funding source(s): EIT Health

Equitable perinatal healthcare for migrants, Portugal: Comparative analysis of a self-assessment tool

Migration is seen as a common risk factor in obstetric management. Migrants often have a higher risk of experience worse pregnancy outcomes, higher rates of operative delivery, and a higher likelihood to receive less adequate postpartum care when compared to native women. This study evaluates self-perceived assessment of migrant women and hospital directors on equitable migrant friendly perinatal healthcare quality and access during intrapartum and postpartum period at public maternity units across Portuguese mainland between 2017-2019.

This cross-sectional study analyses perinatal health data from migrant women over 18 years giving birth in public maternity units from between April 2017 and March 2019 as part of the baMBINO project. Data on the assessments of maternity units' directors on equitable migrant friendly healthcare was collected in a self-assessment tool. Two standards on healthcare access and on healthcare quality were developed by: 1) scoring 25 and 30 questions, respectively, from 0 (worst) to 5 (best); 2) calculating the average of each score. The One-Sample Wilcoxon Test (non-parametric) was applied to compare the assessment of hospital directors with the migrant mothers and the Kruskal-Wallis one-way analysis of variance to test for regional differences.

Significant differences between migrant woman and healthcare directors' assessments on migrant friendly healthcare access and quality of care were found. Directors rated healthcare access with a median score of 2.4, twice as good as migrant women (1.3). Migrant women rated healthcare quality with a median score of 4.0 (directors: 3.2). Significant differences between the regions for quality of care and healthcare access were found. Statistically significant difference between migrants from Portuguese and non-Portuguese speaking countries was identified for healthcare access (p-value < 0.001) and healthcare quality (p-value < 0.05).

Key messages

The need to guarantee equitable healthcare access and quality contemplates as a first step to overcome health inequalities for migrant women in Portugal. The comparison between patients and healthcare providers’ assessments assists in the understanding of existent barriers in access to health care and improves quality assurance.

0529 Behavioral Therapy Components for Insomnia and Fatigue in COPD

Introduction

Insomnia contributes to fatigue, a common symptom in COPD. Our study aims were: (1) to determine the efficacy of a) cognitive behavioral therapy for insomnia (CBT-I) and b) COPD education (COPD-ED) on insomnia and fatigue, and (2) to define potential mechanistic contributors to pre/post intervention change in insomnia and fatigue in patients with COPD and insomnia.

Methods

A randomized 2x2 factorial design was used with factors representing CBT-I (yes/no) and COPD-ED (yes/no). Attention control (health videos) were used in the absence of CBT-I or COPD-ED. All patients received 6, 75-minute weekly sessions. Dependent variables included insomnia severity (Sleep Impairment Index (SII), range 0-28) and fatigue (Chronic Respiratory Disease Questionnaire (CRQ) range 1-7) measured at baseline, just post-intervention, and at 3-months post-intervention.

Results

One hundred nine patients (FEV1% predicted 67 ± 24% (mean ± SD), age 65 ± 8 years, SII 15.9 ± 8, CRQ 3.7 ± 1.1) participated in the study. After 6 sessions, insomnia decreased more in patients who received CBT-I (-5.8) than those who did not (-2.2; p=0.0002). This effect was sustained at the 3-month follow-up (p=0.0003). Fatigue showed no significant differences for CBT-I at 6-weeks (p=.27) but at 3-months patients receiving CBT-I showed marginally better improvement (.75, a clinically important difference) compared to those who did not receive CBT-I (.43; p=.09). COPD-ED showed no effect on insomnia or fatigue. Two main effects suggest mechanisms for the pre-post efficacy of CBT-I: improved sleep beliefs (p=0.0257) and self-efficacy for sleep (p=0.0619) after 6 sessions which were sustained at 3 months (p=0.0184 and p=0.0431 respectively).

Conclusion

CBT-I produced sustained decreases in insomnia in patients with COPD. Results suggest that changes in beliefs about sleep and improved self-efficacy for managing sleep may mediate CBT-I associated decreases in insomnia.

Support

This research was supported by the National Institute of Nursing Research of the National Institutes of Health R01NR013937.

VPA/PLGA microfibers produced by coaxial electrospinning for the treatment of central nervous system injury

The central nervous system shows limited regenerative capacity after injury. Spinal cord injury (SCI) is a devastating traumatic injury resulting in loss of sensory, motor, and autonomic function distal from the level of injury. An appropriate combination of biomaterials and bioactive substances is currently thought to be a promising approach to treat this condition. Systemic administration of valproic acid (VPA) has been previously shown to promote functional recovery in animal models of SCI. In this study, VPA was encapsulated in poly(lactic-co-glycolic acid) (PLGA) microfibers by the coaxial electrospinning technique. Fibers showed continuous and cylindrical morphology, randomly oriented fibers, and compatible morphological and mechanical characteristics for application in SCI. Drug-release analysis indicated a rapid release of VPA during the first day of the in vitro test. The coaxial fibers containing VPA supported adhesion, viability, and proliferation of PC12 cells. In addition, the VPA/PLGA microfibers induced the reduction of PC12 cell viability, as has already been described in the literature. The biomaterials were implanted in rats after SCI. The groups that received the implants did not show increased functional recovery or tissue regeneration compared to the control. These results indicated the cytocompatibility of the VPA/PLGA core-shell microfibers and that it may be a promising approach to treat SCI when combined with other strategies.

Linking contaminant distribution to hydrodynamic patterns in an urban estuary: The Douro estuary test case

An increase in anthropogenic activities in coastal regions can put at risk their flora and fauna and their ecosystem services. Therefore, it is important to evaluate possible impacts. In particular, we need to understand the links between contaminants concentrations and the hydrodynamic patterns of these highly productive regions to anticipate the effects of contaminants in the environment. Towards that aim there is the need to carry out regular campaigns to monitor the evolution of the coastal systems. In this work we analyse in-situ measurements of physico-chemical parameters, and look for possible relations between observed contaminants patterns and estuarine hydrodynamics. Data collected in the Douro estuary, one of the main estuarine regions of the Iberian western coast, revealed the presence of 5 hazardous and noxious substances (HNS), 14 polycyclic aromatic hydrocarbons (PAHs) and 6 trace metals in water and sediment samples. Water temperature and salinity analysis revealed a strong variability, which can affect the water solubility properties and the organisms' tolerance to certain toxins. A relationship between the salinity and the HNS and PAHs concentrations was found, caused by the existence of a salt-wedge that triggers the salting-out effect. Sinker contaminants (PAHs and trace metals) can be re-suspended both during low and high flow conditions associated with the salt-wedge and with strong river flows. Floater contaminants (HNS) are completely depended on the tide, which has the capacity to distribute them through the entire estuary, during low river flow regimes. However, strong river flows, with associated river plumes, can distribute both sinker and floater contaminants to the coastal region trapping them over the inner-shelf. The results clearly show that hydrodynamic patterns are a major driver for contaminants dispersion and pathways in coastal areas, inducing harmful effects to the flora and fauna and, consequently, to the ecosystem services of these regions.

Software code complexity assessment using EEG features

This paper provides a study using Electroencephalography (EEG) to investigate the brain activity during code comprehension tasks. Three different code complexity levels according to five complexity metrics were considered. The use of EEG for this purpose is relevant, since the existing studies were mostly focused on neuroimaging techniques. Using Leave-One-Subject-Out cross-validation procedure for 30 subjects, it was found that the features related with the Gamma activity were the most common in all the folds. Regarding the brain regions, right parietal was the most frequent region contributing with more features. A Linear Discriminant Analysis Classifier for task classification, obtained a F-Measure of 92.71% for Code complexity easy, 52.25% for Code complexity intermediate and 53.13% for Code complexity advanced, revealing an evidence of mental effort saturation with the code complexity degree. This suggests that current code complexity metrics do not capture cognitive load and might not be the best approach to assess bug risk.

Latent states extraction through Kalman Filter for the prediction of heart failure decompensation events

Cardiac function deterioration of heart failure patients is frequently manifested by the occurrence of decompensation events. One relevant step to adequately prevent cardiovascular status degradation is to predict decompensation episodes in order to allow preventive medical interventions.In this paper we introduce a methodology with the goal of finding onsets of worsening progressions from multiple physiological parameters which may have predictive value in decompensation events. The best performance was obtained for the model composed by only two features using a telemonitoring dataset (myHeart) with 41 patients. Results were achieved by applying leave-one-subject-out validation and correspond to a geometric mean of 83.67%. The obtained performance suggests that the methodology has the potential to be used in decision support solutions and assist in the prevention of this public health burden.

P724 The mysteries of sinus of Valsalva

Sinus of Valsalva aneurysms are a rare pathology that can be clinically silent during years and/or become suddenly symptomatic. We described 3 cases with different clinical presentation, complications and surgical treatment.

A 26-year-old male, competitive cyclist was admitted with a 1.5 month history of fatigue, palpitations, and nocturnal cough and sweating. At physical examination he was apyretic, blood pressure 157/49mmHg and radial pulse 96 bpm; jugular vein engorgement and continuous heart murmur, were noticed. Blood samples only revealed a mild raised BNP. EKG showed sinus tachycardia and right intraventricular conduction delay and the transthoracic echocardiography (TTE) revealed high velocity systolic-diastolic shunt (image) between a non-dilated right coronary sinus (RCS) and the right atrium (RA); moderate left ventricle dilation, severe right atrium and mild right ventricle enlargement with mild pulmonary hypertension and normal biventricular systolic function. He was referred to angioCT that showed a large communication between a non-dilated RCS and RA with signs of right ventricular overload. He was submitted to surgery, where ruptured aneurysm sac was found. Fistula closure, aneurysm sac suture and tricuspid annuloplasty were performed.

A 45-year-old male asymptomatic, with no relevant medical background went to a Cardiology consultation after detection of a holossistolic murmur in the physical exam. EKG showed sinus rhythm arrhythmia with a nonspecific intraventricular conduction delay and the TTE revealed a communication between a dilated noncoronary sinus (NCS) and RA; the biventricular systolic function was normal. He was referred to angioCT which confirmed the diagnosis. He was submitted to surgery where an exeresis and closure of the fistula was performed.

A 38-year-old male with no relevant medical background was admitted to emergence room for an intermittent anterior thoracic pain radiating to the neck (2 days of evolution). The EKG showed sinus tachycardia, incomplete right bundle branch block and the high-sensitivity troponin assays were negative. The TTE revealed severe sinus of Valsalva aneurysm, particularly of the NCS with mild aortic regurgitation. The patient performed transesophageal echocardiography and angioCT which excluded an acute aortic syndrome. He was oriented to surgery where a contained rupture of the RCS and a non-visualization of the ostium right coronary artery were detected, suggesting an intimal dissection. The patient was submitted to Bentall procedure and a bypass with internal mammary artery to right coronary artery.

In spite of the unclear etiology, all the cases had a good clinical and echocardiographic evolution at follow-up. The difficulty in making a timely diagnosis is related to the variability of clinical presentation and the need of high clinical suspicion. Echocardiography and angioTC have demonstrated its value, in providing a prompt diagnosis and appropriate management guidance.

Abstract P724 Figure. Ruptured aneurysm sac and fistula

Obstetric interventions among native and migrant women: a survey of episiotomy in Portugal

Introduction

It is unclear whether migrant women experience worse pregnancy outcomes than native women. A better comprehension of obstetric care provision, including controversial interventions such as episiotomy, is important to improve equity of service provision, overall maternal and neonatal health and to support evidence-informed perinatal health policy-making. We aimed to determine if migrant and native women giving birth vaginally have different risks of episiotomy and if the risk differs by migrant sub-groups.

Methods

This study is based on a cross-sectional survey of foreign-born women with a random sample of native women, implemented in 32 public maternity units in mainland Portugal. We included 3583 women with vaginal delivery. Migrant status was defined by the woman’s country of birth (migrants, born abroad, vs natives, born in Portugal), then as subgroups of migrants from Brasil, Portuguese-speaking African countries (PSAC) and non Portuguese-speaking countries vs natives. The association between migrant status and episiotomy was assessed using multilevel logistic regression models, stratified by delivery mode, and adjusted for main risk factors of episiotomy.

Results

The overall frequencies of episiotomy were 52.6% and 48.2% among the 1707 natives and the 1876 migrants, respectively (p = 0.01). With spontaneous delivery, migrant women had decreased odds of having an episiotomy (adjusted OR 0.70 [95% CI 0.58-0.83]), especially those from PSAC (aOR 0.57 [0.46-0.71]). However, with instrumental delivery, migrant women had increased odds of episiotomy (aOR 2.47 [95% CI 1.50-4.07]), especially those from Brasil (aOR 3.24 [1.18-8.92]) and non Portuguese-speaking countries (aOR 3.75 [1.82-7.71]).

Conclusions

These results suggest non-medically justified differential care during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use, in a country with a high frequency of medical intervention during delivery.

Key messages

Portugal displays a high frequency of medical interventions during delivery, including episiotomy, highlighting the need for developing evidence-based recommendations. Migrant and native women have different risks of episiotomy, suggesting non-medically justified differential care.

Risk Prediction of Heart Failure Decompensation Events in Multiparametric Feature Spaces

Cardiac function deterioration of heart failure patients is frequently manifested by the occurrence of decompensation events. One relevant step to adequately prevent cardiovascular status degradation is to predict decompensation episodes in order to allow preventive medical interventions. In this paper we introduce a methodology with the goal of finding relevant feature spaces from multiple physiological parameters which may have predictive value in decompensation events. The best performance was obtained for the feature space comprising the following features: mean weight, standard deviation of the blood pressure and mean of extra-thoracic impedance in a time window of 20 days. Results were achieved by applying leave-one-out validation and correspond to a geometric mean of 88.32%. The obtained performance suggests that the methodology has the potential to be used in decision support solutions and assist in the prevention of this public health burden.

Interval colorectal cancer after colonoscopy

INTRODUCTION AND AIMS

Interval colorectal cancer (iCRC) can occur due to missed lesions or to a newly developed lesion. The present study aimed to assess the iCRC rate and its characteristics in our population and find possible explanations.

MATERIALS AND METHODS

A retrospective study was conducted on patients with colorectal cancer (CRC) diagnosed between January 2011 and January 2015 at our department. Demographics, endoscopic data, and tumor characteristics (location, histology, staging) were collected. We identified patients diagnosed with CCR who underwent colonoscopy at our department in the previous 10years and presented the disease (iCRC) before the date of their next recommended exam. The cases of iCRC were characterized and compared with other CRC cases. Possible explanations for the appearance of iCRC were analyzed.

RESULTS

A total of 266 patients presented with CRC, 61.7% were men, and mean patient age was 70.7years. We identified 10 patients with iCRC: 6 were men, and mean patient age was 71.1years. Mean time for iCRC diagnosis after index colonoscopy was 3.5±1.84years. Tumor was located in the right colon in 50% of the patients with iCRC and in 24.5% of the patients without iCRC (P=.091). More patients with iCRC had a family history of CRC (50%) than the patients with reference CRC (3.1%) (P=.000).

CONCLUSIONS

In our case series, 3.76% of all CRC were iCRC. There were no statistically significant differences between patients with or without iCRC, with the exception of family history of CRC.