Influence of at-risk family interactions on the course of psychiatric care in adolescence

Dysparenting, referring to inappropriate parental attitudes, is a vulnerability factor for mental disorders during adolescence and a therapeutic leverage, yet clinicians lack reliable tools to assess it in daily clinical practice. Moreover, the effect of this dysparenting on the amount of psychiatric care remains unclear. The Family and Care study aims to develop the at-risk family interactions and levers (ARFIL) scale, a comprehensive 30-item clinical scale, and to assess in a cross-sectional design, the impact of these at-risk family interactions on the care of adolescents (n = 425) hospitalized in psychiatry and aged 13-19 years old. Factorial analysis shows that the ARFIL scale consists of three main dimensions associated with cohesion/conflicts, love/hostility, and autonomy/control with good psychometric properties. Multivariate regressions show that the ARFIL intensity score predicts the duration of hospital care, regardless of age, gender, medical severity on admission, assessed by the Global Assessment of Functioning scale, the presence of maltreatment and psychiatric diagnoses. Moreover, the ARFIL diversity score (number of items present regardless of their severity) predicts both the number and duration of hospitalizations. At-risk family interactions are a determining dimension of psychiatric adolescent care, and the ARFIL scale could constitute a valuable tool, not only for holistic evaluation and treatment, but also for prevention.

Surgeon experience in second-look transurethral resection of bladder cancer - a prospective study

INTRODUCTION AND OBJECTIVES

Transurethral resection of bladder tumor (TURBT) is crucial in the treatment of bladder tumors and when incorrectly performed can cause staging mistakes. To avoid these errors, a second resection is recommended in selected cases. The aim of this study is to evaluate the surgeon's ability to predict histologically complete primary resection of newly diagnosed bladder tumors avoiding the need for a second TURBT.

METHODS

This is a prospective, observational study involving 47 consecutive patients with newly diagnosed bladder tumors who had previously undergone primary TURBT, and met EAU criteria for second-look TURBT. Second-look TURBT specimens were analyzed for routine histological assessment and compared with the surgeon's impression of the tumor at initial resection.

RESULTS

Of 91 patients submitted to primary TURBT, 47 met the criteria for second-look TURBT. Second-look specimens revealed residual disease in 20.9% of patients and 3 (6.4%) of patients showed upstaging disease. The sensitivity of a senior to detect disease on second-look TURBT in relation to muscle invasion was 75%, and the specificity was 85%.

CONCLUSIONS

Second-look TURBT is crucial in the treatment of bladder cancer and cannot be replaced by a surgeon's opinion, so international recommendations should be followed. Supervision of less experienced surgeons is a cornerstone.

New materials and complications of prostheses in humans: situation in Spain

Prostheses or implantable medical devices (IMDs) are parts made of natural or artificial materials intended to replace a body structure and therefore must be well tolerated by living tissues. The types of IMDs currently available and usable are very varied and capable of replacing almost any human organ. A high but imprecise percentage of Spaniards are carriers of one or more IMDs to which they often owe their quality of life or survival. IMDs are constructed with different types of materials that are often combined in the same prosthesis. These materials must combine harmlessness to human tissues with high wear resistance. Their durability depends on many factors both on the host and the type of prosthesis, but the vast majority last for more than 10-15 years or remain in function for the lifetime of the patient. The most frequently implanted IMDs are placed in the heart or great vessels, joints, dental arches or breast and their most frequent complications are classified as non-infectious, particularly loosening or intolerance, and infectious. Complications, when they occur, lead to a significant increase in morbidity, their repair or replacement multiplies the health care cost and, on occasions, can cause the death of the patient. The fight against IMD complications is currently focused on the design of new materials that are more resistant to wear and infection and the use of antimicrobial substances that are released from these materials. Their production requires multidisciplinary technical teams, but also a willingness on the part of industry and health authorities that is not often found in Spain or in most European nations. Scientific production on prostheses and IMD in Spain is estimated to be less than 2% of the world total, and probably below what corresponds to our level of socio-economic development. The future of IMDs involves, among other factors, examining the potential role of Artificial Intelligence in their design, knowledge of tissue regeneration, greater efficiency in preventing infections and taking alternative treatments beyond antimicrobials, such as phage therapy. For these and other reasons, the Ramón Areces Foundation convened a series of experts in different fields related to prostheses and IMDs who answered and discussed a series of questions previously formulated by the Scientific Council. The following lines are the written testimony of these questions and the answers to them.

ForMAX - a beamline for multiscale and multimodal structural characterization of hierarchical materials

The ForMAX beamline at the MAX IV Laboratory provides multiscale and multimodal structural characterization of hierarchical materials in the nanometre to millimetre range by combining small- and wide-angle X-ray scattering with full-field microtomography. The modular design of the beamline is optimized for easy switching between different experimental modalities. The beamline has a special focus on the development of novel fibrous materials from forest resources, but it is also well suited for studies within, for example, food science and biomedical research.

Two- and three-dimensional transesophageal echocardiographic assessment and successful occlusion of a window-like patent ductus arteriosus in two dogs

A 16-month-old Labrador-poodle cross (case 1) and a 3-month-old German shorthaired pointer (case 2) were referred for patent ductus arteriosus (PDA) occlusion. Two-dimensional transthoracic and two- and three-dimensional transesophageal echocardiography revealed a window-like PDA characterized by a wide and short ductus. Due to the atypical PDA morphology with no ampulla in case 1, ductal occlusion was attempted with non-canine-specific Amplatzer occluder devices. However, these were too small and failed to remain stable. Amplatz Canine Duct Occluder (ACDO) devices were used with success in both cases. Due to the defects' morphology, the proximal ACDO disc protruded into the aorta but there were no signs of obstruction to aortic blood flow 16 months (case 1) and 1 month (case 2) post-occlusion. We describe two cases of a window-like type PDA that were successfully occluded with an ACDO.

Hypertrophic cardiomyopathy in a dog: a systematic diagnostic approach

A seven-year-old female neutered Parson Russel Terrier was referred for syncopal episodes. An electrocardiogram revealed paroxysmal atrial flutter followed by periods of sinus arrest, suggesting sick sinus syndrome. Echocardiography showed severe biventricular wall thickening (hypertrophic cardiomyopathy (HCM) phenotype) with no signs of fixed or dynamic left ventricular outflow tract obstruction. Blood pressure, abdominal ultrasound, serum total thyroxin and thyroid-stimulating hormone, and insulin-like growth factor-1 were all within normal limits. Cardiac troponin I was elevated (1.7 ng/mL, ref<0.07). Serological tests for common infectious diseases were negative. A 24-h Holter confirmed that the syncopal episodes were associated with asystolic pauses (sinus arrest after runs of atrial flutter) ranging between 8.5 and 9.6 s. Right ventricular endomyocardial biopsies (EMB) were performed at the time of pacemaker implantation to assess for storage or infiltrative diseases that mimic HCM in people. Histological analysis of the EMB revealed plurifocal inflammatory infiltrates with macrophages and lymphocytes (CD3+ > 7/mm2) associated with myocyte necrosis, but no evidence of myocyte vacuolisation or infiltrative myocardial disorders. These findings were compatible with myocardial ischaemic injury or acute lymphocytic myocarditis. Molecular analysis of canine cardiotropic viruses were negative. The dog developed refractory congestive heart failure and was euthanised 16 months later. Cardiac post-mortem examination revealed cardiomyocyte hypertrophy and disarray with diffuse interstitial and patchy replacement fibrosis, and small vessel disease, confirming HCM. We described a systemic diagnostic approach to an HCM phenotype in a dog, where a diagnosis of HCM was reached by excluding HCM phenocopies.

Impact of acute psychosocial stress on attentional control in humans. A study of evoked potentials and pupillary response

Psychosocial stress has increased considerably in our modern lifestyle, affecting global mental health. Deficits in attentional control are cardinal features of stress disorders and pathological anxiety. Studies suggest that changes in the locus coeruleus-norepinephrine system could underlie the effects of stress on top-down attentional control. However, the impact of psychosocial stress on attentional processes and its underlying neural mechanisms are poorly understood. This study aims to investigate the effect of psychosocial stress on attentional processing and brain signatures. Evoked potentials and pupillary activity related to the oddball auditory paradigm were recorded before and after applying the Montreal Imaging Stress Task (MIST). Electrocardiogram (ECG), salivary cortisol, and subjective anxiety/stress levels were measured at different experimental periods. The control group experienced the same physical and cognitive effort but without the psychosocial stress component. The results showed that stressed subjects exhibited decreased P3a and P3b amplitude, pupil phasic response, and correct responses. On the other hand, they displayed an increase in Mismatch Negativity (MMN). N1 amplitude after MIST only decreased in the control group. We found that differences in P3b amplitude between the first and second oddball were significantly correlated with pupillary dilation and salivary cortisol levels. Our results suggest that under social-evaluative threat, basal activity of the coeruleus-norepinephrine system increases, enhancing alertness and decreasing voluntary attentional resources for the cognitive task. These findings contribute to understanding the neurobiological basis of attentional changes in pathologies associated with chronic psychosocial stress.

Technological features of smartphone apps for physical activity promotion in patients with COPD: A systematic review

INTRODUCTION

Low physical activity (PA) levels have a negative impact on the health status of patients with Chronic Obstructive Pulmonary Disease (COPD). Smartphone applications (apps) focused on PA promotion may mitigate this problem; however, their effectiveness depends on patient adherence, which can be influenced by the technological features of the apps. This systematic review identified the technological features of smartphone apps aiming to promote PA in patients with COPD.

METHODS

A literature search was performed in the databases ACM Digital Library, IEEE Xplore, PubMed, Scopus and Web of Science. Papers including the description of a smartphone app for PA promotion in patients with COPD were included. Two researchers independently selected studies and scored the apps features based on a previously developed framework (38 possible features).

RESULTS

Twenty-three studies were included and 19 apps identified, with an average of 10 technological features implemented. Eight apps could be connected to wearables to collect data. The categories 'Measuring and monitoring' and 'Support and Feedback' were present in all apps. Overall, the most implemented features were 'progress in visual format' (n = 13), 'advice on PA' (n = 14) and 'data in visual format' (n = 10). Only three apps included social features, and two included a web-based version of the app.

CONCLUSIONS

The existing smartphone apps include a relatively small number of features to promote PA, which are mostly related to monitoring and providing feedback. Further research is warranted to explore the relationship between the presence/absence of specific features and the impact of interventions on patients' PA levels.

Nannochloropsis oceanica microalga feeding increases long-chain omega-3 polyunsaturated fatty acids in lamb meat

To test the hypothesis that lambs fed freeze-dried Nannochloropsis oceanica (NO) biomass will have a higher deposition of EPA in tissues than those fed other Nannochloropsis EPA-sources, we fed 28 lambs with one of four diets: i) C, control, without EPA; ii) O, with 1.2% Nannochloropsis oil; iii) SD, with 12.3% spray-dried NO biomass; iv) FD, with 9.2% freeze-dried NO biomass. Dry matter intake, growth, tissues fatty acid composition, oxidative stability and sensory traits of the resultant meat were evaluated. The EPA was highest in tissues of lambs fed SD and FD compared with O but was similar between SD and FD. Total trans-18:1 did not differ among treatments, but the t10/t11-18:1 ratio decreased with all EPA containing diets. EPA diets were also supplemented with Vitamin E preventing the lipid oxidation in EPA-enriched meat and the meat sensory traits were not affected although occasionally some off-flavours were detected in FD meat.

Thin and hypokinetic myocardial segments in cats with cardiomyopathy

INTRODUCTION/OBJECTIVES

Thin and hypokinetic myocardial segments (THyMS) represent adverse ventricular (LV) remodeling in human hypertrophic cardiomyopathy. We describe the echocardiographic features and outcome in cats with THyMS, and in a subpopulation, the echocardiographic phenotype before LV wall thinning was detected (pre-THyMS).

ANIMALS

Eighty client-owned cats.

MATERIALS AND METHODS

Retrospective multicenter study. Clinical records were searched for cats with THyMS, defined as LV segment(s) with end-diastolic wall thickness (LVWT) <3 mm and hypokinesis in the presence of ≥one LV segment(s) with LVWT >4 mm and normal wall motion. When available, echocardiograms pre-THyMS were assessed. Survival time was defined as time from first presentation with THyMS to death.

RESULTS

Mean thickest LV wall segment (MaxLVWT) was 6.1 mm (95% CI 5.8-6.4 mm) and thinnest (MinLVWT) was 1.7 mm (95% CI 1.6-1.9 mm). The LV free wall was affected in 74%, apex in 13% and septum in 5%. Most cats (85%) presented with heart failure and/or arterial thromboembolism. Median circulating troponin I concentration was 1.4 ng/mL ([range 0.07-180 ng/mL]). Prior echocardiography results were available for 13/80 cats, a mean of 2.5 years pre-THyMS. In segments subsequently undergoing thinning, initial MaxLVWT measured 6.7 mm (95% CI 5.8-7.7 mm) vs. 1.9 mm (95% CI 1.5-2.4 mm) at last echocardiogram (P<0.0001). Survival data were available for 56/80 cats, median survival time after diagnosing THyMS was 153 days (95% CI 83-223 days). Cardiac histopathology in one cat revealed that THyMS was associated with severe transmural scarring.

CONCLUSIONS

Cats with THyMS had advanced cardiomyopathy and a poor prognosis.

Oral and maxillo-facial injuries in victims of political repression during the Chilean dictatorship

INTRODUCTION

Chile was under a civil-military dictatorship from 1973 to 1990. During that time, systematic violations to human rights were perpetrated. Oral and maxillo-facial trauma was not an exception, and such trauma was carried out through different methods of torture or ill treatment by agents of the State. Currently, Chile has laws and programs in the public healthcare system to carry out the re-habilitation and reparation process in victims, and the registration of the suffered injuries is considered an important part of these med-ico-legal procedures. The aim of this study is to describe and classify the type of torture or ill-treatment in the orofacial area of victims of political repression during the Chilean military dictatorship and relate them to the injuries registered in written reports.

METHODS

14 reports of oral and maxillo-fa-cial injuries of tortured victims from 2016 to 2020 were analyzed, considering the alleged history of the patient, the visible effects on the oral examination, and the type of torture that was inflicted. Historical clinical records and X ray exams were analyzed when available.

RESULTS

6 variations of torture and ill-treat-ment that involve the maxillo-facial area were caused by agents of the State during the dic-tatorship period.

DISCUSSION

According to the patient ́s account and the clinical examination, all of the torture techniques applied caused, directly or indirectly, the loss of teeth. This resulted in not only physical problems, but psychological problems for the victims.

Lewy Body Pathology and Alzheimer Disease in Down Syndrome

Introduction/Objective

Aging adults with Down syndrome (DS) develop Alzheimer disease neuropathology (AD) by the age of 40 years, primarily due to the overexpression of the amyloid precursor protein on chromosome 21. Lewy bodies (LBs), containing alpha-synuclein protein, are observed in 7-60% of AD patients in the amygdala and in cortex. Prior DS studies (n=20-56 cases) find the frequency of LB pathology to range between 8-50% of cases being affected. We hypothesized that LB pathology would also be present in DS brain with similar locations and prevalence to AD. Thus, we evaluated the frequency of LB in our UCI cohort of DS cases that we have collected over the past 25 years.

Methods/Case Report

Neuropathology reports from 55 cases with DS from the UCI-ADRC were included in this study. Cases were stained for beta-amyloid, phosphor-tau, alpha-synuclein and TDP-43 as per NACC protocols (one case each v7,8,9 and three v11).

Results (if a Case Study enter NA)

We identified 6 cases (10.9%), all male, with a mean age of 57 years (SD=3) that showed LB and/or Lewy neurites. LB pathology was classified as amygdala predominant in 3 cases, brainstem predominant in one, intermediate/transitional in one, and diffuse/neocortical in one. Five cases were BRAAK stage 6 and one was stage 5. Five cases had CERAD neuritic plaque score C and one case had a B score. Two of 3 cases were Thal phase 5, and one was phase 4. The case with diffuse/neocortical LB pathology demonstrated hippocampal sclerosis.

Conclusion

The observation that all our LB positive cases were male may reflect a sample bias. In our study, Lewy pathology was most common in amygdala but other sites of involvement are seen similar to a prior DS study and AD studies. Prior DS studies (n=20-56 cases) find the frequency of LB pathology to range between 8-50% of cases being affected. The prevalence of LB in our DS cohort (10.9%) is in the low end of the range seen in other DS and AD studies.

P-064 Clinical outcomes of 127 patients with recurrent implantation failure treated with testicular sperm aspiration (TESA)

Study question

Are the embryological, clinical and newborn outcomes using aspirated testicular sperm improved in cases with recurrent implantation failure previously treated with ejaculated sperm?

Summary answer

Aspirated testicular sperm enabled to obtain significant higher embryological, clinical and newborn outcomes in cases with recurrent implantation failure previously treated with ejaculated sperm.

What is known already

High levels of sperm DNA fragmentation (SDF) were associated to poor clinical outcomes (1-Simon et al., 2017). Testicular sperm display lower SDF than ejaculated sperm (2-Sakas and Alvarez, 2010), improving clinical outcomes in cases with abnormal semen parameters (3-Awaga et al., 2018; 4-Kang et al., 2018), recurrent implantation failure (RIF) and pregnancy loss (RPL) (5-Esteves et al., 2017), and elevated SDF (6-Ambar et al., 2021). As only a few studies are specifically dedicated to RIF, we expanded the number of cases and first provided full demographic, stimulation, embryological, clinical and newborn outcomes.

References

1-(https://doi.org/10.4103/1008-682X.182822);

2-(https://doi.org/10.1016/j.fertnstert.2009.10.046);

3-(https://doi.org/10.1016/j.rbmo.2018.08.017);

4-(https://doi.org/10.1038/s41598-018-26280-0);

5-(https://doi.org/10.1016/j.fertnstert.2017.06.018);

6-(https://doi.org/10.5534/wjmh.200084

Study design, size, duration

We retrospectively evaluated during consecutive years (2010-2020) 63 patients with recurrent implantation failure, which accepted to perform testicular sperm aspiration (TESA) as an alternative treatment. These patients presented a long history of failed treatments (153 cycles) using ejaculated sperm. From these cycles, no pregnancy ensued. The present study compares 127 treatment cycles, 80 with testicular sperm (17 cases repeated TESA) and 47 with ejaculated sperm from the same patients performed at the present IVF clinic.

Participants/materials, setting, methods

Patients were screened for karyotype abnormalities, for Y-chromosome microdeletions (7-Gonçalves et al., 2016), and for SDF with the TUNEL assay (8-Sá et al., 2015). Conventional semen analysis was performed according to World Health Organization guidelines (9-WHO, 2010). Male evaluation and TESA was performed by the same experienced urologist (LF) according to established protocols (10-Madureira et al 2014). The procedure was performed entirely on an outpatient basis, with no complications reported.

References

7-(https://doi.org/10.4103/1008-682X.172827);

8-(https://doi.org/10.1016/j.rbmo.2015.06.019);

9-(https://apps.who.int/iris/handle/10665/44261);

10-(https://doi.org/10.1111/j.2047-2927.2014.00231.x).

Main results and the role of chance

The mean ages were 35.5±3.4 (26-42)-female and 38.1±5.7 (29-59)-male. There were 4 abnormal karyotypes (3-female, 1-male), all without known relevance. Most cases had asthenozoospermia and teratozoospermia (65.1%), or oligoasthenoteratozoospermia (41.8%). Of the 19 cases with &lt;5M/ml, none presented Y-chromosome microdeletions. Although we do not routinely perform SDF testing, 15 patients had previous SDF values (12, &gt;20%; 8, &gt;36%). Female basal characteristics and testicular evaluation were under normal values. The TESA procedure took about 15-20 min, and the time of laboratorial search around 30-60 min. Cases using testicular sperm showed significant higher rates of fertilization (64% vs 73%-p=0.005), blastocyst development (47% vs 62%-p=0.010), implantation (6% vs 27%-p=0.000), clinical pregnancy (10% vs 39%-p=0.001), live birth delivery (5% vs 28%-p=0.005) and newborn (5% vs 32%-p=0.000) than ejaculated sperm. No significant differences were observed regarding the rates of embryo cleavage (95% vs 94.8%) and high quality embryos (89.4% vs 94%), in the mean number of transferred embryos (1.8±0.4 vs 1.9±0.4), or in the abortion rate (2 cases-50% vs 7 cases-25.9%). Cases using testicular sperm had 22 frozen-thawed embryo transfer cycles, enabling per initiated cycle a cumulative pregnancy rate of 45%, live birth delivery rate of 31.3% and newborn rate of 37.5% (32 newborn).

Limitations, reasons for caution

Although presenting the higher number of cycles using TESA in the treatment of RIF, this number needs to be increased for drawing more definitive conclusions, as these women present a diversity of conditions, rendering subgrouping difficult. In the future, it would also be important to evaluate SDF in all cases.

Wider implications of the findings

In conclusion, the present results gave further evidence for the superiority of using testicular sperm instead of ejaculated sperm in cases with recurrent implantation failure. Data also evidences the security of using testicular sperm aspiration, as there were no pregnancy or delivery complications, or congenital anomalies among the 32 newborn.

Trial registration number

Not Applicable

AB0926 ENTHESITIS OF THE HAND IS A DOMINANT LESION IN PSORIATIC ARTHRITIS AND MAY HELP DISTINGUISH IT FROM RHEUMATOID ARTHRITIS: CASE-CONTROL, SINGLE-CENTRE, ULTRASOUND STUDY

Background

Enthesitis is the hallmark of psoriatic arthritis (PsA) and may assist in distinguishing PsA from other forms of arthritis (1,2). Its clinical evaluation is hampered by lack of specificity of physical examination (3). Ultrasound (US) may provide information about its presence and response to treatment. Although some previous works have shown that enthesitis of the hand is important in PsA (4), most US studies and scores focused on greater size entheses.

Objectives

To explore the prevalence of enthesitis of the hand in PsA patients as evaluated by US, and compare it with other inflammatory arthritides, namely rheumatoid arthritis (RA).

Methods

Cross-sectional study in which consecutive patients with PsA and RA were recruited for an US protocol evaluating 4 entheses of the hand including: 1. measurement of the extensor digitorum tendon central slip at its insertion at the middle phalanx of the 2nd and 3rd finger bilaterally; 2. search for the presence of power-Doppler (PD) sign; 3. identification of structural lesions.

Linear regression models were built to test if diagnosis (PsA vs RA) explained part of the variance of the thickness of tendons insertion while controlling possible influences of age, type of work and body surface area. A ROC curve was built to find a mean thickness cut-off allowing distinction between PsA and RA. The prevalence of PD sign and structural lesions of the entheses was compared between groups.

Results

Fifty-eight patients were recruited (29 with PsA and 29 with RA) and a total of 232 entheses were evaluated.

Mean thickness of the interest entheses was superior in PsA patients compared to RA patients (2nd finger – 0.96 ± 0.16mm vs. 0.74 ± 0.09mm; 3rd finger – 0.96 ± 0.20mm vs. 0.76 ± 0.11mm).

Linear regression models including diagnosis and potential confounders significantly explained mean thickness of both entheses (2nd finger – R2=0.56, p<.001; 3rd finger – R2=0.41, p<.001), with the diagnosis group being the most important predictor (Table 1). ROC curve (AUC 0.897, p<.001) showed a cut-off value of 0.925mm for the mean of the 4 entheses had a specificity of 93.1% for the identification of PsA patients.

Table 1.

Multiple linear regression models explaining thickness of the entheses.

2nd finger (mean of both sides)3rd finger (mean of both sides)Linear regression modelR2=0.56p<.001***R2=0.39p<.001***Diagnosis (PsA vs RA)β=0.587; B=0.203mmp<.001***β=0.483; B = 0.182mmp<.001***

In our sample, 8 (3.5%) entheses had a measured thickness above mean + 2 SD, all belonging to PsA patients; 6 (75%) had signs of ongoing inflammatory process as proved by the presence of PD sign (Figure 1). Regarding structural lesions, enthesophytes or bone irregularities/erosions were found in 13.8% of PsA entheses, which compared to 1.7% of RA entheses.

Figure 1.

Enthesitis of the central slip of extensor digitorum of the 3rd finger in a patient with PsA: swelling of the 3rd proximal interphalangeal joint (A) due to inflammatory process originating in the enthesis, with no signs of synovitis, as evaluated by US (B).

Conclusion

This work reinforces enthesitis as a key lesion in PsA. It also shows enthesitis occurs significantly in small entheses, like the ones of the hand and that, in some instances, it may be the dominant lesion in a swollen joint. US may be valuable for establishing a diagnosis in the setting of inflammatory arthritis of unknown etiology.

References

[1]Mease P. Enthesitis in psoriatic arthritis (Part 3): clinical assessment and management. Rheumatology. 2020 Mar 1;59(Supplement_1):i21–8.

[2]Sapundzhieva T, Karalilova R, Batalov A. Hand ultrasound patterns in rheumatoid and psoriatic arthritis: the role of ultrasound in the differential diagnosis. Rheumatol Int. 2020 Jun;40(6):837–48.

[3]Kaeley GS. Enthesitis in psoriatic arthritis (Part 2): imaging. Rheumatology. 2020 Mar 1;59(Supplement_1):i15–20.

[4]Smerilli G, Di Matteo A, Cipolletta E, Grassi W, Filippucci E. Enthesitis in Psoriatic Arthritis, the Sonographic Perspective. Curr Rheumatol Rep. 2021 Sep;23(9):75.

Disclosure of Interests

None declared

Depression and health-related quality of life in critical COVID-19 survivors

Introduction

Long-term neuropsychiatric consequences of critical illness are well known. Therefore, it is expected that critical COVID-19 patients might also present several psychiatric symptoms such as depression, with inevitable negative effect on health-related quality of life (HRQoL), commonly used as an indicator of illness and treatment impact.

Objectives

To identify depressive symptoms in critical COVID-19 survivors and to examine its association with HRQoL domains.

Methods

This preliminary study involved critical COVID-19 patients admitted into the Intensive Care Medicine Department (ICMD) of a University Hospital, between October and December of 2020. Patients with an ICMD length of stay (LoS)≤24h, terminal illness, major auditory loss, or inability to communicate at the follow-up time were excluded. From 1-2 months after discharge, all participants were evaluated by telephone at follow-up appointment, with Patient Health Questionnaire (PHQ-9) (depression) and EuroQol 5-dimension 5-level EQ-5D-5L (HRQoL). This study is part of the longitudinal MAPA project.

Results

Eighty-three patients were included with a median age of 63 years (range: 31-86) and the majority were male (63%). The most reported problems on EQ-5D-5L domains were usual activities (82%) and mobility (76%). About 27% presented depressive symptoms, and with more problems of self-care (68%vs41%; p=0.029), pain/discomfort (86%vs49%; p=0.002), and anxiety/depression (96%vs54%; p<0.001).

Conclusions

These preliminary results are in line in previous studies in critical COVID-19 survivors, with depression being associated with worse HRQoL. Bearing this in mind, follow-up approaches with an early screening and treatment of these psychiatric symptoms will be fundamental to optimize the recovery of these patients.

Disclosure

No significant relationships.

POS1518-HPR BELIEFS ABOUT MEDICATION IN A POPULATION OF PATIENTS WITH INFLAMMATORY ARTHROPATHY

Background

The beliefs that patients have regarding their medication, namely about its need and concerns regarding possible adverse effects, are a determining factor for adherence and therapeutic success1.

Objectives

Determine which sociodemographic and clinical factors are associated with beliefs related to medication, either in terms of necessity or concerns about medication, in patients with Rheumatoid Arthritis (RA) or Psoriatic Arthritis (PsA).

Methods

Observational study, with a sample consisting of 58 patients (female 72,4%, male 27,6%; mean age = 51,0 ± 13,2 years; education < 9 years 39,7%, ≥ 9 years 60,3%). Of these, 33 had a diagnosis of RA and 25 of PsA (mean years of disease duration = 8,2 ± 7,3 years; mean disease activity by DAS28-PCR or DAS28-PCR 3 variables = 2,32 ± 0,95). Between March 2021 and June 2021, a brief questionnaire was applied with sociodemographic and clinical variables, such as the use of classic or biological DMARDs and their administration´s route. The Specific Beliefs About Medication Scale (BMQ) was anonymously applied, adapted from the Beliefs About Medicines Questionnaire, comprising 2 sections: section 1 – Specific Needs, patients beliefs about the need for medication; section 2 – Specific Concerns, beliefs related to the dangers of addiction and long-term toxicity or side effects. Higher scores (scale from 5 to 25 points), in sections 1 and 2, reflect the belief of greater need and greater concern regarding medication, respectively. The average scores in section 1 and in section 2 of the BMQ were 9 and 15,7 points, respectively. Statistics: descriptive, Student t-Test, Pearson Correlation and ANOVA, p<0,05.

Results

Patients with PsA and younger age had a higher mean score in section 2 of the BMQ (p= 0,049 e p<0,01, respectively). The variables male gender, education ≥ 9 years and shorter duration of the disease also showed a tendency to be associated with the higher score in section 2 of the BMQ, with p-values close to statistical significance (p=0,091, p=0,074 and p=0,094, respectively). In the multivariate analysis with the above variables, only the diagnosis of PsA showed a statistically significant association with the score in section 2 of the BMQ (B=4,269; p<0,001; CI 95%=[2,060-6,477]). There was also a statistically significant correlation (p=0,007) between the scores in section 1 and section 2 of the BMQ. Regarding analysis of the sample by diagnosis, there was an association between the subcutaneous route of drug administration in individuals with RA and greater concern with the adverse effects of the medication (p=0,007), and between low disease activity and greater belief in the specific need for medication for the disease (p=0,006).

Conclusion

In this study, patients with PsA were more concerned about the possible adverse effects of medication than patients with RA. RA patients who take subcutaneous drugs are more afraid of the drug’s toxic potential, and those with lower disease activity have a greater need to comply with the prescribed therapy, which can be explained by the previous effectiveness of the drug in disease control. It was also found that the greater the belief in the need for medication, the greater the concern with its possible long-term harmful effects.

References

[1]Smolen JS, Gladman D, McNeil HP, et al. Predicting adherence to therapy in rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis: A large cross-sectional study. RMD Open. 2019;5(1):1-13. doi:10.1136/rmdopen-2017-000585

Acknowledgements

I have no acknowledgements to declare.

Disclosure of Interests

None declared