Real-world outcomes for first line next-generation hormonal agents in metastatic prostate cancer: a systematic review

Aim: This review aims to summarize published evidence on the real-world (RW) outcomes of abiraterone or enzalutamide in first-line metastatic castration-resistant prostate cancer. Materials & methods: Studies reporting on RW effectiveness, safety, economic and/or health-related quality of life outcomes were identified by systematic literature review (2011-2021, incl. Embase®, MEDLINE®) and presented in a qualitative synthesis. Risk of bias was assessed using ROBINS-I or the Molinier checklist. Results: 88 studies (n = 83,427 patients) were included. Median progression-free (40 studies) and overall survival (38 studies) ranged from 3.7 to 20.9 months and 9.8 to 45 months, respectively. Survival, safety and economic outcomes were similar across individual treatments, while limited health-related quality of life evidence suggested improvements with abiraterone. Risk of bias was moderate to high. Conclusion: RW outcomes in first-line metastatic castration-resistant prostate cancer remain poor despite treatment, highlighting an unmet need for new regimens. This review was supported by AstraZeneca and Merck Sharp & Dohme.

Cost-Effectiveness Analysis of Biomarker Testing to Guide First-Line PARP Inhibitor Maintenance for Patients with Advanced Ovarian Cancer After Response to First-Line Platinum Chemotherapy in the USA

BACKGROUND

Poly(ADP-ribose) polymerase inhibitor maintenance treatments are available for platinum-sensitive advanced ovarian cancer. Olaparib (O) is available for BRCA mutation patients or in combination with bevacizumab (O+B) for patients with homologous recombination deficiency (HRD+); niraparib (N) is available for all patients.

OBJECTIVE

This study aimed to evaluate the cost effectiveness of biomarker testing and maintenance treatments (mTx) with poly(ADP-ribose) polymerase inhibitor in platinum-sensitive advanced ovarian cancer in the USA.

PATIENTS AND METHODS

Ten strategies were evaluated (S1-S10), representing biomarker testing (none, BRCA or HRD), and mTx (O, O+B, N or B). PAOLA-1 data were used to build a model estimating progression-free survival (PFS), second PFS (PFS2) and overall survival for O+B. PFS was modelled through mixture cure models; PFS2 and overall survival were modelled by standard parametric models. Hazard ratios of PFS for O+B versus B, N and O were obtained from the literature to estimate PFS for B, N and O. PFS2 and OS for B, N and O were informed by PFS benefits.

RESULTS

S2 (no testing, B) had the lowest cost while S10 (HRD testing, O+B for HRD+ and B for HRD-) had the highest quality-adjusted life-years (QALYs). All niraparib strategies were dominated. S2, S4 (BRCA testing, O for BRCA+ and B for BRCA-), S6 (BRCA testing, olaparib plus bevacizumab for BRCA+ and bevacizumab for BRCA-) and S10 were the non-dominated strategies with an incremental cost-effectiveness ratio of $29,095/QALY, $33,786/QALY and $52,948/QALY for S4 versus S2, S6 versus S4 and S10 versus S6, respectively.

CONCLUSIONS

Homologous recombination deficiency testing followed by O+B for HRD+ and B for HRD- is a highly cost-effective strategy for patients with platinum-sensitive advanced ovarian cancer. A HRD biomarker-guided approach provides most QALYs with good economic value.

Cost-Effectiveness Analysis of Olaparib in Combination with Bevacizumab Compared with Bevacizumab Monotherapy for the First-Line Maintenance Treatment of Homologous Recombination Deficiency-Positive Advanced Ovarian Cancer

BACKGROUND

In the PAOLA-1 trial, olaparib plus bevacizumab demonstrated significant clinical benefit following partial or complete response to platinum-based chemotherapy in homologous recombination deficiency (HRD)-positive ovarian cancer. Our study evaluated the cost effectiveness of olaparib plus bevacizumab compared with bevacizumab alone as a maintenance treatment for women in this population.

METHODS

Our model was a cohort-level partitioned survival model with a lifetime horizon from a US healthcare system perspective. Its four health states were progression-free, post first progression, post second progression, and death, modeled using time to first progression (PFS1), second progression (PFS2), and overall survival (OS) from PAOLA-1. We modeled PFS1 through mixture survival modeling, and PFS2 and OS by fitting standard parametric models. Time-on-treatment was sourced directly from PAOLA-1, with treatment capped at 24 months for olaparib and 15 months for bevacizumab. Costs included drug acquisition and administration, adverse events, disease management, biomarker testing, and subsequent treatments. Deterministic and probabilistic sensitivity analyses tested the results.

RESULTS

Compared with bevacizumab alone, olaparib plus bevacizumab increased quality-adjusted life-years (QALYs; +2.89) and life-years (LYs; +3.43) at an incremental cost of $164,209, leading to an incremental cost-effectiveness ratio of $56,863 per QALY. Olaparib plus bevacizumab had a 97.0% probability of being cost effective compared with bevacizumab alone at a willingness-to-pay threshold of $100,000 per QALY.

CONCLUSION

The addition of olaparib to bevacizumab led to clinically significant increases in progression-free survival, resulting in substantial predicted LYs and QALYs gained, while being cost effective in the maintenance treatment of advanced ovarian cancer with HRD in the US.

Cost comparison of adverse event management among breast and ovarian cancer patients treated with poly (ADP-ribose) polymerase inhibitors: analysis based on phase 3 clinical trials

BACKGROUND

The economic impact of adverse events (AEs) for poly (ADP-ribose) polymerase inhibitors (PARPis) in ovarian or breast cancer has not been widely evaluated.

OBJECTIVE

Compare PARPi-related AE management costs from a US payer perspective.

METHODS

The frequency of treatment-related grade 3-4 AEs was obtained from published clinical trials of PARPis for the treatment of advanced ovarian cancer (AOC), platinum-sensitive recurrent ovarian cancer (PSROC), and metastatic breast cancer (MBC). AE management costs per patient (2020 USD) per treatment course were calculated by multiplying the AE unit costs by the frequency of AEs for each arm of each trial. Sensitivity analyses were conducted according to the lower and upper limits of the 95% confidence interval for AE rates and unit costs, respectively. Scenarios were also performed to explore the uncertainty of outcomes.

RESULTS

Total AE management costs in AOC were: $3,904, olaparib; $5,595, olaparib plus bevacizumab; and $12,215, niraparib. In PSROC, total costs were: $3,894, olaparib; $6,001, rucaparib; and $11,492, niraparib, and in MBC: $3,574, olaparib; and $9,489, talazoparib. Hematological toxicities were the key drivers of AE management costs for PARPis.

CONCLUSIONS

The main AEs among PARPis were hematological. Olaparib was associated with lower AE costs compared to other PARPis.

Stigma and Discrimination During the Covid-19 Pandemic

Introduction

A frequently discussed topic today, stigma and/or discrimination are social phenomena that, in the broader context of medical discourse and especially in the current epidemiological situation, Covid-19 pandemic, appear and need a detailed examination

Objectives

This study aims are to examine the literature and to present the aforementioned phenomena, comparing them with the Link & Phelan stigma model and offering pros and cons for their congruence with the model.

Methods

Literature analysis with searching words: stigma, discrimination, Covid-19, medical and especially psychiatric pathology, in Pubmed and Google scholar engine.

Results

The studied 32 articles provided 4 stigmatized subgroups in the social context of the pandemic: that of patients and medical staff, that of comorbidities sufferers, that of stigmatized ethnic groups, and that of stigmatized races. These groups, stigmatized directly or by overlapping with the “actual” group, were studied in the most relevant PubMed articles, and evidence for the congruence of their stigma with the model was presented in this review.

Conclusions

This work could also serve as a starting point for further study on combating stigma, improving the lives of our patients, colleagues affected by occupational exposure, and, finally, society at large

Disclosure

No significant relationships.

Bio-psycho-social model of aggressive behaviour

Introduction

The state of knowledge from scientific literature will be presented from biologic perspective, psychopathology and social context in development of agression.

Objectives

The aim of this presentation is to create a bio-psycho-socio model of agression.

Methods

The literature research in risk factors of aggressive behaviour was done, and the results grouped in three domains biologic, psychologic and social. A didactic bio-psycho-socio model was constructed.

Results

The complex picture of aggressivity could be distorted if we reduce understanding to a narrow super-specialization perspective. This presentation enlarge approach with genetic, endocrine, neurologic, psychologic and sociologic perspective. All this data will be include in a schematic bio-psycho-socio model, and describe the application in mental health practice in understanding the patients with psychiatric disorder. The main result will be a Bio-psycho-social model of aggressive behavior, which could be helpful in understanding and predicting aggressive behavior.

Conclusions

Complex perspective of aggresive behaviour could help better understand and prevent aggresive behaviour

Disclosure

No significant relationships.

AB1172 POSTER: SARS-COV 2 INFECTION AND ANTI TNF THERAPY IN RHEUMATOID ARTHRITIS PATIENTS

Background

High levels of tumor necrosis factor (TNF), a key proinflammatory cytokine, is associated with SARS-CoV-2 infection. In rheumatoid arthritis patients with SARS-CoV-2 infection, anti TNF therapy reduces not only TNF but other cytokines responsible for high morbidity and mortality.

The severe systemic inflammation in COVID-19 causes respiratory symptoms, fever, fatigue, neurological and gastrointestinal manifestations.

Objectives

We followed the evolution of SARS-CoV-2 infection in rheumatoid arthritis patients who received anti TNF blockers.

Methods

Our study included 95 rheumatoid arthritis patients who were diagnosed with SARS CoV-2 infection through a positive RT-PCR-SARS-CoV2 test. 21 patients were men and 74 were women. Mean age was 58 ±11,5. 24 patients received monotheraphy with anti TNF blockers (Adalimumab/ Infliximab), 48 received TNF blockers in combination with Methotrexate (10 mg per week) and 23 received TNF blockers in combination with Leflunomide (20 mg per day).

We followed serum ferritin, C reactive protein and D-dimer in all patients. 59 patients were vaccinated with two doses of Pfizer-BioNtech (64.1 %).

The study group was analyzed from 30th December 2021 to 1st of January 2022. From 95 patients, 35 (36,8%) were hospitalized and 60 received ambulatory care.

Results

Our patients with COVID-19 presented with asimptomatic forms, forms with mild symptoms and complicated forms that required hospitalization. No patients had died.

Milder forms were associated with the use of TNF blockers and Methotrexate and patients with monotherapy – TNF blockers. They presented with mild symptoms (fever, arthralgia, odynophagia, dysgeusia/ageusia, anosmia). Hospitalization rate in patients who received monotheraphy with TNF blockers was 29,1%, 31,2% in patients who received TNF blockers and Methotrexate and 56,5% in patients with TNF blockers and Leflunomide (69,3%). Factors associated with higher odds of hospitalization included older age (p=0,001), active disease (p=0,02), obesity (p=0,005), pulmonary chronic disease (p=0,02), diabetes (p=0,001) and concomitent dose of Leflunomide (p=0,0006).

Female sex was associated with milder forms of the disease. Patients with high levels of D-dimer had a higher odd of hospitalization (p<0,001). Strong positive correlation was observed between elevated D-dimers and hospitalization odds.

Conclusion

TNF blockers in monotheraphy or associated with Methotrexate were correlated with lower odds of hospitalization and milder forms of COVID-19. No significant difference of hospitalization odd was observed between vaccinated and unvaccinated patients.

References

[1]Brito CA, Paiva JG, Pimentel FN, et al. COVID-19 in patients with rheumatological diseases treated with anti-TNF. Annals of the Rheumatic Diseases 2021;80:e62.

[2]Alesi M, Shojaie B, Farajzadegan Z, Salesi N, Mohammadi E. TNF-α Blockers Showed Prophylactic Effects in Preventing COVID-19 in Patients with Rheumatoid Arthritis and Seronegative Spondyloarthropathies: A Case-Control Study. Rheumatol Ther. 2021 Jul 23:1-16. doi: 10.1007/s40744-021-00342-8. Epub ahead of print. PMID: 34316436.

[3]Baslilar S, Pehlivan O. Evaluation of factors affecting the frequency and clinical course of COVID-19 in patients using anti-TNF-alpha agents. Rev Assoc Med Bras (1992). 2021 Sep;67(9):1286-1292. doi: 10.1590/1806-9282.20210568. PMID: 34816922.

Disclosure of Interests

None declared

Epidemiology of hospitalized burns in Romania: A 10-year study on 92,333 patients

BACKGROUND

No epidemiological information is available of the number of burns treated in the past 30 years in Romania. The aim of the present study is to investigate the extent of burn injuries in Romania, as well as to detect and analyze the essential epidemiological characteristics.

METHODS

A comprehensive retrospective study was conducted over a period of 10 years (1.01.2006 to 31.12.2015). Patient-related data were obtained from the Diagnosis-related group (DRG) Center of National School of Public Health, Management and Professional Development, which is the only official national structure that collects and manages data concerning all the hospitalized patients in Romania.

RESULTS

Included in this study were all 92,333 patients with burn injury as the main International Classification of Diseases (ICD-10) code of discharge from Romanian hospitals. The data was analyzed using SPSS V.24, IBM Statistics Package. The annual number of burns decreased gradually from 10,547 in 2006 to 7313 in 2015, reaching statistical significance (p = 0.001). The incidence decreased from 47 cases per 100,000 in 2006 to 36.93 per 100,000 in 2015. The seasonal evolution showed that the number of burns increases in July-August (8.8% and 9.1% of annual burns). The mean length of stay (LoS) was 10.59 days, with the highest value in 2012 (11.00) and the lowest in 2014 (10.30). The median LoS and the mean LoS values during the 10 years period have a plateau-type evolution, with no tendency for improvement. We found a significant correlation (r = 0.708, p = 0.0118) between increased mortality and the year of study.

CONCLUSIONS

This is the first nationwide epidemiological study concerning hospitalized burns in Romania. It provides insight in demographical characteristics but also uncovers a worrying trend of increasing mortality rates, which requires further investigation. This study cannot make any reference to the severity of burns (surface and depth) or towards major burns events which unfolded during the studied period, due to lack of data. Consequently, it should raise awareness towards policymakers and caregivers that for a durable burns management strategy in Romania, it would be extremely useful to implement a national burn registry.

5 years follow up study on changes of romanian psychiatric residents’ opinion on factors which influence their decision to emigrate

Introduction

Important changes have been done in economic status of residents in 2018. The impact of these measures in changing opinion was checked.

Objectives

The prioritization exercises of main factors related with psychiatric residents’ decision to emigrate could be a starting point of elaboration of a strategy of reforms.

Methods

The study was cross sectional evaluation at national level on a randomized selected sample of Romanian psychiatric residents’ opinion on factors which influence decision of migration in EU countries in two time points: 2015 and 2020.

Results

38% of residents intend to work abroad comparing with 78% before the economic changes (25.84% versus 71.66% for a limited period of time and 15.73% versus 28.33% intend to emigrate) and 2% versus 5% intend to leave the speciality. The most important factors for decision to emigrate changed from “Better working conditions” (15.73 versus 37.31% residents) to “Better training” 20.25% residents and the factor “respect and appreciation by colleagues” remained important for 19.10% versus 17.91%. “Lack of working place for partner” was considered by 26.96% of responders as an important disadvantage of working abroad. “Being far from family members” which was considered 5 years ago by 64.18% of responders as an important disadvantage of working abroad, nowadays concerns only 6.74%, probably because it seems easier to go abroad together with the family members.

Conclusions

The factors (better training in psychiatry and psychotherapy, better supervision, more involvement in research) which influence the residents’ decision to emigrate represent the starting points on futures reforms in educational and medical system in psychiatry.

Disclosure

No significant relationships.

Coping mechanisms and resilience in psychiatric trainees during COVID-19 pandemic

Introduction

The Covid-19 pandemic has a profound impact on all domains of day to day life, forcing individuals to make substancial change in the way of living. Such change is known to cause an important psychological distress, and in some persons evidencing silent disorders among apparently functional individuals. Good coping mechanisms and resilience can be the key to overpass this difficult period.

Objectives

The aim of this study is to evaluate the coping mechanisms and resilience that Romanian psychiatric trainees used during Covid19 pandemic.

Methods

We developed an online questionnaire. We included questions about different socio-demographical variables and about coping mechanisms (using COPE scale), resilience (using Connor-Davidson Resilience Scale) and quality of life (using QoL Scale).

Results

The preliminary data show that staying busy, seeking social support and having a positive minset are emotion-focused coping strategies present in individuals who overpass easier this period.

Conclusions

The Covid-19 pandemic is creating significant distress and impairment in functioning, but individuals who have good psychological mechanisms and who are more adaptable are less vulnerable during Covid-19 pandemic. Future research should build upon these findings to better understand coping mechanisms during crises and also social policies should be developed to acknowledge the variable needs in adults.

Stereotactic Ablative Radiation Therapy for Large (≥5 cm) Non-small Cell Lung Carcinoma

AIMS

Stereotactic ablative radiation therapy (SABR) is a standard of care for medically inoperable early stage non-small cell lung carcinoma. Tumours greater than 5 cm have been excluded from randomised trials using SABR and, hence, it is not used as a standard for larger lung tumours. However, improvements in radiation therapy techniques and the success of SABR in treatment of early stage disease may allow safe delivery of ablative doses to larger tumours. We analysed our experience with tumours ≥5 cm to determine the efficacy and toxicity profile of SABR in this setting.

MATERIALS AND METHODS

We evaluated survival, control rates, patterns of failure and toxicity in patients with a tumour diameter larger than 5 cm that had no nodal or distant metastases treated with SABR technology. Patients had been treated in two centres since 2009 and were retrospectively analysed. All patients had positron emission tomography staging, were discussed at a tumour board and were documented to have no nodal or distant metastatic disease. Treatment outcomes were analysed using Kaplan-Meier estimates and compared using the Log-rank test. Cox regression was used to investigate the association between the survival outcomes and predictor variables.

RESULTS

In total, 86 patients were identified. Six patients had no follow-up imaging. Therefore, 80 patients were available for analysis. All patients were reclassified according to the updated AJCC eighth edition. The median follow-up was 19.6 months. No patients received neoadjuvant or concurrent systemic therapy. One patient received adjuvant systemic therapy. The median age at treatment was 77 years (range 58-91). Eighty-four per cent were stage T3N0M0 and 16% were staged T4N0M0. The median tumour diameter was 5.8 cm (range 5.0-9.3 cm). The median gross tumour volume, measured on a single phase of the respiratory cycle, was 45.7 cm³ (range 12.1-203.3 cm³). The median overall survival was 20.9 months (95% confidence interval 12.6-29.1 months). One-, 2- and 3-year overall survival was 71%, 48% and 32%, respectively. The median local failure-free survival was 19.5 months (95% confidence interval 14.4-24.6). The median disease-free survival was 15.1 months (95% confidence interval 9.9-20.4 months). Local control at 1, 2 and 3 years was 85% (95% confidence interval 76-94%), 71% (95% confidence interval 58-84%) and 57% (95% confidence interval 40-74%), respectively. Forty-four patients (55%) had any treatment failure (local, mediastinal, intrapulmonary or distant metastases). Out-of-field intrapulmonary disease progression was the most common mode of failure, occurring in 21 patients (26%). Local failure occurred in 19 patients (24%) - alone or in combination with other progression. Distant metastases occurred in 20 patients (25%). Neither histological subtype, tumour size nor gross tumour volume had a statistically significant effect on local failure-free survival. Two patients experienced grade 3 late dyspnoea. There were no other reported grade 3 or higher acute or late toxicities.

CONCLUSION

SABR for larger lung tumours ≥5 cm results in high local control and acceptable survival in patients with medically inoperable large non-small cell lung carcinoma treated with radiation alone. Such patients should be considered for SABR owing to fewer treatment fractions and acceptable toxicity. Local control analysis reveals a sustained pattern of local failure emphasising the need for long-term follow-up. Improvements in technical strategies are required to further improve local control.

SAT0220 BIOLOGICAL PREDICTORS OF ECHOGRAPHIC SALIVARY GLAND INVOLVEMENT SEVERITY IN PATIENTS WITH SJÖGREN’S SYNDROME

Background:

Echographic evaluation of salivary gland increasingly became a routine imaging modality in patients with Sjogren’s syndrome (SS). However, predictive parameters associated with the severity of echographic features are still incomplete evaluated.

Objectives:

The aim of this study was to evaluate the predictors for severe echographic involvement in patients with SS followed in a tertiary center.

Methods:

We included 63 patients with SS (mean age: 52.3±11.9; 59 female). The complete laboratory workup, clinical manifestations and treatment were reviewed and the EULAR Sjögren’s syndrome disease activity index (ESSDAI) was calculated for each patients. We performed the standard echographic evaluation of salivary gland in all patients and used a 4 grade system for severity staging.

Results:

The distribution of echographic grade was: no any echographic features – 4 pts (6.3%); grade 1 - 24 pts (38.1%); grade 2 – 20 pts (31.7%); grade 3 – 10 pts (15.9%); grade 4 – 5 pts (7.9%). The ESSDAI and the hydroxichloroquine use were similar in these subgroups. We didn’t find differences regarding CRP and fibrinogen and echographic features. The age of the patients, the anti-SSA and anti-SSB, ESR, total protein, IgA, IgG and rheumatoid factor levels were significantly higher and lymphocyte count was lower in patients with echographic severity above grade 2 when compared with patients with no or mild echographic features. However, using ANOVA test and post-hoc analysis, the only parameters associated with the severity of echographic features were high ESR (53 vs 17 in grade 4 vs 1, p=0.02), IgA (363 vs 190 in grade 4 vs 1, p=0.004) and IgG (1985 vs 1191 U/l in grade 4 vs 1, p=0.001) levels.

Conclusion:

Parameters linked to polyclonal hypergammaglobulinemia (IgA and IgG levels; and ESR) seem to be linked to the severity of echographic appearance of salivary gland in patients with SS. Further studies are needed in order to better characterize this link.

Disclosure of Interests:

Ancuta MIHAI: None declared, DENISE MARDALE: None declared, Daniela Opris-Belinski Speakers bureau: as declared, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Ciprian Jurcut: None declared

AB0429 NEUTROPHIL TO LYMPHOCYTE RATIO INDEPENDENTLY PREDICTS CUTANEOUS MANIFESTATIONS IN PATIENTS WITH SJÖGREN’S SYNDROME

Background:

Various cutaneous manifestations are described in patients with Sjogren’s syndrome (SS). However, the predictors for its occurrence are not fully investigated. Recently, data regarding the role of hematological parameters ratios in patients with rheumatic diseases were reported. However, routine hematological parameters and the derived ratios were not studied in SS patients.

Objectives:

The aim of this study was to evaluate the predictors for cutaneous manifestations in a large cohort of patients with SS followed in a tertiary center.

Methods:

We included 114 patients with SS (mean age: 53.1±12.1; 94.7% female). We divided the patients in group A – patients with cutaneous manifestations and group B – without cutaneous manifestations. The complete laboratory workup [including the calculation of neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV) to platelet ratio, platelet distribution width (PDW) to platelet ratio], clinical manifestations and treatment were reviewed and the EULAR Sjögren’s syndrome disease activity index (ESSDAI) was calculated for each patients.

Results:

Cutaneous manifestations were diagnosed in 11 patients (9.6%). The age of the patients, the levels of anti-SSA, complement, inflammatory markers (ESR, CRP), immunoglobulins and vitamin D levels, the ultrasonographic score of salivary glands and the ESSDAI value were similar in both groups. The patients with cutaneous manifestations were more frequently treated with hydroxychloroquine (9/11 vs 49/103, p=0.03) but the mean doses were similar in both groups. The values of anti-SSB were marginally higher in patients with cutaneous manifestations (102.3±83.1 vs 53.6±79.9, p=0.07). The lymphocyte, neutrophil count, MPV and PDW were similar in both groups, while platelet count was lower in patients with cutaneous manifestations (224090.9±59528.9 vs 264339.8±60669.0, p=0.03). The MPV/Plt ratio tended to be higher in patients with cutaneous manifestations (0.051±0.017 vs. 0.043±0.013, p=0.07), but the values of PDW/Plt ratio (0.064±0.022 vs 0.051±0.018, p=0.03) and of NLR (3.82±2.30 vs 2.35±0.92, p=0.001) were found to be significantly higher in these patients. In multivariate analysis, only the NLR remains independently associated with cutaneous manifestations (p=0.001). Using the ROC curve analysis, a cutoff of 2.70 for NLR had a 63% sensitivity and 69% specificity for cutaneous manifestations.

Conclusion:

The hematological parameters related to platelets appear to be modified in patients with SS and cutaneous manifestations. However, only neutrophil to lymphocite ratio is independently associated with cutaneous involvement in these patients.

Disclosure of Interests:

Ancuta MIHAI: None declared, DENISE MARDALE: None declared, Daniela Opris-Belinski Speakers bureau: as declared, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Ciprian Jurcut: None declared

The role of parents’ divorce in adolescents’ internet addiction

Internet addiction is an excessive, ingrained habit and a thoughtless on-line/offline computer usage which can be divided into three subgroups related with games, web pages with sexual contents or email and internet chat programs. The causal factors of this trouble are still debated.

Aims

The purpose of our study is to survey the habits of teenagers concerning the use of internet and furthermore to investigate the frequency of internet addiction and its predisposing factors.

Material and methods

We investigated the habits of high school students (n = 154) in the county of Mureş using questionnaires (Internet Addiction Test).

Results

Young people spend daily an average of 3 hours and 38 minutes in front of a computer. 45% of the boys spend daily more than two hours with computer games while 74, 53% of the girls chat daily. 3, 41% of the adolescents think that they spend a lot of time on the net and their learning and school problems are a result of this. 9,3% of the teenage boys spend daily more than 4 hours 20 minutes in front of a computer (weekly 30 hours), what is qualified as dependence according to the American specialists. There is a strong correlation between internet addiction and parents divorce.

Conclusions

The rate of young people addicted to internet gains considerable importance. Moreover this addiction is associated with other addictions so there would be a serious need for health education programs already in high schools.

Spice plants induced psychosis-case presentation

Spice shops, selling ethnobotanical plants like Salvia divinorum, Mitragina speciosa, Amanita muscaria and others, have become very numerous in Romania, first of all because they are legal, second of all because more and more young people are tempted to experiment new sensations. These plants can cause different psychiatric illnesses and associating theme with alcohol or drugs can also be fatal.

Our objective was to present the case of a 25 year old male patient consulted at emergency service, and admitted in our department, presenting psychomotor agitation, anxiety and the specific elements of a psychotic episode, delusions and hallucinations, after smoking a cigarette with sage and night-shade.

The symptomatology remitted rapidly, after approximately 12 hours, revealing the complications of psychoactive substance use.

Conclusions

This case shows the importance of knowledge of psychiatrists concerning the psychoactive substances of ethnobotanical plants, because of their legality and easy procuration possibility. We consider that the role of psychiatrists in mediatizing the side effects of these plants is very important.

Comorbidity of major depressive disorder and personality disorder increase the risk for suicide

Introduction

Personality disorder (PD) with an associated diagnostic of major depressive disorder (MDD) is a common occurrence, being considered a factor of treatment resistant depression. In this study, we compare two groups of patients’ one group having Major Depressive Episode (MDD) and the other with MDD and PD as comorbidity.

Methods

This is an observational study of all patients admitted with diagnosis of MDD during one month period in an acute psychiatric hospital. Data collection is made using patients files. During one month period a total number of 105 MDD cases were recorded (group A-75 cases with MDD and group B-30 patients with PD and MDD). The diagnosis was recorded in files by a specialist psychiatrist. Data is analyzed using SPSS v.20.

Results

A significant difference is found when comparing age groups, mean age for group A being 60 years and for group B 35 years (P = 0.05). Regarding suicide attempts a higher prevalence is found in Group B (Group A 6.7%, Group B 20%) although with statistical relevance (P = 0.04). Study limitation: small sample size of group B does not allow analysis on different type of personality disorders, length of hospitalisation could be biased by the requirements of assurance company.

Conclusions

The risk of admission is higher at younger age in patients with MDD associated with PD then in MDD alone. The risk of suicide attempts is significantly higher in group of MDD associated with PD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Decreased paraoxonase 2 enzymatic activity in monocyte/macrophages cells. A comparative in vivo and in vitro study for diabetes

AIM

To investigate peripheral blood monocytes/macrophages (Mo/Mᴓ) paraoxonase 2 (PON2) in diabetes and the factors modulating its activity.

METHODS

One hundred and eighteen patients with newly diagnosed uncomplicated type 2 diabetes mellitus were compared regarding clinical, biochemical and oxidative stress parameters with 80 healthy subjects. The capacity of the peripheral blood mononuclear cells (PBMNC) to release pro-oxidants and to neutralise them was determined by measuring the respiratory burst (RB) and the intracellular antioxidant enzyme PON2. In vitro experiments were conducted on a differentiated monocytes cell line (dU937) that was exposed to serum deprivation followed by addition of isolated lipoproteins (VLDL or LDL).

RESULTS

Paraoxonase 2 activity in Mo/Mᴓ was significantly lower in type 2 diabetes patients (0.042 ± 0.044 vs 0.165 ± 0.133U lactonase activity/mg protein in controls, p < .0005) and decreased in the obese in all groups. It was inversely correlated to parameters of adiposity (BMI and Waist Circumference), of glucose control (blood glucose, fructosamine and HbA_1c) and insulin resistance (HOMA-IR). In multivariate regression models, 15-34% of the PON2 variance was explained by diabetes. The in vitro addition of VLDL normalised the RB of serum deprived dU937 cells, S- (to 82 ± 18% of the cells incubated with serum, S+) and PON2 activity (from 0.524 ± 0.061 in S - to 0.298 ± 0.048 U/mg protein). In contrast, when LDL was added, the RB remained lower (61 ± 12% of S+, p = .03) and PON2 higher (0.580 ± 0.030 U/mg protein, p = .003).

CONCLUSIONS

The decrease in monocyte/macrophage PON2 enzymatic activity observed in type 2 diabetes cannot be totally explained by abdominal obesity and insulin resistance. The underlying molecular mechanisms need to be identified.

Serotonin and the bone assessment

Introduction: Lately, the in vitro and in vivo studies on serotonin metabolism have been pointing its influence in bone health. Also, there are no particular recommendations in performing the serum serotonin assessment in order to evaluate the skeletal status.

Aim: We aimed to correlate the bone turnover markers and lumbar bone mineral density (BMD) with serotonin.

Material and methods: There is a cross-sectional study in Caucasian postmenopausal women. They were not diagnosed with carcinoid syndrome, or bone anomalies, and received no treatment (including antiresorptives). The following bone formation markers were performed: serum alkaline phosphatase (AP), serum osteocalcin (OC), and the bone resorption marker: serum CrossLaps (CL). Serum serotonin (high-pressure liquid chromatography), as well as central DXA (GE Prodigy) were assessed.

Results: 191 women of 57.1 years mean age were grouped according to DXA (WHO criteria). The linear regression analysis between serum serotonin and CL were not statistically significant (SS), between serotonin and OC was SS in the newly diagnosed osteoporosis group (N=40, r=0.4, p=0.03), between serotonin and AP SS was found in osteopenia group (N=88, r=0.24, p=0.03), with no changes when adjusting for age and BMI. The partial correlation between serotonin and BMD was not SS.

Discussion: The study raises the question of serotonin as a bone metabolism marker seeing that the results were not consistent. The main limit of our study was that we did not analyze the possible use of antidepressants to these women. Overall, this was a pilot study in clinical practice where few reports have been published, but still necessary, because the use of serum serotonin in current skeletal evaluation is still unclear.

5 -year complex clinical and histopathological follow-up of a case of early gastric carcinoma (signet ring cells type)

The paper presents the case of a male patient, hospitalized for acute abdomen due to perforated callous ulcer. Though the clinical appearance suggested a benign pathology, the histopathological exam of the resection piece showed multicentric early gastric carcinoma, signet ring cell type. At the patient's request, total gastrectomy was not performed, a conservative solution being chosen instead. Superior digestive endoscopy with biopsy and oncological dispensarization was performed one month after surgery, then at every 6 months. After 2 years of benign results, the histopathological exam revealed the presence of malign singlet ring cells in the bioptic specimen. Respecting the patient's option of preserving a good quality of life, subtotal gastrectomy with Pean type gastroenteroanastomosis was performed followed by postoperatory chemotherapy. Endoscopic and oncological follow-up were performed at every six months for another 3 years (up to present), and the evolution was favorable with no local or metastatic recurrence. Histopathological examination was of great help in the surgical management of this case, allowing a fortunate early diagnosis, a conservative surgical approach, and the preserving of a good quality of life.

Prevalent osteoporotic fractures in 622 obese and non- obese menopausal women

Hypothesis. The osteoporotic fractures represent a worldwide economical issue. In order to prevent them, we need to understand the risk factors constellation. Although obesity was traditionally considered as protective against osteoporosis, recent data exposed an increased risk of falling and thus a high risk of some fractures.

Objective. We aimed to analyze the body mass index (BMI) in relationship with the bone mineral density (BMD) and the prevalent fractures.

Methods and Results. Between 2008 and 2014, a cross-sectional observational study included Romanian menopausal Caucasian women without a previous diagnosis of bone maladies, or specific anti-osteoporotic therapy. Prevalent fragility fractures were both self-declared and incidental vertebral. All the subjects had lumbar BMD (GE Lunar Prodigy DXA machine).

Out of 622 females (mean age of 58.65 years, mean BMI of 30.30 kg/ m2), 39.22% were obese (BMI ≥ 30kg/ m2). The fracture prevalence was 1.35% versus 1.67% in obese versus non-obese patients. The correlation coefficient between lumbar BMD and BMI was r=0.165, p<0.005. BMI in the fracture group was 31.68 kg/ m2 vs. 30.04 kg/ m2 in the non-fracture group (p=0.08). 15.91% of the entire cohort had prevalent fractures. Obesity prevalence among females with fractures was 30.3% versus 40.73% in the non-fracture group. The most frequent sites were distal forearm (42.42%) and vertebral (21.21%).

Discussions & Conclusions. Although the vertebral fractures might be underdiagnosed in our study and despite the fact that we enrolled a relatively young menopausal population, BMI positively correlated with BMD, regardless of the fractures’ prevalence. In early menopause, the most frequent fracture is distal forearm. BMI is higher in patients with prevalent fractures vs. non-fractures (borderline significance). Obesity might not protect from any type of fracture but future evidence is necessary since one third of osteoporotic fractures are met in women with a BMI ≥ 30kg/ m2.

The serotonin and the bone assessment

Introduction. Lately, the in vitro and in vivo studies on serotonin metabolism pointed their influence in bone health. In addition, there are no particular recommendations in performing the serum serotonin assessment in order to evaluate the skeletal status.

Aim. We aimed to correlate the bone turnover markers and lumbar bone mineral density (BMD) with serotonin.

Material and Methods. There is a cross-sectional study in Caucasian postmenopausal women. They were not diagnosed with carcinoid syndrome, or bone anomalies, and received no treatment (including antiresorptives). We performed the bone formation markers: serum alkaline phosphatase (AP), serum osteocalcin (OC), and the bone resorption marker: serum CrossLaps (CL). Serum serotonin (high-pressure liquid chromatography), as well as central DXA (GE Prodigy) were assessed.

Results. 191 women of 57.1 years mean age were grouped according to DXA (WHO criteria). The linear regression analysis between serum serotonin and CL was not statistically significant (SS), between serotonin and OC was SS in the newly diagnosed osteoporosis group (N=40, r=0.4, p=0.03), between serotonin and AP we found SS in osteopenia group (N=88, r=0.24, p=0.03), with no changes when adjusting for age and BMI. The partial correlation between serotonin and BMD was not SS.

Discussion. The study raises the question of serotonin as a bone metabolism marker seeing that the results were not consistent. The main limit of our study is that we did not analyze the possible use of antidepressants by these women. Overall, this is a pilot study in clinical practice in which few reports have been published yet, but still necessary because the use of serum serotonin in current skeletal evaluation is still unclear.

Quality-of-life outcomes in high-risk prostate cancer patients treated with helical tomotherapy in a hypofractionated radiation schedule with long-term androgen suppression

PURPOSE

We examined the impact of hypofractionated radiation therapy and androgen suppression therapy (AST) on quality of life (QOL) in high-risk prostate cancer patients.

METHODS

Between March 2005 and March 2007, 60 patients with high-risk prostate cancer were enrolled in a prospective phase ii study. All patients received 68 Gy (2.72 Gy per fraction) to the prostate gland and 45 Gy (1.8 Gy per fraction) to the pelvic lymph nodes in 25 fractions over 5 weeks. Of the 60 patients, 58 received ast. The University of California-Los Angeles Prostate Cancer Index questionnaire was used to prospectively measure QOL at baseline (month 0) and at 1, 6, 12, 18, 24, 30, and 36 months after radiation treatment. The generalized estimating equation approach was used to compare the QOL scores at 1, 6, 12, 18, 24, 30, and 36 months with those at baseline.

RESULTS

We observed a significant decrease in QOL items related to bowel and sexual function. Several QOL items related to bowel function were significantly adversely affected at both 1 and 6 months, with improvement toward 6 months. Although decreased QOL scores persisted beyond the 6-month mark, they began to re-approach baseline at the 18- to 24-month mark. Most sexual function items were significantly adversely affected at both 1 and 6 months, but the effects were not considered to be a problem by most patients. A complete return to baseline was not observed for either bowel or sexual function. Urinary function items remained largely unaffected, with overall urinary function being the only item adversely affected at 6 months, but not at 1 month. Urinary function returned to baseline and remained unimpaired from 18 months onwards.

CONCLUSIONS

In our study population, who received hypofractionated radiation delivered using dynamic intensity-modulated radiotherapy with inclusion of the pelvic lymph nodes, and 2-3 years of ast prescription, QOL with respect to bowel and sexual function was significantly affected; QOL with respect to urinary function was largely unaffected. Our results are comparable to those in other published studies.

Medical implication of intoxication with legal spice plants in Romania

In lasts years in Romania a new challenge for the young appears: the legal spice shops. The promotions of using these substances include the promising like: relaxation, happiness, energy, sexual performance, increasing of social abilities.

Aims

evaluation of medical consequences of intoxication with spice plants (Bonsai, “magic charge”, “mariciuca”, Salvia divinorum, Mitragina speciosa and others). The precise composition of substance used was not clear but the known drugs were excluded. Material and method: all patients with diagnosis of intoxication of spice plants, admitted for at least 24 hours in Department of Drug Dependence, in a 3 months period, in 2010 were evaluated, not only concerning psychiatric psychopathology but also for other medical symptoms or diseases.

Results

We excluded the patients who have used other known drugs, and had positive results in blood and urine analysis. 17 patients used spice plants associate with alcohol less then 0.5%0, coffee or tobacco, 7 patients used only spice plants. The cardiovascular symptoms were present in 53%, gastrointestinal symptoms in 73%, neurological symptoms in 53%, renal symptoms 5%. We verified the personal history of diseases and also co-morbid acute diseases. Psychiatric symptoms were characteristic to substance induced psychotic disorders.

Conclusions

This study wanted to define and underline the specificity of clinical presentation of intoxication with spice plants, being useful to be known in emergency settings. These medical implications of use of this legal spice plants should also involve community, administrative or political actions for prevention of these medical consequences.

Cone beam computed tomography as a method of quantitative and qualitative analysis of alveolar crest in the frontal mandibular area

New radiographic maxillofacial techniques, cone beam computerized tomography (CBCT) are a necessity in the assessment of jaw bone offer to effectively evaluate the treatment.

AIM

To quantitatively and qualitatively evaluate anterior mandibular area on CBCT comparing to orthopantomography (OPG).

MATERIAL AND METHODS

Fifty-one dental patients, aged between 20 and 77 years, were quantitatively analyzed and 81 dental patients, aged between 20 and 79 years, were qualitatively analyzed. ANOVA and Mann-Whitney tests were used for statistical analyses.

RESULTS

Strong statistical significant differences were recorded between CBCT and OPG assessments for all groups of teeth (p<0.001), when evaluation was performed on distances to mandibular base. When assessing the distance to the incisive canal, the differences were recorded only for the left canine zone. Mean densities of central incisor, lateral incisor and canine regions, were 1,400-1,425 HU, 1,212-1,224 HU, and 1,150-1,175 HU, respectively. There was a marginal statistical evidence that bone density was lower in canine zone comparing to central incisor area (p=0.08).

CONCLUSIONS

Measurements on CBCT are more accurate when compared with OPG. Bone density of central incisor region is higher. Therefore, CBCT permits the clinician to have all necessary information when planning dental implants.