C-41 Functional Impairments in Girls with Attention-Deficit Hyperactivity Disorder

Objective

ADHD is a neurodevelopmental disorder known to cause functional impairments. Few studies have identified impairments specific to girls with ADHD. The objective of this study was to explore the relationship between ADHD subtypes and measures of functional impairment in girls.

Method

Participants were chosen from a sample of girls ages 5 – 18 years old, diagnosed with ADHD at an outpatient ADHD clinic at a large children’s hospital (N = 303). Measures included parent and teacher BASC subscales of adaptability, homework problems, and comorbid clinical diagnoses based on the diagnostic interview for children and adolescents-revised parent version (DICA-R). Potential relationships between impairment measures and ADHD subtypes were assessed using multiple and logistic regressions to control for age and socioeconomic status (SES).

Results

Number of inattentive ADHD symptoms correlates positively with DICA diagnosis of ODD (x2 = 4.008, p = 0.045) and homework problems (r = 0.227, p = 0.0001). Number of combined ADHD symptoms is positively associated with DICA diagnosis of ODD (x2 = 26.812, p = 0.0001) and homework problems (r = 0.171, p = 0.0001) and negatively associated with parent reported social skills (r = 0.092, p = 0.006), adaptability (r = 0.146, p = 0.001) and teacher reported adaptability (r = 0.057, p = 0.01), after controlling for age and SES.

Discussion

Girls with ADHD exhibit functional impairments in the domains of comorbid diagnoses, homework problems, parent and teacher report of adaptability, and parent report of social skills. Additional research should include self-reports of functional impairment to determine self-perception of impairment.

A Cross-Sectional Study of Antibiotic Prescribing for Childhood Upper Respiratory Tract Infections in Irish General Practice

Introduction This study aimed to analyse antibiotic prescribing in cases of upper respiratory tract infection (URTI) in children under 6 years attending Irish daytime and out-of-hours General Practice (GP) services. There have been large scale changes in entitlements for free GP care for this group in recent years. Methods A cross-sectional study of children under 6 years with URTI presentations was performed, over a two-week period for three years from 2015 to 2017. Factors associated with antibiotic prescription and preferred antibiotic compliance were examined using multivariate logistic regression. Results 1,007 Under-6 patients presented with an URTI in our sample over the study period. Following introduction of free GP care, patients were 50% less likely to receive an antibiotic prescription. Overall antibiotic prescribing fell from 70% to 50% in daytime services and from 72% to 60% in the out-of-hours setting. Patients presenting to out-of-hours services were more likely to receive an antibiotic (OR: 1.42) and less likely to receive a deferred antibiotic (OR: 0.53). One quarter to one third of all prescriptions were for deferred antibiotics. Year-on-year trends showed a 13% decrease in prescriptions and 13% increase in preferred antibiotic use. Conclusion The introduction of free GP care led to significant reductions in antibiotic prescribing, which may be due to changes in health seeking behaviour by parents or other reasons. Antibiotic prescribing was more commonplace in the out-of-hours setting, and rates remains high by international standards. This study underlines the importance of ongoing work around GP antimicrobial stewardship, particularly in the out-of-hours setting.

Direct costs of first-generation protease inhibitors for the treatment of genotype 1 chronic hepatitis C viral infection

To evaluate the cost-effectiveness of Hepatitis C therapy, robust real-world data are needed to understand the costs and benefits of treatment alternatives. The objective of this study was to evaluate the true direct cost of treatment in an unselected sequential population of patients treated at a tertiary care centre for hepatitis C virus genotype 1. A total of 200 consecutive patients were treated with interferon, ribavirin and a first-generation direct-acting antiviral agent (DAA) between 2011 and 2013. A total of 41% had cirrhosis, 31% were prior relapsers, and 41% were prior partial or null responders. Costs used were wholesale acquisition cost prices for medications, average hospital costs per day for each diagnosis code based on US inpatient hospital charges. All costs were adjusted to 2013 dollars. Sustained virologic response (SVR) was achieved in 97 patients (48.5%). A total of 14% experienced relapse, 19% breakthrough or nonresponse, and 18.5% discontinued secondary to side effects. Twenty per cent of patients had at least one hospitalization attributable to a complication of therapy. Thirty-seven per cent of patients required erythropoietin-stimulating agents, 16% received filgastrim, and 15% needed a red blood cell transfusion. The mean overall cost of treatment was $83,851 per patient. The cost per SVR was $172,889; $266,670 for patients with cirrhosis. The costs per SVR after treatment with first-generation DAAs are dependent on the stage of disease and therapy side effects. These real-world costs significantly exceed those described in prior cost-effectiveness assessments and should be used instead for future studies.

Diagnostic and prognostic use of FDG-PET scans in Waldenstrom's macroglobulinemia

e19518

Background: Waldenstrom's macroglobulinemia (WM) is a rare lymphoplasmacytic lymphoma. More sensitive tools of tumor burden and prognosis are needed in these patients (pts). The use of FDG-PET has not been previously studied in WM but has proved an effective diagnostic and prognostic tool effective in low-grade lymphomas. Therefore the objective of this study was to determine whether FDG-PET was an effective tool in evaluating pts with WM. Methods: We included all pts enrolled on a prospective phase II clinical trial of bortezomib and rituximab for pts with upfront or relapsed/refractory (RR) WM. All pts were CD20 positive with histologically confirmed disease and underwent staging evaluation by FDG-PET in combination with CT scan before and after therapy. Patients received 6 cycles of bortezomib IV weekly at 1.6mg/m2 on days 1, 8, 15q28 and rituximab at 375 mg/m2 on days 1, 8, 15 and 22 in cycles 1 and 4. Correlation was made with the international prognostic scoring system for WM and monoclonal protein response rate. Results: 53 pts were included, of which 35 were RR and 18 pts were upfront. Median age was 63 years (range 42–81), 64% were male. Before therapy, 34 pts (64.2%) had positive FDG-PET findings with a median IgM of 2825, Beta 2 microglobulin of 3.6, and Age of 61. 36 pts showed a minor response or greater with a correlation to negative PETs after therapy. Conclusions: Over 60% of WM pts demonstrated FDG-avid disease when using FDG-PET scans, with the majority showing negative disease after therapy. This correlates with the 67.9% response rate. Positive PET images were inversely correlated to IgM level and directly related to elevated Beta-2 microglobulin and age. Significantly PET positive individuals may demonstrate a poorer prognosis. FDG-PET scans may prove an effective tool in the diagnosis and prognosis in WM.

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Phase II trial of combination of bortezomib and rituximab in relapsed and/or refractory Waldenstrom macroglobulinemia

8535

Background: This phase II study aimed to determine safety and activity of weekly bortezomib in combination with rituximab in patients with relapsed/refractory Waldenstrom macroglobulinemia (WM). Methods: Patients who had at least one previous therapy for WM and who had relapsed or refractory disease were eligible. NCI CTCAE v3.0 was used for toxicity assessment. All patients received bortezomib IV weekly at 1.6mg/m2 on days 1, 8, 15, q 28 days × 6 cycles, and rituximab 375 mg/m2 at days 1, 8, 15, 22, on cycles 1 and 4. Results: 37 pts (26 men and 11 women, median age 62 years, range 42 - 73) have been treated to date. The median number of lines of prior treatment was 3 (range 1 - 5). All patients had received prior rituximab and 5 pts received prior bortezomib. The median IgM at baseline was 3540 mg/dL (range 700-10,800). The median follow up is 12 months (range 5 - 26 months). Thirty-five pts are evaluable for response. Complete remission and near complete remission occurred in 2 (6%), partial remission in 17 (48%), and minimal response in 10 (29%). Progressive disease occurred in 1 (3%) and stable disease occurred in 5 (14%). Most patients achieved response rapidly within 3 months of therapy (2–7 months). Rituximab flare occurred only in 6 patients (20%). At 24 months of follow up, 8/35 pts have shown relapsed disease. The median time to progression and duration of response has not been reached. Patients tolerated therapy well without significant toxicities: grade 3 peripheral neuropathy occurred in only 2 pts. Grade 1 and 2 neuropathy occurred in 10 pts (26%). Other grade 3 and 4 toxicities included neutropenia in 5 patients, and anemia and thrombocytopenia in 4 patients. Grade 5 pneumonia and viral infection occurred in 1 patient who was within the first cycle of therapy and did not receive herpes zoster prophylaxis. Attributable toxicities otherwise proved manageable with appropriate supportive care and the combination was generally well tolerated. Conclusions: The combination of weekly bortezomib and rituximab has been well tolerated and demonstrates encouraging activity, with CR+ PR + MR in 83% of evaluable patients with relapsed WM. No significant peripheral neuropathy has been observed to date with this regimen.

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Detection of QTL for growth rate in the blacklip abalone (Haliotis rubra Leach) using selective DNA pooling

The objective of this study was to identify QTL for growth rate in the blacklip abalone Haliotis rubra using selective DNA pooling. Three full-sibling families of H. rubra derived from crosses of wild broodstock were used. DNA was extracted from the largest and smallest 10% of progeny and combined into two pools for each phenotypic tail. The DNA pools were typed with 139 microsatellites, and markers showing significant differences between the peak height ratios of alleles inherited from the parents were individually genotyped and analysed by interval mapping. A strong correlation (r = 0.94, P < 0.001) was found between the t-values from the analysis of pools and the t-values from the analysis of individual genotypes. Based on the interval mapping analysis, QTL were detected on nine linkage groups at a chromosome-wide P < 0.01 and one linkage group at a chromosome-wide P < 0.05. The study demonstrated that selective DNA pooling is efficient and effective as a first-pass screen for the discovery of QTL in an aquaculture species.

Computerized synthesis of electromyographic interference patterns

Computer simulation is a process that appears to have wide application in many disciplines. Electromyographic (EMG) interference patterns can be computer-synthesized by inputting parameters of individual motor unit action potentials (MUAPs) such as amplitude, duration, and phases, and recruitment parameters of number of motor units, and the firing rate and its standard deviation. The resulting simulated EMG interference patterns can then be used to test hypotheses regarding the effect of alteration of the individual MUAP parameters on the interference pattern. An example of the usefulness of simulation is demonstrated by the analysis of the simulated patterns by the Fast Fourier Transform (FFT), which indicates that the major frequency band in the FFT results from the duration of the individual phases of the MUAP. The motor unit's recruitment rate is superimposed on the FFT envelope in the low-frequency end. The variability of the firing rate influences the distinctness of the low-frequency peaks. The MUAP amplitude and number of motor units in the recruitment pattern are reflected in the FFT power. Simulation appears to be a useful tool for further investigation and development of EMG signal analysis techniques.