[Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study]

INTRODUCTION

Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access.

METHODS

A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes.

RESULTS

A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence. Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy.

CONCLUSION

The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations. Inadequate use of combination therapy was observed. This study underscores the urgent need for targeted interventions addressing cardiovascular risk factors in poor areas to mitigate the burden of CVD.

ZART: A novel multiresolution reconstruction algorithm with motion-blur correction for single particle analysis

One of the main purposes of CryoEM Single Particle Analysis is to reconstruct the three-dimensional structure of a macromolecule thanks to the acquisition of many particle images representing different poses of the sample. By estimating the orientation of each projected particle, it is possible to recover the underlying 3D volume by multiple 3D reconstruction methods, usually working either in Fourier or in real space. However, the reconstruction from the projected images works under the assumption that all particles in the dataset correspond to the same conformation of the macromolecule. Although this requisite holds for some macromolecules, it is not true for flexible specimens, leading to motion-induced artefacts in the reconstructed CryoEM maps. In this work, we introduce a new Algebraic Reconstruction Technique called ZART, which is able to include continuous flexibility information during the reconstruction process to improve local resolution and reduce motion blurring. The conformational changes are modelled through Zernike3D polynomials. Our implementation allows for a multiresolution description of the macromolecule adapting itself to the local resolution of the reconstructed map. In addition, ZART has also proven to be a useful algorithm in cases where flexibility is not so dominant, as it improves the overall aspect of the reconstructed maps by improving their local and global resolution.

AB1185 PATIENT-REPORTED EXPERIENCE IN IMMUNE MEDIATED INFLAMMATORY DISEASES (IMID) IN THECONTEXT OF THE COVID-19 PANDEMIC: ACCESSIBILITY AND CONTINUITY OF CARE

Background

The lockdown and mobility restrictions in early COVID19 pandemic had a great impact in chronic patient care due to limited access and scheduled visits. In our hospital, coordinated non-pharmacological interventions (NPI) were designed in Rheumatology and Pharmacy services to maintain the accessibility and continuity of care for patients with IMID.

Objectives

To evaluate the patient reported experience (PRE), health status and quality of life in Rheumatology outpatient IMID subjects since March 14, 2020 when lockdown was imposed and during subsequent restrictions, related to the healthcare team and medications accessibility, and continuity of care.

Methods

Observational study, using a patient survey. Adult patients attending the rheumatology outpatient clinic between Nov 2, 2020 to Feb 13, 2021, with rheumatoid arthritis (RA), psoriatic arthritis (PsA), spondylarthritis (SpA) or systemic autoimmune diseases (SAD), with at least 1 year from diagnosis and 1 month of treatment with conventional synthetic (cs) targeted synthetic (ts) or biological (b) disease modifying antirheumatic drugs (DMARD). Face to face or phone interviews were conducted using an ad hoc designed questionnaire that included COVID19 related questions, the 11 IEXPAC scale items (5 point Likert scale ranging from never to always) (www.iexpac.org), and 4 items (5 points, very good to very bad) of the global scale PROMIS 10 (Patient-Reported Outcomes, PRO). All questions refer to the patient’s experience during the 6 months prior to data collection.

Results

From 174 screening patients, 158 completed the survey, mainly woman (66.5%) with a median age of 60 (IQR 47-69,3) years. The most frequent diagnosis was RA (43%) followed by ESAP (35%), EAS (22%) and PsA (13%). 46.8% of the patients have been prescribed b or ts DMARD and 53.2% sc DMARD, 32.9% in combination. From 158, 39 persons requested healthcare for COVID-19 related symptoms and diagnosis was confirmed in 17 (10,8%). Just 2 patients required hospital admission. Clinical control and continuity of care for COVID19+ patients were carried out from their primary care center and by phone consultation. Some key results of the survey are displayed in Table 1.

Table 1.

PRO and Patients’ perception during COVID19 lockdown and restrictions.

During confinement and restrictions due to covid-19, in the last 6 months …Responses (%)N= 158Your degree of concern about the COVID19 crisis is.High + Quite high (86.7)PRO (PROMIS 10)How good was your health …?Very good (11.4), Good: (43.7)and your emotional/mental health, including mood and ability to think?Very good (10.1)Good (41.1)your quality of life was.Very good (8.25) Good (49,4)Your satisfaction in performing daily tasks (home, work, family) was.Very good (7.8)Good (55.1)Accessibility to care and medicationsI could contact my rheumatologist whenever I needed (email, phone).Always (79.9)My rheumatologist changed my face-to-face visit for a phone callYes (53)I received my medication at home from the hospital pharmacyYes (16)I picked up my medication from the hospital pharmacy, without incident.Yes (21)I maintained the prescribed dose medication…Always + almost always (96,2)At some point I modify a medication by my own decisionYes (6)My doctor changed the dose or route of administrationYes (7)Your satisfaction with the care provided from all professionals in the team wasVery + Quite satisfied (75)PREMS (IEXPAC)Item 2. The professionals … are coordinated to offer me good healthcareAlways (34.18)Item 8. They make sure that I take my medication correctlyAlways (73.42)Item 9. They worry about my welfareAlways (74.68)

Conclusion

Lessons have learned during the COVID19 lockdown and restrictions by assessing patients’ health status and patients-reported experience. Coordinated NPI such as medication monitoring and home delivery, appointment reorganization and protocolized phone visits can result in a good patient perception and medication adherence whilst receiving care in a challenging situation.

Disclosure of Interests

None declared

Inactivation of SARS-CoV-2 isolates from lineages B.1.1.7 (Alpha), P.1 (Gamma) and B.1.110 by heating and UV irradiation

Currently, the rapid global spread of SARS-CoV-2 is related to G clade (including GH, GR, GRY and GV clades), which are associated with more than 98 % of sequenced viral isolates worldwide. The unprecedented velocity of spread of SARS-CoV-2 outbreak represents a critical need for prevention strategies. Vaccines are recently being available and antiviral drugs have shown limited efficacy in COVID-19 patients. Thus, it is needed to know how to reduce the infectivity of the virus by different physicochemical conditions in order to prevent exposure to contaminated material.

This work describes heating and irradiating UV-C light procedures to reduce the infectivity of SARS-CoV-2 belonging to different three lineages. Results of physicochemical treatment showed no differences among viral lineages. Analytical conditions for efficient inactivation of SARS-CoV-2 were determined.

Accuracy of automated three-dimensional ultrasound imaging technique for fetal head biometry

OBJECTIVES

To evaluate the accuracy of an automated three-dimensional (3D) ultrasound technique for fetal intracranial measurements compared with manual acquisition.

METHODS

This was a prospective observational study of patients presenting for routine anatomical survey between 18 + 0 and 22 + 6 weeks' gestation. After providing informed consent, each patient underwent two consecutive ultrasound examinations of the fetal head, one by a sonographer and one by a physician. Each operator obtained manual measurements of the biparietal diameter (BPD), head circumference (HC), transcerebellar diameter (TCD), cisterna magna (CM) and posterior horn of the lateral ventricle (Vp), followed by automated measurements of these structures using an artificial intelligence-based tool, SonoCNS® Fetal Brain. Both operators repeated the automated approach until all five measurements were obtained in a single sweep, up to a maximum of three attempts. The accuracy of automated measurements was compared with that of manual measurements using intraclass correlation coefficients (ICC) by operator type, accounting for patient and ultrasound characteristics.

RESULTS

One hundred and forty-three women were enrolled in the study. Median body mass index was 24.0 kg/m² (interquartile range (IQR), 22.5-26.8 kg/m² ) and median subcutaneous thickness was 1.6 cm (IQR, 1.3-2.0 cm). Fifteen (10%) patients had at least one prior Cesarean delivery, 17 (12%) had other abdominal surgery and 78 (55%) had an anterior placenta. Successful acquisition of the automated measurements was achieved on the first, second and third attempts in 70%, 22% and 3% of patients, respectively, by sonographers and in 76%, 16% and 3% of cases, respectively, by physicians. The automated algorithm was not able to identify and measure all five structures correctly in six (4%) and seven (5%) patients scanned by the sonographers and physicians, respectively. The ICCs reflected good reliability (0.80-0.88) of the automated compared with the manual approach for BPD and HC and poor to moderate reliability (0.23-0.50) for TCD, CM and Vp. Fetal lie, head position, placental location, maternal subcutaneous thickness and prior Cesarean section were not associated with the success or accuracy of the automated technique.

CONCLUSIONS

Automated 3D ultrasound imaging of the fetal head using SonoCNS reliably identified and measured BPD and HC but was less consistent in accurately identifying and measuring TCD, CM and Vp. While these results are encouraging, further optimization of the automated technology is necessary prior to incorporation of the technique into routine sonographic protocols. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

A simple method for SARS-CoV-2 detection by rRT-PCR without the use of a commercial RNA extraction kit

The World Health Organization (WHO) has declared a pandemic caused by a new coronavirus named SARS-CoV-2. The growing demand for commercial kits used for automated extraction of SARS-CoV-2 RNA, a key step before rRT-PCR diagnosis, could cause a shortage of stocks that hinders the rapid processing of samples.

Although the recommendation is to use automated methods for nucleic acid extraction, alternatives are necessary to replace commercial kits. However, these alternatives should be as reliable as automated methods.

This work describes a simple method to detect SARS-CoV-2 from specimens collected in different preservation media. Samples were previously inactivated by heating and precipitating with a PEG/NaCl solution before rRT-PCR assays for Orf1ab, N and S genes. The new method was compared with an automated protocol of nucleic acid extraction. Both procedures showed similar analytical results. Consequently, this simple and inexpensive method is a suitable procedure for laboratory diagnosis of SARS-CoV-2 infection.

The Lived Experience of Functional Movement Disorder (FMD)

Date Presented 03/27/20

The purpose of this research is to present findings on the lived experience of people living with FMD. It aims to educate OT practitioners and students about FMD from the voices of those living with it. It will include an analysis of data from qualitative interviews with nine people with FMD and a discussion of the major themes identified by the research participants, including what they would like healthcare professionals to know.

Primary Author and Speaker: Stephanie Zuba-Bates

Additional Authors and Speakers: Antonia Gustaitis, Zeba Khan, Lisa Musto

Contributing Authors: Jae Lim, Elizabeth Ramirez

AB0334 COST-EFECTIVENESS OF JAK INHIBITORS IN RHEUMATOID ARTHRITIS IN THE REAL WORL PRACTICE

Background:

The Janus Kinase (JAK) inhibitors Baricitinib (BAR) and Tofacitinib (TOF), both in monotherapy or in combination with methotrexate, are indicated for moderate to severe active rheumatoid arthritis (RA) with inadequate response to conventional synthetic disease modifying anti-rheumatic drugs (csDMARD). Data about cost-effectiveness in a real-world setting are still scarce.

Objectives:

To assess the cost-effectiveness (C-E) of BAR and TOF in patients with RA in usual clinical practice.

Methods:

Retrospective observational study of adult RA patients who started BAR and TOF between September 2017 and December 2019, in a university hospital. Data were collected from the electronic medical records and the Dominion® External Patient Dispensing program. Demographic, clinical and laboratory parameters [erytrocyte sedimentation rate (ESR), C reactive protein (CRP), Rheumatoid factor (RF), anti-citrullinated peptide antibodies (ACPA)], concomitant csDMARD, previous biological (b) DMARD, DAS28-ESR activity score items, and treatment duration were registered. DAS28-ESR remission or low disease activity (LDA) were used as the effectiveness measure to estimate C-E. The official Spanish prices were considered to calculate the costs of the treatments. Statistical analysis was performed with SPSS v.15 program. Descriptive statistics are shown in proportions, medians and interquartile ranges (IQR). The Wilcoxon signed ranges test was applied for the changes from baseline of DAS28-ESR and CRP.

Results:

39 patients were included, 87.2% women, median age 62.9 (49.9-74.4) years. 9/39 patients (23.1%) werenaiveto bDMARD, 6 (15.4%) had received 1, 18 (46.1%) 2, and 6 (15.4 %) ≥3 previous bDMARD. Demographic, clinical and effectiveness characteristics are shown by drug in the Table:

Table 2.

Median for the time of survival of remission or LDA in RA patients treated with tofacitinib.

Baricitinib (n=30)Tofacitinib (n=9)p valueSex (women, n, %)26 (86,7)8 (88,9)0,676Age [med (IQR)]63,3 (49,7-74,8)59,7 (49,8-68,6)0,857Rheumatoid Factor + (n, %)23 (76,7)9 (100)0,132ACPA + (n, %)21 (70,0)7 (77,8)0,501Erosive disease (n, %)16 (53,3)6 (66,7)0,377Concomitant csDMARD (n, %)26 (86,7)8 (88,9)0,676bDMARD-naive(n, %)7 (23,3)2 (22,2)0,419Treatment duration (months) [med (IQR)]8,4 (6,5-20,3)13,2 (3,9-20,7)0,909Baseline CRP (mg/dl) [med (IQR)]2,2 (0,3-1,0)1,4 (0,3-1,0)0,806Final CRP (mg/dl) [med (IQR)]0,9 (0,1-0,3)1,0 (0,1-0,4)-Baseline DAS28-ESR [med (IQR)]5,5 (3,6-4,3)6,1 (3,8-5,3)0,315Final DAS28-ESR [med (IQR)]3,9 (2,2-2,8)5,5 (2,6-3,6)-DAS28-ESR Remission (n, %)10 (33,3)3 (33,3)0,663DAS28-ESR LDA (n, %)8 (26,7)1 (11,1)0,316

Regarding BAR, 17 patients (56.6%) continue on treatment and 3 (10%) changed to TOF. The change in DAS28VSG was statistically significant (p = 0.000), as well as difference in CRP (p = 0.008). The total cost per analysed period was € 357,806.40, with 18/30 patients (60%) achieving remission or LDA. The C-E was € 19,878.13. As for TOF, 6 patients (66.6%) remain on drug, with no switch to BAR. Neither the difference from baseline in DAS28VSG nor the CRP changes reached statistical significance (p = 0.08 and p = 0.735, respectively). The total cost per analysed period was € 90,201.72, with 4/9 patients (44.4%) achieving remission or LDA. The C-E was € 22,573.0

Conclusion:

In our daily practice, JAK inhibitors are mainly used in combination with csDMARD and commonly after failure to ≥ 1 bDMARD. In this real setting, BAR proves to be cost-effective, while TOF renders less effectiveness. However, results should be addressed with caution because of the smaller sample size of TOF population. Additional studies with greater follow-up and sample size are needed to confirm these findings.

Disclosure of Interests:

Alberto Calvo Garcia: None declared, Noelia García Castañeda: None declared, Cristina Valero: None declared, Irene Llorente Speakers bureau: Lilly, Janssen, Novartis, Sanofi, Gebro, Blanca Varas: None declared, Alberto García-Vadillo: None declared, Isidoro González-Álvaro Grant/research support from: Roche Laboratories, Consultant of: Lilly, Sanofi, Paid instructor for: Lilly, Speakers bureau: Abbvie, MSD, Roche, Lilly, Alberto Morell: None declared, Esther Ramirez: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi

AB1339-HPR SAFETY AND ADHERENCE OF THE JAK INHIBITORS IN CLINICAL PRACTICE IN RHEUMATOID ARTHRITIS

Background:

The Janus Kinase (JAKi) inhibitors Baricitinib (BAR) and Tofacitinib (TOF) are indicated for moderate to severe active rheumatoid arthritis (RA). Data about safety, effectiveness in refractory patients and adherence in real clinical practice in our population are scarce.

Objectives:

An evaluation of safety, adherence and reasons to consider suspension of JAKi in routine clinical practice.

Methods:

Retrospective observational study of patients with RA treated with BAR and TOF according to usual clinical practice between September 2017 - December 2019. Data were collected from the electronic medical record and from the Dominion® Outpatient Drug Dispensing program.

Demographic, clinical, laboratory and treatment-related variables were collected, including reasons for discontinuing JAKi (inefficiency and toxicity). Adherence was calculated using the Compliance Questionnaire on Rheumatology (CQR-5), and the average possession ratio (RMP), which is defined as the number of days with treatment dispensed between the total days of the period analyzed, considering the adherent patient when RMP had a ≥ 0.8.

Laboratory abnormalities were defined according to normal limit values (NLV) and specifications of data sheet. A descriptive analysis was performed using proportions, medians and interquartile ranges (IQR) using the SPSS v.15 program.

Results:

Thirty patients were included in treatment with BAR and nine with TOF. The median age was 62.9 (RIQ 49.9-74.4), 34 (87.2%) were women, 28 (71.2%) anti-CCP and 32 (82.1%) were rheumatoid factor positive, with erosive disease in 34 (87,2%) patients. In the previous treatment, 9 (23.1%) were naive to biological, 6 (15.4%) had received 1 biological, 18 (46.1%) 2 biologicals, and 6 (15.4%) ≥ 3 biologicals. The median treatment time was 8.4 months (RIQ 6.5-20.3) in BAR and 13.2 (RIQ 3.9-20.7) in TOF.

The reasons for consider suspension shown in Table 1.

Table 1.

Treatment Discontinuation

BARICITINIBInitial DAS28[median (IQR)]Final DAS28[median (IQR)]Continue treatmentn (%): 17/30 (55.6)4.20 (2.95-5.72)2.60 (1.70-2.77)Reasons for suspension-Refractory n (%): 7/13 (55.8%)4.38 (4.16-5.43)4,16 (3.56-5.23)-Side effects n (%): 4/13 (30.7)4.16 (3.45-4.84)3.15 (2.69-4.41) ◦Thrombocytosis (1) ◦Herpes Zoster (1) ◦Anemia (1) ◦Tubaritis (1)-Patient decisión n (%): 2/13 (15.4)TOFACITINIBContinue treatmentn (%): 6/9 (66.6)4.82 (3.28-6.20)2.61 (2.45-3.70)Reasons for suspension-Refractory n (%): 2/3 (66.6)5.27 (5.23-5.31)5.48 (5.04-5.92)-Side effects n (%): 1/3 (33.33)

Based on the CQR5 questionnaire, all patients treated with BAR and TOF were adherent “HIGH” class, and a median of RMP = 1.01 (IQR = 0.93-1.06) was obtained for BAR and RMP = 1, 00 (IQR = 0.91-1.01) for TOF, all adherents (≥ 0.8).

Table 2.

Safety results of the treatment shows the safety results.

Side EffectBaricitinib(n, %)Tofacitinib(n, %)Hb <11 g/dl7 (23,3)0Hb < 8 g/dl0 (0)/Hb Recovery >11 g/dl2/7 (28,6)/Neutrophils < 1500/mm30 (0)/Lymphocytes < 1000/mm33 (10,0)2 (22,2)Platelets > 600 × 103/mm31 (3,3)0AST o ALT > 1 NLV4 (13.3)0 (0)Hypercholesterolemia (> 1 NLV)13 (43.3)5 (55.5)Infections13 (43.3)0 (0)Herpes zoster6 (20,0)0 (0)

Conclusion:

In our population, mostly refractory to biological, more than half of the patients maintain treatment with JAKi, with optimal adherence. The main reason for the suspension of both drugs was inefficiency. The most frequent adverse effects were hypercholesterolemia in both groups and infections in BAR, with a high frequency of herpes zoster. No cardiovascular or thromboembolic events were observed.

Disclosure of Interests:

Cristina Valero: None declared, Alberto Calvo Garcia: None declared, Noelia García Castañeda: None declared, Ana Ortiz: None declared, Irene Llorente Speakers bureau: Gebro, Janssen, Sanofi, Lilly., Blanca Varas: None declared, Santos Castañeda: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi, Esther Ramirez: None declared

Barriers and Facilitators of Colorectal Cancer Screening Among a Hispanic Community in Michigan

INTRODUCTION

Colorectal cancer (CRC) is the third leading cause in the USA for cancer-related deaths. Hispanics demonstrate the lowest CRC screening (CRCS) rate and research suggests that causes of screening disparities differ among ethnic groups and geographic locations. The aim of this study was to determine the rate of CRCS and to identify barriers and facilitators to screening in the Hispanic population of Flint, Michigan METHODS: Cross-sectional study. Consenting participants completed a previously validated survey in their language of preference. Variables obtained included sociodemographic information, insurance status, language preference, primary care physician (PCP), language spoken by PCP, recommendation of CRCS, acculturation, and fatalism. Univariate and multivariate logistic regressions were performed to determine the association between predictors associated with previous CRCS.

RESULTS

Seventy subjects completed the survey. Overall previous CRCS rate was 60%. Multivariate results indicated that having a physician that speaks both English and Spanish significantly increases the likelihood of CRCS. It also indicated that those who have been living in the USA for equal or less than 30 years and those that physician had never recommended screening were less likely to have been screened.

DISCUSSION

Our study provides important preliminary data that may help improve CRCS among this Hispanic population. Interventions include providing a list of bilingual physicians in the community and to educate them regarding CRCS to mitigate the lack of physician recommendations. Notably, this study highlights the importance of cultural sensitivity and competence in preventive healthcare to promote inclusiveness of minority populations.

Cultural and Linguistic Competency Training from a Socially Responsible Neuropsychology Model: Perspectives from Trainees

Objective

The Cultural Neuropsychology Program (CNP) is the sole bilingual clinical training program specifically focused on culturally and linguistically competent neuropsychological services to the Latino/a population in the UCLA Health System. Following the Socially Responsible Neuropsychology Model (SRN; Suarez et al., 2016), trainees learn the best practices in providing equitable clinical care to all patients irrespective of their background. The current paper discusses various trainees’ professional development in the process of becoming culturally and linguistically competent clinical neuropsychologists.

Method

The use of case studies illustrates the competency paradigm shift trainees encounter when systematically integrating the SRN model with their clinical training. Three components of the model are emphasized: (1) integration of Etic and Emic approaches during the clinical intake, (2) merging psychometric properties with qualitative processes to compensate for the cultural-linguistic limitations of mainstream gold-standard neuropsychological tools, and (3) becoming an advocate through this social justice framework.

Outcomes

All trainees were previously exposed to the foundational - and typically required - knowledge-based competency model of understanding and appreciating cultural-individual differences and diversity in neuropsychology. Attaining cultural and linguistic competency through the SRN model, however, requires a salient paradigm shift in all skill-based competencies that trainees may not have been prepared for through their previous education.

Discussion

By presenting trainees’ perspectives regarding their professional development, the importance of the explicit and systematic integration of fundamental brain-behavior relationships with the SRN model early in graduate training is highlighted. In so doing, this approach can ultimately augment the number of culturally- and linguistically-competent neuropsychologists needed to reduce health disparities.

References

Suárez, P., Casas, R., Lechuga, D., Cagigas, X. Socially Responsible Neuropsychology in Action: Another Opportunity for California to Lead the Way. Feature in The California Psychologist. Fall of 2016.

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.

CONCLUSIONS

Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.

Biosynthesis and characterization of polyhydroxyalkanoates produced by an extreme halophilic bacterium, Halomonas nitroreducens, isolated from hypersaline ponds

AIMS

Morphological, biochemical and genotypic characterization of a halophilic bacterium isolated from hypersaline ponds located at Las Coloradas (Río Lagartos, Yucatán, Mexico). Characterization of polymer produced by this strain was also performed.

METHODS AND RESULTS

Twenty strains were isolated from water samples of salt ponds and selected based on both morphological features and their PHA storage capacity, which were determined by SEM and staining methods with Nile red and Nile blue, respectively; strains were also analysed by the fluorescence imaging technique. Among them, JCCOL25.8 strain showed the highest production of PHA's reason why phenotypic and genotypic characterization was performed; this strain was identified as Halomonas nitroreducens. Polymer produced by this strain was characterized by FTIR, DSC, GPC and EDX spectroscopy. Results indicated that the biosynthesized polymer was polyhydroxybutyrate (PHB) which had a melting peak at 170°C and a crystallinity percentage of about 36%.

CONCLUSIONS

Based on phenotypic and genotypic aspects, JCCOL25.8 strain was identified as H. nitroreducens and it was capable to accumulate PHB.

SIGNIFICANCE AND IMPACT OF THE STUDY

To our knowledge, there is only one study published on the biosynthesis of PHA's by H. nitroreducens strains, although the characterization of the obtained polymer was not reported.

Piperacillin-induced DRESS: distinguishing features observed in a clinical and allergy study of 8 patients

BACKGROUND

DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome is characterized by fever, rash, eosinophilia, and multiorgan failure. Previous reports have described differences in clinical and laboratory findings of DRESS syndrome depending on the inducing drug. Piperacillin has been reported as the drug responsible for this syndrome in 3 patients.

OBJECTIVE

To analyze and describe the clinical, laboratory, and allergy study findings of piperacillin-induced DRESS.

PATIENTS AND METHODS

Retrospective case series of patients diagnosed with DRESS associated with piperacillin-tazobactam (Pip/Taz) according to the Kardaun diagnostic score criteria. Assessment of causality was established using the Spanish Pharmacovigilance System and the lymphocyte transformation test (LTT). The allergy study included skin and epicutaneous tests.

RESULTS

Eight patients were diagnosed with DRESS due to Pip/Taz (3 probable and 5 definite cases). Skin rash was observed in all cases and facial edema in 50%; the mean latency period was 18 days. Fever was present in 7 patients. Liver and kidney injuries were detected in 6 and 3 patients, respectively. All patients had eosinophilia and a full recovery. The LTT to Pip/Taz was strongly positive in all patients, with a stimulation index of over 6. Three of 3 patients had a positive intradermal test to Pip/Taz, and 1 of 4 had a positive patch test. All patients had a negative LTT to carbapenems.

CONCLUSIONS

We have reported on the first case series of piperacillin-induced DRESS. A latency period of 18 days, skin rash, eosinophilia, fever, liver injury, and good prognosis were the most common features. The allergy study, and the LTT in particular, was highly useful for identifying Pip/Taz as the culprit drug and piperacillin as the responsible active ingredient.

Mineral Properties and Dietary Value of Raw and Processed Stinging Nettle (Urtica dioica L.)

Stinging nettle (Urtica dioica L.) has a long history of usage and is currently receiving attention as a source of fiber and alternative medicine. In many cultures, nettle is also eaten as a leafy vegetable. In this study, we focused on nettle yield (edible portion) and processing effects on nutritive and dietary properties. Actively growing shoots were harvested from field plots and leaves separated from stems. Leaf portions (200 g) were washed and processed by blanching (1 min at 96-98°C) or cooking (7 min at 98-99°C) with or without salt (5 g·L(-1)). Samples were cooled immediately after cooking and kept in frozen storage before analysis. Proximate composition, mineral, amino acid, and vitamin contents were determined, and nutritive value was estimated based on 100 g serving portions in a 2000 calorie diet. Results show that processed nettle can supply 90%-100% of vitamin A (including vitamin A as β-carotene) and is a good source of dietary calcium, iron, and protein. We recommend fresh or processed nettle as a high-protein, low-calorie source of essential nutrients, minerals, and vitamins particularly in vegetarian, diabetic, or other specialized diets.

SU-E-T-202: Comprehensive Quality Assurance Procedures for Uniform Scanning Proton Therapy Machines

PURPOSE

Quality assurance (QA) is essential in safe and accurate delivery of radiation therapy. However, QA in proton therapy is challenging due to complicated and often facility-specific beam delivery systems and limited beam time for QA. The purpose of this study is to develop an efficient and comprehensive QA procedure for a multi-room proton therapy center using uniform scanning beams.

METHODS

Our proton therapy center is comprised of a 230 MeV cyclotron, one fixed beam room, two inclined beam rooms, and one gantry room. Uniform scanning is employed exclusively in all treatment rooms. A rfDaily QA3 (Sun Nuclear Inc., Melbourne, Florida) together with home-made devices is used for daily QA. Parallel plane chambers, a multi-layer ionization chamber array (Zebra, IBA dosimetry, Schwarzenbruck, German), and an IC profiler (Sun Nuclear Inc., Melbourne, Florida) are used to QA the characteristics of the uniform scanning beams, including output, range, modulation width, flatness, symmetry, and penumbra, for both monthly and annual QA. QA procedures and acceptance criteria were developed, taking into account the likelihood and potential risk of failure, as well as the available equipment, personnel and other resources.

RESULTS

QA procedures and tolerances were developed for daily, monthly and annual QA at our proton therapy center. Daily QA is performed by radiation therapists, and can be completed within 30 minutes for all rooms. Monthly QA and annual QA are performed by physicists, taking about 4 hours and a weekend respectively. Trend analysis was performed for various machine characteristics, such as machine output, range, flatness, and symmetry.

CONCLUSION

QA standards are desired in Radiation Oncology, but not many standards are developed and available for proton therapy. In the mean time, facility-specific QA procedures should be developed based on the equipment failure modes and available resources.

SU-E-T-127: Feasibility Study for Using a 2D Array Detector for All Beam Measurements in Monthly Quality Assurance Procedure for a Uniform Scanning Proton Therapy System

PURPOSE

To develop a more efficient monthly quality assurance (QA) process by utilizing one detector with multiple setups instead of multiple detectors with multiple setups.

METHOD

The Sun Nuclear IC Profiler was used to measure machine output, transverse profiles, and depth-dose profiles. The IC Profiler contains 251 ionization chambers aligned in the X, Y, and diagonal axes, and was designed to measure machine output and transverse profiles. In order to measure depth-doses, a Lucite compensator with an angled surface was fabricated. To test the capability of the detector, a proton beam of 10.5 cm range in water was used. The distal edge coincided with the overall water equivalent depth upstream of the detector on central axis. The measurement was repeated with an additional 1.0 mm of solid water placed in front of the detector. The measured profiles from both measurements were compared to quantify the IC Profiler response for a small range change.

RESULTS

The IC Profiler performs within vendor specification for measuring machine output and transverse profiles. When measuring depth-doses with an angled compensator, the IC profiler measures a change in profile along central axis of 17.0% for a 1.0mm range change. Based on overall reproducibility of the beam delivery system, the IC profiler is capable of detecting 0.3 mm range shift. Therefore, the sensivity of the IC profiler response is suffficient to detect sub millimeter changes in delivered range.

CONCLUSION

The Sun Nuclear IC Profiler is capable of measuring machine output, transverse profiles, and depth-dose profile constancy with a high degree of accuracy and precision. Using a single detector for all beam measurements increases the overall QA efficiency by reducing multiple detector overhead while not sacrificing the accuracy and precision of the measurements.

Concentrations of organochlorine pesticides and polychlorinated biphenyls in human serum and adipose tissue from Bolivia

Organochlorine pesticides and polychlorinated biphenyls (PCBs) are synthetic chemicals that are highly resistant to biodegradation and have proven adverse health effects. The objectives of this study were to determine concentrations of three selected organochlorine pesticides (p,p'-DDT, p,p'-DDE, HCB) and three specific PCB congeners (PCB 138, 153, 180) in adipose tissue and serum samples from an urban adult population (n=112) in the city of Santa Cruz de la Sierra, Bolivia, and to investigate their relationships within and between the two matrices and with selected socio-demographic characteristics. The percentages of samples positive for these compounds ranged from 40% for PCB 180 to 100% for p,p'-DDE in adipose tissue, and from 21% for HCB to 93% for p,p'-DDE in serum. Median number of residues per sample was five for adipose tissue and three for serum. Geometric mean concentrations indicate a considerable historical and recent exposure to organochlorine pesticides and PCBs in this population. Adipose tissue:serum ratios ranged from 149.3 to 590.3 (wet basis) and from 0.9 to 3.5 (lipid basis). We found positive and statistically significant correlations between adipose tissue and serum concentrations only in p,p'-DDE and HCB. This novel study in Bolivia underlines the need for human biomonitoring to assess exposure to environmental pollutants in South America.

Drug prescribing for hypertension at primary healthcare facilities in Trinidad

OBJECTIVE

To describe the drug prescribing pattern for hypertension at primary healthcare facilities throughout Trinidad.

METHODS

A descriptive, cross-sectional survey was conducted at 22 primary healthcare facilities across Trinidad using a de novo, pilot-tested questionnaire during June to August 2006.

RESULTS

A total of 547 hypertensive patients were recruited into the study. There was a high prevalence of diabetes mellitus (57.6%). Information on the current drug prescribed was available for 442 patients (80.0%) and 26 of these patients (6.1%) were managed without drug intervention. On average, patients were prescribed 1.47 antihypertensive drugs. Angiotensin converting enzyme (ACE) inhibitors, particularly enalapril, were the most commonly prescribed class of antihypertensive drugs in 63.6% of patients. beta-blockers, thiazide diuretics and calcium channel blockers were prescribed in 29.2%, 25.8% and 12.0% of patients respectively.

CONCLUSIONS

There was significant use of ACE inhibitors, beta-blockers, thiazide diuretics and calcium channel blockers. Angiotensin converting enzyme inhibitors (as monotherapy or in combination with other drug classes) were more likely to be prescribed in diabetic hypertensive patients. Thiazide diuretics were not used as frequently as expected given the evidence which demonstrate similar efficacy with other classes of drugs and associated cost-saving. The observed prescribing pattern in the Trinidad public healthcare setting seems to point to an attempt to conform to recognized international and regional guidelines for the management of hypertension.